Earnings Are Down but Oncologists Still Do Well

Shelly Reese


May 17, 2013

In This Article

Earnings Shrink, Yet Commitment to Oncology Climbs

In many ways, oncologists mirror the views of physicians as a whole. More than half (51%) say that they are fairly compensated, slightly higher than the rate for physicians overall (48%). More than half (51%) of oncologists and physicians as a group say that they would choose medicine as a career again if given the opportunity.

But in the 2013 survey, oncologists expressed a resurgent commitment to their chosen specialty. Of the oncologists who said they'd choose a medical career again, 57% said they'd choose the same specialty. That's up from 47% last year and dramatically exceeds the 42% rate for physicians overall. Indeed, of all the specialists surveyed, dermatologists (59%), followed by oncologists and HIV/infectious disease specialists (both 53%), reported the highest overall satisfaction rate. The number of oncologists who would choose the same practice setting likewise improved: Nearly a quarter (24%) of oncologists said that they would choose the same practice setting, up from 19% last year.

Oncologists in the field aren't pulling out party hats and favors, though. Although satisfaction numbers may have improved, practitioners say that the field is in a tremendous state of flux and the dust has yet to settle. Like other physicians, oncologists are flocking to hospital employment. The move affords welcome stability, which may account for higher practice setting "satisfaction," says Jeffrey Ward, MD, a medical oncologist at the Swedish Cancer Institute in Seattle, Washington. But, he adds, it's fraught with headaches.

"Speaking as an oncologist who transitioned from private practice to a hospital setting a month and a half ago, I think the satisfaction you're seeing may be less satisfaction than relief," Ward says. "I'm in the middle of an EPIC [an electronic health record] conversion right now, so I would say that's a source of dissatisfaction with my practice setting, but if we hadn't made the move, we'd no longer be in business. How long that sense of relief will stay depends on the future."

The gravitation toward hospitals may likewise explain why oncologists are moving toward Accountable Care Organizations (ACOs) faster than physicians as a whole. In last year's Compensation Report, only 9% of oncologists either participated in an ACO or planned to join one in the coming year. This year, the share more than tripled to 29%, 5 percentage points higher than the rate for physicians as a whole (24%).

"It may be that the hospitals the oncologists are joining are part of or are becoming part of ACOs," Dr. Ward posits.

The Medicare Reimbursement Cut Is a Real Problem

Medicare reimbursement is an enormous issue for oncologists. More than 60% of cancer patients rely on Medicare for health coverage, notes Sandra M. Swain, MD, President of the American Society of Clinical Oncology (ASCO).

Recognizing Medicare's importance to patients, nearly two thirds (64%) of the oncologists whom Medscape surveyed indicated that they will continue to see current and new Medicare and Medicaid patients, compared with 59% of physicians overall. What's more, oncologists were more likely than physicians as a group to consider dropping low-paying insurers as "inappropriate behavior" (26% vs 18%).

But a 2% funding cut to Medicare chemotherapy reimbursement, mandated by the sequester, may be affecting many oncologists' noble intentions. In the wake of the cut, which went into effect on April 1, nearly 50% of oncology clinics responding to an ASCO survey released in May say that they can no longer treat Medicare patients who do not have supplemental insurance, and 14% say that they have stopped taking Medicare patients entirely.

Oncologists likewise recognize the economic impact of treatment on their patients. Cancer treatment can run more than $10,000 per month, and a growing number of patients are covered by high-deductible plans. Still, most oncologists aren't addressing the issue head-on. Only 28% of oncologists say that they regularly discuss cost with patients and another 48% say that they occasionally discuss costs, if a patient brings it up, according to the Medscape survey.

"I think your survey is probably right and only about a third of oncologists are having these discussions proactively," says Swain. "My recommendation is that everyone should be having them. Patients are frightened and vulnerable. It's difficult to talk about cost with them because they'll say, 'I don't want to talk about costs. I want to have what will help me.' But I think we as physicians need to be much more transparent about cost and toxicity and treatment benefits. I think we really owe it to them because we're the trusted source of information."