Trends in Physician Compensation: Growth in Workload Continues to

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hysicians in the United States in virtually all medical and surgical specialties enjoyed in- creases in compensation from 1998 to 1999. However, that greater pay was only possible thanks to significantly greater increases in work and production during the same time period. Thus, revers- ing prior year trends in which compensation levels remained relatively stable, physicians generally enjoyed increased pay in 1999, but only with considerable addi- tional work.

These findings are based on data from the Physician Compensation and Production Survey: 2000 Report Based on 1999 Data , 1 conducted by the Medical Group Manage- ment Association (MGMA).Continuing a trend that started in 1998, primary care physicians as a whole enjoyed compensation increases of 3.39% in 1999. However, an 11.55% increase in production (defined as gross charges) over the previous year 9s levels was required for that greater pay. Primary care physicians are clearly working harder to receive their increases in compensation.

In today 9s market, those primary care physicians that are working at the same or a slower pace than in years past will likely face stagnation or decline in their compensation levels. Specialist physicians also enjoyed relatively healthy increases in compensation in 1999, reversing down- ward trends that occurred ... more. less.

from 1995 through 1997. In 1998, specialists enjoyed a 5.22% increase in compen- sation, followed by a 6% increase in 1999. Specialist physicians also had to increase their productivityto achieve growth in compensation, though generally not at the same magnitude as their primary care col- leagues. In 1999, specialist physician production in- creased 8.5% over 1998 levels. The MGMA Physician Compensation and Production Survey: 2000 Report Based on 1999 Data is based on the survey responses of 1315 medical practices in the United States,representing 27,985 physicians and mid- level providers. The survey of MGMA member prac- tices has been conducted annually since 1987. Data are reported for 97 physician subspecialties and 17 mid- level provider specialties. The report contains sections on physician compensation, benefits, and productivity, as well as summary tables for selected specialties. Data examined in this article include: "Compensation and gross charges levels for pri- mary care (Figure 1) and specialist physicians (Figure 2) for 1995 through 1999 "Percentage change in compensation and pro- duction levels for primary care (Figure 3) and specialist physicians (Figure 4) for 1995 through 1999 "Median compensation and production levels for selected specialties for 1999 and the 5-year trend (Table 1) "Operating costs as a percentage of total net med- ical revenue for 1990 through 1999 (Figure 5). (Operating cost data was obtained from the MGMA Cost Survey: 2000 Report based on 1999 Data . 2 ) "Median compensation for selected specialties by group type (Table 2 and Figure 6) "Compensation by geographic region of the United States (Table 3 and Figure 7) "Compensation by years in practice (Table 4 and Figure 8) "Compensation by specialty and gender (Table 5) "Percentage change in mid-level provider com- pensation and production levels for 1995 through 1999 (Figure 9) P Mr. Johnson is a principal, MGMA Health Care Consulting Group, Medical Group Management Association, Englewood, CO, specializing in physician compensation system development and benchmarking. www.turner-white.comHospital Physician March 2001 47 Special Report Trends in Physician Compensation: Growth in Workload Continues to Outpace Growth in Compensation Bruce A. Johnson, JD, MPA FIVE-YEAR TRENDS IN COMPENSATION AND PRODUCTION Trends related to physician compensation and pro- duction levels over the 5-year period from 1995 through 1999 reveal the increased effort required to earn additional income. Figure 1 and Figure 2 show median compensation and gross charges (production) levels for primary care and specialist physicians during this 5-year period. Both figures show gradual increases in compensation levels, combined with more aggressive increases in production levels. This trend is reflected in Figure 3 and Figure 4 , which illustrate the percentage 48 Hospital Physician March 2001 www.turner-white.com Johnson : Trends in Physician Compensation : pp. 47 358 0 50,000 100,000 150,000 200,000 250,000 300,000 350,000 400,000 Production Compensation 1999 1998 1997 1996 1995 C ompensation, $ 0 100,000 200,000 300,000 400,000 500,000 600,000 700,000 800,000 Production Compensation 1999 1998 1997 1996 1995 C ompensat i on, $ Figure 1. Median compensation and production for primary care physicians, 1995 31999. Data from MGMA Physician compensation and production