Data from AMGA’s 2019 Medical Group Compensation and Productivity Survey shows physician compensation increased in 2018, while changes in work relative value unit (wRVU) productivity remained low.
The survey, conducted by AMGA’s subsidiary, AMGA Consulting, found that overall physician compensation increased by a median of 2.92%, compared to a 0.89% increase the previous year. Productivity increased by 0.29%, compared to a 1.63% decline in 2017. Compensation per wRVU ratio increased of 3.64%, compared to a 3.09% increase the previous year.
“The 2019 survey shows that physician compensation in 2018 rebounded from a stagnant 2017,” said Fred Horton, M.H.A., AMGA Consulting president. “While productivity also increased, it did not increase enough to surpass the decline we saw in last year’s survey, meaning productivity still has not risen since 2016.”
In 2018, median compensation for all primary care specialties increased by 4.91%, up significantly from 0.76% in 2017. While compensation increased more than it had over the past several years, productivity was flat, with wRVUs increasing by only 0.21% in 2018. As a result, the median compensation per wRVU ratio increased 3.57%, the largest increase for primary care specialties in four years.
Fig. 1 Change from 2017-2018: Primary Care
|Type||Compensation||wRVUs||Compensation per wRVU|
|All Primary Care||4.91%||0.21%||3.57%|
“As healthcare organizations move from volume-based to value-based payment models, we’ve observed increased scrutiny on primary care performance. Medical groups continue to focus on delivering care in the most appropriate setting with the greatest efficiency—and often place primary care providers at the center of this strategy,” said Elizabeth Siemsen, AMGA Consulting director. “Concurrently, in recent years, the AMGA survey has shown a slow uptick in the proportion of primary care physicians reported at less than a 1.0 clinical FTE, indicating an increase in part-time providers. In order to recruit and retain the primary care workforce, it may be that the market demanded a compensation course correction this past year.”
Medical specialties saw an increase of 1.9% in median wRVU production over last year’s survey. The compensation per wRVU ratio increased by 2.65%, and the overall median compensation was up for medical specialties by 3.39%. A sample of medical specialties with more remarkable changes to the compensation per work RVU ratio are cardiology, dermatology, gastroenterology (GI), hospitalist–internal medicine, and psychiatry.*
Fig. 2 Change from 2017-2018: Specialty Care
|Specialty||Compensation||wRVUs||Compensation per wRVU|
|Hospitalist (Internal Medicine)||2.1%||1.1%||4.4%|
* Press copy contains compensation and productivity data on all 143 medical specialties.
“Data from this year’s survey shows compensation is increasing without an equivalent increase in wRVU production for many specialties. This trend is causing organizations to absorb additional compensation expenses without balancing revenue from production increases,” Horton said. “More intentionally transitioning to value-based care is one strategy medical groups can use to mitigate this trend, as it would help them better clarify their organizational strategies and objectives.”
Advance Practice Providers
Care model changes are also leading nurse practitioners and physician’s assistants to more frequently work with their own panel of patients. The following figures capture changes in compensation and productivity from 2017 to 2018 for these roles. However, pure production compensation models are less common for advance practice providers.
Fig. 3 Change from 2017-2018: Advance Practice Provider
|Compensation||wRVUs||Compensation per wRVU|
|Nurse Practitioner – Primary Care||2.92%||3.46%||0.91%|
|Physician’s Assistant – Primary Care||2.50%||-0.05%||2.36%|
About This Year’s Survey
The 2019 survey is the 32nd edition from AMGA and constitutes the largest database in the survey’s history. The data are from 272 medical groups and represent more than 117,000 providers, an 11% increase from the 2018 survey. While the data are representative of independent and system-affiliated groups, the latter provided 76.5% of respondents. The makeup of the AMGA database skews to larger medical groups, with over 40% of the groups having more than 300 physician full-time equivalents (FTEs).