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Solo and smallgroup physicians report that they have reduced Medi-Cal by 13 percent each, and, surprisingly, large-group physicians report that they have reduced Medi-Cal by more than 25 percent.
2007 San Diego County Physician Workforce and Compensation Survery By Tom Gehring, SDCMS CEO and Executive Director n 2002, the San Diego County Medical Society (SDCMS) conducted San Diego County’s first Physician Workforce and Compensation Survey, the results of which provided SDCMS and local healthcare policymakers with their first insights into physicians’ attitudes toward their work and workplace – with our 2002 survey quantifying as well San Diego County’s physician compensation environment. In 2005, we conducted our second Physician Workforce and Compensation Survey, and in 2007 our third. Our 2007 survey, the highlights of which are detailed in this report, contained all of the questions included in our 2005 survey, and added two questions about physician on-call behavior and several questions about reimbursements from County Medical Services.
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I. KEY FINDINGS A) Physicians were asked about their history and plans for Medicare. 1. Physicians were asked whether they took Medicare three
2.
3.
years ago. a) For every grouping except solo physicians, physicians reported no change from three years ago. b) However, solo physicians reported a 10 percent drop – from 91 percent to 81 percent – in taking Medicare. In the face of a 10 percent cut in Medicare, a significant number of physicians would change their behavior with respect to Medicare: a) Roughly two-thirds of community clinic and academic physicians would continue to see Medicare “as is,” but one-third would change their Medicare practice by reducing or eliminating Medicare. b) Roughly 40 percent of large- and medium-group physicians would continue to see Medicare “as is,” but roughly 60 percent would change their Medicare practice by reducing or eliminating Medicare. c) Only about one-quarter of small-group and solo physicians would continue to see Medicare “as is.” Recognizing that not every physician accepted Medicare before a postulated 10 percent cut, the net Medicare acceptance rate, without any change in practice pattern, is presented in blue below.
3.
TABLE 2: MEDI-CAL ACCEPTANCE RATES WITH AND WITHOUT A 5% PHYSICIAN REIMBURSEMENT CUT
90%
81%
67%
5% Cut - Continue to Take Medi-Cal “As Is”
65%
64% 59%
60% 53%
50% 50%
40%
36%
30% 20%
20% 10% 0% Community Academic Clinics Medicine
19%
30%
80% 70%
0% Cut - Continue to Take Medi-Cal “As Is”
72%
4.
35%
77%
70%
100% 21%
86%86%
80%
TABLE 1: NET MEDICARE ACCEPTANCE RATES WITH AND WITHOUT A 10% PHYSICIAN REIMBURSEMENT CUT
90%
prisingly, large groups report that they have reduced MediCal by more than 25 percent. Table 2 graphically represents the percentage of physicians currently taking Medi-Cal who would continue to take Medi-Cal “as is.” All others would either eliminate MediCal, significantly reduce the number of patients they see with Medi-Cal, or take no new Medi-Cal patients.
