Here are 30 things to know about the physicians and procedures of three top ambulatory surgery center specialties.
Gastroenterology
1. There were approximately 11,594 gastroenterologists in the United States from 1999 to 2005, or 3.9 gastroenterologists per 100,000 people, according to the American Journal of Gastroenterology report International Comparisons of Manpower in Gastroenterology. But call for colorectal cancer screening continues to rise and supply may not be able to meet the demand. By 2020, it is estimated that the United States will need an additional 1,050 gastroenterologists, according to a report by The New York Times.
2. In 2013, gastroenterologists earned an average annual salary of $348,000, according to the Medscape Gastroenterologist Compensation Report 2014. Here are nine statistics on average gastroenterologist compensation across the country.
• Northwest: $368,000
• West: $340,000
• Southwest: $380,000
• North Central: $378,000
• South Central: $365,000
• Great Lakes: $382,000
• Southeast: $349,000
• Northeast: $335,000
• Mid-Atlantic: $319,000
3. On average self-employed gastroenterologists earn more at $395,000 per year, while employed gastroenterologists earn an average of $300,000. Here are seven statistics on gastroenterologist compensation by practice setting, according to the Medscape Gastroenterologist Compensation Report 2014.
• Office-based multispecialty group practice: $404,000
• Office-based single-specialty group practice: $395,000
• Healthcare organization: $392,000
• Outpatient clinic: $366,000
• Office-based solo practice: $339,000
• Hospital: $266,000
• Academic (non-hospital, research, military, government): $239,000
4. Here are six statistics on gastroenterologist benefits, according to Salary.com.
• Social Security: $12,274 (2.7 percent of total compensation)
• 401(k)/403(b): $9,000: (2 percent of total compensation)
• Disability: $3,243 (0.7 percent of total compensation)
• Healthcare: $6,592 (1.5 percent of total compensation)
• Pension: $15,750 (3.5 percent of total compensation)
• Time off: $44,350 (9.8 percent of total compensation)
5. Gastroenterology represents the highest volume specialty performed in ambulatory surgery centers. GI/endoscopy procedures represent 27 percent of overall ASC case volume, according to VMG Health's 2012 Intellimarker Ambulatory Surgical Center Financial & Operational Benchmarking Study. GI/endoscopy procedures performed in ASCs in the Southwestern United States have the highest net revenue per case at $949, while GI/endoscopy procedures performed in Southeastern ASCs have the lowest net revenue per case at $663.
6. Of the 20 most commonly performed ASC procedures, seven are GI/endoscopy-related, according to MedPAC data. Here are the seven procedures by case volume.
• Upper GI/endoscopy, biopsy: 8.1 percent
• Colonoscopy and biopsy: 5.8 percent
• Lesion removal colonoscopy: 4.5 percent
• Diagnostic colonoscopy: 3 percent
• Colorectal cancer screening, high-risk individual: 1.9 percent
• Colon cancer screening, average-risk individual: 1.6 percent
• Upper GI/endoscopy, diagnosis: 1.1 percent
7. In 2009, 6.9 million upper endoscopies, 11.5 million lower endoscopies and 228,000 biliary endoscopies were performed in the United States, according to the Medscape report Burden of Digestive Diseases. Each year gastrointestinal diseases create $142 billion in direct and indirect costs. In 2009, outpatient GI endoscopy examinations cost $32.4 billion.
8. Colorectal cancer is the number one cause of GI-related mortality. Colonoscopy has long been considered the gold standard of colorectal cancer screening, but there are a growing number of modalities. Over the past decade, the percentage of Americans up-to-date on screening recommendations increased from 55 percent to 65 percent. Colorectal cancer rates among Americans 50 and older over the past 10 years has dropped 30 percent. But, colorectal cancer continues to be the third leading cause of cancer mortality in the United States, according to the Colorectal Cancer Statistics, 2014 report.
Here are four statistics on the estimated number of new colorectal cases and mortality in 2014.
• New cases (male): 71,830
• New cases (female): 65,000
• Deaths (male): 26,270
• Deaths (female): 24,040
The National Colorectal Cancer Roundtable has begun a campaign to increase the screening rate to 80 percent of eligible adults by 2018.
9. The global market for endoscopy equipment is expected to reach a value of $37.9 billion by 2018, according to a Markets and Markets report. The market is expected grow at a compound annual growth rate of 6.1 percent from 2013 to 2018.
10. In 2013, general gastroenterology was the most in-demand GI specialty, followed by pediatric gastroenterology and hepatology, according to the HEALTHeCAREERS Network 2014 Gastroenterology Employment Fact Sheet. Job postings for general gastroenterologists rose 2 percent from 2012 to 2013.
