Primary-care physicians enjoyed their greatest income boost in at least four years in 1993-8%-while median compensation for some specialties declined 10% or more, according to the Medical Group Management Association's annual compensation survey.
Another recent survey, by Ernst & Young, concluded that compensation for primary-care physicians and specialists increases under managed care, contrary to some physicians' fears.
In 1993, median compensation for family practitioners increased 7% to $120,000, internists saw an 8% boost to $129,350, and pediatricians realized an 8% gain to $125,389, according to the MGMA survey (See chart).
That followed a 6.5% increase for primary-care physicians in 1992 and a 4% increase in 1991. However, some specialists who enjoyed double-digit increases three and four years ago lost ground in the past two years. For instance, anesthesiologists' incomes increased 11% in 1990 and 1991, to a high of $245,000, but their median compensation decreased 4.1% in 1992 and 2% in 1993, to $230,366.
Other losers in 1993 included cardiovascular surgeons, down 11% to $446,990; radiologists, down 5% to $257,414; and noninvasive cardiologists, down 10% to $218,424.
The survey was based on responses from more than 1,300 group practices that belong to MGMA.
Alex Hunter, senior vice president of Cejka & Co., which funded the MGMA survey, said the largest increases for primary-care physicians have yet to come. He predicts increases of 6% to 10% in each of the next two years.
The effects of managed care, capitation, the resource-based relative value scale and other cost-cutting measures that emphasize primary care are influencing compensation figures, Mr. Hunter said. Also, primary-care physicians are "realizing their value" as gatekeepers and expecting more, he said.
Cejka President Sue Cejka predicted that internists who recently earned $90,000 to $100,000 could earn $200,000 to $250,000 as the healthcare system shifts its focus to prevention.
Other MGMA findings:
Some specialists enjoyed increases in 1993, notably infectious disease physicians, who saw a 15% increase to $143,710; hematology/oncology physicians, up 10% to $183,481; and rheumatologists, up 7% to $140,325.
Men out-earn women by 9% to 18%. For example, median compensation for female obstetricians and gynecologists is $183,110, 13% less than males.
In Ernst & Young's 1994 compensation survey, the firm showed earnings up to 38% higher for physicians employed in managed care vs. traditional fee-for-service settings.
Internists with primarily managed-care revenues averaged $137,300, while those with primarily fee-for-service revenues averaged $99,300. Internists employed by HMOs earned $116,800, followed by those in integrated health systems, who made $110,000. At hospitals and group practices, internists earned $97,100 and $95,000, respectively (See chart).
Primary-care physicians benefit most from providing managed-care services, but specialists also have increased their incomes through managed-care contracting, the survey found.
The Ernst & Young survey was based on data from 5,400 physicians, 1,900 allied health providers and 600 physician administrators nationwide.
The survey found that HMOs use quality measures and patient satisfaction data more frequently than medical groups, hospitals and health systems do in determining compensation.
All HMOs reported that patient satisfaction surveys and quality measures had a bearing on compensation vs. 20% of group practices. Patient satisfaction surveys were used by 50% of hospitals and 37% of integrated health systems. Quality measures were used by 61% of hospitals and 27% of integrated systems.
Overall, the number of patient visits was the most frequent criterion in physician compensation, used by 49% of the institutions surveyed.