Large Group
Medium Group
Small Group
Solo
Recognizing that not every physician accepted Medi-Cal before a postulated 5 percent cut, the net acceptance rate, without any change in practice pattern, for Medi-Cal is presented in blue below:
TABLE 3: NET MEDI-CAL ACCEPTANCE RATES AFTER A 5% PHYSICIAN REIMBURSEMENT CUT
69%
60%
100% 7%
50% 40%
79% 65%
80%
44%
70% 33%
Take Medicare “As Is” after 10% Cut Do Not Take Medicare “As Is” after 10% Cut
31%
19%
81%
70%
30% 20%
17%
90%
60%
10%
50%
0%
40%
62% 86% 93%
Community Academic Clinics Medicine
Large Group
Medium Group
Small Group
83%
81%
Solo 30% 56%
B)
Physicians were asked about their history and plans for Medi-Cal. 1. On average, 63 percent of physicians took Medi-Cal in 2007. Physicians reported that three years ago 70 percent took Medi-Cal. 2. Physicians reported that for solo and small-group physicians, they have reduced Medi-Cal by 13 percent each, and, sur-
20%
38%
Take Medi-Cal After 5% Cut Do Not Take Medi-Cal After 5% Cut
10% 14% 0%
F E B R U A R Y
Community Academic Clinics Medicine 2 0 0 8
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Medium Group
Small Group
Solo
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C)
Physicians were asked about their history and plans for County Medical Services (CMS). 1. On average, 47 percent of physicians took CMS in 2007. 2. Physicians reported that three years ago, 48 percent took CMS. Community clinic physicians reported they reduced CMS by 14 percent. All other modes had no significant change in CMS acceptance. 3. Projecting forward, absent a change in CMS reimbursement, the future looks bleak for CMS patients who need to see a physician:
TABLE 4: COUNTY MEDICAL SERVICES ACCEPTANCE RATES WITH NO CHANGE IN CMS REIMBURSEMENT
100% 11% 90%
17%
14%
83%
86%
29% 80%
42%
70%
63%
60% 50% 89%
40% 71% 30%
58%
20%
37%
Take CMS If Unchanged Do Not Take CMS If Unchanged
10%
Large Group
Medium Group
Small Group
Solo
D) The
specialties that are in crisis in San Diego County – defined as having longer-than-average wait times for new patients, a perception that this specialty was in shortage, and a perception of difficulty recruiting within the specialty – are internal medicine, neurology (also in crisis in 2005), orthopedic surgery (also in crisis in 2005), and psychiatry (also in difficulty in 2005).
E)
The specialties that are in difficulty in San Diego County – defined as one meeting two of the three criteria defining a specialty “in crisis” (see “D” above) – are family medicine, ob-gyn (also in difficulty in 2005), hematology/oncology, nephrology, otolaryngology, (also in crisis in 2005), and pulmonology (also in difficulty 2005).
F)
Forty-five percent (unchanged from 2005) of physician respondents felt there was a physician shortage; however, when the significant influx of academic respondents in the 2007 survey is factored out (resulting in an “apples to apples” comparison to 2005 data), there is an increase from 45 percent to 50 percent of physicians who believe there is a shortage. When examined by practice size, 43 percent (up from 35 percent in 2005) of solo and small-group physicians felt there was a physician shortage, while 54 percent (up from 48 percent in 2005) of physicians practicing in a medium or large setting felt there was a physician shortage. Academic physicians do not believe there is a physician shortage.
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than 20 physicians felt there were shortages. Of those listed, some specialties had longer-than-average wait times for a new patient appointment – an informal indicator that a perceived shortage by physicians is translating into a real problem for patients. 1. Internal Medicine (repeat from 2005) (excessive wait time in 2007) 2. Family Medicine (repeat from 2005) 3. Gastroenterology 4. Neurology (repeat from 2005) (excessive wait time in 2007) 5. Dermatology (repeat from 2005) 6. Endocrinology 7. Pain Medicine 8. Psychiatry (repeat from 2005) (excessive wait time in 2007) 9. General Surgery (repeat from 2005) 10. Neurosurgery (repeat from 2005) 11. Rheumatology 12. Orthopedic Surgery (repeat from 2005) (excessive wait time in 2007) 13. Obstetrics and Gynecology (repeat from 2005) (excessive wait time in 2007) 14. Otolaryngology (repeat from 2005) (excessive wait time in 2007) 15. Pediatrics 16. Anesthesiology (repeat from 2005) H) Of those who were recruiting or involved in recruiting, 41 per-
0% Community Academic Clinics Medicine
G) The following is a list (in priority order) of specialties where more
F E B R U A R Y
cent (down slightly from 45 percent in 2005) reported some difficulty in recruiting, while 33 percent (essentially unchanged from 34 percent in 2005) reported significant difficulties recruiting. 1. A significant difference emerged when analyzing recruiting difficulty by practice size. An astonishing 86 percent of solo and small-group physicians reported difficulty recruiting (either some difficulty or significant difficulty). No less surprising and disconcerting is that academic physicians are similarly challenged: 74 percent reported difficulty recruiting (either some difficulty or significant difficulty). That same statistic for physicians practicing in medium and large groups was “only” 64 percent. Everyone is having a problem recruiting physicians to San Diego County. 2. Significant in-specialty recruiting difficulty was indicated for the following specialties (sorted alphabetically): • Family Medicine (repeat from 2005) • General Surgery (repeat from 2002 and 2005) • Hematology/Oncology (upgrade from some recruiting difficulty in 2005) • Internal Medicine (repeat from 2005) • Nephrology • Neurology (repeat from 2002 and 2005) • Orthopedic Surgery (repeat from 2005) • Otolaryngology (repeat from 2005) • Psychiatry (repeat from 2002 and 2005) • Pulmonology (upgrade from some recruiting difficulty in 2005) • Radiology (repeat from 2002 and 2005) 2 0 0 8
3.
