Physician Income
in the Rochester Area –
How Do We Compare?
Report of a Survey of Physician Income
Rochester Physician Workforce Task Force
Monroe County Medical Society
September, 2005
Revised November 2005
Disclaimer: the 2004 Physician Income Survey and Report are intended solely for
the purpose of providing information to physicians and policy makers regarding
physician recruitment and retention in the Rochester region. It may not be used for
any purpose that may violate federal and/or state anti-trust laws. No legal,
accounting or professional advice is rendered herein, and readers should discuss
specific situations with their own professional advisors.
The Medical Society provides only aggregated income data to be used only for
informational purposes, and disclaims any attempt to directly or indirectly suggest
what income or reimbursement should be established for physicians. The Monroe
County Medical Society strives not to violate any U.S. antitrust laws in collecting or
disseminating income information.
Please be aware that, despite the most careful planning, any report contains some
inherent errors. This data is provided “as is” and the Monroe County Medical
Society makes no warranty, either express or implied, including but not limited to,
warranties of correctness and fitness for a particular purpose.
The Monroe County Medical Society
wishes to thank the following
individuals and groups
for making this study possible:
The nearly 1,000 area physicians for completing the survey
including the always private and personal information on income
The Finger Lakes Health Systems Agency
for acting as an independent recipient of the survey data
and for their analysis and primary authorship of this report
and the Rochester Physician Workforce Task Force
for oversight of this survey and
their ongoing efforts to assure that there is an
adequate and appropriate physician workforce
to meet the community’s health care needs.
Rochester Physician Workforce
Task Force
Aetna
Eastman Kodak Company
Excellus BlueCross BlueShield, Rochester Region
Finger Lakes Health Systems Agency
Greater Rochester Independent Practice Association
Monroe County Department of Public Health
Monroe County Medical Society
Monroe Plan for Medical Care
Preferred Care
Rochester Business Alliance
Rochester Community Individual Practice Association
Rochester General Physician Organization
Rochester Health Commission
Rochester Individual Practice Association
Unity Health System
University of Rochester Medical Center
ViaHealth
Table of Contents
Executive Summary
Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Page i
Recommendations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Page iii
Report
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Page 1
Response Rate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Page 3
Hours of Work . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Page 5
Professional Income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Page 7
Urban / Rural Differences . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Page 13
Is Physician Income in the Rochester Area Competitive? . . . . . . . . . . . . . . . . . . . . . . . . . Page 14
Incidental Findings from the Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Page 16
Age Issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Page 16
Trends in Supply of Physicians . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Page 16
List of Figures, Charts, and Appendices
Response Rate to Survey by Specialty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Patient Care Hours Per Week by Specialty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Professional Income by Specialty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Ratio of Local Income to MGMA, Unadjusted and Adjusted for Work-Time, by Specialty . . . 10
Income by Specialty, Employed and Self-Employed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Ratio of Local Income to MGMA, Employed and Self-Employed, by Specialty . . . . . . . . . . . . 12
Urban/Rural Differences in Income by Specialty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Survey Response, “Are Rochester MD Incomes Competitive?” . . . . . . . . . . . . . . . . . . . . . . . . . 14
Themes of Free-text Response, by Specialty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Appendix, Survey Questionnaire . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Executive Summary
Conclusions
The present study does not answer all questions about physician income –more information is always
needed. While the study garnered a response rate far higher than most surveys of the physician
community, for a number of specialties there were not sufficient numbers of responses to be assured
that the sample was representative. The survey, to be less burdensome to the respondents (and
thereby achieve a better response rate) eliminated a number of questions from the 2003 survey,
including questions of total professional work time. Despite any shortfalls, this survey provided
information from which several conclusions can be drawn, and by which many conclusions from the
2003 survey can be verified:
!
Overall income levels generally appear to be below comparison values (see Table 4). Six
specialties are within ±10% of MGMA regional income benchmarks, but 11 specialties
report incomes which are 10% to 20% below their regional counterparts, and 7 others are
more than 20% below regional medians, including 2 specialties which are more than 30%
below comparisons.
!
If one adjusts for direct care hours worked, the income comparison is somewhat less
depressed. Six specialties have median incomes which appear to be more than regional
comparisons, 9 specialties are in the ±10% band, and 3 specialties are 10% to 30% below
regional comparisons. However, the number of specialties whose incomes are more than
30% below their regional peers increases to 5, when adjusted for patient care time worked.
!
Reflective of national trends, income is less for cognitive services than for procedural
services. Primary care practitioners and practitioners in specialties such as Child Psychiatry,
Occupational Medicine, Infectious Diseases, Endocrinology, Physical Medicine & Rehab all
receive incomes below the Rochester area median.
!
While remunerated at levels substantially less than procedural specialties, local primary care
– Family Practice, Pediatrics, and Internal Medicine – and other cognitive specialties are
remunerated at levels equal to their regional colleagues.
Monroe County Medical Society
September 2005
!
