New research from The American Medical Group Association shows that for the first time in a decade, physician compensation and productivity did not "meaningfully increase" in 2017.
The AMGA 2018 Medical Group Compensation and Productivity Survey, conducted by AMGA's subsidiary, AMGA Consulting, showed an overall drop in the national median for physician productivity by a weighted average of -1.63 percent, and an increase in compensation of only 0.89 percent, making 2017 the first year physician compensation increased by less than 2 percent in over a decade.
Changes in provider productivity and compensation seemed to vary significantly by specialty, however the weighted average change in median compensation in all medical specialties in 2017 was +1.2 percent and the weighted average change in median work relative value units, or RVUs, was -1.5 percent.
Cardiac/thoracic surgery saw a 6.4 percent increase in its median compensation and a 4.7 percent in work RVUs. The next highest compensation increase by specialty was emergency medicine with only a 1 percent increase in its median compensation and a whopping 4.7 percent drop in Work RVUs. On the other end of the scale, ophthalmology saw a 2.3 percent drop in median compensation and a less than 1 percent increase in work RVUs.
This year was the survey's 31st year, and AMGA received a record high number of provider responses. The responses came from 270 large, multispecialty medical groups and integrated health systems, representing more than 105,000 clinical providers. The average number of providers per participant group was approximately 380.
While other research may shown different numbers in terms of compensation, stagnant or near stagnant productivity has been found elsewhere. A May report by MGMA showed that primary care physicians' compensation rose by more than 10 percent over the past five years, however the data showed that the pay increase was not in tandem with higher productivity. For instance, when broken down by primary care focus, family medicine physicians saw a 12 percent rise in total compensation over the past five years, but their median number of work RVUs, increased by less than 1 percent.
While no definitive reason for the decline in productivity was pinpointed, the burdens imposed on doctors by EHR use, patient complexity, and administrative and compliance requirements were said to be potential factors.
"Medical groups today consistently report several factors that have an impact on their clinical output...The production levels reported this year could be a consequence of any or all of these factors," said Fred Horton, president of AMGA Consulting.
Indeed, change fatigue and growing administrative burdens on physicians have not only fueled a rising chorus of complaints and frustration, they are fueling trends in physician burnout and by some accounts, leaving the field of medicine altogether or cutting back on hours.
Legislative and regulatory changes have certainly been drivers of administrative burden, the most recent and prominent of these being the implementation of MACRA. Pleas and comments regarding crafting the legislation in such a way as to not increase administrative burden persist to this day, as the law continues to evolve and doctors strive to spend more time with patients, instead of doing paperwork. Numerous advocacy groups including the American Medical Association and the American Academy of Family Physicians have called for lessening the administrative burden on doctors, something many feel MACRA either hasn't helped or has actually increased.