I)
In 2005, significant problems were reported in recruiting primary care physicians in internal medicine and family medicine. In 2007, this trend dramatically accelerated: The quantitative numbers on physicians reporting difficulty in recruiting to internal medicine and family medicine are very high.
On the subject of physician retention, the 2007 survey projects that 82 percent of San Diego County physicians will maintain their practice “as is” for the next three years. 1. This is essentially unchanged from 2005. When analyzed by district, North County Inland and South Bay physician “retention” was lower than the average. 2. Not surprisingly, of those physicians likely to change their practice mode, there was a clear dropoff for physicians in practice for more than 30 years, of whom only 59 percent said they would be in practice in three years. 3. Very surprisingly, there is a sharp dip in physician retention at the six- to 10-year point.
J) The
average number of total hours worked by San Diego County physicians, including clinical and non-clinical hours, was 60.1 hours per week, up from 57 hours in 2005. The most significant component of this increase was from academic physicians. When compared to 2002 data, the physician workweek is getting longer. The 2002 average was 53 hours, in 2005 the workweek was 57 hours, and in 2007 it was 60.1. Over the past five years, working hours have increased by seven hours. 1. There was a clear difference in total hours worked when analyzed by group size. Solo and small-group physicians work longer hours – on average 61.9, up from 60 hours per week in 2005 – than doctors practicing in the medium- and large-group settings: 54.4 hours per week (unchanged from 2005). 2. The total hours worked by female physicians was significantly less: 53.6 (same as in 2005) hours per week versus
3.
K)
62.1 hours (up from 58 hours per week in 2005) worked by their male counterparts. Of note, there was no significant difference in the number of patient-care hours for female versus male physicians. Specialists averaged 62.8 total hours per week (up from 58 hours per week). Primary care physicians averaged 54.7 total hours per week (up from 53 hours per week), with no significant difference in patient-care hours between specialists and primary care doctors.
A San Diego County physicians spend, on average, 39 hours per week seeing patients. 1. There was a significant difference in patient hours between full-time male (40.4 hours seeing patients) and full-time female physicians (35.7 hours seeing patients). 2. There was also significant variation between the hours spent with patients for the various modes of practice: a) Solo and small-group physicians: 42.6 hours per week seeing patients. b) Medium- and largegroup physicians: 39 hours per week seeing patients. c) Physicians practicing in academic medicine: 34.3 hours per week seeing patients. 3. When compared to 2005 data, the number of hours spent directly in patient care in 2007 dropped. However, in 2005 there were almost no academic physicians. If the academic physicians are factored out of the 2007 data, then there is negligible difference between the 2005 and 2007 data for patient hours per week.
F E B R U A R Y
1.
2.
L) Sixty percent of physicians responded that time spent with patients was adequate, while 39 percent said that time spent was inadequate. This is unchanged from 2005. Solo and small-group physicians, by a 62 percent to 38 percent ratio, felt (overwhelmingly) that time spent with patients was adequate. Of note, this satisfaction with time spent for solo and small-group physicians is down significantly from 2005 data. Medium- and large-group physicians, on the other hand,
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3.
4.
5.