Specialties which rely largely on procedures, on the other hand, are less well paid than their
colleagues in other areas. Examples are orthopedics (68% of time-adjusted MGMA regional
median), ophthalmology (69%), plastic surgery (74%), otolaryngology (70%), and general
surgery (83%).
!
The current survey indicates that many local physicians spend less time in direct patient care
than national averages. Because of the question design, the survey is unable to differentiate
how much of this variation is related to administrative tasks versus differences in practice
patterns (i.e., teaching, research, part-time status).
!
There is a perception expressed by many respondents that they are having to work harder,
compared even to a few years ago, to maintain their income.
!
In some specialties – such as colorectal surgery, general surgery, neonatology, oncology, and
vascular surgery – the region is in danger of losing a significant portion of its practitioners
to retirement within the next 5 years.
The focus of this survey was to gather data on the income levels for physicians to discern their
effects on physician recruitment and retention. The “marketplace” for physicians has changed
dramatically in the last decade with national shortages present and developing in many specialties.
Our area now has to compete on a national level for physicians to ensure access to quality
professional services. While reimbursement level is certainly not the only factor in recruitment and
retention, it plays an increasing role as competition for these professionals has heated up.
Unfortunately, this survey confirms the impression from the 2003 survey that in aggregate physician
compensation lags regional benchmarks, and in some critical specialties we are 30% or more below
specialty-specific benchmarks.
The results of this survey need to be viewed in the context that income level is only part of the
equation in workforce attraction and maintenance. There is a lower cost of living here than other
areas, especially other areas in the urban northeast. There are cultural and environmental amenities
here not found in many places. But with that said, we as a community need to address the deficit in
reimbursement that is identified with this survey, to have a reasonable chance at maintaining the
excellent level of health care we currently enjoy and that area businesses tout as an advantage as they
recruit essential employees for their work force.
Monroe County Medical Society
September 2005
Page ii
Recommendations
1.
Recognizing that the physician workforce committee is not empowered to actually affect the
rates paid for physician services, yet given that 60% of respondents did not feel their income
was competitive, this committee should continue to monitor and report to the community the
status of the community’s “competitive position” in physician reimbursement. It can act as
a resource to those groups that have more direct control over factors determining
reimbursement (insurers, physician organizations, employers).
2.
This survey provides important information regarding physician income. However, in order
to ensure that the local physician supply is adequate to meet the needs of our community
other factors must be considered. Additional study should be given to quantifying the other
direct factors that affect our ability to recruit and retain physicians. Professional lifestyle,
matching opportunities to the goals of residents, the relatively low cost of living in the
Rochester area, relatively small number of insurers, by many accounts low pressure “health
care management” compared to areas such as California – all contribute to being competitive.
3.
In discussing solutions to the reimbursement issue, information on work effort, such as
RVUs, should be considered along with the results of this study.
4.
Before there is a crisis in access to care, efforts should be made to recruit physicians in
specialties identified as currently being in shortage or projected to develop shortages due to
retirement. Efforts should also be made to improve ways to retain current physicians,
including older physicians.
5.
There are national shortages predicted in some specialties. These trends should be
considered as we address issues of competitive salaries. Primary care specialties are
highlighted by some as an area where future focus will be needed.
6.
The next study by the Task Force should include quantification of a) the amount of work
done by area physicians to earn their income – perhaps measured in RVUs rather than hours
– compared to other areas, and b) the amount of non-clinical time required per unit of clinical
time. These items would seek to specifically measure the perception that local physicians
work harder than their peers in other areas of the country to earn the same (or lower) income.
Monroe County Medical Society
September 2005
Page iii
Introduction
In a report1 issued in July 2003, the Monroe County Medical Society-organized Rochester Physician
Workforce Task Force reported on a survey of physicians conducted for the Task Force by the Center
for Governmental Research. The survey was focused on determining factors affecting recruitment
and retention of physicians in the Rochester area.
The 2003 Report found that, to have a positive effect on physician recruitment/retention, the Task
Force and other Rochester-area parties needed to:
!
!
!
Restore a collaborative health care environment;
Actively promote the Rochester Community to prospective and current physicians;
Address financial issues.
A key finding from the study was that six out of ten responding physicians indicated that financial
compensation was lower here than elsewhere, making them want to leave the area and/or standing
as a barrier to recruitment. Unfortunately, the CGR study was able to garner only a 26% response
rate, which substantially limited the Task Force’s ability to draw conclusions, including which
specialties were most affected by reimbursement shortfalls. As a result, the Task Force recommended that there was a need to further address the financial issues raised by the responding
physicians.
The issue of financial compensation for physicians is one that has been studied nationally by
academic researchers, policy experts and physician groups. The Center for Health Systems Change
found that physicians experienced a decline in real income between 1995 and 1999 (6.4% for
primary care and 4% for specialists). The researchers attributed the decline to managed care plans
1
Rochester Physician Workforce Task Force, Monroe County Medical Society, “The
Rochester Community Physician Workforce: Factors Affecting Recruitment and Retention”,
July 2003.