survey: 2000 report based on 1999 data. Tables A and B: Median compensation and produc- tion for selected specialties, 1995 31999. Englewood (CO): Medical Group Management Association; 2000. Figure 2. Median compensation and production for specialist physicians, 1995 31999. Data from MGMA Physician compen- sation and production survey: 2000 report based on 1999 data. Tables A and B: Median compensation and production for selected specialties, 1995 31999. Englewood (CO): Medical Group Management Association; 2000. Figure 3. Percentage change in compensation and production for primary care physicians, 1995 31999. Data from MGMA Physician compensation and production survey: 2000 report based on 1999 data. Tables A and B: Median compensation and production for selected specialties, 1995 31999. Englewood (CO): Medical Group Management Association; 2000. Figure 4. Percentage change in compensation and production for specialist physicians, 1995 31999. Data from MGMA Physician compensation and production survey: 2000 report based on 1999 data. Tables A and B: Median compensation and production for selected specialties, 1995 31999. Englewood (CO): Medical Group Management Association; 2000. 0 2 4 6 8 10 12 Production Compensation 1999 1998 1997 1996 1995 Compensation, % -2 0 2 4 6 8 10 12 Production Compensation 1999 1998 1997 1996 1995 Compensation, % Johnson : Trends in Physician Compensation : pp. 47 358 www.turner-white.comHospital Physician March 2001 49 Table 1. Median Compensation and Production for Selected Physician Specialties MedianChange in Change in MedianChange in Change in CompensationCompensationCompensationProductionProduction Production 1999, $1995 31999, %1998 31999, %1999, $1995 31999, %1998 31999, % Primary care Family practice (without obstetrics)141,493 0 9.562.33 0 370,382 24.1415.81 Internal medicine (hospitalist)148,846 0 NANA 0 299,275NANA Internal medicine (general)145,397 0 4.363.01 0 369,685 23.4512.96 Pediatric/adolescent medicine143,011 10.795.93 0 387,583 27.9213.02 Specialties Anesthesiology244,755 0 1.70 3 2.18 0 643,487 14.71 0 1.56 Cardiology (invasive)340,010 0 0.89 3 2.851,355,882 42.39 0 9.56 Cardiology (noninvasive)278,712 16.42 3 0.071,029,822 55.0113.50 Dermatology205,973 18.16 0 8.21 0 697,547 28.96 0 2.96 Emergency medicine186,663 0 5.79 0 5.93 0 462,65215.4922.13 Gastroenterology264,500 26.0010.081,057,214 58.5317.77 General surgery 236,572 0 9.24 0 4.84 0 927,482 39.0710.87 Hematology/oncology255,167 35.3220.07 0 519,083 31.2510.98 Neurology178,197 0 8.4610.96 0 570,370 34.2020.04 Obstetrics/gynecology219,029 0 1.87 0 1.26 0 755,331 26.7311.95 Orthopaedic surgery319,315 0 5.76 0 2.231,128,647 23.93 0 4.57 Psychiatry151,90314.66 0 6.42 0 280,79321.60 0 1.97 Pulmonary medicine192,221 12.72 0 4.82 0 544,891 22.34 0 0.07 Radiology (diagnostic)315,048 27.2915.901,100,000 48.5716.24 Urology268,825 25.9412.01 0 975,872 52.6511.79 NA = not available. Data from MGMA Physician compensation and production survey: 2000 report based on 1999 data. Tables A and B: Median compensatio n and production for selected specialties, 1995 3 1999; Table 1: Physician compensation (all specialties); Table 18: Physician gross charges (technical component excluded). Englewood (CO): Medical Group Management Association; 2000. change in primary care and specialist physician com- pensation and production during the same 5-year peri- od. For primary care physicians as a whole, compensa- tion increased from 1995 through 1999 by 7.98%, but it took a 23.78% increase in production to achieve that increase in pay. The disparity between compensation and production increases was also significant for special- ists, whose 32.91% increase in production from 1995 through 1999 yielded only a 13.86% increase in com- pensation during the same 5-year period. Data presented in Table 1 reveal the same overall trends related to compensation and production levels over the 5-year period for selected medical and surgical specialties. There are several possible reasons why pro- duction consistently increases at a rate that is greater than that of compensation. These include continuing decreases in reimbursement due to managed care arrangements, continued downward pressure in govern- mental and private payer reimbursement rates, and increased operating costs associated with the practice infrastructure that is necessary to practice medicine in today 9s increasingly complex business and regulatory environment. These factors, combined with a brisk national economy and shortages of skilled labor in many regions, have helped to further increase practice operat- ing costs, thus placing increased pressure on the size of the portion of the medical practice cpie d that remains for payment of physician compensation and benefits. PRIMARY CARE PHYSICIAN COMPENSATION Primary care