Radiology Salaries Inch Up Slightly
Although experts had predicted numbers would hold steady or even drop for physicians in 2008, revenue and compensation increased slightly for radiologists last year, keeping in line with most specialties, according to an annual salary survey.
 Brad Vaudrey, M.B.A., C.P.A. RSM McGladrey, Inc. |
 Richard Duszak Jr., M.D. Mid-South Imaging & Therapeutics |
These findings are part of the American Medical Group Association (AMGA) 2009 Medical Compensation and Financial Survey sent to 2,700 medical groups in February 2009. Survey administrator RSM McGladrey received responses from 231 medical groups representing 44,200 providers.
According to the survey, salaries for interventional radiologists increased by 3.19 percent in 2008—down from the 5.28 percent increase that subspecialty posted in 2007. The median salary for an interventional radiologist was $478,000, remaining the second highest among 30 specialties included in the AMGA survey.
With a median salary of $438,115, diagnostic radiologists’ compensation increased by 4.10 percent in 2008, jumping from the 1.44 percent increase in 2007. Diagnostic radiologists scored the fifth highest annual compensation among the specialties surveyed.
Cardiac/thoracic surgeons were the highest paid specialty, with a median salary of $507,143, for a 1.98 percent increase. Specialties with the highest compensation increases from 2007 to 2008 were ophthalmology at 6.58 percent, otolaryngology at 8.63 percent, pathology at 11.02 percent and urgent care at 7.33 percent, according to the survey.
“We had projected that collected charges would be flat or even decrease in many specialties due to the changes in reimbursement from Centers for Medicare and Medicaid Services (CMS),” according to Brad Vaudrey, M.B.A., a director with RSM McGladrey’s Health Care Consulting Group. “But in terms of the physician compensation increase, there was an average increase of approximately 3.6 percent across all specialties.”
The marginal fluctuation in compensation for most specialties is tied to the current economic climate and push to reform healthcare, according to Donald W. Fisher, Ph.D., president and chief executive officer of AMGA. “The modest increases this year reflect the negative impact of declining reimbursements, competition for specialists, the cost of new technology and other factors impacting practice revenues in most parts of the country,” said Dr. Fisher.
Radiology “Cools” Off
Although radiology has been “hot” in recent years due to high profits and increasing demand, the changing market is having a cooling effect on the specialty, said Vaudrey. “The demand for radiology is still there, but in terms of compensation the market has begun to catch up with consecutive prior years of an above average compensation increases.” he said. “Now we are experiencing a flattening effect on both compensation and relative value units (RVU).
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RVUs are the primary measure of a physician’s productivity at the majority of participating medical groups, according to AMGA. The average increase in work RVUs, from 2007 to 2008 was 1.6 percent for all specialties surveyed.
For interventional radiologists, the AMGA analysis shows a 6.28 percent decrease in median work RVUs last year, dropping from 8,671 in 2007 to 8,127 in 2008. Diagnostic radiologists registered a 4.70 percent increase in RVUs from 7,610 in 2007 to 7,968 last year.
In 2007, CMS adjusted RVUs, in part, to provide more money to primary care, a strategy that was reflected in the survey, Vaudrey said.
Previously flat for several years, primary care saw an increase in 2008 and is now starting to show an overall increase, while technical services are seeing less reimbursement and could be starting to flatten out, Vaudrey said. “That’s what we expected to see and was one of the intended consequences of the CMS changes.”
Despite the redistribution of payment under CMS—compensation for physicians, including radiologists—increased overall.
“Radiologist salaries stayed in line with everybody else,” said Richard Duszak Jr., M.D., an interventional radiologist with Mid-South Imaging & Therapeutics in Memphis and a member of the American Medical Association’s Current Procedural Technology Editorial Panel.
There appears to be an increasing demand for physician services across the board because of the aging population, and consequently patient volume is increasing and compensation is growing marginally, according to Dr. Duszak.
Diagnostic Radiologists Bolster Workload, Not Paycheck
Pointing out that the salary increase for diagnostic radiologists did not keep pace with the RVU increase indicated in the AMGA survey, Dr. Duszak said he believes that “diagnostic radiologists are working harder to earn the same amount we did before.”
He attributed the discrepancy to a “hostile payer community,” including CMS, which he said is issuing an increasing number of nonpayment edicts.
“Patient and referrer demand is driving volume but payments are basically maintaining parity,” said Dr. Duszak. “This same principle applies to a number of other medical specialties as well.”
“Interestingly, interventional radiologists are not getting paid more on a per unit basis, so what I think we are seeing is the consequence of an increase in wider specialty encroachment upon interventional radiology.”
Turf battles between specialties may also be impacting compensation, said Dr. Duszak.
“For instance, the amount of peripheral vascular disease I treat daily has gone way down, but the amount I have to cover on call has gone up,” he said. “Because people are cherry picking the turf, it is difficult for interventionalists to generate the same amount of revenue for their practices as they did in the past.”
At the practice level, dollars are shifting from diagnostic radiology toward the subsidization of interventional radiologists, he said.
“This is one way a contracted radiology group can cover its entire book of radiology services,” said Dr. Duszak. “The group knows some services will be more lucrative than others and must find a way to adjust to keep the business.”
The willingness of hospitals to help radiology groups subsidize the salaries of interventional radiologists will also contribute to the stabilization of interventional radiology coverage, he said.
Salaries Could Be Tied to Quality Outcome
Looming changes on the healthcare horizon will have a considerable impact on physicians’ salaries, said Vaudrey.
“With healthcare reform, a lot of the focus is on quality initiatives,” he said. “When our firm does compensation planning, clients are not only looking at how to get more dollars from productivity increases, but how to enhance revenue based on quality outcomes. We are seeing more focus on quality and more dollars tied to quality outcomes.”
The concept of compensation being tied to quality outcomes is an idea that RSNA President Gary J. Becker, M.D., will explore in his RSNA 2009 President’s Address, “Quality Counts.”
“Delivering quality affordable care, engaging in physician performance assessment and improvement, demonstrating achievement of outcomes and embracing transparency and accountability through public reporting are the ways in which we radiologists and other physicians will earn the public’s trust and succeed in the new system of value-based healthcare purchasing,” he said.