Monroe County Medical Society
September 2005
negotiating lower prices and controlling utilization. Similar events had occurred in the Rochester
area, and there was an often-heard perception from physicians that they were working harder and
earning less. Thus, the identified dissatisfaction with physician compensation was seen as having
both national and local components.
In order to better document both the reality and the perception of physician frustration over
compensation, the Rochester Physician Workforce Task Force committed to re-survey the physician
community. In an attempt to improve the survey participation rate, the survey was sharply focused
on compensation and made as short as possible. The survey data were collected from September
2004 to May 2005 and requested data for calendar year 2003; results are presented in this report.
Using a combination of mailing lists of the Medical Society and Preferred Care, surveys were
distributed to all active physicians in the Rochester service area2. To avoid any business or privacy
issues, none of the survey responses were received by the Medical Society or any insurer. Rather,
the survey responses were received and compiled by Finger Lakes Health Systems Agency; aggregate
results were provided to and discussed by the Task Force.
The survey was initially distributed by fax, with responses to be faxed to FLHSA. This proved to
be difficult for physicians, with many expressing concerns about data privacy in the physician office
and in-ability to transmit the sensitive income data anonymously to FLHSA. The survey was
subsequently distributed through physician mailboxes in hospitals and staff and committee meetings.
Two waves of mailings of the survey, with return envelopes, followed. Responses were received
from 987 individuals. Some responses announced retirements, were from non-physician providers
or were otherwise unusable, resulting in a final total of 976 usable responses, a 41% response rate.
2
In addition to Monroe County, also includes Orleans and Genesee Counties to the west and
Livingston, Steuben, Ontario, Wayne, Seneca and Yates Counties to the south and east.
Monroe County Medical Society
September 2005
Page 2
Response Rate
As mentioned, the overall response rate was 976 usable surveys, a 41% response rate. This compares
very favorably with national experience with surveys of physicians, which typically average about
a 20% response rate. Responses by specialty varied substantially, from 50%-75% response for some
specialties but 10%-15% response from others. Table 1 displays the results overall and for all
specialties; 5 responses which did not indicate specialty are included in the totals only.
The number of physicians in the area used as the denominator in calculation of response rate is based
on active physicians participating with one of the local insurers. Some mis-classifications of
specialty lead to response rates in excess of 100%. For instance, it is believed that a number of
physicians who describe their specialty as “hospitalist” are listed in the insurer’s data as, for instance,
internal medicine specialists; child psychiatrists and occupational medicine specialists exhibit similar
problems.
While a 41% response rate is exemplary, it still leaves some specialties with small numbers of
respondents. Care must be taken to avoid release of information where small numbers would make
it possible to discern sensitive data. Further, some specialties had relatively low response rates,
raising questions about the representativeness of the data. After consultation with statisticians, the
decision was made by the Task Force that generally it would not analyze information for specialties
where there was less than a 20% response rate. Following that rule, the survey is able to report
information on 29 separate specialties. While the decision rules were different, the 2003 survey also
had to suppress some specialities’ responses and was able to report out on 15 specialties.
Monroe County Medical Society
September 2005
Page 3
TABLE 1
Response Rate to Physician Surveys
2005 S urvey*
Specialty
Responses
ALL RESPO NS ES**
ALLERGY
ANESTHESIOLOGY
CARDIOLOGY
CHILD PSYCHIATRY
COLORECTAL SURGERY
CRITICAL CARE MEDICINE
DERMATOLOGY
EMERGEN CY MED
ENDOCRINOLOGY
FAMILY MED
GASTROENTEROLOGY
GENERAL SURGERY
GYN
HOSPITALIST
IM/PED
INF DIS
INTERNAL MED.
NEONATOLOGY
NEPHROLOGY
NEURO SURGERY
NEUROLOGY
OB/G YN
OCCU PATIONAL MED
ONCOLOGY
OPHTHALMOLOGY
ORAL SURGERY
ORTHOPEDIC SURGERY
OTOLARYNGOLOGY
PATHOLOGY
PEDIATRICS
PHYSICAL MED AND REHAB
PLASTIC SURGERY
PSYCHIATRY
PUBLIC HEALTH
PULMONAR Y MED
RADIATION ONCOLOGY
RADIOLOGY
RHEUMATOLOGY
UROLOGY
VASCULAR SURGERY
OTHER
MISSING
976
9
11
10
19
4
7
9
21
4
96
7
46
3
8
8
12
217
10
3
2
18
54
6
15
33
3
35
21
6
150
5
5
54
1
7
5
24
6
7
6
# in Area
2003 S urvey*
# in
Response
Response %
Responses
Area
%
2,363
23
89
92
18
4
31
38
34
18
214
40
92
41%
39%
12%
11%
106%
100%
23%
24%
62%
22%
45%
18%
50%
604
5
10
2,311
13
89
26%
38%
11%
2
4
50%
7
14
7
54
37
34
20
190
19%
41%
35%
28%
34
82
41%
5
19
28
503
12
28
15
64
150
5
18
74
13
90
38
8
219
15
21
88
160%
42%
43%
43%
83%
11%
13%
28%
36%
120%
83%
45%
23%
39%
55%
75%
68%
33%
24%
61%
5
0
NA
153
705
22%
1
11
32
12
67
142
8%
16%
23%
24
70
34%
9
10
6
92
7
5
41
87
33
8
295
16
20
143
10%
30%
75%
31%
34%
25%
29%
37
20
131
20
38
11
19%
25%
18%
30%
18%
55%
22
4
7
6
13
23
137
17
32
22
36
16%
24%
22%
27%
36%
5
Insufficient response for further analysis due to small response percent (less than 20%).
