www.medscape.com

Physician Compensation -- A Deeper Dive: Does Money Make Them Happy? Carol Peckham

April 15, 2014

The American Physician's Frustration

The Medscape 2014 Physician Compensation Report is based on an extensive survey of more than 24,000 US

physicians representing 25 specialties. Although healthcare is undergoing many challenges, the report shows some

encouraging trends: Compensation increases were reported in 19 specialties, and the income gap between men and

women is narrowing. Among other key professional issues, physicians' responses this year reveal their views on

health insurance exchanges; their satisfaction with medicine, their specialty, and practice setting; and how much time

they spend with patients and on paperwork.

Does Money Bring Happiness? High and Low Earners

As in past Medscape compensation surveys, those who perform procedures have the highest incomes compared

with those who manage chronic illnesses. At the top of the earnings list are orthopedists ($413,000), cardiologists

($351,000), urologists ($348,000), gastroenterologists ($348,000), and radiologists ($340,000). Radiologists have

moved down a bit compared with our earlier surveys, and anesthesiologists have been knocked out of their previous

spot among the top five.

The lowest earners are physicians in HIV/ID ($174,000), with primary care physicians and endocrinologists also in

the bottom five (family physicians at $176,000, pediatricians $181,000, endocrinologists $184,000, and internists

$188,000).

In general, the Medscape survey findings are supported by government reports and other surveys.[1] A 2013 Centers

for Medicare & Medicaid Services (CMS) report to Congress provided findings from a government study showing that

certain procedural groups and radiologists had calculated annual earnings that were more than twice those for the

primary care groups.[2]

Who's Satisfied With Their Compensation?

Whether a physician is in the high or low earnings group does not necessarily correlate with compensation

satisfaction or even with whether a physician would choose medicine as a career again.

Satisfaction with compensation has not changed much in the past 4 years. In 2013, 50% of all physicians said they

feel fairly compensated; 48% of primary care physicians feel fairly compensated. These figures are extremely close

to the 2011 report percentages, in which 48% of all physicians say they feel fairly compensated, and 51% of primary

care physicians said they feel that way.

When looking at specialties, dermatologists, at 64%, were the most satisfied with their compensation and they were

also among the top 10 earners. The amount of compensation, however, does not necessarily correlate with how

fairly a physician believes he or she is paid. Other specialties that were high on the list of feeling fairly compensated

were in the middle of or below on the earnings list: emergency medicine (61%), pathology (59%), and psychiatry

(59%). Internists and family physicians were also low earners, but at 46% and 50%, respectively, they were in the

middle or toward the top of the list of those who felt fairly compensated.

On the other hand, 3 specialist groups at the top of the earnings list are in the bottom half of those who feel fairly

compensated (44% of orthopedists and cardiologists and 41% of urologists). Plastic surgeons, who are among the

top 7 earners are the least satisfied (37%) with their compensation of all physicians.

Why Wouldn't Some Choose Medicine or Their Own Specialty Again?

When comparing this year's responses with those from 2011 for the question "Would you choose medicine again?"

69% of physicians said "yes" in 2011, but in 2014 only 58% answered in the affirmative. Of note, when comparing

these 2 years for the question about who would choose their own specialty again, the bias was reversed, with 47% of

physicians answering yes in 2011 and 61% this year.

High earners were not necessarily the ones who were most likely to choose medicine again. In fact, the least likely to

choose medicine again (plastic surgeons, orthopedists, radiologists, anesthesiologists) were among the top earners.

Conversely, those who are on the low rungs of earnings (internists, family physicians, pediatricians, and infectious

disease specialists) were in the top five for choosing medicine again.

Of interest, one could observe an inverse relationship among the highest and lowest earners in regard to those who

would choose medicine and those who would choose their own specialty again (Table 1). Those in some of the

higher-income specialties would choose their own specialty over medicine, while a higher percentage of primary care

physicians would choose medicine again but are far less happy with their particular field.

