Medscape Physician Compensation Report Physicians Skeptical of ACO Model

Medscape, WebMD’s flagship site for medical professionals, issued a report in the end of April highlighting the opinions of 24,000 U.S. physicians regarding their compensation, and opinions on healthcare reform, including Accountable Care Organizations (ACOs) and treatment guidelines.  The survey was conducted from Feb. 1-17, 2012 via an online survey from a third-party collection site. The respondents represented 25 different physician practice areas.  Below is a summary of findings. 

Medscape Physician Compensation Report 

ACO’s: Currently, only about 3% of physicians participate with ACOs, which are a type of payment and delivery model that ties provider reimbursement to quality metrics and reduction in the total cost of care for an assigned patient population; they may initiate bundling of payments for various clinical outcomes.  Another 5% say that they plan to become involved in the coming year.  52% percent of physicians believe that ACOs will cause a decline in income, while 12% say they will have little or no effect.  “Most people are averse to change, and doctors are the same,” says Bohannon. “Until more ACOs are up and running, you can expect resistance and skepticism.” 

Quality Measures:  Physicians are skeptical about whether quality measures and treatment guidelines will improve patient care. Close to half of doctors say that they will have a negative impact on care, while 22% believe that they will lead to better-quality care.  Elements of healthcare reform entail following treatment and quality guidelines set by insurers and Medicare for shared savings programs, but physicians are clearly skeptical that they will improve patients’ quality of care. 

• Almost half of physicians surveyed (47%) said these measures will have a negative impact,
• whereas 29% said it will have no impact on quality.
• Only 25% of physicians believe it will lead to better-quality care. 

Between 26% and 31% of internists, family physicians and pediatricians say that quality measures and treatment guidelines will have a positive effect.  “No physician likes being told how to treat patients,” says Bohannon. “They fear that guidelines are promoted for cost-cutting reasons rather than the patient’s best interest. Physicians already give up so much autonomy going from a profession that was mainly private practice to one where they’re more likely to be employed. They see the guidelines as a greater loss of autonomy.” 

Healthcare reform’s “unnecessary care” goal met with skepticism – One healthcare reform goal of reducing “unnecessary care” garners negative response from physicians. The vast majority (67 percent) of physicians said they won’t reduce the amount of tests, procedures, and treatments they perform in order to comply with insurer treatment guidelines, either because the guidelines aren’t in their patients’ best interests or because doctors still need to practice defensive medicine.  Only about a quarter of doctors (27%) said that they would reduce the number of tests and procedures because the guidelines are valid.

Private Practice: Although physicians are rushing toward employment, partners in private practice far outearned physicians in any other work environment. “Owners of practices are busier than hospital-employed doctors,” said Bohannon. “Medium-sized groups do well because of economies of scale and greater bargaining power with health plans.” 

• Partners in private practice earned a mean of $308,000.
• Solo-practice owners earned a mean of $222,000,
• Employed physicians earned a mean of $194,000.

 Board-Certification: Physicians who are board certified earned a mean of $236,000; that’s 89% more than non-board-certified doctors, who earned a mean of $125,000. Board certification has great impact on more than just compensation. It is often required for inclusion in health plans and for hospital privileges. “As patients are becoming savvier, they research physicians’ backgrounds. Board certification becomes more important,” said Bohannon. 

Specialties: The top-earning specialties in 2012 were the same as in the previous year, although their incomes declined in general.  In 2012, radiologists and orthopedic surgeons again topped the list at a mean income of $315,000, followed by cardiologists ($314,000) and anesthesiologists ($309,000). The same four specialties were in the leading positions in last year’s survey. The bottom-earning specialties also remained similar: pediatrics ($156,000), family medicine ($158,000), and internal medicine ($165,000). 

Some salaries are down, but other specialties saw gains:  The biggest income increases were in ophthalmology (up 9 percent to $270,000) and pediatrics (up 5 percent to $156,000). Nephrology ($209,000), oncology ($295,000), and rheumatology ($180,000), were all up 4 percent. The largest declines were in general surgery (down 12 percent to $265,000); orthopedic surgery ($315,000) and radiology ($315,000), both down 10 percent; and neurology (down 8 percent to $184,000). 

Gender Gap: Overall, male physicians earn 40 percent more than female physicians, although that difference is only 23 percent in primary care. Experts say that the difference is related to choice of specialties and lifestyle preferences, and that if female physicians worked the same number of hours as men, they’d likely earn about the same.  Also, these experts point out that young male physicians are making similar lifestyle decisions to females, in choosing to work less, which could lead to a decrease in compensation gap in the future. However, the gap in income is narrower in some specialties. Male obstetricians/gynecologists earned about 12% more than their female counterparts in 2012, and male pathologists earned about 8% more than females.  

