OrthoBuzz occasionally receives posts from guest bloggers. This guest post comes from Megan Conti Mica, MD, in response to the 2018 Medscape Orthopaedist Compensation Report.
In a recently published Medscape survey looking at orthopaedic compensation, orthopods were the second-highest paid specialists overall. Despite that, only 51% of orthopaedist respondents to the Medscape survey felt they were fairly compensated. My question to you is: How fairly compensated would orthopods feel if that second-highest salary was decreased by $150,000 annually without reason?
While the reported overall wage gap between female and male physicians is more than $50,000 annually1, the Medscape survey found that the gender wage difference for orthopaedic surgeons was $143,000 annually—adding injury to insult. That annual gap would amount to $4 million of lost wages for women over a 30-year career as an orthopaedic surgeon.
Why does medicine in general and orthopaedics in particular have a gender gap? Is it because male surgeons have better outcomes than female surgeons? Not according to a 2017 study that found that patients of female surgeons experienced lower death rates, fewer complications, and fewer 30-day readmissions to the hospital, compared with patients of male surgeons.2 While I do not believe that gender alone makes one a better surgeon, I do believe that gender diversity within our field is imperative.
What is more disheartening is it seems no one with the power to make change is doing anything to close the gap. In 2009, only 4% of the AAOS fellows were female. Honestly, I cannot blame women for not trying to join the “boys club.” If someone told you that you would be a distinct minority in your profession, make less, and have to work harder, most rational human beings would find a different career. If we want more women in orthopaedics, we need to understand that the gender wage gap is just the surface of a bigger issue.
I challenge everyone (men and women) to do better. Help your female partners. Be more attentive and mentor female surgeons. Support women when they speak up, and champion for them when they don’t. The attributes that make a great orthopaedic surgeon—love of and dedication to this great specialty—are gender-neutral.
Megan Conti Mica, MD is a hand and upper-extremity surgeon at the University of Chicago Medical Center and a member of the JBJS Social Media Advisory Board.
- JAMA Intern Med. 2016;176(9):1294-1304. doi: 10.1001/jamainternmed.2016.3284
- BMJ 2017;359:j4366, Published 10 October 2017. doi: 10.1136/bmj.j4366
For its 2016 survey of physician compensation, Medscape received information from more than 19,000 physicians across 26 specialties. Orthopaedists again topped the list this year at $443,000 (see graph below), followed by cardiologists ($410,000), and dermatologists ($381,000). Orthopaedists and cardiologists were the top two earners last year also (see related OrthoBuzz post).
Although orthopaedists were the highest-paid group overall, only 44% of them felt they were fairly compensated (see graph below). Orthopaedists who felt fairly paid made $156,000 more than those who believed their compensation was not fair.
On a more positive note, nearly half (46%) of orthopedists believe that relationships with patients are a major source of satisfaction (see below). In the comments section included with this question in the Medscape survey, orthopaedists frequently mentioned helping patients and teaching as rewards of practice.
In Medscape’s calculations, compensation for employed physicians included salary, bonus, and profit-sharing contributions. For partners, compensation included earnings after business taxes and deductions, but before income taxes.
Last year, we reported on orthopaedic surgeon compensation data from Medscape. This year, we take a look at orthopaedist compensation numbers (base salary, plus incentives and discretionary compensation) from the American Medical Group Association (AMGA).
According to the AMGA’s 2014 Medical Group Compensation and Financial Survey, median orthopaedic surgeon compensation in 2014 was $538,123, up 2.5% from 2013. Among the eight surgical specialties surveyed for compensation data (neurosurgery was not included), orthopaedists came in second to cardiac/thoracic surgeons (whose median was $569,073, up 8.2% from 2013).
Compensation data from orthopaedic subspecialists revealed the following medians, from lowest to highest:
Foot and Ankle $505,606
Sports Medicine $549,048
Joint Replacement $563,896
Readers should keep in mind that two-thirds of the more than 950 orthopaedists who responded to the compensation portion of the AGMA survey were from group practices comprised of more than 150 physicians. Data from those individuals may not represent the compensation realities for orthopaedic surgeons in independent or smaller group practices.
According to Medscape (login required), a dozen changes coming in 2015 could affect physician income and practice workflows. Here’s the list:
- Rise of High-Deductible Health Plans – According to the Kaiser Family Foundation, 18% of insured patients have at least a $2,000 deductible. Higher deductibles often mean more paperwork for practices, the need to provide cost estimates in advance, and increasing involvement with collection agencies.
- Declining Malpractice Premiums– For three benchmark specialties, ob/gyns, internists, and general surgeons, malpractice insurance premiums decreased by 13% since 2008. Some experts attribute the declines to tort reforms that were enacted many years ago, but most expect that premiums, which have proven to be cyclical, will start rising again.
- ICD-10 Really Coming– Many experts are saying the Oct. 1, 2015 deadline for the new ICD-10 coding system is for real this time, after repeated implementation delays. Although ICD-10 is supposed to cut down on errors and speed reimbursement, many physicians are skeptical that the technology will work.
