9% Drop in General Surgery Salary in 2018

[Medicaldoctorintraining]

Does anybody have any explanation for the drastic (9%!) drop in general surgery compensation reported on Medscape between 2017-2018?

(I can't post a link on here but if you google 2018 Medscape General Surgeon Compensation Report and click to slide 3/34 you will see what i mean).

I know Medscape's methodologies are far from exact and that the results are simply compiled from surveys and should be taken with a huge grain of salt. Nonetheless, 9% just seems way too high to be accounted for by sample error.

So I was just wondering if there was a recent change in reimbursements that slashed general surgeon salaries? Any shifts in practice models with greedy corporations buying up private practices?

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[LucidSplash]

You should go back to the part you wrote about methodologies and results from surveys being unreliable. That is more than enough to explain a 9% swing in already unreliable data.

 

[Pir8DeacDoc]

See if you can get your hands on the newest mgma. May be more useful.

 

[doc05]

Agree. Medscape data is worthless.

 

[Winged Scapula]

In addition to the above, which is absolutely correct, more general surgeons are employed now than in private practice.

This tends to keep salaries down so some reimbursement differences may reflect the practice environment of the participants.

 

[Medicaldoctorintraining]

Ok thank you for the responses. So what it sounds like, from the three responses, is that there hasn't been any significant change in how surgeons are compensated?

I was just curious because I was going through historical data and when I saw a big drop like that there was usually an explanation (Example: Neurology when there was a slash in EMG reimbursements etc.)

 

[Winged Scapula]

Ok thank you for the responses. So what it sounds like, from the three responses, is that there hasn't been any significant change in how surgeons are compensated?

I was just curious because I was going through historical data and when I saw a big drop like that there was usually an explanation (Example: Neurology when there was a slash in EMG reimbursements etc.)

There’s a HUGE difference in HOW surgeons are compensated.

When I finished just over a decade ago, 2/3 of General Surgeons were in PP and somewhat controlled how much they made by how much they worked, how many patients they saw, the complexities of those patients, how many surgeries they did etc.

Now about 1/3 are in PP and the rest are employed. While some employment models will have a bonus structure or allow busier more productive Surgeons to earn more there are many which are flat salary with no extra pay for number of cases, taking ER call or based on RVUs.

If I use my own group as an example, two of our employed surgeons are happy with a flat base salary and are not interested in working extra hours or seeing more patients to make more money. They make about 1/3 of the busier ones.

What has NOT changed significantly is reimbursement. Ones payment will change with CMS rates (and your payor mix and contracts) and does not keep pace with inflation, while the costs of running a business increases every year. This is why an employer needs to verify that their employee is bringing in enough to cover their salary and overhead costs. This is true whether you’re in private practice or working at a big-name academic center. Some of the cost cutting maneuvers in the latter are done so to keep the department in the black.

Now if significant portion of your business is dependent on a single CPT code and the reimbursement for that gets slashed, then of course you are going to see a difference in the income, whether you’re in private practice or employed position. The radiologist used to fight me to do stereotactic breast biopsies when the reimbursement was over $1200. Now that it’s about 1/8 of that suddenly they’re no longer caring whether I do them or they do them.

 

[Pir8DeacDoc]

Wow, can't believe you have folks that would sign on to take a flat salary and no potential bonus based on RVU productivity. That's just dumb. I fully get that some people want more lifestyle oriented practice, but wow.

 

[Winged Scapula]

Wow, can't believe you have folks that would sign on to take a flat salary and no potential bonus based on RVU productivity. That's just dumb. I fully get that some people want more lifestyle oriented practice, but wow.

There is some truth to the stereotype that (some) women don't know how to bargain. They both came from straight salary backgrounds, so they didn't ask for anything else. They also didn't want to be "bothered" with running numbers and being concerned whether they were seeing enough patients.

It was also probably a factor that they didn't want to work as hard; frankly, given the number of patients they see, the length of their office day and cases done per week, they would have a hard time doing as well on any other model. We actually had to tell them they had to see more patients to make the same salary they were making before (they were employed by an oncology group that used them as loss leaders for the in house referrals so there was no oversight into hours they worked, number of patients they saw, etc). Let's just say we weren't going to pay them $250K to see 5-8 patients per day.

 

[Pir8DeacDoc]

So many different ways to practice /be paid. Interesting