New survey shows troubling trend in physicians' income

In the midst of the COVID-19 crisis, physicians have a new cause for concern: declining income. The results of a new survey of America’s physicians conducted by The Medicus Firm reveal that a substantially larger number of physicians expect to see their income drop in 2020 vs those who anticipated a lower income in 2019. Other surveys have predicted similar results but those surveys used pre-COVID data or relied on speculation, while this survey uses recent data from more than one thousand doctors surveyed between June and July 2020.

According to The Medicus Firm survey, more than 44% of physicians expect their incomes to fall this year, either somewhat (26.4%) or substantially (18.2%). Compare that with 2019, when about 11% of physicians expected to see a drop in income. Likewise, only 17% of physicians foresee an income improvement in 2020, the survey found. That’s well below the 29% of physicians who anticipated their incomes would rise in 2019. About 35% of respondents expect their income to remain flat this year, compared with about 33% who said so last year.

“The number one factor driving this negative expectation is the unknown,” said Jamie Thomas, an executive vice president at The Medicus Firm (a sister company to MDLinx). “As the pandemic has lingered and during a national election year, there has rarely been this much uncertainty. Expectations for the future continue to reflect this uncertainty and are communicated by candidates consistently.”

The 2020 Practice Preference & Relocation Survey was conducted in June and July 2020 via a third-party survey program. This year’s survey reflects what US physicians think about the effects of COVID-19 on their income and careers. A national sample of 1,266 physicians participated, including numerous primary care physicians and a wide range of specialists. (The complete survey also included responses from several hundred physician assistants, nurse practitioners, and other advanced practice clinicians, but this article only covers responses from physicians.)

More hours, less pay

According to half (50.6%) of survey respondents, the foremost reason for the income shortfall in 2020 is the COVID-19 outbreak. For hospitals, revenues are down due to drastically fewer elective surgeries. As a result, some hospitals have asked doctors and staff to take pay cuts or furloughs. Many private practices have been forced to adopt similar tactics. The result is less money going to healthcare workers, even as many physicians have had to work harder and longer to help patients survive COVID-19.

In fact, slightly more doctors reported working longer hours in 2020 compared with this time last year—about 72% said they put in more than 40 hours a week in 2020 vs less than 70% who said so in 2019. The long hours and the pressure lead to greater stress and burnout—and nearly half of physicians were already burned out long before the COVID-19 crisis started.

“I love the job and my patients and would love to stay, but COVID and changes to insurance plans make it difficult for providers in rural settings,” said a pediatrician in Tennessee. “It’s not just one factor but many.”

Indeed, doctors still have all the usual challenges that put pressure on their patience and profits every year. These include familiar problems such as cuts in reimbursement, lighter patient volumes, administrative headaches, increases in overhead, and competition with other physicians. (Then again, nearly 9% of survey respondents said their incomes are lower because they’re choosing to work less and earn less. More power to them.)

An uncertain future

When asked specifically about the effect of the pandemic on income this year, a fortunate 5% divulged that it has actually increased their income, while about 28% said it’s had no impact. But more than half of respondents (52%) reported that the pandemic has adversely affected their income. Patient visits are down, for instance, while overhead costs remain.

“At the peak of the pandemic, physician practices experienced a 60% decrease in patient volume,” said Nathan Miller, an executive vice president at The Medicus Firm. “This not only negatively affected current conditions, but also stunted growth, leaving lingering questions about the future. In some areas of the country, elective procedures—a major source driving revenue—were shelved for months.” 

Though many doctors’ offices and surgery centers are now open again for business, daily routines aren’t back to normal. New infection precautions, for instance, eat up a chunk of each day’s schedule. “More time is needed in between patient visits in order to comply with new safety guidelines, decreasing the volume of daily office visits and procedures,” Miller said.

Among respondents who reported a decrease in 2020 income, they say they have or will receive 22.4% less income on average due to COVID-19. The top five specialties reporting a decrease in income are Family Practice, Anesthesiology, Internal Medicine, Emergency Medicine, and General Surgery.

Fewer physicians looking for a career change

Physicians aren’t so interested in a change in their careers in the near future, according to survey results. Though 26.6% of respondents in last year’s survey expected to make a career change, only 21.6% currently say they’re likely or definitely planning a career change in the next 12 months. Similarly, the number of respondents who said they’re not very likely or definitely not making a career change increased by about 8%, from 50% in 2019 to approximately 58% in 2020.

“Based on the uncertainty of the future, prompted by COVID as well as the national election, I think more physicians are staying with the status quo,” said Thomas. “When the election is completed and the pandemic ends, there’s an expectation that a new ‘new normal’ will be established. But until that happens, physicians are less inclined to make significant life changes. Historically, election years alone can reflect fewer physicians looking to make major career changes.”

Many doctors aren’t looking for career changes because they’ve already had to change and adapt just to stay afloat. “Most everyone I was working with was laid off once and probably again,” said a family medicine doctor in California. “I signed a 3-year contract and moved without my spouse to get work.”

What will happen next?

Whether physicians’ incomes continue to drop or whether they level off—or even increase—appears to hinge on two major events: the upcoming 2020 presidential election and the availability of an effective coronavirus vaccine. The timelines for both are indefinite, with the election decision potentially delayed for weeks due to counting mail-in ballot votes and the vaccine unlikely to be ready until later in the year (according to a recent prediction by Anthony Fauci, MD). 

2020 has been a highly unpredictable year so far, so there’s no way to reliably predict how physicians’ income will change in the next 12 months and beyond. But in these uncertain times, one thing is certain: America relies on its doctors now more than ever.