Transcript Trends in Physician Compensation (and other thoughts)

Physician Compensation
Trends
Paul Evans DO, FAAFP, FACOFP
Dean and Professor of Family Medicine
Objectives
•
Review Compensation Trends 2002-2007
o
Primary Care Physician
o
Specialty Care Physicians
•
Present Trends Impacting Physician
Practice
o Physician Responses
o “Hot” Specialties (now and long-term)
•
Discuss Physician Recruiters (friend or
foe?)
References
Compensation data and graphs
excerpted from 1.8.2009 SOMA
GA-PCOM presentation by:
Douglas T. Cardinal, RN, FACHE
President, DT Cardinal Consulting
(770) 622-5799
[email protected]
Introduction
Factors influencing practice decisions:
o High student loan burden
 Loan debt in excess of $200,000
o “Life style” vs. compensation
 predictable call , weekends off
 time off to have families
 collegial nature of larger groups
Lower Reimbursements- Now What?
Physician Response
 Increasing “production”
 2000 FP Relative Value Unit = 3,834
 2007 FP Relative Value Unit =4,600 (up 20%)
 Compensation for ER and house call
 Medical Directorships
 Embracing “alternative” health and lifestyle
modalities
 CAM, Acupuncture
 Medical “spas”, aesthetic procedures
 Concierge medicine
Lower Reimbursements- Now What?
Institutional Response
 Hire physicians into hospital owned or
controlled medical groups
 Changing physician compensation formulas
from fixed salary or gross charges to:
 Net collections less actual and allocated
expenses
 Compensation per Work Relative Value
Unit produced
Lower Reimbursements- Now What?
 Government Response
 Auditing physician-hospital compensation
relationships of all kinds – more denial payments
 CMS OIG
 Compensation must be “reasonable” and
“fair market value”
 Physician recruitment incentives
 Payments for relocation - actual move of
practice
 Physicians within the first two years of
practice exempt
Medical Specialties of Interest to
PCOM Students
Primary Care
 Family Practice,
Sports Medicine
 Internal Medicine
 Pediatrics
Medical Specialties,Subs
 Allergy/Immunology
 Cardiology, Pediatric, Invasive
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Interventional and Noninvasive
PM&R (Physical Medicine &
Rehabilitation)
Rheumatology
Hematology/Oncology, Pediatric and
Adult
Pediatric Endocrinology
Neurology, Movement Disorders
Psychiatry
Dermatology
Infectious Diseases
Pulmonology
Interventional Radiology
Emergency Medicine
Medical Specialties of Interest to
PCOM Students
Surgical Specialties and
Subspecialties
 Orthopedic Surgery, Hand

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
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Surgery, Sports Medicine
General Surgery
Urological Surgery
Anesthesiology,
Anesthesiology Pain Medicine
Cardiothoracic Surgery
Gastrointestinal Surgery
Neurosurgery
Pathology
Specialties Without
Reliable Compensation
Data
 Pediatric PM&R
 Osteopathic Manipulative
Medicine
Specialty Selection
Compensation Comparisons
 Median = 50 percentile
 Midpoint of all specialists
 Average age is now about 50-55
 Starting from residency may be less
 90th Percentile
 Top earners
 Most productive (80-100 hours per week)
 Most experienced (20 + years in practice)
 Most business savvy
