Survey Report: How are medical subspecialists doing?

October 8, 2001

We surveyed earnings and fees in 10 fields?from allergists to rheumatologists. Some of our findings may surprise you.

 

SURVEY REPORT

How are medical subspecialists doing?

Jump to:Choose article section...Which IM subspecialties are making the most? Subspecialists work longer hours than primary care doctors, but see fewer patientsHow income varies The range of net earnings for IM subspecialists What IM subspecialists charge, and collect, for office visits Charges for selected services

We surveyed earnings and fees in 10 fields—from allergists to rheumatologists. Some of our findings may surprise you.

By Wayne J. Guglielmo
Senior Editor

Want to make lots of money as an internal medicine subspecialist? The choice is clear: Go into invasive cardiology. In 2000, the median net income for doctors in this demanding field was $296,130. Among IM subspecialists, only gastroenterologists—who brought home $237,400 last year—even came close.

As a group, internal medicine subspecialists netted more than their colleagues in primary care: $215,400 compared with $131,700. "Despite some ratcheting down in recent years, the future for the internal medicine subspecialists is still very bright," says Gray Tuttle, Jr., a practice management consultant based in Lansing, MI.

Who's who among income leaders is just one of the nuggets we discovered when we surveyed the major internal medicine subspecialties.* The data come from the Medical Economics Continuing Survey, which polls MDs and DOs in office-based private practice.

Here are some other findings:

• In 2000, subspecialist net income was highest (at $267,910) in groups of 25 or more. Solo and salaried doctors netted the least: $171,350 and $183,180, respectively.

• For subspecialists overall, the best bet for high income is the Midwest, where the median net was $236,570.

• IM subspecialists put in more hours per week than their primary care counterparts, but generally see fewer patients. Among the subspecialties, pulmonologists and nephrologists see the most patients, noninvasive cardiologists and gastroenterologists the fewest.

• Allergists are the most dependent on managed care for their income. Ninety-four percent had at least one contract with an HMO or PPO, and income from these sources made up nearly 80 percent of their total gross. Nephrologists are the most heavily involved in capitation, which accounted for 41 percent of their total gross income.

• Nearly across the board, IM subspecialists charge more for office visits—for both new and established patients—than their primary care colleagues. And usually, they're reimbursed more by third-party payers.

Clearly, this is a good time to be an IM subspecialist—especially a cardiologist (either invasive or noninvasive), a hematologist/oncologist, or a gastroenterologist. Not only are these the most aggressively recruited subspecialties, but, not surprisingly, they were also four of the top net earners in 2000. "The demand is fairly universal," says Mark Smith, executive vice president of Merritt, Hawkins & Associates, the Texas-based recruiting firm. "And metropolitan areas are now recruiting as aggressively as rural areas."

Why the subspecialty shortage? One reason is the push toward primary care in recent years. Another is that aging boomers are demanding more—and more sophisticated—diagnostic and preventive care. All this creates a hot subspecialty market that isn't likely to cool down soon.

Use the following tables to compare yourself with internal medicine subspecialists. For information on how the Continuing Survey was conducted, see "Doctors' earnings: Time to call a code?" in the Sept. 17, 2001, issue.

 

*We included allergy and immunology, even though it's been considered a subspecialty in its own right since 1971, when the American Board of Allergy and Immunology began awarding subspecialty certificates.

 

 

Which IM subspecialties are making the most?

 2000 gross2000 net
Cardiologists (invasive)$490,410$296,130
Gastroenterologists398,270237,400
Allergists/allergy immunologists386,930187,740
Hematologists oncologists/immunologists355,620212,250
Pulmonologists297,010190,770
Cardiologists (noninvasive)284,920214,960
Endocrinologists279,260138,770
Nephrologists270,420188,060
Rheumatologists267,160154,080
Infectious disease specialists229,800166,980
General internists179,980127,130
All IM subspecialists1345,590215,400
All primary care physicians2210,730131,700

 

Subspecialists work longer hours than primary care doctors, but see fewer patients

 Hours worked per weekVisits per week*
Allergists/allergy immunologists5097
Cardiologists (invasive)68100
Cardiologists (noninvasive)6086
Endocrinologists60100
Gastroenterologists6086
Hematologists oncologists/immunologists6098
Infectious disease specialists60105
Nephrologists60116
Pulmonologists64120
Rheumatologists60100
General internists58102
All IM subspecialists60100
All primary care physicians55110

 

How income varies

 GrossNet
Male$360,260$222,390
Female198,490130,600
Solo$327,560$171,350
Expense-sharing436,260227,240
3-9 physicians$370,320$251,130
10-24 physicians475,180266,860
25+ physicians424,360267,910
Single specialty (3 or more physicians)388,280258,240
Multispecialty (3 or more physicians)393,580246,660
1-10$319,720$207,720
11 and over353,410218,470
Under 45$320,990$208,640
45 and over354,780218,300

