Oncologists in Top 10 of High-Earning Specialties

Zosia Chustecka

April 24, 2012

April 24, 2012 — Oncologists are among the most highly compensated medical specialists in the United States, according to the Medscape Oncologist Compensation Report: 2012 Results.

However, only 15% of oncologists consider themselves to be "rich," and only half feel satisfied — a lot less than last year.

With an average annual compensation of $295,000, oncologists were number 7 of 25 medical specialties surveyed.

The top earners were radiologists, with an average annual income of $315,000, followed by orthopedists, cardiologists, anesthesiologists, urologists, and gastroenterologists, all topping $300,000.

At the bottom of the pile were pediatricians, who earn only half of this — their average annual compensation is $156,000. In total, 8 specialties reported earning less than $200,000 per year, including neurologists, psychiatrists, rheumatologists, and family doctors.

The report compiles the results from an online survey of 24,216 American physicians conducted in February 2012.

Oncologists made up 2% of all respondents (n = 433).

Internal medicine had the most respondents (15%), followed by family doctors (14%), psychiatrists and pediatricians (8% each), and emergency medicine physicians (6%). The remaining specialties each had less than 5% of the pie. The overall number of respondents by specialty mirrors the American Medical Association breakdown, the researchers report.

Compensation takes into account several factors and excludes any nonpatient-related activities (such as speaking engagements, expert witness services, and product sales). For employed physicians, compensation was calculated from salary, bonuses, and profit-sharing contributions. For partners, it was based on earnings after tax-deductible business expenses but before income tax.

Big Variation Within Oncology

A breakdown of the responses shows that the highest-earning oncologists are those who work in group practices.

Oncologists in multispecialty group practices earned slightly more than those in single-specialty practices ($347,000 vs $338,000 per annum), but both had nearly double the income of academics ($164,000). Also on the lower end were oncologists working in a hospital ($190,000).

Oncologists with incomes near the average worked in healthcare organizations ($272,000), outpatient clinics ($274,000), and solo practices ($296,000).

It seems that quite a few are dissatisfied with their choice of practice setting. Only 19% of oncologists would choose the same practice setting if they were starting again — down from 47% last year.

Earnings Up From Last Year

Since last year, when this survey was conducted for the first time, physician income has declined in general, although 11 of the 25 specialties surveyed reported an increase in income.

Oncologists were in the group showing an increase; their responses showed that incomes have risen, on average, 4% since 2011.

However, within the specialty, only a quarter of oncologists (26%) reported an increase in earnings. Around half saw no difference in income.

Across all the specialties, the biggest jump in income was seen by ophthalmologists (up 9%).

The remaining 14 specialties reported a downturn, with the biggest decreases reported by general surgeons (down 12%) and by orthopedists and radiologists (both down 10%).

Few Consider Themselves Rich

There is nearly a 50/50 split on whether physicians feel they are fairly compensated, but few consider themselves rich.

Overall, only 11% of physicians said that they consider themselves rich. Another 45% said that their income probably qualifies them as rich, but they have so many debts and expenses that they don't feel rich.

Against these overall figures, oncologists come out near the top of all specialties, with 14% reporting that they feel rich, similar to radiologists (also 14%) and just behind pathologists (15%).

At the bottom of this scale were plastic surgeons —only 6% reported that they felt rich.

"Can't Get No Satisfaction"

This year's survey shows less satisfaction in all specialties.

Only 54% of all physicians surveyed said that they would choose medicine again as a career, far less than last year (69%).

Overall satisfaction also fell. Last year's survey showed that many specialties had scores of more than 70% for overall satisfaction, with dermatologists at the top (80%). This year's scores were much lower; dermatologists were still in the lead, but scored only 64%.

The most discontented specialty is plastic surgery, with only 41% satisfied overall. In addition, high levels of frustration were reported by internists and family physicians.

Oncologists are midway in the satisfaction scores, compared with the other specialties, but the scores have fallen substantially from last year, hinting at a growing discontentedness.

Half of the oncologists (50%) surveyed said that they were satisfied overall with their careers, but this compares with last year's rate of 70%.

Again, about half said that they would choose medicine again as a career (49%, down from 75% last year), and about half said that they would choose the same specialty again (47%, down from 79%).

Sex and Geography

A gap between men and women is seen in all specialties. Overall, male physicians earn 40% more than female physicians.

For oncologists, the difference was nearly half that (23%). For men, average income was $276,000 per annum; for women, it was $224,000.

One explanation put forward for this gap is that more women work part-time, Tommy Bohannon, divisional vice president of Merritt Hawkins, a physician recruiting firm, noted in the report.

The survey also revealed a geographic divide. The highest-earning oncologists (average income, $342,000 per annum) were found in the Southwest (Arizona, Utah, Colorado, New Mexico, and Nevada). Next highest were those in the Southeast, and the lowest average incomes ($207,000) were reported by those in the Northeast.

Reduce Testing?

In addition to compensation, the survey asked about ongoing changes that are affecting the medical profession in the United States, many related to healthcare reform.

Overall, physicians are skeptical about many of these changes. When asked about quality measures and treatment guidelines set by insurers and Medicare for shared savings programs, only a small minority (22%) of physicians overall (and oncologists) said that these measures would improve patients care. The great majority felt that they would have no impact on patient care or that they would have a negative impact.

What about reducing testing to contain costs? The vast majority (67%) of physicians overall said that they would not reduce testing because they feel that it isn't in the patients' best interest or because they have to practice defensive medicine.

Responses from oncologists were similar, but slightly less (58%) said that they would not reduce testing, either because this is not in the patients' best interest (39%) or because they are going to continue to practice defensive medicine (19%).

Oncologists who said that they would reduce the amount of testing were, for the most part (33%), doing so because this is good guidance, but 9% said they were doing so because this testing affected their income.

These responses were recorded in February 2012, before the American Society of Clinical Oncology (ASCO) issued its recommendation on 5 cancer practices that must stop, which include cutting down on expensive imagining tests in cancer patients. It will be interesting to look at the responses to this question next year to see if the ASCO recommendation has had any effect on oncologists' attitudes about testing.

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