Editor's note: This popular story from the Daily Briefing's archives was republished on Sept. 5, 2018.

Almost all types of U.S. physicians saw a "modest" increase in earnings over the last year, according to the Medscape Physician Compensation 2018 report. But six specialties broke the trend with lower compensation overall.

Report details

For the report, Medscape surveyed 20,329 physicians from more than 29 specialties between Nov. 21, 2017, and Feb. 21, 2018. The responses were weighted based on the American Medical Association's physician distribution by gender, specialty, and state.

In the report, physicians reported their total compensation for providing care. For example, employed clinicians reported their salary, bonus, and income from profit-sharing arrangements, while physician partners and those with solo practices reported their earnings before factoring in income taxes, but after factoring in business taxes and deductibles.

Overall increase in compensation

Medscape in the latest report finds the "average overall physician salary" in 2018 is $299,000, up from $294,000 last year. Average primary care physician salary increased from $217,000 to $223,000, while average specialist salary increased from $316,000 to $329,000.

Physician incomehas continued to increase over the last seven years, Medscape reports. Tommy Bohannon, VP of Merritt Hawkins, said, "The fact remains that the physician workforce is relatively stagnant in terms of growth and that demand for physician services keeps rising. The result, inevitably, is more spending and higher incomes for physicians."

Highest, lowest compensation by specialty

According to Medscape, the five specialties with the highest average compensation packages in 2018 were:

• Plastic surgery, at $501,000;
• Orthopedics, at $497,000;
• Cardiology, at $423,000;
• Gastroenterology, at $408,000; and
• Radiology, at $401,000.

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By contrast, the specialties with the lowest average compensation packages were:

• Public health and preventive medicine, at $199,000;
• Pediatrics, at $212,000;
• Diabetes and endocrinology, at $212,000;
• Family medicine, at $219,000; and
• Internal medicine, at $230,000.

Several specialties saw average compensation increase over the past year. The six specialties with the greatest percentage increase in compensation were:

• Psychiatry, which saw a 16% increase;
• Plastic surgery, which saw a 14% increase;
• Physical medicine and rehabilitation, which saw a 13% increase;
• Oncology, which saw a 10% increase; and
• Rheumatology and critical care, which both saw a 9% increase.

According to Bohannon, Medscape in its 30-year history has "never seen demand for psychiatrists this high." He added, "Demand for mental health services has exploded, while the number of psychiatrists has not kept pace. The short version is that aging produces many mental health challenges, including dementia and its associated pathologies, and societal ills, such as the opioid crisis, are driving the need for more mental health professionals."

Meanwhile, six specialties saw a decrease in average compensation when compared with last year, including:

• General surgery, which saw a 9% decrease;
• Urology, which saw a 7% decrease;
• Diabetes/endocrinology and otolaryngology, which both saw a 4% decrease; and
• Neurology and pathology, which both saw a 2% decrease.

As in years past, the survey found that self-employed physicians had higher annual compensation ($356,000) than employed physicians ($277,000). Overall, 55% of respondents said they felt they are compensated fairly. The rate was highest among emergency physicians, at 74%, followed by pulmonologists, at 70%. The rate was lowest among doctors in physical medicine and rehabilitation, at 46%, and those in diabetes/endocrinology, at 47%.

Demographic trends

According to the survey, physician compensation is highest in the North Central region, at $319,000, and the Southwest, at $309,000. Indiana has the highest physician compensation of any state, at $334,000.

In comparison, physician compensation is lowest in the Northeast, at $275,000, and the Southwest, at $277,000. Washington, D.C., has the lowest physician compensation, at $229,000.

The survey also revealed other compensation differences. For example, the survey found that U.S.-trained doctors made more than most of their foreign-trained counterparts—except those trained in Canada. U.S.-trained physicians' average compensation was $303,000, while Canada-trained physicians' was $324,000.

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Disparities in gender, race persist

The survey also asked participants about their race and ethnicity, finding that Caucasian/white physicians had the highest average annual compensation, while African American/black physicians had the lowest. Specifically, the report found average annual compensation wasfor physicians who identify as:

• Caucasian/white was $308,000;
• Asian was $293,000;
• Hispanic/Latino was $278,000;
• Mixed was $264,000; and
• African American/black was $258,000.

According to the survey, "many factors influence" racial disparities, such as age, specialty choice, and "possible bias." Overall, Caucasian/white doctors were most likely to say they felt fairly compensated, with 63% saying they feel that way, while African American/black doctors were least likely to say they felt fairly compensated, at 45%.

The survey also found gender disparities remain in pay for primary and specialty care. Among primary care practitioners, the survey found male doctors had an average annual compensation of $239,000—nearly 18% higher than their female colleagues, whose annual compensation averaged $203,000. Among specialists, the survey found male specialists' compensation was $358,000, while female specialists' was $263,000—a 36% difference. According to the survey, the pay gap among specialists persisted even when comparing the compensation of male and female physicians within the same specialty.

Fewer physicians participating in ACOs, survey finds

The survey also asked respondents about payment models. According to the survey, insurance-based payment was the most common payment model, with 73% of respondents saying they used it. Concierge practices was the least common payment model, with only 2% of respondents saying they used it.

The survey also found that 27% of respondents are participating in ACOs this year, down from 36% in 2017. The rate was just 3% in 2012. "The model has not yet proven that it can consistently enhance efficiency and improve outcomes while achieving the savings that participating physicians can share in," Bohannon said "There is still work to do when it comes to convincing physicians of the efficacy of the ACO model" (Kane, Medscape, 4/11; Brooks, Medscape, 4/11).