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Carol Peckham | April 18, 2018
| Contributor Information
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Medscape Orthopedist Compensation Report 2018
Carol Peckham | April 18, 2018 | Contributor Information
The Medscape Physician Compensation Report is the most comprehensive and widely used physician salary survey in the United States for the eighth year in a row. Orthopedists who responded to this year's survey disclosed not only their compensation but also how many hours they work per week, how many minutes they spend with each patient, what they find most rewarding—and challenging—about their work, and more. (Some totals in this presentation do not equal 100% due to rounding.)
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Medscape Orthopedist Compensation Report 2018
Carol Peckham | April 18, 2018 | Contributor Information
Survey respondents were asked to provide their annual compensation for patient care. For employed physicians, that includes salary, bonus, and profit-sharing contributions. For partners, it includes earnings after taxes and deductible business expenses before income tax. Orthopedists, along with plastic surgeons and cardiologists, were among the top earners this year. This year's lowest-earning specialties were the same as they were 5 years ago in Medscape's 2013 Compensation Report.
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Medscape Orthopedist Compensation Report 2018
Carol Peckham | April 18, 2018 | Contributor Information
Compensation for orthopedists increased slightly this year. The greatest increases were seen among psychiatrists, plastic surgeons, and physiatrists. Medscape's results align with industry data regarding psychiatry. "We have never seen demand for psychiatrists this high in our 30-year history," says Tommy Bohannon of Merritt Hawkins, a physician recruiting firm. "Demand for mental health services has exploded, while the number of psychiatrists has not kept pace."
Decreases in earnings were evident in only six specialties this year, with general surgery and urology among the hardest hit.
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Medscape Orthopedist Compensation Report 2018
Carol Peckham | April 18, 2018 | Contributor Information
Where a physician attended medical school can be a factor in future earnings. Some graduates of US medical schools are American citizens who studied outside of the United States; others grew up in the country where they went to medical school and moved to the United States to practice. Average compensation for foreign-trained orthopedists exceeds that reported this year by their US-trained peers.
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Medscape Orthopedist Compensation Report 2018
Carol Peckham | April 18, 2018 | Contributor Information
Among orthopedists there is a disparity in gender inclusion, with men generally outnumbering women across ethnicities. The difference is large among the racial groups presented here. (Other racial groups were represented by too low a percentage of respondents to be included in this comparison.)
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Medscape Orthopedist Compensation Report 2018
Carol Peckham | April 18, 2018 | Contributor Information
Orthopedists who are employed earn less than those who are self-employed, presuming they will trade a higher salary for a steadier income and less time focusing on running a business. According to a survey from the Physicians Foundation, however, employment does not necessarily reduce nonclinical workload.[1]
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Medscape Orthopedist Compensation Report 2018
Carol Peckham | April 18, 2018 | Contributor Information
More orthopedists are now employed rather than self-employed. This reflects a national trend toward physician employment, as hospitals and other entities have consolidated and absorbed private practices, and younger physicians have sought a steadier income stream and more regular hours. There is some indication, however, that the trend has plateaued, as hospitals reach staffing limits.[2]
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Medscape Orthopedist Compensation Report 2018
Carol Peckham | April 18, 2018 | Contributor Information
This year, as in all previous years, the male orthopedists Medscape surveyed reported higher earnings than did their female counterparts. Although women are more likely to work part-time, which would give them a lower average income, this report uses full-time salaries for compensation, so part-time work does not account for the difference.
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Medscape Orthopedist Compensation Report 2018
Carol Peckham | April 18, 2018 | Contributor Information
Equal percentages of male and female orthopedists are employed, so this factor does not explain the disparity in income between the two groups.
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Medscape Orthopedist Compensation Report 2018
Carol Peckham | April 18, 2018 | Contributor Information
Percentages of part-time female and male physicians have varied somewhat over the years, with 22% of women and 12% of men reporting this year that they work fewer than 30 hours per week. About the same percentage of male and female orthopedists work part time, with fewer female orthopedists doing so than women in other physician groups.
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Medscape Orthopedist Compensation Report 2018
Carol Peckham | April 18, 2018 | Contributor Information
All orthopedists, whether employed or self-employed, were asked about their benefits this year. Most said that they receive employer-subsidized health insurance, liability coverage, and dental plans. Few orthopedists reported that they receive no benefits at all.
