2005 Physician Workforce and Compensation Survey

In 2002, the San Diego County Medical Society conducted the first physician workforce and compensation survey in San Diego County. A paper survey was mailed to all the then-known physician addresses in San Diego County. The results of that survey provided the first insights into the attitudes of physicians toward their work and workplace, in addition to quantifying the compensation environment for San Diego County.

In October and November of 2005, the second San Diego County physician workforce and compensation survey was conducted. This survey, unlike the 2002 survey, was an online survey announced by an e-mail to all physicians in San Diego County for whom SDCMS had valid e-mail addresses. The key findings were as follows:

• When compared to 2002 data, there is a significant lengthening of the wait times for new patient appointments. The average time for a new patient to obtain an appointment in 2005 was 2.2 weeks … or 11 business days. There was significant variation in new patient waiting times for an appointment between specific specialties. Several specialties had significantly higher than normal wait times in both 2005 and 2002: dermatology, neurology, ophthalmology, orthopedic surgery, psychiatry, and urology. Of note, wait times for OB/GYN in 2005 were significantly reduced when compared to 2002.
• It was easier to obtain a new appointment with solo/small-group physicians than with medium/large-group physicians.
• The average total number of hours worked by San Diego County physicians, including clinical and non-clinical work, was 57 hours per week. The physician work week is getting longer. The 2002 average was 53 hours, i.e., over the past three years, working hours have increased by 7 percent.
• A San Diego County physician spends, on average, 42 hours per week seeing patients. There was negligible variation when the data was analyzed by gender, practice size, or specialty/non-specialty.
• Solo/small-group physicians work longer total hours (on average 60 hours per week) than medium/large-group physicians (on average 55 hours per week).
• The total hours worked by female physicians was significantly less (53 hours per week versus 58 hours per week) than the total hours worked by their male counterparts. There was, however, no significant difference between female and male physicians in the total hours spent on patient care.
• Specialists averaged a total work week of 58 hours, while primary care physicians averaged 53 hours per week, again with no significant difference in hours spent directly on patient care.
• Solo/small-group physicians feel much more strongly than medium/large-group physicians that time spent with patients was adequate: 73 percent of solo/small-group physicians, versus 52 percent of medium/large-group physicians.
• The dissatisfaction of physicians with the practice of medicine in San Diego County is strong. Overall, 53 percent were less satisfied with the practice of medicine than they were five years ago. On the bright side, when compared to 2002 data, there was some amelioration of the dissatisfaction: from 67 percent in 2002 to 53 percent dissatisfied in 2005.
• When compared to 2002 data, there was a reduction in the sense that there is a physician shortage in San Diego County. Even so, 44 percent of physician respondents felt there was a physician shortage. When examined by practice size, 35 percent of solo/small-group physicians felt there was a physician shortage, while 48 percent of medium/large-group physicians felt there was a physician shortage.
• There were multiple statistical indicators that there was a shortage of specialists practicing in dermatology, otolaryngology, neurology, neurosurgery, orthopedics, rheumatology, and urology.
• There is strong concern about recruiting physicians to San Diego County. Solo/small-group physicians are having a much harder time bringing on new physicians. Compared to 2002, there are greater problems in 2005 recruiting physicians to live and work in San Diego County. There was significant recruiting difficulty reported for general surgery (repeat from 2002), hand surgery, neurology (repeat from 2002), ophthalmology, orthopedic surgery, otolaryngology, psychiatry (repeat from 2002), radiology (repeat from 2002)), urology (repeat from 2002), and, very surprisingly, internal medicine and family medicine.
• The 2005 survey projects that San Diego County will see 81 percent of its physicians maintaining their practice as is for the next three years. When compared with 2002 data, there is considerable improvement in physician retention.
• Medium/large-group practices have high acceptance rates for Medicare and Medi-Cal and do not intend to change even in the face of a potential reduction in rates. 87 percent took Medicare three years ago, and 87 percent report taking Medicare today. 78 percent took Medi-Cal three years ago, and 74 percent report taking Medi-Cal today.
• There has been a clear exodus from Medi-Cal and Medicare for solo/small-group physicians, and among solo/small-group practices, that trend is exacerbated for specialists. Among solo/small-group physicians, 92 percent took Medicare three years ago, and 85 percent report taking Medicare today, a drop of 7 percent. Solo/small-group physicians reported that 58 percent took Medi-Cal three years ago, and 50 percent report taking Medi-Cal today, a drop of 8 percent.
• Solo/small-group physicians report that in the face of a 5 percent cut in Medi-Cal rates, only 33 percent would continue to take Medi-Cal as is.
• Solo/small group physicians are paid less than medium/large-group physicians. Female physicians earn less than their male counterparts. Primary care physicians are reimbursed less than specialists. In a geographic anomaly, solo/small-group physicians in Hillcrest and South Bay are paid less than their geographic peers.
• The general compensation trend is positive, with the female physician compensation trend slightly more positive than for males. The compensation of primary care physicians has increased relative to that of specialists. Not surprisingly, younger physicians see their compensation increasing, while older physicians do not.
• The specialties that are in crisis in San Diego County are neurosurgery, neurology, orthopedic surgery, otolaryngology (ENT), and urology.
• The specialties that are in difficulty in San Diego County are OB/GYN, dermatology, general surgery, ophthalmology, psychiatry, pulmonology, radiology, and rheumatology.