The Specialist/Primary Care Split Continues and Not Just in Compensation
The demand for primary care doctors continues to grow, but specialists still earn the most money, according to Medscape’sPhysician Compensation Report: 2011. The report is based on a survey that garnered responses from over 15,000 US physicians representing 22 specialties.
The highest earning medical specialties are orthopedic surgeons and radiologists (median compensation: $350,000), followed by anesthesiologists and cardiologists ($325,000). Dermatologists report that they are happiest with their specialty (93%).
If they had to do it all over again, primary care doctors were least likely to choose the same specialty (43%), followed by pulmonologists (52%) and obstetricians/gynecologists (53%). While pediatricians were lowest on the income rung, 61% would choose the same specialty again.
These are just a few of the not-to-be-missed findings of Medscape’s 2011 Physician Compensation Report, which was fielded during February 2011 and based on 2010 data.
Other key findings include:
Doctors in private practice spend more time seeing patients than do their employed colleagues;
Sex still makes a difference across the specialties surveyed, women doctors reported a 2010 median income of $160,000 compared with men’s $225,000;
Income for most doctors has remained flat from 2009 to 2010, although a percentage of doctors saw increases; and
More than one fourth of primary care physicians (29%) spend between 13 and 16 minutes with each of their patients.
The specialties continue to command the highest rungs on the income ladder. At the very top are orthopedic surgeons and radiologists, whose 2010 median salary was $350,000. Just 1 rung below are anesthesiologists and cardiologists, each of whom had a median salary last year of $325,000. Below these 2 groups, in descending order, are urologists, general surgeons, gastroenterologists, and dermatologists.
At the other end of the income ladder are pediatricians, whose 2010 median income was $148,000. Doctors in primary care which includes both internal medicine and family medicine did somewhat better last year than their pediatric colleagues, but not by much: their median salary in 2010 was only 7% higher than that for pediatricians $159,000.
A surprising number of primary care respondents earned even less. Of the primary care doctors participating in the Medscape survey, 18% had a 2010 median income of $100,000 or less, which is indicative perhaps of the number of physicians working less than full time.
Still, for about 3 in 10 primary care physicians (PCPs) responding to the survey, 2010 earnings outstripped 2009 earnings by anywhere from a few percentage points to more than 20%. Another 2 in 10 PCPs saw a decline in their 2010 earnings within this same range. And slightly more than 5 in 10 or 52% of primary care respondents reported no substantial change in their 2010 median income compared with 2009.
When the other specialties are thrown into the mix, the 2010/2009 earning comparisons remain largely the same, with about half of the respondents reporting no change, a little less than one third reporting an increase, and the remaining 20% or so reporting a decrease.
“All of this seems about right to me,” says Mark E. Kropiewnicki, an attorney and consultant with Health Care Law Associates P.C., in Plymouth Meeting, Pennsylvania, who works with physician clients all over the country. “I have found that most of my clients have been holding their own over the last 2 years, a smaller group of clients is increasing, and a few are going down.”
Like the compensation gap between specialists and primary care physicians, the one between male and female doctors continues. Across the 22 specialties surveyed, this gap is significant, with women respondents reporting a 2010 median income of $160,000 compared with men’s $225,000. There are several potential reasons for the stubborn persistence of the income disparity between the sexes.
For one thing, female physicians on average spend fewer hours per week seeing patients than their male counterparts do, the likely result of their efforts to juggle multiple familial and professional commitments.
“From my experience, if a man and a woman are in the same practice doing the same work, they’re making the same amount of money,” says Kropiewnicki. “But if either the man or woman says, ‘I only want to work 30 or 35 hours per week,’ well, the next person who’s still working 60 hours is going to make more money. That’s just the way the real world operates.”
For another thing, fewer women than men are represented in some of the higher-earning specialties, such as orthopedic surgery, cardiology, and gastroenterology. This fact also tends to depress female physicians’ median income.
But the male-female income gap in primary care. In 2010, according to the Medscape survey, median income for male and female primary care doctors was $170,000 and $140,000, respectively. A gap of $30,000 will never be anyone’s idea of chump change, of course; nevertheless, survey findings clearly show that, when compared economically with their male colleagues, women fare better in primary care than they do in the other specialties.
That said, neither men nor women in primary care feel especially well paid. A majority, albeit a slim one (52%), answered No to the question, “Do you feel you’re compensated fairly for your work?” Compare this finding to the almost equal percentage of physicians across 22 specialties who say they are fairly compensated for their work. This gap in pay satisfaction levels between specialists and primary care doctors would widen still further, Kropiewnicki points out, if PCPs were excluded from the group of 22 specialists.
The choice of where and how to practice is not just a matter of income, of course; personal preferences play a huge role, as do lifestyle and family considerations. (On the whole, as other surveys have shown, younger doctors tend to take such lifestyle choices more into account than older and mid-career physicians do.) Still, as the Medscape survey shows, some choices about where, how, and with whom to practice really do affect doctors’ wallets.
When it comes to where doctors earn more, the North Central US is the nation’s Gold Coast minus the coast, of course.
Results for income by geographic area contained some head scratchers, at least at first glance. Doctors in the North Central US – comprising reported the highest overall median income ($225,000), while physicians in the northeast and southwest reported the lowest ($190,000). “The higher income areas may have a specialty mix tilted in favor of the higher-earning specialties,” says Tommy Bohannon, vice president of hospital-based recruiting at Merritt Hawkins & Associates, in Irving, Texas, “but it’s generally true that physicians do better away from the coasts.” (Results may vary due to small sampling size from North Central region.)
Similarly interesting were the results of the second question asking about income by community type. Here we find out that internists and family physicians in small towns and rural areas with populations under 25,000 actually earned more in 2010 than their big city colleagues did $164,000 to $150,000, respectively.