physician compensation levels have gen- erally returned to the same relationship between com- pensation and production that preceded the cbidding wars d that occurred in many regions during in the mid- 1990s for primary care physician practices. Figure 3 doc- uments that 1995 was perhaps the final year of the primary care cbuying frenzy, d in which increases in com- pensation levels for primary care physicians exceeded the corresponding increases in production. Primary Care Compensation Winners and Losers Specific changes in compensation and production for primary care physicians from 1998 to 1999 (Table 1) include: "Family practice 4median compensation in 1999 was $141,493, reflecting a 2.3% increase over 1998 levels. During the same period, produc- tion increased 15.81%. "Internal medicine 4median compensation in 1999 was $145,397 for general internists, up 3.01% from 1998 levels. During the same peri- od, production in this group increased 12.96%. 50 Hospital Physician March 2001 www.turner-white.com Johnson : Trends in Physician Compensation : pp. 47 358 0 10 20 30 40 50 60 70 Cardiology Orthopaedic surgery Family practice Multispecialty groups 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 Operating cost, % Figure 5. Operating cost as a percent of total medical revenue, 1990 3 1999. Data from MGMA Cost survey: 2000 report based on 1999 data. Graph 4. Englewood (CO): Medical Group Management Association; 2000. "Pediatrics/adolescent medicine 4median com- pensation in 1999 was $143,011, up 5.93% from 1998. Production increased 13.02% in this group during the same time period. Hospitalist Compensation The trend toward the use of hospitalist physicians that started several years ago continued unabated in 1999. These physicians generally received compensation that was slightly higher than what their counterparts in gener- al internal medicine received (Table 1). Trend data reflecting changes in compensation and production is not yet available, reflecting the relatively newness of this specialty area. However, in 1999, median gross charges (production) for these physicians was significantly lower than the levels for general internal medicine physicians ($299,275 versus $370,382). This reality, combined with the slightly higher compensation levels, may indicate the different operating costs that are associated with hospital- based versus office-based primary care physicians. SPECIALIST PHYSICIAN COMPENSATION Though physicians in most medical and surgical specialties also enjoyed increases in compensation lev- els in 1999, median levels in a few specialty areas actual- ly decreased from 1998 to 1999 (Table 1) 4particularly anesthesiology and cardiology. Compensation in most other medical and surgical specialties increased from 1998 to 1999. In virtually all specialties, production increased more than compensation. Notable excep- tions to this include dermatology, hematology, pul- monary medicine, and psychiatry. Specialty Compensation Winners and Losers Table 1 provides compensation and production information for several medical and surgical specialties, Johnson : Trends in Physician Compensation : pp. 47 358 www.turner-white.comHospital Physician March 2001 51 0 50,000 100,000 150,000 200,000 250,000 300,000 350,000 400,000 Multispecialty Single specialty Urology Radiology (diagnostic, noninvasive) Pulmonary medicine Psychiatry Pediatrics (general) Orthopaedic surgery (general) Obstetrics/gynecology Neurology Internal medicine (hospitalist) Internal medicine (general) Hematology/oncology General surgery Gastroenterology Family practice (w/o obstetrics) Emergency medicine Dermatology Cardiology (noninvasive) Cardiology (invasive) Cardiology (invasive, interventional) Anesthesiology Compensation, $ Figure 6. Median compensation by group type and physician specialty, 1999. Data from MGMA Physician compensation and production survey: 2000 report based on 1999 data. Table 2: Physician compensation by group type. Englewood (CO): Medical Group Management Association; 2000. including the following: "Anesthesiology 4median compensation in 1999 was $244,755, reflecting a 2.18% decrease over 1998 levels. Notably, production levels for anes- thesiologists during this same time period in- creased only 1.56%. "Invasive and noninvasive cardiologists 4these specialists also experienced stagnation in com- pensation levels. In 1999, median compensa- tion for invasive cardiologists was $340,010 (down 2.85% from 1998 levels), and $278,712 for noninvasive cardiologists (showing virtually stable pay 4a decrease of 0.07% from 1998). In both cases, however, production was increasing at a much more dramatic pace 49.56% for inva- sive cardiologists and 13.5% for noninvasive car- diologists. "Dermatology 4compensation levels for derma- tologists outpaced their increases in