We surveyed earnings and fees in 10 fields?from allergists to rheumatologists. Some of our findings may surprise you.
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 fieldsfrom allergists to rheumatologists. Some of our findings may surprise you.
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 gastroenterologistswho brought home $237,400 last yeareven 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 visitsfor both new and established patientsthan their primary care colleagues. And usually, they're reimbursed more by third-party payers.
Clearly, this is a good time to be an IM subspecialistespecially 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 moreand more sophisticateddiagnostic 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.
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 |
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 |
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 |
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 |
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 |
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 injectionunlisted therapeutic prophylactic, or diagnostic injection (90799) | 21 | 15 |
Wayne Guglielmo. Survey Report: How are medical subspecialists doing?.
Medical Economics
2001;19:84.