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July 24, 2017 01:00 AM

Primary-care​ doc​ pay​ rises​ with​ demand, but​ the industry disparity​ is​ still​ large

Steven Ross Johnson
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    One of the lingering challenges to recruiting more doctors to pursue a career in primary care over the years has been the large wage differential found between those types of physicians and just about every other kind.

    THE TAKEAWAY

    Demand for primary care is on the upswing, leading to a boost in compensation for primary-care physicians. But the industry has a long way to go before there is compensation parity between primary-care doctors and most other physician specialists.

    And while progress is being made in paying primary-care physicians relatively more, in absolute terms the highest pay still goes to the specialists who have traditionally been paid the most, according to the results of Modern Healthcare's 24th annual Physician Compensation Survey. The median income for an orthopedic surgeon was the highest among 23 medical specialties in 2016 at $579,000, yet the median income for a pediatrician was about 40% of that figure at $228,530.

    Following orthopedic surgeons on the pay list were invasive cardiologists with an annual median income of $575,810, radiation oncologists at $515,999, gastroenterologists at $495,300, and radiologists with a median income of $477,390.

    Click here for the Physician Compensation Survey results

    After borrowing heavily to pay for medical school, medical students often find non-primary-care specialties to be a more attractive choice. "These people come out of training with massive loans and debt to pay back, and so there's still an incentive to specialize in more lucrative specialties from a compensation perspective," said Josh Halverson, a principal with healthcare consulting firm ECG Management Consultants.

    About the survey firms

    AMGA

    The Alexandria, Va.-based consultancy and professional membership organization, which represents large multispecialty medical groups, surveyed 102,261 physicians and 269 organizations representing 140 positions/specialties. The survey was conducted from January to May 2017. The full report costs $1,000. For more information, call Christopher Gibbs at 703-838-0033, ext. 362.

    Cejka Search

    The St. Louis-based physician and executive search firm surveyed 81 physicians and 56 organizations representing 82 positions/specialties. The survey was conducted from Jan. 1 to Dec. 31, 2016. For more information, call Tiffanie Lee at 314-236-4542.

    Compdata Surveys &Consulting

    The Olathe, Kan.-based data services and consulting firm surveyed 9,580 physicians and 299 organizations representing 100 positions/specialties. The survey was conducted from July to August 2016. The full report costs $699. For more information, call the firm's customer service department at 800-300-9570.

    ECG Management Consultants

    The Seattle-based healthcare management consulting firm surveyed 40,000 physicians and 130 organizations representing 150 positions/specialties. The survey was conducted in January 2017 and is based on 2016 data. For more information, call Maria Hayduk at 314-726-2323. Data submitted are preliminary.

    Jackson Physician Search

    The Alpharetta, Ga.-based physician staffing firm surveyed 364 physicians and 200 organizations representing 38 positions/specialties. The survey was conducted from January through April 2017. Data represent permanent placements only. Full survey results are available free of charge. For more information, call Ashley Bowlin at 770-643-5557.

    The Medicus Firm

    The Dallas-based physician search firm surveyed 2,351 physicians and one organization representing 24 positions/specialties. The survey was conducted in May 2017. Full survey results are available free of charge. For more information, call Steve Marsh at 214-382-9925. Data submitted are preliminary.

    Merritt Hawkins

    The Dallas-based physician search firm surveyed 3,287 physicians and 1,056 organizations representing 20 positions/specialties. The survey was conducted from April 2016 to March 2017. Its figures represent starting salaries rather than overall physician compensation. Full survey results are available free of charge. For more information, call Samantha Avila at 800-876-0500.

    Medical Group Management Association

    The Englewood, Colo.-based consulting and professional membership organization surveyed 121,709 physicians and 6,644 organizations representing 213 positions/specialties. The survey was conducted January to February 2017. For more information, call the MGMA at 877-275-6462, ext. 1801.

    Pacific Companies

    The Aliso Viejo, Calif.-based healthcare staffing firm surveyed 2,684 physicians and 269 organizations representing 20 positions/specialties. The survey was conducted from December 2016 through March 2017. For more information, call Chris Kahl at 800-741-7629. Data submitted are preliminary.

    Pinnacle Health Group

    The Atlanta-based physician recruitment firm surveyed 114 physicians and 160 organizations representing 51 positions/specialties. The survey was conducted in June 2017. Full survey results are available free of charge. For more information, call Ashlee Dennis at 800-492-7771. Data submitted are preliminary.