Privacy caution will be used in reporting due to small numbers (fewer than 6 responses).
* 2003 survey included aggregation of some smaller specialties into primary specialties such as internal medicine.
** Total includes 5 responses which did not indicate specialty.
Monroe County Medical Society
September 2005
Page 4
Hours of Work
The 2003 survey (which reported on 2001 data) found that local physicians, on average, spend less
time in patient care and less time in total hours of work than national averages. However, this
measure is highly dependent on the subjective interpretation of what “direct patient care” is. The
current survey chose the “direct patient care” wording to best represent the supply of physicians
available to patients. The option of simply asking hours worked was rejected, as it would have been
inclusive of time spent in teaching, research, and administration.
The 2003 report compared its survey findings with data from the AMA. However, the AMA data
on patient care time included not only direct, face-to-face patient care hours, but also “having
telephone conversations with patients or their families, consulting with other physicians, and
providing other services to patients such as interpreting lab tests and x-rays.” While these activities
are legitimate patient care activities, there was a real sense among the Task Force that local
physicians provided “face-to-face” time in their survey responses, leading to some apparent disparity
in reported patient care effort.
The present survey could have attempted to rectify the confusion about definitions. Unfortunately,
however, the AMA no longer produces the data on physician work hours or income. Further, there
are differences in the make-up of physicians surveyed by AMA compared to the local physician
population: the former tend to include largely independent practice physicians, while locally about
50% of physicians are employed. In this report, responses are compared to survey data of the
Medical Group Management Association (MGMA); MGMA tends to be representative of physicians
in larger group practices. The MGMA data does not include an “All Respondents” figure.
In the current survey (labeled 2005 Survey in all following tables, and reporting on 2003 income
data), physicians were asked to indicate their “number of hours of direct patient care per week.”
Overall, respondents say they provide an average of 38.9 hours and a median of 40.0 hours of patient
care time per week. These figures were slightly higher than that of the 2003 survey, when
respondents indicated they provide 38.0 hours per week for patient care activities. That survey also
found that respondents spent 6 hours per week on administrative tasks and lesser amounts on
teaching, research and other activities. The 2005 survey, which was primarily focused on income
issues but also supply or availability of physicians to provide patient care, did not measure all
professional time, but text comments provided suggest that area physicians believe the non-patient
care time requirements have increased in recent years.
Monroe County Medical Society
September 2005
Page 5
TABLE 2
PATIENT CARE HOURS PER WEEK
Specialty
2005 Survey
Rochester
Mean
Median
2003 Survey
Rochester
MGMA
Regional
Median
ALL RESPONSES
38.9
40.0
38.0
NA
ALLERGY
29.1
31.0
31.4
40
CHILD PSYCHIATRY
31.9
28.5
40
COLORECTAL SURGERY
41.5
40.0
47
CRITICAL CARE MEDICINE
47.5
50.0
40
DERMATOLOGY
28.4
30.0
31.9
36
EMERGEN CY MED
29.5
28.0
25.8
40
FAMILY MED
33.1
35.0
32.1
40
GENERAL SURGERY
55.9
57.5
51.5
55
HOSPITALIST
40.0
40.0
45.6
40
IM/PED
30.7
35.0
40
INFECTIOUS DISEASE
11.9
8.0
40
INTERNAL MEDICINE
40.3
40.0
NEONATOLOGY
30.8
20.0
NEUROLOGY
28.4
25.0
31.0
44
OB/G YN
48.5
47.5
41.4
45
OCCUPATIONAL MEDICINE
31.3
32.0
ONCOLOGY
44.7
40.0
OPHTHALMOLOGY
39.8
40.0
35.8
40
ORTHOPEDIC SURGERY
47.4
50.0
53.0
45
OTOLARYNGOLOGY
50.8
50.0
45.7
40
PATHOLOGY
24.0
10.0
25.8
PEDIATRICS
32.2
32.0
34.6
40
PHYSICAL MED AND REHAB
47.2
50.0
32.2
44
PLASTIC SURGERY
65.0
65.0
40.0
50
PSYCHIATRY
35.9
40.0
31.9
40
RADIATION ONCOLOGY
42.0
40.0
RHEUMATOLOGY
24.3
22.5
30.0
40
VASCULAR SURGERY
54.0
60.0
Monroe County Medical Society
39.9
40
47
50
September 2005
Page 6
Professional Income
The 2005 survey asked respondents to indicate their total 2003 professional income after expenses
but before taxes. The wording of the question was the same as the previous survey, and the same
as the question found on the AMA and MGMA surveys.3
The survey asked for patient care time, only a portion of professional activity, but total net practice
income, a potential mis-match. What portion of income is derived from patient care? Surprisingly,
most specialties indicated that 95% or more of income was derived from patient care activities. A
major exception was infectious diseases, where practitioners indicated they spend only 12 hours per
week in direct patient care and derive only 16% of income from patient care. A few other specialties
derived only 65% to 75% of income from direct patient care, but no pattern could be discerned.
