26 S A N D I E G O P H Y S I C I A N . o r g | F E B R U A R Y 2 0 0 8

By Tom Gehring, SDCMS CEO and Executive Director

PHYSICIAN WORKFORCE

2007 San Diego CountyPhysician Workforce andCompensation Survery

n 2002, the San Diego County Medical Society (SDCMS)conducted San Diego County’s first Physician Workforceand Compensation Survey, the results of which providedSDCMS and local healthcare policymakers with their first

insights into physicians’ attitudes toward their work and work-place – with our 2002 survey quantifying as well San DiegoCounty’s physician compensation environment. In 2005, we con-ducted our second Physician Workforce and Compensation Sur-vey, and in 2007 our third. Our 2007 survey, the highlights ofwhich are detailed in this report, contained all of the questionsincluded in our 2005 survey, and added two questions aboutphysician on-call behavior and several questions about reim-bursements from County Medical Services.

I

Solo and small-group physicians report that they have reduced Medi-Cal by 13percent each, and, sur-prisingly, large-groupphysicians report thatthey have reducedMedi-Cal by more than 25 percent.

F E B R U A R Y 2 0 0 8 | S A N D I E G O P H Y S I C I A N . o r g 27

II.. KKEEYY FFIINNDDIINNGGSS

A) Physicians were asked about their history and plans for Medicare.1. Physicians were asked whether they took Medicare threeyears ago.

a) For every grouping except solo physicians, physiciansreported no change from three years ago.

b) However, solo physicians reported a 10 percent drop – from 91 percent to 81 percent – in taking Medicare.

2. In the face of a 10 percent cut in Medicare, a significant number of physicians would change their behavior withrespect to Medicare:

a) Roughly two-thirds of community clinic and academicphysicians would continue to see Medicare “as is,” butone-third would change their Medicare practice by re-ducing or eliminating Medicare.

b) Roughly 40 percent of large- and medium-group physicians would continue to see Medicare “as is,” but roughly 60 percent would change their Medicare prac-tice by reducing or eliminating Medicare.

c) Only about one-quarter of small-group and solo physicians would continue to see Medicare “as is.”

3. Recognizing that not every physician accepted Medicare before a postulated 10 percent cut, the net Medicare ac-ceptance rate, without any change in practice pattern, is pre-sented in blue below.

TABLE 1: NET MEDICARE ACCEPTANCE RATES WITH AND WITHOUT A 10% PHYSI-CIAN REIMBURSEMENT CUT

B) Physicians were asked about their history and plans for Medi-Cal.1. On average, 63 percent of physicians took Medi-Cal in 2007. Physicians reported that three years ago 70 percenttook Medi-Cal.

2. Physicians reported that for solo and small-group physicians,they have reduced Medi-Cal by 13 percent each, and, sur-

prisingly, large groups report that they have reduced Medi-Cal by more than 25 percent.

3. Table 2 graphically represents the percentage of physicianscurrently taking Medi-Cal who would continue to takeMedi-Cal “as is.” All others would either eliminate Medi-Cal, significantly reduce the number of patients they see withMedi-Cal, or take no new Medi-Cal patients.

TABLE 2: MEDI-CAL ACCEPTANCE RATES WITH AND WITHOUT A 5% PHYSICIANREIMBURSEMENT CUT

4. Recognizing that not every physician accepted Medi-Cal beforea postulated 5 percent cut, the net acceptance rate, withoutany change in practice pattern, for Medi-Cal is presented inblue below:

TABLE 3: NET MEDI-CAL ACCEPTANCE RATES AFTER A 5% PHYSICIAN REIM-BURSEMENT CUT

100%

90%

80%

70%

60%

50%

40%

30%

20%

10%

0%CommunityClinics

AcademicMedicine

LargeGroup

MediumGroup

SmallGroup

Solo

67%

33%

69%

31%

35%

65%

30%

70%

21%

79%

19%

81%

Take Medicare “As Is” after 10% Cut

Do Not Take Medicare “As Is” after 10% Cut

90%

80%

70%

60%

50%

40%

30%

20%

10%

0%

CommunityClinics

AcademicMedicine

LargeGroup

MediumGroup

SmallGroup

Solo

86%86%

77%

65%

72%

53%

81%

59%64%

36%50%

20%

0% Cut - Continue to Take Medi-Cal “As Is”

