2013 Annual ASMBS Compensation Survey

Teresa LaMasters MD, FACSJohn Magaña Morton, MD, MPH, FACS,

FASMBS

Background

• Nationally more physicians are becoming employed

• This is especially true in Bariatric surgery due to programmatic requirements and overhead

• There is a lack of valid benchmarking for physicians and hospitals to use when negotiating compensation

Background

• MGMA and AGMA models have been inadequate in the past and do not take into account specialized bariatric surgeons vs. general surgeons also involved in bariatric surgery

• Initial pilot survey sent to ASMBS members in 2012 – results on website

• Further development and refinement of the survey was required

Objective

• Determine compensation ranges and practice patterns for ASMBS members– Hospital employed– Private Practice

Who can Benefit?

• All surgeons negotiating contracts with employers

• New graduating fellows• ASMBS Leadership to better understand

membership needs• All surgeons evaluating joining a practice• Surgeons who desire to see a snapshot of

future career

Methods

• Surveys sent out electronically 3 times by ASMBS in 2013 regarding data from 2012.

• Survey was sent to ASMBS membership• Survey Monkey was utilized

Response Rate Hospital employed

N = 66 Total sample used = 65 Exclusions

Part-time surgeon (n=1) Data from 62 respondents used in the compensation summary

The 3 respondents not used either did not provide compensation information or provided it in a form that was not feasible (e.g. a response of 500)

22 states represented Private Practice

N=47 Total sample used = 46 Exclusions

Part-time surgeon (n=1) Data from 39 respondents used in the compensation summary

The 7 respondents not used either did not provide compensation information or provided it in a form that was not feasible (e.g. a response of 500)

24 states represented

Hospital Employed Questions• Which of the following best

describes your practice model?• How many years have you been

in practice? • How much experience do you

have performing bariatric surgery?

• What is your career volume for bariatric surgery?

• What is your employment status?

• What percent of your time is dedicated to bariatric surgery?

• In what state are you employed?• Did you complete a Fellowship?

If yes, what type?• Select the method that most

accurately reflects your current compensation model.

• What is the amount of your total compensation?

• What is your estimated annual retirement contribution?

• Which of the following benefits are provided to you and paid by your employer?

Hospital Employed Questions• Do you receive a bonus or

incentive? If yes indicate what the bonus is based upon.

• If your compensation is based on WRVU production, provide the amount paid per WRVU

• Provide the threshold amount at which the incentive begins and the compensation amount per WRVU that you receive

• How many work RVUs did you produce?

• How many days a month do you take bariatric, general surgery and trauma call?

• Are you paid for taking call? If yes, how much?

• At how many hospitals do you operate?

• How many bariatric practices are present at your primary hospital?

• Provide volume for each of the procedures listed on the attached table

Demographics – Hospital

• 49 of 65 had a fellowship and 37 completed a bariatric fellowship

76%

25%

Fellowship with Bariatrics

YesNo

Demographics – Private Practice

• 28 of 47 had a fellowship and 18 completed a bariatric fellowship

64%

36%

Fellowship with Bariatrics

YesNo

Hospital EmployedYears in Practice vs Bariatric n=66

In the previous survey (2012), there was a trend of a significant portion of surgeons starting in bariatrics later in their career around 5-10 years after they started their practice.

Years in Practice

Years Bariatric Surgery

0-5 years 5-10 years >10 years

0-5 years 19 0 0

5-10 years 2 14 0

10-20 years 1 4 15

>20 years 0 4 7

Private Practice Years in Practice vs Bariatric n=47

Years in Practice

Years Bariatric Surgery

0-5 years 5-10 years >10 years

0-5 years 8 0 0

5-10 years 2 8 0

10-20 years 0 2 15

>20 years 0 2 10

Hospital EmployedTime vs Surgeries n=64

Time Dedicated to

Bariatric Surgery

Number Surgeries Performed

<50 50-150 150-500 500-1000 >1000

<20% 0.0% 3.1% 0.0% 0.0% 1.6%

21-50% 1.6% 6.3% 12.5% 7.8% 4.7%

51-80% 0.0% 1.6% 9.4% 6.3% 15.6%

>80% 0.0% 0.0% 3.1% 12.5% 14.1%

Private PracticeTime vs Surgeries n=44

Time Dedicated to

Bariatric Surgery

Number Surgeries Performed

<50 50-150 150-500 500-1000 >1000

<20% 1 (2.3%) 1 (2.3%) 0 1 (2.3%) 0

21-50% 0 3 (6.8%) 0 2 (4.5%) 4 (9.1%)

51-80% 0 1 (2.3%) 0 2 (4.5%) 8 (18.2%)

>80% 0 0 2 (4.5%) 1 (2.3%) 18 (40.9%)

Hospital Employed – Call

Days BariatricN=59

General Surgery

N=60Trauma

N=51

0 1 (2%) 14 (23%) 41 (80%)1-14 23 (39%) 45 (75%) 10 (20%)

15-30 35 (59%) 1 (2%) 0

Hospital employed bariatric surgeons are most likely to take bariatric and general surgery call and least likely to take trauma call.80% do not take any trauma call and 23% do not take any general surgery call.

