Why are Urologists unsatisfied with Salary?

[Strider_91]

I was reading the physician compensation reports from medscape, which I know aren't super reliable for numbers but a consistent theme seems to be that urologists are consistently in the bottom 3 of physician specialties that are satisfied with their salary. I find this odd because they seem to make a lot of money compared to other physicians, have a great job market, good outcomes, and a decent lifestyle for a surgical subspecialty?

 

Link: https://www.medscape.com/slideshow/compensation-2017-urology-6008589#11

 

Anyone got insights?

Is this a weird artifact?

Also, Derm finally got displaced by a specialty and EM now reigns supreme as most satisfied with their salary.

[MPMD]

paywall.

[Strider_91]

I googled paywall and I don't think I understand what you mean.

[MPMD]

it means you have to register to see the article.

[hightower]

Strider_91 wrote:

I was reading the physician compensation reports from medscape, which I know aren’t super reliable for numbers but a consistent theme seems to be that urologists are consistently in the bottom 3 of physician specialties that are satisfied with their salary. I find this odd because they seem to make a lot of money compared to other physicians, have a great job market, good outcomes, and a decent lifestyle for a surgical subspecialty?

 

Link: https://www.medscape.com/slideshow/compensation-2017-urology-6008589#11

 

Anyone got insights?

Is this a weird artifact?

Also, Derm finally got displaced by a specialty and EM now reigns supreme as most satisfied with their salary.

Click to expand...

From past surveys like this I've seen, Ortho is usually pretty low on the list of job satisfaction as well even though they are usually the highest paid docs out there.  Hard to imagine making 7 figures and being unhappy with your job, but then again, who knows.

Don't know that there's much value to these sort of surveys really.

[Urogirl]

As probably one of the few Urologists on this board, I feel compelled to answer. The short answer is the compensation has not increased with the increase in workload and call burden. Yes, compared to other specialties we are highly compensated, have created a system with an excellent job market and typically have excellent outcomes.  However, the lifestyle over the past 10 years has significantly changed. The aging specialty is having trouble recruiting since there are so many opportunities for graduating residents. That means that people are taking call longer in their careers. Urology call is not easy. There are a few urologic emergencies that will cause death or loss of ?limb if not handled promptly.  Septic stones, priapisms, torsions and the occasional penile fracture for some reason seem to occur at night more than the day. Most groups are now negotiating with hospitals to pay for call but the going rate still does not compensate adequately for the call. Given that many of those taking call are >55 yo, there has been a significant decrease in qualify of life and therefore job satisfaction. Call takes a different toll on your body at age 30 vs 40 so I can only imagine how my 60 yo partners feel post call. I personally feel it is still a great field and I do not regret choosing Urology.

[VagabondMD]

I would start by saying that those surveys are very unscientific, and what passes as a conclusion may be attributable to noise.

Second, over the years in practice, I have noticed a trend in private practice urology for financially successful urology groups to buy all of the related ancillary services and operate them- imaging, pathology, radiation, etc. Now, having control of those service lines can be very lucrative if operated optimally or an unmitigated disaster, even worse than not owning these, if operated poorly. I have seen both outcomes up close.

So, in short, there are three broad categories of private practice urology:

1. Those that perform urologic services and collect the professional fees. As @Urogirl states above, this alone is not a great lifestyle and compensation combination.

2. Those that perform urologic services and struggle in the ownership and management of the ancillary services. Maybe better off than #1, maybe not, maybe worse.

3. Those that perform urologic services and are successfully owning and operating the ancillary services. This group is probably quite satisfied with their compensation.

[q-school]

in the 90s there was this jama article that had urology listed as number one in job satisfaction among specialties.

in the 00s, it was still a specialty where they could remain independent of hospital acquisition.  there were simple procedures, office procedures, complex procedures, some requiring? robots.  lots of subspecialties.  there were short relationships with patients and longterm relationships with patients.  you could find ways to fit your practice to your tastes.  eventually the hospitals dominated and now urology is getting beat up like the rest of medicine.  (in my opinion).

I think some of the dissatisfaction is related to change from having flexibility to being employed.  it used to be good lifestyle with high pay, now its lifestyle is closer to getting beat up like cardiology and ortho, except the call is more frequent.  at our hospital, there are a number of independent urologists in the community who don't work weekends or nights, so all their patient issues that can't be handled over the phone get transferred here.  hospitalists hate it.  urologists hate it.  emergency room hates it.  somewhere some administrator may like it, I assume.

I don't really think more money makes the problems better or the satisfaction better (see hightower's post above).

all this is jmo.  ymmv.

etc etc

 

[Panscan]

Urology call isn't easy but for a surgical specialty it's pretty nice. Besides surg onc, ent or omfs what surgeon has easier call?

Txp, gen, CT, Ortho plastics all way way worse call.

[q-school]

how bad is plastics call?  I agree that general, ct and ortho worse.

it's sometimes not how bad is it, but how bad compared with how you expected it to be.

 

 

[Zaphod]

q-school wrote:

how bad is plastics call?  I agree that general, ct and ortho worse.

it’s sometimes not how bad is it, but how bad compared with how you expected it to be.

 

 

Click to expand...

If you're at a university, and especially depending on the share of hand/face call sharing amongst ortho/ent...plastics call can be absolutely brutal. Not usually life threatening, etc...type injuries, but its not really call as you can pretty much just be there all the time seeing relatively minor injuries and have a cranking OR schedule with facial fractures, hand injuries, etc...It can be very rough.

Depends where you are as well, but where I did residency when attendings were on call it was rough even with residents on front lines.

Otoh, you can have basically no call outside your own patients in private practice which is pretty low key.

[trebizond]

I suspect it's mostly the discordance between expectations and reality. Most people (I hope!) who go into cardiology know they will be dealing with sick patients and have frequent emergencies and have call. I bet a lot of dissatisfied urologists had the impression they would have few emergencies. I doubt it's the salary.

[Zaphod]

trebizond wrote:

I suspect it’s mostly the discordance between expectations and reality. Most people (I hope!) who go into cardiology know they will be dealing with sick patients and have frequent emergencies and have call. I bet a lot of dissatisfied urologists had the impression they would have few emergencies. I doubt it’s the salary.

Click to expand...

I guess thats possible but residency should kinda open their eyes dont you think?

[trebizond]

Actually I think surgical subspecialties tend to delude medical students more than medical ones do. When I did my medicine AI I was often frustrated by the notewriting ad nauseum and discharge planning etc but it was very realistic. Medicine residents also have a good grasp of what it's like to be a cardiologist given their exposure to the floors, CCU, consult services etc.

I can easily see a future urologist being totally blindsided by things because their surgery clerkship and elective was all operative and very little floors/consults. Heck, I LOVED my surgery clerkship and thought about going into it, but realized I would hate all the perioperative management and my research career would be over. Hopefully the surgical AIs give future urologists a good impression of what awaits them in residency.

[VagabondMD]

q-school wrote:

how bad is plastics call?  I agree that general, ct and ortho worse.

it’s sometimes not how bad is it, but how bad compared with how you expected it to be.

 

 

Click to expand...

It probably depends quite a bit on the setting, Level 1 trauma vs. sleepy community hospital, location, number of people in the Call pool, capability of ER docs, exact nature of Call (face lacs only vs lacs plus hand Call), and lots of other factors that I do not understand well enough to speak to.