Executive Summary

Direct Patient Contact

For the purposes of this survey, those in solo practice, clinical research and those in single specialty, multispecialty and acacemic clinics were grouped to provide an overall picture of the economics of rheumatology practice.

About 84 percent of practice is devoted to adult rheumatology. Pediatrics comprises 5 percent. Less than 10 percent is devoted to primary care. Respondents indicated that they desire to spend about 93 percent of their time dedicated to rheumatology.

Direct patient care comprised slightly more than 78 percent of income. Lab, x-ray and DEXA accounted for nearly 9 percent of income. Teaching accounts for 5 percent, and administration accounts for 3 percent.

The bulk of respondents, about 42 percent, earn between $126,000 and $200,000. Ten percent earned more than $250,000. About 20 percent earned less than $100,000.

Medicare is the largest payer at 35 percent of revenue. PPO/discounted fee for service was 26 percent of revenue. HMOs account for slightly more than 11 percent of revenue. Less than 1 percent of income is from capitation (primary care or rheumatology).

Overhead was about 53 percent. About 72 percent of booked charges were collected.

Respondents reported 3 ½ full-time equivalent support personnel per rheumatologist.

More than half of the respondents said they were planning to add or replace retiring associates within five years. Waiting time until next consultation is nearly 4 ½ weeks. Time until the next return office visit was 3 weeks.

The scheduled office hours per week was about 28, though this is skewed somewhat by those in academic clinical practice and those conducting clinical trials. Each new patient visit lasted nearly 50 minutes while return visits lasted about 18 minutes.

About 77 percent of respondents were male. The average age of respondents was 48.

About 86 percent of the visits for this group were adult rheumatology. Pediatric rheumatology accounted for less than 2 percent. Primary care comprised nearly 12 percent of the visits.

Rheumatologists in solo practice want about 92 percent of their practice to be devoted to rheumatology, so there is slightly more primary care in their practices than they desire.

Direct patient care accounted for 86 percent of their compensation. Lab made up slightly less than 4 percent, x-ray made up 2.6 percent, and DEXA made up 2.5 percent. Clinical trials, medical/legal work and teaching/lecturing each accounted for 1.5 percent.

More than 20 percent of solo practitioners earned $151,000-$200,000, but nearly that many (18.2 %) earned $50,000-$100,000. About 19 percent earned more than $250,000.

Medicare, at 42 percent of revenue, was the largest payer. PPO/discounted fee for service comprised about 28 percent of revenue. Only 5 percent of revenue came from HMOs, and only a handful of solo practitioners accepted capitation.

More than three-fourths of booked charges were collected. About 46 percent of total collections went towards physician compensation and insurance; overhead was about 54 percent.

Each solo practitioner had 3.5 support personnel. The average time until the next available consultation was 3.7 weeks, and the average time until the next return patient was 2.6 weeks.

The average solo practitioner scheduled 32 hours of office time per week. Each new patient took 51 minutes, and each return patient took 18 minutes. Seventy return patients and 11 new patients were seen per week.

Nearly 94 percent of patient encounters were adult rheumatology. Pediatric rheumatology comprised less than 2 percent of patient visits. Primary care comprised the rest of the patient encounters. There was virtually no discrepancy between the actual amount of time spent on rheumatology vs. the desired amount of time spent on rheumatology.

Patient care constituted 74 percent of compensation. Lab constituted 9 percent, x-ray 6 percent, and DEXA 4 percent.

More than 25 percent of respondents in this category reported an income of $151,000-$200,000. About 22 percent earned $126,000-$150,000. More than 10 percent earned over $300,000.

Medicare was the largest payer at 38 percent of revenue. PPO/discounted fee for service was the second greatest source with 32 percent. HMOs comprised just over 6 percent of revenue, and virtually no one accepted capitation.

Nearly 74 percent of booked charges were collected. Of the total collections, about 47 percent went for physician compensation. Overhead was about 53 percent.

For each physician in this category, there were 4.3 support personnel. The average group included 2.8 rheumatologists. More than 57 percent planned to add or replace retiring physicians with five years.

Wait time for the next available consult was 4.4 weeks, and wait time for return visits was 2.9 weeks. The average rheumatologist in a single specialty clinic schedules 30.5 office hours per week. Average time spent on new patients was 49.2 minutes, and average time spent on return patients was 16.8 minutes. In an average week, 11.5 new patients were seen, and 77 return patients were seen.

The average group size was 167 physicians with 3.3 rheumatologists. About 83 percent of office visits were with adult rheumatology patients. About 2 percent of visits were with pediatric rheumatology. Primary care constituted 13.5 percent of visits. This contrasted with a desired amount of time dedicated to rheumatology of 90 percent.

About 86 percent of compensation was derived from patient care. Lab constituted 3.5 percent, x-ray 2.9 percent, and DEXA 2.2 percent.

Almost 29 percent reported an income of $126,000-$150,000. Another 27 percent reported an income of $151,000-$200,000. Only 5 percent reported incomes over $251,000.

Medicare was the largest single payer, with 31.8 percent of revenue coming from that source. PPO/discounted fee for service represented about 23 percent, and HMOs represented a little over 20 percent. Only about ½ of 1 percent of respondents reported accepting capitation.

About 74 percent of booked charges were collected. Of the charges collected, about 48 percent went to physician compensation. Therefore, overhead was about 52 percent.

