Memo from the Managing Editor

A new look at income

David Azevedo

Like many of you recently, we've been concerned about income. Your income, in fact. Year after year for decades, our Continuing Survey has brought you a comprehensive look at physician income, broken down as far as we dared by specialty, region, group size, age, years in practice, gender, board certification, and any other factor we could think of.

A dwindling response rate and the increasing complexity of practice arrangements have made it more and more difficult to gather reliable, scientifically valid data. So this year we decided to search beyond our own walls for income data that would serve you at least as well as our past efforts.

We considered perhaps a dozen of the leading physician income surveys. We found, not surprisingly, that none was perfect. Most looked at only a slice of the physician universe. Others were dated; the AMA's survey is only now reporting data from 2000.

The best in terms of methodology, and the one we report on in the story "More hours, more patients, no raise?", was the extensive survey conducted by the Medical Group Management Association. The source of the information is the MGMA membership—group administrators, who have access to the "right" numbers. The number of responses to this survey is generally high, another important factor.

While you may have seen snippets of MGMA income data published elsewhere, ours is the most in-depth treatment you will have seen. We learned long ago, by fielding hundreds of phone calls from interested readers, that what you want is a profile you can compare your own income to. That means, for example, not just looking at what other FPs make, but also at what FPs in the West make; what male FPs make; what FPs in groups of 26-50 make; what FPs . . . you get the idea. Only with thin-sliced data can you get a true picture of where you stand.

What's missing from the MGMA data, though, are figures for solo practitioners and two-doctor partnerships. That's a big chunk of the physician universe, and one we've tried to address with a set of supplemental numbers from a survey done by the National Association of Healthcare Consultants, in conjunction with The Society of Medical-Dental Management Consultants.

The Association polls its members—practice management consultants—who report on the practices they work with. This survey includes a large percentage of soloists and partnerships, and because the figures are reported by the folks who have intimate knowledge of the practices' accounting, the numbers are reliable.

What the Association's survey lacks, however, is a scientific sample—respondents are disproportionately from Southern and North Central states—and large numbers of responses. So we present these numbers not as a definitive statement of average physician income, but as a benchmark and another view to use in conjunction with the MGMA's numbers.

What you'll find in these two surveys won't be news to many of you—it's getting harder and harder to maintain your income. Primary care income may have hit a plateau. RBRVS has been fully phased in, and indeed Medicare's reduced fee schedule for 2002 hammered primary care specialties as hard as others—and that won't bode well for 2002 income figures that we'll report on next year.

There's reason for hope, however. Congressional moves to rethink the Medicare Fee Schedule formula may not happen fast enough to save doctors from another hit in 2003, but any future change will be to doctors' advantage. Also, a bit more of skyrocketing health care premiums may find their way into doctors' pockets as employee copays escalate.

Whatever happens to physician income in the future, you can be sure we'll be there to tell you about it—in the kind of meaningful detail you won't find in any other magazine.

 

David Azevedo. Memo from the Managing Editor: A new look at income. Medical Economics 2002;22:6.