Despite an overall slowing of compensation increases across all medical specialties, interventional radiologists (IR) saw their incomes take a sizeable leap in 2012, while salaries for diagnostic radiologists (DR) dipped slightly for the second year in a row.
Of the 30 specialties surveyed for the 2013 American Medical Group Association (AMGA) 26th Annual Medical Group Compensation and Financial Survey, more than 60 percent experienced compensation increases from 2011 to 2012. Nevertheless, the overall weighted average of 1.6 percent marked the third consecutive year salaries increased below the approximate 3 percent average threshold, according to AMGA.
AMGA mailed the survey questionnaire to medical groups across the country in January 2013 and received responses from 280 groups representing more than 67,000 providers.
The survey showed that the median compensation level for interventional radiologists was $504,277, a 4.02 percent increase from 2011 to 2012, while median compensation for diagnostic radiologists fell by 1.3 percent to $453,216 in that time. In terms of compensation levels, radiologists again ranked fourth and fifth, respectively, among specialties surveyed.
Nevertheless, the sizeable salary increase in 2012 for interventional radiology actually falls in line with more moderate increases in other specialties, after factoring in the year-to-year percentage change from 2011-2013, said Brad Vaudrey, M.B.A., C.P.A., principal at Sullivan, Cotter & Associates, Inc., which administered the AMGA survey.
“I was surprised by the 4.02 percent increase,” Vaudrey said. “We’ve seen a definite slowing down on the revenue side with radiology. It looks like a blip in compensation for this year, but if you look at it overall between 2011 and 2013, the average change for interventional was 2.5 percent. So overall, it’s still been fairly level.”
Changing demographics among the medical groups surveyed could be a factor in the increase seen by interventional radiologists, Vaudrey said. Medical groups continue to merge and make acquisitions, which sometimes provide the acquired physician some guaranteed salary or one-time retention bonuses.
“Our surveys show that groups are getting bigger,” Vaudrey said. “There’s a bit of a population shift underway. Medical groups as acquisitions are occurring in large numbers, and that includes radiology. Our demographics have traditionally been very much focused on larger multispecialty groups, and those are the groups that are acquiring these practices.”
“We’re seeing increasing integration throughout the country, with groups affiliating or merging to form larger health systems to focus on population health,” said Donald W. Fisher, Ph.D., CAE, AMGA’s president and chief executive officer. “Also, new payment models are emerging that rely on various specialties collaborating to achieve outcomes. Radiologists are a central part of any multispecialty medical group or organized system of care seeking to treat patients for their entire life span, so the specialty is still in high demand. These may be contributing factors to the increase in compensation for interventional radiologists. It will be interesting to monitor over the next few years as these trends continue to evolve.”
Compensation for primary care specialties increased by approximately 2.8 percent— the same increase as in 2011—while the survey showed compensation increased by only 1.5 percent for other medical specialties and even less for surgical specialties (0.5 percent).
The troubled U.S. economy and uncertainty in payment reform models continued to be a factor in keeping overall compensation increases to below the approximate 3 percent average, which historically tracks at or slightly above the overall inflationary index, Vaudrey added.
“Overall we’re seeing a relative flattening in compensation rates,” Vaudrey said. “In some cases we’re seeing decreases, but overall we’re anticipating a low-rise increase for the next year or two. We’re not going to see significant jumps like we’ve seen in the past for some of the surgical and medical specialties. I still expect primary care to experience bigger compensation increases down the line.”
Cath lab cardiologists overtook cardiac/thoracic surgeons to become the highest-paid specialty, earning a median average salary of $547,112, a 4.27 percent increase from 2011. Cardiac/thoracic surgeons were second with a median salary of $525,944, a decrease of 3.33 percent, while orthopedic surgeons received a median salary $525,000, a 1.79 percent drop from the previous year.
The biggest increases in annual compensation were seen in endocrinology (up 5.81 percent to a median $234,258), infectious disease (up 5.64 percent to a median $242,477), rheumatology (up 4.89 percent to a median $240,250) and anesthesiology (up 4.6 percent to a median $394,734).
Relative Value Units are a measure of physician output based on the value assigned to each Current Procedural Terminology (CPT) code through the resource-based relative value scale used partially by Medicare and nearly all health maintenance organizations. Reimbursement by the Centers for Medicare & Medicaid Services (CMS) is based on the RVU system, so overall revenue rises when RVUs increase, as they did in 2012. Overall, weighted-RVUs increased by approximately 1.5 percent across all specialties in 2012.
According to the survey, RVUs for medical and surgical specialties remained flat, increasing 0.1 percent and 0.8 percent, respectively, while RVUs for primary care specialties increased by 2.5 percent on average. The highest work RVU increases were seen in psychiatry (10.5 percent) and infectious disease (10.3 percent). Diagnostic radiology was next with a 6.32 percent average increase while interventional radiology saw only a 1.02 percent increase from the previous year.
Over two years (2010 and 2012), the survey shows a downward trend in work RVUs for both diagnostic (-2 percent) and interventional (-7.5 percent) radiology. Experts believe this could be related to the recent CMS Medicare Physician Fee Schedule guidelines lowering fees for multiple studies provided to the same patient by the same physician during a single healthcare visit and for imaging contiguous body parts in the same session.
“The CMS change has affected radiology to a great degree,” said David Yousem, M.D., M.B.A., a professor in the Department of Radiology, vice-chair of program development and director of neuroradiology at Johns Hopkins Hospital in Baltimore, and a nationally recognized expert on radiology economics. “RVUs are down because of the new way they are calculated. When radiologists conduct a chest and abdomen exam, the second study only gets credited for 50 percent of the RVUs, as opposed to the previous rate of 100 percent.”
Vaudrey said he once again expects between a 1 to 3 percent increase in the year-to-year annual compensation rates across all specialties, including radiology. He also said an overall decrease in annual compensation is unlikely.
“I don’t think we’ll see a decrease unless there is a decrease in the production level overall,” Vaudrey said. “We’ll see moderate increases for the next two or three years and the same with productivity. RVUs will probably remain fairly steady, barring CMS value changes.”
More information about the American Medical Group Association is available at www.amga.org.
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