Ophthalmology: Still a Well-Paid Specialty

Jennifer Garcia

April 24, 2012

April 24, 2012 — Ophthalmologists are among the top 10 highest-paid specialists, with a mean income of $270,000, according to the Medscape Physician Compensation Report 2012.

Respondents to the survey included 24,216 US physicians across 25 specialty areas. Compensation for all employed physicians surveyed included salary, bonus, and profit-sharing contributions. Compensation for partners included earnings after tax-deductible business expenses but before income tax.

Data specific to ophthalmologists were compiled in the Medscape Ophthalmologist Compensation Report 2012 , which found that despite an overall decline in physician compensation, the mean income for ophthalmologists was up from 2010. Roughly 38% of ophthalmologists reported an increase in their income, whereas 31% saw a decrease in their 2011 earnings compared with 21% the previous year.

Gender and Location Still Matter

Among the ophthalmologists who participated in the survey, approximately 75% were male, 36% were under age 45, and 87% were board certified.

The Medscape survey found that the earnings disparity between male and female physicians was 40% overall. The disparity is slightly smaller among ophthalmologists, with men earning 37% more than women. Some of this may be due to the fact that female physicians work part-time, according to Tommy Bohannon, divisional vice president of Merritt Hawkins, a physician recruitment firm, who was quoted in the Medscape survey.

Regionally, ophthalmologists in the West (California, Alaska, and Hawaii) and the Great Lakes area earned the most, with a mean income of $315,000 and $301,000 respectively. Ophthalmologists in the Southeast reported the lowest income, with an annual mean salary of $253,000.

When broken down by practice setting, ophthalmologists employed by healthcare organizations had the highest mean income ($352,000), followed by those in single-specialty group practices ($327,000). Ophthalmologists who earned the least were hospital-based ($147,000) and those in academia ($201,000).

Despite their income, 43% of ophthalmologists don't perceive themselves as "rich" because of higher debts and expenses compared with nonphysicians, and 50% don't feel they are fairly compensated.

How Do They Spend Their Time at Work?

Among those surveyed, 39% of ophthalmologists spend 30 to 40 hours seeing patients every week, slightly less than reported last year. Over a third of respondents, however, report spending 41 to 50 hours a week seeing patients.

The number of patients seen each week is slightly less than last year, with 21% of ophthalmologists reporting they see 100 to 124 patients per week. Some (30%) see more than 125 patients per week, which is down from last year (39%).

According to the Medscape survey, approximately 36% of ophthalmologists spend 9 to 12 minutes with each patient, and 27% spend 13 to 16 minutes. Visits lasting less than 9 minutes account for only about 15% of all visits.

Additionally, 57% of ophthalmologists report spending 5 to 14 hours a week on paperwork and other administrative tasks every week. This is similar to what was reported in 2011.

Attitudes About Patient Care and Payment

According to the Medscape survey, alternative patient care and payment models are not popular among ophthalmologists; only 1% are involved in concierge practices and 3% in cash-only practices.

Approximately 2% of ophthalmologists participate in accountable care organizations (ACOs), a model that ties provider reimbursement to quality metrics and cost of care for an assigned patient population. Nearly 60% of ophthalmologists surveyed feel that ACOs will cause a decline in income, but 37% said it is too soon to tell.

Reflecting their skepticism, only 10% of ophthalmologists, and 25% of physicians in general, believe that the trend in healthcare reform toward shared savings programs will result in better patient care. The majority of ophthalmologists (56%) actually believe these measures will have a negative impact on care, while 35% feel they will have no impact.

Further, 60% of ophthalmologists and almost half of all physicians surveyed said they have no intention of changing the way they practice (reducing the number of tests they order or treatments they perform) because they do not believe that new quality guidelines are in the patients' best interest. Another 21% said their practices won't change because of the need to practice defensive medicine. Only 9% said they would reduce tests and procedures because the guidelines will affect their income.

Similar to physicians overall, 45% of ophthalmologists said they discuss cost of care with patients, but only if the patient raises the subject. Another 45% of ophthalmologists, on the other hand, discuss cost issues with patients routinely, compared with 38% of all physician respondents. Four percent don't discuss cost at all because they feel it is inappropriate to do so.

Job Satisfaction on the Decline

Only 53% of ophthalmologists said they would still choose a career in medicine if they could do it all over again, down from 66% last year. Roughly 58% said they would choose the same specialty, compared with 79% the year before. The most significant drop, however, was choice of practice setting: Only 29% said they would choose the same practice setting compared with 54% the previous year.