Physician Incomes Up in 2018, but Productivity Stagnant: AMGA Survey

Ken Terry

August 29, 2019

Overall physician compensation increased by a median of almost 3% in 2018, although productivity did not keep pace, according to the 2019 Medical Group Compensation and Productivity Survey of the American Medical Group Association (AMGA).

"Data from this year's survey shows compensation is increasing without an equivalent increase in wRVU [work relative value unit] production for many specialties. This trend is causing organizations to absorb additional compensation expenses without balancing revenue from production increases," said Fred Horton, MHA, president of AMGA Consulting, the association's consulting arm, in a news release.

The AMGA survey found that in 2018, overall physician compensation increased by a median of 2.92%, compared to a 0.89% increase the previous year. Productivity increased by 0.29%, compared to a 1.63% decline in 2017. Compensation per wRVU rose 3.64%, slightly more than the 3.09% increase the prior year.

In primary care — including family medicine, internal medicine, and pediatrics — median compensation was up 4.91%, a significant increase from 0.76% the previous year. Although this was the largest jump in compensation in several years, productivity was flat, with wRVUs increasing by only 0.21% in 2018. As a result, the median compensation per wRVU increased 3.57%.

AMGA's report also presents median compensation and productivity statistics for 2014–2018. These figures reveal that although primary care wRVUs were fairly flat during that period, compensation for family physicians and internists increased more than in most other specialties.

Family doctors' productivity increased 3.7% during the 4-year period, while their compensation shot up 15%. Similarly, median wRVUs for internists barely budged, yet their compensation increased by 13.8%.

Specialty Care

Cardiologists experienced a comparable pay increase, with 15% higher compensation durng the 4-year period, but their median wRVUs rose by 8%.

Median income went up for many specialties; overall compensation rose 3.39%. Medical specialties saw an increase of 1.9% in median wRVU production over last year's survey, while the compensation per wRVU ratio increased by 2.65%, according to the release.

As for compensation change from 2017 to 2018, cardiology (general) went up 4.4%; dermatology, 3.3%; hospitalists-internal medicine, 2.1%; and psychiatry, 15.6%. Gastroenterology saw a dip of 0.4%.

Primary care physicians are apparently being paid more, regardless of productivity, because of their important role in value-based care. "As healthcare organizations move from volume-based to value-based payment models, we've observed increased scrutiny on primary care performance," said Elizabeth Siemsen, director of AMGA Consulting, in the release. "Medical groups continue to focus on delivering care in the most appropriate setting with the greatest efficiency — and often place primary care providers at the center of this strategy."

In recent years, Siemsen noted, the AMGA survey has shown a slow increase in the percentage of part-time primary care providers. She thinks this may have contributed to the hefty compensation increases for family doctors and internists.

"In order to recruit and retain the primary care workforce, it may be that the market demanded a compensation course correction this past year," she said.

Respondents

AMGA received survey responses this year from 272 groups, representing more than 114,000 providers. Nearly three quarters of the participants were AMGA members. The responding groups included 143 physician specialties and 27 other provider specialties.

Just over 40% of the respondents were groups of more than 300 physicians. Groups of fewer than 50 physicians formed just 15.4% of the sample. The giant groups contained 74% of the physicians.

Hospitals and healthcare systems owned 68% of the groups in the survey, and only 32% were independent. Nearly three quarters of the respondents represented not-for-profit organizations.

Average clinic hours per week ranged from 35 for primary care physicians to 39 for anesthesiologists. The minimum number of hours required to be considered a full-time physician was 36–40 hours for 67% of respondents and 31–35 hours for 23%.

Besides wRVU, which was the dominant measure of productivity for determining pay, many groups offered incentives for patient satisfaction (78%), quality and outcomes (72%), "citizenship," meaning cooperation with others (51%), patient access (44%), care coordination (28%), and utilization of care (12%).

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