Physician Incomes Begin to Recover From Pandemic: Survey

Avery Hurt

April 15, 2022

Though the pandemic is by no means over, life has returned to something approaching normal. Practices have reopened, and elective procedures are beginning to fill physicians' schedules once again.

After taking a dip in 2020, when many practices were closed and most patients were staying home, physician compensation began to recover in 2021, according to the latest Medscape Physician Compensation Report. For the first time in the 11 years Medscape has been conducting this poll, all specialties saw an increase in income in 2021, likely owing to an easing of pandemic restrictions.

"Compensation for most physicians is trending back up as demand for physicians accelerates," says James Taylor, chief executive officer of AMN Healthcare's Leadership Solutions Division.

This year's report featured responses from over 13,000 physicians in more than 29 specialties.

In 2022, physicians overall earned on average $339,000. Specialists pulled in $368,000, and primary care providers averaged $260,000. Though self-employed physicians are becoming increasingly rare, those who do go it alone reported 20% more income than their employed counterparts.

Despite the gains, many individual physicians are still under water. One fifth of those surveyed saw their incomes drop in 2021, though this year, fewer put the blame on the pandemic than did so last year (70% vs 92%). Some of the lingering problems may be due to side effects of the pandemic.

Increased use of telehealth (and its associated costs) along with staffing problems are still pinching practice budgets. "I'm able financially to just make ends meet and hoping this will turn around," said one respondent. "Last year, we got loans and grants to help, but nothing so far this year."

These problems have been especially difficult for family practice doctors. Tochi Iroku-Malize, MD, MD, president-elect of the American Academy of Family Physicians, told Medscape Medical News that family physicians are already way down the pay scale in comparison with other specialties, and the pandemic dealt a serious blow to already stressed practices.

"The pandemic exacerbated the financial pressures we already had," she said. Things have improved, but not enough. An August 2021 survey by the Primary Care Collaborative found that only 30% of family physicians said their practice was on solid financial footing. "That means 70% are not okay," said Iroku-Malize.

However dire the numbers, doctors are not responding by dropping their least profitable patients. Seventy percent said they would continue to take existing and new Medicare and Medicaid patients, even though the pay rates from these insurers are lower.

Gender, Ethnic Pay Gaps Remain

Though salaries have risen overall for all specialties over the years, the income gap between men and women has remained fairly constant. In Medscape's 2012 survey, male primary care providers earned 23% more than their female counterparts. In 2021, men edged slightly more ahead, earning 25% more than women.

The news is somewhat better for women in specialties. The gender gap in this year's report is 31%; that's down from 37% in 2012 and 33% in 2019. This could be because women are entering the higher-paying specialties in greater numbers. According to the 2016 survey, 26% of oncologists were women; now that figure is 33%. The number of women in critical care went from 25% to 31% in the same period.

"A great many of the specialty organizations have efforts underway not just to increase the number of women in specialties but also to address gender pay gaps and bias in evaluations during residency and fellowship," said Ron Holder, chief operating officer of the Medical Group Management Association.

Addressing women's pay is especially complicated because pay gaps tend to get baked in. Iroku-Malize points out that raises for doctors of both genders tend to be based on starting salary. So as a female physician moves up the ladder, even if her salary increases, the gap follows her.

While White physicians are still the top earners in the field, all racial and ethnic groups have seen an increase in income in recent years, and the racial/ethnic gap may be beginning to shrink. Since the 2017 report, compensation for Black physicians has increased by 19%, and it has increased by 21% for Latinix/Hispanic physicians. Asian American physicians have seen an increase of 16%. White physicians saw a 14% increase over the past 5 years.

Geography makes a difference as well. Many Southern states face physician shortages and lower overall health, especially in rural areas. In recent years, many of these states have offered higher salaries and other incentives to attract physicians to these underserved areas. This is reflected in the findings that six of the top 10 states for physician income are in the South, and all six ranked among the worst for overall health, according to a United Health Foundation report.

A Commitment to Medicine

Despite the challenges physicians face, those posed by the pandemic as well as preexisting ones, the percentage of physicians who would choose medicine if they had to make the decision again is higher now than it was in 2011. Then, only 69% would again go into medicine; today that number is 73%.

It may be another matter when it comes to choosing a specialty, however. Only 68% of family physicians and 63% of internists would choose the same specialty if they could go back in time. Dermatologists, at 99%, and orthopedists, at 97%, are still among the top of those who would stay in the same field.

Though the decline in income was certainly unwelcome, physicians as a rule are better able to cope than many who lost work during the pandemic. Many physicians — 36% of those surveyed — adjusted to the loss of income by taking on extra jobs.

"Physicians are fortunate to have a huge array of potential side gigs available to them. Supplemental income that pays well is not difficult to find," says Sylvie Stacy, MD, MPH, author of 50 Nonclinical Careers for Physicians.

The coronavirus pandemic has given us all pause to think about what matters in life. Physicians are no exception. While "gratitude/relationships with patients" and "being very good at what I do/finding answers, diagnoses" still topped the chart when it came to the most rewarding part of the job, "knowing that I'm making the world a better place" increased from 12% in 2015 and 2017 to 23% this year. It's not all about the money.

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