The annual Physician Placement Starting Salary Survey from the Medical Group Management Association (MGMA) provides salary and benefits benchmarking data for recruiters and healthcare organizations. It also provides a snapshot into important trends in healthcare—namely, a continued emphasis on primary care services.
The 2012 compensation survey, based on data from 2011, shows that both primary care and specialty care groups have increased their median first-year compensation rates—a trend that began in 2006—but primary care compensation has grown 25% compared to specialty care's 10% growth.
But one of the survey's authors warns that these trends are imperiled by the uncertainty around the sustainable growth rate formula. The growth in primary care compensation is all predicated, at least in the short run, on the belief that the SGR formula will be remedied and encourage physician spending, says Todd B. Evenson, MBA, assistant director of survey operations at MGMA. "It's anybody's guess as to what will happen if that's not corrected."
"What we're finding now, in terms of uncertainty in the marketplace and specifically year over year, all that [the SGR] does is promote a situation where it becomes a protectionist type of environment," says Evenson. "There's lots of confusion about what the correct thing is to do, and as a result it's difficult to reinvest dollars because the uncertainty and chaos that exists in the space."
"What is imperative is that the federal government finally corrects the SGR and gives physicians of all specialty types the stability they need in these uncertain times to be able to make strong business decisions for the sustainability of their practices into the future," says Evenson.
According to the 2012 MGMA survey, primary care first-year guaranteed compensation in a single-specialty practice grew by 9.3% since 2009. Single-specialty practice first-years in 2011 earned 5.9% more than those in multispecialty practices.
The increase in first-year compensation growth in the primary care setting shows that hospitals and integrated delivery systems are working hard to appeal to new physicians looking for that work style and a higher first-year guaranteed income, says Evenson. "It's not to say that primary care provider, if they were in a single-specialty practice, couldn't earn more, but they might be exposed to more risk."
Although primary care compensation is experiencing growth, first-year specialty care compensation remains higher, with median salary of $255,000 versus $175,000 for first-year primary care placements. Although compensation is not the only factor in determining a specialty, it plays a role, with student loans averaging $161,290 for the 2011 graduating class of medical students and 86% of medical students carrying outstanding loans, according to the Association of American Medical Colleges.
Even in placements for experienced physicians in their first year at a new practice, median first-year compensation showed a substantial difference between primary care and specialty care. Established primary care physicians in their first year at a new practice earned 2.9% more than first-year primary care physicians placed directly out of residency or fellowship—a notable difference when compared to the 14% increase in compensation between first-year and established specialty care physicians.
"There's a lot of things that are in play in terms of how we as a nation should look towards primary care, and offer up solutions to make that a more attractive specialty to providers that are considering entering into that space as they graduate medical school," says Evenson.
The survey data also noted trend shifts based on practice ownership. Median first-year compensation for hospital or integrated delivery system–employed primary care physicians grew by 9.1% in 2011 and was higher than at independent practices, a trend that has been consistent since 2007. In a shift from the trend of the previous two years, specialty care physicians reported comparable median first-year compensation from hospital or IDS-owned versus independent practices. In the 2012 report, 51.5% of the practices surveyed were hospital/IDS-owned.
When compared across geographic regions, first-year specialty care physicians' median salaries varied more than those in primary care. The Eastern region of the United States reported the most significant growth (20%) in specialty care and primary care (13.1%) first-year compensation since 2009. The Southern region reported the smallest amount of growth for first-year primary care compensation (5.9%) since 2009, while the Western region reported the smallest change in specialty care compensation (2%).
"The thing medical groups need to consider today is that they are competing on a national level more today than ever for new physicians entering the marketplace," says Evenson. "So if you're looking to recruit physicians, it's no longer a situation that you're measuring against within your state or your region to attract physicians. You really have to consider the mobility of physicians."
The MGMA survey this year added data comparing provider's starting compensation packages, as well as trends from 2006 to 2011 within median starting salaries among specialty and primary care physicians. It also contains data from 2009 to 2011 on median starting salaries by group type. The MGMA-ACMPE (American College of Medical Practice Executives) conducts the survey in collaboration with the National Association of Physician Recruiters (NAPR). The 2012 survey reported starting salary information from 749 groups and 4,600 positions. MGMA has been producing this compensation survey since 2003, but has been collecting physician compensation data for over thirty years.
The survey breaks down physician placement location trends geographically by the U.S. Department of Health and Human Services regions. From 2009 to 2011, HHS Region 4 (AL, FL, GA, KY, MS, NC, SC, and TN) and HHS Region 5 (IL, IN, MI, MN, OH, and WI) have made the most physician placements, but the trend growth is beginning to slow, according to the survey. Slight declines in physician placements have occurred since 2009 in HHS Regions 1, 2, 4, 7, and 8. By state, the highest numbers of physician placements (more than 300) are occurring in California. In a comparison of placements versus relocations, HHS Region 2 (NJ and NY) had the largest difference between physicians relocating to the area versus leaving.
Chelsea Rice is an associate editor for HealthLeaders Media.