5% Cut - Continue to Take Medi-Cal “As Is”

100%

90%

80%

70%

60%

50%

40%

30%

20%

10%

0%

CommunityClinics

AcademicMedicine

LargeGroup

MediumGroup

SmallGroup

Solo

86%

14%

62%

38%

17%

83%

44%

56%

19%

81%

7%

93%

Take Medi-Cal After 5% Cut

Do Not Take Medi-Cal After 5% Cut

28 S A N D I E G O P H Y S I C I A N . o r g | F E B R U A R Y 2 0 0 8

C) Physicians were asked about their history and plans for CountyMedical Services (CMS).1. On average, 47 percent of physicians took CMS in 2007.2. Physicians reported that three years ago, 48 percent tookCMS. Community clinic physicians reported they reducedCMS by 14 percent. All other modes had no significantchange in CMS acceptance.

3. Projecting forward, absent a change in CMS reimbursement,the future looks bleak for CMS patients who need to see aphysician:

TABLE 4: COUNTY MEDICAL SERVICES ACCEPTANCE RATES WITH NO CHANGE INCMS REIMBURSEMENT

D) The specialties that are in crisis in San Diego County – definedas having longer-than-average wait times for new patients, a per-ception that this specialty was in shortage, and a perception ofdifficulty recruiting within the specialty – are internal medi-cine, neurology (also in crisis in 2005), orthopedic surgery (alsoin crisis in 2005), and psychiatry (also in difficulty in 2005).

E) The specialties that are in difficulty in San Diego County –defined as one meeting two of the three criteria defining a spe-cialty “in crisis” (see “D” above) – are family medicine, ob-gyn(also in difficulty in 2005), hematology/oncology, nephrology,otolaryngology, (also in crisis in 2005), and pulmonology (alsoin difficulty 2005).

F) Forty-five percent (unchanged from 2005) of physician respon-dents felt there was a physician shortage; however, when thesignificant influx of academic respondents in the 2007 survey isfactored out (resulting in an “apples to apples” comparison to2005 data), there is an increase from 45 percent to 50 percent ofphysicians who believe there is a shortage. When examined bypractice size, 43 percent (up from 35 percent in 2005) of solo andsmall-group physicians felt there was a physician shortage, while54 percent (up from 48 percent in 2005) of physicians practicingin a medium or large setting felt there was a physician shortage.Academic physicians do not believe there is a physician shortage.

G)The following is a list (in priority order) of specialties where morethan 20 physicians felt there were shortages. Of those listed, somespecialties had longer-than-average wait times for a new patientappointment – an informal indicator that a perceived shortageby physicians is translating into a real problem for patients.1. Internal Medicine (repeat from 2005) (excessive wait timein 2007)

2. Family Medicine (repeat from 2005)3. Gastroenterology4. Neurology (repeat from 2005) (excessive wait time in 2007)5. Dermatology (repeat from 2005)6. Endocrinology7. Pain Medicine8. Psychiatry (repeat from 2005) (excessive wait time in 2007)9. General Surgery (repeat from 2005)10.Neurosurgery (repeat from 2005)11. Rheumatology12.Orthopedic Surgery (repeat from 2005) (excessive waittime in 2007)

13. Obstetrics and Gynecology (repeat from 2005) (excessivewait time in 2007)

14.Otolaryngology (repeat from 2005) (excessive wait time in2007)

