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

Leigh Page

Disclosures

April 04, 2017

In This Article

Doctors Hard-Pressed to Treat New Medicaid Patients

Another reason for the influx of new patients seeking care in recent years is the expansion of Medicaid eligibility in 31 states under the ACA. The expansion brought in 10.7 million more patients, plus 3.4 million more people enrolled in Medicaid who could have enrolled before.

How are physicians handling this wave of new Medicaid patients?

In the Medscape survey, 69% of doctors agreed with the statement, "I will continue taking new and current Medicare/Medicaid patients."

Singleton says the influx of new Medicaid patients, combined with new exchange patients, is sorely testing the capacity of doctors to treat these patients. "Physicians haven't been able to keep up with so many patients," he says.

As evidence of this, Singleton points to Merritt Hawkins' survey finding that wait times to get an appointment rose by 30% in big-city markets between 2014 and 2017.

He blames this on poor output of new physicians. While the ACA boosted demand, "it did not increase the supply of providers," Singleton says. The number of federally funded residency positions has been capped since 1997, and only a relatively small proportion of new slots are being funded through private sources.

Nurse practitioners (NPs) and physician assistants (PAs) have been able to fill in the supply gap to some extent, but they are bumping up against the limits of their scope of practice, Singleton says.

The result, he says, is that while millions more people have gained coverage, they are having trouble actually getting healthcare.

Growth in Direct Pay and Concierge Has Leveled Off

Concierge and direct-pay practices appeal to physicians who are tired of mounting paperwork, dealing with payers, and curtailed appointment times in traditional practices.

In both concierge and direct-pay models, sometimes known as cash-only, doctors have fewer patients and see them for longer appointments, in exchange for a monthly or yearly fee. Concierge involves one-on-one care with virtually round-the-clock access, while direct pay offers somewhat less access to doctors in exchange for fees that are about one third those of concierge care.

The problem is that only a limited number of people want to pay for these extra services, and this may explain why recent Medscape reports, including this year's, have seen a slowdown in the growth of concierge and direct-pay practices.

Participation in concierge increased from 1% to 3% in Medscape reports from 2012 to 2014, but it has been stuck at that 3% since then. Similarly, participation in direct pay rose from 3% to 6% in that same period, but it has also not budged any more.

Concierge and direct pay are still moneymakers, though. In this year's Medscape survey, direct-pay physicians earn $310,000 and concierge ones earn $300,000, and both earned more than the $294,000 of the average physician.

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