The survey found that responding physicians had an average 2003 income of $174,000, with a
median of $150,000 (see Table 3). The median value is a drop from the 2001 value of $155,000
found in the previous survey, but it is uncertain if the change is significant or merely differences in
sampling. There have been changes in local physician reimbursement rates in the intervening two
years, but they include both increases and reductions. It is important to note that these salary figures
do not separate out situations where subsidies are provided to employed physicians. This survey
cannot comment on the prevalence of subsidies, but there are anecdotal reports of substantial
subsidies for some practitioners. If subsidies are prevalent, the survey may overstate the amount
earned by provision of medical care services, and may be reflected in the differences between
employed and self-employed physicians observed in Tables 5 and 6.
The primary care specialties, particularly Family Medicine and Pediatrics, are among the lowestcompensated specialties in the current survey; as will be seen, however, their income is similar to
incomes of colleagues in other parts of the nation. Other specialties which are more cognitive and
evaluative (rather than being procedure-oriented), such as child psychiatry, infectious disease,
occupational medicine, and physical medicine and rehabilitation, also report relatively lower income.
Procedure-based specialties, such as orthopedic surgery, earn a larger income than cognitive
specialties, but lag farther behind their regional peers.
3
“During 2003, what was your own net income from medical practice to the nearest $10,000
after expenses but before taxes? Please include both your direct compensation (e.g. salary, bonus,
research stipends, honoraria, etc.) AND all voluntary salary reductions (e.g. 401(k), 403(b), etc.).
Do not include investment income from medical-related enterprises independent of your medical
practice.”
Monroe County Medical Society
September 2005
Page 7
TABLE 3
PROFESSIONAL INCOME
2005 Survey
2003 Survey
(2003)
Mean
Median
(2001)
Roch
% of
AM
A N atl
Median
AAMC
MGMA
(2003)
Natio nal
Median
MGMA
(2003)
Regional
Median
Specialty
ALL RESPONSES
174
150
ALLERGY
239
CHILD PSYCHIATRY
155
89%
NA
NA
250
235
301
120
125
180
COLORECTAL SURGERY
214
183
CRITICAL CARE MEDICINE
192
183
DERMATOLOGY
287
200
EMERGEN CY MED
202
200
ENDOCRINOLOGY
135
130
FAMILY MEDICINE
110
110
107
79%
GENERAL SURGERY
220
200
193
80%
HOSPITALIST
149
140
IM/PED
144
145
INFECTIOUS DISEASE
141
140
INTERNAL MEDICINE
153
142
NEONATOLOGY
143
150
NEUROLOGY
198
155
144
90%
OB/G YN
203
200
187
93%
OCCUPATIONAL MEDICINE
140
140
ONCOLOGY
236
218
OPHTHALMOLOGY
216
240
191
ORTHOPEDIC SURGERY
298
268
275
OTOLARYNGOLOGY
243
245
200
PATHOLOGY
195
190
PEDIATRICS
127
120
PHYSICAL MED & REHAB
129
120
PLASTIC SURGERY
216
250
PSYCHIATRY
158
160
RADIATION ONCOLOGY
323
330
RHEUMATOLOGY
150
VASCULAR SURGERY
202
235
235
208
262
223
99%
211
185
109%
170
150
145
150
135
231
255
229
162
159
180
185
154
141
218
175
145
185
187
201
233
200
299
243
208
254
346
97%
237
364
355
99%
237
277
281
136
153
139
192
160
280
289
259*
141
159
149
185
193
175
200
433
455
145
101%
148
86%
135
150
108%
111%
*Used Eastern instead of North Atlantic median
Monroe County Medical Society
September 2005
Page 8
As can be seen above, there are substantial differences in national estimates of income by specialty.
In general, the MGMA data4 indicates higher incomes than does the AMA data, with the academicoriented AAMC data usually between. Some of the difference could be due to varying years for
which the data was collected. The regional data tends to be lower than the national data.
The Task Force believes the most appropriate comparison is to the regional estimate from MGMA5.
While there is a national market for physicians, the regional figure best reflects reimbursement
patterns. The AMA data is now out of date and not being updated.
