Rheumatologists saw an average increase of $14,000 in compensation in 2020, up from an average income of $262,000 in 2019 to an average income of $276,000, according to the 2021 Medscape Rheumatologist Compensation Report.1 This finding is a larger increase than from 2018 to 2019, during which rheumatologists saw an average $3,000 increase, from an average $259,000 to an average $262,000.2,3
Each year, the annual Medscape Physician Compensation Report tracks and ranks compensation for 29 medical specialties. The online survey was conducted from October 2020 to February 2021 and was administered to 17,000 physicians, of which 170 were rheumatologists.4 Although this sampling of the rheumatology field is small, the reported 1.4% increase for rheumatologist compensation is good news, notes Beth Jonas, MD, chief of the Division of Rheumatology, Allergy and Immunology at the University of North Carolina School of Medicine, Chapel Hill, and chair of the ACR’s Rheumatology Training and Workforce Issues Committee.
She says the small sample of rheumatologists for a survey taken during the height of the COVID-19 pandemic should be considered when reviewing the findings. Example: Rheumatologist respondents reported a decline in patient volume in 2020 due to COVID-19. When compared with pre-pandemic volumes, that decline was from an average of 85 patients per week to 77.
Dr. Jonas
“There is no doubt that during 2020—and perhaps early 2021 before widespread vaccine use—there was a significant decline in patient visits. Some practices were able to pivot to telehealth, but [patient] volumes and billings were definitely down,” Dr. Jonas says. “From what I know, most practices have rebounded their volumes.”
With the delta variant surging in many communities, particularly in the southern U.S., Dr. Jonas is concerned about an additional downturn. However, she notes a very high demand still exists for rheumatology services. “My assessment is that the volumes will rebound in time. The timeline is uncertain and will depend a lot on how we do in controlling the COVID-19 pandemic,” she says.
Private Practice
Among the self-employed rheumatologists surveyed, almost half believed a drop in patient volume of up to a quarter may be permanent. Also, many said it will take two to three years to build back patient volume.
Dr. Snow
However, this fear of a permanent drop in patient volume is not an issue for Marcus Snow, MD, a practicing rheumatologist with the University of Nebraska Medical Center and Nebraska Medicine, Omaha, Neb., and chair of the ACR Committee on Rheumatologic Care.
“In my practice, we did not have a drop in volume, job loss or hours,” Dr. Snow says. “Certainly, during the beginning in the pandemic, we did have a drop and a switch to telemedicine. However, we have been able to be back to normal—or above normal—volume since last summer.”
Patient demand is very high regionally in Omaha, he adds, noting a pre-COVID-19 trend of rheumatologists retiring. In fact, he jokingly encourages rheumatologists looking to practice in Nebraska to reach out because job openings are available.
Looking more broadly at patient volume across the country, Dr. Snow believes any shortage of patients is short term. “I suspect some patients cancelled their appointments early in the pandemic and then felt they didn’t need to see rheumatology for their osteoarthritis or fibromyalgia, perhaps instead choosing to visit their primary care provider or felt better than expected off their medication,” he says.
Dr. Snow also notes a drop in patients could be the result of some patients not wanting to keep up with their visits through telemedicine during the height of the pandemic. “It’s tough to say, but I doubt any drop in patients is a long-term trend,” he says. “The shortage of rheumatologists nationally is so great, and I am not concerned about a shortage of patients.”
Reimbursement
Medicare coverage was a concern for some of the rheumatologists surveyed, of which 15% said they will stop treating at least some current patients on Medicare or may not take on new patients on Medicare. This same question regarding treating Medicare patients was asked in the Medscape Physician Compensation Report 2020, in which only 6% of rheumatologists said they would stop seeing these patients.5 This finding means there was an increase in surveyed rheumatologists who are changing or considering a change regarding accepting patients on Medicare.
Also, 68% of surveyed rheumatologists said they will participate in Centers for Medicare & Medicaid Services’ Merit-Based Incentive Payment System (MIPS) in 2021.
How Does Rheumatology Compare?
This year, rheumatologists ranked 21st in compensation compared with other medical specialties. This ranking is up slightly, with rheumatologists ranking 23rd in overall physician specialty compensation in both 2020 and 2019. The 2021 report shows rheumatologists’ annual income ranking just below that of neurologists, who reported $291,000 in annual income, and just above psychiatrists, who reported $275,000 in annual income.4
Plastic surgery and orthopedics remain the highest paid medical specialties, with plastic surgeons edging out orthopedists with a $47,000 increase from the 2020 report to top the list of physician earners at $560,000 in annual income. Pediatrics is the lowest paid physician specialty, at $221,000 for reported annual salary.3
Overall, more than half of surveyed rheumatologists said they think they are compensated fairly, which is no surprise to Dr. Jonas. Although she says appropriate compensation for all rheumatologists is critically important, “money is not generally what attracts people to rheumatology.”
Carina Stanton is a freelance science journalist based in Denver.
References
- Martin KL. Medscape rheumatologist compensation report 2021. Medscape. 2021 May 14.
- Martin KL. Medscape rheumatologist compensation Report 2020. Medscape. 2020 May 20.
- Kane L. Medscape rheumatologist compensation report 2019. Medscape. 2019 Apr 24.
- Kane L. Medscape physician compensation report 2021. Medscape. 2021 Apr 16.
- Kane L. Medscape physician compensation report 2020. Medscape. 2020 May 14.
