Clinical skills, workload, and medical liability protection don’t always equate with what doctors perceive as “adequate compensation.”

Survey Results

The broad range in compensation relates to medical specialty, clinical skills and overall professional experience. 

Each year, Jackson & Coker conducts a Physician Compensation survey. This year’s survey focused on trends in physician compensation, how satisfied doctors are with their current compensation / reimbursement levels and other aspects of their medical practice, and what changes in health care they would favor to improve their particular financial situation.

Respondents’ Profiles

During the month of April, Jackson & Coker e-mailed surveys to physicians in over 45 major medical specialties throughout the United States. In sum, 943 respondents answered 24 key questions, some of which allowed open-ended comments.

The majority of respondents were male (78%), board certified (84%), and in practice more than ten years (64%). By and large, they represented Primary Care specialties (31%), including OB/GYN. Other medical specialty representation included:

Current Reimbursement Levels

Several questions were central to the survey. First of all, as consumer healthcare insurance premiums have increased, do practicing physicians feel that their level of compensation or reimbursement for medical services has increased proportionately? Five percent of respondents maintain that their reimbursements have increased proportionately, whereas 19% feel that reimbursement is about the same. However, 76% believe that their level of reimbursement has actually decreased.

To what extent are the physicians’ current earnings in line with professional skills, efforts and workload? Only 8% feel they are paid / reimbursed very well, and 31% believe that they are paid / reimbursed fairly. On the other hand, 60% contend they are underpaid or under-reimbursed. (These statistics are relatively the same for both male and female respondents.)

Physicians who contend that they are underpaid indicate by how much:

Discussion of reimbursement must be placed in the context of what the future of health care will look like if our country adopts major healthcare reform, often referred to as Universal Health Care (UHC). (See last month’s survey: “2008 Healthcare Professionals’ Opinions on Presidential Health Plans Survey” at http://www.jacksoncoker.com/newsletter/survey-presidential.aspx.)

Physicians were asked which model of payment under healthcare reform they would be most interested in supporting. Thirty-two percent of all participants favor fee for service—with the patient paying for a percentage and an insurer paying a percentage. Twenty-two percent favor some form of Universal Health Care—with a single payer and overall healthcare costs covered by the government. Twelve percent would opt for UHC as administered by private insurance with some government oversight, and an equal percentage support the current mix of private and public pay for service.

Current Compensation: Gender Differences

Physicians were asked to state their current compensation. Unlike most physician compensation surveys, Jackson & Coker’s 2008 Physician Compensation Survey differentiates between responses of males versus females, leading to some interesting observations.

For instance, the majority of female Anesthesiologists (43%) report earnings in the $300,001 to $350,000 range, but not higher. Most male Anesthesiologists (14%) are in this earning category; yet nearly 20% report earnings in the range of $400,001 to $450,000. Furthermore, two percent of male MD’s indicate earnings approaching $750,000.

Dermatologists’ compensation also shows a gender difference. Female Dermatologists top out at $250,000, whereas 17% of their male counterparts reported earnings in the range of $500,001 to $550,000.

Family Practice, a specialty that has always attracted females, reflects other income disparities. Most females (49%) and males (40%) report earnings in the category of $100,001 to $150,000. Both genders are even (23%) with respect to their stated compensation in the $150,001 to $200,000 category. However, 6% of males (and no females) specify income at $300,001 or above.

OB/GYN attracts a sizeable number of female physicians. Fifty-tree percent of female physicians earn between $100,001 and $200,000. On the other hand, 55% of male OB/GYN doctors earn between $150,001 and $250,000. It is interesting that on the upper end of the scale, nearly 7% of females report income above $500,000; while only 3% of their male counterparts match these earnings. It is quite likely that more established female OB/GYN physicians have developed a larger patient base and enjoy increased compensation as a result.

One of the most interesting findings concerns General Radiology. A majority of female Radiologists specifies compensation in the $300,001 to $350,000 range. Concerning male Radiologists, compensation ranges from almost 5% earning $150,000 or less, to an equal number (5%) earning over $700,000. The highest percentage of earnings for males (24%) is in the category of $350,001 to $400,000.

Survey results show that surgical specialties attract more males and offer them greater compensation. For instance, female Thoracic Surgeons report earnings between $200,001 and $350,000. By contract, 43% of their male counterparts state earnings in excess of $450,000 up to $1,000,000.

Somewhat less compensation disparity is associated with Orthopedic Surgery. Fifty percent of female Orthopedists earn between $400,000 and $500,000. Only 15% of males fit in this category. However, almost one fourth of male Orthopedists earn between $500,000 and $1,000,000.

These statistics relate to base salary only. Another survey question pertained to additional financial benefits such as bonus, equity participation, and other perks.

In the category of added benefits totaling $25,000 or less, females outrank males two to one. In the $25,001 to $50,000 category, males outrank women 29% to 18%. On the far end of the scale, seventeen percent of males and six percent of females report additional financial benefits from $50,001 to $100,000.

Taking Earned Vacation

Enjoying time off from work is important to most physicians. Twenty-seven percent of doctors have 2-3 weeks of paid vacation. The majority of doctors surveyed (35%) report four weeks of earned vacation. Twenty-four percent have 5-6 weeks of vacation, and 10% are entitled to eight weeks or more.

It appears that physicians don’t always use the amount of vacation they have earned. Although only one percent of physicians indicate that they have just one week of vacation, 7% of all respondents note that they only take one week off. Similarly, 9% state that they have two weeks of earned vacation; yet 20% of all respondents mention taking just two weeks of vacation. Forty-seven percent respond that they take 3-4 weeks of annual leave. On the far end of the spectrum, 11% typically take 7-8 weeks, or more, of earned vacation.