Table 4, below, indicates that many local specialists are paid well below the regional benchmark.
Some adjustments may be appropriate, however. As seen earlier (Table 2), local physicians work
different numbers of hours than observed in the MGMA data; some work fewer hours, but some
(e.g., plastic surgeons) work more hours. Using those figures, the MGMA income data has been
adjusted for time worked. For example, local Family Practitioners indicate they work 35 clinical
hours per week, while FPs in the MGMA sample work a median of 40 hours. If the MGMA
respondents only worked 35 hours instead of 40, their income might be reduced proportionally, from
the base figure of $135,000 to an adjusted figure of $118,000. The ratio of the local FP income
figure of $110,000 to the adjusted MGMA figure of $118,000 is 93.1%, instead of the basic ratio of
81.5%. Table 4 displays both the unadjusted and the adjusted income ratios. On a time-adjusted
basis, incomes of most local specialties contrast more favorably to the benchmark; some like plastic
surgery, however, point out that for the amount of time they spend in care, they are less well paid
than their colleagues.
4
Medical Group Management Association, 2004 Physician Compensation and Production
Survey, based on 2003 data.
5
The MGMA survey includes data from 10 regions; New York is part of the North Atlantic
region, which also includes New Jersey and Pennsylvania. The Eastern Region, used as a substitute
for some specialties, includes states from Maine to Virginia.
Monroe County Medical Society
September 2005
Page 9
TABLE 4
Income Comparisons I
2005 survey
Specialty
Mean
Ratio of local income
to MGMA
regional median
Median (<100% indicates MGMA is larger)
Ratio of local income
to time-adjusted MGMA
regional median
(<100% indicates MGMA is larger)
ALLERGY
239
250
83.1%
107.2%
CHILD PSYCHIATRY
120
125
69.4%
97.5%
COLORECTAL SURGERY
214
183
77.7%
91.3%
CRITICAL CARE
192
183
77.9%
62.3%
DERMATOLOGY
287
200
89.7%
107.6%
EMERGEN CY MED
202
200
108.1%
139.0%
ENDOCRINOLOGY
135
130
86.7%
119.5%
FAMILY MEDICINE
110
110
81.5%
93.1%
GENERAL SURGERY
220
200
87.3%
83.5%
HOSPITALIST
149
140
88.1%
88.1%
IM/PED
144
145
INFECTIOUS DISEASE
141
130
75.7%
378.4% *
INTERNAL MEDICINE
153
142
100.4%
100.4%
NEONATOLOGY
143
150
85.7%
201.4%
NEUROLOGY
198
155
82.9%
145.9%
OB/G YN
203
200
100.0%
93.7%
OCCU PATIONAL MED
140
140
ONCOLOGY
257
235
89.7%
112.1%
OPHTHALMOLOGY
215
240
69.4%
69.4%
ORTHOPEDIC SURGERY
298
260
75.5%
67.9%
OTOLARYNGOLOGY
243
245
87.2%
69.8%
PATHOLOGY
195
190
PEDIATRICS
127
120
86.3%
107.9%
PHYSICAL MED AND
129
120
75.0%
66.0%
PLASTIC SURGERY
216
250
96.5%
74.3%
PSYCHIATRY
158
160
107.4%
107.4%
RADIATION ONCOLOGY
323
330
RHEUMATOLOGY
150
185
95.9%
105.7%
REHAB
*Probably erroneous in that a large portion of time is spent in non-clinical activities .
Monroe County Medical Society
September 2005
Page 10
Also affecting comparisons of income is the status of the physician as employed or self employed.
Employed status is less common in other parts of the nation than in the Rochester area.
There is no consistent pattern of whether self employed physicians make more or less than their
employed counterparts. Physicians may become employed because they wish to work fewer hours
and be relieved of the tasks of running a practice, thus being willing to accept a lower income for
lifestyle gains. Alternately, they may be highly prized clinicians and command a premium in the
marketplace, leading to higher salaries than their self-employed colleagues. Some specialties, such
as dermatology, may provide non-clinical opportunities to earn income, leading to higher incomes
for self-employed physicians.
TABLE 5
Income Comparisons II
2005 Survey
Mean
Median
Specialty
2005 Survey
Median
Self Employed
ALL RESPONSES
170
174
150
ALLERGY
283
239
250
CHILD PSYCHIATRY
123
120
125
COLORECTAL SURGERY
214
183
CRITICAL CARE MEDICINE
192
183
-0DERMATOLOGY
400
287
200
EMERGENCY MEDICINE
202
200
ENDOCRINOLOGY
135
130
FAMILY MEDICINE
90
110
110
GENERAL SURGERY
195
220
200
HOSPITALIST
-0149
140
IM/PED
144
145
INFECTIOUS DISEASE
-0141
130
INTERNAL MEDICINE
140
153
142
NEONATOLOGY
-0143
150
NEUROLOGY
198
155
OB/G YN
200
203
200
OCCU PATIONAL MED
140
140
ONCOLOGY
257
235
OPHTHALMOLOGY
200
215
240
ORTHOPEDIC SURGERY
250
298
260
OTOLARYNGOLOGY
150
243
245
PATHOLOGY
-0195
190
PEDIATRICS
145
127
120
PHYSICAL MED AND REHAB
129
120
PLASTIC SURGERY
216
250
PSYCHIATRY
160
158
160
RADIATION ONCOLOGY
-0323
330
RHEUMATOLOGY
150
185
Cells with few er than 6 res ponses have been suppressed for privacy.