15. Pediatrics16. Anesthesiology (repeat from 2005)

H)Of those who were recruiting or involved in recruiting, 41 per-cent (down slightly from 45 percent in 2005) reported some dif-ficulty in recruiting, while 33 percent (essentially unchanged from 34 percent in 2005) reported significant difficulties re-cruiting.1. A significant difference emerged when analyzing recruitingdifficulty by practice size. An astonishing 86 percent of soloand small-group physicians reported difficulty recruiting(either some difficulty or significant difficulty). No less sur-prising and disconcerting is that academic physicians aresimilarly challenged: 74 percent reported difficulty recruiting(either some difficulty or significant difficulty). That samestatistic for physicians practicing in medium and largegroups was “only” 64 percent. Everyone is having a problemrecruiting physicians to San Diego County.

2. Significant in-specialty recruiting difficulty was indicatedfor the following specialties (sorted alphabetically):• Family Medicine (repeat from 2005)• General Surgery (repeat from 2002 and 2005)• Hematology/Oncology (upgrade from some recruitingdifficulty in 2005)

• Internal Medicine (repeat from 2005)• Nephrology• Neurology (repeat from 2002 and 2005)• Orthopedic Surgery (repeat from 2005)• Otolaryngology (repeat from 2005)• Psychiatry (repeat from 2002 and 2005)• Pulmonology (upgrade from some recruiting difficultyin 2005)

• Radiology (repeat from 2002 and 2005)

100%

90%

80%

70%

60%

50%

40%

30%

20%

10%

0%

CommunityClinics

AcademicMedicine

LargeGroup

MediumGroup

SmallGroup

Solo

29%

71%

63%

37%

11%

89%

42%

58%

17%

83%

14%

86%

Take CMS If UnchangedDo Not Take CMS If Unchanged

PHYSICIAN WORKFORCE

F E B R U A R Y 2 0 0 8 | S A N D I E G O P H Y S I C I A N . o r g 29

3. In 2005, significant problems were reported in recruitingprimary care physicians in internal medicine and familymedicine. In 2007, this trend dramatically accelerated: Thequantitative numbers on physicians reporting difficulty inrecruiting to internal medicine and family medicine are veryhigh.

I) On the subject of physician retention, the 2007 survey projectsthat 82 percent of San Diego County physicians will maintaintheir practice “as is” for the next three years.1. This is essentially unchanged from 2005. When analyzed

by district, North County Inland and South Bay physician“retention” was lower than the average.

2. Not surprisingly, of those physicianslikely to change their practice mode, there was a clear drop-off for physicians in prac-tice for more than 30 years, of whom only 59 percent said they would be in practicein three years.

3. Very surprisingly, there is a sharpdip in physician retention at thesix- to 10-yearpoint.

J)The average number of total hours workedby San Diego Countyphysicians, includingclinical and non-clinical hours, was 60.1 hours perweek, up from 57 hours in2005. The most significant component of this increase wasfrom academic physicians. Whencompared to 2002 data, the physicianworkweek is getting longer. The 2002 average was 53 hours, in 2005 the workweek was 57 hours, and in 2007 it was 60.1. Over the past five years, working hours have increased by seven hours.1. There was a clear difference in total hours worked whenanalyzed by group size. Solo and small-group physicianswork longer hours – on average 61.9, up from 60 hours perweek in 2005 – than doctors practicing in the medium- andlarge-group settings: 54.4 hours per week (unchanged from2005).

2. The total hours worked by female physicians was signifi-cantly less: 53.6 (same as in 2005) hours per week versus

62.1 hours (up from 58 hours per week in 2005) worked bytheir male counterparts. Of note, there was no significantdifference in the number of patient-care hours for female versus male physicians.

3. Specialists averaged 62.8 total hours per week (up from 58hours per week). Primary care physicians averaged 54.7 totalhours per week (up from 53 hours per week), with nosignificant difference in patient-care hours between specialistsand primary care doctors.

K) A San Diego County physicians spend, on average, 39 hoursper week seeing patients.

