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Exclusive Survey Earnings: Primary care tries to hang on

Article

Family physicians and internists didn't keep up with inflation in 2003.

 

Jump to:
Choose article section... Who's king of the compensation hill? With less managed care, Southern physicians earn more How revenue and compensation varied in 2003 In primary care,employed docs bring home less bacon Work in the city—but not too far in The gender gap narrows in primary care Where do you stand on the earnings ladder? Primary care earnings— in a holding pattern

Family physicians and internists didn't keep up with inflation in 2003.

In news reports last year, the word "economy" was frequently preceded by the word "sluggish." Nobody knew that better than primary care physicians. Their median total compensation in 2003 was the same as it was in 2002—$150,000.

This glum picture emerges from the latest Medical Economics Continuing Survey, which sampled office-based MDs and DOs in 24 specialties. With flat earnings, primary care doctors actually lost ground financially, as they watched the cost of living jump 1.9 percent last year.

Doctors' earnings blues stemmed from a number of causes. One is flat reimbursement. Medicare increased its fees by a paltry 1.6 percent in March 2003, and commercial payers, who typically take Medicare's lead, were just as stingy, either freezing their fees or cutting them. In some markets, laid-off workers who lost their health insurance translated into fewer visits. "People just put off going to the doctor," says consultant Keith Borglum in Santa Rosa, CA.

Meanwhile, the cost of running a practice continued to climb. "Our health insurance premiums went up 5 percent in 2003," says FP Michael Fleming, member of a 10-doctor group in Shreveport, LA, and president of the American Academy of Family Physicians. "We also needed to give raises to our employees to retain them." Not surprisingly, there wasn't any raise for Fleming himself last year.

To Atlanta consultant Gary Matthews, stagnant earnings in primary care represent a hangover from the heyday of managed care in the 1990s. "Compensation was artificially high when the gatekeeper concept was in vogue," says Matthews. "Hospitals and large groups were giving income guarantees as high as $180,000 a year to doctors straight out of residency. When the guarantees ended, everybody realized that the doctor couldn't bring in enough to justify that pay."

Despite facing some of the same economic forces as primary care doctors, many procedure-based specialists fared well in 2003. Invasive cardiologists, for example, registered an 11-percent jump in income. The proceduralists have benefited from the waning of the gatekeeper model, since they're now more accessible to patients. And they're kept busy by graying baby-boomers anxious to preserve their hearts, knees, and various organs.

Specialists also have managed to make up for meager third-party reimbursement by generating income from ancillary services such as diagnostic imaging, outpatient surgery centers, and even specialty hospitals, says Dan Stech, director of survey operations for the Medical Group Management Association. "Primary care doctors typically don't have enough money to launch a big ancillary service."

As is always the case, the income picture also changes considerably by geography, the size of the practice, age, gender, and a number of other variables. Job-hunting physicians, for instance, might want to remember the following factoid: You'll make the most down South. Doctors there earned a median $200,000 in 2003, $40,000 more than their Eastern counterparts, who were at the bottom of the income pecking order.

What accounts for the difference? Supply and demand is one likely explanation. Eastern states on the whole have more physicians per capita than any other region. Massachusetts, for example, had 419 physicians per 100,000 population in 2001, about two and half times the rate in Mississippi and twice the rate in Texas. Doctors in short supply tend to be busier. Conversely, insurers have more bargaining power to drive down fees where doctors abound, adds Dan Stech.

Physician income also tends to rise where HMOs are weakest. In 2003, the South had the lowest rate of HMO enrollment—15 percent—in the country, according to Interstudy Publications, a managed care research organization in St. Paul, MN. The Midwest had the second lowest penetration rate—19 percent—and, perhaps not coincidentally, the second highest level of physician income. "Capitated physicians often don't do as well as others," notes attorney and consultant Daniel Bernick with The Health Care Group in Plymouth Meeting, PA. "And HMOs have tighter referral policies than other types of plans."

Group practice is another predictor of financial success. Soloists ranked the lowest in earnings with $177,000, while doctors in groups of 10-24 were tops at $250,000. Income tailed off in groups of 50 or more, perhaps reflecting a greater prevalence of lower-paid employed physicians.

Male physicians once again out-earned their female counterparts in 2003, this time to the tune of $70,000, although the gender gap shrinks to $30,000 in primary care. On one level, it's a matter of sheer production. Because their family duties generally exceed those of men, female physicians tend to work fewer hours at the office and consequently see fewer patients.

Likewise, women gravitate to family-friendly employee positions with more fixed schedules. "Those jobs don't offer opportunities for greater income," says Leesburg, VA, public health specialist Diane Helentjaris, president of the American Medical Women's Association. And the specialties they choose tend to be less call-intensive—dermatology as opposed to neurosurgery—and, not surprisingly, less lucrative.

There's one more explanation for why female physicians make less—gender discrimination. "From what my AMWA members tell me, it's not over yet," says Helentjaris.

Gender, demographics, the post-9/11 economy—there are stories galore behind the numbers in our income survey. How about your income story? The accompanying charts and tables will help you compare yourself to other doctors.

