News | Published: Tuesday, August 27, 2019
MedAxiom has released its seventh annual Cardiovascular Provider Compensation and Production Survey report, revealing trends across cardiology, surgery, advanced practice providers (APPs) and non-clinical compensation. The report’s findings (based on 2018 data) are instrumental in optimizing cardiology organizations of all sizes and ultimately advancing cardiovascular care.
“This year’s report is more robust than ever with the addition of data for the advanced heart failure subspecialty designation,” notes MedAxiom President Gerald (Jerry) Blackwell, MD, MBA, FACC. “We’re also excited about the potential to marry our survey data with the National Cardiovascular Data Registry in future years, thanks to our new relationship with the American College of Cardiology.”
Highlights from this year’s report include:
• Overall cardiology compensation reached the second highest total since 2012 and electrophysiologists are once again the top earners
• Heart failure (HF) cardiologist compensation (reported for the first time) is 10 percent lower than general non-invasive compensation
• The income gap between private and integrated physicians shrank
• There are more cardiologists age 61 and over than ever before
“I find the MedAxiom Cardiovascular Compensation & Production Survey Report to be very valuable as we review trends and see how our group’s compensation and production levels measure up with our peers,” says Jonathan Fialkow, MD, chief population officer, Baptist Health South Florida. “It provides us with a comprehensive resource as we plan and make decisions for the upcoming years.”
For the fifth year in a row and for the seventh year out of ten, overall cardiology compensation increased over the previous year in 2018, with a median total compensation of $577,329 per full-time equivalent (FTE). Both private and integrated physicians saw increases, with the gap between the two cohorts closing to one of its lowest levels (11 percent) since the integration wave of cardiology began in 2008. In terms of real dollars, private cardiologists earned just under $65,000 less per FTE than their peers in integrated settings.
Electrophysiology (EP) was once again the top earner in cardiology, with median total compensation of $629,641 per FTE. This is just ahead of interventional cardiology at median total compensation of $621,090, less than 1.5 percent below EP. In the 2018 data, general non-invasive physicians continued to be the lowest compensated of the traditional cardiology subspecialties, with median total compensation of $493,733.
Continuing its tradition of evolving with the changing marketplace, MedAxiom began collecting data for the new subspecialty of advanced HF several years ago. In its inaugural reporting year, HF cardiologists, who comprise just 2 percent of the cardiology workforce, debuted with median total compensation of $441,845 per FTE, 10 percent lower than general non-invasive peers.
In regards to supply and demand, one in four cardiologists (27 percent) is now over the age of 61 and interventional and general/non-invasive cardiologists are hit the hardest, with 29 percent and 31 percent of physicians over the age of 61, respectively.
Overall cardiology production has remained quite stable over the past five years. Private cardiologists continue to outpace those in integrated models in terms of overall wRVU production levels.
After falling back in 2017, cardiac surgery total compensation surged forward in 2018, jumping nearly $194,000 per FTE physician to a median of $795,461. Vascular surgery also increased by a modest 2.5 percent to a median of $491,072 per FTE. Cardiac surgeons out earned vascular surgeons when considering overall results and for those employed or integrated with a hospital or health system.
Despite the significant jump up in total compensation for cardiac surgeons, median wRVU production fell slightly in 2018, as did median production for vascular surgeons. In both cases this continues a general trend downward in production for these cardiovascular surgery specialties.
Cardiac and vascular surgeons who are integrated with a hospital or health system earned nearly identical total compensation per wRVU rates.
Cardiac and vascular surgeons continued to utilize more APPs per physician FTE than cardiologists, a pattern that has remained relatively consistent over time. The stagnant utilization of APPs, particularly in cardiology, is surprising given the current heavy focus of programs on expanding access and reducing costs.
Surgical APPs earned more than their cardiology peers at each of the percentiles within the survey. At the medians, cardiac surgery APPs earned just over $22,000 more per FTE than cardiology APPs. Vascular surgery APPs earned nearly the same as cardiology APPs when comparing medians ($105,000 per FTE and $104,647 per FTE respectively).
However, cardiology APP total compensation, measured at the median, has been steadily increasing over time while cardiac surgery APP total compensation has remained relatively flat.The median production for a full-time cardiology APP has been trending steadily upward over time. Still, at 918 wRVUs, this production is well below the reasonable ability of an APP to generate wRVUs over the course of the year, which points to two main probabilities: 1) the work performed by the APPs is being billed under the physician provider number; or 2) the APP is performing mostly non-billable work.
Non-Clinical Compensation Results
Nearly half of groups have some form of non-clinical incentive compensation. Of note is the size of the pools of “available” hospital incentives, which in 2018 found half the groups had over $1 million in potential earnings at risk.
Compensation for call activities was the most significant, with a median of just over $20,000 per FTE physician. Total compensation from non-clinical sources at the median was $33,450 in 2018 and represented 7 percent of the physician’s total compensation. For 25 percent of groups, these non-clinical sources represented over 10 percent of total compensation and were north of $60,000 per physician FTE.
A total of 184 groups, representing 2,267 full-time cardiovascular physicians, completed this year’s MedAxcess survey (providing 2018 data). In addition, there were 146 part-time physicians whose data were used in some of the findings, particularly the section on volume trends, for a total of 4,108 providers (physicians and APPs). The median size of the responding groups to this year’s survey was 13 FTE physicians.
What does the 2019 Cardiovascular Provider Compensation and Production Survey mean for your organization? Join report author Joel Sauer for a webinar on Sept. 12 from 1-2 p.m. ET to review this year’s trends and learn how you can use this essential strategic planning tool to optimize your organization. Register now.