Tuesday Apr 16, 2019
Surveys: Physician Salaries Are Increasing, Burnout Persists
"We will cure this dirty old disease. If you've got the poison, I've got the remedy. The remedy is the experience. It is a dangerous liaison."
-- Jason Mraz
Spring has arrived, and with it comes longer days and, of course, baseball! Your 2019 world champion Washington Nationals(www.mlb.com) are off to a rough start, but there is a lot of baseball left to play. I remain optimistic that I will get an opportunity to watch World Series games in Washington, D.C., come October. (I can dream, I can dream.)
Last week, Medscape published its 2019 Physician Compensation Report.(www.staging.medscape.com) This annual report provides a snapshot of various aspects of the practice of medicine that are common to all specialties, according to physicians themselves.
The practice of medicine, across all specialties, remains predominantly aligned with the insurance industry. In fact, 81% of physicians reported a relationship with at least one insurance company. We know from AAFP member surveys that more than 60% of family physicians have contracts with seven or more insurance companies.
Only 6% of physicians from all specialties reported being in a cash-only practice, with no relationships with commercial insurance companies. For family medicine, AAFP data show that about 3.5% of family physicians practice in a direct primary care practice model, but a small subset of this group also accepts insurance.
Seventy-one percent of physicians from all specialties reported they participate in Medicare and/or Medicaid and plan to continue doing so in the coming year. With respect to Medicare, 42% of primary care physicians surveyed are participating in the Merit-based Incentive Payment System, and 12% are participating in an alternative payment model.
There are some interesting findings in the report and certainly some findings that are encouraging, but there are also a few items that are startling and should prompt some alarm bells to go off -- now.
Let's lead with the encouraging findings:
- Average salaries for primary care physicians have reached $237,000, according to the report. That's a 21.5% increase since Medscape's 2015 report.
- Looking at all specialties, self-employed physicians earn, on average, more than employed physicians -- $359,000 to $289,000. Self-employed physicians also are older; 64% of them are older than 50 compared with only 46% of employed physicians.
- Fifty-three percent of family physicians reported feeling fairly compensated. This percentage was higher than I anticipated, but it reflects the intrinsic motivation of patient care common among many family physicians. (Hint: You are undercompensated, and we're working to fix that.)
- Seventy-four percent of family physicians indicated they would choose medicine as a career again, and 68% indicated that they would choose family medicine again.
- When asked why they continue to practice medicine, 29% of physicians surveyed said they were motivated by their relationships with their patients, and 22% reported knowing that they were "making the world a better place."
It is difficult to surprise me, but the statistics associated with administrative and regulatory compliance in the Medscape report were startling. According to the survey, 74% of physicians spend 10 or more hours per week on paperwork, and 36% report spending 20 or more hours per week.
This is crazy. Consider this: In 2012, 53% of physicians reported they spent one to four hours per week on paperwork. These two datapoints suggest at least a 150% increase in paperwork over a six-year period. It goes without saying that physician compensation hasn't increased at a similar pace.
Not surprisingly, 26% of physicians reported that compliance with rules and regulations was the most challenging part of their job. Fifteen percent reported that their electronic health record was the most challenging part, and 13% said getting fair compensation was the biggest challenge.
No wonder physicians continue to report symptoms of burnout and professional moral injury at an alarming rate. According to the 2019 Medscape National Physician Burnout, Depression & Suicide Report,(www.medscape.com) 44% of all physicians reported that they are burned out. If we look exclusively at family medicine, 48% of physicians reported they are burned out.
Here are what physicians (all specialties) reported to Medscape as the factors driving their professional dissatisfaction:
- 59% say too many bureaucratic tasks;
- 34% say too many hours at work;
- 32% say increasing computerization of practice;
- 30% say a lack of respect from administrators, employers, colleagues or staff; and
- 29% say insufficient compensation.
According to the 2019 Medscape compensation report, the gender pay gap among primary care physicians (checks notes) ... increased? The average salary for male primary care physicians was $258,000, but for female primary care physicians it was $207,000 -- an astonishing 25% delta. Making this even worse is the fact that the delta was 18% in 2018 and 16% in 2016. The gender pay gap in primary care is increasing, not decreasing.
Adding salt to an open wound, the Medscape data point to the fact that 50% of female physicians across all specialties report they are burned out, compared with 39% of male physicians.
I will admit that after reviewing the data, I anticipated that the average respondent would be older and in the latter stages of their career. You know, the "old man yells at cloud"(www.abc.net.au) bias. My bias was wrong: 61% of compensation survey respondents and 55% of burnout survey respondents were between the ages of 28 and 54.
In other words, these statistics reflect information provided by the current physician workforce and, more importantly, the physician workforce our country will rely on for the next 15 to 20 years. Again, alarm bells should be ringing.
My colleague, Clif Knight, M.D., AAFP senior vice president for education, summarizes the situation extremely well: "Burnout is the problem. The system is the cause. We are the answer."
Let's address the cause first. Clearly, increased and appropriate payment or compensation for service provided by family physicians remains a top priority for the AAFP. I have written extensively about the Academy's work on payment issues -- for instance, here and here.
The AAFP also has prioritized the reduction of administrative burden, and we are aggressively pursuing solutions to reduce the day-to-day burden for family physicians and the system drivers of burden. The AAFP's Principles for Administrative Simplification document lays out four priority areas to focus efforts aimed at cutting administrative burden:
- prior authorization,
- quality measures and the need for measure harmonization,
- certification and documentation, and
- medical record documentation
Now, let's address the problem -- burnout. In 2017, the AAFP published a position paper titled "Family Physician Burnout, Well-Being, and Professional Satisfaction." At the same time, the AAFP began investing heavily in developing resources and programs aimed at helping family physicians learn about burnout and create a plan to improve physician well-being for themselves or their colleagues. The anchor of our efforts is the Physician Health First portal. This collection of resources is a good starting point for all family physicians. If you are interested in a more dynamic and social experience, please join us at the Family Physician Health and Well-Being Conference June 5-8 in Phoenix.
Posted at 09:09AM Apr 16, 2019 by Shawn Martin