Physician pay is on the rise, but for which specialties?
Key Takeaways
Physician compensation increased, but improvement in productivity remained low in 2018, according to data from the American Medical Group Association’s (AMGA) new 2019 Medical Group Compensation and Productivity Survey. Among specialties, primary care physicians and psychiatrists earned significantly more, while other specialists—notably pediatricians, radiologists, ophthalmologists, and OB/GYNs—had a loss in compensation.
Income on the rebound
Overall, compensation among all physicians rose by a median of 2.92% in 2018, compared with a 0.89% increase the previous year. Meanwhile, productivity (as measured by work relative value unit, or wRVU) increased by only 0.29%, but that’s in comparison with a 1.63% decline in 2017.
“The 2019 survey shows that physician compensation in 2018 rebounded from a stagnant 2017,” said Fred Horton, MHA, president, AMGA Consulting, Alexandria, VA. “While productivity also increased, it did not increase enough to surpass the decline we saw in last year’s survey, meaning productivity still has not risen since 2016.”
AMGA Consulting (an AMGA subsidiary) conducted the survey by compiling data submitted by 272 medical groups, representing 117,030 providers from across the country.
In 2018, compensation-per-wRVU ratio increased 3.64%, compared with a 3.09% increase the previous year. Hospital administrators and employers use this ratio as a guide to align productivity relative to compensation.
Primary care compensation
For all primary care specialties, median compensation increased by 4.91% in 2018—a significant gain from the 0.76% increase in 2017. Meanwhile, productivity was flat, with wRVUs increasing only 0.21% in 2018. As a result, the median compensation-per-wRVU ratio increased 3.57%—the largest increase for primary care specialties in 4 years.
Primary care specialty | 2018 median compensation | 2017 median compensation | % change |
Family medicine | $260,108 | $244,799 | 6.3% |
Internal medicine | $273,254 | $258,027 | 5.9% |
Pediatrics | $245,043 | $245,153 | -0.04% |
The high demand for primary care providers likely explains this recent upsurge in compensation, explained Elizabeth Siemsen, director, AMGA Consulting.
“[I]n recent years, the AMGA survey has shown a slow uptick in the proportion of primary care physicians reported at less than a 1.0 clinical [full-time equivalent], indicating an increase in part-time providers,” she said. “In order to recruit and retain the primary care workforce, it may be that the market demanded a compensation course correction this past year.”
Hiring more nurse practitioners and physician assistants has been another strategy to satisfy the demand for primary care services. Accordingly, compensation for nurse practitioners in primary care rose 2.9% last year, and that of primary care physician assistants increased 2.5%.
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Specialty Care
Most specialists had an increase in compensation in 2018, although others saw a notable reduction. For medical specialties overall, median compensation rose by 3.39% in 2018. At the same time, median wRVU productivity increased by 1.9% from 2017, resulting in a 2.65% rise in the compensation-per-wRVU ratio.
Compensation for some specialties was better than others in 2018:
Specialty | 2018 median compensation | 2017 median compensation | % change |
Psychiatry | $296,388 | $256,400 | 15.6% |
Endocrinology | $269,750 | $252,111 | 7.0% |
Cardiology | $519,964 | $497,888 | 4.4% |
General surgery | $431,163 | $415,987 | 3.6% |
Urology | $469,755 | $453,419 | 3.6% |
Emergency medicine | $363,201 | $351,728 | 3.3% |
Dermatology | $475,379 | $460,238 | 3.3% |
Urgent care | $283,787 | $275,959 | 2.8% |
Neurology | $310,518 | $302,060 | 2.8% |
Hematology/oncology | $450,502 | $438,496 | 2.7% |
Allergy/immunology | $322,009 | $313,591 | 2.7% |
Hospitalist | $293,252 | $287,099 | 2.1% |
Otolaryngology | $451,219 | $442,057 | 2.1% |
Anesthesiology | $436,404 | $430,754 | 1.3% |
Gastroenterology | $527,998 | $529,880 | -0.4% |
Diagnostic radiology | $482,599 | $487,239 | -1.0% |
OB/GYN | $340,388 | $345,908 | -1.6% |
Ophthalmology | $385,168 | $405,500 | -5.0% |
Specialties with significant changes to their compensation-per-wRVU ratios included anesthesiology, radiology, cardiology, dermatology, gastroenterology, hospitalist, and psychiatry.
“Data from this year’s survey shows compensation is increasing without an equivalent increase in wRVU production for many specialties,” Horton said. “This trend is causing organizations to absorb additional compensation expenses without balancing revenue from production increases.”
He added: “More intentionally transitioning to value-based care is one strategy medical groups can use to mitigate this trend, as it would help them better clarify their organizational strategies and objectives.”
Dollar differences by US region
The survey results also revealed that physicians around the country earned different levels of compensation depending on where they live. For most specialties, median compensation amounts were highest in Northern states but lowest in the East.
Specialties in Western states tended to have the highest median compensation-per-wRVU ratios, while the lowest median compensation-per-wRVU ratios were found down in the South.