Executive Summary Report MGMA 2015 Physician and Production Report Based on 2014 survey data Medical Group Management Association
MGMA 2015 Physician and Production Report Medical Group Management Association (MGMA) continues to be the leader in benchmarking data for medical practices across the nation. This year s provider compensation data remains the gold standard, representing 3,847 groups and 69,411 providers. The following analyses were created to help industry professionals understand what drives compensation and to give insight into current trends. These analyses use the median unless otherwise stated, and the report reflects data submitted for the 2014 fiscal year. trends Five-year trends for both primary and specialty care physicians continues to rise year over year. Primary care median compensation is $241,273, up 3.56% from 2013 data. Specialty care compensation is up 2.39% from 2013, with a median of $411,852. Primary care, however, is proving a more steady increase over recent years. Since 2010, compensation increases in primary care have stayed in a range of 3.56-5.45% increase each year, with a 19.21% increase overall. Specialty care is close behind with a 15.40% increase since 2010, but with lower increases in more recent years. Total Percent Increase Year to Year 5.16% 7.73% 3.81% 3.06% 5.45% 1.51% Primary Care Specialty Care 3.56% 2.39% Throughout the report, data is broken out by primary and specialty care. Here is a list of what specialties are included in each. Primary care data includes: Family medicine (with OB) Family medicine (without OB) Family medicine: ambulatory only (no inpatient work) Family medicine: sports medicine Family medicine: urgent care Geriatrics Hospice/palliative care Hospitalist: family medicine Hospitalist: internal medicine Internal medicine: general Internal medicine: ambulatory only (no inpatient work) OB/GYN: general OB/GYN: gynecology (only) Pediatrics: general Pediatrics: adolescent medicine Pediatrics: hospitalist Pediatrics: hospitalist internal medicine Pediatrics: internal medicine Pediatrics: sports medicine Pediatrics: urgent care Urgent care Specialty care data includes all other specialties found in the MGMA DataDive Provider 2015. 2011 2012 2013 2014 2
Ten-year trends Breaking this data out into select specialties gives more insight into compensation trends. Family medicine physicians who do not perform obstetric services had the largest compensation increase this year at nearly 5% since 2013, with a 37.76% increase since 2010. Emergency medicine, gastroenterology and radiology: diagnostic reported decreased compensation this year. 10-Year Trends for Select Specialties $600,000 $500,000 $400,000 $300,000 $200,000 $100,000 $0 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 Orthopedic Surgery Gastroenterology Radiology: Diagnostic Dermatology Anesthesiology Otorhinolaryngology Surgery: Obstetrics/Gynecology Emergency Medicine Internal Medicine Pediatrics: Family Medicine (without OB) Specialty % increase 2005-2014 % difference 2013-2014 Anesthesiology 25.30% 4.18% Dermatology 44.00% 2.76% Emergency medicine 30.61% -0.89% Family medicine (without OB) 37.76% 4.71% Gastroenterology 31.37% -1.21% Internal medicine 36.39% 4.03% Obstetrics/gynecology 23.79% 2.74% Orthopedic surgery 36.83% 1.64% Otorhinolaryngology 28.58% 0.89% Pediatrics: general 35.45% 2.52% Radiology: diagnostic 17.30% -1.29% Surgery: general 31.47% 3.09% 3
Evolution of compensation drivers Production Production-based compensation is on a downward trend over the last three years, yet is still prevalent as the secondmost common compensation plan used among groups participating in the MGMA Provider Survey. The most common plan, utilized by 31.50% of groups who indicated their type of compensation plan, is a 50% or more salary-based compensation plan with added incentive payments. This type of plan was the most frequently used this past year, and has been increasing since 2012. Plan Trend by Percent of Reporting Medical Groups 47.00% 39.38% 31.28% 31.50% 2012 2013 2014 25.18% 17.62% 15.40% 14.40% 2.61% 7.36% 2.48% 19.32% 15.67% 14.61% 10.28% 100% Salary 100% Equal Share 100% Productivity 50% or More Salary Plus Incentive 50% or More Production Plus Incentive When compensating physicians based on production, it is important to know that as production increases, compensation per unit of production often decreases. Reviewing the MGMA survey data by quartile of work RVUs, physicians in general surgery performing in the top quartile for work RVUs had higher compensation than those in lower quartiles of production. However, the compensation to work RVU and per collections ratios decreased with higher production. Quartiles grouped by Work RVUs for Surgery: to Work RVUs Ratio $90.00 $80.00 $70.00 $60.00 $50.00 $40.00 $30.00 $20.00 $10.00 Total $900,000 $800,000 $700,000 $600,000 $500,000 $400,000 $300,000 $200,000 $100,000 Total to Collections Ratio to Work RVUs Ratio 1.800 1.600 1.400 1.200 1.000 0.800 0.600 0.400 0.200 to Collections Ratio $0.00 $0 Quartile 1 Quartile 2 Quartile 3 Quartile 4 0.000 4
