Blair concurs, saying, “It’s been pretty well documented that cognitive specialties don’t fare as well as procedural specialties,” he says, and offers a quick history lesson. “The original idea was that CT scanners and MRIs are expensive equipment, so you’ve got to factor in those costs for reimbursement. Now the more ‘things’ you do, the more you get paid; the less ‘things’ you do, the less you get paid.”
Rather paradoxical in light of what medicine is all about; “Or what people would like,” says Blair.
Anatomy of a paycheck
This year, we asked physicians a bit more about what makes up their take-home pay beyond straight salary. Nearly half of respondents (47.24 percent) receive no bonus at all. Of those that do receive bonuses, nearly two-thirds (64.4 percent) report that it ranges between 1 percent and 10 percent of their total salaries. The numbers shrink rapidly from there: 14.85 percent of the total respondents claim 11 percent to 25 percent of income as bonus money, 3.82 percent receive 26 percent to 50 percent in bonus form, and a lucky three people claim that more than 50 percent of their pay packets are stuffed with bonuses (unless said bonus is completely contingent on productivity, as in sales, which would heap quite a stress load on those “lucky” three).
My mom, the doctor
According to the U.S. Health and Human Services report, “Physicians Supply and Demand: Projections to 2020,” nearly half of all physicians completing their training through programs of graduate medical education each year are women.
That’s significant, because most women approach their careers differently than men. The large portion of new female doctors is changing not only primary care, but the business of medicine in general.
Women are more likely to choose non-surgical specialties than men are because a hospitalist or emergency physician has a set schedule and no call — both necessary perks for managing the family, which remains largely in the hands of women, despite significant female entry into the nation’s work force over the past generation or two. Female physicians also are much more likely to job-share or work part-time.
We found ourselves curious about how the gender issue plays out in our own survey, so this year, we asked respondents to indicate their genders. Our results show about a 60/40 split between males and females, respectively.
Interestingly, the “Did Not Respond” crowd swelled for the 46- to 55-year-old set. But consider that this age group’s college time was smack in the middle of the
“I Am Woman, Hear Me Roar” years, so it’s possible their “nunya beeswax” attitude is a vestige left over from those gender equality trail-blazing years.
Women tend to stick with the same practice longer than men, with about one in 10 female physicians reporting she’s been in her current practice for 11 to 15 years, compared to just 3.23 percent of male physicians. Men, of course, dominate the “21-plus years” tenure category at 33.87 percent (women: 1.92 percent), but that has much to do with how male-dominated this field used to be.
But that’s all changed. “The ranks of the younger primary-care docs are dominated by women; that’s where primary care is headed,” says Mosley. “According to the AMA, they’re less productive. They’re not lazy; they have a different methodology.”
They also have much to do beyond doctoring. Mary Craig, a primary-care physician with Jarrettsville Family Care in Jarrettsville, Md., has been practicing medicine for 10 years. She works a 30-hour work-week — on paper — at the two-physician practice, which is owned by another female physician, Linda Walsh. Jarrettsville Family Care is the only primary-care practice in this small town (pop. 2,750), so of course they’re quite busy. Unfortunately, like everywhere else, reimbursements sag while expenses mushroom. But they’re the lucky ones, says Craig. “We both have spouses who work and do well financially. I could not pay back my school loans and raise a family with the salary I’m earning.”
To be fair, women don’t do all the child-rearing these days. With more male/female parity than ever before in family duties, male doctors are picking the kids up from soccer, too — sometimes all on their own. When asked if he ever had to juggle work and family needs with his career as a physician, Jade Norton, a family care physician at Eagleridge Family Medicine in Pueblo, Colo., responded, “Ohhhh yahhh. I have three small children, and I’m a single 42-year-old dad.”
Blessed are the not-so-meek
Our survey shows that for the most part you’re busy but not frazzled, although there are variations to this theme. “What we see is an increase in morale,” Mosley says. “[Primary-care physicians] all felt like second-class citizens; that is changing. They’re getting asked to dance again.”
Our survey certainly reveals fewer wallflowers. Last year, 13.6 percent of partner respondents were afraid they would have to close their practices within the next five years. This year, only 3.6 percent of surveyed partners are feeling discouraged enough to considering stopping the practice of medicine. That 10 percent seems to have shifted up a notch to the “mixed” category — a tad less pessimistic.