A 2012 Urban Institute survey found that 30% of primary care physicians between the ages of 35 and 49 planned to

leave their practices within 5 years. The rate increased to 52% for those over 50.[3] Although this might seem high, to

put this in perspective one should look at other high-pressure professions. For example, nearly half of new public

school teachers leave their profession within 5 years.

Table 1. Percent Difference Between Physicians Who Would Again Choose Their Specialty vs Medicine as a

Career

Specialty Difference Between Choosing Specialty and Medicine

Dermatology 24%

Orthopedics 20%

Plastic Surgery 16%

Radiology 9%

Gastroenterology 8%

Cardiology 6%

Ophthalmology 5%

General Surgery 4%

Anesthesiology 1%

Oncology 1%

Pathology 0%

Urology -1%

Psychiatry & Mental Health -6%

Rheumatology -7%

Diabetes & Endocrinology -8%

Critical Care -9%

Neurology -11%

Pediatrics -11%

HIV/ID -12%

Emergency Medicine -15%

Nephrology -16%

Ob/Gyn & Women's Health -16%

Pulmonary Medicine -23%

Family Medicine -35%

Internal Medicine -42%

High earners who are less likely to choose medicine again tend to be interventionalists, who are expecting lower

incomes due to changes in the way physicians will be compensated under the Affordable Care Act (ACA). In fact,

when tracking the percentage by specialty of those who would choose medicine against those facing a decrease in

income from health exchanges, there appeared to be an inverse relationship between not choosing medicine again

and having greater expectations of an income decrease, regardless of a specialty's actual current compensation

level (Figure 1). This relationship was not observed when tracking choosing medicine as a career again vs

compensation satisfaction or physicians' relative level of earnings.

Do Gender Compensation Disparities Contribute to Dissatisfaction?

Today, about half of all graduating physicians are female, and 61% of female physicians are under 45 compared with

only 38% of men.[4] One could expect that the income gap between male and female physicians will be narrowing,

and it is -- but it is still considerable. In 2010, male physicians earned 40% more than female physicians, and in the

current survey they earned 30% more.

The gender pay disparity varies by specialty (Figure 2), with the greatest differences observed among plastic and

general surgeons (28% and 37%, respectively). Primary care physicians reported smaller discrepancies but they

were still considerable (13% among internists and 19% among family physicians).

There are more female than male pediatricians (53% vs 47%, respectively), and although there are fewer female

than male ob/gyns (46% vs 54%), the specialty is fairly well balanced. Nevertheless, disparities are still significant in

both specialties, with male pediatricians outearning women by 20% and male ob/gyns outearning by 12%. Urology

was the only specialty to report higher-paid women than men, although the difference was very small (1%).

Gastroenterologists came next with an income disparity of only 5%.

In looking at how men and women compare in satisfaction with their income, in spite of the income differences,

women are often as satisfied (or dissatisfied). Where disparities are smallest, women are often more satisfied than

men (Figure 3). In urology, where female respondents reported a slightly higher income, they are far more likely to

be satisfied with their income (71% vs 41%). Female gastroenterologists make only 5% less than male

gastroenterologists, and 55% are satisfied with their income compared with 46% of men. Even in some specialties

where men are the far higher earners, women are happier with their income. For example, male ob/gyns outearn

female ob/gyns by 20%, but 47% of women are satisfied with their compensation compared with 38% of men.

Nevertheless, Ileana Piña, a Medscape advisor and Associate Chief of Cardiology at Montefiore Einstein Vascular

and Cardiac Center in the Bronx, New York, commented, "Women are not happy about salary disparities when they

find out. For instance, salaries in universities are secret, so unless you are in the inner circle, you may never know. If

you don't know, you can't complain. Now, I ask upfront for salary levels."

Why the Disparity?

