News | Published: Monday, September 19, 2022
MedAxiom has released its 10th annual Cardiovascular Provider Compensation and Production Survey Report, revealing trends across cardiology, surgery, advanced practice providers (APPs) and non-clinical compensation. This report – powered by MedAxcess, the cardiovascular industry’s leading proprietary database and business intelligence application – includes year-over-year comparisons that provide insights into where cardiovascular programs have returned to, or even exceeded, pre-pandemic levels and where they are still lagging.
2022 Report Highlights:
Overall median cardiology compensation returned to pre-pandemic levels, but not as high as 2019
Compensation for cardiologists in private programs is only 3% lower than cardiologists in integrated programs; compared to a 20% gap only four years ago
New patient visits climbed in 2021, surpassing pre-pandemic levels
Procedure volumes rebounded for all three advanced imaging modalities and cardiac catheterizations
Employed/integrated continues to be the overwhelmingly dominant ownership model (nearly nine out of 10 programs)
When we compare pre-pandemic (2019) to 2021 for total compensation per wRVU, the data have largely normalized. The shift downward can likely be explained by the upward change in wRVUs caused by the E/M code increases.
The exception is advanced heart failure (HF), which experienced a significant decline in median total compensation per wRVU compared to 2019. The suspected reason for this is not that the market values these subspecialists less in 2021, but that there is a more robust sampling of physicians in the survey. In 2019 there were only 22 advanced HF physicians in the MedAxiom report, whereas for 2021 that sampling grew to 68 across integrated and private programs.
In 2021 the data show that ambulatory new patients have surpassed pre-pandemic levels with the median now sitting at 361 per FTE cardiologist. On the hospital side, median new patient volumes also recovered from 2020 and are consistent with the median from previous years. Likewise, subsequent hospital visits jumped back up in 2021 and are within 5% of the previous four-year high watermark.
Focusing on the more advanced cardiac procedures, median transcatheter aortic valve replacement (TAVR) volumes held in 2021 at their previous high watermark of 2.5 per 1,000 active cardiology patients set in 2020. In addition, the median number of TAVRs performed by each FTE interventional cardiologist also jumped up in 2021 to 41, compared to 34 in 2020 and 38 in 2019.
Electrophysiology (EP) procedures did not see a significant impact from the COVID pandemic unlike cardiology procedures. It is also important to note that not all EP procedures are performed by EP physicians.
Prior to 2021, 30-day event monitors and 24-hour Holter monitors, along with a few mobile telemetry devices, were the only trackable (billable and assigned a CPT code) monitor volumes in the MedAxiom survey. With the rapidly expanding remote monitoring technology, codes have been expanded to include patches and a host of telemetry devices.
Overall median surgical compensation has trended up over the past five years. Looking at that timeline median total compensation for have increased 60% for cardiac surgeons and 30% for vascular surgeons, respectively.
Work Relative Value Unit (wRVU) production jumped in 2021 for both surgical cohorts, as did total compensation, but not by the same margins. This is particularly true for vascular surgeons. The mathematical result was a decline in compensation per wRVU over the prior year by $2.50 for cardiac surgeons. Vascular surgeons gave back $7.60 per wRVU compared to the preceding year’s data.
The APP to cardiologist ratio has continued to rise with a 30% increase since 2017. Of note with the expanding APP workforce is that nearly one in four APPs (23%) are reported as part-time. This most likely allows for flexibility in scheduling but could also present challenges in consistency and covering daily needs.
In terms of wRVU production, cardiology APPs hold the top spot of the three major cardiovascular specialties, with median production of 1,582 wRVUs per FTE compared to 643 and 248 for vascular and cardiac surgery, respectively.
Non-Clinical Compensation Results
Median hourly compensation for medical directorships was reported at $230 per hour surpassing cardiovascular service line leadership at $191 per hour. Twenty-five percent of cardiovascular programs report having over $80,000 per FTE tied to non-clinical efforts. When focusing on hospital incentives, the top quartile is earning more than $50,000 per physician for this non-clinical work.
In total, 198 programs representing 5,651 cardiovascular providers completed the 2022 MedAxcess survey (providing 2021 data), a 13% increase in the number of providers represented year-over-year. Of these providers, 2,866 were full-time cardiovascular physicians and 1,778 were full-time cardiovascular APPs.
The median size of programs responding to this year’s survey was 11 FTE physicians for cardiology, an increase of one physician year-over-year.