Monroe County Medical Society
Employed
150
143
183
200
118
200
140
150
150
150
150
198
218
250
288
280
190
110
150
330
% of Respond.
Em ployed
52.4
22
37
50
100
33
86
75
57
24
100
38
100
52
100
72
48
67
73
24
23
52
100
55
80
40
50
100
67
September 2005
Page 11
Some specialties do better or worse when compared to the MGMA Regional benchmark depending
on employed/self employed status.
Table 6
Income Comparison III
2005 Survey
Med ian (2003)
Specialty
Self
Employed Employed
Ratio of EMPLOYED
incom e
to MG MA (2003)
(<100% indicates
MGMA is larger)
150
NA
Ratio of SELF-EMPLOYED
incom e
to MG MA (2003)
(<100% indicates
MGMA is larger)
ALL RESPONSES
170
ALLERGY
283
NA
CHILD PSYCHIATRY
123
143
79.2%
CRITICAL CARE
MEDICINE
-0-
183
77.7%
DERMATOLOGY
400
200
94.8%
90
118
87.4%
70.4%
195
200
87.3%
85.2%
140
88.1%
93.9%
68.1%
COLOR ECTAL
SURGERY
EMERGENCY MEDICINE
179.4%
ENDOCRINOLOGY
FAMILY MEDICINE
GENERAL SURGERY
HOSPITALIST
IM/PED
INFECTIOUS DISEASE
150
81.1%
INTERNAL MEDICINE
140
150
106.4%
NEONATOLOGY
-0-
150
85.7%
150
80.2%
198
98.8%
NEUROLOGY
OB/G YN
200
99.3%
100.0%
OCCU PATIONAL MED
ONCOLOGY
218
84.4%
200
250
72.3%
57.8%
OR TH OP ED IC
SURGERY
250
288
84.5%
70.4%
OTOLARYNGOLOGY
150
280
99.6%
53.4%
PATHOLOGY
-0-
190
PEDIATRICS
145
110
79.1%
104.3%
PSYCHIATRY
160
150
100.7%
107.4%
RADIATION ONCOLOGY
-0-
330
OPHTHALMOLOGY
ORAL SURGERY
RHEUMATOLOGY
Cells with few er than 6 res ponses have been suppressed privacy.
Monroe County Medical Society
September 2005
Page 12
Urban / Rural Differences
The present survey was distributed to physicians practicing in the 9-county area surrounding
Rochester. Are there differences in income among physicians outside Monroe County? The
following table, in which a number of specialties are grouped in order to ensure that the rural
groupings have an adequate number of respondents, shows that rural physicians enjoy largely equal
incomes to their urban colleagues. The exception appears to be among surgical specialists.
This result is consistent with a recent report6, which found that rural physicians often have higher
incomes than urban physicians, especially if cost of living is taken into account.
TABLE 7
Income Comparison IV
Urban/Rural Differences in Income
2005 SURVEY
UR BAN
RU RAL
N
M ED IAN
(000)
N
M ED IAN
(000)
806
$160
141
$150
56
$110
38
$120
PEDIATRICS
132
$120
14
$119
INTERNAL MEDICINE
192
$144
31
$140
52
$200
5
$210
100
$200
12
$270
GENERAL SURGERY
32
$200
13
$200
ORTHOPEDICS
21
$292
8
$215
OTHER SURGERY
58
$250
9
$232
163
$160
11
$202
ALL RESPONDENTS
FAMILY MEDICINE
OB/G YN
MEDICAL SPECIALTIES
HOSPITAL-BASED / OTHER
6
Reschovsky JD and Staiti A, “Physician Incomes in Rural and Urban America,” Issue Brief
92, Center for Studying Health System Change, January 2005.
Monroe County Medical Society
September 2005
Page 13
Is Physician Income in the Rochester Area Competitive?
Survey respondents were asked, “Do you
consider your income competitive for
recruitment and retention?” Nearly 60% of
respondents did not consider their income
competitive. Even if one considers that there
may be a negative response bias, the nearly
600 physicians who believe their income is
not competitive with other areas of the
country represent a substantial pool of
dissatisfaction. The perception may not be
accurate, however, as examined below.
Approximately 350 respondents, over onethird of all responses, provided free-text comments concerning the competitiveness of their income.
