Anesthesiologists’ Compensation and Practice Information from Medscape’s 2015 Survey
Medscape is one of the very few organizations that surveys physicians on compensation and practice patterns, breaks out the specialty of anesthesiology and publishes the results for free. The Medscape Anesthesiologist Compensation Report also has one of the larger absolute response rates; in the most recent survey, reported in March 2015, 1179 responses were received from anesthesiologists during the period December 30, 2014 – March 11, 2015. For those reasons alone, it behooves anesthesiology practices to be familiar with the Medscape data. The sample is small. It is probably not representative. As science, the survey does not pass muster. But since there is so little information of any better quality available, the Medscape compensation surveys are being used, usually in conjunction with other surveys such as those published (and sold) by the Medical Group Management Association (MGMA) and American Medical Group Association.
The weakness of the information is slightly mitigated by comparing several years’ worth of survey data. Consistency over time may enhance the credibility of the values—or at least their direction. Thus it is plausible that average compensation increased by 9.25 percent between late 2012 and early 2015 (from $337,000 to $358,000), but the absolute values may be on the low side because of an apparent overrepresentation of employed physicians among the respondents. Very low reported compensation levels for academic and government-employed anesthesiologists, which includes military physicians, may have an undue influence. Compensation for self-employed physicians (2015: $410,000) and those working in “office-based single-specialty groups” (2015: $429,000) as opposed to “healthcare organizations” (2015: $385,000) seems more in line with, but still lower than, the average compensation figures in the most recent MGMA Physician Compensation and Production Survey: 2014 Report Based on 2013 Data, which reported a national mean total compensation level of $439,509 (and a standard deviation of $121,743). Then again, Doximity, a LinkedIn style social network for physicians featured in The Atlantic online (January 27, 2015) claimed to include data from more than 18,000 physicians with an average anesthesiologist salary of $357,116.
It is impossible to determine the extent to which the Medscape information is representative based on what was published. That said, anesthesiologists need to know what the Medscape data appear to show, since hospitals and payers will be using them. Table 1 below contains compensation information from the 2013, 2014 and 2015 surveys. The data in each case were collected around the start of the new year. According to Medscape, ”For employed physicians, compensation includes salary, bonus, and profit-sharing contributions. For partners, compensation includes earnings after tax-deductible business expenses but before income tax.”
Three specialties—orthopedics, cardiology and gastroenterology—in that order, reported higher average incomes than anesthesiology in the most recent survey. In 2014, urology and radiology also came in above anesthesiology. Overall career satisfaction, as well as satisfaction with income, placed anesthesiologists behind dermatology, pathology and emergency medicine in 2015.
The South Central states (Texas, Oklahoma and Arkansas) reported the highest average compensation levels in 2015 and the North Central States (North Dakota, South Dakota, Nebraska, Kansas, Iowa and Missouri) placed first in 2013 and 2014. The MGMA survey shows the Midwest and the Southern regions reporting the greatest average compensation, with the Eastern region coming in lowest, as it did in the 2013 Medscape surveys but not in 2014 or 2015.
Reactions to Obamacare include clear expectations that incomes will decrease with participation in Health Insurance Exchanges (HIEs). As shown in Table 2 below, 65 percent of anesthesiologists responding to the 2014 Medscape survey expected a decrease, as did 58 percent this year. The proportion of anesthesiologists who planned to participate in HIEs dropped from 27 percent to 19 percent even though the proportion that did not anticipate that HIE participation would bring about any change in their income grew from 31 percent to 39 percent—perhaps a reflection of uncertainty about the future of HIEs and Obamacare altogether.
In contrast, the interest in accountable care organizations (ACOs) has been growing—as has the interest in accepting cash only and no third party payment arrangements. More anesthesiologists, especially the self-employed (approximately one-third of respondents), have begun offering ancillary services, typically postoperative pain management.
Medical practice surveys, in the end, remind us of Rorschach inkblot images—what one person sees in them is often very different from what the image says to another individual. Most such surveys suffer from very small and unrepresentative response samples. The questions asked are often ambiguous and the definitions alone can be as long as, or longer than, the questionnaire. The response pool seems to grow ever smaller in anesthesia, as more and more practices join large national companies that eschew third-party surveys altogether and rely on their own internal information.
Nevertheless, negotiations over anesthesiologists’ compensation often involve third party surveys. As in all negotiations, it is important to know the information available to the other party. It is in that spirit that we offer the foregoing summary of the Medscape survey, and we do encourage readers to go to the source if you need a better understanding of the data.