Flat, declining salaries inflate physician worries over payments, red tape

Most primary care physicians love their work, but they are clearly frustrated about their income and the increasing compliance challenges associated with payers and government initiatives, according to results from the 85th annual Medical Economics 2013 Exclusive Continuing Study, which collected responses from physicians about their professional life.

Although the income data show slight gains for internal medicine and declines for physicians with an ownership stake in practice and family medicine, nearly 33% of those physicians surveyed are moonlighting in secondary roles as a way to boost their earnings. 

Related coverage: Physician practice owners take a 6% pay cut

Also, consider that the majority of the 4,934 responding physicians fear the impact of declining reimbursements and note that  frustrations with their practice have less to do with patient visits, and a lot more to do with hassles associated with payers, prior authorizations, and government red tape. These sentiments are so strong that they are actually changing attitudes about the profession. When asked about the future of practice, one physician simply stated: “Sometimes, the grass is greener.”

Nearly 45% of internists responding to this survey said that if they could go back in time, they would change either their specialty or their career. The same sentiment was expressed by 43% of  the family physicians who responded.

In this Special Report, Medical Economics showcases the results of its 2013 Physician Earnings Survey and takes a closer look at compensation trends, secondary incomes, malpractice, technology frustrations, work/life balance, and attitudes about the future of healthcare. 

Here are the most frequently cited professional concerns:

• Fees and reimbursement (68%)

• Burden of paperwork (56%)

• Healthcare reform (54%)

• Value of primary care vs. specialty care and use of midlevels (43%)

• Third-party interference (43%)

• Malpractice/tort reform (39%)

• Doctor shortage (29%)

• EHRs (28%)

• Accountable care organizations (17%)

Some of the top themes emerging from the data set include:

Fear and uncertainty

As healthcare remains in the throes of rapid change as it relates to insured patient populations, volume and reimbursement during reforms from the Affordable Care Act (ACA), nearly 84% of the physicians surveyed told Medical Economics that the financial state of practice compared to 1 year ago is either worse or the same. Only 15% of those respondents on average say the economic conditions have improved.

Payer perspectives

Insurance coverage was investigated from two perspectives, percentage of patients covered by public or private payers, and the percentage of revenues derived from each. About 44% of surveyed physicians’ patients have private health plans, representing about 47% of revenue. Medicare accounts for about 23% of patients and about 22% of revenue; Medicaid represents about 20% of patients and 17% of revenue. Private pay or uninsured accounts for 8% and 6% of patients and 9% and 4.5% of revenue, respectively.

Productivity

While most physicians are still posting an average of 50 hours per week in the practice, numbers of patients seen have remained consistent in primary care. The ACA may be a game changer, though. In fact, ACA provisions, increased patient populations, and a renewed vigor to reduce healthcare costs in the United States likely will  force physicians to work more efficiently.

Ownership trends

 So, who is going to purchase your practice? This survey asked those without an ownership stake whether they wanted one. Interestingly, physicians in smaller practices had more of an interest in an ownership position than physicians in large practices. Just as interesting, those physicians seeing more patients each week may be more likely to seek an ownership position.

Frustrated by technology

The vast majority of primary care physicians use electronic health records (EHRs). Still, a significant minority of physicians are balking at going digital. Also, the survey examines costs related to EHR implementation and use.

Malpractice premiums

Most primary care practices are seeing malpractice premiums hold steady or decline, but the ACA could reverse the trend. 

Reality check

Excepts of comments submitted by physicians to Medical Economics in gathering data for this report:

• "In spite of its imperfections, a career in family medicine has great rewards. I just hope it stays that way.”

• "Still love the practice of medicine, because I do it on my terms.”

• "Family medicine is all guts, no glory.”

• "We can still change the world.”

• "Family practice carries the responsibilities of providing most of the care, yet the reimbursements are the lowest.”

• "Family medicine services pay so little that I have no time for vacation, time away from my office, and often no money to pay overdue bills. We are required to cram multiple patients into our day just to make ends meet, which reduces the quality of care.”

• "Still enjoy the patient interaction, and diagnostic challenge.”

• "It’s too much regulation, paperwork, compliance, insurance, and not enough patient time. Also, the reimbursement inequity is glaring.”

• "Primary care is not valued in the United States. Priority is given for population and chronic disease management. No financial incentive for time and commitment.”

Other 2013 survey results related to compensation, productivity and malpractice:

What primary care physicians earn: A five-year review (chart)

Primary care physician earnings by gender (chart)

Primary care physician earnings by community (chart)

Primary care physician earnings by region (chart)

Productiving in primary care is geared for a revival

Malpractice premium trends (chart)

Competition driving malpractice premiums down

ABOUT THE SURVEY

The 2013 Exclusive Physician Earnings Survey was part of the 85th annual Continuing Study conducted by Medical Economics. The survey sample consisted of all 104,570 physicians in Advanstar Communications’ database of doctors with working email addresses. This database was compiled from the circulations (print and digital) of publications produced by Advanstar including Medical Economics, Contemporary Pediatrics, Contemporary Ob/Gyn, Cosmetic Surgery Times, Dermatology Times, Ophthalmology Times, and Urology Times.

Data collection took place via the Internet in June. Readex Research broadcast initial email requests to all sample members, inviting them to participate in the survey by visiting the access-controlled website hosted by Readex.

A total of 4,934 responses were received. Qualifying for the final tabulation were the 4,604 respondents who indicated that they are actively practicing (that is, not retired) and that their primary field of practice is not academic/research or a field other than the 15 listed on the survey. From these, 4,200 respondents were randomly selected for the final tabulation.

Percentages are subject to a margin of error of ±1.5% at the 95% confidence level. Percentages calculated on smaller tabulation bases-for example, primary field or age-are subject to more statistical variability.

WHO PARTICIPATED

The survey found that, overall, practicing physicians are highly experienced. Nearly 84% of the participants have been in practice more than 10 years, including nearly half (57%) who have been in practice for more than 20 years. Correspondingly, 67% are aged more than 50 years, including 34% who are at least 60 years old. Only 3% are aged fewer than 35 years. The median respondent has 24 years of experience and is 56 years old.

Two-thirds of responding physicians are male (66%), and one-third are female (33%). Representation of women increases substantially among younger age cohorts: 40 to 49 (46% female), 35 to 39 (49%), and under 35 (62%).

The respondent base offer wide national representation. When asked in which state they primarily practice, the highest response came from physicians in the South (35%), with about equal proportions saying Northeast (21%), Midwest (19%), and West (21%). By individual state, the greatest representation came from California (10%), New York (8%), Texas (8%), and Florida (6%).

By community type, about half of participating physicians are located in suburban areas (52%). About one-third are in either urban communities (27%) or the inner city (8%). About one in eight are located in rural areas (12%).

Half of the physician respondents have an ownership interest in their practices.

Thirty percent are in solo practice. Among those in group practices, the most common ownership group size is three to 10 physicians (26%). Sixteen percent are in groups of 11 to 50, and 13% are with groups of more than 50 physicians.

Most participating physicians are in single-specialty practices (73%). This proportion remains about the same across all fields of practice. Highest percentages are among those in dermatology (85%) and plastic
surgery (84%).