- ACOs Enter a Crucial Year – 2015 marks the end of the 3- year shared-savings Medicare ACO contract, which shielded ACOs from losing money. Those that stay in the program will face financial penalties if they don’t hit certain targets. The Centers for Medicare & Medicaid Services (CMS) said that only one quarter existing Medicare ACOs received a shared-savings bonus.
- Concerns about Telemedicine– More patients may start using web- and phone-based physician services in 2015. The three largest telemedicine companies more than doubled their volume from 2011 to 2013 and continue to grow. Telemedicine does seem to be siphoning some patients from traditional practices, but the main concern is the quality of telemedicine-based diagnoses and treatments.
- Competition from Retail Clinics– Visits to walk-in, retail clinics skyrocketed by 400% from 2007 to 2009. Consultant Thomas Charland advises doctors to forge reciprocal referral relationships with retail clinics, rather than fighting them.
- PCPs to Lose Enhanced Medicaid Payments – At the beginning of 2015, Medicaid reimbursements for PCPs will fall back to their pre-“enhanced” levels, which average 40% below Medicare. Unless Congress extends the funding, some PCPs may be forced to reconsider how many Medicaid patients their practices can afford to take.
- Meaningful Use: Carrot Becomes Stick – In 2015, penalties for not entering the Medicare Meaningful Use program begin, starting at 1% of Medicare payments and moving to 3% in 2017. A survey by Medscape shows that 3 out of 4 doctors who have an EHR are attesting to Meaningful Use.
- Penalties Start under PQRS– In 2015. The Physician Quality Reporting System turns from voluntary to penalty-eligible. The penalty for not reporting quality data is 1.5% in 2015 and rises to 2% in 2016.
- New Physician-Payment Websites– Open Payment and Medicare payment websites report payments made to doctors either from Medicare or from drug and device manufacturers. Both websites have had technical glitches and have posted inaccurate information.
- Medicare Will Pay for Chronic Care Outreach –Medicare will pay physicians in 2015 for managing patients with two or more chronic conditions by phone or email. Doctors will receive $40.39 per patient per month for providing a minimum of 20 minutes of care. To qualify, doctors need to have an EHR system and be able to exchange patient information with other caregivers.
- New CPT Modifiers for Greater Specificity – Starting in January, instead of the catch-all, amorphous modifier 59, CMS will implement four new subset modifiers – XE, XS, XP and XU. The intention is to increase efficiency of payments to doctors.
According to a report on Medscape.com (registration required), for Francisco Velazco, an unemployed Seattle handyman, an online auction yielded an affordable solution to getting his torn ligament repaired. Without health insurance and unable to pay the $15,000 estimated cost from a local provider, Velazco turned to MediBid, an online medical auction site that matches patients who are seeking non-emergency treatment with physicians. MediBid doesn’t check provider credentials but requests physician license numbers so prospective patients can check on the physician’s credentials themselves.
Valazco paid $25 to post his request for surgery and a few days later he had bids for outpatient treatment from surgeons in New York, California, and Virginia. One bid for $7,500 included the anesthesia and related costs and information about orthopaedist Dr. William T. Grant in Charlottesville, Virginia. Velazco eventually underwent surgery in an outpatient surgical center that Dr. Grant co-owns. This was Dr. Grant’s first MediBid case, and he said, “I was certainly invested in wanting this to be a positive experience for everybody.” According to Velazco, the experience was ideal.
About 120,000 consumers have used MediBid, with many of them uninsured or covered by high-deductible health plans. On the provider end, there are about 6,000 physicians or surgery centers on board with MediBid, and they too pay a fee to bid on requests.
Not surprisingly online auctions for medical services have critics, among them Arthur L. Caplan, head of the division of bioethics at New York’s Langone Medical Center, who said, “Cheap sounds good, but in these auctions you’re not getting any information: Was the guy at the bottom of his class in medical school?”
Despite an average resident salary of $55,330 a year and over a third (36%) claiming they owe more than $200K in loans when they finish residency, 83% of residents polled by Medscape said they are still looking forward to practicing as a physician. Medscape’s recent survey, Residents Salary & Debt Report 2014, polled 1,200 residents across 25 specialties and revealed that orthopaedic residents make an average annual salary of $57,000. The highest average resident salaries of $65,000 are in critical care, and the lowest ($52,000) are in family medicine.
Despite low salaries, heavy debt load, and long work hours (66% of Year 1 residents spend 60+ hours a week at work), roughly half (48%) of male residents and 60% of female residents said they are compensated fairly.
Gender influences salaries in resident programs, but the male/female differential is only 4%, much lower than the 24% difference by gender among non-resident physicians. Geography also makes a difference in resident pay. Residents in the Northwest receive the highest salary (an average of $71K) followed by those in the Northeast, with an average salary of $61K.
Almost everyone will be affected by the Affordable Care Act in one way or another. For many, it will mean an abundance of new patients because as of Jan. 1, 2014, twenty-two states and the District of Columbia expanded access to Medicaid to children and adults with individual or family incomes less than 133% of the federal poverty levels. Additionally, Jan. 1st means the beginning of Stage 2 requirements of the CMS meaningful use program for EHRs. February 28 is also the reporting deadline for physicians to submit performance data that qualifies for a bonus through the Physician Quality Reporting System. To see more important dates and deadlines for physicians and healthcare providers, see Medscape’s slideshow (login required).