Medscape physician compensation report 2017

[DefinitelyNotTaylorSwift]

Anyone know why plastics suddenly jumped up?

http://www.medscape.com/slideshow/compensation-2017-overview-6008547

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[673441]

Feeding the American ego by crafting artificial appearances en lieu of underlying unsettled problems in their self-esteem/consciousness. I call em surgical psychiatrists.


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[cellsaver]

Feeding the American ego by crafting artificial appearances en lieu of underlying unsettled problems in their self-esteem/consciousness.

Spot on

 

[750335]

whoa - pathology 293k?

 

[Warderino92]

These numbers are self reported right? It could just be the mix of people reporting or how truthful they want to be with accurate numbers.

 

[Dro133]

How is it that the "I would choose medicine again" numbers are so much higher in this year's report compared to last? Page 38 of this year's report, and here's last year's:

Medscape Physician Compensation Report 2016

 

[673441]

How is it that the "I would choose medicine again" numbers are so much higher in this year's report compared to last? Page 38 of this year's report, and here's last year's:

Medscape Physician Compensation Report 2016

I have a theory as to why this may be the case... our board scores are pivotal, and so getting high scores often times will cloud your judgement in favor of the highest paying residency programs. This would mean that unless you're very passionate about PC, then you are unlikely to pursue it. On the flip-side, you got low board scores and you're just generally speaking happier about getting "a" residency. Unless you're at a IVY league PC program, then you likely didn't have high board scores (not all, but most). So, some really brilliant med students who are naturally more fit for family, end up in ortho and run into a role conflict when they realize that these other ortho guys aren't relatable to them. Just my theory, no evidence at all here. Proof is when you try to apply to a community family program with 90+ board scores, that program will not rank you by virtue of disbelief that you "probably" wouldn't rank them back. So they would pick someone more likely to rank them as their number 1.


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[Dr. Death]

My theory is that different people responded this year than last. The sample sizes are small enough that you can't make broad sweeping statements from anything in this study. 19k physicians represents less than 2% of the physicians in the United States. And across 26 specialties comes out to be an average of 730 physicians per field. Obviously not all fields are the same size which is why you get year to year variation in smaller fields, like plastic surgery.

 

[McDreamy123]

Eh, I've been told by people senior to me it's all about the MGMA reports --not sure how medscape compares. And plastics is odd ball field where you have people working in academics slaving away on reconstruction, burns, wound care etc for $350k and then people running private cosmetic centers doing wolf of wall street stuff. Hugely variable so any fluctuation could be expected by the nature of the variability within the field itself.

 

[dempty]

My theory is that different people responded this year than last. The sample sizes are small enough that you can't make broad sweeping statements from anything in this study. 19k physicians represents less than 2% of the physicians in the United States. And across 26 specialties comes out to be an average of 730 physicians per field. Obviously not all fields are the same size which is why you get year to year variation in smaller fields, like plastic surgery.

The sample size is less likely to be the issue in comparison to whether or not the sample is representative of the population. That's the whole point of sampling and a fundamental idea of statistics. A representative subset of the population of interest can give you a pretty accurate picture of the population.

 

[DefinitelyNotTaylorSwift]

My theory is that different people responded this year than last. The sample sizes are small enough that you can't make broad sweeping statements from anything in this study. 19k physicians represents less than 2% of the physicians in the United States. And across 26 specialties comes out to be an average of 730 physicians per field. Obviously not all fields are the same size which is why you get year to year variation in smaller fields, like plastic surgery.

The sample size is less likely to be the issue in comparison to whether or not the sample is representative of the population. That's the whole point of sampling and a fundamental idea of statistics. A representative subset of the population of interest can give you a pretty accurate picture of the population.

Um from my understanding they gave out the surveys to the same group of people who responded last year so fluctuations in sample selection would not be an issue at all... these are the same people responding, which is why I wanted to know how the plastics salary jumped up so much.

 

[Autopsy101]

whoa - pathology 293k?

Pathology is a field where salaries vary widely between private practice, academics, commercial labs, and area of the country. This depends entirely on who chooses to respond to the survey and what practice setting they are in.