    Sullivan, Cotter & Associates

    The national independent consulting firm submitted results for two surveys this year—one from medical groups and another from a broader sample of physicians and organizations. The medical group survey included over 110,000 providers and 269 organizations representing 177 positions/specialties. The physician survey included nearly 135,000 physicians and 579 organizations representing 226 positions/specialties. Both surveys were conducted from Jan. 1 to April 28, 2017. For more information, call 888-739-7039 or email [email protected] Submitted medical group survey data are published, while the submitted physician survey data are preliminary.

    Primary-care specialties such as internal medicine, family medicine, emergency medicine, pediatrics, hospitalist care and obstetrics and gynecology all remained at the bottom end of the physician pay scale despite most seeing steady rises in compensation from 2015 to 2016.

    "I anticipate that the gap between primary care and some of the procedural specialties will continue, but I do see some acceleration of compensation for primary care," Halverson said.

    Indeed, among the medical specialties that saw the biggest average percentage gains in compensation over that period were emergency medicine, which increased by 7.9%; neonatology, which increased by 6.9%; and hospitalist care, where annual pay rose by an average of 6.1% from 2015 to 2016.

    Experts say the year-over-year increases in compensation have been a direct result of more competition among hospitals and other providers to hire professionals within certain medical specialties. And among the most highly sought after specialties are those within the primary-care field, most of which saw a marked rise in compensation the past year.

    "The biggest movement that we've seen over the past 18 months in terms of rapidly shifting compensation are within primary care," said Steve Look, executive vice president with the healthcare recruiting firm Medicus.

    Currently doctors in primary-care specialties make up roughly 48% of the entire physician workforce in the U.S., according to the Kaiser Family Foundation. An additional 8,500 primary-care practitioners would be needed to provide care for the more than 65 million Americans currently living in the more than 6,500 areas where there is less than one provider for every 3,500 people.

    Growing demand has also been seen within psychiatry, where salaries rose by an average of 3.3%. The field was the second-most-recruited physician specialty behind family medicine from April 2015 through March 2016, according to a 2016 review of recruiting incentives by Merritt Hawkins.

    The increase seen in the need for many primary-care specialties in recent years also reflects the move by hospitals to pay greater attention to population health management, which leads to more emphasis on quality and wellness. And as part of the change from volume to value in care delivery comes the increased use of reimbursement models that rely more on quality metrics.

    "As we get into this new era of population health and chronic disease management, we look at those physicians that are maybe spending more time to manage that chronic population," said Travis Singleton, senior vice president at Merritt Hawkins. "Regardless of how it looks, we are fairly confident that quality is going to be a major driver of our healthcare system. The debate now is about by how much."

    Efforts to tie doctor pay to quality have been underway on a wider scale since the CMS last October issued its final rule for implementing the Medicare Access and CHIP Reauthorization Act, which included provisions that replaced the sustainable growth-rate formula for determining how much doctors got paid under Medicare.

    Some see the performance-based reimbursement models created under MACRA as already playing a role in the changes seen in physician pay for primary-care specialties. It's a role that they see will only increase in the coming years and be a larger determinant in how much physicians get paid, which could reduce pay for non-primary-care specialties.

    "As MACRA becomes more firmly in place, and we begin to see quality parameters outstrip volume, then we do think that compensation will decline some," said Dr. C. Michael Valentine, vice president of the American College of Cardiology and an interventional cardiologist with Virginia-based Centra Medical Group, part of Centra Health. "We don't expect it to be a major drop, and we don't think it will be career-changing for anyone. We think this is just a natural progression in the healthcare system."

    The greater role primary-care physicians will likely play within such a financial model will keep demand high and may induce hospitals to continue or increase incentives to recruit such clinicians. Some of those efforts have included signing bonuses of $5,000 to $15,000, loan forgiveness and relocation expenses for doctors and their entire families.

    Medicus' Look said some of the hospitals and health systems that are most successful at attracting physicians can be found in large metropolitan areas where they not only have the advantage of being located in a large urban environment, but tend to pay above-average starting salaries and higher bonuses than more-rural providers.

    Loan forgiveness or assistance could be important to steering more physicians into primary care. At least 79% of medical school graduates in 2015 had school debt totaling more than $100,000, with a median debt amount of more than $180,000, according to the Association of American Medical Colleges.

    Dr. Richards Olds, president of St. Georges University, a medical school based in the West Indies, suggested medical schools offer more in the way of scholarships for students who promise to work in primary care in underserved areas upon graduation as one of the best ways to even the playing field between large and smaller providers for recruiting primary-care physicians.

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