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Leslie Kane, MA | May 14, 2020 | Contributor Information
Amid the COVID-19 pandemic, physicians have been struggling through intense challenges caring for patients while trying to protect their own and their families' health and well-being.
Doctors' most critical concerns are those involving life and death. Still, while confronting this crisis, salary and income are important to one's career and livelihood.
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Medscape Physician Compensation Report 2020
Leslie Kane, MA | May 14, 2020 | Contributor Information
The health impact of COVID-19 has been grave, and the financial fallout is widespread.
Many physician offices have closed or have greatly reduced their hours. Hospitals, clinics, and large groups throughout the nation are laying off staff and cutting salaries. Specialties that relied upon elective procedures have lost much or most of their business. Those include, but are not limited to, orthopedics, plastic surgery, dermatology, cardiology, and ophthalmology.
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Medscape Physician Compensation Report 2020
Leslie Kane, MA | May 14, 2020 | Contributor Information
"We found out that we have a 10% salary decrease effective May 2 to December 25. Our bonus will be based on clinical productivity, and since our numbers are down, that is likely to go away." - Pediatric emergency physician
"Viewing the backlog of cases that haven't been attended to, I think we'll be really busy for a while." - George W. Monks, MD, dermatologist in Tulsa and president of the Oklahoma Medical Association
"Lower volume means lower pay for employed physicians when they are paid on straight productivity or other models that require high volumes. Some health systems have intervened to make sure these physicians get some money." - Terrence R. McWilliams, MD, chief clinical consultant at HSG, a Louisville, Kentucky-based consultancy for not-for-profit hospitals and health systems
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Medscape Physician Compensation Report 2020
Leslie Kane, MA | May 14, 2020 | Contributor Information
The data for this year's Compensation Report was collected prior to February 10, 2020, and reflect physician salary and income prior to the COVID-19 crisis. Physicians told us about their incentive bonuses, income, hours worked, greatest challenges, what gives them satisfaction, and more.
Survey respondents reported their compensation for patient care. For employed physicians, that includes salary, bonus, and profit-sharing contributions. For self-employed physicians, it includes earnings after taxes and deductible business expenses, before income tax. Only full-time salaries are included in our results. This report includes responses from more than 17,000 physicians in over 30 specialties.
Overall, prior to the COVID-19 crisis, physician income continued to rise. In last year's report, primary care physicians (PCPs) earned an average of $237,000, compared with $243,000 this year (a 2.5% increase). Specialists earned an average of $341,000, compared with $346,000 this year (a 1.5% increase).
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Medscape Physician Compensation Report 2020
Leslie Kane, MA | May 14, 2020 | Contributor Information
Orthopedics and cardiology have been among the top five specialties for 6 years. The primary care specialties are among the lower-earning specialties, similar to last year.
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Medscape Physician Compensation Report 2020
Leslie Kane, MA | May 14, 2020 | Contributor Information
More than half of physician respondents (56% overall) have an incentive bonus. "Most people agree we are motivated by having something like a carrot; that's what incentivizes extra effort," said Michael Belkin, JD, divisional vice president at Merritt Hawkins, a national physician recruiting firm. "I think it's almost a given that candidates today are looking for some kind of bonus." Belkin says that in his experience, about 75% of hospitals offer an incentive bonus.
The two major types of incentive bonuses are collections bonus and relative value unit (RVU) bonus, says Belkin. "For the collections bonus, if the physician reaches a benchmark and additionally generates a net profit, he or she has the opportunity to keep part of that profit. The second bucket involves work RVUs, which are a measure of productivity, and are tracked through the electronic health records (EHRs)."
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Medscape Physician Compensation Report 2020
Leslie Kane, MA | May 14, 2020 | Contributor Information
The chart shows the average base salary overall and average incentive bonus among physicians who earn an incentive bonus.
The two major types of incentive bonuses are collections bonus and relative value unit (RVU) bonus, says Belkin. "For the collections bonus, if the physician reaches a benchmark and additionally generates a net profit, he or she has the opportunity to keep part of that profit. The second bucket involves work RVUs, which are a measure of productivity, and are tracked through the electronic health records (EHRs)."
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Medscape Physician Compensation Report 2020
Leslie Kane, MA | May 14, 2020 | Contributor Information
The average incentive bonus is 13% of total salary, but that percentage varies by specialty. Orthopedists and otolaryngologists, who earn among the highest incentives, are among those with the highest salaries. (Results are shown only for specialties where sample sizes are sufficient.)
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Medscape Physician Compensation Report 2020
Leslie Kane, MA | May 14, 2020 | Contributor Information
Overall, physicians earn about two thirds of their potential bonus. According to Belkin, this is in part because employers are concerned about the Stark Law against self-referral and want to build in safe harbor provisions that protect them from possible penalty, and so may cap the incentive that a physician can earn.
