Surgical specialties post gross-charge increases

November 1, 2008

The American Medical Group Assn.'s compensation and financial survey indicates trends among surgical specialties, based on compensation RVUs and gross charges over a four-year period

The american medical group Assn.'s 2008 Medical Group Compensation and Financial Survey is not painting an especially lucrative picture for surgical specialties, whose compensation rose an average of 3.7% in 2007, compared with an increase of 6% in 2006.

Cardiac and thoracic surgery, however, jumped 8.11%, more than most surgical and medical specialties, while compensation for urology surgery rose 4.65%, the second-highest increase. Other surgical specialties' compensation rose less, with emergency medicine, otolaryngology and general surgery bringing up the rear with 0.53%, 2.67% and 2.96% compensation increases, respectively.

Brad Vaudrey, director of the healthcare consulting practice for RSM McGladrey Inc. in Minneapolis, which conducted the survey, says that office-based medical specialties-dermatology (8.97%) and medical oncology (7.66%)-earned the largest percentage jumps in compensation between 2006 and 2007, while surgical specialties were nearly flat.

Faye Gargiulo, vice president of physician and service-line development for a multi-specialty practice in Southeast Virginia, Riverside Medical Group, also puts her money on procedural-based specialties, for which she has seen a disproportionate rate of growth in compensation.

"The irony is surgical specialties' livelihoods depend on medical specialties that refer their patients," she says. "Unfortunately, since there is not much incentive to encourage practicing primary care, the shortage is affecting surgeons."

Vaudrey anticipates that as the population ages, compensation for orthopedic surgery will increase, along with subspecialties that prove profitable.

PROFESSIONAL VALUE

Median work RVUs, which represent the professional value of services provided by a physician, matched compensation in most cases except for emergency medicine, which jumped 22.22% between the two years. In the surgery mix, cardiac and thoracic surgery led the pack with 33.32% because of a high rate of coronary bypasses and to 2007 RVU changes, Vaudrey says, followed by urology (13.62%) and ob/gyn (10.66%), attributed to their office-based procedures.

GROSS CHARGES

The survey also measured median gross charges-a measure of a physician's productivity. Again cardiac and thoracic surgery increased the most among the surgical disciplines (15.97%), ahead of emergency medicine (6.17%), general surgery (4.88%) and urology (4.02%), with orthopedic surgery lagging furthest behind at 2.09%.

Comparing longer-term trends, cardiac and thoracic surgeons saw a 44.25% increase from 2004 to 2007-again, the highest increase-and it was the general surgeons who saw the least increase over the time period, with median gross charges increasing 13.65%.

Even though emergency medicine surgical specialists show the lowest median gross charges for 2007 by dollar amount, their percent change since 2006 of 6.17% was second only to cardiac and thoracic surgeons.

Comparing dollar amount changes over the four-year period shows a leading uptick of $666,212 for cardiac and thoracic specialists, while emergency-medicine specialists charged $106,015 more, the lowest increase.

-Mari Edlin Commentary is independent of source data