Physician Incomes Up in 2018, but Productivity Stagnant: AMGA

Are physicians maxed out?  The incidence of depression, frustration and burnout have been increasing. MGMA, an association for medical consultants just released a study from 2018 that harbors a fact. While physician compensation has risen, productivity has not increased.

"Data from this year's survey shows compensation is increasing without an equivalent increase in wRVU [work relative value unit] production for many specialties. This trend is causing organizations to absorb additional compensation expenses without balancing revenue from production increases," said Fred Horton, MHA, president of AMGA Consulting, the association's consulting arm, in a news release.

The AMGA survey found that in 2018, overall physician compensation increased by a median of 2.92%, compared to a 0.89% increase the previous year. Productivity increased by 0.29%, compared to a 1.63% decline in 2017. Compensation per wRVU rose 3.64%, slightly more than the 3.09% increase the prior year.

In primary care — including family medicine, internal medicine, and pediatrics — median compensation was up 4.91%, a significant increase from 0.76% the previous year. Although this was the largest jump in compensation in several years, productivity was flat, with wRVUs increasing by only 0.21% in 2018. As a result, the median compensation per wRVU increased 3.57%.

AMGA's report also presents median compensation and productivity statistics for 2014–2018. These figures reveal that although primary care wRVUs were fairly flat during that period, compensation for family physicians and internists increased more than in most other specialties.

Family doctors' productivity increased by 3.7% during the 4-year period, while their compensation shot up 15%. Similarly, median wRVUs for internists barely budged, yet their compensation increased by 13.8%.

Family doctors or primary care physicians (PCPs) are already maxed out in terms of patient volume. Their increase in income is due to several factors, a readjustment of CPT codes for visits, d-emphasizing procedural CPT codes. PCPs do fewer procedures than specialists.  Medicare, realizing this made a modification to office visit CPT codes (which are the majority of PCP visits) .  At the same time demand for PCPs exceeds their availability and groups in order to attract PCPs have raided the reimbursement accordingly.

Primary care physicians are apparently being paid more, regardless of productivity, because of their important role in value-based care. "As healthcare organizations move from volume-based to value-based payment models, we've observed increased scrutiny on primary care performance," said Elizabeth Siemsen, director of AMGA Consulting, in the release. "Medical groups continue to focus on delivering care in the most appropriate setting with the greatest efficiency — and often place primary care providers at the center of this strategy."

In recent years, Siemsen noted, the AMGA survey has shown a slow increase in the percentage of part-time primary care providers. She thinks this may have contributed to the hefty compensation increases for family doctors and internists.

"In order to recruit and retain the primary care workforce, it may be that the market demanded a compensation course correction this past year," she said.

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Physician Incomes Up in 2018, but Productivity Stagnant: AMGA: A 2019 medical group compensation and productivity survey also shows hefty increases for primary care specialties as value-based care gains traction.