April 28, 2014

Anesthesiologists, once the third most highly-paid specialists, have dropped to sixth place in Medscape’s latest survey of physician compensation.  The 2014 report, based on 2013 data, shows an average income from patient care activities of $338,000 for anesthesiologists, compared to $413,000 for orthopedic surgeons, who are at the top of the list.

In contrast, according to the MGMA Physician Compensation and Production Survey, 2013 Report Based on 2012 Data, the average compensation for anesthesiologists was $428,208, or about $90,000, one year earlier.  The median was $427,000 and the 90th percentile was over $584,000.  Furthermore, the MGMA Report indicates that between 2008 and 2012, anesthesiologist compensation increased in every year but 2010.

The average anesthesiologist compensation figure produced by Jackson & Coker’s physician salary calculator a year ago was $456,078, as reported in 8 Statistics on Annual & Hourly Anesthesiologist Compensation in Becker’s Hospital Review on April 25, 2013.

What should one make of such different data?  Surveys vary in the nature and number of respondents, for one thing.  While only about 1,444 anesthesiologists completed the Medscape survey, the MGMA values came from 2,660 anesthesiologists (in 141 practices)—and the Jackson & Coker figure was based on pay data for 24,521 anesthesiologists in the staffing company’s proprietary provider database.  The proportions of the Medscape respondents located in each region, and whether they were in private or academic practice was not stated.  The single value reported for Jackson & Coker was a national average; it is likely that geographic differences can be determined by parties with access to the calculator.

The method of data collection and the survey definitions are among the other factors affecting the information synthesized and making apples-to-apples comparisons very difficult.  No other organization releasing data on physician compensation provides as much detail on its survey methodology, nor as many different breakdowns by physician specialty, subspecialty, geographic region, type and size of practice, years in practice as does MGMA, and that is a major reason that MGMA’s numbers always merit very serious consideration.

Another Source of Income for Anesthesiologists:  Medical Directorships 

MGMA has just published the results of another survey, the Medical Directorship and On-Call Compensation Survey, 2014 Report based on 2013 data.  The mean total annualized compensation, consisting of stipends and deferred compensation such as an annuity, for medical director services, across all 27 anesthesiology participating in the survey, was $51,636.  The 25th percentile was $15,000, the median was $37,800 and the value at the 90th percentile $90,000—figures that should be interpreted in light of the fact that the standard deviation was greater than the mean.  The average number of hours spent on directorship activities was 9.4.

Regional differences were highly significant.  The median directorship paid more than ten times as much in the Eastern section of the country than in the Midwest.

Medical director services included: attend standing meetings, clinical patient complaints, clinical peer review, community relations, develop policies/procedures, documentation/care planning, emergency issues, equipment selection/maintenance/planning, monitor quality/appropriateness of medical care, physician behavior/impairment issues, physician education, physician relations/representation, provide guidance/leadership for performance guidelines, provider of last resort/call availability, recruitment, regulation/licensure/credentialing, research, strategic development and technical oversight.  The list is reproduced here because of its potential utility in developing position descriptions and compensation packages.

More Information from the Medscape Survey

Because the Medscape survey is one of the very few that reports its results extensively and publicly, we should be acquainted with some of its data on anesthesiologists:

• Anesthesiologists’ incomes are the highest in the North Central states, followed in order by South Central, Southeast, Great Lakes and Mid-Atlantic (tied), Southwest, West and Northeast (tied) and, in last place, the Northwest.
• 79% spend more than 40 hours per week seeing patients.
• 32% have an average of 25-49 patient visits per week, with 49% having 50 or more.
• 23% participate in ACOs and another 9% plan to do so this year.
• Equal numbers (22%) say that they will drop insurers that pay poorly and that they need to participate with all payers. Another 18% say that they will not drop poor payers because it would be “inappropriate” to do so.
• 65% expect their incomes to decrease as health insurance exchanges expand.
• Only about one-third offer ancillary services, including postoperative pain management.
• One of the benefits of practicing anesthesiology is the relatively low amount of time spent on paperwork and administrative tasks.  More than 80% of the respondents reported spending fewer than 10 hours per week on such work.  One-fourth of self-employed physicians and 35% of employed physicians in other specialties spent at least 10 hours per week on paperwork.
• If the respondents “had to do it all over again,” 47% would choose medicine as a career, 48% would choose the same specialty, and only 23% would choose the same practice setting.  The anesthesiologists were less satisfied than physicians collectively, 58% of whom would choose medicine again.  The percentages for the various specialties are set forth in the table below:

The data noted above are from Medscape’s Anesthesiologist Compensation Report.  The Report encompassing all specialties provides for some interesting comparisons, and also for some trend information.  ACOs, for example, are growing quickly; while only three percent of physicians participated in ACOs in 2011, 24 percent did in 2013, and another 10 percent expect to join ACOs this year. 

Given the numbers of respondents in each specialty, and given that the Reports reveal very little of the respondents’ demographics or of the survey methodology, the Medscape data is best used to supplement other surveys such as those fielded by our specialty’s professional organizations, notably MGMA and the ASA.  Reliable survey data are extremely important to negotiating, planning and other exercises, as we all know.  We appreciate the serious efforts that have gone into responding to the professional organization surveys and encourage everyone to participate in future versions.

With best wishes,

Tony Mira
President and CEO