Results from the 2010 ASPHO Compensation/Productivity Survey Presented by Jeffrey Hord, M.D. Chair, APSHO Practice Management Committee

Methods  In Spring 2010, ASPHO offered an online survey of compensation to its members  The goal was to obtain comprehensive 2009 subspecialty compensation, productivity, and workforce data for members to use in practice management  The primary variables analyzed were region of practice, gender, practice type, academic rank, experience, administrative responsibilities  The survey was offered to 1018 members and was completed by 527 members (36 PT/491 FT) for a response rate of 51.7%.  58% of all PT responders were from the Eastern US  11% of all female responders were PT compared to 4% of all male responders  Compensation results are from FT respondents only.

Characteristics of Survey Responders

Gender of All Responders 59.4%

Years Post-Fellowship- All 28.8% 16.7%

Years Post-Fellowship- by Gender

Clinical Responsibilities

Division Director

Department Chair

How many responders have an Academic Appointment? 458 of 527 (87%)

Academic Rank by Gender- 458 of 527 (87%) had an Academic Appointment

Of those with an an academic appointment, what promotion track? 33% of males and 23% of females on Tenure Track 32% of males and 46% of females on Clinical Track

Board Certification of Responders Ped Hem/OncGeneral Ped Yes472 (90%)433 (82%) No55 (10%)94 (18%) Note-21% of males not Board Cert in Gen Peds compared to 13% of females Of the 94 not Board Cert in Gen Peds, 86 are Board Cert in Ped Hem Onc 9 of the 106 Div Directors who responded are not Board Cert in Ped Hem/Onc

Practice Characteristics

Practice Type Note- 11% of males and 7% of females in Pvt Prac 60% of males and 68% of females in Univ/Acad

US Geographic Regions

Location of Practice

Compensation

Type of Compensation Plan

Measure of Clinical Productivity (n=166)

Sources of Compensation Other sources included Fed GME dollars, Military, Federal Govt, State Govt, HMO, Pharm sales, County Taxes

Total Compensation for Full-Time PHO Physicians Non-Division Directors  Median for all (n=381)= $162,300  Median for Females (n=160)= $146,500  Median for Males (n=221)= $180,000 Division Directors  Median for all (n=101) = $225,000  Median for Females (n=28)= $203,200  Median for Males (n=73)= $235,000

Median Total Compensation- Comparison with other Sources Non- Directors DirectorsAll ASPHO162,300 (381) 225,000 (101) 180,000 (489) Sullivan, Cotter, Assoc 181,280 (163) 263,645 (24) CHCA209,713 (114) ECG Mgmt198,408 (145) SK&A, Cegedim 205,999 (1138) MGMA208,000 (91)

Non-Division Directors- Compensation by REGION

Median Total Compensation of Non-Division Directors by Region and Gender- 2009

Median Total Compensation by Practice Size and Region/ ALL Non- Division Directors-2009 <60 New Onc Pts New Onc Pts >150 New Onc Pts East 167,000 (42) 170,000 (41) 145,000 (35) Midwest 164,500 (25) 149,000 (30) 167,000 (27) SE 195,000 (17) 158,500 (20) 186,000 (11) Mt. West --- (4) --- (4) 150,500 (10) S. Central 188,000 (9) 148,000 (11) 151,000 (27) West 210,000 (9) 152,500 (18) 176,000 (14) ( ) = sample size

Median Total Compensation of Univ-Based Non- Division Directors by Region and Gender- 2009

Non-Division Directors- Compensation by EXPERIENCE

Full-Time Non-Directors by Experience (in thousands)- Percentiles <5 (n=106) 5-9 (n=85) (n=52) (n=58) >20 (n=79) 25 th % th % th %

Median Total Compensation of Non-Division Directors by Experience and Gender-2009

Median Total Compensation (in thousands) by Experience in University-Based Non-Division Directors-2009

Median Total Compensation by Experience and Region/ ALL Non- Division Directors-2009 <5 yr5-9 yr10-14 yr15-19 yr> 20 yr East 127,050 (32) 142,000 (26) 162,500 (20) 183,000 (21) 220,000 (28) Midwest (26) 146,000 (21) 200,000 (9) 191,000 (14) 212,500 (18) SE 146,250 (14) 171,500 (14) --- (5) 223,500 (7) 231,000 (10) Mt. West 126,500 (7) --- (3) --- (4) --- (2) --- (2) S Central 130,000 (17) 148,000 (10) 206,500 (6) 180,000 (9) 192,000 (10) West 151,500 (10) 138,500 (10) 167,000 (9) --- (5) 230,000 (11) ( ) = sample size

Median Total Compensation by Experience and Region/ Female vs Male Non- Division Directors-2009 <5 yr5-9 yr10-14 yr15-19 yr> 20 yr East 123(21) 140(11) (14) (12) 158(7) 170(13) 156(6) 200(15) 193(10) 256.5(18) Midwest 127(15) 142(11) 147(7) 145.9(14) (7) 199(7) (15) SE 135(7) 160(7) (9) (6) (7) Mt. West --- S Central 127(8) 136(9) 146(7) (8) West (8) 137(7) (6) (7) ( ) = sample size