1. There was a significant difference in patient hours between full-time male (40.4 hours

seeing patients) and full-time femalephysicians (35.7 hours seeing pa-tients).

2. There was also significantvariation between the hoursspent with patients for thevarious modes of practice:a) Solo and small-groupphysicians: 42.6 hoursper week seeing pa-tients.b) Medium- and large-group physicians: 39hours per week seeingpatients.c) Physicians practicingin academic medicine:34.3 hours per weekseeing patients.

3.When compared to 2005data, the number of hours

spent directly in patient care in2007 dropped. However, in 2005

there were almost no academic physi-cians. If the academic physicians arefactored out of the 2007 data, thenthere is negligible difference betweenthe 2005 and 2007 data for patienthours per week.

L) Sixty percent of physicians re-sponded that time spent with

patients was adequate, while 39percent said that time spent was in-

adequate. This is unchanged from 2005.1. Solo and small-group physicians, by a 62 percent to 38 percentratio, felt (overwhelmingly) that time spent with patientswas adequate. Of note, this satisfaction with time spent forsolo and small-group physicians is down significantly from2005 data.

2. Medium- and large-group physicians, on the other hand,

30 S A N D I E G O P H Y S I C I A N . o r g | F E B R U A R Y 2 0 0 8

PHYSICIAN WORKFORCE

were almost evenly split (55 percent to 45 percent) that timespent with patient care was adequate. This is unchangedfrom 2005.

3. Of note, physicians practicing in an academic setting werethe most satisfied with time spent with patients of any of themodes of practice at 66 percent.

4. In 2007, 57 percent of male physicians were satisfied withthe time spent with patients, while 66 percent of femalephysicians were satisfied with the time spent with patients.Of note, this a reversal from 2005 data, where the ratio wasmales at 61 percent satisfied versus females at 52 percentsatisfied.

5. Specialists are 64 percent satisfied with time spent withpatients, while primary care physicians were at 54 percent.This is essentially identical to 2005 values.

M) Overall wait times for new patient appointments have notchanged since 2005. The average time for a new patient to obtainan appointment in 2005 and 2007 was 2.2 weeks, or 11 businessdays. In a reversal from 2005, the time to obtain an appointmentfor solo physicians went from the shortest in 2005 to next tolongest.1. In 2007, small- and medium-group wait times for newappointments went from among the longest to the twoshortest wait times.

2. In 2007, there were longer-than-average wait times fornephrology, neurology, allergy and immunology, ophtha-mology, hematology/oncology, psychiatry, orthopedicsurgery, and pulmonology.

3. Neurology, ophthalmology, and pulmonology also hadlonger-than-average wait times from 2005.

4. When compared to 2005 data, the wait times for internalmedicine increased significantly, while wait times for familymedicine dropped.

N) The dissatisfaction of physicians with the practice of medicinein San Diego County is strong. Overall, 50 percent (downslightly from 53 percent in 2005) are less satisfied with the prac-tice of medicine than they were five years ago. Physicians re-ported that 19 percent – up from 13 percent two years ago – aremore satisfied, and 31 percent (almost unchanged) see no changein their satisfaction with the practice of medicine. Unlike 2005,there is strong variation along several axes of data analysis.1. Male physicians are significantly more dissatisfied (54 percentvs. 39 percent) than female physicians.

2. Solo and small-group physicians are hugely more dissatisfied(60 percent dissatisfied vs. 10 percent more satisfied) thanmedium- and large-group physicians or academic physicians(where the dissatisfied still outweigh the satisfied but by amuch lower ratio: about 42 percent dissatisfied vs. 22 percentsatisfied).

3. A similar differential exists when analyzed by specialty versusprimary care. The specialists are much more dissatisfied (57percent dissatisfied vs. 14 percent more satisfied) than primarycare physicians (39 percent dissatisfied vs. 28 percent more

satisfied).4. There is a huge dissatisfaction-satisfaction differential when examined by years in practice. Physicians who have been inpractice six to 10 years are unhappy, and those practicingbetween 11 and 15 years are even unhappier. The dissatisfied-satisfied differential (the difference between those who aremore satisfied and those less satisfied) goes from 26 percentfor physicians in their first five years of practice to 38 percent in their second five years of practice to 47 percent in theirthird five years of practice.

