High Salaries Not Key to Satisfaction Among Physicians, Survey Finds

Interaction With Patients Trumps Compensation Concerns, Says One FP

April 28, 2014 03:53 pm Michael Laff

Family physicians may not be the highest-paid specialists in the medical field, but the majority of them report they would choose a career in medicine if they had to make the decision again, says a recent survey.

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According to the Medscape Physician Compensation Report 2014(www.medscape.com), overall, the specialists who ranked among the highest paid in 2013 reported the lowest levels of satisfaction with the profession. For example, anesthesiologists, radiologists and orthopedists were among the highest-paid subspecialists, but they reported the lowest levels of career satisfaction. Among the three specialties, the percentage who said they would still choose to go into medicine if given a second chance ranged from 44 percent to 47 percent.

Conversely, 67 percent of family physicians said they would choose medicine again as a career. Yet despite being satisfied with the medical profession overall, the survey indicated they do not feel the same about their specialty. Only 32 percent of family physicians said they would stay in the same medical specialty.

At the top of the salary scale, orthopedists reported earning an average of $413,000, far ahead of cardiologists in the No. 2 spot. Family physicians earned an average salary of $176,000, the survey found, with one-half of them saying they thought they received fair compensation.

Breaking Down the Numbers

AAFP Board Chair Jeff Cain, M.D., of Denver, cited two reasons why family physicians might relish their work in medicine but grow weary of the specific field.

Story highlights
  • In a recent survey, the highest-paid specialists ranked among the least satisfied with medicine as a career.
  • Despite relatively lower compensation, two-thirds of family physicians reported they would choose medicine as a career again, if given the chance.
  • Pending changes to physician payment models may be a source of future concern for some specialists.

"The amount of daily hassles in the office is increasing with paperwork, regulatory hoops and changing (electronic medical records)," Cain told AAFP News. "Nobody went to medical school to do paperwork.

"Second, the amount of compensation we receive relative to the value we provide to our patients is lower than (that of) our (subspecialty) colleagues."

Still, family physicians derive a great deal of career satisfaction from interacting with the same patients they have known for years, Cain pointed out.

"I came to the office today not because of a paycheck but to see Mrs. Baker," he said. "It's because of the relationships we develop over the years, and (that fact) is often overlooked by students in medical school."

Overall, 58 percent of all physicians said they would choose medicine again as a career. Forty-seven percent said they would choose the same specialty, and 26 percent said they would choose the same practice setting.

"It's still an incredibly rewarding profession, and the data reflects that," said Drew Harris, director of health policy at the Jefferson School of Population Health at Thomas Jefferson University in Philadelphia. "It's a little less rewarding than it used to be."

Harris cited ongoing and pending practice changes such as dealing with electronic health records, negotiating contracts with accountable care organizations (ACOs) and considerations related to selling a practice as issues that preoccupy many physicians. Many well-paid subspecialists acknowledge that their income may decline with pending changes in payment methods.

"Incomes have been going up steadily for years," said Harris. "Now people are saying the system is unsustainable, so that will turn the tide."

Robert Wachter, M.D., a professor of medicine at the University of California, San Francisco, said the survey indicates that physicians are evaluating likely changes to their careers over the next five years. He described physician salaries as a "zero sum game," predicting that salaries for subspecialists will decrease as the health care system moves away from fee-for-service and predetermined pay scales set by Medicare and insurance companies.

Harris agreed with Cain that physicians on the lower end of the salary scale chose their field for reasons other than compensation, citing himself as an example. "I'm an internist, and I chose to be one because I thought it would be satisfying," he said. "We wish the pay was better, but we knew that we would not make as much as proceduralists."

Additional Survey Results

Besides comparing the salaries of physicians in various specialties, the survey addressed how physicians spend their time in practice, whether they accept Medicare patients and whether they participate in alternative payment models.

Of the family physicians surveyed, 29 percent of respondents said they spend between 13 and 16 minutes with each patient. Another 25 percent said they spend 17 to 20 minutes with each patient.

However, in terms of the total number of hours spent per week with patients, family physicians ranked at the lower end of the scale, with 42 percent of respondents reporting that they spend more than 40 hours each week seeing patients. That's compared with nearly 80 percent of anesthesiologists, critical care physicians, cardiologists and urologists who reported spending over 40 hours per week seeing patients. (It should be noted that the majority of physicians who spend the most time with patients are hospital-based.)

Physicians also were asked if they would stop accepting Medicare and/or Medicaid patients. Among self-employed physicians overall, 57 percent said they would continue taking new and current patients, and 15 percent said they would no longer take new patients. Another 25 percent said they were undecided on the issue.

And finally, fee-for-service may be the primary payment model now, but that trend is changing steadily. Between 2011 and 2013, the number of physicians who reported being part of an ACO rose from 3 percent to 24 percent. The percentage of physicians who said they planned to join an ACO within the year also increased during that period, rising from 5 percent in 2011 to 10 percent in 2013.