 Scarcity / geographic considerations important
Primary Care Trends
Median Compensation 2003 through 2007
$220,000
Family Practice w/o OB
$200,000
$180,000
$160,000
Family Practice Sports
Medicine
$140,000
Internal Medicine
$120,000
Pediatrics
$100,000
2003
2004
2005
( 50th percentile)
Fam Med no OB
FM, SM
IM general
Peds
2006
2007
2007 ($ k)
175
201
191
183
% change
+14.0
-2.4
+15.4
+15.4
Primary Care Trends
90th Percentile Compensation 2003 through 2007
$450,000
$400,000
$350,000
Family Practice w/o OB
$300,000
Family Practice Sports Medicine
Internal Medicine
$250,000
Pediatrics
$200,000
$150,000
2003
FP no OB
FP, SM
IM
Peds
2004
2005
2006
2007
2007 ($k)
283
% change
+18.2
312
295
301
-19.0
+20.2
+18.3
Medical Sub Specialty Trends
Median Compensation Medical Sub Specialties 2003 through 2007
2007 ($k) %
Cardiology
410
+17.6
Card invasive
485
+10.4
Card peds
Heme Onc
Heme Onc
Peds
270
363
202
+29.8
+15.0
+20.6
$550,000
Cardiology
$500,000
Cardiology, Invasive
Interventional
$450,000
$400,000
Cardiology, Pediatric
$350,000
Hematology Oncology
$300,000
$250,000
Pediatric Hematilogy Oncology
$200,000
Neurology
$150,000
Neurology
228
+19.2
PMR
234
+9.8
Rheumatology 219
+9.9
PM&R
$100,000
2003
2004
2005
2006
2007
Medical Sub Specialty Trends
90th Percentile Medical Sub Specialties 2003 through 2007
2007 ($k)
%
Cardiology
596
+6.6
Card invasive
881
+12.3
Card peds
Heme Onc
Heme Onc Peds
Neurology
487
778
294
412
+25.1
-11.8
+11.8
+23.6
$1,200,000
$1,100,000
$1,000,000
Cardiology
$900,000
Cardiology, Invasive Interventional
$800,000
Cardiology, Pediatric
$700,000
Hematology Oncology
$600,000
Pediatric Hematilogy Oncology
$500,000
Neurology
$400,000
PM&R
$300,000
Rheumatology
$200,000
2003
PMR
380
-21.8
Rheum
365
+1.2
2004
2005
2006
2007
Medical Sub Specialty Trends
Median Compensation Medical Sub Specialties 2003 through 2007
Allergy/Immun.
2007 ($k)
%
268
+4.0
$400,000
$350,000
Peds Genetics
Peds Endocrine
Psychiatry
Dermatology
161
175
194
358
+8.3
+33.2
+20.3
+27.8
$300,000
Allergy/Immunology
$250,000
Pediatric Genetics
Pediatric Endocrinology
$200,000
Psychiatry
$150,000
Dermatology
$100,000
Infectious Diseases
Pulmonology
$50,000
$0
2003
Infec. Disease
193
+7.8
Pulmonary
274
+19.7
2004
2005
2006
2007
Medical Sub Specialty Trends
90th Percentile Medical Sub Specialties 2003 through 2007
Allergy/Immun.
2007 ($k)
%
539
-9.3
$700,000
Peds Genetics
Peds Endocrine
236
+6.6
$600,000
255
+10.2 $500,000
268
$400,000
Allergy/Immunology
Pediatric Genetics
Pediatric Endocrinology
Psychiatry
+14.9
Psychiatry
Dermatology
$300,000
Dermatology
608
+14.6 $200,000
Infec. Disease
269
-5.4
Pulmonary
453
+27.1
Infectious Diseases
Pulmonology
$100,000
2003
2004
2005
2006
2007
Hospital Based Physician Trends
Median Compensation 2003 through 2007
2007 ($k)
%
$550,000
$500,000
Radiology
diag.
451
+13.9
$450,000
Radiology, Diagnostic
$400,000
Rad interven. 495
+15.5
EM
+19.0
257
Radiology, Diagnostic
Interventional
$350,000
$300,000
Emergency Medicine
$250,000
Hospitalist
$200,000
Hospitalist
198
+19.8
$150,000
$100,000
2003
2004
2005
2006
2007
Hospital Based Physician Trends
90th Percentile Compensation 2003 through 2007
2007 ($k)
%
Radiology
diag.
687
+26.1
Rad interven.