O) Physician compensation has improved vis-à-vis 2005.1. Physicians were asked whether their compensation went up,stayed the same, or went down relative to their compensa-tion three years ago. The general compensation trend is pos-itive. Forty-three percent felt that compensation increasedsince 2005; 28 percent felt that compensation remainedthe same; and 29 percent felt that compensation decreased.

2. In a geographic anomaly, solos and small-group physicians in Hillcrest and South Bay are paid less than their geo-graphic peers.

3. Female physicians make less than their male counterparts,though the female physician compensation trend is morepositive than the male physician compensation trend.

4. Relative to three years ago, the compensation trend of spe-cialists has not been as positive as primary care physicians,though primary care physicians are reimbursed less thanspecialists.

5. When analyzed for years in practice, the trends are not sur-prising: Younger physicians see their compensation increas-ing, while older physicians do not. However, the 6–10 yearcohort is not getting the increases in pay they expect.

P) Specialty-specific compensation information (more detailed in-formation is presented in the complete report).1. The lowest paid specialties are family medicine, nephrology, neurology, pain medicine, pediatrics, internal medicine, andpsychiatry.

2. The highest paid specialties are neurosurgery, cardiology, orthopedic surgery, otolaryngology, pathology, radiology, thoracic surgery, and gastroenterology.

Q) Physicians were asked about average on-call days per month.1. Solo and small-group physicians: 2.3 days of call withoutstipend and 1.4 days of call with stipend

2. Medium- and large-group physicians: 2.7 days of call withoutstipend and 0.8 days of call with stipend

3. Academic physicians: 4.0 days of call without stipend and1.3 days of call with stipend.

IIII.. AA TTAALLEE OOFF TTHHRREEEE PPRRAACCTTIICCEESS

An underlying theme of the 2005 Physician Workforce and Com-pensation Survey was the widening gulf between the solo and small-group practices – defined as fewer than five physicians in a practice

F E B R U A R Y 2 0 0 8 | S A N D I E G O P H Y S I C I A N . o r g 31

– and the medium- and large-group practices. With the significantnumber of academic physicians responding to the 2007 survey, thereappear to be three distinct cohorts in modes of practice. Across a num-ber of factors, there are significant differences between these practicetypes. Table 5 below summarizes the differences:

TABLE 5: TABLE DIFFERENCES BETWEEN SOLO AND SMALL-GROUP PRACTICES ANDMEDIUM- AND LARGE-GROUP PRACTICES

IIIIII.. DDIIFFFFEERREENNCCEESS BBEETTWWEEEENN MMAALLEE AANNDD FFEEMMAALLEE PPHHYYSSIICCIIAANNSS

While there are many similarities, there are some differences betweenmale and female physicians. Table 6 below summarizes the differences:

TABLE 6: DIFFERENCES BETWEEN MALE AND MALE PHYSICIANS

IIVV.. PPHHYYSSIICCIIAANN DDIIFFFFEERREENNTTIIAALL BBEEHHAAVVIIOORR AALLOONNGG TTHHEE AAGGEE CCOONNTTIINNUUUUMMWhile there are many similarities, there are some clear differencesalong the age continuum.

A. With respect to physician retention:1. There is a surprisingly sharp dip in physician retentionat the six- to 10-year point.