Hospital Employed >80% Bariatrics– Call

Days BariatricN=18

General Surgery

N=17Trauma

N=17

0 0 9 (53%) 15 (88%)1-14 8 (44%) 8 (47%) 2 (12%)

15-30 10 (56%) 0 0

Hospital employed surgeons who dedicate 80% of their time to bariatrics, are more likely to take bariatric call than general surgery call. In addition, they are least likely to take trauma call.88% do not take any trauma call and 53% do not take any general surgery call.

All Private Practice – Call

Days BariatricN=40

General Surgery

N=39Trauma

N=36

0 2 (5%) 13 (33%) 30 (83%)1-14 18 (45%) 23 (59%) 5 (14%)

15-30 20 (50%) 3 (8%) 1 (3%)

Private practice bariatric surgeons are most likely to take bariatric and general surgery call and least likely to take trauma call.83% do not take any trauma call and 33% do not take any general surgery call.

Private Practice >80% Bariatrics– Call

Days BariatricN=20

General Surgery

N=18Trauma

N=17

0 2 (10%) 11 (61%) 15 (88%)1-14 6 (30%) 7 (39%) 2 (12%)

15-30 12 (60%) 0 0

Private practice surgeons who dedicate 80% of their time to bariatrics, are more likely to take bariatric call than general surgery call. In addition, they are least likely to take trauma call.88% do not take any trauma call and 61% do not take any general surgery call.

All Hospital Employed

36.9

32.3

30.8

Percent time dedicated to Bariatric Surgery

0-50%51-80%>80%

N=65

All Private Practice

27.7

23.4

46.8

Percent time dedicated to Bariatric Surgery

0-50%51-80%>80%

N=47

All Hospital Employed

15.4

4027.7

16.9

Regions represented overall

MidwestNortheastSouthWest

22 Different States represented

N=65

All Private Practice

17.4

21.741.3

17.4

Regions represented overall

MidwestNortheastSouthWest

24 Different States represented

N=46

All Hospital Employed

Midwest

Northeast

South

West

0

5

10

15

20

25

30

35

40

45

0-50% time in Bariatrics51-80%>80 time

14.1

39.126.6

20.3

Regions represented overall

MidwestNortheastSouthWest

N=64

All Private Practice

Midwest

Northeast

South

West

05

101520253035404550

0-50% time in Bariatrics51-80%>80 time

17.8

22.240

20

Regions represented overall

MidwestNortheastSouthWest

N=45

Hospital Employed2012

Compensationn=62

Total RVUn=33

Retirementn=51

RVU Incentive Threshold

n=19

Incentive Above RVU Threshold

n=12Overall N=66Mean $445,032 8,279 $36,666 7,413 $48.9Std. Dev. $188,564 3,458 $35,280 2,484 $8.4Minimum $200,000 3,230 $10,000 5,000 $39.0Maximum $1,100,000 20,000 $240,000 16,000 $70.0Percentiles 20th $301,000 5,440 $17,500 6,000 $42.3 50th $388,500 7,900 $28,000 6,500 $48.5 75th $497,750 9,000 $39,000 7,500 $52.2 90th $698,500 12,480 $60,000 10,000 $54.8

Hospital Employed > 80% 2012

Compensation n=20

Total RVUn=10

Retirement n=17

RVUIncentiveThreshold

n=7

Incentive Above RVU Threshold

n=4Overall N=20Mean $464,050 8,202 $41,176 6,809 $56.4Std. Dev. $219,404 3,773 $53,830 1,435 $9.0Minimum $283,000 3,230 $13,000 6,000 $51.0Maximum $1,100,000 14,995 $240,000 10,000 $70.0Percentiles 20th $325,000 5,321 $17,100 6,000 $51.6

50th $386,000 8,100 $25,000 6,500 $52.4 75th $450,000 8,800 $36,000 6,853 $57.1 90th $761,200 14,100 $62,000 8,000 $64.8

Private Practice 2012

Compensationn=39

Retirementn=35

Overall N=47Mean $658,116 $40,593Std. Dev. $907,700 $24,745Minimum $200,000 $5,000Maximum $5,850,000 $125,000

Percentiles 20th $290,000 $21,900

50th $400,000 $40,000 75th $640,000 $50,000 90th $931,000 $54,600

Survey respondents reported their total compensation. It is possible this compensation may include revenue from non clinical sources. It’s also possible that, different from hospital employed physicians, private practice physicians are responsible for the payment of benefits (e.g. health insurance, malpractice insurance. etc.) from this reported compensation. Hence the outlying maximum salary.