There were 3.3 support personnel for each rheumatologist. About 2/3 of those responding said they planned to add or replace retiring associates within the next five years.

Waiting time until the next consultation averaged 4.3 weeks; for return visits the average was 2.8 weeks. The average number of office hours scheduled was 31.6. Each new patient visit lasted 46 minutes, and each return patient visit lasted 18 minutes.

Adult rheumatology visits comprised about three-fourths of patient encounters for members in academic clinical practice. About 16 percent of their visits were with pediatric rheumatic disease patients. The rest of the visits were primary care.

The bulk of compensation (68%) was derived from patient care, though nearly 20 percent was from teaching/lecturing and about 9 percent was from administration. Nearly a third of the respondents in this practice category reported earning $101,000-$125,000. Another quarter of the respondents reported earning $50,000-100,000.

Medicare was the largest payer (26%), followed closely by PPO/discounted fee for service. Slightly more than 12 percent of revenue was obtained from HMOs, though virtually no one was accepting capitation or Medicare risk. Slightly more than half of the total booked charges were collected.

There were about 2.5 support personnel for each rheumatologist in the academic clinic. The average number of associates in each academic clinical practice was 9. Nearly 60 percent of respondents in this category said they were planning to add or replace retiring associates within 5 years.

The next available consultation was more than five weeks away, and the next return office visit was 4 weeks away. Each new patient took 53 minutes, and each return patient took about 22 minutes. The number of scheduled clinic hours per week was about 17. Nearly 82 percent of respondents indicated a need for more rheumatologists in the clinic.

About 82 percent of the patients seen by clinical researchers were adults with rheumatalogic problems. Only about 4 percent were pediatric rheumatology patients. Seven percent were primary care. Clinical trials work represented 41 percent of their compensation with direct patient care comprising another 39 percent. Teaching and lecturing accounted for about 10 percent of their total compensation.

More than half of the respondents in this category earned $125,000 or less, but nearly 10 percent earned more than $300,000. Medicare was the leading payer at 31 percent. PPO/discounted fee for service followed with 21 percent.

There were three support personnel for each clinical researcher. The average number of physicians in each clinical research group was 6. More than half plan to add or replace retiring physicians within five years.

Waiting time until next consultation was 5.7 weeks and until the next return visit was 4.2 weeks.

The average clinical researcher scheduled 14 hours of office time per week. New patients took, on average, 52 minutes. Return patients took 21 minutes.

• Capitation is not a significant factor for rheumatologists.
• HMOs, except for rheumatologists in multispecialty clinics, is a relatively small source of revenue.
• Pediatric rheumatology comprises a very small portion of practice except in the academic setting.
• The difference between desired and actual time spent in rheumatology (as opposed to primary care) is very slim except in the multispecialty clinic setting, where there is about a 5 percent difference.
• Income for rheumatologists in the academic practice setting was generally less than their counterparts in other practice settings.
• A significant number of rheumatologists in practice earn more than $250,000. The vast majority, however, earn between $126,000-$200,000.
• There is also a significant group earning less than $100,000, particularly in the academic clinical setting. About a quarter of solo practitioners earn less than $100,000 while only about 13 percent of those in a multispecialty group earn less than $100,000. Note that the survey did not distinguish between full-time and part-time practice. The scheduled hours of office time per week (less than 32 for solo and multispecialty practice; about 30 for single specialty practice) indicates that some respondents practiced less than full-time.
• Income figures at the practice type level do not necessarily correspond with number of hours in the clinic. Those in private practice, whether in solo practice, multispecialty group or single specialty group, schedule between 30.5 and 32 hours in the clinic each week. The group scheduling the most hours, solo practice at 32, also had the largest percentage of people earning less than $100,000.
• Overhead was 52-54 percent of revenue for those practicing outside the academic setting.
• Ancillaries comprise a significant portion of income for practicing rheumatologists. Those in solo practice and in the multispecialty clinic derive about 9 percent of their revenue from ancillaries (lab, x-ray, DEXA) while those in single specialty groups are heavily dependent on ancillaries, which comprise about 19 percent of their revenue.
• Support personnel varies by setting ranging from 2.5 per rheumatologist in the academic clinical practice to 4.3 in the single specialty group.
• Medicare remains the single largest payer for all practice settings. About one-third of a rheumatologist’s reimbursement is from traditional Medicare. Adding in Medicare risk raises this number only slightly.
• For practitioners other than the small group that classified themselves as clinical researchers, clinical trials represent only a minimal source of revenue. Even for single specialty groups, the figure was under 4 percent of revenue.
• The wait for an appointment with a rheumatologist can be significant, particularly for consults. Solo practitioners have the shortest wait time, but for other practice settings, the wait can be four or five weeks until the next available consult.
• Somewhere between half and two-thirds of all respondents indicated that they planned to add or replace retiring associates within the next five years. This, coupled with the long waiting times for appointments, may indicate a growing need for more rheumatologists. The percent of time spent on rheumatology remains relatively high in most settings, indicating that those currently in practice have not been forced to increase the portion of practice dedicated to primary care in order to keep productivity high.
• Solo practitioners are more diversified in their sources of revenue (patient care, lab, x-ray, DEXA, PT/OT, clinical trials, lecturing, consulting) than those in other practice settings

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