715
EM
Hospitalist
$800,000
$700,000
Radiology, Diagnostic
$600,000
353
275
+28.7
+18.0
+19.1
$500,000
Radiology, Diagnostic
Interventional
$400,000
Emergency Medicine
$300,000
Hospitalist
$200,000
$100,000
2003
2004
2005
2006
2007
Surgical Physician Trends
Median Compensation Surgical Sub Specialties 2003 through 2007
2007 ($k)
%
$500,000
Anesthesiology
Anesthesiology 399
Anes/Pain
458
+25.7
+27.0
$450,000
Anesthesiology, Pain
Medicine
$400,000
Cardiothoracic Surgery
$350,000
CT Surg
462
-0.3
GI Surg
377
+12.7
$250,000
Gen Surgery
317
+19.9
$200,000
Gastrointestional Surgery
$300,000
General Surgery
Pathology
2003
Pathology
319.4
-4.2
2004
2005
2006
2007
Surgical Physician Trends
90th Percentile Surgical Sub Specialties 2003 through 2007
2007 ($k)
%
$1,400,000
Anesthesiology 559
+11.8
Anesthesiology
$1,200,000
Anes/Pain
660
+8.4
CT Surg
700
-2.9
$800,000
GI Surg
1,200
+130.8
$600,000
Anesthesiology, Pain
Medicine
$1,000,000
Cardiothoracic Surgery
Gastrointestional Surgery
General Surgery
$400,000
Gen Surgery
499
+13.7
Pathology
$200,000
Pathology
539
-2.6
2003
2004
2005
2006
2007
Surgical Physician Trends
Median Compensation Surgical Specialties 2003 through 2007
OB/GYN
2007 ($k)
%
281
+18.3
$700,000
NeuroSurg
638
+19.6
OB/GYN
$600,000
Neurosurgery
Orthopedics
446
+15.9
$500,000
Orthopedic Surgery
$400,000
Ortho Hand
Ortho SM
446
553
6.5
+23.6
Orthopedic Surgery, Hand
$300,000
Orthopedic Surgery, Sports
Medicine
$200,000
Otolaryngology
$100,000
ENT
345
+16.5
Urology
198
+19.8
2003
2004
2005
2006
2007
Surgical Physician Trends
90th Percentile Compensation Surgical Specialties 2003 through 2007
OB/GYN
2007 ($k)
%
450
+17.3
$1,400,000
OB/GYN
Neuro Surg
1,200
+34.6
Orthopedics
800
+9.4
Ortho Hand
840
-1.0
Ortho SM
1,000
+22.0
ENT
614
+12.5
Urology
644
+10.0
$1,200,000
Neurosurgery
$1,000,000
Orthopedic Surgery
$800,000
Orthopedic Surgery, Hand
$600,000
Orthopedic Surgery, Sports
Medicine
$400,000
Otolaryngology
$200,000
2003
2004
2005
2006
2007
Demographic and Economic
Trends
 For the next 19 years, 70 million new aging Americans.
 Life expectancy:
o In 1959-1961
 Males
66.8
 Females
73.24
o In 2004 at age 55
 Males
79.04
 Females
83.3
Medicare eligibility 1.8 years
Medicare eligibility 8.24 years
Medicare eligibility 14.04 years
Medicare eligibility 18.3 years
 Boomers have more money to spend on Healthcare
o Demand quality care and are willing to pay for it

Specialties for the next two decades are those
specialties that focus on diseases of ageing:
Medical Specialties
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Internal Medicine
Geriatrics
Hospitalist
Pulmonary Medicine
Rheumatology
Cardiology
Endocrinology
Hematology/Oncology
Physiatry (PM&R)
Geriatric Psychiatry
Surgical Specialties
 Orthopedic Surgery
 General Surgery
 Surgical Oncology
 Vascular Surgery
 Urology
Physician Responses
 Physicians /residency programs slow to
respond
 Some physicians close to Medicare (opt out).
 Some physicians are leaving medicine.
 Primary care physicians = more ambulatory
patients only (hospitalists).
 Opening “concierge” practices
Physician Responses
 Physician Responses by age group:
o 35 to 45- Expand practice or retrain to take
advantage of older population
o 45 to 55- Expand practice, look at
opportunities to use experience in
alternative ways
o 55 to 70- Hang on and plan for eventual
retirement
Physician Recruiters - Friend or
Foe?
 Recruiters bombard you the second year residency
 Critically evaluate
 Location
 Lifestyle
 Practice Style
 Loan forgiveness packages
 Eliminate those offers that do not fit into your goals
 Never pay a recruiter (they will come to you).
 Recruiters work for the hiring organization, not you.
 Never pay for visit to a potential practice location.
 Last year of the residency allows for short absences for
recruiting trips.
Conclusion
 Physicians still make a good living
 Important day is the Residency
Match Day (FEB/MAR in 4th year).
 Know your goals, and make
flexible decisions based on these
whenever possible
Physician Recruiters - Friend or Foe
Resources
 National Association of Physician Recruiters
http://www.napr.org
 Merritt Hawkins and Associates
1-800-876-0500
http://www.merritthawkins.com
 Cejka Search
1-800-678-7858
http://www.cejkasearch.com/
 Health Management Associates
1-239-552-3636
http://www.hma.com/