production in 1998, showing an 8.21% increase in compen- sation based upon a 2.96% increase in produc- tion. Median compensation for dermatology physicians in 1999 was $205,973. "Hematology/oncology 4as with dermatology, compensation levels for physicians in these spe- cialties increased nearly 20% compared with 1998 levels, based on a 10.98% increase in pro- duction levels. "Psychiatry 4these physicians were also winners in terms of compensation, with an increase of 6.42% based on an increase in production of only 1.97%. "Pulmonary medicine 4compensation increased 4.82% compared with 1998 levels, while requir- ing only a 0.07% increase in production. One reason for the relatively lower increases in physician compensation over the past several years is the generally steady increase in practice operating costs.Operating costs generally have shown consistent increases over the past 10 years, reflecting the chang- ing business and regulatory environment of health care. Figure 5 shows operating costs for medical group practices for multispecialty and select single-specialty groups (family practice, orthopaedic surgery, and car- diology) from 1990 to 1999 as a percentage of total net medical revenue. Although the overall trend line has a number of peaks and valleys, practice operating costs have generally increased over the past decade. And while the size of increase may not be huge (for exam- ple, a 2.7% increase in costs for single-specialty family practice groups during the period), in an age of declin- ing reimbursement even slight increases in costs will need to be made up by increased work levels. The end result is a flattening of compensation levels despite increases in production. These trends, when taken together, illustrate the important role of physician and medical practice efficiency in determining physician compensation levels. OTHER FACTORS INFLUENCING COMPENSATION Practice Setting Figure 6 and Table 2 summarize compensation levels 52 Hospital Physician March 2001 www.turner-white.com Johnson : Trends in Physician Compensation : pp. 47 358 Table 2. Median Compensation for Selected Physician Specialties and Group Type, 1999 Median Compensation, $ Single-Multi- Specialty Specialty Groups, $Groups, $ Primary care Family practice (without obstetrics)137,174 142,264 Internal medicine (general)150,000 145,295 Internal medicine (hospitalist)*148,530 Pediatrics (general)159,643 140,122 Specialties Anesthesiology251,500 218,504 Cardiology (invasive)306,248 287,155 Cardiology (invasive, interventional)367,366 362,500 Cardiology (noninvasive)295,675 254,117 Dermatology286,595 197,859 Emergency medicine234,538183,283 Gastroenterology292,602 246,980 General surgery 280,213 228,588 Hematology/oncology342,324 213,389 Neurology186,560 174,578 Obstetrics/gynecology233,397 216,246 Orthopaedic surgery (general)338,216 283,774 Psychiatry*150,703 Pulmonary medicine278,790 184,360 Radiology (diagnostic, noninvasive)340,000 233,105 Urology300,788 229,349 *Insufficient responses to report. Data from MGMA Physician compensation and production survey: 2000 report based on 1999 data. Table 2: Physician compensation by group type. Englewood (CO): Medical Group Management Associ- ation; 2000. in selected specialties for physicians in single-specialty and multispecialty groups. For the most part, specialists in single-specialty groups fared better than those in multispecialty groups. This is typically a result of many factors, including the higher operating costs associated with multispecialty enterprises, plus some spreading of practice income within a multispecialty setting among primary care and specialist physicians to promote group cohesiveness and other goals. Of course, while physicians in single-specialty groups may garner higher wages for their efforts, physicians in multispecialty practices 4particularly specialists 4enjoy the built-in referrals of the multispecialty setting. More- over, many specialists prefer multispecialty groups for various nonfinancial reasons, including enhanced con- tracting, access to patients, quality of care, conve- nience, practice culture, and other tangible and intan- gible benefits. Geographic Location As in the past, median physician compensation levels tend to be higher in the southern United States, followed by the midwestern, eastern and, finally, the western regions ( Figure 7 and Table 3 ). This pattern generally conforms with the overall penetration of managed care throughout the United States. Physi- cians in the eastern and western United States have the lowest levels of compensation, primarily owing to increased managed care penetration in these regions, an overabundance of physicians in certain specialties, and relatively lower reimbursement rates. These trends might also reflect, to some degree, differences in the cost