Ophthalmology
1. As of March 2014, there were 25,152 ophthalmologists in the United States, according to the International Council of Ophthalmology. Here are five statistics on the ophthalmologist workforce.
• There are 81 ophthalmologists per one million people.
• There are 490 ophthalmologists entering practice in 2014.
• There are 350 ophthalmologists leaving practice in 2014.
• 87.5 percent of ophthalmologists perform surgery.
• There are 1,350 ophthalmology residents.
2. The average ophthalmologist salary in 2013 was $291,000, according to the Medscape Ophthalmologist Compensation Report 2014. The average salary increased 5 percent between 2012 and 2013. Here are nine statistics on ophthalmologist salary across the country.
• Great Lakes: $333,000
• Northwest: $320,000
• Southeast: $318,000
• North Central: $294,000
• South Central: $283,000
• Northeast: $273,000
• Mid-Atlantic: $263,000
• West: $260,000
• Southwest: $239,000
3. Ophthalmologists in office-based single-specialty group practices had the highest average salary in 2014 at $325,000, according to the Medscape report. Here are six statistics on ophthalmologist salary by practice setting.
• Healthcare organization: $315,000
• Office-based multispecialty group practice: $309,000
• Office-based solo practice: $291,000
• Academic (non-hospital), research, military, government: $208,000
• Hospital: $177,000
• Outpatient clinic: $159,000
4. Here are six statistics on ophthalmologist benefits, according to Salary.com.
• Bonuses: $2,812 (0.8 percent of total compensation)
• Social security: $10,880 (3.2 percent of total compensation)
• 401(k)/403(b): $9,000 (2.6 percent of total compensation)
• Disability: $2,378 (0.7 percent of total compensation)
• Healthcare: $6,592 (1.9 percent of total compensation)
• Pension: $15,750 (4.6 percent of total compensation)
• Time off: $32,518 (9.5 percent of total compensation)
5. Ophthalmology represents 17 percent of total case volume in ambulatory surgery centers, second only to GI/endoscopy, according to VMG Health's 2012 Intellimarker Ambulatory Surgical Center Financial & Operational Benchmarking Study. ASCs located in the Southwestern U.S. had the highest gross charges per case at $7,290, while ASCs located in the Midwest had the highest net revenue per case at $1,328. ASCs with more than four operating rooms have the highest net revenue per case at $1,380, compared to net revenue of $1,167 at ASCs with one to two ORs.
6. Of the top 20 procedures performed in ASCs, four are ophthalmological, according to MedPAC data. The most common procedure is cataract surgery with IOL insert, stage one, representing 16.9 percent of ASC case volume. After cataract laser surgery is the sixth most common ASC procedure, at 3.9 percent of total case volume. Upper eyelid revision surgery is the 18th most common procedure, at 0.9 percent of total case volume, and complex cataract surgery is the 15th most common procedure at 1.3 percent of total case volume.
7. The direct medical costs for treating cataracts, which affects approximately 22 million Americans aged 40 and older, are estimated to by $6.8 billion each year, according to the American Academy of Ophthalmology.
8. Here are 4 statistics on cataract surgery performed in ambulatory surgery centers, according to the Accreditation Association for Ambulatory Health Care.
• Cataract surgery patients spend an average of 117 minutes in an ASC, from check-in time to discharge.
• Pre-procedure time is an average of 81 minutes.
• Cataract surgery procedure time is an average of 14 minutes.
• Discharge time takes an average of 22 minutes.
9. In April, CMS disclosed data on $77 billion in payments made to physicians and providers in 2012. Ophthalmologists were third among the top paid providers, behind hematologists/oncologists and radiation oncologists. The data included 17,067 ophthalmologists who were paid an average of $327,239 each in 2012.
10. There are nine subspecialties in ophthalmology, according to the American Academy of Ophthalmology, including:
• Cornea and external disease
• Cataract and refractive surgery
• Glaucoma
• Uveitis and ocular immunology
• Vitreoretinal diseases
• Ophthalmic plastic surgery
• Pediatric ophthalmology
• Neuro-ophthalmology
• Ophthalmic pathology
Orthopedics
1. There are approximately 27,773 orthopedic surgeons in the United States, according to the American Academy of Orthopaedic Surgeons. Nationally, there are 8.72 orthopedic surgeons per 100,000 people. Here are 10 statistics on the lowest and highest orthopedic surgeon density by state.
