Exciting Times Converge With Declining Satisfaction
A quick scan of recent health news headlines is all it would take to identify gastroenterology as one of the most fluid, challenging specialties in medicine. Once-in-a-generation curative treatments for hepatitis C have instantly changed the lives of thousands of patients. Colonoscopy screening programs are regarded to be among the most successful campaigns in contemporary cancer prevention, contributing to significant reductions in mortality. Identification of the microbiome's expansive role in overall health is at the vanguard of medical research, upending old notions while simultaneously discovering new treatment pathways.
Yet for the practitioners themselves, the story is more complicated. The responses of gastroenterologists participating in Medscape's 2016 Physician Compensation Report reveal larger downward trends in income, satisfaction, and administrative burdens. Though there is also no denying that gastroenterologists are thoroughly engaged by their work and are very well-compensated for it, the horizons have undoubtedly dimmed in recent years.
Earning Power: Front and Back of the Pack
The compensation report offers annual patient-care income for 26 medical specialties. Averages are calculated for employed physicians by including salary, bonus, and profit-sharing contributions, and for partners by including earnings after taxes and deductible business expenses before income tax. This analysis found that gastroenterologists ranked fourth with an average annual compensation of $380,000, placing them just behind their peers in orthopedics ($443,000), cardiology ($410,000), and dermatology ($381,000).
When you look at the percentage by which average annual compensation increased over the previous year, however, the data show a less favorable ranking. Though gastroenterologists experienced a 3% increase in their average annual compensation compared with 2015, this was good enough only for 19th place among all specialties. (Rheumatology and internal medicine led the pack, each with 12% increases over last year.) By comparison, in last year's compensation report, gastroenterology ranked 12th among all specialties for percentage increase of annual compensation.
According to gastroenterologists interviewed for this article, this decreasing trend is clearly linked to Medicare's reductions in the fees for endoscopies and similar planned reductions for colonoscopies in the coming year.
"The downward trend in gastroenterology is just the tip of the iceberg," said David A. Johnson, MD, professor of medicine and chief of gastroenterology at Eastern Virginia Medical School in Norfolk, Virginia. "We are facing up to a 20% cut in some of the Medicare codes of high-volume procedures, and colonoscopy-based type procedures in particular."
According to Stephen B. Hanauer, MD, medical director of the Digestive Disease Center at Northwestern Medicine in Chicago, Illinois, procedures likely account for 80% of income in gastroenterology, making them the financial engine of the specialty and a particularly attractive target for those looking to decrease costs.
"Increasingly, payments are set by government, and the third-party payers are falling in line with them," Dr Hanauer said. "Because it's recognized that procedures account for a disproportionate amount of cost, they're going to be focused on trying to reduce that. We're going to be vulnerable to continued lower reimbursement rates."
For certain gastroenterologists, the decline in procedure-related reimbursement will likely not have so substantial an impact, according to Nancy Reau, MD, chief of the section of hepatology and associate director of solid organ transplantation at Rush University Medical Center in Chicago.
"As a hepatologist, colonoscopy and endoscopy were never going to be anything that fueled my salary," Dr Reau said. "When you break apart gastroenterology, I'm sure we nonluminal individuals make a lot less, and we're not alone. The nutritionist service might not do a lot of endoscopy, and other groups certainly have limited procedural aspects within gastroenterology.”
Yet despite their separate duties, Dr Reau said that all gastroenterologists are feeling the sting of reductions in reimbursement across medicine as a whole.
"Medicine is one of the few fields where there has been no increase for cost of living or other related costs," she said. "Most of our reimbursements have decreased every single year. Our salaries may not always reflect that, though, because our ability to produce more keeps us from major salary shifts."
Medscape Gastroenterology © 2016 WebMD, LLC
Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.
Cite this: Compensation Report Shows Signs of Mounting Frustration Among Gastroenterologists - Medscape - Jul 06, 2016.
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