Oncologists' Earnings Are Up, But Career Satisfaction Is Not

Roxanne Nelson, RN

April 21, 2015

Times are changing for oncologists, as they are in medicine in general. And oncologists are slightly less satisfied with their specialty than they were a few years ago, according to the fifth consecutive annual Medscape report.

The latest figures, covering 2014 earnings, were compiled from an extensive online survey of 19,916 physicians. Around 2% (n = 398) of the respondents were oncologists. Their responses are summarized in the Oncologist Compensation Report 2015.

Overall, oncologists were well compensated; average yearly earnings were $302,000, ranking them slightly above the median for all specialties. As in previous reports, orthopedists top the income list ($421,000), followed by cardiologists ($376,000) and gastroenterologists ($370,000). At the bottom of the income list were pediatricians ($189,000), family medicine physicians ($195,000), and those in internal medicine and diabetes/endocrinology ($196,000).

Oncologists' earnings were up 4% over 2013. Infectious disease physicians reported the greatest increase in earnings (22%), followed by physicians who are primarily employed by medical centers and hospitals: pulmonologists (15%), emergency medicine physicians (12%), and pathologists (12%). In contrast, rheumatologists reported a decrease in income (–4%), as did urologists (–1%).

Income differences persist between male and female oncologists; this trend has been observed in all previous Medscape reports. The earning gap between men and women was significantly greater for employed than for self-employed oncologists (25% vs 5%). However, women tended to work fewer hours and fewer weeks, which could account in part for this earning gap.

For employed oncologists, men reported earnings of $301,000, whereas women reported earnings of $226,000. For self-employed oncologists, men reported earnings of $359,000, whereas women reported earnings of $340,000.

And there has been a decline in satisfaction with income. Fewer female oncologists reported less satisfaction with their income in 2014 than in 2013 (37% vs 48%). The same pattern was true for male oncologists (47% vs 54%).

Geographic location might play a role in what an oncologist can expect to earn. The highest incomes were reported in the Southwest ($358,000) and Southeast ($353,000); the lowest incomes were reported in the Northeast ($237,000) and the West ($268,000).

Less Satisfaction With Career Choice

Oncologists appear to be less satisfied with their career choice than they were a few years ago.

In the 2011 Medscape report, 76% of oncologists said they would choose medicine as a career again, and 79% said the would choose their own specialty. In the 2015 report, 67% said they would choose medicine again, but only 51% said they would choose their own specialty.

Furthermore, in the 2011 report, 47% said they would choose their own practice setting, but in the 2015 report, only 17% said they would go that same route.

Overall, oncologists report a decline in general career satisfaction. After an analysis of the percent of oncologists who would choose medicine again, who would choose their own specialty again, and who thought they were fairly compensated, oncologists ranked ninth in overall satisfaction (54%); in the 2014 report, they ranked fifth (56%).

Physicians determined to be most satisfied were dermatologists (63%), psychiatrists (57%), pathologists (57%), and emergency medicine physicians (56%). Those determined to be least satisfied were internists (47%), nephrologists (48%), and general surgeons (49%).

Payment Issues

Medicare and Medicaid reimbursement are complex issues for oncologists, especially because more than 60% of cancer patients are covered by Medicare. The American Medical Association has warned that Medicare payments could be cut by more than 13% by the end of the decade, but oncologists have not given up on Medicare just yet. In this year's report, 74% of employed and 64% of self-employed oncologists reported that they will continue to take new and current Medicare or Medicaid patients. This is an increase over last year's report, when 71% of employed and 57% of self-employed oncologists said they would take these patients. However, fewer self-employed oncologists reported that they do not take Medicare or Medicaid patients in this report than in the 2014 report (7% vs 21%).

In accordance with the Patient Protection and Affordable Care Act, health insurance marketplaces or exchanges were set up in each state to facilitate the purchase of health insurance. About half of oncologists (57%) and primary care practitioners (51%) seem to be on the fence about whether or not they will participate in the health exchanges. Only 20% of oncologists said that they are planning on participating, which is down slightly from the 23% in last year's report. And 23% said they will not be participating, which is up from the 15% in last year's report.

When asked about the impact of health insurance exchanges on their income, 55% of oncologists predicted that there will be no change, and 39% predicted that exchanges will cause incomes to decrease. Only 6% predicted that incomes will increase. In contrast, 10% of primary care practitioners predicted that incomes will increase and 27% predicted that they will decline.

Patient-Related Issues

Cancer treatments are expensive and, despite the advent of health reform, many patients struggle to pay for their therapy. But according to the 2015 Medscape report, only 25% of oncologists regularly discuss this issue with their patients; 32% do so only occasionally and under certain circumstances and 25% discuss it if the patient brings it up. Of those who never discuss it, 8% said it is because they don't know the cost of treatment and 4% said they think discussing the cost of therapy is inappropriate.

Individual time spent with a patient varied among oncologists. On average, 41% reported spending less than 16 minutes with a patient, 30% reported spending up to 20 minutes, and 18% reported spending at least 25 minutes.

When asked about the most rewarding aspect of the job, most female and male oncologists cited relationships with patients (42% and 43%, respectively), followed by being very good at their job (27% and 26%, respectively), making the world a better place (12% and 11%, respectively), and making good money at a job they enjoyed (9% and 9%, respectively).

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