 

[Dro133]

Um from my understanding they gave out the surveys to the same group of people who responded last year

Where does it say this?

 

[67552931811]

Clearly a poor representation of the grueling hardships and staggering debt most if not all physicians incur as a result of their passion for helping the undeserved. MGMA is wildly inflated too; don't believe their lies.

As physicians, we should not disparage other specialties because we all rise and fall together.

Incorrect.

 

[dempty]

Um from my understanding they gave out the surveys to the same group of people who responded last year so fluctuations in sample selection would not be an issue at all... these are the same people responding, which is why I wanted to know how the plastics salary jumped up so much.

Not sure how this applies to what I said.

 

[FindMeOnTheLinks]

Um from my understanding they gave out the surveys to the same group of people who responded last year so fluctuations in sample selection would not be an issue at all... these are the same people responding, which is why I wanted to know how the plastics salary jumped up so much.

Nowhere does it say they only send the survey to the same people who responded last year. If so, the people running the medscape survey are freaking idiots and nobody should take it seriously anyway.

Also this still doesn't really address the concept that a representative sample can be an accurate depiction of the population at large independent of sample size. Even if it's the same people responding every year (which is highly doubtful), if that sample is representative, then it's representative and the sample size does not matter.

 

[ERDOC555]

The jumps for surgery aren't surprising to me. If you talk to any practicing surgeon outside of academia the majority are clearing 400k per year for most fields. This is anecdotal, but my theory is that this year is more accurate and past years had deflated surgical salaries.

 

[673441]

Nowhere does it say they only send the survey to the same people who responded last year. If so, the people running the medscape survey are freaking idiots and nobody should take it seriously anyway.

Also this still doesn't really address the concept that a representative sample can be an accurate depiction of the population at large independent of sample size. Even if it's the same people responding every year (which is highly doubtful), if that sample is representative, then it's representative and the sample size does not matter.

It would be a statistical disaster! But even so, the sample populations from last year and this year could be taken in together to increase the power marginally. I'm confused why this data gets such little respondents?


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[dempty]

... the sample populations ... taken together to increase the power...

Not trolling, but out of curiosity, what do you mean by "sample populations"? A sample is a subset of experimental units from the population. The population is the whole, typically unobservable, set of potential experimental units about which we're trying to learn.

I'm also not entirely sure how combining the yearly samples would do anything for the power, since power would only be useful in the case of inferential statistics. I couldn't read the article for some reason, so I don't know if they did any sort of testing, but I thought these reports were typically just descriptive in nature.

 

[dempty]

Nowhere does it say they only send the survey to the same people who responded last year. If so, the people running the medscape survey are freaking idiots and nobody should take it seriously anyway.

Also this still doesn't really address the concept that a representative sample can be an accurate depiction of the population at large independent of sample size. Even if it's the same people responding every year (which is highly doubtful), if that sample is representative, then it's representative and the sample size does not matter.

It's always a fun conversation when people try to use election polling as the example: "...1000 people isn't enough to get it right about hundreds of millions of people..." The real issue with election polling, like many things, is that it's incredibly far from representative sampling.

 

[673441]

Not trolling, but out of curiosity, what do you mean by "sample populations"? A sample is a subset of experimental units from the population. The population is the whole, typically unobservable, set of potential experimental units about which we're trying to learn.

I'm also not entirely sure how combining the yearly samples would do anything for the power, since power would only be useful in the case of inferential statistics. I couldn't read the article for some reason, so I don't know if they did any sort of testing, but I thought these reports were typically just descriptive in nature.

That's why I said marginal... lmao also, I have no idea wtf I'm talking about...


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[dempty]

That's why I said marginal... lmao also, I have no idea wtf I'm talking about...


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This is probably the most commendable response I've heard from someone, rather than some BS

 

[ChrisMack390]

Is it me or does there seem to be a disconnect between this report and the doom and gloom we often see on SDN? Looks like wages are increasing every year and the majority of physicians are satisfied with their pay and would choose to enter medicine again.