of nonphysician labor and in other operating costs in different regions of the nation. Years of Practice Compensation by years of practice tends to show a Johnson : Trends in Physician Compensation : pp. 47 358 www.turner-white.comHospital Physician March 2001 53 0 50,000 100,000 150,000 200,000 250,000 300,000 350,000 400,000 450,000 Western Southern Midwest Eastern Urology Radiology (diagnostic, noninvasive) Pulmonary medicine Psychiatry Pediatrics (general) Orthopaedic surgery (general) Obstetrics/gynecology Neurology Internal medicine (hospitalist) Internal medicine (general) Hematology/oncology General surgery Gastroenterology Family practice (w/o obstetrics) Emergency medicine Dermatology Cardiology (noninvasive) Cardiology (invasive) Cardiology (invasive, interventional) Anesthesiology Compensation, $ Figure 7. Median compensation by geographic region of the United States, 1999. Data from MGMA Physician compensation and production survey: 2000 report based on 1999 data. Table 3A: Physician compensation by geographic section for all practices. Englewood (CO): Medical Group Management Association; 2000. rather steep increase after completion of the initial 1- to 2-year period of associate physician status. Figure 8 and Table 4 show median compensation levels in 1999 by years of practice for selected specialties. In all medical and surgical specialties, associate physicians in their first 1 to 2 years of practice received significantly lower levels of compensation than physicians with more years of experience. Moreover, although there were significant differences in the compensation received by a group 9s junior and most senior partners, these differences were still significantly less than those between associate and partner salaries. Average compensation for primary care physicians in their first 1 to 2 years of practice was $122,177. In comparison, average compensation for primary care physicians with 3 to 7 years of practice was $141,245; 8 to 17 years of practice, $152,162; and 18 or more years of practice, $160,458. Similar trends were demon- strated with specialist compensation. Average compen- sation for specialists with 1 to 2 years of practice in 1999 was $178,046. This is compared to average com- pensation of $239,166 for specialists with 3 to 7 years of practice, $261,319 for specialists with 8 to 17 years of practice, and $256,942 for those with 18 or more years of practice. These data reflect the general life cycle of compen- sation levels in most groups, with physicians at the out- set and in the ctwilight d of their careers generally re- ceiving lower levels of compensation. The decreases experienced by the most senior physicians are likely the result of various factors, including the addition of new and younger physicians to medical groups (thus diluting the established practices of more senior physi- cians) and the increased use of productivity-oriented 54 Hospital Physician March 2001 www.turner-white.com Johnson : Trends in Physician Compensation : pp. 47 358 Table 3. Median Compensation by Geographic Region of the United States (All Practice Types), 1999 Median Compensation, $ EastMidwestSouthWest Primary care Family practice (without obstetrics)137,714 140,435 155,103 135,126 Internal medicine (general)148,417 143,490 154,926 142,386 Internal medicine (hospitalist)170,300137,697161,680127,500 Pediatrics (general)144,785 144,651 145,836 135,946 Specialties Anesthesiology222,036 265,069 265,000 232,551 Cardiology (invasive)312,530 328,025 343,063 245,709 Cardiology (invasive, interventional)314,000 353,491 424,314 315,939 Cardiology (noninvasive)288,745 278,818 350,201 220,197 Dermatology240,521 194,174 232,259 190,062 Emergency medicine165,000210,188261,715184,784 Gastroenterology269,843 285,864 288,854 212,478 General surgery 214,254 250,037 281,799 214,043 Hematology/oncology300,000 246,550 304,386 206,479 Neurology169,733 192,897 181,467 161,073 Obstetrics/gynecology203,975 235,194 267,549 198,750 Orthopaedic surgery (general)312,215 336,642 365,625 272,542 Psychiatry131,362160,068160,000146,869 Pulmonary medicine237,695 184,978 216,666 168,494 Radiology (diagnostic, noninvasive)266,518 320,600 379,236 248,527 Urology280,464 297,265 278,018 221,686 Data from MGMA Physician compensation and production survey: 2000 report based on 1999 data. Table 3A: Physician compensation b y geo- graphic section for all practices. Englewood (CO): Medical Group Management Association; 2000. compensation methods in group practices. Even rela- tively cohesive single-specialty groups are increasingly turning to productivity-oriented compensation plans as a means of rewarding varying work levels and accommodating various income, work, and lifestyle goals of physicians at different stages of their careers. Gender Table 5 presents median compensation