The business of medicine is in flux. Practices are merging, getting bigger, moving into integrated health care delivery systems. With all these changes, is the way physicians are paid also changing? If we are moving away from a fee-for-service to a value-based health care system, should we not see changes in how we are compensated? Over the last eight years, the American Medical Association has analyzed its every other year Physician Practice Benchmark Survey results to assess how physicians are compensated. The latest data, from the 2016 survey, recently released in a paper written by Apoorva Rama, has some interesting insights for the allergist. Compare your compensation sources to the data below.
In 2016, an average of 52.5% of physician compensation came from salary, 31.8% from personal productivity, 9% from practice financial performance, 4.1% from bonuses, and 2.5% from other sources. Over half of physicians (54.4%) indicated that their compensation was based on more than one method, greater than what was observed in both 2014 and 2012.
As reported in this survey, it was not surprising that methods of physician compensation varied by ownership status, practice type and specialty. The average compensation share from salary was higher for physicians who were employees as compared to those who were owners of their practice (69.9% to 30.1%). In contrast, the share based on productivity was higher for physicians who were owners compared to physicians who were employees in their practice (44.7% to 22.3%).
Physicians in single and multi-specialty practices were less likely to receive a salary and more likely to report productivity as a compensation method, compared to physicians who were employed directly by a hospital or who worked in faculty practice plans (FPPs), for medical schools or in other practice types. Though allergists were not reviewed separately in this survey, it would appear for us that productivity is the major method of compensation due to our high rate of single and multi-specialty practices. This trend will move more to salaries as more allergists become employees.
For physicians for whom salary made up most of their compensation, how was the salary determined? This data may be helpful to the allergist looking at employment opportunities. In order of highest incidence in accounting for salary is the particular physician’s specialty, followed closely by time working at the practice. Next, what was the physician’s prior productivity in RVUs? As we are seeing, RVUs are increasing in importance in determining physician pay. For the allergist, this is a major negative, as it devalues compensation from allergen immunotherapy. Lastly, salary is based on scores on clinical “report cards.”
The Medscape Physician Compensation Report does specifically look at allergists. In the recently released 2018 edition, it was stated that the average annual allergist compensation was $272,000, which was an increase of 6% from the previous year. This increase was more than that seen with the average physician over the one-year period. As they have shown over the years, employed physicians on average earn less per year than self-employed ones and men make more than women. Forty-seven percent of the allergists surveyed felt that they were fairly compensated, which put our specialty toward the bottom of the list, just above physical medicine and rehabilitation at 46%. Allergists were also at the bottom of the list for specialties that would choose medicine again, 62%, with our friends in pulmonary medicine at the highest, 88%. But when asked if allergists would choose the same specialty, the results were much more optimistic at 88%. The results to this question ranged from orthopedics at the highest at 98% to nephrologists at 52%. It’s interesting to compare ourselves to other specialties, but I’m not sure how valid this data is. The sample size was 20,329 respondents with allergists only making up 1% of the total surveyed —just 203 of us took part. Nevertheless, it is fun to benchmark ourselves to our colleagues and, even if the data may be flawed. it is good to see allergists’ compensation rising.
Michael Blaiss, MD, FACAAI, Executive Medical Director