A 2009 American Medical Association (AMA) report stated that gender disparities persist.[5] One study supporting

such a finding concluded that female primary care physicians consistently earn lower annual incomes than do

men.[6] Reports indicate, however, that more female physicians are employed (vs self-employed) than males, and

they also work fewer hours than men, which may account for the difference.[4]

The Current and Future Effects of Healthcare Reform

New rules under the ACA are attempting to tip the income balance between primary care physicians and specialists -

- especially interventionalists -- by increasing payments and bonuses for those who manage chronic diseases and

lowering reimbursements for procedures. This year, a few (but not all) of the specialties involved in procedures

experienced small declines in compensation. Primary care physicians showed small increases, but so did others,

including surgeons and other interventionalists. The variations in compensation among all physicians between 2012

and 2013 are very small, in any case, and are probably not important yet. In addition, these small increases were not

enough to compensate for inflation, which in 2013 was 1.5%. It is unlikely that income disparities between primary

care physicians and specialists will reverse, but over time they should lessen.

Health Insurance Exchanges: Who's in, Who's Out?

The Medscape Physician Compensation Report found that 43% of all physicians expect their incomes to decrease

under the health insurance exchanges, including about a third of primary care physicians (33% of internists and

family physicians and 29% of pediatricians). Only 7% of all physicians foresee an increase.

When asked whether they were planning to participate in the exchanges, only a quarter of respondents (27%) said

yes, another 20% said no, and more than half (53%) said they were not sure. Self-employed physicians were more

likely to give a definitive no to the exchanges (24%) compared with the employed (17%).

Regarding the exchanges, Robert Morrow, MD, a Medscape Family Medicine advisor and Clinical Associate

Professor at Albert Einstein College of Medicine in the Bronx, commented, "Several deep proprietary mysteries veil

the health exchange. If I'm on, what will I get paid? Even if the payment on the exchanges is sufficient, will the

insurers pay their premium? A 90-day grace period does not favor the doc."

Charles Vega, MD, Health Sciences Clinical Professor at University of California Irvine School of Medicine, and also

a Medscape Family Medicine advisor, was more optimistic. "I understand why physicians are having a difficult time

identifying their role in the ACA. It's not dissimilar from the confusion that every other stakeholder -- patient, third-

party, and even the government -- has felt as the rollout of the program started, halted, and started again. It is very

difficult for the average working physician to predict how it might affect her/his practice. That's temporary. The ACA is

the law of the land and will help millions to better health over time. Physicians will have to broadly participate in the

exchanges in order to care for communities and maintain their practice. But the path to that day has not been at all

straightforward, and we need to do better if ACA is to live up to its promise."

Who's Dropping Out of Medicare and Medicaid?

In this year's Medscape survey, self-employed physicians are much more likely to stop taking new or current

Medicare or Medicaid patients (18%) and less likely to continue with current or new ones (57%) than are employed

physicians (6% and 69%, respectively). According to CMS, the number of doctors who opted out of Medicare tripled

between 2009 and 2012, although those numbers were still relatively small (3700 and 9539, respectively).[7]

In a move that may discourage physicians further from taking Medicare, CMS has publicly released data about the

number and type of healthcare services that individual physicians and certain other healthcare professionals

delivered in 2012 and the amount that Medicare paid them for those services.[8] Medical societies and physicians are

concerned that the information could be misused and misunderstood, unless the necessary safeguards are adopted.

"Medicare and other payers pay fixed prices for services based on fee schedules; therefore the amount paid to

physicians is generally far less than what was charged and is not an accurate portrayal of payment," the AMA said in

a statement.[9] A concerned clinician responded to CMS' invitation for public comment: "Releasing physician payment

data will do nothing but create an adversarial relationship between patients and their doctors and not lead to greater

fraud detection. Many of our local doctors have already dropped Medicare and Medicaid as payers simply out of

frustration with attacks on our profession such as this."[10] Whether repealing Medicare's generally despised use of

the Sustainable Growth Rate for setting reimbursements rates will keep physicians from dropping patients is not

known.[11]

Of further concern, some Medicare Advantage insurers are dropping doctors -- notably United Healthcare, which

recently cut thousands of physicians across the country. They say they must shrink their physician networks because

they face major government payment cuts, but there is no clear reason why specific physicians are being

terminated.[12] David May, MD, chair of the American College of Cardiology board of governors, said, "This does not

seem to be about quality of care or even utilization." Whatever the reason, "I would like to know what the metrics

were that drove it. I'm willing to bet that it has to do with the financial side and not the performance side of the

practices and providers that they are getting out of the network."[13-15]

As for Medicaid, fees for physicians currently average about 66% of those for Medicare, with states varying widely.

