Internists Least Likely to Choose Their Specialty Again, Survey Shows

Marcia Frellick

May 21, 2020

Internists spent an average of 18.5 hours per week on paperwork, according to the Medscape Internist Compensation Report 2020. That number was surpassed only by intensivists, who spent 19.1 hours on such tasks.

Again this year, internists' income ranked near the bottom of the more than 30 specialties in the survey, with average pay of $251,000. Although that number was up $8000 from last year, it was still less than half that of the top-earning specialists.

The top four specialties in terms of pay were the same this year as they were last year and ranked in the same order: orthopedists made the most, at $511,000, followed by plastic surgeons ($479,000), otolaryngologists ($455,000), and cardiologists ($438,000).

However, internists ranked in the middle of all physicians as to feeling fairly compensated. Just more than half (52%) reported they were fairly compensated, compared with 67% of oncologists, emergency medicine physicians, and radiologists, who were at the top of the ranking, and 44% of nephrologists, who were on the low end.

Also, just as last year, male internists earned 23% more than their female colleagues, which is a slightly smaller pay gap than the 31% gap seen overall.

COVID-19 Reversing Income Gains

However, the compensation picture is changing for all physicians. This report reflects data gathered between October 4, 2019, and February 10, 2020. Since that time, the COVID-19 crisis has reversed income gains for physicians overall. A study from the Medical Group Management Association (MGMA) indicates that more than half of medical practices reported a drop in revenue by early April of 55% and a drop in patient volume of 60%.

The MGMA notes, "[P]ractices are struggling to stay afloat ― and many fear that this is only the beginning."

Specialty Choice May Vary

In the Medscape survey, internists were the physicians least likely to say they would choose their specialty again. Only 66% said they would choose it again, compared with the most enthusiastic specialists: orthopedists (97%), oncologists (96%), and ophthalmologists and dermatologists (both at 95%).

However, three fourths of internists (75%) said they would choose medicine again, which was a larger proportion than that reported by family physicians (74%), neurologists (73%), and plastic surgeons (72%).

This year's Medscape survey is the first to ask about incentive bonuses. More than half of all physicians (56%) reported receiving one. Bonuses for internists ranked near the bottom, at an average of $27,000. Orthopedists averaged $96,000 bonuses, and family physicians received the least, at an average of $24,000.

Most internists (63%) said their bonus had no effect on the number of hours worked, which was similar to physicians in other specialties.

In good news, internists lost less money on claims that were denied or that required resubmission than most of their colleagues in other specialties. By comparison, internists reported losing 15% on such claims, and plastic surgeons lost almost twice that percentage (28%).

The survey authors note, "One study found that, on average, 63% of denied claims are recoverable, but healthcare professionals spend about $118 per claim on appeals."

Relationships With Patients Most Rewarding

When asked about the most rewarding part of their job, internists ranked "gratitude/relationships with patients" at the top. In this survey, internists spent about the same amount of time with patients that all physicians spent with patients on average, 37.9 hours per week.

"Making good money at a job I like" was the fourth-biggest driver of satisfaction (only 11% said that was the most rewarding part), behind "being very good at what I do/finding answers, diagnoses" and "knowing that I'm making the world a better place."

Some questions on the survey pertained to the use of advanced practice providers. More than half of internists (54%) reported their practice included nurse practitioners (NPs), and 36% included physician assistants (PAs); 37% employed neither.

Half of the internists who employed NPs and PAs said they had no effect on profitability, 44% said they increased it, and 6% said they decreased it. Physicians overall were split (47% each) on whether NPs and PAs increased profitability or had no effect on it.

Marcia Frellick is a freelance journalist based in Chicago. She has previously written for the Chicago Tribune and Nurse.com and was an editor at the Chicago Sun-Times, the Cincinnati Enquirer, and the St. Cloud (Minnesota) Times. Follow her on Twitter at @mfrellick.

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