 

[Strider_91]

Is it me or does there seem to be a disconnect between this report and the doom and gloom we often see on SDN? Looks like wages are increasing every year and the majority of physicians are satisfied with their pay and would choose to enter medicine again.

My thoughts exactly..:salaries have increased for almost every specialty since 2012. Would love to know what the baby boomers were making in the 80s and 90s that makes them say medicine is no longer "worth it." In my town growing up I didn't know a single family bringing in 300k...

Although I do know an attorney that did personal injury and the no fault insurance in my state apparently used to reimburse around 5k for an epidural. This is literally a 10 minute procedure that doesn't even work a large majority of the time and you need to do several more....now I think they reimburse around 200 bucks so I guess I'd be butthurt about that too but cmon...that **** was atrocious to charge that much.

 

[Stagg737]

Is it me or does there seem to be a disconnect between this report and the doom and gloom we often see on SDN? Looks like wages are increasing every year and the majority of physicians are satisfied with their pay and would choose to enter medicine again.

It's an anonymous forum where a lot of people come to vent their frustrations and like the survey is a very small sample size of all physicians/future physicians. Most of the docs I know/work(ed) with really do like their jobs as a whole, but it doesn't always seem that way because it's a demanding career that can tire you out pretty easily. I can relate as I've loved most of my rotations but sometimes people think I'm miserable just because I'm exhausted during my down time.

My thoughts exactly..:salaries have increased for almost every specialty since 2012. Would love to know what the baby boomers were making in the 80s and 90s that makes them say medicine is no longer "worth it." In my town growing up I didn't know a single family bringing in 300k...

A few things to think about when the older docs say it's no longer "worth it". The first, from what I've heard, is that there was a lot less administrative and bureaucratic interference with medicine in the past. Doctors could practice what they felt was best and not have to worry about bowing down to administrators or getting blasted by sanctions and government following seemingly arbitrary government standards. To go along with that, the technologic takeover of medicine, especially in terms of charting changed everything and a lot of the older guys just didn't adjust well to having to use EMRs. It changed the entire way they documented, which can be miserable when you've been able to chart how you wanted to for 30+ years. Throw in the sheer number of different EMRs out there, many of which have or had major compatibility issues and I understand their frustration.

I also don't think it has to do with them making less, I think it has to do with them feeling like they have to do 10x the work (because of all the hoops to jump through) to make the same or a little more than they used to. Insurance companies have made billing ridiculous to the point that there are multiple codes for the same treatment, but you won't be reimbursed if you don't use the correct one. To compensate for that, a lot more physicians have taken the route of being employed instead of entering private practice (or even had to sell their practice). The tradeoff is that they may not have to worry about getting paid if they make a mistake, but they've sacrificed autonomy.

That brings up another major issue, which is the general shift in power in the medical field. Where in the past the doctors were in charge and had final say about how they would treat their patient, that power has shifted to administrators, insurance companies, and the government (which may get even more power over this in the near future). It's tough to go from being the king of the hill to being told what you can or can't do, and some people would rather retire than have to deal with it.

Some of the older attendings can add to this post or correct me where I'm wrong, but for those people you talked to I think it's less about the actual income and more about the general landscape of the healthcare industry. On the monetary side though, even if they are making significantly more than they used to in terms of raw salary, everything has become more expensive. So while they may make "just as much" or more than they used to, their spending power may have actually gotten worse due to rises in costs of living. Being a millionaire 30 years ago was a big deal. Today, not so much.

Edit: Looking at the report it's impressive to see every field getting above the 200k mark though. Given how expensive med school has become it's encouraging to see even the lower paying fields have a shot at paying back large debts and still have a shot at a good lifestyle.

 

[Mr Kenobi]

PM&R doing work!




*No survey replies received due to golf priorities.

 

[Strider_91]

It's an anonymous forum where a lot of people come to vent their frustrations and like the survey is a very small sample size of all physicians/future physicians. Most of the docs I know/work(ed) with really do like their jobs as a whole, but it doesn't always seem that way because it's a demanding career that can tire you out pretty easily. I can relate as I've loved most of my rotations but sometimes people think I'm miserable just because I'm exhausted during my down time.



