Physician Earnings: Income Is Up, Morale Is Split

Mark Crane


April 25, 2013

In This Article

Will You Keep Seeing Medicare/Medicaid Patients?

For more than a decade, physicians have faced a planned annual reduction in pay for Medicare under the government's sustainable growth rate formula that determines physician pay. Each year since 2002, Congress has acted at the last minute to enact a "doc fix" to postpone the cuts. The American Medical Association has frequently warned that many doctors will be forced to stop seeing Medicare patients if the cuts go through.

Medscape's survey found that physicians are reluctant to drop Medicare and Medicaid. Some 59% said they intend to keep treating these patients. About 9% said they would stop seeing new Medicare/Medicaid patients, whereas 2% said they plan to stop seeing current patients as well. Some 29% said they haven't decided yet, adopting a wait-and-see attitude.

"This varies by location," said Judy Aburmishan. "At least in Illinois, most of my doctor clients see Medicare as one of the better payers. Medicaid is a bigger problem because the pay is so low. Most insurers pay some multiple of Medicare. At least with Medicare, doctors know what they'll get and when. Doctors have more trouble getting private insurers to pay on time."

Physicians are putting all insurers under closer scrutiny than ever. Practice management consultants have long advised that doctors review what their insurers pay and drop the lowest-paying insurers -- if they can. Our survey shows that more physicians are starting to do that: Almost one quarter said they are dropping insurers who pay poorly. Another 19% said they can't do this because they need all the payers they can get. Some 18% said it's inappropriate behavior to drop those insurers.

"There's more of a squeeze on income, so doctors have to look for ways to be more cost-efficient, and that means dropping bad payers," said Judy Aburmishan.

Discussing Cost Issues With Patients

Fewer physicians are discussing the costs of treatment with patients. Only 30% said they regularly discuss the issue, down from 38% in last year's survey. Another 38% discuss the issue only occasionally, if the patient brings up the subject. That's down from 46% one year ago. Some 16% of physicians said they never discuss the issue, either because they don't know the costs of treatment or they feel it's inappropriate -- about the same as the previous year.

"In general, doctors want to be clinicians and seldom get into conversations with patients about the cost of treatment," said Judy Aburmishan. "They're trained to be doctors. It's a different business than most others. Can you imagine a baker who couldn't tell you what his cakes cost?"

As doctors see more patients, they have less time than ever to discuss costs, said Tommy Bohannon. "In the new employment environment, there's pressure to maintain volume. And if they're working in hospitals or large groups, it's more likely that someone on the administrative staff will have these discussions. More and more, doctors want to detach themselves from concerns about the business aspect of practice."

The Rewards of a Medical Career

Anyone who says that doctors are just in it for the money are just plain wrong. Despite some gloom-and-doom attitudes, the majority of doctors found aspects other than money that made their careers worthwhile and rewarding. They especially noted their relationship with patients and the challenge and satisfaction of being able to solve problems and make patients feel better.

Doctors described the most gratifying part of being a doctor: "Being good at what I do, finding answers and diagnoses" (34%); "gratitude for their relationships with patients" (31%); "knowing that I am making the world a better place" (12%); and "making good money at a job I like" (9%). Only 2% of respondents felt there was nothing rewarding whatsoever about being a physician.

For further details on physician compensation, see Medscape's Physician Compensation Report: 2013 Results.