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Medscape Physician Compensation Report 2020
Leslie Kane, MA | May 14, 2020 | Contributor Information
Incentive bonuses are tied to performance objectives, and are intended to motivate people to work more or be more productive. Among physicians who have an incentive bonus, about a third of both PCPs and specialists say the prospect of an incentive bonus has encouraged them to work longer hours.
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Medscape Physician Compensation Report 2020
Leslie Kane, MA | May 14, 2020 | Contributor Information
Physicians gave varied reasons for the change in their earnings:
For the decrease: "Less reimbursement for the same procedures"; "government regulations and requirements costing me more overhead"; "more uninsured patients and more patients not paying their bills"; "the birth of my son, so I took an extra week off"; "decrease in RVU value"; "poor patient turnouts."
For the increase: "Treating more patients and performing more surgeries than the previous year"; "merit raise"; "elective call"; "more weekend coverage"; "better payer mix of private insurance and limiting Medicare"; "changed job"; "seeing more patients."
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Medscape Physician Compensation Report 2020
Leslie Kane, MA | May 14, 2020 | Contributor Information
As in the past 10 years of Medscape Physician Compensation reports, men continue to earn more than women. Among PCPs, men earn about 25% more than women, which is about the same percentage as last year.
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Medscape Physician Compensation Report 2020
Leslie Kane, MA | May 14, 2020 | Contributor Information
Among specialists, men earn 31% more than women; last year, there was a 33% pay gap. Many physicians expect the gender pay gap to narrow in coming years.
"Many organizations have been carefully analyzing their culture, transparency, and pay practices to make sure they aren't unintentionally discriminating against any group of employees," says Halee Fischer-Wright, MD, pediatrician and CEO of the Medical Group Management Association (MGMA). "Also, physicians are often receiving numerous offers for jobs and have more leverage to negotiate on pay because of the growing physician shortage. Again, more visibility on the gap is empowering women to negotiate harder."
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Medscape Physician Compensation Report 2020
Leslie Kane, MA | May 14, 2020 | Contributor Information
Over the years, more women have become specialists. Some specialties that have seen a notable increase in the percentage of female practitioners since 2015 are ob/gyn (58% vs 50% in 2015), pediatrics (58% vs 50%), rheumatology (54% vs 29%), dermatology (49% vs 32%), and family medicine (43% vs 35%). In some of the higher-paid specialties, there's been little change in percentage of women practitioners over the past 5 years: urology (10% vs 8% in 2015), orthopedics (11% vs 9%), cardiology (16% vs 12%), and plastic surgery (16% vs 18%).
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Medscape Physician Compensation Report 2020
Leslie Kane, MA | May 14, 2020 | Contributor Information
This year, states new to this list are Utah, Ohio, and North Carolina, replacing Connecticut, Arkansas, and Nevada.
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Medscape Physician Compensation Report 2020
Leslie Kane, MA | May 14, 2020 | Contributor Information
Self-employed physicians earn 20% more than employed physicians overall. Age may be one contributing factor; a greater percentage of self-employed physicians (41%) are 45 years or older, compared with 21% of physicians younger than 45 who are self-employed. In Medscape's Resident Salary & Debt Report 2019, 22% of residents said they anticipated being self-employed, although 19% said they might want to be both employed and self-employed, and another 33% said they were undecided.
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Medscape Physician Compensation Report 2020
Leslie Kane, MA | May 14, 2020 | Contributor Information
Fee-for-service maintains a stronghold, although somewhat less than last year. Concierge and cash-only models, despite enthusiasm from their participants, still comprise a small proportion of physicians. The number of ACOs continues to decline somewhat; in 2020, there are 517 ACOs participating in the Medicare Shared Savings Program, down from the high of 561 ACOs that participated in 2018.
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Medscape Physician Compensation Report 2020
Leslie Kane, MA | May 14, 2020 | Contributor Information
Physicians overall spend an average of 37.8 hours per week seeing patients. Add this to the average of 15.6 hours per week spent on paperwork, and doctors are on average putting in a 53.4-hour workweek.
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Medscape Physician Compensation Report 2020
Leslie Kane, MA | May 14, 2020 | Contributor Information
On average, physicians spend 15.6 hours per week on paperwork and administration. Specialties that spent the most time on paperwork and administration include critical care, internal medicine, infectious diseases, and physical medicine & rehabilitation. Specialties with lower amounts of such tasks include anesthesiology and ophthalmology.
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Medscape Physician Compensation Report 2020
Leslie Kane, MA | May 14, 2020 | Contributor Information
Practices lose large amounts of money on denied claims. One study found that, on average, 63% of denied claims are recoverable, but about $118 per claim is spent on appeals in hospital settings. The leading cause of denial was "registration/eligibility" (23.9%), followed by "missing or invalid claim data" (14.6%). An estimated 50%-65% of denied claims are never resubmitted. (Results are shown only for specialties where sample sizes are sufficient.)
