Internists' Pay Nearly Flat, Still Ranks Near the Bottom

Marcia Frellick

April 18, 2018

Internists' pay went up 2%, to $230,000, in this year's Medscape Compensation report, but it still ranked near the bottom among specialties.

The largest gain was in psychiatry (16%), and the biggest pay drop was in general surgery, where compensation fell 9%.

Only four specialties had pay lower than internal medicine's: family medicine ($219,000), diabetes & endocrinology and pediatrics (both at $212,000), and public health and preventive medicine ($199,000).

Plastic surgeons earned the most, at $501,000, followed by orthopedists at $497,000 and cardiologists at $423,000.

A gender pay gap existed among internists, as it has in all years of the survey. This year, male internists made $244,000 and women made $210,000. Although female internists were more likely to work part time (19% vs 11%), the survey compared only full-time compensation, so that would not account for the difference, the authors note.

Many more internists (74%) are employed than self-employed (23%), reflecting the national trend of hospitals' consolidation and purchases of physician-owned practices. However, self-employed internists made more than their employee counterparts, at $259,000 vs $220,000.

The gender gap is small in numbers of employed internists, with 76% female and 72% male, but that could help explain a small part of the compensation gender gap.

Internists Are as Happy With Pay as Orthopedists

The same proportion of internists (51%) reported being satisfied with their compensation as orthopedists, even though internal medicine was among the lowest paid specialties and orthopedics was second highest.

Emergency medicine had the highest percentage of participants who were satisfied with pay (74%), whereas physical medicine and rehabilitation had the lowest, at 46%.

When asked whether they would drop insurers who pay poorly, 18% of internists answered yes. A small proportion (5%) said they would no longer take new Medicaid patients, and 14% said they would no longer take new Medicare patients. However, 18% said they were undecided on whether they would continue to take new and current Medicare or Medicaid patients.

Half Talk About Costs With Patients

As the size of deductibles continue to increase and patients pay more out of pocket, interest in price transparency has grown.

When internists were asked whether they talk about costs of care with patients, 51% said occasionally and 36% said regularly. Thirteen percent said they never talk about costs with patients.

Almost half (49%) said they spend 30 to 45 hours per week seeing patients. Nine percent saw patients more than 65 hours a week, and 17% saw patients fewer than 30 hours a week.

Most internists (69%) spent an average of 13 to 24 minutes with each patient.

Administrative tasks continue to be a big driver of physician burnout, and this year, 79% of internists reported spending at least 10 hours a week on paperwork and administrative tasks. That's up from 62% who put in at least 10 hours on such tasks last year.

When asked what was the most rewarding part of their job, the most frequent answer among internists was "gratitude/relationships with patients" (31%), followed by a sense of "being very good at what I do/finding answers, diagnoses" (22%), and "knowing that I'm making the world a better place" (17%). Eleven percent said they are rewarded most by "making good money at a job I like."

As with other specialties, the top challenge was "having so many rules and regulations," which was rated highest by 30% of internists.

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