Doctors' Incomes Are on the Rise -- Is Yours? Medscape Physician Compensation Report 2017

Leigh Page

Disclosures

April 04, 2017

In This Article

New Survey Category Shows Income Lag for Black and Hispanic Doctors

For the first time, the Medscape survey asked respondents to identify their ethnicity and race, allowing Medscape to report comparative income data in this area.

White/Caucasian physicians earn the most ($303,000), followed by those who are Asian ($283,000), Hispanic ($271,000), and black/African American ($262,000).

The gap can be partly explained by participation in primary care, which pays less. Of the four groups, black/African American doctors are most likely (30%) and white doctors least likely (20%) to be PCPs, the survey found.

White physicians were also more likely to feel fairly compensated (57%), compared with those who are Asian (51%), black (50%), and Hispanic (49%).

A 2016 studyin BMJ[12] found an even wider gap than the new Medscape report in payment levels for black doctors. White male physicians in the United States earned as much as 35% more than black physicians, even after accounting for specialty, experience, number of hours worked, number of Medicaid patients, and whether the physician is a PCP, the study found.

In comments on a recent Medscape article[13]on the BMJ findings, several black physicians said discrimination against them had made it harder to do their work.

"No matter how hard I try, or how well I treat my patients and the staff, I do not receive as much respect or credit for my efforts as does my male, white counterpart," a female neonatal/perinatal doctor wrote. "One nurse even told me to shut up."

Due to an unconscious bias, administrators may hold down salaries for minorities and women, according to a 2016 report.[14] The report said the University of Minnesota Medical Center asks department chairs and others in charge of hiring physicians to attend training sessions to become aware of their unconscious bias and eliminate it.

An Influx of Exchange Patients Tests Capacity to Treat Them

Medscape survey results show that doctors are under great strain to treat people who have coverage through subsidized insurance exchanges, officially known as marketplaces, set up by the Affordable Care Act (ACA).

The exchanges enrolled 11.5 million people in 2017, according to a February report by the Kaiser Family Foundation.[15] These newly insured patients are not evenly distributed. High concentrations of exchange patients, for example, are in parts of North Carolina, Georgia, Montana, and much of Florida, the report said.

According to the Medscape survey, 52% of PCPs are treating new patients from the exchanges this year. That's pretty close to the 49% rate reported last year.

Specialists are seeing more exchange patients than last year, but their 2017 rate is only 38%, well below that of PCPs.

Forty-one percent of survey respondents, the largest group, aren't sure whether they will participate in exchanges.

One reason for their uncertainty is that insurers often place doctors in their "other provider" networks into their exchange network without informing them, according to a report by Kaiser Health News.[16] Even when these patients arrive at doctors' offices, staff still might not know that they're exchange patients because their insurance cards may not indicate this, the report said.

Recently, some insurers have been reducing reimbursements in their exchange plans due to financial losses. In Pennsylvania in 2016, for instance, Highmark announced that it was cutting doctors' payments for exchange patients by 4.5%, according to a news report.[17]

Another concern about exchange patients is that they may frequently switch policies to find the lowest premiums, causing confusion about their coverage limits. They also tend to choose high-deductible plans, forcing practices to collect fees directly from them.

Moreover, if exchange patients don't pay their premiums, the ACA requires insurers to keep listing them as insured during a 90-day "grace period." Physicians who unwittingly treat these patients during the grace period may not be paid by the exchange plan.

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