April 7, 2016 -- Burnout rates are high among doctors, but there are signs that things may be getting better -- and it isn't all about the money.
In this year's Medscape compensation report, more docs are saying they'd choose medicine again than they did 2 years ago. The highest percentages are among family physicians and internists, who tend to earn less than most doctor groups.
More women are entering the profession, and their income is rising at a higher rate than that of the men. The trend toward higher employment numbers, particularly among younger doctors, may be taking some of the stress off the profession.
Nearly 19,200 physicians participated in this year’s survey. The doctor groups at the bottom and top of the earnings list have not changed much over the past 6 years.
In this year’s report, Medscape’s sixth annual, the lowest earners, starting from last place, are pediatricians ($204,000), endocrinologists ($206,000), and family physicians ($207,000). In 2010, those groups were also in the bottom three.
The top three earners this year are orthopedists ($443,000), cardiologists ($410,000), and dermatologists ($381,000). In the 2011 report, orthopedists were also first, followed by radiologists, anesthesiologists, and then cardiologists. Dermatologists were eighth 6 years ago.
In our 2016 report, men still earn more than women, whether they are primary care doctors ($225,000 vs. $192,000, respectively) or specialists ($324,000 vs. $242,000, respectively). But women's earnings increased more between 2012 and 2015 than did men's: 40% for female primary care doctors and 34% for their male peers. For specialists, the percentage increases between those years were 36% for women and 29% for men.
Overall, female doctors make 24% less than their male peers do, although the disparity is less among primary care doctors (15%) than among specialists (25%).
Location and 'Obamacare'
This year, the highest earnings were reported in the North Central ($296,000) and Southeast ($287,000) regions, whereas the lowest were in the Northeast ($266,000) and Mid-Atlantic ($268,000) regions. Uneven distribution of doctors, particularly in primary care, has been a problem for decades in rural and poor communities. Numerous government policies are aimed at improving access to doctors in these areas. As a result, higher incomes are found in these regions.
The three top-earning states in this year's Medscape report are North Dakota ($348,000), New Hampshire ($322,000), and Nebraska ($317,000).
The same three states/areas as last year were at the bottom in terms of compensation. The lowest-paying locations are Rhode Island ($224,000), District of Columbia ($226,000), and Maryland ($231,000).
This year, 19% of doctors said they would be participating in the health insurance Exchanges, 29% were not, and slightly over half (52%) were uncertain.
Asked whether their income was affected by the Affordable Care Act (also called "Obamacare"), 63% reported no change and 11% said it had increased. About one quarter (26%) reported a decrease.
Nearly half of primary care doctors (49%) and 30% of specialists report having more patients because of the health-care reform law. Of note, emergency medicine physicians have been particularly hard hit, with more than one-half (55%) reporting seeing new patients because of Obamacare.
Patient Time, Burnout, and Fair Pay
The number of hours spent seeing patients has shifted over time. In the 2012 Medscape survey, 22% of doctors spent 30-40 hours per week seeing patients, and nearly half (49%) spent more time than that. This year, over one-half (51%) spent 30-40 hours per week with patients, and about one-third (34%) spent more time.
The amount of doctor face-time with a patient is often an issue, and lately both physicians and patients complain that this time has been getting shorter. But the results of Medscape's 2016 survey were consistent with all surveys since 2011: The largest time category of patient visits is 13-16 minutes, followed by 17-20 minutes.
Bureaucratic tasks were the prime cause of doctor burnout, according to this year's report, as well as previous ones. Second was spending too many hours at work.
Slightly over half of all doctors (52%) think their compensation is fair. Less than half of women (49%) believe they're fairly paid, compared with 54% of men. Of interest, the overall percentage of doctors who feel fairly compensated has not varied much over the past 5 years.
Those who felt most fairly paid were dermatologists (66%), who are also the third-highest earners this year. That’s held true for every year since 2012. Pathologists (63%) and emergency medicine physicians (60%) followed in satisfaction. The least satisfied with compensation are urologists (42%), followed by allergists and endocrinologists (both 43%).
Despite complaints about red tape, work requirements, and changes in the health care field, a full 98% of physicians found gratifying elements about being a doctor and treating patients.
This year, about one-third cited their relationships with patients (34%) and being good at their job (32%) as the two most rewarding aspects of their work, which were the same top rewards given 3 years ago (31% and 34%, respectively). Most who commented on this question simply mentioned caring for or helping people.