M)
N)
30
were almost evenly split (55 percent to 45 percent) that time spent with patient care was adequate. This is unchanged from 2005. Of note, physicians practicing in an academic setting were the most satisfied with time spent with patients of any of the modes of practice at 66 percent. In 2007, 57 percent of male physicians were satisfied with the time spent with patients, while 66 percent of female physicians were satisfied with the time spent with patients. Of note, this a reversal from 2005 data, where the ratio was males at 61 percent satisfied versus females at 52 percent satisfied. Specialists are 64 percent satisfied with time spent with patients, while primary care physicians were at 54 percent. This is essentially identical to 2005 values.
Overall wait times for new patient appointments have not changed since 2005. The average time for a new patient to obtain an appointment in 2005 and 2007 was 2.2 weeks, or 11 business days. In a reversal from 2005, the time to obtain an appointment for solo physicians went from the shortest in 2005 to next to longest. 1. In 2007, small- and medium-group wait times for new appointments went from among the longest to the two shortest wait times. 2. In 2007, there were longer-than-average wait times for nephrology, neurology, allergy and immunology, ophthamology, hematology/oncology, psychiatry, orthopedic surgery, and pulmonology. 3. Neurology, ophthalmology, and pulmonology also had longer-than-average wait times from 2005. 4. When compared to 2005 data, the wait times for internal medicine increased significantly, while wait times for family medicine dropped. The dissatisfaction of physicians with the practice of medicine in San Diego County is strong. Overall, 50 percent (down slightly from 53 percent in 2005) are less satisfied with the practice of medicine than they were five years ago. Physicians reported that 19 percent – up from 13 percent two years ago – are more satisfied, and 31 percent (almost unchanged) see no change in their satisfaction with the practice of medicine. Unlike 2005, there is strong variation along several axes of data analysis. 1. Male physicians are significantly more dissatisfied (54 percent vs. 39 percent) than female physicians. 2. Solo and small-group physicians are hugely more dissatisfied (60 percent dissatisfied vs. 10 percent more satisfied) than medium- and large-group physicians or academic physicians (where the dissatisfied still outweigh the satisfied but by a much lower ratio: about 42 percent dissatisfied vs. 22 percent satisfied). 3. A similar differential exists when analyzed by specialty versus primary care. The specialists are much more dissatisfied (57 percent dissatisfied vs. 14 percent more satisfied) than primary care physicians (39 percent dissatisfied vs. 28 percent more S A N
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4.
satisfied). There is a huge dissatisfaction-satisfaction differential when examined by years in practice. Physicians who have been in practice six to 10 years are unhappy, and those practicing between 11 and 15 years are even unhappier. The dissatisfiedsatisfied differential (the difference between those who are more satisfied and those less satisfied) goes from 26 percent for physicians in their first five years of practice to 38 percent in their second five years of practice to 47 percent in their third five years of practice.
O)
Physician compensation has improved vis-à-vis 2005. 1. Physicians were asked whether their compensation went up, stayed the same, or went down relative to their compensation three years ago. The general compensation trend is positive. Forty-three percent felt that compensation increased since 2005; 28 percent felt that compensation remained the same; and 29 percent felt that compensation decreased. 2. In a geographic anomaly, solos and small-group physicians in Hillcrest and South Bay are paid less than their geographic peers. 3. Female physicians make less than their male counterparts, though the female physician compensation trend is more positive than the male physician compensation trend. 4. Relative to three years ago, the compensation trend of specialists has not been as positive as primary care physicians, though primary care physicians are reimbursed less than specialists. 5. When analyzed for years in practice, the trends are not surprising: Younger physicians see their compensation increasing, while older physicians do not. However, the 6–10 year cohort is not getting the increases in pay they expect.
P)
Specialty-specific compensation information (more detailed information is presented in the complete report). 1. The lowest paid specialties are family medicine, nephrology, neurology, pain medicine, pediatrics, internal medicine, and psychiatry. 2. The highest paid specialties are neurosurgery, cardiology, orthopedic surgery, otolaryngology, pathology, radiology, thoracic surgery, and gastroenterology.
Q)
Physicians were asked about average on-call days per month. 1. Solo and small-group physicians: 2.3 days of call without stipend and 1.4 days of call with stipend 2. Medium- and large-group physicians: 2.7 days of call without stipend and 0.8 days of call with stipend 3. Academic physicians: 4.0 days of call without stipend and 1.3 days of call with stipend.
