Despite a chorus of complaints about lagging reimbursement, rising overhead and skyrocketing malpractice insurance costs, America's physicians-particularly specialists such as radiologists and oncologists-are reaping better-than-average pay increases atop comfortable salaries again this year. >
In a carry-over of a trend that now stretches back several years, specialists-the royalty of a generally well-compensated profession-continue to distance themselves from the comparative paupers in general medicine, taking home annual salaries more than double those of internists, pediatricians and family practitioners.
Still, even the humble family practitioner is earning an average salary ranging from a low of $146,000 to a high of $165,599, according to Modern Healthcare's Physician Compensation Survey, an annual compendium of surveys and studies from 10 associations, consulting firms and staffing companies.
"Physicians are doing as well as-or better than-I've ever seen in terms of income," says Joe Goddard, president of Goddard Healthcare Consulting, a Coppell, Texas-based physician recruitment firm participating in the survey.
Although this year's raises vary widely by physician category and survey firm, the increases have come at a price: Many doctors, Goddard says, are working considerably longer hours to generate the higher pay. "Instead of coming in from 9 a.m. to 5 p.m. and seeing 12 to 15 patients," he says, "they're seeing 20, 25 patients and starting earlier and staying in the office later. They're working harder than they've ever worked before to earn these salaries."
William Jessee, a physician who is president and chief executive officer of the Englewood, Colo.-based Medical Group Management Association, says the salary figures alone don't tell the entire story. Although most physicians are keeping pace with inflation, he says, they are accomplishing that by seeing more patients, adding procedures and generating more charges.
"At some point, there's got to be an end to that," Jessee says. "We can't keep working harder. A wheel will spin only so fast."
Still, most specialists remain among America's true professional elite in cash compensation. Average salaries for radiologists reached as high as $386,214 this year, the top average of all categories surveyed, while the highest figure for anesthesiologists was $334,121 and the top salary for urologists was $334,019. All three figures were cited by the MGMA, whose numbers traditionally have been on the high side of the spectrum. Jessee says he believes his group's figures are "skewed" higher because MGMA medical practices, managed by professional administrators, are more likely to be on the lower end of the expense side, thus boosting salaries for doctor-members. The MGMA survey also does not include the pay of academic physicians, whose salaries tend to be lower than those in the private sector.
While specialists remain at the top of the salary charts, internists dropped toward the opposite end of the salary scale, ranging from a low of $150,000, or a 1% increase, in a survey compiled by the staffing firm of Merritt, Hawkins and Associates, to a high of $179,000, a 3% decrease, in the analysis by Irving, Texas-based Martin, Fletcher, another physician-recruitment company.
"Specialists have been on the rise throughout America, and they continue to be," says Kurt Mosley, vice president of business development at Irving, Texas-based Merritt, Hawkins.
Mosley says anesthesiologists and radiologists were among specialties that are at a "crisis point" in terms of demand, triggering big boosts in salaries and perquisites. All 10 surveys showed increases in current salaries for anesthesiologists, ranging from a low of $242,886, a 1% increase over 2002, to the MGMA's high-water mark, $334,121, which represents an 8% rise. The Philadelphia-based Hay Group reported a 26% jump in salaries for anesthesiologists.
Salary increases for radiologists, meanwhile, ranged from a 12% spike in the MGMA's survey to as high as 23% in the Hay report. Average compensation for radiologists ranged from $192,457 to $386,214. Warren Surveys, based in Rockford, Ill., was the only participant to show a decrease for this specialty, an 11% drop to $192,457.
The overall percentage increase for all physician salaries, which stood at about 4% in 2000, has fallen marginally to about 3.6% this year, according to Rosanne Cioffe, director of reports for Oakland, N.J.-based Hospital and Healthcare Compensation Service.
"It's been a very small increase," Cioffe says. "We didn't even see the planned percentage increase of 3.96% that people were expecting."
Yet the average increase for doctors this year was still higher than the national average in 2002 of 2.5% for all workers covered by state and federal unemployment insurance, according to the U.S. Bureau of Labor Statistics. And even the lowest-paid doctors earn far higher salaries than the national average cited by the bureau: $36,214.
Now in its 10th year, Modern Healthcare's physician salary survey presents the average cash compensation by specialty as reported by each organization. The size of the samples, the kinds of practices and the methodology varied among the surveying organizations, factors that account for some of the wide disparities in salary figures (For information on each firm, see Data Trackers).
The lowest listed annual average salary is $131,688 for psychiatrists, which represents a 26% plunge from 2002, according to the HHCS survey. That decrease was the largest of any category. The HHCS survey, meanwhile, also included the highest increase: a 50% jump for cardiologists that took these specialists to an average of $304,209, underscoring their huge demand across the country.
"There's been a severe shortage of cardiologists, especially in rural areas," says C. Dirk Leidecker, vice president of operations at Martin, Fletcher.
The MGMA, which represents primarily small medical groups, posted the highest average salary figures in nine of the 15 categories covered in the survey, and placed second in three others. The Alexandria, Va.-based American Medical Group Association, which represents most of the larger medical groups in the nation, was in the middle of the pack in most categories but topped the listing for general surgeons at $291,104, a 9% increase over 2002. The AMGA also reported a 14% pay increase for hospitalists, whose average salary reached $168,947, according to its report, but still considerably lower than the MGMA's figure of $180,772.
"More and more clinics and organizations are starting to realize the value of hospitalists," says Brad Vaudrey, manager of healthcare consulting at RSM McGladrey, a Bloomington, Minn.-based accounting and consulting firm that compiled the numbers for the AMGA. "They're understanding how to use them more efficiently."