The gap is greatest in primary care services (59%). Eight states -- California, Florida, Michigan, Missouri, New

Hampshire, New Jersey, New York, and Rhode Island -- account for about 40% of total Medicaid enrollment and pay

the least relative to Medicare. In 2013, Medicaid fees were expected to rise for primary care physicians by 73%, but

whether this will have an impact on their acceptance of this program is not yet known.[16] Dr. Morrow told Medscape,

"Medicaid is required to be on par with Medicare. I received one Medicaid payment for $37 for the same code that

Medicare pays $82 for. By the by, my visit cost averages $80 before I get paid. As Groucho said, 'I might make some

money if I don't sell too many of these.'"

The Rise of the Salaried Doctor

Among physicians overall, self-employed doctors earned an average of $281,000 compared with employed

physicians, who earned $228,000. In primary care, the difference was less pronounced; self-employed physicians

earned $188,000 and employed physicians earned $180,000. The most common payment method for employed

doctors is straight salary, although physicians increasingly also have to meet productivity targets.

A New York Times article reported that 64% of positions looking to be filled last year were in hospitals, compared

with only 11% in 2004.[17] In the recent Medscape report on physician employment, nearly 80% of those who are

employed were either satisfied (49%) or neutral (30%) about their income, which could reflect that even if they were

making less money than if they were self-employed, the benefits of a regular paycheck (and possibly doing less work

for the same money) might compensate for not being self-employed.

Location, Location, Location: Does Setting Affect Income and Satisfaction? Income by Practice Setting

Physicians in single-specialty group practices are the highest earners, while those in solo practices are third from the

bottom, making an average of $57,000 less than those in group practices. Physicians who work for healthcare

organizations are the second highest earners. The lowest earners are in outpatient clinics. A 2012 AMA report found

that 60% of physicians now work in physician-owned practices, with a upward trend toward large groups, whether

hospital employed or in independent practices.[18]

Hardly Anyone Likes Their Practice Setting

Income levels by practice setting do not appear to affect a physician's satisfaction with it. Only about a quarter of

physicians would choose their own practice setting again if given the choice, and no setting proved much more

appealing than another (Figure 4). There was a slight preference for office-based single-specialty group settings

(where earnings were highest) and solo practice (earnings were third from the bottom), but no percentage favoring

any setting exceeded 30%.

The Rise of the ACO

Between 2011 and 2013, there has been a dramatic rise in physician participation in Accountable Care

Organizations (ACOs), with nearly a quarter of all physicians now employed in these organizations, compared with

only 3% in 2011. ACOs are designed to deliver improved care for patients. Within these settings there are various

payment models, including shared savings programs,[19] advanced payment models (mostly for rural

providers),[20] and the Pioneer ACO Model, which is for organizations and providers with experience in coordinating

patient care.[21]

Ancillary Services: A Threatened Source of Revenue?

Ancillary services are still a popular means of bringing in more income. It is estimated that some practices may be

able to earn as much as 15% or more from ancillary services.[22] They can be classified into 3 categories: diagnostic,

therapeutic, and custodial. At the top of the list in Medscape's survey, about a third of orthopedists offer ancillary

services, which may include in-office surgical centers with pain centers, MRI, and physical therapy with orthotics and

braces.[23]Anesthesiologists came in second at 31%, with most of their services involving procedures for

postoperative pain.[24] Although not at the top of the list, 23% of family physicians provide ancillary services, which

can include medication dispensing, weight-loss services, in-office diagnostic tests, nutrition counseling, cosmetic

services, and alternative treatments such as acupuncture and massage.

A 2007 report indicates that approximately $8 billion is spent annually on physicians' extra income derived from their

ownership in outpatient facilities, including ambulatory surgery centers, diagnostic imaging centers, and diagnostic

laboratories.[25] The Stark Law was passed to reduce costs and prevent abuse from self-referral. The law provides

exceptions, which include physician or in-office ancillary services and ownership in a publicly held firm. Recently a

bill was introduced that would curtail some of these in-office exceptions, including diagnostic services, radiation

therapy services and supplies, and physical therapy.