II. A TALE OF THREE PRACTICES An underlying theme of the 2005 Physician Workforce and Compensation Survey was the widening gulf between the solo and smallgroup practices – defined as fewer than five physicians in a practice
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– and the medium- and large-group practices. With the significant number of academic physicians responding to the 2007 survey, there appear to be three distinct cohorts in modes of practice. Across a number of factors, there are significant differences between these practice types. Table 5 below summarizes the differences:
An astonishing 86 percent of solo and small-group physicians reported difficulty recruiting (either some difficulty or significant difficulty).
TABLE 5: TABLE DIFFERENCES BETWEEN SOLO AND SMALL-GROUP PRACTICES AND MEDIUM- AND LARGE-GROUP PRACTICES
SOLO OR SMALL GROUP PHYSICIANS
MEDIUM- OR LARGE-GROUP PHYSICIANS
ACADEMIC MEDICINE PHYSICIANS
Very Dissatisfied
Somewhat Dissatisfied
Somewhat Dissatisfied
Satisfied
Less Satisfied
Very Satisfied
Longer
Shorter
Much Longer
Longer Than Average
Average
Shorter Than Average
Lesser
Greater
Greater
CONCERNED ABOUT RECRUITING NEW PHYSICIANS:
Very Concerned
Less Concerned
Concerned
CONCERN ABOUT A PHYSICIAN SHORTAGE:
Less Concerned
Concerned
Not Concerned
DISSATISFACTION WITH THE PRACTICE OF MEDICINE: SATISFACTION WITH TIME SPENT WITH PATIENTS: TOTAL WORK HOURS: PATIENT CARE HOURS: COMPENSATION
III. DIFFERENCES BETWEEN MALE AND FEMALE PHYSICIANS While there are many similarities, there are some differences between male and female physicians. Table 6 below summarizes the differences: TABLE 6: DIFFERENCES BETWEEN MALE AND MALE PHYSICIANS
TOTAL WORK HOURS: PATIENT CARE HOURS: SATISFACTION WITH TIME SPENT WITH PATIENTS: DISSATISFACTION WITH THE PRACTICE OF MEDICINE: COMPENSATION AND COMPENSATION TREND:
MALE PHYSICIANS
FEMALE PHYSICIANS
Longer
Shorter
Slightly Longer
Slightly Shorter
Slightly Less
Slightly More
More Dissatisfied
Less Dissatisfied
Paid More, but Improvement Rate Lower
Paid Less, but Improvement Rate Greater
IV. PHYSICIAN DIFFERENTIAL BEHAVIOR ALONG THE AGE CONTINUUM While there are many similarities, there are some clear differences along the age continuum. A. With respect to physician retention: 1. There is a surprisingly sharp dip in physician retention at the six- to 10-year point. F E B R U A R Y
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Not surprisingly, of those physicians likely to change their practice mode, there was a clear drop-off for physicians in practice for more than 30 years, of whom only 59 percent said they would be in practice in three years. There is a huge dissatisfaction-satisfaction differential when examined by years in practice. The physicians who have been in practice for six to 10 years are unhappy, and those 2.
B.
C.