for female and male physicians in selected specialties. In 1999, male physicians made, on average, 14.7% more than their female counterparts in primary care disciplines, and 21.1% more than their female counterparts in medical and surgical specialties. This translated to an average difference in compensation of $22,316 for pri- mary care physicians and $54,042 for specialists. The gender gap continues to be present even in obstetrics and gynecology, a specialty in which female physicians are often viewed as having greater access to patients. In 1999, male ob/gyn physicians had median compensa- tion levels of $234,235, compared to a median of $198,443 for female ob/gyn physicians, reflecting a dif- ference of 15.3%. The disparity between male and female compensa- tion levels may result from a number of factors. Many female physicians elect to work part-time work sched- ules. Although such a schedule provides flexibility and more time to spend on family duties, it typically results in lower levels of production and compensation.Prac- tice groups are increasingly turning to predominantly production-driven compensation schemes in part, as a means to accommodate differing physician prefer- ences related to lifestyle and work levels. While such systems promote greater flexibility, physician autonomy and choice, these benefits frequently carry an associat- ed financial cost. Johnson : Trends in Physician Compensation : pp. 47 358 www.turner-white.comHospital Physician March 2001 55 0 50,000 100,000 150,000 200,000 250,000 300,000 350,000 400,000 450,000 18 + yr 8 3 17 yr 3 3 7 yr 1 3 2 yr Average (specialist ) Urology Radiology (diagnostic, noninvasive) Pulmonary medicine Psychiatry Orthopaedic surgery (general) Obstetrics/gynecology Neurology Hematology/oncology General surgery Gastroenterology Emergency medicine Dermatology Cardiology (noninvasive) Cardiology (invasive) Cardiology (invasive interventional) Anesthesiology Average (primary care) Pediatrics (general) Internal medicine (hospitalist) Internal medicine (general) Family practice (w/o obstetrics) Compensation, $ Figure 8. Median compensation by years in practice, 1999. Data from MGMA Physician compensation and production survey: 2000 report based on 1999 data. Table 7B: Physician compensation by years in specialty. Englewood (CO): Medical Group Management Association; 2000. MID-LEVEL PROVIDER COMPENSATION Mid-level providers include nurse practitioners, pri- mary care and surgical physician assistants, certified reg- istered nurse anesthetists, optometrists and psycholo- gists. Figure 9 presents mid-level provider compensation and production from 1995 through 1999. Mid-level provider compensation trends during this time period tended to mirror the basic trends experienced by prima- ry care physicians, but with a slight 1- to 2-year delay. In 1995, primary care physicians were garnering increases in compensation that outpaced their increases in pro- duction. During that same year, mid-level providers enjoyed only slight increases in compensation (1.39%) despite significant increases in production in compari- son to prior-year levels. These trends were reversed in 1996, as primary care physicians 9 pay reverted to the more representative trend of production outpacing increases in compensation.Conversely, in 1996, mid- level providers enjoyed increases in compensation despite production levels that were decreased from the previous year, thus mirroring the primary care cycle but with a slight timing delay. In 1997, however, the relationship between produc- tion and compensation levels for mid-level providers 56 Hospital Physician March 2001 www.turner-white.com Johnson : Trends in Physician Compensation : pp. 47 358 Table 4. Median Compensation for Selected Physician Specialties and Years in Practice, 1999 Median Compensation, $ 1 32 Years3 37 Years8 317 Years18 + Years Primary care Family practice (without obstetrics)124,041 131,263 150,000 148,446 Internal medicine (general)128,446 137,352 154,439 160,000 Internal medicine (hospitalist)120,000161,653156,209175,406 Pediatrics (general)116,222 134,711 148,000 157,978 Average (primary care)122,177141,245152,162160,458 Specialties Anesthesiology180,855 242,561242,681 234,026 Cardiology (invasive)212,044 312,000 336,488 311,316 Cardiology (invasive, interventional)282,590 364,023 363,385 409,719 Cardiology (noninvasive)175,000 266,883 296,087 269,762 Dermatology154,820 200,699 223,858 223,090 Emergency medicine170,119178,912192,547209,099 Gastroenterology179,352 264,500 285,242 253,365 General surgery 181,391 225,009 242,755 250,785 Hematology/oncology141,234 230,988 287,644 277,455 Neurology136,475 184,993 184,058 176,470 Obstetrics/gynecology170,000 211,597 231,138 234,000 Orthopaedic surgery (general)221,810 312,154 333,438 314,220 