SOLO OR SMALL GROUP PHYSICIANS MEDIUM- OR LARGE-GROUP PHYSICIANS ACADEMIC MEDICINE PHYSICIANS

DISSATISFACTION WITH THE PRACTICE OF MEDICINE:

Very Dissatisfied Somewhat Dissatisfied Somewhat Dissatisfied

SATISFACTION WITH TIME SPENT WITH PATIENTS:

Satisfied Less Satisfied Very Satisfied

TOTAL WORK HOURS: Longer Shorter Much Longer

PATIENT CARE HOURS: Longer Than Average Average Shorter Than Average

COMPENSATION Lesser Greater Greater

CONCERNED ABOUT RECRUITING NEW PHYSICIANS:

Very Concerned Less Concerned Concerned

CONCERN ABOUT A PHYSICIAN SHORTAGE:

Less Concerned Concerned Not Concerned

MALE PHYSICIANS FEMALE PHYSICIANS

TOTAL WORK HOURS: Longer Shorter

PATIENT CARE HOURS: Slightly Longer Slightly Shorter

SATISFACTION WITH TIME SPENT WITH PATIENTS: Slightly Less Slightly More

DISSATISFACTION WITH THE PRACTICE OF MEDICINE: More Dissatisfied Less Dissatisfied

COMPENSATION AND COMPENSATION TREND: Paid More, but Improvement Rate Lower Paid Less, but Improvement Rate Greater

An astonishing 86 percent of solo and small-group physicians reported difficulty recruiting (either some difficulty or significant difficulty).

32 S A N D I E G O P H Y S I C I A N . o r g | F E B R U A R Y 2 0 0 8

PHYSICIAN WORKFORCE

2. Not surprisingly, of those physicians likely to changetheir practice mode, there was a clear drop-off forphysicians in practice for more than 30 years, of whom only 59 percent said they would be in practice in threeyears.

B. There is a huge dissatisfaction-satisfaction differential whenexamined by years in practice. The physicians who have been in practice for six to 10 years are unhappy, and those

practicing between 11 and 15 years are even unhappier. The dissatisfied-satisfied differential (the difference betweenthose who are more satisfied and those less satisfied) goes from26 percent for physicians in their first five years of practiceto 38 percent in their second five years of practice to 47percent in their third five years of practice.

C. When analyzed for years in practice, the trends are notsurprising: Younger physicians see their compensation in-

TABLE 7: OVERVIEW OF SPECIALTIES IN CRISIS AND IN DIFFICULTY

Red = In Crisis • Blue = In Difficulty (See definitions of “in crisis” and “in difficulty” on page 28, letters “D” and “E.”)

PRIMARY CARE

FEWER THAN FIVERESPONSES

GREATER THAN AVERAGE WAITTIMES FOR NEW PATIENTS

PHYSICIANS PERCEIVE THIS AS A SHORTAGE

DIFFICULTYRECRUITING

Family Medicine Yes Yes Significant

Internal Medicine Yes Yes Yes Significant

Pediatrics Yes Yes Some

OB/GYN (in difficulty 2005) Yes Yes Yes Some

Allergy and Immunology Yes Some

Anesthesiology Yes Some

Cardiology Some

Dermatology (in difficulty 2005) Yes

Emergency Medicine Some

Endocrinology Yes Yes

Gastroenterology Yes Yes

General Surgery (in difficulty 2005) Significant

Geriatric Medicine Yes Yes

Hand Surgery Yes

Hematology/Oncology Yes Some Significant

Hepatology Yes

Nephrology Yes Significant

Neurology (in crisis 2005) Yes Yes Significant

Neurosurgery (in crisis 2005) Yes

Occupational Medicine Yes

Ophthalmology (in difficulty 2005) Yes Some

Orthopedic Surgery (in crisis 2005) Yes Yes Significant

Otolaryngology (in crisis 2005) Yes Significant

Pain Medicine Yes Yes

Pathology

Physical Medicine and Rehabilitation Yes

Plastic Surgery Yes

Psychiatry (in difficulty 2005) Yes Yes Significant

Pulmonology (in difficulty 2005) Yes Some Significant

Radiology (in difficulty 2005) Some Significant

Radiation Oncology Yes

Rheumatology (in difficulty 2005) Yes Yes

Sports Medicine Yes

Thoracic Surgery Yes

Urology (in crisis 2005) Some

Vascular Surgery Yes Some

F E B R U A R Y 2 0 0 8 | S A N D I E G O P H Y S I C I A N . o r g 33

creasing, while older physicians do not. However, the six- to10-year cohort is not getting the increases in pay they expect.