practicing between 11 and 15 years are even unhappier. The dissatisfied-satisfied differential (the difference between those who are more satisfied and those less satisfied) goes from 26 percent for physicians in their first five years of practice to 38 percent in their second five years of practice to 47 percent in their third five years of practice. When analyzed for years in practice, the trends are not surprising: Younger physicians see their compensation in-
TABLE 7: OVERVIEW OF SPECIALTIES IN CRISIS AND IN DIFFICULTY
Red = In Crisis • Blue = In Difficulty (See definitions of “in crisis” and “in difficulty” on page 28, letters “D” and “E.”) PRIMARY CARE
Family Medicine
Yes
Internal Medicine
Yes
Pediatrics
Yes
OB/GYN (in difficulty 2005)
Yes
FEWER THAN FIVE RESPONSES
GREATER THAN AVERAGE WAIT TIMES FOR NEW PATIENTS
PHYSICIANS PERCEIVE THIS AS A SHORTAGE
DIFFICULTY RECRUITING
Yes
Significant
Yes
Significant
Yes
Some
Yes
Yes
Some
Yes
Some
Yes
Allergy and Immunology
Yes
Anesthesiology
Some
Some
Cardiology
Yes
Dermatology (in difficulty 2005)
Some
Emergency Medicine Endocrinology
Yes
Yes
Gastroenterology
Yes
Yes
Geriatric Medicine
Yes
Yes
Hand Surgery
Yes
Significant
General Surgery (in difficulty 2005)
Yes
Hematology/Oncology
Some
Significant
Yes
Hepatology Nephrology
Yes
Neurology (in crisis 2005)
Yes
Significant Yes
Significant
Yes
Neurosurgery (in crisis 2005)
Yes
Occupational Medicine Ophthalmology (in difficulty 2005)
Yes
Orthopedic Surgery (in crisis 2005)
Yes
Otolaryngology (in crisis 2005)
Yes
Pain Medicine
Some Yes
Significant
Yes
Significant
Yes
Pathology Physical Medicine and Rehabilitation
Yes
Plastic Surgery
Yes
Psychiatry (in difficulty 2005)
Yes
Yes
Significant
Pulmonology (in difficulty 2005)
Yes
Some
Significant
Some
Significant
Radiology (in difficulty 2005) Radiation Oncology
Yes
Rheumatology (in difficulty 2005)
Yes
Sports Medicine
Yes
Thoracic Surgery
Yes
Yes
Some
Urology (in crisis 2005)
Yes
Vascular Surgery
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creasing, while older physicians do not. However, the six- to 10-year cohort is not getting the increases in pay they expect.
The dissatisfaction of physicians with the practice of medicine in San Diego County is strong.
V. SPECIALTY SPECIFIC INFORMATION Although highly subjective, the study identified specialties in crisis – defined as longer-than-average wait times for new patients, a perception that this specialty was in shortage, and a perception of difficulty recruiting within the specialty – highlighted in red in Table 7. The specialties that are in crisis in San Diego County are internal medicine, neurology (also in crisis in 2005), orthopedic surgery (also in crisis in 2005), and psychiatry (also in difficulty in 2005). In addition, those specialties that were in difficulty – defined as meeting two of the three criteria above – were highlighted in blue in Table 7. The specialties that are in difficulty in San Diego County are family medicine, ob-gyn (also in difficulty in 2005), hematology/oncology, nephrology, otolaryngology (also in crisis in 2005), and pulmonology (also in difficulty 2005).
E.
VI. DEMOGRAPHICS OF THE PHYSICIAN RESPONDERS 359 active physicians responded. Eight residents, students, retired physicians, and physicians not seeing patients were removed from the total response of 367 data pool. The 2005 survey had approximately 100 more respondents. B. 70 percent of the respondents were SDCMS members. This was consistent with the 2005 survey. SDCMS members represent about 30 percent of San Diego County’s approximately 6,500 to 7,000 active, practicing physicians. C. Respondents were 70 percent male and 30 percent female. This compares favorably with a 75/25 ratio of male-tofemale physicians in San Diego County. Proportionally more female physicians responded than in the last two surveys. D. Respondents were evenly distributed throughout the physician lifecycle: 32 percent in their first 10 years of practice; 31 percent were in their second decade of practice; and 37 percent were in practice for more than 20 years. This was consistent with the 2005 survey. A.
F.
