Physicians see income drop — what happens next?

From skyrocketing inflation to CMS pay cuts, physicians are facing compensation declines affecting their practices and livelihoods. 

Seven physician leaders recently spoke with Becker's about their level of happiness with their income and what they would like to see changed. 

Question: How satisfied with your income are you currently? What changes do you hope to see related to your income?

Editor's note: Responses were edited lightly for brevity and clarity. 

Robert Chavez, MD. Internal Medicine Specialist at NYU Langone Health: Income satisfaction on a scale of 1 to 10 is a 4. Medicare cuts and the No Surprises Act is killing emergency room groups. I would like to see insurance companies pay the independent resolution decisions they lose. It would also be nice for CMS to come to a decision to unfreeze the IDR process and stop putting the artificially low qualifying payment amount as the dominant factor.  

Eric Eskioglu, MD. Executive Vice President and Chief Medical and Scientific Officer of Novant Health (Charlotte, N.C.): There is general wariness of decreasing Medicare and private payer reimbursements. Even though we avoided the catastrophic Medicare physician reimbursement cuts, we still ended up with around 4 percent decrease beginning in 2023. When you include the annual inflation rate of 7 percent, this means physicians are making approximately 11 percent less than just a year earlier. I also see continued physician compensation pressures on legacy integrated delivery network systems. Companies like Optum, Amazon Health, CVS, Walgreens and even Walmart are directly competing for the shrinking pool of physician candidates with the advantage of not having to worry too much about fair market value due to them not coming to any acute care businesses. We are in for continued disruption.

Marsha Haley, MD. Clinical Assistant Professor of Radiation Oncology at University of Pittsburgh School of Medicine: My colleagues and I in radiation oncology provide a necessary and valuable service for cancer patients. Despite our treatments being extremely cost-effective, Medicare reimbursement rates for radiation oncology have been cut more than 20 percent over the last decade. This makes it more difficult for freestanding radiation oncology clinics to stay open and results in consolidation into large health systems. Not only does this make it harder on patients who must travel farther for treatment, but as the operating margins for hospitals diminish, it becomes harder to pay staff such as myself a competitive wage.

Taif Mukhdomi, MD. Interventional Pain Physician at Pain Zero (Columbus, Ohio): Being in the first six months of starting our own practice in Columbus, Ohio, I'm not the best person to talk about income. However, the current trend of declining reimbursements specifically in the office setting shows a preference of CMS to hospital-based care. With the growing studies and literature showing hospital consolidation has not led to improved quality or reduced costs, I am hopeful to see policy swing towards favoring professional fees as well as office-based and ambulatory surgical center sites of service.

Thomas Sweet, MD. Hematology and Oncology Physician at Southern California Permanente Medical Group (San Diego): My income in an integrated healthcare system is below par in my opinion. More egregious is the relative lack of support that I receive.

 Kerry Willis, MD. Family Practice Physician (Beaufort, N.C.): As a rural family physician, my income is good but inadequate compared to other physicians with similar training and expertise. Because of discriminatory fee schedules by BCBS, Medicare Advantage plans and Medicare and Medicaid itself, rural physicians are being hunted into extinction by the forces claiming to support them. Compensation to family physicians is less than the cost of living for the last 10 years and continues to decline as no requirements for costs of living exist in contracts. Since COVID-19, labor shortage and supply chain disruption have caused massive increases in overhead and labor costs without any concomitant increase in fees, even as a member of a risk-bearing accountable care organization, my net income was cut. 

Lance Wobus. Psychiatry Resident at Richmond University Medical Center (New York City): I am a PGY-1 resident, so of course I'm very dissatisfied with my income. I make about $79,000 a year in New York City and am working 60 to 80 hours a week in my medicine rotation (I am a psych resident). I've always thought the match is essentially forced labor — we take whatever the programs decide to give us or else we don't practice medicine.

The best way forward is to unionize, hands down. This is a growing movement, although everyone I know fears being labeled as a "troublemaker," so they stay quiet. They'd rather suffer (what I consider to be) injustice rather than getting dismissed from a residency program, jeopardizing their medical career. More moonlighting opportunities to supplement income would also be beneficial, but there is simply no time, at least in my schedule.

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