Median Total Compensation (in thousands) by Experience and Practice Type/ All vs Female vs Male Non-Division Directors-2009 <5 yr5-9 yr10-14 yr15-19 yr> 20 yr Private Practice 175 (9) (7) 212 (7) (6) --- University/ Academic 125 (74) 122(43) 134 (31) (62) 140(33) 145.8(28) (36) 162(14) (22) 176 (41) 162.5(17) 199 (24) 201 (49) 172(15) (34) Hospital- based 170 (22) (12) (10) 182 (9) (6) 205 (12) (9) (10) (7) 215(17) (13) ( ) = sample size

Non-Division Directors- Compensation by RANK

Median Total Compensation by Academic Rank and Region/ ALL Non- Division Directors-2009 InstructorAssistAssocFull East 110,500 (8) 140,500 (55) 175,000 (33) 225,000 (15) Midwest --- (2) 140,000 (46 180,000 (19) 231,000 (12) SE --- (3) 160,000 (23) 170,000 (10) 250,000 (7) Mt. West --- (2) 130,750 (6) --- (4) --- (2) S Central --- (5) 145,500 (22) 157,000 (13) 198,000 (7) West --- (0) 140,000 (114) 160,000 (13) 286,000 (6) ( ) = sample size

Median Total Compensation by Academic Rank and Region/ Female vs Male Non- Division Directors-2009 InstructorAssistAssocFull East (31) 146.5(24) 155(11) 192(33) (11) Midwest (23) 150(23) (14) (7) SE (8) 175(15) (7) (6) Mt. West--- S Central (12) 150(10) 153.5(6) 182(7) --- West (7) 160(8) 160(7) 165(6) (6) ( ) = sample size

Median Total Compensation by Academic Rank and Region/ University Non- Division Directors-2009 InstructorAssistAssocFull East 110,500 (8) 140,000 (40) 174,000 (27) 217,500 (12) Midwest --- (2) 135,300 (34) 165,000 (13) 235,000 (9) SE --- (2) 138,750 (16) 160,000 (9) 250,000 (7) Mt. West --- (1) --- (0) --- (4) --- (3) S Central --- (5) 144,000 (17) 151,000 (10) 198,000 (8) West --- (0) 140,000 (12) 160,000 (10) 286,000 (6) ( ) = sample size

Median Total Compensation for Full-Time Non-Directors by Region vs % Actual Change Change in CPI to 2009* East Midwest Southeast South Central Mt West West *Consumer Price Index data from US Bureau of Labor Statistics

DIVISION DIRECTORS

Total Compensation of Division Directors by Region Median Total Comp Mean Total Comp Range East$226,250 (28)$252,286$150K-$450K Midwest$226,000 (27)$244,741$154K-$380K SE$258,000 (13)$275,923$175K-$420K Mt. West$212,500 (6)$226,667$187.5K-$292.5 S. Central$217,500 (15)$232,000$155K-$300K West$203,200 (12)$219,450$135K-$350K ( ) = sample size

Total Compensation of Division Directors by Experience Yrs after Fellowship Median Total Comp Mean Total Comp Range <5 (2) (6)$215,750$225,250$195K-$300K (14)$202,500$205,857$135K-$333K (23)$265,000$256,800$187.5K-$380K >20 (56)$225,000$254,687$150K-$450K ( ) = sample size

Total Compensation of Division Directors by Academic Rank/ Tenure Track RankMedian Total Comp Mean Total Comp Range Instructor (0)--- Assistant (1)--- Associate (6)$214,000$233,000$199K-$295K Full (30)$235,000$259,130$155K-$420K ( ) = sample size

Total Compensation of Division Directors by Academic Rank/ Non-Tenure Track RankMedian Total Comp Mean Total Comp Range Instructor (0)--- Assistant (7)$179,500$181,714$135K-$230K Associate (8)$275,500$260,750$180K-$325K Full (14)$232,000$269,357$195K-$450K ( ) = sample size

Total Compensation of Division Directors by Practice Type Practice TypeMedian Total Comp Mean Total Comp Range Private Multispecialty (8) $215,000$222,188$180K-$300K University (54) $225,000$241,535$150K-$425K Hospital- based (31) $248,000$259,581$135K-$450K ( ) = sample size Only categories with > 5 responses shown

Total Compensation of Division Directors by Practice Size New Onc Patients/ Yr Median Total Comp Range <60 (40)$201,750$135K-$380K (36)$232,000$150K-$450K >150 (20)$282,750$191K-$395K ( ) = sample size

Median Total Compensation for Full-Time Directors by Region vs % Actual Change Change in CPI to 2009* East Midwest Southeast South Central Mt West West *Consumer Price Index data from US Bureau of Labor Statistics

Workforce/ Productivity

Staffing Assessment by Division Directors

Other Support FellowsHospitalists for PM/Wkends Yes298 (56.5%)97 (18.4%) No229 (43.5%)430 (81.6%)

