Front-line COVID-19 responders in middle of pack on pay

Dive Brief:

  • Prior to the coronavirus pandemic, primary care doctors earned an average annual salary of $243,000, up almost 3% from 2019, while specialists earned $346,000, a 2% increase, according to Medscape’s annual survey.
  • Emergency physicians on the front-line of the novel coronavirus pandemic are in the middle of the pack when it comes to compensation. On average, ER doctors earn $357,000 a year and $40,000 in incentive bonuses, almost $150,000 less than orthopaedic surgeons, who lead the pack at $511,000 annually and $96,000 in incentives.
  • Men continue to earn more than women, a trend that’s held now for a decade of Medscape reports. Among primary care physicians, men earn roughly 25% more than women, at $264,000 compared to $212,000 annually. Among specialists, men earn 31% more than women, at $375,000 compared to $286,000 annually.

Dive Insight:

The COVID-19 pandemic is exposing the pitfalls of a majority fee-for-service payment model, as hospitals and practices report plummeting volumes as potential patients shelter in place, slashing revenue and sparking pay cuts, layoffs and furloughs nationwide.

“Lower volume means lower pay for employed physicians when they are paid on straight productivity or other models that require high volumes,” Terrence McWilliams, chief clinical consultant at HSG, wrote of the results. The healthcare sector lost 1.4 million jobs in April on top of 43,000 in March due to the precarious economic environment.

The future, even in the short-term, is highly uncertain. The virus could lessen through the remainder of the year, resurge in the fall, or become a steady backdrop to American life. However, some analysts predict providers will receive a much-needed jolt in the second half of the year as they begin to work on the backlog of non-essential procedures delayed amid the pandemic.

Orthopaedic surgeons, the top-earning specialty, are seeing weekly volumes down 90% but predict a return to normal volumes in just six months as lucrative hip and knee replacements ramp back up. Orthopaedics and cardiology have been in the top five specialties for six years now, while the primary care disciplines are typically lower earning.

Rebecca Pifer/Healthcare Dive, data from Medscape

Public health and preventative medicine saw the biggest salary boost (11%) between 2019 and 2020, followed by allergy and immunology (9%), orthopaedics (6%) and oncology and neurology (5%). Otolaryngology and dermatology both saw pay decrease slightly, by 1% and 2% respectively.

Men continue to earn more than women in the same fields. For primary care, that gap remained unchanged from 2019, though in specialties it decreased somewhat from 33% to 31% as more women move into specialty fields. It’s a marked change from last year’s report, which found the pay gap ballooned between 2018 and 2019 from 18% to 25%.

Roughly two-thirds of survey respondents were male.

Fee-for-service continues to dominate the payment landscape. A small portion of doctors are in concierge and cash-only models, though they’re popular with adoptees. The number of accountable care organizations continues to decline: In 2020, 517 ACOs are participating in the Medicare Shared Savings Program, down from the program’s high of 561 in 2018.

Respondents also expressed disappointment in the Merit-based Incentive Payment System, a Medicare program that’s been applauded for incentivizing cost reduction and patient outcomes but criticized for burdensome reporting requirements. This year, just 39% of primary care physicians and 36% of specialists said they planned to continue in the program, compared with 42% and 37% last year.

Doctors continue to report high levels of administrative overhead, spending an average of 15.6 hours weekly on paperwork and 37.8 hours seeing patients. Main stressors include a thicket of rules and regulations, long hours and working with a complex EHR system.

However, doctors still report satisfaction and positivity about their fields, with an overwhelming majority (77%) saying they would choose to practice medicine again.

Survey data was collected pre-pandemic up to Feb. 10.