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Medscape Orthopedist Compensation Report 2018
Carol Peckham | April 18, 2018 | Contributor Information
Just over one half of orthopedists said they believe that they are fairly compensated, although their compensation is high compared with other physician groups. Specialists' satisfaction sometimes does not coincide with their compensation relative to other physicians. Plastic surgeons, too, are among the least satisfied with their compensation despite being among the highest paid. Conversely, public health physicians reported relatively low compensation but were among the most satisfied with their pay.
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Medscape Orthopedist Compensation Report 2018
Carol Peckham | April 18, 2018 | Contributor Information
This year, the Medscape survey asked physicians who reported that they are not satisfied with their compensation how large an increase they feel they deserve. Around one third each of orthopedists feel that they should be paid between 11% and 25% and 26% and 50% more.
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Medscape Orthopedist Compensation Report 2018
Carol Peckham | April 18, 2018 | Contributor Information
Most orthopedists reported that they are paid through an insurance carrier, with just under one half saying they are reimbursed on a fee-for-service basis. Less than one fifth said they are paid through accountable care organizations (ACOs), which is one of the advanced alternative payment systems under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). A very small percentage reported that they have adopted the direct primary care model, which is gaining popularity compared with concierge and cash-only models among physicians whose practices allow direct pay.[3]
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Medscape Orthopedist Compensation Report 2018
Carol Peckham | April 18, 2018 | Contributor Information
Since MACRA was implemented, there have been numerous changes in the Merit-based Incentive Payment System (MIPS), one of CMS's two Quality Payment Programs (QPPs), and more are anticipated. The changes have created confusion and frustration among physicians, and some would like to see MIPS significantly reformed, if not replaced. Orthopedists' participation in MIPS fell above the middle relative to all physicians surveyed.
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Medscape Orthopedist Compensation Report 2018
Carol Peckham | April 18, 2018 | Contributor Information
The other QPP introduced by CMS, Alternative Payment Models (APMs), is generally implemented in large organizations, generally through CMS initiatives. Orthopedists reported a higher participation rate in this payment model compared to other physician groups, although physician participation overall is lower in APMs than in MIPS.
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Medscape Orthopedist Compensation Report 2018
Carol Peckham | April 18, 2018 | Contributor Information
In this year's survey, most orthopedists said they would not drop insurers that pay poorly. Over one third, however, reported that they would, a higher percentage than among other physicians groups.
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Medscape Orthopedist Compensation Report 2018
Carol Peckham | April 18, 2018 | Contributor Information
In spite of billing and other administrative challenges, most orthopedists surveyed said they will continue to take Medicare and Medicaid patients. Very few indicated that they would stop taking on or drop patients who are recipients, although one quarter of orthopedists reported that they are undecided on this question.
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Medscape Orthopedist Compensation Report 2018
Carol Peckham | April 18, 2018 | Contributor Information
Increases in the number of physicians reporting that they participate in health insurance exchanges have stabilized since their introduction in 2014, and there is almost no change from last year's survey in the percentage of participating orthopedists. A fair number, however, indicated that they are unsure about whether they will participate.
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Medscape Orthopedist Compensation Report 2018
Carol Peckham | April 18, 2018 | Contributor Information
Anecdotally, physicians have complained about the effect of the Affordable Care Act on their incomes. Results from this year's survey suggest that nearly one quarter of orthopedists who participate in an exchange have experienced a decrease.
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Medscape Orthopedist Compensation Report 2018
Carol Peckham | April 18, 2018 | Contributor Information
Healthcare continues to cause financial worry among Americans, but there is little guidance for physicians about how to discuss costs with their patients. Barriers include unfamiliarity with patients' insurance or financial status and even the cost of the treatments they recommend.[4] Even so, most orthopedists reported that they occasionally or regularly have such discussions with their patients.
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Medscape Orthopedist Compensation Report 2018
Carol Peckham | April 18, 2018 | Contributor Information
Physicians say that instituting a no-show policy helps them avoid overscheduling in order to ensure that all time slots are filled. Most orthopedists, however, reported that they do not charge patients who miss an appointment without providing notification.
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Medscape Orthopedist Compensation Report 2018
Carol Peckham | April 18, 2018 | Contributor Information
Whereas about two fifths of orthopedists reported that they spend 30 to 45 hours each week with patients, about the same percentage spend more than 45 hours. The latter percentage, however, is lower than in the two prior years' reports.
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Medscape Orthopedist Compensation Report 2018
Carol Peckham | April 18, 2018 | Contributor Information
Medscape asked physicians about the time they themselves—not a physician assistant, nurse, or medical assistant—spend with each patient. More than two thirds of orthopedists reported that they spend between 9 and 16 minutes.