Clinical Hours Per Week by Clinical FTE’s 57 clinical hours/week = 1.0 clinical FTE

Clinical FTE Hem/Onc Physicians/ # New Oncology Patients- ALL Centers 13.3 new pts/physician

Clinical FTE Hem/Onc Physicians/ # New Oncology Patients- NON-TRANSPLANT Centers 19 New Onc Pts/Physician

Clinical FTE Hem/Onc Physicians/ # New Oncology Patients- TRANSPLANT Centers 12.2 New Onc Pts/ Physician

Total Clinical FTE’s (Physicians, APN’s, PA’s) for Number of New Oncology Patients 11.7 New Onc Pts/FTE 11.1 New Onc Pts/ FTE

Providers in Programs with 30 New Oncology Patients Annually- Directors Hgb d/o pts Bldg d/o patients # BMT’s / year PhyscnsNP/PA’sClinic FTE’s Total Providers Practice Type FT 2 PT 0 FT 0 PT 1.83Hosp FT 0 PT 0 FT 0 PT 2.73Univ FT 0 PT 1 FT 0 PT 33Hosp FT 0 PT ? FT 2 PT ?5Univ FT 1 PT 1 FT 0 PT 36Univ FT 0 PT 1 FT 0 PT 22Hosp

Providers in Programs with 60 New Oncology Patients Annually- All Hgb d/o pts Bldg d/o pts # BMT’s / year PhysnsNP/PA’ s Clinic FTE’s Total Providers Practice Type New3 FT 0 PT 5 FT 0 PT 88Univ FT 1 PT 3 FT 0 PT ?6Univ FT 0 PT 0 FT 0 PT 33Hosp FT 0 PT 1 FT 1 PT 56Pvt Mult Spec FT 1 PT 2 FT 0 PT 6.257Univ FT 0 PT 10 FT 1 PT ?23Univ

Providers in Programs with 100 New Oncology Patients Annually-All Hgbpthy pts Bldg d/o pts # BMT’s / yr PhysnsMLP’sClinical FTE’s Total Providers Practice Type FT 0 PT 12 FT 0 PT 37 Univ FT 1 PT 3 FT 0 PT 7.88Univ FT 0 PT 12 FT 0 PT 57 Univ FT 0 PT 10 FT 0 PT 1040Univ FT 0 PT 5 FT 0 PT 810Univ FT 5 PT 4 FT 0 PT 1113Hosp

Providers in Programs with 120 New Oncology Patients Annually- Directors Hgb d/o patients Bldg d/o patients # BMT’s / year PhyscnsNP/PA’sClinical FTE’s Total Providers Practice Type FT 2 PT 2 FT 0 PT 68NP Med Grp FT 0 PT 10 FT 2 PT 2032Univ FT 1 PT 5 FT 0 PT 1518Univ FT 1 PT 3 FT 2 PT Hosp

Providers in Programs with 200 New Oncology Patients Annually Hgbpth pts Bldg d/o pts # BMT’s / yr PhysnsMLP’sClinic FTE’s Total Providers Practice Type FT 0 PT 6 FT 0 PT 26 Univ FT 2 PT 8 FT 4 PT 1838Univ FT 5 PT 10 FT 0 PT 29 Univ FT 2 PT 15 FT 0 PT ?29Hosp FT 2 PT 10 FT 0 PT ?28Univ FT 0 PT 5 FT 2 PT Univ

2009 wRVU’s By Clinical FTE CHCA median wRVU- 3547/provider ECG median wRVU- 3673/provider 1.O Clinical FTE= 3750 wRVU’s

2009 wRVU’s by Hours Spent Per Week Caring For Patients To earn 3750 wRVU’s must work 61.5 hours/ week

SUMMARY

There is a Gender Gap

Conclusions  40% of respondents are < 10 years out from training and most of them are female (54%)  68% of respondents care for both hematology and oncology patients  The ASPHO self-reported compensation results are less than those reported by national benchmarking groups  Compensation in our subspecialty has increased between 2004 and 2009 at about the same rate as the consumer price index  Compensation gradually increases with increasing experience and rank (and practice size for directors)  Regional compensation differences are small

Conclusions  Compensation for non-directors in private practice > hospital-based > university/academic  Compensation for directors at hospital-based practice> private practice> university/academic  Median total compensation for female non-division directors was 18.6% less than that of males  Median total compensation for female division directors was 13.5% less than that of males  Multivariate regression analysis quantified gender inequality of $16,012 when controlling for all other significant factors

Conclusions  Assessment of staffing by directors balanced between “adequate” and “insufficient” for present time, in 5 yrs, and 10 yrs  1.0 Clinical FTE should generate between wRVU’s annually  A full-time clinician must spend hours/week seeing patients to generate 3750 wRVU’s  Ratio of new onc diagnoses/1.0 clinical FTE physician is about 19/1 for non-transplant centers and 13/1 for transplant centers but there is great variability in staffing between centers with similar volumes