How Do Physicians Spend Their Time? Minutes Spent per Patient Visit

The amount of time physicians spend with the patient during a typical visit has not changed significantly over the

past few years (Table 2).

Table 2. Amount of Time Spent Seeing Patients in 2010 and 2013 (All Physicians)

Minutes Spent Seeing Patients 2010 2013

9 to 12 minutes 18% 16%

13 to 16 minutes 21% 29%

17 to 20 minutes 17% 25%

25 minutes or more 15% 13%

Regarding primary care physicians specifically, in this year's report, 50% said they spend less than 16 minutes with

patients and 48% spend more than 17 minutes, compared with last year's 55% and 42%, respectively, which

suggests that patients may be getting slightly more time to talk to their doctors. Hopes are being pinned on wider

implementation of the patient-centered medical home (PCMH) as at least a partial solution to improving amount of

time spent with patients.[26]Although data are limited and findings on PCMH are mixed to date, an encouraging 2014

comparative study found that physicians in a PCMH intervention group experienced reduced time pressure because

they could delegate administrative tasks, which freed up time for longer encounters and more detailed discussions

with patients.[27]

Hours per Week Spent With Patients

Less than half (45%) of physicians who responded to the survey spend 40 or fewer hours seeing patients, with

slightly over half (51%) spending more time. (Three percent see no patients at all.) Nearly 80% of anesthesiologists

and intensivists claim to spend 40 or more hours with patients. In fact, most physicians at the top of the list tend to be

hospital-based specialists. Office-based physicians, such as family physicians, pediatricians, and psychiatrists, tend

to be on the lower half of the list. Perhaps the reason for this is that these latter physicians might need to spend more

time on administrative tasks. According to 2009-2010 data from the Centers for Disease Control and Prevention

(CDC), 40% of primary care physicians work evenings or weekends compared with 19% of specialists.[28]

A 2010 study in JAMA found that there was no significant change in hours spent on patients between 1977 and

1997, but those hours decreased steadily from 54.6 to 5.1 hours per week between 1997 and 2007. The decline was

observed regardless of gender or employment status, but it was largest for nonresident physicians under 45 and for

those working outside the hospitals. The authors attributed the decrease to a parallel 25% inflation-adjusted decline

in fees over that same period. They point out that some physicians may have compensated by increasing ancillary

services at the expense of patient time. Time spent by physicians working in relatively low-patient-hour specialties,

such as dermatology, pathology, and emergency medicine, changed by less than 1%.[29]

In looking at the number of hours that primary care physicians spend on patients in hospitals, an interesting trend

emerged: 31% of internists spend more than 25 hours, compared with only 19% of pediatricians and 5% of family

physicians. Most likely, the higher percentage reported by internists reflects the rise in hospital medicine over the

past decade. The Society for Hospital Medicine estimates that there are more than 40,000 practicing hospitalists,

most of whom are internists, up from about 1000 practicing hospitalists 20 years ago.[30]

Number of Patient Visits per Week

Thirty percent of physicians reported seeing between 25 and 75 patients per week and a third between 76 and 124,

with a small percentage of physicians seeing either more or fewer patients. (The question was not applicable to 6%

of respondents.) According to the CDC, the annual visit load for primary care physicians between 2009 and 2010

was 30% higher than for specialists.[28] In spite of changes related to the ACA, an organization's or practice's revenue

will still be determined largely by volume generated by physicians, and therefore the pressure of seeing more

patients will still exist. The optimal size of a patient panel is difficult to set, but it is important to balance appointment

supply and patient demand.[31]

How Much Time Does Paperwork Take?

