Rheumatologists' Income Stable, but Satisfaction Declining

Jennifer Garcia

April 26, 2012

April 26, 2012 — Income for rheumatologists in 2011 stayed fairly stable compared with the previous year, but job satisfaction has definitely gone down, according to the Medscape Physician Compensation Survey 2012 .

The report, released this week, 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.

In 2011, rheumatologists earned a mean annual income of $180,000. The top earners were radiologists and orthopedists, with an average annual income of $315,000, followed by cardiologists, anesthesiologists, urologists, and gastroenterologists, all topping $300,000.

The Medscape Rheumatologist Compensation Report 2012 , which compiled survey data specific to rheumatologists, found that approximately 27% of rheumatologists saw an increase in their income from last year while 22% reported a decrease.

The Gender Divide

According to the Medscape survey, there is a significant gap in earnings between male and female rheumatologists. While male rheumatologists earn an average of $191,000 a year, women earn $149,000, a 29% difference. Among physicians as a whole, male physicians out-earned female physicians by 40%.

Some of these differences may be attributed to the fact that female physicians are more likely to work only part-time, according to Tommy Bohannon, divisional vice president of Merritt Hawkins, a physician recruitment firm, who was quoted in the Medscape survey.

Rheumatologists who responded to the survey were predominately male (69%), about 52% were younger than age 45, and almost all (97%) were board-certified.

Location Matters

The Medscape survey found that when analyzed by geographic area, rheumatologists who earned the most ($216,000) live in the North Central region of the United States (Iowa, Kansas, Nebraska, and the Dakotas). Those living in the Mid-Atlantic region were the next-highest earners ($196,000), and those in the Southwest earned the least ($140,000).

Practice setting also plays a large role in income earned, with rheumatologists in office-based, single-specialty group practices earning the most ($228,000). At $214,000, rheumatologists in multispecialty groups came in second, and those in academic/government settings earned the least ($120,000).

Rheumatologists don't believe they are fairly compensated — 58% express dissatisfaction with their income. This is higher than the rate for physicians overall, about 50% of whom feel they are fairly compensated. Only 6% of rheumatologists perceive themselves as wealthy. The majority (57%) said they don't feel rich because their income is no better than that of many nonphysicians.

What Does Their Typical Week Look Like?

According to the Medscape survey, 39% of rheumatologists spend 30 to 40 hours a week seeing patients and almost 25% spend 41 to 50 hours per week with patients. Nearly half of the rheumatologists surveyed see between 50 and 99 patients per week.

More than half of rheumatologists spend between 13 and 20 minutes with each patient, and 8% report spending 12 minutes or less. Interestingly, close to 30% report spending 25 minutes or more with each patient, probably because of the amount of patient care involved in rheumatology.

Paperwork and administrative activities account for 5 to 9 hours per week of their time for approximately 25% of rheumatologists. Roughly the same percentage spends 10 to 14 hours a week on these tasks, and 15% reported spending 4 hours or less.

Job Satisfaction Is Declining

Frustration is growing among physicians in general when it comes to their jobs, and rheumatologists are no exception. Despite considering themselves one of the happiest specialties according to the Medscape Physician Lifestyle Report 2012 . only 56% of rheumatologists surveyed said they would still choose a career in medicine if they could do it all over again. This is a dramatic decline from 75% the previous year. Only 42% said they would choose the same specialty, down from 66% last year.

Still Unsure About Alternative Patient Care Models

According to the Medscape survey, only 1% of rheumatologists have concierge practices and about 2% participate in an accountable care organization (ACO). These organizations tie provider reimbursement to quality metrics and cost reduction for an assigned patient population and are a sensitive topic among physicians. More than half of rheumatologists (54%) believe ACOs will cause a decline in their income, and 38% said it is too soon to tell what effect they will have.

Many physicians have expressed skepticism that healthcare reform laws that require the use of specific treatment and quality guidelines will improve the quality of care patients receive. Among rheumatologists, 20% believe these measures will improve patient care whereas nearly half believe they will have a negative effect.

The survey also asked physicians whether these measures would change the way they practice medicine. Among rheumatologists, 44% said they would not reduce the amount of tests, procedures, or treatments they perform because they do not feel these guidelines are in their patients' best interest. Approximately 26% responded that their need to practice defensive medicine would keep them from altering their case management routines. Only 18% believe the guidelines are beneficial, and 11% would reduce tests and procedures because the measures will otherwise affect their income.

Interestingly, 56% of rheumatologists regularly discuss cost of care with their patients, compared with 38% of physicians overall, and 33% will discuss cost only if the patient brings up the subject.

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