Most physicians want to know what top- earning physicians have in common. Last year, the Medical Group Management Association published a report that discussed themes and patterns of the top-earning physicians. To identify the physicians who earn the most, the MGMA looked at the patterns of the upper third (66^th percentile) in identifying the top earners. Due to the brevity of this article, I am going to discuss the common themes which combine all specialties. The percentages will vary by specialty, but the common themes or characteristics will not. Although the study looked at the 66^th percentile for income, or as we have said the top-earning physicians, and patterns I will refer sometimes to the median level for comparison sake. 

 

Irrespective of the specialty, the top-earning physicians have one area of similarity. Whether primary care, medical or surgical, the median compensation for physicians in the lower third percentile was almost always half that of the doctors in the upper third. The study also pointed out the most obvious reason for the earnings difference: Median collections for the least compensated doctors were half that of the collections for the doctors in the upper 66^th percentile, the same pattern as in compensation because collections and compensation are closely linked. I guess this should be obvious.

 

Certain patterns are discussed in the study. Doctors who earn the largest amounts are seldom young. Looking at interventional cardiologists for example, only 3.7 percent of invasive –interventional cardiologists with one to two years of experience were in the upper third for compensation. Also, the oldest doctors in this specialty – those with 18 or more years of experience–have a lower percentage in the highest-compensated category than the doctors with eight to 17 years of experience. 

 

This pattern of physicians with some but not the most experience having higher compensation is also evident in the surgical and medical specialties. However, primary care specialties show a different trend. Primary care physicians with most experience showed to have the greatest percentage of doctors with compensation with compensation in the upper third of the specialty. 

 

Also, five themes are common to doctors in the upper third of top earning physicians. They are male, partners or shareholders in their practice, have on-call duties, work under a productivity-based compensation plan, and log more than 40 clinical service hours a week.

 

Comparing the demographic profile of doctors compensated at the highest level of their specialty with their peers provides insight into the characteristics of top-earning physicians.

 

As we have discussed in previous articles in the Memphis Medical News, physician alignment with hospitals are here in Memphis as they are throughout the country. Will the model change for successful hospital physician integration? This author has no opinion, and only points out that in this study by the MGMA produced in 2009, hospital-owned physician practices did not perform financially as well as non-owned. Knowing the provider community is working hard toward alignment, let's learn from studies such as this to identify what areas historically need to be looked at and understood for hospitals and physicians to be more successful now than they were 15 years ago. 

 

For there to be success where there has been failure in the past, a new corps of "employed yet empowered physicians" will be the most important part of an integrated or accountable health organization.

 

In the book, Integrated Health Care: Lessons Learned, contributed and edited by J. William Appling, published in 1999, the author ended the book with this last comment in the summary: Will there be integration in the years ahead? You can bet on it. What will it look like? You are the artist. The medical executives and physicians of today will help draw the integrated system of tomorrow. Hopefully, you will use the lessons learned from the past decade as your palette for the next one.