Again, Endocrinologists' Pay Ranks Near the Bottom

Miriam E Tucker

April 18, 2018

Endocrinologists are among the lowest paid of all medical specialists and their compensation decreased in the past year, yet a majority would still choose the career path again, according to new findings from the Medscape Endocrinologist Compensation Report 2018.

The endocrinologist survey is part of the online annual Medscape Physician Compensation Report, the most comprehensive and widely used physician salary survey in the United States for the eighth year in a row.

This year's survey included 20,329 US-based physicians from 29 medical specialties who responded between November 21, 2017 and February 21, 2018. Two thirds (66%) of respondents were men, and participants were distributed across all age groups.  

Endocrinologists Take a Pay Cut

For the second year in a row, endocrinologists' reported pay ranked third lowest overall, just above pediatrics and public health/preventive medicine.

And of concern, endocrinologists' pay actually dropped by 4% from 2017, in contrast to last year's gain of 7%.

Endocrinologists' reported annual compensation — including salary, bonus and profit-sharing for employed physicians, and earnings after taxes and deductible business expenses before income tax for partners — was $212,000 in 2018, compared with $220,000 in 2017.

Endocrinologists who were foreign-trained, self-employed, and male earned more than US-trained, employed, and female endocrinologists. 

Nearly three quarters (73%) of endocrinologists reported being employed and 27% were self-employed in 2018. But female endocrinologists were far more likely to be employed, at 86%, compared with 63% of men. This difference could account for some of the $49,000 disparity in wages between the sexes.  

Not surprisingly, endocrinologists also ranked near the bottom for feeling that they are fairly compensated for their work, with just 47% having that belief.

Among those reporting pay dissatisfaction, 42% said they should be earning 11% to 25% more, while 38% thought they should be making 26% to 50% more.

Payment Model Participation

Most endocrinologists (72%) accept insurance, and 35% are still reimbursed on a fee-for-service basis.

A third (33%) said they were paid through accountable care organizations (ACOs), one of the advanced alternative payment systems under the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015. That proportion is actually a drop from 2017, when 44% reported participating in ACOs, and from 2016, at 43%.

In the 2017 survey, 40% of endocrinologists said they anticipated participating in MACRA. However, numerous changes to the MACRA-authorized Merit-Based Incentive Payment System (MIPS) have created confusion and frustration among physicians.

Asked about expected participation in MIPS in the 2018 survey, just 32% of endocrinologists anticipated doing so, placing them in the bottom half among specialties. The proportion expecting to participate in Alternative Payment Models was far lower, with just 8% of endocrinologists predicting this.

The majority of endocrinologists (60%) plan to continue taking new and current Medicare and Medicaid patients, but that's a drop from 77% in 2017.

Another 32% said they plan to drop and/or stop taking new Medicare and Medicaid patients, while 24% had not yet decided. 

The proportion participating in health insurance exchanges, 40%, is nearly unchanged from last year's 36%.

Interacting With Patients vs Paperwork

The number of hours a week spent seeing patients dropped somewhat from last year. The proportion reporting spending 30 to 45 hours/week with patients declined from 67% in 2017 to just 60% in 2018, while the number spending less than 30 hours/week rose from 11% to 23%.

The proportion of endocrinologists spending 10 hours/week or more on paperwork and administration — a major cause of physician burnout — jumped from 67% in 2017 to 74% in 2018. 

Asked about the most challenging aspects of their work, 27% of endocrinologists responded "having so many rules and regulations," 20% "difficulties getting fair reimbursement," and 17% "dealing with difficult patients."

How Do Endocrinologists Feel About Their Work? 

As for the most rewarding parts of their job, 40% endorsed "gratitude/relationships with patients," 26% "being very good at what I do/finding answers, diagnosis," and 13% "Knowing that I'm making the world a better place." 

And despite the challenges and dissatisfaction over pay, 78% would choose a career in medicine again, and of those, 82% would still choose endocrinology.

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