Quartiles grouped by Work RVUs for Surgery: 1st Quartile 2nd Quartile 3rd Quartile 4th Quartile Total to Collections Ratio to Work RVUs Ratio 10th %tile $202,250 $279,832 $313,542 $358,524 25th %tile $285,000 $320,382 $360,686 $440,271 50th %tile $331,214 $375,140 $422,552 $573,691 75th %tile $378,633 $449,966 $507,930 $685,045 90th %tile $462,155 $517,298 $614,151 $865,854 10th %tile 0.42 0.50 0.50 0.48 25th %tile 0.67 0.60 0.61 0.58 50th %tile 1.02 0.83 0.74 0.70 75th %tile 1.29 1.06 0.91 0.85 90th %tile 1.76 1.28 1.05 1.03 10th %tile $56.52 $47.63 $42.03 $36.04 25th %tile $69.06 $55.01 $46.85 $42.49 50th %tile $83.55 $63.74 $56.83 $52.21 75th %tile $109.69 $76.21 $66.69 $63.33 90th %tile $151.38 $88.28 $78.14 $71.68 Value Compensating physicians based on value is a rising trend in the industry. According to MGMA survey data, providers with compensation tied to patient satisfaction or quality metrics had slightly higher compensation than those who reported that none of their compensation was tied to patient satisfaction or quality. Conversely, production was lower for those with value metrics tied to compensation when compared to those without. * $437,478 $446,775 $428,139 $257,903 $250,210 $245,681 Work RVUs* Primary Care Physicians 5,149 5,164 4,650 Specialty Care Physicians 7,499 6,692 6,160 Tied to Patient Satisfaction Tied to Quality Not Tied to Value Metrics Primary Care Physicians Specialty Care Physicians * Data shows providers who reported a percentage of their compensation is tied to patient satisfaction or quality, versus those who reported 0% for both. 5
Additional key findings Academic providers Academic providers in internal medicine and family medicine (without obstetrics) reported a larger increase in compensation this year compared to 2013. Physicians in orthopedic and general surgery are seeing a slightly lower increase in compensation from last year. All specialties listed below had an overall two-year increase in compensation ranging between 7.38% and 9.95%. Total Percent Increase Emergency Medicine 5.85% Family Medicine (without OB) Internal Medicine: Orthopedic Surgery: Surgery: 9.43% 7.38% 8.69% 9.66% 9.95% 11.39% 6.79% 6.45% 6.97% 3.38% 1.78% 3.01% 2.78% 2013 2014-3.60% for academic providers varies by the percent of time providers are spending on billable/clinical work. Most academic providers are compensated the highest when working in the range of 34-67% or 67%+ billable/clinical activity, with the rest of their time spent performing teaching and research duties. Total by Percent of Billable/Clinical Activity 0% to 33% 34% to 67% More than 67% $334,691 $352,439 $333,907 $255,611 $281,911 $262,729 $200,786 $190,000 $175,000 $250,182 $310,634 $317,517 $182,296 $196,423 $196,912 $228,240 $255,819 $254,867 $329,000 $346,000 $343,221 Anesthesiology Emergency Medicine Family Medicine (without OB) Gastroenterology Internal Medicine: Obstetrics/ Gynecology: Radiology: Diagnostic 6
On-call compensation Providers compensated for taking call are most commonly compensated with a defined daily stipend, closely followed by hourly rate compensation. Daily stipends are not defined by the number of hours, but rather are based on a fixed amount per day. Type of compensation method used % providers paid for call Daily stipend 35.87% Hourly rate 27.44% Per shift 13.58% Annual stipend 12.01% Other compensation method 11.10% The southern section has the highest daily on-call stipend for primary care specialties at $750 per day. Hourly on-call rates for nonphysician providers are double the amount in physician-owned practices, at $80 per hour compared to $40 per hour in hospital/integrated delivery system (IDS)-owned practices. $750 Daily On-Call for Primary Care Physicians by Geographic Region $500 $360 $125 Eastern Midwest Southern Western Hourly On-Call by Ownership $80 $40 Nonphysician Providers Physician Owned Hospital/IDS Owned 7
Starting salary and signing bonuses The southern section of the United States reports the highest starting salary for both primary and specialty care physicians. Signing bonuses do not vary significantly among geographic regions. Primary care signing bonuses fall between $15,000 and $20,000, and specialty care signing bonuses are slightly higher, with a range of $20,000 to $25,000. Primary Care by Geographic Section Signing Bonus $210,000 $200,000 $190,000 $180,000 $170,000 Eastern Midwest Southern Western $25,000 $20,000 $15,000 $10,000 $5,000 Signing Bonus Specialty Care by Geographic Section $280,000 $270,000 $260,000 $250,000 $240,000 $30,000 $25,000 $20,000 $15,000 $10,000 Signing Bonus $230,000 Eastern Midwest Southern Western $5,000 for medical directorships Providers who are contracted internally for medical directorships in their own groups have higher compensation than those contracted with external organizations. Primary Care Internal Directorship External Directorship Annualized compensation $20,000 $13,200 Hourly rate compensation $132.94 $130.00 Monthly stipend compensation $2,250 $1,542 Providers compensated annually for directorship duties report spending more hours per week on their directorship than providers who are compensated hourly. Provider compensation and production are influenced by a variety of components. Understanding how to effectively benchmark data against various demographic and trend characteristics can give a practice the competitive edge it needs to recruit and retain providers. The MGMA DataDive Provider 2015 allows for a wide range of additional analysis beyond those included within this executive summary. No part of this document may be reproduced, stored in a retrieval system or transmitted in any form or by any other means digital, electronic, mechanical, photocopying, recording or otherwise or conveyed via the Internet or a Web site without prior written permission from the Medical Group Management Association. 8