 

The range of net earnings for IM subspecialists

 Allergists/allergy immunologistsCardiologists (invasive)Cardiologists (noninvasive)EndocrinologistsGastroenterologists
$700,000 or more1%3%0%0%2%
600,000-699,99915101
550,000-599,9992002
500,000-549,99919201
450,000-499,99917402
400,000-449,99936204
350,000-399,99964535
300,000-349,999313807
250,000-299,999151818521
200,000-249,0001418141721
140,000-199,9992211202521
100,000-139,0002028278
80,000-99,99922893
Less than $80,0001019152
 Hematologists oncologists/ immunologistsInfectious disease specialistsNephrologistsPulmonologistsRheumatologistsGeneral internists
$700,000 or more3%0%0%0%
600,000-699,999200
550,000-599,99900000
500,000-549,99930110
450,000-499,999302100
400,000-449,999302311
350,000-399,99943661
300,000-349,99932431
250,000-299,9991812111464
200,000-249,00015161817169
140,000-199,999273130343426
100,000-139,00082316122429
80,000-99,9992415510
Less than $80,000109841120

 

What IM subspecialists charge, and collect, for office visits

 New patient
9920199202992039920499205
FeeActual paymentFeeActual paymentFeeActual paymentFeeActual paymentFeeActual payment
Allergists/allergy immunologists$52$40$75$60$110$83$150$110$175$137
Cardiologists (invasive)6939906012580160100200150
Cardiologists (noninvasive)65—*100—*12887180113225150
Endocrinologists—*—*—*—*130—*180110220140
Gastroenterologists6038866012080160110200140
Hematologists/oncologists immunologists6540946312580175120210150
Nephrologists55—*80—*10080150125185150
Pulmonologists6037805910584150114200150
Rheumatologists6740956113092180131225160
General internists5938785510070140100177125
All IM subspecialists6039866012082160110200148
All primary care physicians53387555977013095165120
 Established patient
99211992129921399214992
FeeActual paymentFeeActual paymentFeeActual paymentFeeActual paymentFeeActual payment
Allergists/allergy immunologists$30$20$45$35$60$45$81$63$125$90
Cardiologists (invasive)30—*50347047907012599
Cardiologists (noninvasive)40—*5035704510070140100
Endocrinologists39—*50—*70499567130100
Gastroenterologists342050326345876112588
Hematologists/oncologists immunologists302045306045856212590
Nephrologists3520483460489070125100
Pulmonologists302050346545906713093
Rheumatologists3020503565489070135100
General internists352048336546886412588
All IM subspecialists302050336545906513093
All primary care physicians302045346045856412290

 

Charges for selected services

 FeeActual payment
Spirometry (94010)$65$40
Bronchospasm evaluation (94060)10065
Respiratory flow volume loop (94375)6039
Percutaneous tests, with allergenic extracts immediate type reaction (95004)200140
Percutaneous tests, sequential and incremental with drugs, biologicals, or venoms (95010)10570
Allergen immunotherapy, 2 or more injections (95125)2923
Patch or application tests (95044)10070
ECG/routine, with interpretation and report (93000)6529
Echocardiography, transthoracic real-time with image documentation (93307)400213
Cardiac catheterization/left heart (93510)800300
Cardiac catheterization: injection for selective left ventricular or left atrial angiography (93543)200—
Echocardiography, transthoracic real-time with image documentation (93350)450—
ECG/routine, with interpretation and report (93000)6532
Biopsy thyroid, percutaneous core needle (60100)150—
Esophagus dilation by unguided sound or bougie single or multiple passes (43450*)200100
Upper gastrointestinal endoscopy (43235)500220
Liver biopsy needle; percutaneous (47000*)300150
Spirometry (94010)7240
Bronchospasm evaluation (94060)10059
Respiratory flow volume loop (94375)6532
Radiologic examination, chest, two views, frontal and lateral (71020)7440
Prolonged postexposure evaluation of bronchospasm (94770)197—
Noninvasive ear or pulse oximetry for oxygen saturation (94760)207
Arthrocentesis, aspiration, and/or injection: small joint (20600*)8560
Arthrocentesis, aspiration, and/or injection: intermediate joint (20605*)9560
Arthrocentesis, aspiration, and/or injection: major joint (20610*)10070
Gold injection—unlisted therapeutic prophylactic, or diagnostic injection (90799)2115

 



Wayne Guglielmo. Survey Report: How are medical subspecialists doing?.

Medical Economics

2001;19:84.