A few things to think about when the older docs say it's no longer "worth it". The first, from what I've heard, is that there was a lot less administrative and bureaucratic interference with medicine in the past. Doctors could practice what they felt was best and not have to worry about bowing down to administrators or getting blasted by sanctions and government following seemingly arbitrary government standards. To go along with that, the technologic takeover of medicine, especially in terms of charting changed everything and a lot of the older guys just didn't adjust well to having to use EMRs. It changed the entire way they documented, which can be miserable when you've been able to chart how you wanted to for 30+ years. Throw in the sheer number of different EMRs out there, many of which have or had major compatibility issues and I understand their frustration.

I also don't think it has to do with them making less, I think it has to do with them feeling like they have to do 10x the work (because of all the hoops to jump through) to make the same or a little more than they used to. Insurance companies have made billing ridiculous to the point that there are multiple codes for the same treatment, but you won't be reimbursed if you don't use the correct one. To compensate for that, a lot more physicians have taken the route of being employed instead of entering private practice (or even had to sell their practice). The tradeoff is that they may not have to worry about getting paid if they make a mistake, but they've sacrificed autonomy.

That brings up another major issue, which is the general shift in power in the medical field. Where in the past the doctors were in charge and had final say about how they would treat their patient, that power has shifted to administrators, insurance companies, and the government (which may get even more power over this in the near future). It's tough to go from being the king of the hill to being told what you can or can't do, and some people would rather retire than have to deal with it.

Some of the older attendings can add to this post or correct me where I'm wrong, but for those people you talked to I think it's less about the actual income and more about the general landscape of the healthcare industry. On the monetary side though, even if they are making significantly more than they used to in terms of raw salary, everything has become more expensive. So while they may make "just as much" or more than they used to, their spending power may have actually gotten worse due to rises in costs of living. Being a millionaire 30 years ago was a big deal. Today, not so much.

Edit: Looking at the report it's impressive to see every field getting above the 200k mark though. Given how expensive med school has become it's encouraging to see even the lower paying fields have a shot at paying back large debts and still have a shot at a good lifestyle.

I think you have hit the nail on the head. The bureaucracy seems to be the death of private practice. Even in the past year working for a private practice physician I have seen an increase in bureacrazy...it seems that more and more of the medications we prescribe get denied or require prior auth. It almost seems that some insurance companies have employed a "never pay on the first attempt model" and see if the physician is willing to go through the trouble to get prior auth/ appeal.

This is obviously annoying (but it usually staff dealing with more than the physician I.e me) and I think it will eventually lead physicians to get behind the "Medicare for all" type system that the Canadians use. According to Canadian reimbursement data they are all still making similar money to American physicians when you factor in overhead costs; up there the physicians making the most seem to ophthalmologists instead of orthopods for some reason but it doesn't seem like the death of physicians becoming top earners in the country.

I have no idea if it's more or less hassle there but to me it would seem to be easier to deal with one insurance company than many with different rules.

 

[Strider_91]

PM&R doing work!




*No survey replies received due to golf priorities.

They make SOOO much they didn't report their numbers so the other specialties don't jealous
; )

 

[Mr Kenobi]

They make SOOO much they didn't report their numbers so the other specialties don't jealous
; )

 

[IlDestriero]

MGMA is a trusted metric for anesthesiologists.


--
Il Destriero

 

[scootad.]

People are forgetting that its compensation being measured by the MedScape survey. Compensation = Salary + Benefits. You can subtract 50-75k from the numbers to get the Salary #

 

[Stagg737]

I think you have hit the nail on the head. The bureaucracy seems to be the death of private practice. Even in the past year working for a private practice physician I have seen an increase in bureacrazy...it seems that more and more of the medications we prescribe get denied or require prior auth. It almost seems that some insurance companies have employed a "never pay on the first attempt model" and see if the physician is willing to go through the trouble to get prior auth/ appeal.

