Physician Compensation, Dissatisfaction Ratchet Up

An annual survey of nearly 20,000 physicians finds a modest increase in average compensation, but a dip in job satisfaction across 26 medical specialties.

Physician compensation has seen modest gains since last year—but satisfaction has not risen along with pay, data from Medscape's Annual Physician Compensation Report shows. The report is analyzes how compensation influences physician career considerations and job satisfaction.

Now in its fifth year, the survey of more than 19,500 physicians across 26 specialties reveals that most physicians saw a modest increase in pay in 2014, and that employment status, therapeutic specialty, and gender were the key drivers for physician compensation.

The report also finds that the average primary care physician earns $195,000 per year while the average specialist brings home $284,000. Orthopedists, cardiologists and gastroenterologists top the best-paid specialists list, while pediatricians and family medicine specialists are the least-well compensated.

Additionally, the report shows that self-employed physicians (32%) earn substantially more than those who are employed (63%). On average, self-employed primary care physicians earn $212,000. Their employed counterparts earn $189,000, and self-employed specialists, on average, earn $329,000 compared to employed specialists ($258,000).

Only rheumatologists and urologists saw a decrease in compensation. Among the specialties with the greatest increases in compensation were infectious disease, and emergency medicine doctors.

But physicians bringing home the largest pay checks aren't always the happiest, the report suggests.

"Docs are generally happy with their decision to practice medicine, but we've seen some changes with their level of job satisfaction," says Michael Smith, MD, medical director and chief medical editor at Medscape's parent, company, WebMD.

"In past reports, we've seen their level of satisfaction… in the upper sixties [in percent of respondents who would choose to continue practicing medicine if they could redo their career]. We're now kind of getting into the low to mid-sixties," Smith said by phone.

The study reveals that poor morale, frustration around changes in the US healthcare system, and concerns around financial uncertainty are common grievances among physicians.

The Drivers of Dissatisfaction
What makes for a miserable MD? Asking physicians to spend a lot of time doing paperwork, dealing with insurance companies, or performing other menial tasks that take them away from doing what they love, are all considered to be unsavory tasks, says Smith.

"What drives satisfaction for physicians is being very good at their jobs and developing strong relationships with their patients. Many of them feel that changes in healthcare are decreasing the amount of time physicians can spend with patients."

An unexpected finding is that physicians in several of the higher-paying specialties, including both general and plastic surgery, report lower satisfaction rates than some lower-earning physicians.

"Money is important, but we know from our survey that is not a driving factor. When you look at the types of specialties and the level of satisfaction, there's really no correlation there. Some of the physicians who had the highest compensation are also the least satisfied with their jobs," explains Smith.

6 in 10 Physicians Would Quit Today

"We see that the highest level of dissatisfaction is actually among those who make the most money."

Among the specialties, dermatologists were most likely to be content with their careers, with a 63% overall satisfaction rate and 73% saying they would reselect their specialty if given the opportunity to start their careers over again.

Internists reported a 45% overall satisfaction rate and only one in four said they would choose the same path if given the opportunity for a career do-over.

Ladies Last
The report finds a 76-cent to each dollar pay gap between male and female physicians. "There's no doubt that we continue to see a difference," says Smith, who suggests the likely driving factors of the pay difference to be choice of lower-paying specialties among women and fewer hours worked on average by female physicians, even when employed full-time.

"Fewer hours worked would likely translate in to fewer patient interactions, and therefore lower income," he explained. Female physicians are also less likely than their male counterparts to be self-employed, with only 23% in private practice, compared to 36% of their male colleagues.

On a positive note, the overall percentage difference between men and women has decreased slightly since the 2011 Medscape report, falling from a 28% difference to 24%. The specialties with the highest number of female physicians were women's health and pediatrics, which are tied with an even split between the genders, while the specialties with the lowest female representation were orthopedics and urology, with 9% and 8% of specialists being female, respectively.

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Other findings included a dramatic jump in ACO participation, up 900% since 2011, and decreases in both concierge medicine and cash only practices in 2014, as well as an increase in employed physicians—a trend Smith predicts will continue.

"I think we'll continue to see an increase in [employed] physicians in the year ahead," predicts Smith. "Employment comes with the benefit of being able to spend more time with your patients—which is what drives job satisfaction. They're the reason why many physicians go in to medicine."