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Medscape Physician Compensation Report 2020
Leslie Kane, MA | May 14, 2020 | Contributor Information
"Our research and research from others shows that nurse practitioners (NPs) and physician assistants (PAs) help with patient access and satisfaction, physician burnout, and revenue and profit," says Fischer-Wright. "Practices are bringing on more and more of these nonphysician providers, especially as we face physician shortages across the United States. The significant growth in the numbers of NPs and PAs means that patients are interacting with them more every day, building relationships that increase trust and acceptance."
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Medscape Physician Compensation Report 2020
Leslie Kane, MA | May 14, 2020 | Contributor Information
"Nurse practitioners and physician assistants are paid substantially less than a typical physician," says Fischer-Wright. "Even if the NPs and PAs see fewer patients or care for patients with less complex medical conditions, the increase in visits and the lower expense leads to higher profitability."
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Medscape Physician Compensation Report 2020
Leslie Kane, MA | May 14, 2020 | Contributor Information
Private insurance physician pay varies greatly, but overall it pays physicians much more than does Medicare for office visits and procedures. As a result, some physicians are either cutting down or limiting the number of Medicare patients they will take. Enrollment in Medicare is expected to reach 64 million people this year. One in 6 Medicare patients is under age 65 and qualified for Medicare because of a disability.
(Note: Label values on charts are rounded).
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Medscape Physician Compensation Report 2020
Leslie Kane, MA | May 14, 2020 | Contributor Information
Physicians who participated in the Merit-based Incentive Payment System (MIPS) were extremely disappointed by the incentive payment they earned, and many feel that it's not worth all the reporting effort. This year, 39% of primary care physicians said they expect to participate in MIPS, compared with 42% last year; 36% of specialists plan to participate this year, compared with 37% last year.
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Medscape Physician Compensation Report 2020
Leslie Kane, MA | May 14, 2020 | Contributor Information
The rewards that physicians get from being a doctor are very similar year over year and are among the reasons that many doctors still feel satisfied with and positive about their jobs, despite the aggravations and pressures.
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Medscape Physician Compensation Report 2020
Leslie Kane, MA | May 14, 2020 | Contributor Information
Physician respondents were quite vocal about the stressors of their jobs: "Forty- minute patients in 20-minute slots"; "administrative interference in patient care"; "trying to deal with insurance even though I don't bill insurance"; "way too much time spent on unnecessary data entry into the EHR"; "difficult diagnoses"; "dealing with colleagues"; "office politics."
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Medscape Physician Compensation Report 2020
Leslie Kane, MA | May 14, 2020 | Contributor Information
Five years ago, the specialties most satisfied with their income were dermatology (61%), emergency medicine (60%), pathology (60%), psychiatry (56%), anesthesiology (53%), and radiology (53%).
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Medscape Physician Compensation Report 2020
Leslie Kane, MA | May 14, 2020 | Contributor Information
This year has seen a huge volume of critiques about the medical profession and the problems physicians face when trying to work and provide good care. Yet there are still enough positive aspects of being a physician that over three quarters of physicians would make that same choice again.
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Medscape Physician Compensation Report 2020
Leslie Kane, MA | May 14, 2020 | Contributor Information
Among physicians who would choose medicine again, orthopedists, oncologists, ophthalmologists, and dermatologists were most likely to choose their own specialty again. This year, family medicine (70%) and internal medicine (66%) were toward the bottom of the list, as they were last year. Five years ago, only 45% of physicians overall said they would again choose their own specialty
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Medscape Physician Compensation Report 2020
Leslie Kane, MA | May 14, 2020 | Contributor Information
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Medscape Physician Compensation Report 2020
Leslie Kane, MA | May 14, 2020 | Contributor Information
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Medscape Physician Compensation Report 2020
Leslie Kane, MA | May 14, 2020 | Contributor Information
Medscape National Physician Burnout & Suicide Report 2020: The Generational Divide
More than 15,000 physicians told us how they feel about burnout and depression. In some cases, their responses differed along generational lines.Slideshow, January 2020
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Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.
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Leslie Kane, MA
Senior Director
Medscape Business of Medicine
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References
MGMA. COVID-19 Financial Impact on Medical Practices. Source
Eldred SM. Firings, furloughs, and pay cuts in advance of COVID-19 surge. Medscape Medical News. March 31, 2020. Source
Sainato M. US for-profit healthcare sector cuts thousands of jobs as pandemic rages. The Guardian. April 14, 2020. Source
Kareo. Kareo survey reveals coronavirus pandemic impact on independent medical practices and their patients. April 6, 2020. Source
IQVIA. Monitoring the Impact of COVID-19 on the Pharmaceutical Market. April 17, 2020. Source
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