 


Who's king of the compensation hill?

2003 practice revenue
 
2003 total compensation
$800,000
Cardiologists (invasive)
$400,000
$700,000
Neurosurgeons
$396,000
800,000
Orthopedic surgeons
$367,600
$600,000
Thoracic surgeons
$325,000
$550,000
Cardiologists (noninvasive)
$300,000
$580,000
Gastroenterologists
$300,000
$650,000
Urologists
$300,000
$660,000
Plastic surgeons
$292,000
$600,000
Dermatologists
$266,000
550,000
Ophthalmologists
$250,000
$400,000
Pulmonologists
$240,000
$450,000
General surgeons
$235,000
$425,000
Nephrologists
$230,00
$575,000
Allergists/Allergy immunologists
$217,000
$500,000
Ob/gyns
$208,000
$520,000
Rheumatologists
$197,000
$305,000
Infectious disease specialists
$160,000
$200,000
Psychiatrists
$160,000
$349,000
Endocrinologists
$150,000
$310,000
Internists
$150,000
$379,100
FPs
$149,300
$365,000
Pediatricians
$140,000
$250,000
GPs
$120,000
$414,000
All respondents
$180,000

 

With less managed care,
Southern physicians earn more

Practice revenue
Total compensation
HMO penetration*
EAST
$360,000
$160,000
31%
New England
360,000

  159,000

Mid-East
365,000
166,000
30
 
 
 
 
MIDWEST
$420,000
$180,000
19%
Great Lakes region
410,000
180,000
19
Plains states
431,000
180,000
19
 
 
 
 
SOUTH
$460,000
$200,000
15%
South Atlantic
432,000
180,000
18
Mid-South
500,000
204,000
14
Southwest
500,000
208,700
11
 
 
 
 
WEST
$400,000
$173,900
35%
Rocky Mountain region
400,000
165,000
21
Far West (including Alaska and Hawaii)
400,000
175,000
40
National
$414,000
$180,000
23%

 


How revenue and compensation
varied in 2003

Practice revenue
Total compensation
All physicians
Primary care
All physicians
Primary care
Solo
$387,000
$346,800
$177,000
$150,000
Expense-sharing
411,000
375,000
190,000
150,000
2 physicians
518,600
450,000
200,000
159,600
3 physicians
486,300
408,000
200,000
170,000
4 physicians
500,000
410,000
221,000
180,000
5-9 physicians
500,000
448,000
245,000
180,000
10-24 physicians
500,000
400,000
250,000
173,300
25-49 physicians
700,000
—
240,000
—
50 or more physicians
580,000
—
190,000
170,000
Single-specialty groups
500,000
430,000
240,000
180,000
Multispecialty groups
500,000
392,000
200,000
170,000
1-5
$385,000
$320,000
$150,000
$135,000
6-10
425,000
360,000
174,000
150,000
11-20
432,000
400,000
189,000
151,000
21-30
426,000
377,000
200,000
160,000
31 +
365,000
330,000
173,900
145,000
30-34
$390,000
$360,000
$135,000
$135,000
35-39
410,000
360,000
160,000
148,000
40-44
400,000
360,000
180,000
145,000
45-49
440,000
400,000
190,000
160,000
50-54
445,500
380,000
200,000
160,000
55-59
424,000
374,900
200,000
160,000
60-64
393,000
325,000
171,600
140,000
65-69
358,000
318,800
175,000
149,200

 


In primary care,employed
docs bring home less bacon

Total compensation
All physicians
Employed physicians
FPs
$149,300
$142,000
GPs
120,000
120,000
Internists
150,000
140,000
Ob/gyns
208,000
200,000
Pediatricians
140,000
120,000
All primary care
$150,000
$140,000

 


Work in the city—but not too far in

Type of community
Practice revenue
Total compensation
Inner city
$300,000
$150,000
Urban
410,000
200,000
Suburban
430,400
180,000
Rural
431,000
175,000

 


The gender gap narrows in primary care

Total compensation
 
Male
Female
% difference*
FPs
$150,000
$130,000
15%
GPs
120,000
100,000
20
Internists
151,000
120,000
26
Ob/gyns
227,300
190,000
20
Pediatricians
160,000
120,000
33
All primary care physicians
$160,000
$130,000
23%
All respondents
$200,000
$130,000
54%

 


Where do you stand
on the earnings ladder?