One explanation for this disparity in median income is obvious: with fewer specialists to refer to, small town and rural physicians simply refer less and do more, from minor excisions to more complicated procedures. Often, it seems, necessity is not only the mother of invention but the proud parent of a fatter paycheck.
The survey breaks the overall issue into a number of key parts: On the question of highest-paid practice settings, the results are mixed, depending on whether all doctors or only PCPs are queried. Among all physicians, those in private practice (2-doctor) partnerships with a median salary of $280,000 lead the pack; if the latter (PCPs only), multispecialty group practices are out in front. In each case, outpatient clinics and academic, research, military, or government settings lag significantly behind.
On the question of income by size of practice, bigger is better, up to a point. Whereas solo practitioners across 22 specialties report a 2010 median income of $140,000, physicians practicing in larger groups report a median income for this same year of up to $175,000. The income boost for doctors in larger practices is partly the result of economies of scale for things like equipment and supplies; larger practices are also able to offer a wider array of patient and ancillary services, other surefire income boosters.
About 4 in 10 primary care physicians (41%) say they spend a median range of between 30 and 40 hours per week seeing patients. Another 37% say they typically spend from 41 to 50 hours a week seeing patients. Above the 50-hour mark, the ranks of PCPs thin considerably, although a stalwart group of workaholics (23%) reports logging anywhere from 51 to more than 65 patient contact hours each week.
Among the specialists, anesthesiologists, cardiologists, gastroenterologists, nephrologists, pulmonary medicine specialists, surgeons, and urologists are the busiest; each spends a median range of 46-50 hours in contact with patients. As a general rule, though, anesthesiologists, like radiologists, do not gauge their productivity in terms of individual patient encounters, points out Merritt Hawkins’ Tommy Bohannon.
As noted previously, female doctors spend fewer hours each week seeing patients than male doctors do, one reason for their overall lower median income. Whereas about half of women report seeing patients between 30 and 40 hours a week, only about 3 in 10 men say they do the same. A larger group of male doctors (36%) reports spending anywhere from 41 to 50 hours a week in contact with patients. In contrast, only 30% of female doctors say they put in a similar number of hours. And by an almost 2-to-1 margin over their male colleagues (33% to 19%), female doctors are more likely to spend fewer than 30 hours during a typical week seeing patients.
Seventy-eight percent of emergency medicine physicians see between 50 and 149 patients per week, making this the busiest specialty in terms of visits per week. Following this hospital-based specialty for the most number of patient visits per week are orthopedic surgeons, obstetricians/gynecologists, PCPs, and pediatricians.
Among PCPs, those in private practice have more patient visits than their employed counterparts; indeed, 27% of physicians in private practice settings see a median range of between 100 and 124 patients per week, compared with only 18% of employed PCPs who do. And doctors in private practice are almost 3 times as likely as employed physicians to have a median of 125 visits and above.
Doctors in small towns and rural areas and those in suburban areas see more patients each week than their colleagues in larger and medium-size metropolitan areas do.
Among specialists who calculate their time according to individual patient encounters, neurologists spend the most time per patient visit 25 minutes or more and dermatologists and ophthalmologists spend the least 9-12 minutes per visit. About 30% of primary care physicians spend between 13 and 16 minutes with each of their patients, although about 46% exceed this range to one degree or another.
Between the sexes, male doctors spend a median range of between 13 and 16 minutes with each of their patients, while female doctors spend between 17 and 20 minutes.
Some physicians have seen the financial wisdom of investing in their own surgery/clinical procedure centers. Among specialists who’ve already taken this step, gastroenterologists lead the way (40%), followed in descending order by urologists, plastic surgeons, orthopedic surgeons, and ophthalmologists. A small but significant percentage of these same specialists say they have not yet taken the plunge but plan to do so in the near future. For at least a portion of such doctors, though, this train may have already left the station, especially anyone considering investing in an ambulatory surgical center.
“If you haven’t done so already, you may be hard pressed to do it going forward,” says Mark Kropiewnicki of Health Care Law Associates, PC. Doctors thinking about setting up their own ambulatory surgical center, he says, face the prospect of lower reimbursements and rising costs for construction and related expenditures. And buying into an existing center may not make good financial sense either, he explains, as long as buyers facing significantly lower future earnings are forced to purchase at current market prices, which often reflect higher past earnings.
Of course, just as in sports where the best offensive is often a good defense, sometimes the best way to boost practice income during tough times is simply to cut expenses. Of the roughly 15% of respondents who followed this game plan in 2010, most said they’d cut expenses by up to 10%. Among this group of cost-cutters, the best represented specialties are plastic surgery (29%), urology (23%), gastroenterology (20%), and cardiology (19%).
Perhaps the most heartening finding of the Medscape survey is that given a mulligan most physicians, specialists as well as primary care doctors, would chose the career of medicine again.
Among the 22 groups of specialists surveyed, 69% said they would take the same career path, 61% said they would choose the same specialty, and 50% said they would choose the same practice setting. Primary care doctors were just as certain as the specialists about their choice of career and practice setting, but they were less certain than their specialist colleagues about choosing the same specialty again. Indeed, 43% of PCPs said they would, while a significant 58% either said No or they weren’t sure.
Of those in either the specialties or primary care who said they would not choose a career in medicine again, business, law, teaching, and finance, in that order, are the most popular alternative careers. Other choices included chef, computer sciences, musician, pilot, and journalist. One respondent said he’d like to be “An assassin of insurance company executives.”
Much further down the list near the very bottom, in fact is a non-medical career choice that at least 1 physician chose, perhaps after an especially hectic day of non-stop pressure. The choice? Zamboni driver.
For further details on physician compensation, see Medscape’s complete Physician Compensation Report .