SURVEY REPORT

How are medical subspecialists doing?

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?

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

How income varies

The range of net earnings for IM subspecialists

What IM subspecialists charge, and collect, for office visits

Charges for selected services

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

Medical Economics

2001;19:84.