This is obviously annoying (but it usually staff dealing with more than the physician I.e me) and I think it will eventually lead physicians to get behind the "Medicare for all" type system that the Canadians use. According to Canadian reimbursement data they are all still making similar money to American physicians when you factor in overhead costs; up there the physicians making the most seem to ophthalmologists instead of orthopods for some reason but it doesn't seem like the death of physicians becoming top earners in the country.

I have no idea if it's more or less hassle there but to me it would seem to be easier to deal with one insurance company than many with different rules.

I doubt this will happen anytime soon in the U.S. as medicare/caid has miserable reimbursement rates. Ask some physicians you know about their reimbursement and they'll tell you that private practices can't support themselves if they take only (or even mostly take) medicare patients. Even some hospitals can't stay open if they're only taking medicare patients and there have been many rural facilities that have closed in the last 5-10 years for this very reason. If the gov decided to drastically increase their reimbursement rates to match current insurance companies you might see more physicians getting behind that plan, but until that happens (probably never), most physicians will continue to prefer patients with private insurance over medicare/caid even if the insurance companies are a pain to work with.

 

[Strider_91]

I doubt this will happen anytime soon in the U.S. as medicare/caid has miserable reimbursement rates. Ask some physicians you know about their reimbursement and they'll tell you that private practices can't support themselves if they take only (or even mostly take) medicare patients. Even some hospitals can't stay open if they're only taking medicare patients and there have been many rural facilities that have closed in the last 5-10 years for this very reason. If the gov decided to drastically increase their reimbursement rates to match current insurance companies you might see more physicians getting behind that plan, but until that happens (probably never), most physicians will continue to prefer patients with private insurance over medicare/caid even if the insurance companies are a pain to work with.

I know the reimbursements are not good right now, but that is in the current climate of significant overheard and difficulty collecting money from even insured patients. If it was Medicare type payments only as it is in Canada the physician I work for could literally fire 80% of his staff. No more 20 person billing department, you would need 1 or 2 people. 100% collection rate on services, no more time filling or prior auths (no staff members you needn't to pay to do this either).

I would think the savvy entrepreneur could run a bare bones small practice which such low overhead that they would be able to make a nice living. The days of a pediatrician in a small office with one reliable employee making appointments and a 1 person billing department could come back.

But hey, who knows...could be terrible

 

[dempty]

It's an anonymous forum where a lot of people come to vent their frustrations and like the survey is a very small sample size of all physicians/future physicians.

It's astounding how easily people conflate the idea of sample size with a representative sample... in the same thread, no less!

 

[Strider_91]

It's astounding how easily people conflate the idea of sample size with a representative sample... in the same thread, no less!

Sdn in a nutshell

Rational person: the future isn't that bleak for physicians. Most of the ones I know seem happy and do really well.

Sdn: I don't want anecdotes I want hard numbers

Rational person: ...shows numbers

Sdn: Those numbers are wrong; the future is bleak, be an NP or a robot they are all going to take our jobs anyway.

 

[Stagg737]

It's astounding how easily people conflate the idea of sample size with a representative sample... in the same thread, no less!

Sample size and representative sample aren't mutually exclusive concepts. If they were, N values in many studies would be irrelevant.

 

[ChrisMack390]

Sdn in a nutshell

Rational person: the future isn't that bleak for physicians. Most of the ones I know seem happy and do really well.

Sdn: I don't want anecdotes I want hard numbers

Rational person: ...shows numbers

Sdn: Those numbers are wrong; the future is bleak, be an NP or a robot they are all going to take our jobs anyway.

The happy docs are out rolling and cash and not posting on SDN

 

[dempty]

Sdn in a nutshell

Rational person: the future isn't that bleak for physicians. Most of the ones I know seem happy and do really well.

Sdn: I don't want anecdotes I want hard numbers

Rational person: ...shows numbers

Sdn: Those numbers are wrong; the future is bleak, be an NP or a robot they are all going to take our jobs anyway.

I'm just saying the numbers could be wrong or they could be right. My whole point is people keep saying "bro it's only a few hundred, so that can't be right!"