Psychiatry132,906140,149163,868177,758 Pulmonary medicine* 179,419 213,643 187,967 Radiology (diagnostic, noninvasive)176,325 259,829 313,142 310,500 Urology155,774 252,947 271,125 271,535 Average (specialist)178,046239,166261,319256,942 *Insufficient responses to report. Data from MGMA Physician compensation and production survey: 2000 report based on 1999 data. Table 7B: Physician compensation b y years in specialty. Englewood (CO): Medical Group Management Association; 2000. returned to the relationship more typical of other health care providers.In 1999, mid-level provider median production levels increased 3.79%, while their compensation increased 2.3%. FUTURE TRENDS IN PHYSICIAN COMPENSATION An assessment of historic trends reveals that physi- cian compensation continues to rise, but only when production or work levels increase more dramatically. It is unclear how long physicians in all medical and sur- gical specialties will be able to sustain the double-digit increases in workload necessary to achieve single-digit increases in compensation.Although many physicians have had excess capacity and have been able to see more patients by enhancing efficiency and working more, changes in health care and society in general may make this approach unsustainable in the long term. Various trends will continue to place increased pres- sure on compensation and production levels in med- ical practice. These include the obvious changes in reimbursement rates and practice operating costs. In addition, changes and restructuring of health care delivery and payment systems involving public and pri- vate payers will most likely continue. Other dynamics may come into play, however. Changing population demographics will result in an increasingly elderly pop- ulation, bringing greater levels of Medicare payment Johnson : Trends in Physician Compensation : pp. 47 358 www.turner-white.comHospital Physician March 2001 57 Table 5. Median Compensation for Selected Physician Specialties and Gender Median Compensation, $ Gender-Based Difference MaleFemale$% Primary care Family practice (without obstetrics)145,779124,61021,16914.5 Internal medicine (general)150,856130,00020,85613.8 Internal medicine (hospitalist)157,000133,745 0 3,25514.8 Pediatrics (general)150,876126,89123,98515.9 Average (primary care)151,128128,81222,31614.7 Specialties Anesthesiology248,709195,99152,71821.2 Cardiology (invasive)301,000232,39868,60222.8 Cardiology (invasive, interventional)380,222301,92878,29420.6 Cardiology (noninvasive)283,546233,71249,83417.6 Dermatology227,192176,62250,57022.3 Emergency medicine197,170164,05533.15516.7 Gastroenterology264,962223,30741,65515.7 General Surgery240,956198,66942,28717.5 Hematology/oncology273,300176,10097,20035.6 Neurology183,023146,56836,45519.9 Obstetrics/gynecology234,235198,44335,79215.3 Orthopaedic surgery (general)317,000259,15457,84618.2 Psychiatry153,345146,997 0 6,348 0 4.1 Pulmonary medicine198,652166,18632,46616.3 Radiology (diagnostic, noninvasive)310,665217,40993,25630.0 Urology271,404183,17288,23232.5 Average (specialist)255,336201,29454,04221.1 Data from MGMA Physician compensation and production survey: 2000 report based on 1999 data. Table 8: Physician compensation by gender. Englewood (CO): Medical Group Management Association; 2000. and challenges in seeing more patients in a shorter period of time.Continued technological developments and direct marketing to consumers may result in increased consumer demand for such developments (including patient demands for the newest innovation or drug that is advertised in the media). Changes in medical education trends will result in fewer physicians being trained in some specialties, which will impose the inevitable forces of supply and demand on com- pensation levels. Together, these factors will continue to affect the underlying trends for physician compensa- tion in the United States. HP REFERENCES 1.MGMA Physician compensation and production survey: 2000 report based on 1999 data. Englewood (CO): Medical Group Management Association; 2000. 2.MGMA Cost survey: 2000 report based on 1999 data. Englewood (CO): Medical Group Management Associa- tion; 2000. 58 Hospital Physician March 2001 www.turner-white.com Johnson : Trends in Physician Compensation : pp. 47 358 Figure 9. Percentage change in mid-level provider compensa- tion and production, 1995 3 1999. Data from MGMA Physician compensation and production survey: 2000 report based on 1999 data. Tables A and B: Median compensation and produc- tion for selected specialties, 1995 3 1999. Englewood (CO): Medical Group Management Association; 2000. -10 -5 0 5 10 15 20 Production Compensation 1999 1998 1997 1996 1995 Compensation, % Copyright 2001 by Turner White Communications Inc., Wayne, PA.All rights reserved.

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