V. SPECIALTY SPECIFIC INFORMATION

Although highly subjective, the study identified specialties in cri-sis – defined as longer-than-average wait times for new patients,a perception that this specialty was in shortage, and a perceptionof difficulty recruiting within the specialty – highlighted in red inTable 7.

The specialties that are in crisis in San Diego County are internalmedicine, neurology (also in crisis in 2005), orthopedic surgery(also in crisis in 2005), and psychiatry (also in difficulty in 2005).In addition, those specialties that were in difficulty – defined asmeeting two of the three criteria above – were highlighted in bluein Table 7. The specialties that are in difficulty in San DiegoCounty are family medicine, ob-gyn (also in difficulty in 2005),hematology/oncology, nephrology, otolaryngology (also in crisis in2005), and pulmonology (also in difficulty 2005).

VI. DEMOGRAPHICS OF THE PHYSICIAN RESPONDERS

A. 359 active physicians responded. Eight residents, students,retired physicians, and physicians not seeing patients wereremoved from the total response of 367 data pool. The 2005survey had approximately 100 more respondents.

B. 70 percent of the respondents were SDCMS members. Thiswas consistent with the 2005 survey. SDCMS members rep-resent about 30 percent of San Diego County’s approxi-mately 6,500 to 7,000 active, practicing physicians.

C. Respondents were 70 percent male and 30 percent female.This compares favorably with a 75/25 ratio of male-to-female physicians in San Diego County. Proportionallymore female physicians responded than in the last two surveys.

D. Respondents were evenly distributed throughout the physi-cian lifecycle: 32 percent in their first 10 years of practice; 31 percent were in their second decade of practice; and 37percent were in practice for more than 20 years. This wasconsistent with the 2005 survey.

TABLE 8: DISTRIBUTION OF SURVEY RESPONDENTS BY YEARS IN PRACTICE

E. Of the responding physicians, 41 percent were in primarycare – defined as practicing in the specialties of family med-icine, ob-gyn, pediatrics, and internal medicine. 59 percentwere categorized as practicing outside of primary care, i.e.,as specialists. This compares favorably with a primary carephysician/specialist ratio of 39 percent/61 percent for all physicians in San Diego County, and was consistent with the 2005 survey. Of note, female physicians make up 42percent of the primary care physicians but only 22 percentof specialists.

F. The mode of practice breakdown was as follows:1. Solo (1-2 physicians): 24 percent2. Small Group (3-4 physicians): 7 percent3. Medium Group (5-25 physicians): 19 percent4. Large Group (more than 25 physicians): 22 percent5. Academic Medicine: 26 percent6. Community Clinic: 2 percent

When compared to the 2005 survey, proportionally fewerPermanente Medical Group physicians participated, and sig-nificantly more UCSD physicians (referred to as physicianspracticing in academic medicine) responded.

TABLE 9: DISTRIBUTION OF SURVEY RESPONDENTS BY SIZE OF PRACTICE

25%

20%

15%

10%

5%

0%

0-5Years

6-10Years

11-15Years

16-20Years

21-30Years

30+Years

16%17% 17%

16%

22%

12%

The dissatisfaction of physicians with thepractice of medicine inSan Diego County

is strong.

50%

40%

30%

20%

10%

0%

Solo(1-2)

SmallGroup(3-4)

MediumGroup(5-150)

LargeGroup(>150)

AcademicMedicine

CommunityClinic

1%

2005

2007

2%6%

26%

48%

22%

14%

19%

7%7%

24%24%

34 S A N D I E G O P H Y S I C I A N . o r g | F E B R U A R Y 2 0 0 8

G. 85 percent were full-time, and 15 percent were half-time.This represents a doubling of the percentage of physiciansworking part-time who responded to the survey, and may beindicative of more physicians working at half-time or less.Of note, there was no significant difference between the per-centage of males and females working part-time (defined as20 hours of patient care or fewer) since the last survey.

