The salaries of cardiothoracic surgeons are increasing faster than any other specialty, according to the American Medical Group Association’s 2018 Compensation and Productivity Survey. Cardiothoracic surgeons pulled in a median of $734,299 last year, up from $690,000 the previous year and a 23.1 percent increase from 2015.
“Today the cardiac surgeons are doing a lot more work with repair and replacement of valves with procedures like TAVR (transcatheter aortic valve replacement) … so there’s been a new set of services that have come into their specialty just based on technology advances,” said Wayne Hartley, COO of AMGA Consulting and the previous operations director for the Minneapolis Heart Institute. “And those are operative procedures, and those tend to be well-valued within the RVU system.”
On the whole, physician work relative value unit (wRVU) productivity declined by 1.63 percent from the 2017 survey and salaries increased by only 0.89 percent—the first time compensation has increased by less than 2 percent in the last decade.
But cardiology seemed largely immune to the salary stagnation, according to the survey, which took into account responses from 270 medical groups representing more than 105,000 providers.
Invasive interventional cardiologists saw their median compensation increase from just below $600,000 last year to $612,910 in the 2018 survey, despite wRVUs staying relatively flat. General (noninvasive) cardiologists’ compensation increased from $485,945 in 2017 to $497,888 in 2018 but they had to work more for that bump, as their compensation per wRVU actually dropped.
Here are the median salaries of other cardiovascular subspecialties:
- Echo lab and nuclear cardiologists: $514,594
- Pediatric cardiac/thoracic surgeons: $700,000
- Cardiovascular surgeons: $697,364
- Electrophysiologists: $580,868
Importantly, average salaries and productivity levels were generally higher because there were providers far above the median levels to bring the average up. For instance, the mean salary of the 388 electrophysiologists who responded was $628,421—almost $50,000 higher than the reported median salary.
Despite the range in reported salaries for the different heart-related subspecialties, Hartley said cardiology practices seem to be among the most interested in developing shared compensation models to close the gap.
“Whether you’re a general noninvasive cardiologist or whether you are a procedurally oriented interventionalist, there’s very different RVU earning potential, there’s different rates that are compensated for those subspecialties,” he said. “And the groups in a lot of cases want to find ways to make their compensation more equal regardless of subspecialization. They want to have kind of a pooled or shared component to the compensation.”
To follow are some other notable takeaways from the survey:
- Median compensation per wRVU went up year-over-year for invasive cardiologists ($64.79, +2.6 percent) and cardiac surgeons ($69.10, +2.2 percent), but down for general cardiologists ($61.25, -0.9 percent).
- 92 percent of medical groups who responded said they rely on market salary data in determining base salaries.
- 85 percent of practices or hospitals offered physicians non-productivity income for patient satisfaction, while 80 percent also used clinical quality and outcomes incentives.
- General cardiologists at smaller organizations (less than 300 physician FTEs) earned 8.9 percent more money than those at larger organizations but also produced 9.6 percent more RVUs. However, invasive cardiologists at smaller organizations still earned 6 percent more despite averaging slightly fewer wRVUs.
Base salaries might be higher at smaller, rural practices because it’s more difficult to recruit there, Hartley noted, and doctors at smaller centers may collect more money from taking call more often.
“If you’re on every third or fourth night instead of once a week, then that may be driving some of it,” he said.
Although there’s been plenty of talk in healthcare about the transition from fee-for-service care toward value-based models, productivity is still the main driver of compensation, said AMGA Consulting president Fred Horton, MHA.
“There’s some steady growth around the percent of the comp plan that is not attributed to productivity. It’s still not anywhere close to a wholesale tradeout,” Horton said. “We still see 10 to 12 to 15 percent depending on specialty that is attributable to value.”
Horton said the other signal that practices are prioritizing value—albeit slowly—is they are beginning to more granularly measure performance.
“Whereas historically it may have been process measures where we’re going to develop X, we’re going to develop Y, we’re going to track this or that—now it’s starting to get to actual performance so we’re seeing a movement from process measures to true performance measures where there’s a stretch goal that’s established,” he said.