Of the responding physicians, 41 percent were in primary care – defined as practicing in the specialties of family medicine, ob-gyn, pediatrics, and internal medicine. 59 percent were categorized as practicing outside of primary care, i.e., as specialists. This compares favorably with a primary care physician/specialist ratio of 39 percent/61 percent for all physicians in San Diego County, and was consistent with the 2005 survey. Of note, female physicians make up 42 percent of the primary care physicians but only 22 percent of specialists. The mode of practice breakdown was as follows: 1. Solo (1-2 physicians): 24 percent 2. Small Group (3-4 physicians): 7 percent 3. Medium Group (5-25 physicians): 19 percent 4. Large Group (more than 25 physicians): 22 percent 5. Academic Medicine: 26 percent 6. Community Clinic: 2 percent
When compared to the 2005 survey, proportionally fewer Permanente Medical Group physicians participated, and significantly more UCSD physicians (referred to as physicians practicing in academic medicine) responded. TABLE 9: DISTRIBUTION OF SURVEY RESPONDENTS BY SIZE OF PRACTICE
TABLE 8: DISTRIBUTION OF SURVEY RESPONDENTS BY YEARS IN PRACTICE
50%
48%
25%
2005
22%
2007
40%
20% 16%
17%
17%
16%
30%
15%
24%24%
12%
22%
26%
19%
20%
10%
14% 10% 7% 7%
5%
6%
1% 2%
0%
0% 0-5 Years
6-10 Years
11-15 Years
16-20 Years
21-30 Years
30+ Years F E B R U A R Y
Solo (1-2)
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Large Group (>150)
Academic Community Medicine Clinic
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There is a huge dissatisfaction-satisfaction differential when examined by years in practice. The physicians who have been in practice for six to 10 years are unhappy, and those practicing between 11 and 15 years are even unhappier.
G.
H.
85 percent were full-time, and 15 percent were half-time. This represents a doubling of the percentage of physicians working part-time who responded to the survey, and may be indicative of more physicians working at half-time or less. Of note, there was no significant difference between the percentage of males and females working part-time (defined as 20 hours of patient care or fewer) since the last survey. Because of the excellent response from UCSD, there was a completely expected geographic distribution peak for academic physicians in Hillcrest and in La Jolla. However, solo, small group, medium group, and large group physicians were evenly distributed. Compared to the last survey, there were fewer Permanente physicians. There were no underrepresented geographic areas.
TABLE 10: DISTRIBUTION OF SURVEY RESPONDENTS BY MODE OF PRACTICE AND BY AREA OF COUNTY
50% 45% Solo/Small
44
Medium/Large Academic Medicine
40% 35% 30% 27
25% 23
23 20
20%
18
17 15
15% 10%
15
15
15
10
9
13
11
6
5%
3 1
2
0% E - East County
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HHillcrest
J - La Jolla
K - Kearny N - North N - North S - South County Mesa County County Coastal Inland
I. SPECIALTY DISTRIBUTION 1. THE FOLLOWING SPECIALTIES HAD MORE THAN 20 RESPONDENTS (# OF RESPONDENTS):
• • • •
PHYSICIANS CAPITAL ASSURANCE SERVICES
“The Physician’s Advocate”
Family Medicine (51) Internal Medicine (40) Pediatrics (36) Obstetrics and Gynecology (22)
2. THE FOLLOWING SPECIALTIES HAD BETWEEN 5 AND 20 RESPONDENTS (# OF RESPONDENTS):
• • • • • • • • • • • • • • • • • • • •
Emergency Medicine (19) Orthopedic Surgery (18) Psychiatry (13) Ophthalmology (13) Radiology (12) General Surgery (12) Otolaryngology (9) Pulmonology (8) Hematology/Oncology (8) Neurology (8) Anesthesiology (7) Nephrology (7) Cardiology (6) Pathology (6) Urology (5) Urgent Care (5) Allergy and Immunology (5) Neurosurgery (5) Infectious Diseases (5) Dermatology (5)
3. THE FOLLOWING SPECIALTIES HAD FEWER THAN 5 RESPONDENTS (# OF RESPONDENTS):
• • • • • • • • • • • • •
Vascular Surgery (4) Gastroenterology (4) Radiation Oncology (4) Plastic Surgery (4) Pain Medicine (3) Occupational Medicine (3) Thoracic Surgery (3) Endocrinology (2) Physical Medicine (2) Geriatric Medicine (2) Hepatology (1) Sports Medicine (1) Rheumatology (1)
Note: Specific specialty pay information is available to SDCMS members and those who filled out the survey. Contact Tom Gehring at Gehring@SDCMS.org to obtain a complete copy of our 2007 San Diego County Physician Workforce and Compensation Survey.
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