Healthy gains

Dr. Renate Savich says she hasn't had a raise in six years.

Savich's neonatology colleagues, however, registered the biggest increase in pay among the 23 specialties tracked in the 20th annual Modern Healthcare Physician Compensation Survey. This year's survey saw more ups than downs and, according to the 13 recruiting firms and professional associations providing data, neonatologists' pay ranged from $246,003 to $328,819 and increased an average of 11.9% to $295,416 from $264,015 the previous year.

“For physicians in academic practice, more and more compensation is being siphoned off to support other aspects of the university's mission,” says Savich, a professor of pediatrics at Children's Hospital of New Mexico in Albuquerque. “Billings may be up, collections may be up, but academic physicians are not seeing these large increases.”

In private practices, however, she says, compensation is being affected by partners' choices to either add more doctors or work more hours (and earn more in the process). Savich says concerns about healthcare reform looms as a major driver in those decisions.

“More groups are concerned about the future and are putting off expanding and have decided to work harder,” says Savich, the chair-elect of the American Academy of Pediatrics' section on perinatal pediatrics.

The dynamics of neonatology are changing as a result of economic and demographic factors, says Dr. Barry Chandler, senior vice president for children's services at Sunrise, Fla.-based Sheridan Healthcare, a provider of anesthesia, emergency department, neonatal and radiology management services.

Chandler, also president of the 300-member Southeastern Association of Neonatologists, says his specialty is seeing an aging workforce, a declining birth rate and a consolidation of healthcare organizations. All of this will lead to a “re-regionalization” of the neonatology field with fewer small departments in community hospitals.

“It will probably change the landscape of neonatology over the next several years,” he says.

Neonatology was the only specialty to see a double-digit increase in compensation in this year's survey. Last year, intensivists—with a 10.3% increase—held that distinction. (Intensivists saw an average increase of 4.8% this year, to $331,232 from $316,063.) Plastic surgeons had the second-highest average pay raise this year, rising 8% to $422,648 from $391,375.

For the fifth consecutive year, orthopedic surgeons and invasive cardiologists topped the survey in average salary, earning an average of $522,557 and $505,346, respectively. Also for the fifth straight year, family physicians and pediatricians finished last and second-to-last, earning an average of $209,050 and $209,986, respectively.

In last year's survey, 10 specialties saw decreases in average compensation. This year, only three specialties saw their average pay fall: anesthesia, to $385,977 from $387,780 (-0.5%); obstetrics/gynecology, to $298,468 from $304,022 (-1.8%); and noninvasive cardiologists, to $402,619 from $421,341 (-4.4%). For anesthesiologists, it was the second straight year with a decline, with last year's survey showing a 1.5% decrease.

The rate of inflation, as determined by the Consumer Price Index, was 1.7% compared with 3.2% the previous year. The lower inflation figure could partially explain why 15 specialties saw average compensation increase above the rate of inflation in this year's survey compared with seven last year.

Five specialties saw increases that were below inflation: oncology, 0.5%; radiation oncology, 0.5%; radiology, 0.6%; gastroenterology, 1%; and pathology, 1.6%

Along with psychiatrists, primary-care physicians occupied the bottom rungs on the survey based on average salary, but all saw healthy increases in compensation. Internists saw their compensation increase an average of 6.2%; hospitalists saw their pay increase an average 4.7%; while pediatricians and family physicians saw average increases of 3.6% and 3.3%, respectively.

Justin Chamblee, vice president of the Coker Group, an Alpharetta, Ga.-based healthcare consultancy, says the Patient Protection and Affordable Care Act has been a major influence on strong primary-care compensation gains. “I think a lot of what we see now is being driven by the ACA,” Chamblee says. “Reform is focused on primary care. Primary care is the foundation, and there is a focus on getting the foundation set correctly.”

Conversely, he says “payers have not shown any interest in payment reform yet for specialty care.”

Travis Singleton, senior vice president for the Dallas-based physician staffing firm Merritt Hawkins, says the ramifications of healthcare reform have yet to be felt and that the surge in physician employment and healthcare mergers and acquisitions was a result of preparation for reform.

“We're on the back end of two years of massive M&A activity,” Singleton says, adding that many of the two- and three-year compensation guarantees given to physicians in preparation of reform will be expiring soon. “We're already starting to see retention suffer.”

Because payment guarantees can't get much higher, he sees future compensation packages becoming a mix of productivity, shared savings and efficiency incentives. Singleton says more organizations also are adding a quality-incentive component to compensation packages, with the number of Merritt Hawkins clients offering a quality incentive growing to 39% this year from 7% two years ago.

“Before it was so minute, it didn't change behavior,” Singleton says of these incentives.

He also says payment reforms, particularly government-led models, will become a bigger factor in compensation. “You can talk about supply and demand, but it all really comes down to who's paying the check,” Singleton says. “It all goes back to what Medicare will pay.”

Singleton's prediction is that it “will be a real interesting” 2014. “We're going to see how much change the system handles.”

Follow Andis Robeznieks on Twitter: @MHARobeznieks