Paperwork takes up a huge chunk of time, and self-employed doctors spend more time on paperwork than do

employed doctors. About 29% of self-employed doctors say they spend from 1 to 4 hours per week on paperwork vs

24% of employed doctors; 31% of self-employed physicians spend 5 to 9 hours on paperwork vs 28% of employed

physicians. Employed physicians spend more time on paperwork than do self-employed physicians only in the

category of 20 to 24 hours per week, and only 6% of employed doctors spend that amount of time. It's likely that

these may be physicians in administration or academia, or who perhaps are involved in clinical trials.

References

1. Herman B. 15 highest-paid specialties: salaries for hospital-employed physicians. Becker Hospital Review.

February 23, 2012. http://www.beckershospitalreview.com/compensation-issues/25-highest-paid-physician-

specialties-by-hospital-ownership.html Accessed February 15, 2014.

2. Medicare Payment Advisory Commission. Report to the Congress. Medicare Payment Policy. March

2013. http://www.medpac.gov/documents/Mar13_entirereport.pdf Accessed April 3, 2014.

3. Rabin RC. Burnt out primary care docs are voting with their feet. April 1, 2014. Kaiser Health

News. http://www.kaiserhealthnews.org/Stories/2014/April/01/doctor-burnout.aspx Accessed April 2, 2014.

4. The Physician Workforce: Projection and Research into Current Issues Affecting Supply and Demand. US

Department of Health and Human Services. December

2008. http://bhpr.hrsa.gov/healthworkforce/reports/physwfissues.pdfAccessed April 2, 2014.

5. American Medical Association. 2008 Annual Meeting. Report 19 of the Board of Trustees (A-08) Gender

Disparities in Physician Income and Advancement http://www.ama-assn.org/resources/doc/council-on-med-

ed/a-08botrpt.pdf Accessed April 2, 2014.

6. Weeks WB, Wallace TA, Wallace AE. How do race and sex affect the earnings of primary care physicians?

Health Aff (Millwood). 2009;28:557-566. http://content.healthaffairs.org/content/28/2/557.long Accessed April

2, 2014.

7. California Healthline. Number of physicians opting out of Medicare nearly tripled. July 29,

2013. http://www.californiahealthline.org/articles/2013/7/29/number-of-physicians-opting-out-of-medicare-

nearly-tripled Accessed February 14, 2014.

8. Blum J. Next steps in Medicare data transparency. The CMS Blog. April 3,

2014. http://blog.cms.gov/2014/04/02/next-steps-in-medicare-data-transparency/ Accessed April 2, 2014.

9. Crane M. Medicare releases individual physician payment data. Medscape Medical News. April 9,

2014. http://www.medscape.com/viewarticle/823360 Accessed April 10, 2014.

10. Lowes R. Medicare will reveal individual doc pay starting mid-March. Medscape Medical News. January 14,

2014. http://www.medscape.com/viewarticle/819202 Accessed April 6, 2014.

11. Lowes R. New SGR repeal bill includes slight pay hikes. Medscape Medical News. February 6,

2014. http://www.medscape.com/viewarticle/820282 Accessed February 14, 2014.

12. Cha AE. Doctors cut from Medicare Advantage networks struggle with what to tell patients. January 25,

2014. The Washington Post. http://www.washingtonpost.com/national/health-science/doctors-cut-from-

medicare-advantage-networks-struggle-with-what-to-tell-patients/2014/01/25/541bfbd8-77b4-11e3-af7f-

13bf0e9965f6_story.html Accessed April 2, 2014.

13. Stiles S. Unfair advantage? United Healthcare boots thousands of MDs from its Part C Medicare plans.

Medscape Heartwire. October 28, 2013. http://www.medscape.com/viewarticle/813318 Accessed April 11,

2014.

14. Lowes R. Court sends United Healthcare and physicians to mediation. Medscape Medical News. January

24, 2014. http://www.medscape.com/viewarticle/819671 Accessed February 16, 2014.

15. Frates C. Docs say insurers dropping them in hopes their costly patients follow. CNN Politics. December 19,

2013. http://www.cnn.com/2013/12/18/politics/obamacare-insurers-dumping-doctors/ Accessed April 2, 2014.

