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The 2018 Medscape Physician Compensation Report still has rheumatologist pay in the bottom third of all surveyed specialties. But the upward trend line continues to show that progress is being made, says Anne Bass, MD, chair of the ACR’s Committee on Rheumatology Training and Workforce Issues.
“I’m definitely heartened,” she says. “We have, as we all know, workforce challenges ahead of us. We need to continue to attract residents into our field. And actually, the demand to go into the field has increased over the past couple of years. … So I’m very heartened, because medical school isn’t getting any cheaper, and if you come out of school with a lot of debt, that definitely plays into training choices.”
The fields that top Medscape’s annual survey—which queried more than 20,000 physicians across nearly 30 specialties—continue to be procedure based. Plastic surgery (avg. $501,000), orthopedics (avg. $497,000) and cardiology (avg. $423,000) were the top three specialties for the second year in a row. At the same time, cognitive fields continue to be the lowest-paid specialties. Public health and preventative medicine had the lowest salaries (avg. $199,000 each), followed by pediatrics (avg. $212,000) and diabetes and endocrinology (avg. $212,000 each).
“The healthcare payment system is very much procedure based, very much biased toward paying proceduralists,” Dr. Bass says. “Half an hour in the operating room gets you an awful lot more income than half an hour with a patient.”
Another issues for rheumatology is the gender disparity in compensation. Male specialists earn about 36% more than female specialists ($358,000 vs. $263,000), according to Medscape. And because a majority of rheumatologists entering the field have been women in recent years, that has a disproportionate effect on the specialty.
Overall, the healthcare payment system also favors inpatient specialties, because inpatient visits receive higher reimbursement.
“The outpatient fields—endocrine, rheumatology, certainly pediatrics, allergy, immunology—those tend to be the least well reimbursed,” Dr. Bass says.
Looking for Change
The ACR continues to lobby for compensation reform that more fairly accounts for the work of cognitive physicians, such as rheumatologists.
“I think our legislative outreach group has been very, very strong and very important in directing the legislative agenda around (the Medicare Access and CHIP Reauthorization Act of 2015), around infusion medicines, around visa issues for foreign medical graduates,” Dr. Bass says. “Our organization has been quite active and has maintained long standing relationships with legislators who are involved in the issues.”
Dr. Bass says that although proceduralists often worry most about how payment reform, such as bundling, may cut their salary, cognitive physicians are more focused on inefficiencies in the current system.
“The issue that is first and foremost in rheumatologists’ minds is the huge amount time wasted on paperwork,” she adds. “Administrative time, filling out preapproval forms to get medications for our patients. That is the thing that bothers [rheumatologists] the most.”
Of course, those frustrations feed into reimbursement issues because the time spent on those tasks takes away from other activities, such as seeing patients.
“If I were to pick one item that was at the top of everybody’s list of priorities, it would be patient access to medications—reducing medication costs and reducing the bureaucracy associated with getting them for our patients,” she says.
To that end, Dr. Bass hopes that rank-and-file physicians see compensation studies from groups like Medscape as a clarion call for action. She believes rheumatologists are engaged in healthcare as a whole—particularly because Medscape’s survey shows that 82% of rheumatologists would still choose to go into medicine if they had it to do over.
But just 72% of those rheumatologists would still choose the specialty, which Dr. Bass attributes to the frustrations of the overall healthcare system. Overall, just 62% of specialists would choose their specialty again, according to the data.
“I don’t see that as a hindrance,” Dr. Bass says. “We’re a happy community. I think it’s, intellectually, a very exciting field, and we have long-term relationships with our patients. It’s a very nice community to be a part of. Those are all great things, but that doesn’t change the fact that we’re working within the American healthcare system, which is a challenge—to put it mildly.”
Richard Quinn is a freelance writer in New Jersey.
- Kane, L. Medscape Physician Compensation Report 2018. Medscape. 2018 Apr 11.