ObGyns are mindfully choosing their practice environments. The trend, as reported by the American College of Obstetricians and Gynecologists (ACOG),1 shows movement from private practice to employment: an increasing number of ObGyns have joined large practices and are employed. Overall, fewer than half of US physicians owned their medical practice in 2016, reported the American Medical Association (AMA).2 This is the first time that the majority of physicians are not practice owners.
Although employed ObGyns earn 9% less than self-employed ObGyns, ($276,000 vs $300,000, respectively), trading a higher salary for less time spent on administrative tasks seems to be worth the pay cut, reports Medscape. Employed ObGyns reported receiving additional benefits that might not have been available to self-employed ObGyns: professional liability coverage, employer-subsidized health and dental insurance, paid time off, and a retirement plan with employer match.3
What matters to ObGyns when choosing a practice setting?
Several decisions about practice setting need to be made at the beginning and throughout a career, among them the type of practice, desired salary, work-life balance, (the latter 2 may be influenced by practice type), and location.
Type of practice
“Patients benefit when physicians practice in settings they find professionally and personally rewarding,” said AMA President Andrew W. Gurman, MD. “The AMA is committed to helping physicians navigate their practice options and offers innovative strategies and resources to ensure physicians in all practice sizes and setting can thrive in the changing health environment.”2
More and more, that environment is a practice wholly owned by physicians. The AMA reports that in 2016, 55.8% of physicians worked in such a practice (including physicians who have an ownership stake in the practice, those who are employed by the practice, and those who are independent contractors).2 An approximate 13.8% of physicians worked at practices with more than 50 physicians in 2016. The majority (57.8%), however, practiced in groups with 10 or fewer physicians. The most common practice type was the single-specialty group (42.8%), followed by the multispecialty group practice (24.6%).2
Paying physicians a salary instead of compensating them based on volume may improve physician satisfaction—it removes the need to deal with complex fee-for-service systems, say Ian Larkin, PhD, and George Loewenstein, PhD. In fee-for-service payment arrangements, physicians may be encouraged to order more tests and procedures because doing so may increase income. A better strategy, say Larkin and Loewenstein, is to switch to a straight salary system. Known for their quality of care and comparatively low costs, the Mayo Clinic, Cleveland Clinic, and Kaiser Permanente have successfully implemented this payment system.4
ObGyn salaries jumped in the last year
The mean income for ObGyns rose by 3% in 2016 over 2015 ($286,000 compared with $277,000), according to Medscape.5 This jump follows a gradual increase over the last few years ($249,000 in 2014; $243,000 in 2013; $242,000 in 2012; $220,000 in 2011).1,5,6
The highest earnings among all physicians were orthopedists ($489,000), plastic surgeons ($440,000), and cardiologists ($410,000). Pediatricians were the lowest paid physicians at $202,000.3
Fair compensation. Fewer than half (48%) of ObGyns who completed the Medscape survey felt they were fairly compensated in 2016, and 41% of those who were dissatisfied with their compensation believed they deserved to be earning between 11% and 25% more. When asked if they would still choose medicine, 72% of ObGyns answered affirmatively. Of those who would choose medicine again, 76% would choose obstetrics and gynecology once more.3
Gender differences. As in years past, full-time male ObGyns reported higher earnings (13%) than female ObGyns ($306,000 vs $270,000, respectively; (FIGURE 1).3,5,7,8
Among ObGyns who responded to the 2017 Medscape survey, 14% of women and 10% of men indicated that they work part-time.3 Last year, 13% of female ObGyns reported part-time employment versus 16% of male ObGyns.6
Among the ObGyns who answered the 2017 survey, there was a gender gap in participation related to race. Although more men than women responded to the survey, more women than men ObGyns among black/African American (women, 78%), Asian (women, 69%), and white/Caucasian (women, 53%) groups responded. Men outweighed women only among Hispanic/Latino ObGyns (60%) who answered the survey.3