Viewpoint: The realities of physician compensation in 2012

August 10, 2012

The days of big paychecks have disappeared. Discover what you'll need to survive.

I am in my 50s, so I remember when physicians were considered "highly paid." I recall being denied office visits on Wednesdays because my doctor was on the golf course making up for seeing patients on Saturdays. I can still hear the words of some who jealously decried that physicians made too much money. Those days, however, are long gone.

These days, I try to describe to my nonphysician friends and family members what it's like to work as a doctor by asking them to imagine their own bosses coming to them and saying, "Next year, we're planning to pay you 35% less than you made this year. But you have to keep up your same workload.

"In fact, you'll have to do more work than you did before. Because we're also planning to make you record and report everything you do-on tools you've never used, which aren't working all that well-to get paid. Have a nice day."

It's a wonder anyone wants to be a physician at all. Which begs the question: Why do you want to be a doctor?

WHY PRACTICE MEDICINE?

Practicing medicine no longer offers physicians the cushy, upper-class life it once did. In fact, it has become one of the hardest, least rewarding jobs on the planet. So what is it that makes folks like you decide to keep on treating patients under today's grueling conditions?

The answer, I believe, is that you practice medicine because you must. It's how you are built. You're driven to treat patients, to keep or make them healthy, and to give them a chance at a good life free of disease or debilitating injuries. And thank goodness you do.

MEDICARE REIMBURSEMENT VERSUS DOCTOR'S SALARY

You and your colleagues in primary care are intimately familiar with the gap between reimbursements received from Medicare (and other health plans) and the salaries doctors take home after paying staff paychecks and covering office overhead. The distinction between physicians' reimbursements and their salaries, however, is mostly lost on the general public. And sometimes, qualified research (although technically accurate) confuses the issue even further.

For example, the Medical Group Management Association's "Physician Compensation and Production Survey" for 2012, which is based on 2011 Data, reported that median compensation for PCPs will increase by 5.16% under the Affordable Care Act (ACA). The survey is correct, but the data aren't referring to physicians' actual salaries, which likely will decline-dramatically.

Matthew Mintz, MD, associate professor of medicine at George Washington University, explained the reason in a recent KevinMD.com blog titled "Primary care doctors are set to lose more than half of their salary."

Mintz has been practicing internal medicine for more than 10 years. He is the respiratory editor of Redi-Reference Clinical Update, a biweekly clinical newsletter for PCPs, and is a peer reviewer for American Family Physician, the Journal of Family Practice, Mayo Clinic Proceedings, and the Journal of General Internal Medicine.

This amount closely matches the $175,000 to $199,000 median salaries the family practitioners participating in Medical Economic's 2011 Physician Earnings Survey reported for 2009 and 2010 (see http://www.MedicalEconomics.com/2011earnings; an upcoming issue of Medical Economics will feature data from the 2012 Physician Earnings Survey).

Here's where it gets painful: If the Centers for Medicare and Medicaid Services' (CMS') 27.4% reduction in Medicare physician reimbursement goes into effect, that $68.97 reimbursement per visit will decrease to a little more than $50, thus reducing the practice's annual revenue to less than $320,000. Without corresponding reductions in staff salaries and practice overhead, the difference can only be recouped from the physician's salary, which drops from around $172,000 to about $60,000.

Mintz believes that if these cuts in Medicare reimbursements come to pass, doctors will either stop accepting new Medicare patients or will stop seeing Medicare patients altogether. So it's clear why you might balk at purchasing expensive electronic health record systems when the entire future of your medical practice is at risk.

Recent health reform initiatives provide opportunities for you to recover some of those losses and increase your income. It requires, however, that you keep an open mind about your practice's revenue.