H. Because of the excellent response from UCSD, there was acompletely expected geographic distribution peak for aca-demic physicians in Hillcrest and in La Jolla. However, solo,small group, medium group, and large group physicians were evenly distributed. Compared to the last survey, therewere fewer Permanente physicians. There were no under-represented geographic areas.

TABLE 10: DISTRIBUTION OF SURVEY RESPONDENTS BY MODE OF PRACTICE AND

BY AREA OF COUNTY

PHYSICIAN WORKFORCE

50%

45%

40%

35%

30%

25%

20%

15%

10%

5%

0%

E - EastCounty

H - Hillcrest

J - LaJolla

K - KearnyMesa

N - NorthCountyInland

S - SouthCounty

10

Solo/Small

Medium/Large

Academic Medicine

15

1

15

23

44

15

6

20

9

27

18

13

N - NorthCountyCoastal

11

23

3

15

17

2

There is a huge dissatisfaction-satisfaction

differential when examined by years in practice.

The physicians who have been in practice for six

to 10 years are unhappy, and those practicing

between 11 and 15 years are even unhappier.

I. SPECIALTY DISTRIBUTION

1. THE FOLLOWING SPECIALTIES HAD MORE THAN

20 RESPONDENTS (# OF RESPONDENTS):

• Family Medicine (51)• Internal Medicine (40)• Pediatrics (36)• Obstetrics and Gynecology (22)

2. THE FOLLOWING SPECIALTIES HAD BETWEEN 5

AND 20 RESPONDENTS (# OF RESPONDENTS):

• Emergency Medicine (19)• Orthopedic Surgery (18)• Psychiatry (13)• Ophthalmology (13)• Radiology (12)• General Surgery (12)• Otolaryngology (9)• Pulmonology (8)• Hematology/Oncology (8)• Neurology (8)• Anesthesiology (7)• Nephrology (7)• Cardiology (6)• Pathology (6)• Urology (5)• Urgent Care (5)• Allergy and Immunology (5)• Neurosurgery (5)• Infectious Diseases (5)• Dermatology (5)

3. THE FOLLOWING SPECIALTIES HAD FEWER

THAN 5 RESPONDENTS (# OF RESPONDENTS):

• Vascular Surgery (4)• Gastroenterology (4)• Radiation Oncology (4)• Plastic Surgery (4)• Pain Medicine (3)• Occupational Medicine (3)• Thoracic Surgery (3)• Endocrinology (2)• Physical Medicine (2)• Geriatric Medicine (2)• Hepatology (1)• Sports Medicine (1)• Rheumatology (1)

Note: Specific specialty pay information isavailable to SDCMS members and thosewho filled out the survey. Contact TomGehring at Gehring@SDCMS.org to obtaina complete copy of our 2007 San DiegoCounty Physician Workforce and Compen-sation Survey.

F E B R U A R Y 2 0 0 8 | S A N D I E G O P H Y S I C I A N . o r g 35

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• You can grow and accumulate wealth in a tax-advantaged manner, while protecting your Accounts Receivable.

• Get a malpractice quote suited to your own personal needs from over 40 insurers,and decrease the risk of lawsuits by legally shielding attachable assets.

• Guarantee asset accumulation and financial security while decreasing the risk of your portfolio.

• Integrate your financial affairs by addressing your needs as an employer, small business owner, head of household and member of the medical community.

• Create a benefit package that will attract and maintain quality employees and save you money.

Physicians Capital Assurance Services • “The Physician’s Advocate”10815 Rancho Bernardo Road, Suite 380 • San Diego, CA 92127www.MDforMDs.com • DrM@MDforMDs.com • (866) 936-8474