16. Zuckerman S, Goin D. How much will Medicaid physician fees for primary care rise in 2013? Evidence from

a 2012 survey of Medicaid physician fees. The Kaiser Commission on Medicaid and the

Uninsured.http://www.acponline.org/running_practice/payment_coding/medicaid/kaiser_rise_in_fees_2013.p

df Accessed February 15, 2014.

17. Rosenthal E. As health care shifts, apprehensive, many doctors shift to jobs with salaries. New York Times.

February 13, 2014. http://www.nytimes.com/2014/02/14/us/salaried-doctors-may-not-lead-to-cheaper-health-

care.html?_r=0Accessed April 10, 2014.

18. Halim L. The future of physician practice: Employed, independent, or something unexpected. Practice Notes.

The Advisory Board Company. September 30, 2013. http://www.advisory.com/research/medical-group-

strategy-council/practice-notes/2013/september/the-biggest-trend-in-physician-demographics Accessed April

2, 2014.

19. Centers for Medicare & Medicaid Services. Shared Savings

Program. http://www.cms.gov/Medicare/Medicare-Fee-for-Service-

Payment/sharedsavingsprogram/ Accessed February 14, 2014.

20. Centers for Medicare & Medicaid Services. Advance Payment ACO

Model. http://innovation.cms.gov/initiatives/aco/ Accessed February 14, 2014.

21. Centers for Medicare & Medicaid Services. Pioneer ACO

Model. http://innovation.cms.gov/initiatives/Pioneer-ACO-Model/index.html Accessed February 14, 2014.

22. Ancillary services can increase revenues. Maximizing Practice Profits. Doctor's

Digest. http://www.doctorsdigest.net/pdf/0102_04.pdf Accessed April 2, 2014.

23. Bert JM. Making your orthopedic office profitable through the addition of ancillary services. Clin Sports Med.

2002;21:245-248, vi.

24. RaveNews. McKesson. Correctly report anesthesia time when separately billing ancillary

procedures. http://anesthesiology.mckessonrevenews.com/index.php/archives/96-correctly-report-

anesthesia-time-when-separately-billing-ancillary-procedures Accessed April 2, 2014.

25. Manchikanti L, McMahon EB. Physician refer thyself: is Stark II, phase III the final voyage? Pain Physician.

2007;10:725-741. http://www.painphysicianjournal.com/2007/november/2007;10;725-741.pdf Accessed April

2, 2014.

26. Longworth DL. Accountable care organizations, the patient-centered medical home, and health care reform:

what does it all mean? Cleve Clin J Med. 2011;78:571-

582. http://www.ccjm.org/content/78/9/571.long Accessed February 16, 2014.

27. Heyworth L, Bitton A, Lipsitz SR, et al. Patient-centered medical home transformation with payment reform:

patient experience outcomes. Am J Manag Care. 2014;20:782-

785. http://www.ajmc.com/publications/issue/2014/2014-vol20-n1/patient-centered-medical-home-

transformation-with-payment-reform-patient-experience-outcomes/ Accessed February 16, 2014.

28. Centers for Disease Control and Prevention. Generalist and Specialty Physicians Supply and Access, 2009-

2010. NCHS Data Brief. Number 105. September

2012. http://www.cdc.gov/nchs/data/databriefs/db105.htm#summary April 10, 2014.

29. Staiger DO, Auerbach DI, Buerhaus PI. Trends in the work hours of physicians in the United States. JAMA.

2010;303:747-753. http://jama.jamanetwork.com/article.aspx?articleid=185433 Accessed February 24, 2014.

30. Punkne H. 3 current hospitalist trends. Bedker's Hospital Review. November 9,

2013. http://www.beckershospitalreview.com/hospital-physician-relationships/3-current-hospitalist-

trends.html Accessed April 2, 2014.

31. Murray M, Davies M, Boushon B. Panel size: how many patients can one doctor manage? Fam Pract

Manag. 2007;14:44-51. http://www.aafp.org/fpm/2007/0400/p44.html#fpm20070400p44-bt2 Accessed

February 16, 2014.

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Cite this article: Physician Compensation -- A Deeper Dive: Does Money Make Them Happy? Medscape. Apr 15, 2014.