Gender difference is also noticeable in this section of the survey results. Almost 60% of females earn 3-4 weeks of vacation per year, in comparison with approximately 50% of males. However, nearly 60% of female physicians take 3-4 weeks of vacation. In contrast, only 47% of male doctors take 3-4 weeks of entitled vacation time. Four percent of females earn over 8 weeks of vacation, and they all appear to take that much. Regarding male doctors, around 12% are entitled to 8 weeks or more, but only 8% take their maximum amount of entitled time off.

It appears that, overall, female physicians are more apt to take advantage of their earned vacation, possibly because of their household and child-rearing responsibilities, as well as their propensity for accepting positions that allow more control over their work hours—as the studies referenced in this summary indicate.

Changing Jobs and Compensation

Another key question concerned the respondents’ future plans for changing jobs, possibly based on compensation. Thirty-six percent of physicians contemplate changing jobs within the next year. Furthermore, 14% expect to do so within a 2-4 year timeframe. Interestingly, 44% have no such plans at this time.

Compensation is obviously important for those doctors contemplating making a career move. Fifty-three percent specify compensation as a principal consideration in looking for another position. Forty-five percent would seek a more supportive work environment, and 39% would favor a community more in keeping with their current lifestyle and family concerns.

Respondents were queried regarding their primary concerns about the practice of medicine in general, which could, of course, fuel their interest in investigating other practice opportunities. The top six concerns for male and female doctors centered on:

• Reimbursement for services
• Lifestyle / career balance
• Medical liability exposure
• Administrative personnel managing patient care
• Federal regulations, policies and procedures
• Unknown future healthcare model.

On a related matter, physicians were asked to identify any significant changes related to the practice of medicine that they would favor. Their responses:

• Compensation 17%
• Paperwork volume 14%
• Managed care 14%
• Reimbursement percentages 13%
• Malpractice claims 12%.

A more pointed question asked of all participants. “If you had to plan your career over, would you choose medicine?” The responses were striking:

* Yes, I would select medicine 72%
* Probably, but not in patient care 8%
* No, I would choose another profession. 20%.

Respondents’ Comments

Some of the respondents’ comments about the practice of medicine today reflect their deep seated concerns regarding compensation and career choices:

• “I am upset about what I see as major bias against women who try to have both career and family. I have been penalized for having children.”

• “The pay is WAY too low for the job headaches and responsibilities.”

• ‘It seems to me [that] patient care issues are secondary to the business side.”

• There is “inadequate reimbursement for academic practices.”

• “[ I’ve experienced ] dissatisfaction with my career altogether.”

• “[ I feel ] pressure to see too many patients in too little time.”

Survey Analysis

Physicians in Primary Care specialties responded in greater numbers as survey participants, possibly reflecting how much their compensation is directly affected by insurer reimbursement issues and other factors that have a bearing on job satisfaction, such as daily patient load.

In keeping with industry trends, physicians are, generally speaking, well compensated for their professional services. In addition, it appears that hospitals and other healthcare employers are fairly generous in adding on other financial incentives and perks that contribute to overall job satisfaction.

Taking time off for vacations is important for busy physicians. However, the statistics indicate that some doctors take less vacation time than they are entitled to, perhaps indicative of their patient work load, overall professional dedication or simply their personal decision to forego some amount of earned vacation. Female physicians, by and large, tend to take more of their vacation time, possibly due to inescapable household and family responsibilities.

No matter how busy doctors are currently, a sizeable number of them contemplate making some sort of career change in the foreseeable future. In fact, nearly half of respondents expect to find another job within the next four years.

One can conjecture that compensation matters play a key factor in this decision. Overall compensation—along with insurer reimbursement—tops the list of personal and professional concerns that are important to physicians. Furthermore, thirty-four percent of the doctors surveyed believe that they are underpaid or under-reimbursed by 50% or more.

As with other professions, there is a noticeable gender gap associated with overall compensation. A number of published studies and articles provide suggestions as to why this is the case.

• A study entitled “Physician Income Expectations and Specialty Choice,” published by The Wharton School at the University of Pennsylvania,” reports: “We find that medical students significantly condition their income expectations on personal characteristics such as gender and ability. For instance, female students expect to earn substantially less than male students, even controlling for differences in the hours they expect to work.” (See full study)

• “The Gender Gap,” by Barbara Alden Wilson, in Unique Opportunities Magazine, links earning potential and lifestyle considerations for women: “…[W]omen in medicine often are employed as salaried physicians, trading high dollar figures for schedules that allow them to juggle careers with the demands of raising a family.” (See full article)

• Published in the British Medical Journal, an article entitled “Marriage costs women doctors in the US an 11% salary drop” quotes a report by Mount Holyoke College (Massachusetts) in connection with a survey by the American Medical Association’s young physicians group that points out: “’After controlling for demographic and professional characteristics, as well as specialty and practice settings, women physicians exhibit an annual earnings gap of 11% for being married and additional gaps of 14% for having one child and 22% for having two or more children.’” (See full article)

These articles point out the obvious: there is no simple answer as to why females in many physician specialties earn less than their male counterparts. A definitive answer would need to account for factors not addressed in this survey.

For both male and female physicians, certainly compensation matters have a bearing on overall job satisfaction. As Jackson & Coker’s 2008 Physician Compensation Survey results point out, given the chance to plan their career over, nearly ten percent of respondents would not select a career involved with direct patient care, and one fifth would, in fact, choose a profession other than medicine.

Overlaying the major concerns that physicians express regarding compensation matters is the uncertainty of how healthcare reform will affect the entire medical profession and individual practitioners in particular. Regardless of what model is possibly adopted in the coming years, the vast majority of physicians expect to be compensated adequately for their services. If not, they are certainly aware of their career options, including finding another position.