Sample size and representative sample aren't mutually exclusive concepts. If they were, N values in many studies would be irrelevant.

I don't recall saying they were mutually exclusive, but frequently, they're different things. As for your "N values", those have a lot more to do with adequate power and precise estimation than they do with representative sampling. You made the point to say that the forum and the survey are a small fraction of the population they're part of, therefore, it's not a good reflection of reality (or something like that). A representative sample is, by definition, a group that's an appropriate reflection of the target population. Pretty much the only way you can make your argument work is by gathering information on the entire population. Then, you have the population, so it is of course representative of itself, and you're not estimating anything.

There's a reason you don't survey 80,000 doctors for their take home pay and conclude this is a good estimate of the mean income for all citizens because it had a relatively large sample size. You'd be far better served by taking a random sample of a few hundred citizens to estimate the mean take home pay for all citizens. These are pretty distinct ideas overall.

Had to cut some out since I was already quoted

 

[Strider_91]

I'm just saying the numbers could be wrong or they could be right. My whole point is people keep saying "bro it's only a few hundred, so that can't be right!"

I don't recall saying they were mutually exclusive, but frequently, they're different things. As for your "N values", those have a lot more to do with adequate power and precise estimation than they do with representative sampling. You made the point to say that the forum and the survey are a small fraction of the population they're part of, therefore, it's not a good reflection of reality (or something like that). A representative sample is, by definition, a group that's an appropriate reflection of the target population. Pretty much the only way you can make your argument work is by gathering information on the entire population. Then, you have the population, so it is of course representative of itself, and you're not estimating anything.

There's a reason you don't survey 80,000 doctors for their take home pay and conclude this is a good estimate of the mean income for all citizens because it had a relatively large sample size. You'd be far better served by taking a random sample of a few hundred citizens to estimate the mean take home pay for all citizens. These are pretty distinct ideas overall.

For what it's worth, I agree with this guy ^^

 

[Stagg737]

I'm just saying the numbers could be wrong or they could be right. My whole point is people keep saying "bro it's only a few hundred, so that can't be right!"

I don't recall saying they were mutually exclusive, but frequently, they're different things. As for your "N values", those have a lot more to do with adequate power and precise estimation than they do with representative sampling. You made the point to say that the forum and the survey are a small fraction of the population they're part of, therefore, it's not a good reflection of reality (or something like that). A representative sample is, by definition, a group that's an appropriate reflection of the target population. Pretty much the only way you can make your argument work is by gathering information on the entire population. Then, you have the population, so it is of course representative of itself, and you're not estimating anything.

There's a reason you don't survey 80,000 doctors for their take home pay and conclude this is a good estimate of the mean income for all citizens because it had a relatively large sample size. You'd be far better served by taking a random sample of a few hundred citizens to estimate the mean take home pay for all citizens. These are pretty distinct ideas overall.

Had to cut some out since I was already quoted

Sorry, that wasn't the point I was trying to make. I was trying to comment that SDN tends to attract a certain type of poster which make up a small portion of the overall physician population and that if more physicians posted here (especially in this particular forum), we'd have a more representative sample. I was inferring that the limited number of posters and the lack of variety often makes SDN more of an echo chamber of misery than a valid group. I think the reasoning behind the disconnect between SDN and the report has to do with both small sample size and some form of selection bias of the users SDN attracts.

 

[CompensationExpert]

The biggest problem with any compensation survey or report is either (a) it has the information to actually come to relevant conclusions or (b) it does not. This Medscape one does not nor do many of the sample surveys out there in articles. This to me is a big problem with reporting any type of salary or compensation. Think about it, you not only need to understand compensation (is it profit, W2, or one of multiple forms), does it include benefits?, but you also need to understand locations, work environments (hospital, private, corporate), and increased workload. In my experience, you need multiple surveys to even get a proper analysis going. The thing that makes me upset is that inaccurate surveys simply disadvantage physicians and do not provide them with relevant value. Of course it is different with everyone but if they keep publishing sample surveys without the necessary components, it just confuses everyone. Just my thoughts on the topic.