April 16, 2014 -- Medicine is going through changes, some for the better and others less so, according to Medscape's "Physician Compensation Report: 2014." Key findings include:
- Compensation has increased slightly in 19 medical specialties.
- The income gap between men and women is narrowing.
- Accountable care organizations (ACOs) are making their impact felt.
- Self-employed doctors earn more than employed ones.
- Cash-only practices, while still a tiny percentage of all practices, are gaining some traction.
The report is based on a survey of more than 24,000 U.S. doctors representing 25 specialties.
Who's on Top?
Orthopedics ($413,000), cardiology ($351,000), urology ($348,000), gastroenterology ($348,000), and radiology ($340,000) are the five top-earning specialties, as they were in last year's survey. Radiology has moved down slightly compared with earlier surveys, and anesthesiology has dropped.
Primary Care Income Has Gone Up Slightly
Compensation for both family doctors and internists is up 1% compared to 2012. While doctors overall have been concerned about income declines due to health care reform, this was not the case in 2013 for 19 specialties that saw modest increases. But inflation in 2013 was 1.5%, so for many, income did not keep up with inflation.
For primary care, some of the increase was probably due to the 10% bonus paid to primary care doctors who see Medicare patients, as included in the Affordable Care Act. Despite the modest increase, family doctors and pediatricians are among the lowest-paid specialists, as they have been in past surveys.
The Income Gap Between Male and Female Doctors Is Narrowing
Among doctors, men earn more than women, as they have in all past surveys. But that picture appears to have improved. In 2010, male doctors earned 40% more than females. In 2013, men earned 30% more. Those percentages vary by specialty. In primary care, the disparity is smaller and hasn't changed much. In 2013, among internists, men earned 13% more than women ($195,000 vs. $173,000). In family medicine, men earned 19% more ($187,000 vs. $157,000).
Although men make more than women in almost every specialty, women tend to be as satisfied as men with their compensation. In some specialties they are more satisfied. For example, female OB/GYNs make $229,000 compared with $256,000 for men, but 47% of women are satisfied with their compensation compared with 38% of men. Female gastroenterologists make less than male ones, but 55% are satisfied with their income vs. 46% of men.
Urology was the only specialty in which women made more than men, and female urologists were also more satisfied with their compensation.
Self-employed Physicians Earn More Than Employed Ones
Among doctors overall, those who are self-employed earned an average of $281,000 compared with employed doctors, who earned $228,000. In primary care, the difference was smaller: self-employed doctors earned $188,000 and employed ones earned $180,000.
ACOs Are Making Their Impact Felt
An ACO is a group of doctors, hospitals, and other health care providers who work together to provide care to patients who use Medicare.
In 2011, 8% of physicians were either in an accountable care organization or were planning to join one that year. In 2013, that percentage rose to 34%.
The growth in ACO participation has been steady: In 2013, almost a quarter of doctors (24%) who responded were already in ACOs, and 10% planned on joining one; in our 2012 survey, only 8% of doctors were either in an ACO or were planning to join one.
Cash-Only Practices Becoming More Appealing?
While still in the minority, the percentage of doctors involved in cash-only practices rose from 3% of respondents in 2011 to 6% in 2013. This is in line with physicians who are dissatisfied with payments and are looking for ways to practice that don't involve insurers.
Medicine as a Career Has Lost Some Appeal
Compare answers from Medscape's 2011 report to the 2014 report:
- Would you choose medicine again? Yes (69% in 2011, 58% in 2014)
- Would you choose the same specialty? Yes (47% in 2011, 61% in 2014)
- Would you choose the same practice setting? Yes (50% in 2011, 26% in 2014)
Insurance Is a Huge Issue
When asked whether they were planning to participate in a health insurance Exchange, more than a quarter of respondents (27%) said yes, 20% said no, and more than half (53%) said they were not sure. Their caution probably has to do with fears about income: 43% of doctors said they expected their income to go down if they were part of health insurance Exchanges, 50% said they expected no change, and 7% said they expected their income to increase.
In general, although a majority of doctors will continue taking new and current Medicare and Medicaid patients, about 25% haven't yet decided whether they will or won't. A very small percentage (3% at most) will stop taking these patients. In regard to private insurance, 25% said they will drop insurers who pay poorly, while 39% will not.
Satisfaction With Compensation Has Not Changed Much
In 2013, 50% of all doctors said they felt fairly compensated. The figure for primary care doctors is 48%. These figures are very close to the 2011 report percentages, in which 48% of all doctors felt fairly compensated, and 51% of primary care doctors felt that way.
The specialties that feel the most fairly compensated are dermatology (64%), emergency medicine (61%), pathology (59%), and psychiatry (59%). Family medicine (50%) and internal medicine (46%) score around the middle of the pack. Least satisfied with their compensation are plastic surgeons (37%), pulmonologists (39%), neurologists (41%), and endocrinologists (41%).
Extra Services Are Still Popular for Bringing in More Income
The specialties that most frequently offer extra services are orthopedics (33%), anesthesiology (31%), and gastroenterology (28%). In primary care, about 23% of family doctors and 20% of internists are offering extra services.
Discussing Treatment Costs With Patients
Cost is a huge factor in treating patients -- in some specialties more than others. Still, particularly in large health systems, treatment costs are most likely to be discussed with the billing staff rather than with the doctor.
Overall, in Medscape's 2014 survey report, 32% of doctors regularly discuss the cost of treatment with patients; 40% discuss it if the patient brings it up. Only 19% of surgeons regularly discuss the cost of procedures with patients, while 41% of eye doctors have this discussion regularly.
Paperwork Takes Up a Huge Chunk of Time
Not unexpectedly, self-employed doctors spend more time on paperwork than do employed doctors. About 29% of self-employed doctors say they spend from 1 to 4 hours on paperwork per week, compared with 24% of employed doctors. And 31% of self-employed doctors say they spend 5 to 9 hours on paperwork vs. 28% of employed doctors.
Time Spent With the Patient
The amount of time spent with the patient has not changed significantly in the past few years. Comparing 2010 and 2013:
- See patients for 13 to 16 minutes: 21% in 2010, 29% in 2013
- See patients for 9 to 12 minutes: 16% in 2010, 18% in 2013
- See patients for 17 to 20 minutes: 17% in 2010, 25% in 2013
- See patients for 25 minutes or more: 15% in 2010, 13% in 2013
Despite the frustrations, most doctors find their careers deeply rewarding. Being good at their jobs, having good relationships with patients, and making the world a better place were cited as key factors in making the practice of medicine worth the effort.