Geography: The highest-earning physicians practice in the North Central region, comprising Iowa, Missouri, Kansas, Nebraska, and South and North Dakota, at a mean income of $234,000, up slightly from the 2011 report. The next highest earners are doctors in the South Central and Great Lakes region at a mean of$228,000. Physicians in the Northeast earn the least, at a mean of $204,000. “There’s less competition among physicians in smaller communities and rural areas,” says Bohannon. “There isn’t that same downward pressure on reimbursement that you have in metropolitan areas. Generally, smaller communities have to pay more to attract physicians.” 

More Physicians are questioning their career choice: In 2012, just over half of all physicians (54 percent) would choose medicine again as a career, far less than in the previous year’s report, where 69 percent of physicians would choose medicine again. 

• Only one quarter of internists and one third of family physicians would choose the same specialty.
• Despite lower incomes, 46% of pediatricians would still choose that specialty.
• About 23% of all doctors would choose the same practice setting, compared with 50% a year ago.
• There was little difference in attitude between male and female physicians.
• The most frustrated with their specialties were internists and family physicians. 

Satisfaction: Last year’s satisfaction scores hit 80% (dermatologists), with many other specialties over 70% (radiologists and oncologists) and several over 60%. In Medscape’s 2012 survey, however, there are fewer smiles. 

• The most satisfied specialty is again dermatology, but this time with a satisfaction score of 64% — considerably down from 80%.
• Close to half the specialties surveyed scored under 50% in overall satisfaction.
• The most discontented were plastic surgeons; only 41% said that they were satisfied overall.
• Internists (44%) and
• Endocrinologists (45%) also expressed lower levels of satisfaction. 

“Rich” Doctor: Overall, only about 11% of physicians said that they consider themselves rich, while 45% said that their income is no better than that of many nonphysicians.  Another 45% said that although their income probably qualifies them as rich, they have so many debts and expenses that they don’t feel rich.  The specialties with the highest percentage of physicians who consider themselves rich were 

–       pathology (15%),

–       radiology, oncology and gastroenterology (14% in each).

–       Even among some of the higher-earning specialties, a majority of anesthesiologists, critical care specialists, dermatologists, urologists, and emergency medicine doctors said that they don’t feel rich because of debts and expenses. 

Time: About 3 in 10 physicians (31%) spend 30-40 hours per week in direct patient care, a slightly higher percentage than in Medscape’s 2011 survey. One quarter of critical care specialists spend more than 65 hours per week seeing patients, as do 11% of general surgeons and cardiologists and 10% of internists and nephrologists. About one quarter of pediatricians, rheumatologists, and family physicians spend less than 30 hours per week in direct patient care. 

Patient Load: Just less than one third (29%) of all physicians see 50-99 patients per week. In the 2011 survey, about 40% of doctors saw that many patients per week. About 23% of physicians see 100-174 patients per week. Radiologists have the most patient visits: One in 5 sees more than 200 patients per week. 

Reimbursement: Although decreased reimbursement has been the recent buzz-phrase, some specialties saw modest gains, whereas others saw significant declines. The biggest income increases were in: ophthalmology (+9%), pediatrics (+5%), nephrology (+4%), rheumatology (+4%), and oncology (+4%). For declines, the largest were in general surgery (-12%), orthopedic surgery (-10%), radiology (-10%), and emergency medicine (-8%). 

Patient Time: As in Medscape’s 2011 survey, the 13- to 16-minute patient visit is still the most common, especially in the primary care specialties of family medicine and internal medicine. Anesthesiologists (49%), critical care physicians (44%), and neurologists (46%) spend more time with each patient: a mean of 25 minutes or more. A majority of dermatologists (40%), radiologists (8%), ophthalmologists (35%), and emergency physicians (35%) spend the least time — a mean of 9-12 minutes per encounter.  The amount of time per patient visit excludes the patient’s time with a nurse practitioner, physician assistant, or medical assistant; it measures only time spent in the presence of a physician.  These data do not include psychiatrists. 

Administrative: More than half of physicians spend a minimum amount of time – 4 hours or less – on paperwork and other administrative activities. Another 23% spend from 5 to 14 hours per week on administrative work. HIV/AIDS physicians (27%) spend at least 25 hours per week, followed by pathologists (33%) and oncologists (18%). Only 10% of family physicians, internists, and pediatricians spend that much time on administrative activity. “More documentation is being required than ever before, and paperwork demands have definitely increased,” says Bohannon.