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Medscape Orthopedist Compensation Report 2018
Carol Peckham | April 18, 2018 | Contributor Information
Bureaucratic tasks remain the primary cause of burnout among physicians, and nearly three quarters of orthopedists reported this year that they spend 10 hours or more per week on paperwork and administration.
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Medscape Orthopedist Compensation Report 2018
Carol Peckham | April 18, 2018 | Contributor Information
Getting promoted in a hospital, clinic, or large group setting typically adds administrative and/or management responsibilities to a physician's job. Such factors may play a role in more than one third of employed orthopedists reporting that they are seeking promotion.
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Medscape Orthopedist Compensation Report 2018
Carol Peckham | April 18, 2018 | Contributor Information
Among orthopedists, more women than men reported this year that they are seeking promotion within their organization. "It's possible that more male doctors already are in leadership positions and female physicians are anxious to catch up," says Tommy Bohannon. "Another factor may be that moving to a full-time or part-time administration role can lead to greater schedule flexibility and better work-life balance."
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Medscape Orthopedist Compensation Report 2018
Carol Peckham | April 18, 2018 | Contributor Information
Orthopedists most often named relationships with and gratitude from patients as the most rewarding aspect of their job, followed by being very good at what they do and making the world a better place. Very small percentages cited teaching or pride in their profession.
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Medscape Orthopedist Compensation Report 2018
Carol Peckham | April 18, 2018 | Contributor Information
Given the current upheaval in the healthcare system, it is no surprise that having so many rules and regulations, difficulties with getting fair reimbursement, and dealing with electronic health records were cited most often in response to the question of what is the most challenging part of an orthopedist's job.
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Medscape Orthopedist Compensation Report 2018
Carol Peckham | April 18, 2018 | Contributor Information
Despite all of the current challenges, just over three quarters of orthopedists said that they would choose medicine again. The rewards of treating patients and having many of them express appreciation, knowing that they are competent in their field, and contributing to a better world appear to make up for the difficulties they face in their jobs.
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Medscape Orthopedist Compensation Report 2018
Carol Peckham | April 18, 2018 | Contributor Information
Almost all orthopedists said they would choose their specialty again if given the opportunity to do so.
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Medscape Orthopedist Compensation Report 2018
Carol Peckham | April 18, 2018 | Contributor Information
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Medscape Orthopedist Compensation Report 2018
Carol Peckham | April 18, 2018 | Contributor Information
More than 20,000 physicians told us how much they earn, how many hours they work, and whether they're satisfied with their compensation.Slideshows, April 2018
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Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.
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Contributor Information
Carol Peckham
Editorial Director
Art Science Code
Disclosure: Carol Peckham has disclosed no relevant financial relationships.
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References + More on Methodology
References
Survey of America's Physicians: Practice Patterns and Perspectives. Boston: The Physicians Foundation/Merritt Hawkins; 2014.
Kane CK. Updated data on physician practice arrangements: physician ownership drops below 50 percent. American Medical Association. Policy Research Perspectives. 2017. Article. Accessed March 26, 2018.
Davis J. States move to enable direct primary care as a new approach to health care services. The Council of State Governments. January 25, 2018. Article. Accessed March 26, 2018.
Ganos G. Costs of care: getting the patient-provider conversation right. Culture of Health Blog. Robert Wood Johnson Foundation. June 15, 2016. Article. Accessed March 26, 2018.
More on Methodology
Survey invitations were emailed to Medscape member physicians from November 21, 2017 to February 21, 2018. Respondents were invited to participate in an online study of "Physician Compensation and Net Worth." Members who completed the survey were entered into a sweepstakes that awarded 50 random winners a $150 Amazon.com gift card.
Respondents were required to be physicians currently practicing in the United States. The total sample size was 20,329. The overall margin of sampling error for this survey was ± 0.69% at a 95% confidence level using a point estimate of 50%. Statistical difference from 50% is the most conservative in measuring sample error.
Other factors may also contribute to error in survey estimates, including measurement error, construct and content validity, question wording, and question order. Standard quality-control measures included checking for clear question wording, proper question ordering, and use of appropriate scales and response categories. In addition, during the field period, the survey was checked to make certain that respondents were answering all questions logically and that skip-pattern programming was working properly.
The final data were cleaned to ensure data quality. Full-time respondents were weighted to reflect the American Medical Association's physician distribution by specialty, state, and gender.
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