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Survey Report: How are medical subspecialists doing?

Article

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 gross
2000 net
Cardiologists (invasive)
$490,410
$296,130
Gastroenterologists
398,270
237,400
Allergists/allergy immunologists
386,930
187,740
Hematologists oncologists/immunologists
355,620
212,250
Pulmonologists
297,010
190,770
Cardiologists (noninvasive)
284,920
214,960
Endocrinologists
279,260
138,770
Nephrologists
270,420
188,060
Rheumatologists
267,160
154,080
Infectious disease specialists
229,800
166,980
General internists
179,980
127,130
All IM subspecialists1
345,590
215,400
All primary care physicians2
210,730
131,700

 

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

 
Hours worked per week
Visits per week*
Allergists/allergy immunologists
50
97
Cardiologists (invasive)
68
100
Cardiologists (noninvasive)
60
86
Endocrinologists
60
100
Gastroenterologists
60
86
Hematologists oncologists/immunologists
60
98
Infectious disease specialists
60
105
Nephrologists
60
116
Pulmonologists
64
120
Rheumatologists
60
100
General internists
58
102
All IM subspecialists
60
100
All primary care physicians
55
110

 

How income varies

 
Gross
Net
Male
$360,260
$222,390
Female
198,490
130,600
Solo
$327,560
$171,350
Expense-sharing
436,260
227,240
3-9 physicians
$370,320
$251,130
10-24 physicians
475,180
266,860
25+ physicians
424,360
267,910
Single specialty (3 or more physicians)
388,280
258,240
Multispecialty (3 or more physicians)
393,580
246,660
1-10
$319,720
$207,720
11 and over
353,410
218,470
Under 45
$320,990
$208,640
45 and over
354,780
218,300

 

The range of net earnings for IM subspecialists

 
Allergists/allergy immunologists
Cardiologists (invasive)
Cardiologists (noninvasive)
Endocrinologists
Gastroenterologists
$700,000 or more
1%
3%
0%
0%
2%
600,000-699,999
1
5
1
0
1
550,000-599,999
2
0
0
2
500,000-549,999
1
9
2
0
1
450,000-499,999
1
7
4
0
2
400,000-449,999
3
6
2
0
4
350,000-399,999
6
4
5
3
5
300,000-349,999
3
13
8
0
7
250,000-299,999
15
18
18
5
21
200,000-249,000
14
18
14
17
21
140,000-199,999
22
11
20
25
21
100,000-139,000
20
2
8
27
8
80,000-99,999
2
2
8
9
3
Less than $80,000
10
1
9
15
2
 
Hematologists oncologists/ immunologists
Infectious disease specialists
Nephrologists
Pulmonologists
Rheumatologists
General internists
$700,000 or more
3%
0%
0%
0%
600,000-699,999
2
0
0
550,000-599,999
0
0
0
0
0
500,000-549,999
3
0
1
1
0
450,000-499,999
3
0
2
1
0
0
400,000-449,999
3
0
2
3
1
1
350,000-399,999
4
3
6
6
1
300,000-349,999
3
2
4
3
1
250,000-299,999
18
12
11
14
6
4
200,000-249,000
15
16
18
17
16
9
140,000-199,999
27
31
30
34
34
26
100,000-139,000
8
23
16
12
24
29
80,000-99,999
2
4
1
5
5
10
Less than $80,000
10
9
8
4
11
20

 

What IM subspecialists charge, and collect, for office visits

 
New patient
99201
99202
99203
99204
99205
Fee
Actual payment
Fee
Actual payment
Fee
Actual payment
Fee
Actual payment
Fee
Actual payment
Allergists/allergy immunologists
$52
$40
$75
$60
$110
$83
$150
$110
$175
$137
Cardiologists (invasive)
69
39
90
60
125
80
160
100
200
150
Cardiologists (noninvasive)
65
—*
100
—*
128
87
180
113
225
150
Endocrinologists
—*
—*
—*
—*
130
—*
180
110
220
140
Gastroenterologists
60
38
86
60
120
80
160
110
200
140
Hematologists/oncologists immunologists
65
40
94
63
125
80
175
120
210
150
Nephrologists
55
—*
80
—*
100
80
150
125
185
150
Pulmonologists
60
37
80
59
105
84
150
114
200
150
Rheumatologists
67
40
95
61
130
92
180
131
225
160
General internists
59
38
78
55
100
70
140
100
177
125
All IM subspecialists
60
39
86
60
120
82
160
110
200
148
All primary care physicians
53
38
75
55
97
70
130
95
165
120
 
Established patient
99211
99212
99213
99214
992
Fee
Actual payment
Fee
Actual payment
Fee
Actual payment
Fee
Actual payment
Fee
Actual payment
Allergists/allergy immunologists
$30
$20
$45
$35
$60
$45
$81
$63
$125
$90
Cardiologists (invasive)
30
—*
50
34
70
47
90
70
125
99
Cardiologists (noninvasive)
40
—*
50
35
70
45
100
70
140
100
Endocrinologists
39
—*
50
—*
70
49
95
67
130
100
Gastroenterologists
34
20
50
32
63
45
87
61
125
88
Hematologists/oncologists immunologists
30
20
45
30
60
45
85
62
125
90
Nephrologists
35
20
48
34
60
48
90
70
125
100
Pulmonologists
30
20
50
34
65
45
90
67
130
93
Rheumatologists
30
20
50
35
65
48
90
70
135
100
General internists
35
20
48
33
65
46
88
64
125
88
All IM subspecialists
30
20
50
33
65
45
90
65
130
93
All primary care physicians
30
20
45
34
60
45
85
64
122
90

 

Charges for selected services

 
Fee
Actual payment
Spirometry (94010)
$65
$40
Bronchospasm evaluation (94060)
100
65
Respiratory flow volume loop (94375)
60
39
Percutaneous tests, with allergenic extracts immediate type reaction (95004)
200
140
Percutaneous tests, sequential and incremental with drugs, biologicals, or venoms (95010)
105
70
Allergen immunotherapy, 2 or more injections (95125)
29
23
Patch or application tests (95044)
100
70
ECG/routine, with interpretation and report (93000)
65
29
Echocardiography, transthoracic real-time with image documentation (93307)
400
213
Cardiac catheterization/left heart (93510)
800
300
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)
65
32
Biopsy thyroid, percutaneous core needle (60100)
150
—
Esophagus dilation by unguided sound or bougie single or multiple passes (43450*)
200
100
Upper gastrointestinal endoscopy (43235)
500
220
Liver biopsy needle; percutaneous (47000*)
300
150
Spirometry (94010)
72
40
Bronchospasm evaluation (94060)
100
59
Respiratory flow volume loop (94375)
65
32
Radiologic examination, chest, two views, frontal and lateral (71020)
74
40
Prolonged postexposure evaluation of bronchospasm (94770)
197
—
Noninvasive ear or pulse oximetry for oxygen saturation (94760)
20
7
Arthrocentesis, aspiration, and/or injection: small joint (20600*)
85
60
Arthrocentesis, aspiration, and/or injection: intermediate joint (20605*)
95
60
Arthrocentesis, aspiration, and/or injection: major joint (20610*)
100
70
Gold injection—unlisted therapeutic prophylactic, or diagnostic injection (90799)
21
15

 



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

Medical Economics

2001;19:84.

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