Total compensation
$600,000 or more
$500,000- $599,000
$400,000- $499,999
$350,000- $399,999
$300,000- $349,999
Allergists/Allergy immunologists
7%
2%
7%
6%
9%
Cardiologists (invasive)
18
12
20
12
12
Cardiologists (noninvasive)
5
10
14
9
14
Dermatologists
10
4
13
7
7
Endocrinologists
1
<1
3
1
4
FPs
1
<1
2
2
4
Gastroenterologists
11
4
11
8
15
GPs
1
<1
1
1
3
General surgeons
3
2
10
7
14
Infectious disease specialists
1
1
3
3
3
Internists
2
<1
2
2
4
Nephrologists
3
2
8
7
10
Neurosurgeons
23
12
16
9
14
Ob/gyns
2
4
5
6
10
Ophthalmologists
10
3
16
6
6
Orthopedic surgeons
20
7
19
10
11
Pediatricians
1
1
1
1
3
Plastic surgeons
14
3
11
7
12
Psychiatrists
0
2
0
1
8
Pulmonologists
1
2
6
8
14
Rheumatologists
2
4
5
4
8
Thoracic surgeons
12
11
14
10
17
Urologists
10
6
16
12
15
All respondents
4%
2%
6%
4%
7%
All primary care
1%
1%
2%
2%
4%
Total compensation
$250,000- $299,999
$200,000- $249,999
$150,000- $199,999
$125,000- $149,999
$100,000- $124,999
Allergists/Allergy immunologists
11%
18%
19%
5%
5%
Cardiologists (invasive)
7
9
5
1
3
Cardiologists (noninvasive)
13
14
9
3
6
Dermatologists
15
21
7
2
4
Endocrinologists
7
13
27
12
18
FPs
6
11
25
18
18
Gastroenterologists
14
18
12
1
2
GPs
3
10
18
10
19
General surgeons
9
14
17
6
8
Infectious disease specialists
12
12
24
16
14
Internists
5
12
26
16
16
Nephrologists
14
17
21
6
6
Neurosurgeons
11
7
4
1
3
Ob/gyns
12
20
19
6
9
Ophthalmologists
10
24
9
6
4
Orthopedic surgeons
11
10
5
4
1
Pediatricians
4
14
21
15
22
Plastic surgeons
18
11
12
2
5
Psychiatrists
2
20
32
3
12
Pulmonologists
17
15
20
8
5
Rheumatologists
9
18
20
13
9
Thoracic surgeons
7
14
5
2
2
Urologists
11
11
8
3
5
All respondents
8%
14%
20%
11%
12%
All primary care
6%
13%
23%
15%
17%
Total compensation
$80,000- $99,999
$60,000- $79,999
Less than$60,000
 
 
Allergists/Allergy immunologists
5%
3%
2%
 
 
Cardiologists (invasive)
<1
1
<1
 
 
Cardiologists (noninvasive)
1
2
1
 
 
Dermatologists
4
1
3
 
 
Endocrinologists
8
3
3
 
 
FPs
5
4
6
 
 
Gastroenterologists
2
0
1
 
 
GPs
14
10
12
 
 
General surgeons
3
3
3
 
 
Infectious disease specialists
6
<1
5
 
 
Internists
7
5
4
 
 
Nephrologists
1
1
4
 
 
Neurosurgeons
1
1
<1
 
 
Ob/gyns
2
3
4
 
 
Ophthalmologists
3
1
2
 
 
Orthopedic surgeons
1
2
<1
 
 
Pediatricians
8
5
3
 
 
Plastic surgeons
2
1
2
 
 
Psychiatrists
11
6
3
 
 
Pulmonologists
1
2
1
 
 
Rheumatologists
2
2
4
 
 
Thoracic surgeons
2
1
2
 
 
Urologists
1
1
1
 
 
All respondents
5%
4%
4%
 
 
All primary care
6%
5%
4%
 
 

 


Primary care earnings—
in a holding pattern

 
Practice revenue
Total compensation
2003
2002
% change
2003
2002
% change
FPs
$379,100
$350,000
8.3%
$149,300
$150,000
–0.5%
GPs
250,000
249,000
0.4
120,000
116,000
3.4
Internists
310,000
318,600
–2.7
150,000
150,000
0
Ob/gyns
500,000
500,000
0
208,000
220,000
–5.5
Pediatricians
365,000
350,000
4.3
140,000
130,000
7.7
All primary care
$361,800
$350,000
3.4%
$150,000
$150,000
0%
Inflation rate 2003
1.9%

 

How we conducted this year's survey

Questionnaires for the 2004 Medical Economics Continuing Survey, spearheaded by Sandy Johnson, manager of field services, were mailed in March to 54,725 MDs and DOs in private, office-based practice throughout the US. This represents a random sampling of 23 specialties from the AMA master list maintained by Phoenix Marketing Group, a subsidiary of St. Louis-based Express Scripts. Nonrespondents received a follow-up mailing in April.

By the cutoff date of May 20, 11,094 MDs and DOs—20.3 percent—had responded. We discarded returns with apparent discrepancies and those from physicians who hadn't rendered office-based patient care throughout 2003. This left us with a working sample of 8,159 physicians. These were coded by the Medical Economics research staff and then tabulated by Suzanne Coopersmith of Crosstabs in Syosset, NY.

The survey sample was selected to be representative within each specialty as to type of practice, age, geographical region, and gender. We weighted the results to reflect these criteria.



Robert Lowes. Exclusive Survey--Earnings: Primary care tries to hang on.

Medical Economics

Sep. 17, 2004;81:52.

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