Private Practice > 80% Bariatrics 2012

Compensationn=18

Retirementn=17

Overall N=22Mean $856,196 $42,692Std. Dev. $1,290,743 $30,999Minimum $260,000 $5,000Maximum $5,850,000 $125,000Percentiles 20th $308,000 $16,000

50th $418,500 $40,000 75th $845,000 $49,500 90th $1,188,500 $81,600

Survey respondents reported their total compensation. It is possible this compensation may include revenue from non clinical sources. It’s also possible that, different from hospital employed physicians, private practice physicians are responsible for the payment of benefits (e.g. health insurance, malpractice insurance. etc.) from this reported compensation. Hence the outlying maximum salary.

Hospital Employed2011

Compensationn=50

Total RVUn=26

Retirementn=45

Overall N=66Mean $420,235 7,780 $32,933Std. Dev. $153,595 3,281 $19,934Minimum $210,000 3,000 $11,000Maximum $850,000 19,000 $100,000Percentiles 20th $300,000 5,000 $16,900

50th $400,000 7,350 $28,000 75th $471,250 9,300 $40,000 90th $650,000 10,000 $51,200

There was significant repetition of data from 2010 and 2011 suggesting possible error in reporting 2010 data. For this reason we did not analyze 2010. The 2011 data was similar to previously reported 2011 data in the past ASMBS survey.

Hospital Employed >80% Bariatrics 2011

Compensationn=17

Total RVUn=6

Retirement n=17

Overall N=20Mean $396,927 7,135 $28,088Std. Dev. $130,307 3,368 $14,895Minimum $275,000 3,512 $11,000Maximum $786,000 12,600 $60,000Percentiles 20th $302,000 4,000 $16,600

50th $350,000 6,850 $20,000 75th $425,000 8,550 $36,000 90th $544,450 10,800 $50,800

There was significant repetition of data from 2010 and 2011 suggesting possible error in reporting 2010 data. For this reason we did not analyze 2010. The 2011 data was similar to previously reported 2011 data in the past ASMBS survey.

All Private Practice 2011

Compensationn=37

Retirementn=33

Overall N=47Mean $617,751 $39,761Std. Dev. $657,527 $21,275Minimum $100,000 $10,000Maximum $4,000,000 $100,000Percentiles

20th $302,000 $24,400

50th $444,143 $38,000 75th $640,000 $49,000 90th $870,000 $54,600

There was significant repetition of data from 2010 and 2011 suggesting possible error in reporting 2010 data. For this reason we did not analyze 2010. The 2011 data was similar to previously reported 2011 data in the past ASMBS survey.

Private Practice >80% Bariatrics 2011

Compensationn=17

Retirementn=17

Overall N=22Mean $763,928 $39,005Std. Dev. $916,368 $26,351Minimum $260,000 $10,000Maximum $4,000,000 $100,000Percentiles

20th $304,000 $18,600

50th $444,143 $32,000 75th $660,000 $47,000 90th $1,350,000 $70,000

Approximately half of the respondents for annual salary and retirement gave the same value for the year of 2010 and 2011. Consequently it was assumed the values reflected 2011 and the previous year was potentially in error, for this reason we did not analyze 2010.

Incentive Bonus

Hospital Employed Private PracticeReceive Incentive Bonus 44 20

Mean Bonus $65,750 (n=22) $121,883 (n=6)

RVU Target

Hospital Employed Private PracticeRVU Target 30 5

Mean Target 6998 6500 (n=2)

Medical Directorship

Hospital Employed (N=66)

Private Practice(N=47)

Medical Directorship (n)

13 4

Mean Compensation

$54,167 $82,000

BenefitsHospital (N=66) Hospital % Private

(N=47) Private %

Malpractice Insurance 63 95.5% 29 61.7%

CME Allowance 59 89.4% 26 55.3%Med Insurance: Employee Only 15 22.7% 6 12.8%

Med Insurance: Employee Dependents

51 77.3% 24 51.1%

Disability Insurance 49 74.2% 16 34.0%

Life Insurance 48 72.7% 12 25.5%

Dental Insurance 54 81.8% 16 34.0%

Vision Insurance 49 74.2% 11 23.4%

Benefits

Malp

ractice

Insu

rance

CME Allo

wance

Med In

sur:E

mployee O

nly

Med In

sur: E

mployee Dep

Disabilit

y Insu

rance

Life In

suran

ce

Dental In

suran

ce

Vision In

suran

ce0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

120.0%

Private PracticeHospital

Quality Metrics

Hospital Employed

N=33

Private Practice

N=7 Participate in QI Projects 5 1 Patient Satisfaction 11 3 Use EMR 9 1 Clinical Outcomes 5 2 Access 1 0 Peer Review 2 0

Compensation Model

Hospital EmployedN=66

Private PracticeN=46

Base Salary Plus Incentive 39 12

Production Model 6 27

Straight/Guaranteed Salary 21 3

Revenue minus Expenses or % of collections

NA 4

The most common model for employed surgeons was base salary plus incentive. The most common model for private practice respondents was a production model.

