Jill Rosenstock’s parents tried to dissuade her from becoming a doctor, citing the huge pile of debt she’d accumulate in medical school and the malpractice litigation scare going on at the time in their home state of Florida.

Rosenstock took the plunge anyway, becoming a primary-care physician and, in the process, running up a bill so big that she jokes about taking some of it to her grave, just as her parents predicted. Fortunately, she has not been sued.

But would she do it all over again if she could?

“Yes, crazy as it sounds,” she says with a laugh. Currently with MedPeds, a six-provider family practice in Laurel, Md., Rosenstock has nearly a decade of practicing behind her now. “I like the long-term relationship. It’s fun to see multiple generations.”

Fun? Really?

“Don’t get me wrong, it’s very frustrating,” says Rosenstock, who is intimately acquainted with all the downsides. Still, her take on primary care reflects many of the results of our second annual Physician Compensation Survey, administered by the national recruiting firm Merritt, Hawkins and Associates. As a group, physicians are under-whelmed with their earnings and frustrated with insurance companies, but you’re not ready to trade it all in for a taco stand on a warm beach. You love your job and your patients.

Mo’ money — sort of

The average salary for a primary-care physician in the United States jumped 11 percent to $161,000 this year, easily outpacing the 3.24 percent inflation rate. At the upper end of the pay scale, the percentage of physicians earning $300,000 or more surged to 13.4 percent from 9.5 percent during the same period last year. Indeed, primary care physicians at every salary range enjoyed at least a 5 percent increase.



The good news was tempered by the fact that overhead increased along with salaries. Merritt, Hawkins considers an overhead margin of no more than 50 percent of practice revenues as a sign of a healthy practice. This year, however, more than 62 percent of respondents reported overhead beyond this cutoff — a 12 percent increase from the year before.

Even worse, the number of those mired in the “80 percent to 100 percent” overhead range more than doubled since last year, from 2.4 percent to 5.2 percent.

None of this comes as too much of a surprise, though. The pressure to enhance productivity, strengthen collections, and cut waste — ways of contending with high overhead, as noted in last year’s survey — shows no signs of abating, which won’t do much to decrease stress or increase career satisfaction. On the other hand, making these changes can actually lighten one’s stress load.

While primary-care physicians made more money this year on average, they had to work even harder than before to earn it. In 2006, just one of every 10 survey respondents chose to characterize their incomes as “excellent” when viewed as a sort of ratio of effort to earnings, while a sizeable 53 percent considered it “disappointing.” That was bad. This year was worse. Now only 8.7 percent think of their incomes as excellent, while the bummed-out crowd has swelled to 58.5 percent.

Internists are particularly begrudged: 67.3 percent are “disappointed” with their earnings.

There’s good reason for their frustration. Focusing on the adult population, internists find themselves doing more and more pulmonary and cardiology work as the baby boomers edge toward their shuffleboard years. Usually, an internist “is not certified in pulmonology, but he’s as competent as anyone I’ve ever met,” says Kurt Mosley, vice president of business development for Merritt, Hawkins. “A lot of internists become ‘junior pulmonologists.’ But they still get compensated as internists.”