At Colorado Springs Health Partners, an increased focus on preventive care and disease management has brought with it the need for providers to spend more time with each patient.

But what kind of “provider” is appropriate for that duty? The roughly 100 doctors at the 11-site multispecialty group are already stretched thin, juggling hospital rotations and more complex patient problems. So the practice is turning increasingly to nurse practitioners and physician assistants — nonphysician providers, sometimes called midlevels, or, (less diplomatically) “physician extenders” — to “spread a physician further,” explains the group’s CEO, Debbie Chandler.

The main goal is to improve patient care by letting physicians focus on more complex patient issues while NPs and PAs handle more of the day-to-day patient complaints typical in primary care, Chandler says. But because midlevels cost far less than primary-care physicians — perhaps as little as half — the move certainly makes financial sense, too.

That’s why practices large and small, feeling the sting of the primary-care physician shortage combined with the need to see more patients, are similarly turning to midlevels to spread their own physicians further.

This trend is one reaction to the financial pressure that continues to mount in primary care. According to our fourth annual Physician Compensation Survey, some practice owners are also considering drastic changes to their practice models, while others are looking to sell, retire, or work as employees. And still others are, like Colorado Springs Health Partners, seeking ways to increase revenue at lower costs.

Employed physicians, meanwhile, are considering how to negotiate for better pay.

We polled more than 1,000 physicians, 61 percent of whom were primary-care docs, to find out what they are making and how they feel about it. Let’s see what they had to say.



(*Editor’s note: To compare last year’s figures read: Getting More — Our Annual Physician Compensation Survey.)

Perils of ownership

This year’s survey revealed rising frustration over income, especially among owners of practices who continue to struggle with declining reimbursement rates and soaring costs. For example, a majority of practice owners described their income as disappointing. No wonder: about four in 10 owners say their pay last year was less than it was the year before, with more than a quarter claiming a drop of more than 10 percent. Only 26 percent of practice owners saw income gains.

Now compare that with how employed physicians are faring: 38 percent saw increased income last year; 20 percent absorbed decreases. Is it any surprise, then, that healthcare policy and economics experts are noticing a renewed trend toward owners selling their practices to hospitals and health systems, becoming employees in the process?



For an increasing number of physicians, the risks of entrepreneurship seem too great compared with the prospective rewards. Only about one in five practice owners made more than $300,000 last year — about the same number as brought home less than $100,000. Many owners, meanwhile, are finding themselves struggling to stay in business. Only 28 percent of owners say their practices are “thriving” while the rest had serious doubts about their long-term viability, calling their survival prospects at best “mixed,” if not “shaky” or “poor.” Seven percent are in this latter category, saying they may have to close their doors in the next one to three years.



Primary-care vs. specialists

There continues to be a clear and deepening disconnect, meanwhile, between primary-care physicians’ incomes and those of their specialist counterparts. Specialists, for example, are six times more likely to earn more than $300,000 a year. A quarter of specialists earned that much; most made more than $175,000. On the other hand, more than a quarter of primary-care doctors have not cracked six figures, and only one in four cleared $175,000, or more.

But that gap doesn’t exempt specialists from the practice owner unrest. A majority of both specialist and primary-care practice owners said their net income was “disappointing.” And these dismal trends have some physicians — primary care and specialists alike — considering taking surprising risks.