Compensation Model

Base Sa

l + In

cent

Producti

on Model

Straig

ht/Gau

ranteed Sa

l

Rev - Exp

or % of c

ollecti

ons05

10152025303540

Hospital EmployedPrivate Practice

VisitsHospital

EmployedPrivate Practice

Clinic Visits N=31 N=18

Average Per Year 1500 1600

Estimated Per Week 29 31

New Patient Visits N=32 N=18

Average Per Year 300 925

Estimated Per Week 8 18

Total visit numbers were similar for employed and private practice surgeons.Private practice had a higher number of new patient visits.

Hospital Employed– Procedures

Hospital Employed: Procedures N 0 1-25 26-50 51-75 76-100 >100 min median maxUpper GI Endoscopy 42 8 8 6 4 6 10 0 50 4,500Lower GI Endoscopy 38 26 4 6 1 0 1 0 0 120Laparoscopy: Gastric Bypass with Roux enY 66 19 9 13 7 8 10 0 36 228Laparoscopy: Place Adj. Gastric Band 66 30 32 1 1 1 1 0 1 350Laparoscopy: Sleeve 66 18 15 16 8 4 5 0 25 185Laparoscopy: VBG 66 66 0 0 0 0 0 0 0 0Laparoscopy: BPD/DS 66 60 4 1 1 0 0 0 0 60Laparoscopy: Revision/Conversion of Band 66 24 38 2 2 0 0 0 3 75Laparoscopy: Revision/Conversion of Gastric Bypass 66 41 25 0 0 0 0 0 0 25Laparoscopy: Revision/Conversion of Sleeve 66 46 20 0 0 0 0 0 0 10Laparoscopy: Revision/Conversion of VBG 66 50 16 0 0 0 0 0 0 7Laparoscopy: Revision/Conversion of BPD/DS 66 62 6 0 0 0 0 0 102 448

Private Practice – Procedures

Private Practice: Procedures N 0 1-25 26-50 51-75 76-100 >100 min median maxUpper GI Endoscopy 29 5 6 2 1 2 13 0 100 500Lower GI Endoscopy 24 13 5 2 0 2 2 0 10 150Laparoscopy: Gastric Bypass with Roux enY 47 15 7 7 5 5 8 0 40 214Laparoscopy: Place Adj. Gastric Band 47 20 18 5 0 2 2 0 2 75Laparoscopy: Sleeve 47 14 11 6 3 5 8 0 21 305Laparoscopy: VBG 47 47 0 0 0 0 0 0 0 0Laparoscopy: BPD/DS 47 44 3 0 0 0 0 0 0 20Laparoscopy: Revision/Conversion of Band 47 20 24 3 0 0 0 0 2 50Laparoscopy: Revision/Conversion of Gastric Bypass 47 28 16 3 0 0 0 0 0 36Laparoscopy: Revision/Conversion of Sleeve 47 39 8 0 0 0 0 0 0 15Laparoscopy: Revision/Conversion of VBG 47 36 10 1 0 0 0 0 0 27Laparoscopy: Revision/Conversion of BPD/DS 47 44 3 0 0 0 0 0 0 2

Conclusion

• The response level is lower than optimal for this survey, however it is equivalent to the response rate for the MGMA survey. Useful and important data is present.

• ASMBS members are a diverse group– Case volume– Years of Experience– Percent of Time Dedicated to Bariatrics

• Practice Environment should be considered in compensation discussions

Contributing Members

• Chair - Samer Mattar MD, FACS• Co-Chair- Teresa LaMasters MD, FACS• Member Ashutosh Kaul MD, MS, FRCS, FACS

Member John D. Scott MDMember Eric S. Bour MDMember Stephen D. Wohlgemuth MD

• Member Marina Kurian MD• President ASMBS 2014-2015 John Magaña

Morton, MD, MPH, FACS, FASMBS

Support Provided

• Jennifer Wynn– Director of Committee Affairs – Assistant to Executive Director– ASMBS

• Georgeann Mallory, RD– Executive Director ASMBS

• Kristen Danielle Hahn– Research assistant UnityPoint Health, Des Moines IA

• Catherine Hackett Renner, PhD– Director Office of Research– UnityPoint Health, Des Moines, IA