Highest density
• Wyoming: 14.96
• District of Columbia: 14.73
• Montana: 14.63
• New Hampshire: 13.58
• Vermont: 13.25
Lowest density:
• Mississippi: 6.55
• West Virginia: 6.58
• Texas: 6.83
• Arkansas: 6.91
• Nevada: 7.01
2. Of the 25 specialties surveyed in Medscape's annual compensation report, orthopedists earned the most with an average salary of $413,000. From 2012 to 2013, orthopedists' average salary rose 2 percent, according to the Medscape Orthopedist Compensation Report 2014. Here are nine statistics on orthopedist compensation across the country.
• Great Lakes: $449,000
• Northwest: $468,000
• West: $343,000
• Southeast: $423,000
• Northeast: $410,000
• Southwest: $408,000
• Mid-Atlantic: $397,000
• North Central: $391,000
• South Central: $382,000
3. Self-employed orthopedists earn an average salary of $439,000, while employed orthopedists earn an average of $388,000. Here are seven statistics on orthopedist salary by practice setting, according to the Medscape Orthopedist Compensation Report 2014.
• Office-based multispecialty group practice: $459,000
• Healthcare organization: $449,000
• Office-based single-specialty group practice: $442,000
• Hospital: $397,000
• Outpatient clinic: $388,000
• Office-based solo practice: $348,000
• Academic (non-hospital), research, military, government: $319,000
4. Compensation varies by subspecialty. Here are five statistics on compensation for a number of other orthopedic subspecialties, based on 2011 data.
• Spinal surgeons: $688,503
• Joint replacement: $605,953
• Hand surgeons: $476,039
• Pediatric orthopedic surgeons: $425,000
• Trauma surgeons: $424,555
5. Bonuses and benefits account for 25 percent of the total average orthopedic surgeon's compensation, according to Salary.com. Here are seven statistics on orthopedic surgeons' benefits.
• Bonuses: $37,112 (6.4 percent)
• Social Security: $13,875 (2.4 percent)
• 401(k)/403(b): $9,000 (1.6 percent)
• Disability: $4,237 (0.7 percent)
• Healthcare: $6,592 (1.1 percent)
• Pension: $15,750 (2.7 percent)
• Time off: $57,937 (10 percent)
6. Orthopedics cases account for 17 percent of total ambulatory surgery center case volume, third only to ophthalmology and GI/endoscopy, according to a VMG Health's 2012 Intellimarker Ambulatory Surgical Center Financial & Operational Benchmarking Study. ASCs in the Southwestern United States have the highest gross charges per orthopedics case at $11,764, while Southeastern ASCs have the lowest gross charges per case at $9,384. Midwestern ASCs have the highest net revenue at $3,166 per orthopedics case, while Southeastern ASCs have the lowest net revenue per case at $2,154.
7. Of the 20 most common procedures performed in ASCs, seven are orthopedics cases. Here are the most commonly performed orthopedics procedures by ASC case volume, according to MedPAC data.
• Injection foramen epidural: lumbar, sacral: 4.1 percent
• Injection spine: lumbar, sacral (caudal): 3.4 percent
• Injection paravertebral: lumbar, sacral add on: 3.4 percent
• Injection paravertebral: lumbar, sacral: 2.4 percent
• Injection foramen epidural add on: 2.1 percent
• Destruction paravertebral nerve, add on: 1.5 percent
• Injection spine: cervical or thoracic: 0.9 percent
8. Orthopedic surgery can have a significant economic impact on individual patients and society as a whole. Here are five points on the economic value of orthopedic surgery, according to a recent Becker's Spine Review report.
• Lifetime societal net benefit for patients undergoing total knee arthroplasty averaged around $19,928.
• In 2009, reported lifetime societal savings per patient from surgical repair for displaced intracapsular and extracapsular hip fractures were $60,000.
• The net societal savings per person who underwent discectomy was $9,822 per person over a four year period, according to the report.
• In 2012, societal savings from surgical treatment of rotator cuff repair in comparison to non-surgical treatment were $16,409.
• Lifetime cost to society for patients undergoing ACL repair was $38,121, compared to lifetime costs of $88,538 for rehabilitation.
9. The global orthopedics device market was valued at $29.2 billion in 2012 and is expected to grow at a compound annual growth rate of 4.9 percent over the next five years, according to a report from Transparency Market Research. By, 2019 the market will reach an estimated value of $41.2 billion. The orthopedic knee device market holds the largest share of the total market, while hip devices hold the second largest share.
10. There are a number of subspecialties in orthopedics. Here are five common areas orthopedic surgeons identify themselves with, according to AAOS.
• Arthroscopy: 38 percent
• Adult knee: 37 percent
• Sports medicine: 36 percent
• Adult hip: 28 percent
• Total joint: 17 percent