Concentrating on the comments of physicians less than 50 years of age (those who might be in the
best position to move if they are unhappy), the free-text was read to determine if there was a
discernible pattern to the comments. Table 8 presents some of those patterns or themes.
Some examples will give a flavor of the comments:
!
Income Inadequate – “Income level is substantially below other areas. Have lost more than
40% of our group to higher reimbursement positions.”
!
Income inadequate for workload – there are actually three ideas subsumed by this
category. The first is that a person has to work harder to earn the same income as a few years
ago. The second is that a person has to work a lot of hours (e.g., more than 60 hours/week)
to earn a desired income. The third is that paperwork and other non-clinical requirements
create an overburden which results in excessive workload, even if clinical time is
“reasonable.”
“Present compensation is 30% less than compensation in 1998-99 despite seeing an increase
in number of patients.” “My income is at that level because of volume of work.” “I work
many long hours including weekends and nights to care for my patients. The paperwork and
hassles are endless.” “My income has progressively gone down over the last 10 years yet I
am working harder.”
!
Income greater in other areas – “Took a [12%] loss of income moving from PA to NY.”
“Fees in Rochester are way too low, 10% higher in Syracuse and Buffalo, 30% higher in
Cleveland and Pittsburgh, 40%-50% higher in Florida.”
Monroe County Medical Society
September 2005
Page 14
Table 8
Specialty
N<50
# of
Comments
An esthe sia
9
4
Inco m e inad equ ate
Cardiology
6
2
Inco m e inad equ ate
Dermatology
6
2
Inco m e inad equ ate
Em ergency Med
12
4
Income greater in other areas
Fam ily Medicine
63
18
Gastroenterology
3
2
Internal Medicine
45
31
Neurology
8
4
W orklo ad/lifestyle
Obstetrics
22
6
Inco m e inad equ ate
Ophthalmology
16
4
Inco m e inad equ ate
Orthopedics
16
7
Income inadequate for workload
General Surgery
23
15
Income inadequate for workload
Pediatrics
76
19
No pa ttern
Psychiatry
28
16
Income inadequate for workload
Radiology
22
11
Inco m e inad equ ate
Others
11
3
Inco m e inad equ ate
“Themes”
Income inadequate for workload
Prim ary care un derp aid co m pare d to spec ialists
Inco m e inad equ ate
Income inadequate for workload
Prim ary care un derp aid co m pare d to spec ialists
In all, 80 (22%) of the 350 commentors indicated they did not feel their income was adequate, and
another 57 (16%) said the income was inadequate for the workload. Thirteen individuals indicated
they were moving away from the region due to inadequate compensation or poor working
environment. Nine blamed NYS issues , e.g., high taxes, for inability to recruit new physicians.
Eleven individuals indicated that the only physicians who can be recruited to Rochester are those
who have family ties or other personal reasons to come here. Interestingly, 7 commentors indicated
this was a good environment in which to practice, while 7 said it was a bad environment.
General surgeons expressed the most dissatisfaction as a specialty group. There was also a great deal
of dissatisfaction expressed by the disparity of income of the primary care practitioners compared
to other specialties.
The comments made were strongly held, but does the evidence match the perception? Commentors
who believed their income was not competitive had a median $10,000 less ($150,000 vs $160,000)
than commentors who believed their income was competitive.
Monroe County Medical Society
September 2005
Page 15
Data indicate that primary care practitioners – Family Practice, Internal Medicine, Pediatrics and
Obstetrics – are near par with income of their colleagues in other areas, but 60% (n=517) indicated
their income was not competitive. As discussed on page x, the disparity in income of primary care
practitioners and specialists is a national problem but a source of major frustrations for local primary
practitioners. On the other hand, the data also suggest that income of procedure-oriented
practitioners, such as General Surgery, Orthopedics, Ophthalmology, Otolaryngology, Plastic
Surgery, are well below their peers, and 85% (n=130) indicated they felt their income was not
competitive.
Incidental Findings from the Survey
Age Issues
The 2002 survey noted that some specialties in this area had a large portion of practitioners who were
approaching retirement age, suggesting possible future problems with access to those specialties.
The 2005 survey also asked respondents about age and retirement plans, incidental to the question
of recruitment and retention. In some specialties, including colorectal surgery, general surgery,
neonatology, oncology, and vascular surgery, over 25% of respondents indicated they would retire
in the next 5 years.
Trends in Supply of Physicians
Based on the number of physicians who bill local insurers, there were 2,363 clinically active
physicians in the area at the end of 2004. This is remarkably similar to the 2,311 physicians active
at the time of the 2003 survey.
A report being prepared for the Rump Group for release in a few months will incorporate the age
data from this survey, as well as data from the University of Rochester on plans of residents
completing their specialty training, interviews of physicians exiting the Rochester area and
interviews of physician and health care leaders. It seeks to identify local barriers to physician
recruiting and retention and to forecast specialties in which the area will need to recruit, retain or
develop additional supply in order to meet the needs of the community.
Monroe County Medical Society
September 2005
Page 16