 And this is fantastic, right? Well, sort of. Welcome back to the channel, everybody. For those of you who are new around here, my name is Michael, aka Dr. Cellini, and I'm a board certified diagnostic and interventional radiologist in New Jersey. I just finished a nice eight hour shift of reading CTs nonstop and I'm a little tired, but I wanted to talk today about why physician salaries are going down. But before we do, I have a little question for you. Did you know that in the last five years, 2017 to 2021, that inflation has outpaced physician salary growth? And this is all according to a survey of 160,000 physicians on the doximity network. Maybe some of you knew that I personally did not. I thought actually physician salaries were way behind inflation, but we're going to get into all that in just a moment. Now the statistic of inflation outpacing physician salary growth is a little alarming, especially since inflation has neared 7% plus over the last few months. Strangely enough, the average pay of physicians has actually increased over the last five years, but unfortunately that has been mitigated by reimbursement cuts. And with inflation, the highest it's been in approximately 30 plus years and the whole conflict going on in Western Europe currently, let's talk about how all of this is affecting physician salaries. So if you actually check out the doximity survey from 2017 through 2021, you'll see a gradual increase in average physician compensation, regardless of specialty or location. If you include the average rate of inflation for the current time period, aka 3.15%, you decrease the percentage of specialties experienced actual salary growth down to approximately 53%. Now that inflation rate I just mentioned of 3.15% is actually based on the consumer price index, which looks like the changes in retail prices for goods and services. And if you even remotely pay attention to anything US economy related, you may have seen that we have the largest annual increase in inflation in approximately 40 years since 1980, which was 7% as of December of last year, which means all of those salary increases over the last five years don't really mean as much unless of course they outpace inflation. So let's talk about the specialties with the greatest salary increase over the last five years year over year. It may come at no surprise that the top five specialties are all kind of similar. And we'll touch on that in just a minute. But leading out number one was urology with an increase of 4.87%. Next we have plastic surgery with a 4.87% increase followed by PM&R in third place with a 4.34% increase. Then we have orthopedic surgery at 4.2% increase and rounding out the top five was our good friends neurosurgery at 4.3%. And obviously after I listed these, you can see the difference in similarities amongst them. 4 out of 5 of these specialties are surgery subspecialties with PM&R being the only one that is not. In fact, most primary care specialties barely edged out inflation and specialist growth varied quite a bit. Let's take a look at this graph. I absolutely love this graph by the way. We already mentioned the top five, but let's take a look at my specialty radiology. Falling in the middle of the pack somewhere with an average increase of about 3.61%, not too happy about that. And of course, let's look at our friends in emergency medicine coming in near the bottom at less than 2.0% average increase, which is a full percent below inflation. And keep in mind here, this is the average from 2017 to 2021. This does not even come close to bearing the full extent of the inflation we are currently experiencing, which is why I keep mentioning the inflation from 2017 to 2021 and average of 3.15%. But given that the inflation is much higher currently, these numbers are going to change drastically. I think it comes at no surprise here seeing the surgical specialties top the list here. As I have talked about this many times on my channel, there are a lot of factors in medicine that push people into these surgical fields in non-primary care subspecialties, including the seemingly never ending student loan burden that I always talked about. Again, looking at this chart here, we see that the average annual growth for primary care fields was around 3.1%, which is just under inflation, versus 4.2% for surgical subspecialties. The article that I'm getting a lot of this data from, which I will, of course, link in the description below, gave an interesting case comparison on projected wage increase for general surgery versus internists over the next 10 years, which came out to about 4.28% versus 3.29%. So I know this is a little bit confusing, but over a 10-year period, they projected the wage increase for general surgery to be 4.28% versus 3.29% for internal medicine doctors. So what happens if annual growth was actually carried out at these rates for the general surgeon and the internal medicine doctor? Well, the difference in pay would be potentially 67% more for general surgeons versus the internist, or $686,012 versus $409,081. And this is all according to the average annual compensation for specialty report released by Doximity each year. You can find that online, and I'll link to that as well in the description below. So why such a large difference between the surgical subspecialties and primary care fields? I think it's obvious that the surgeons can bill for surgeries and other procedures, whereas the internal medicine doctor or primary care specialists cannot. So what about those pediatricians? I always love to bring up when we're talking about physician salaries. If you don't know what I'm talking about, link to this video up here. Well, it may come at no surprise that the pediatricians have experienced some of the lowest annual salary growth since 2017. Let's pull up the chart again. You can see here that PEDES cardiology is at 2.71% annual increase, PEDES infectious disease at 2.57% increase, and our good friends PEDES into chronology at a terrible 0.77% and even worse PEDES emergency medicine at 0.58% in a lot of the decreased wages for emergency medicine, maybe secondary to layoffs, wage cuts, and all that stuff that happened during the pandemic, which we're kind of slowly marching out of. And by the way, just to compare the PEDES emergency medicine versus the adult emergency medicine that is 0.58% increase for PEDES emergency medicine versus 1.97% like I mentioned earlier. So what about location? Does that play a role in salary increase year over year? Well, let's look at it. Let's take a look at another lovely draft of the United States of America this time. If you look at the average salary for 44 plus metropolitan areas surveyed over the last five years, salary increased at all of these areas. Most of them are mentioned here. Locations with the highest salary increase were Cincinnati topping out the Midwest at 5.6%, Philadelphia at 4.4%, topping out the East Coast, and on the West Coast we have Sacramento at 4.2%. So what does all of this tell us? Well, almost every metropolitan area had a salary increase that outpaced inflation, with only a few exceptions, which at the end may come at no surprise, LA at 2.9% and San Francisco at 2.5%. And the worst metropolitan city with a low salary increase year over year was Milwaukee at 1.6%. In of note, the actual salary increase was affected by the workplace as well. So where you actually practice or what kind of environment you practice medicine growth rates were higher for single or multidisciplinary practices, while academics had a slightly lower growth 5.5% for the multidisciplinary practices versus 4.5% for academics. So a solid 1% less for academics. An interesting surprise for all of this was how well the urgent care centers did, which are usually on the lower end of the spectrum for salary growth, but they had an 8.1% salary growth rate from 2018 to 2021. This may all be related to the increased growth of the healthcare system or all of the needs brought upon by the pandemic. If you recall, the pandemic made urgent cares quite important, especially for all those COVID tests. And every time someone got a COVID test, they also had other issues which brought in more business for the urgent cares. And that's probably the reason for the salary increase. Okay, so what's the point of all this? Why am I throwing all of these numbers at you that don't make any sense? Well, the point is to show you that we've had some pretty solid growth among salaries for physicians over the last five years from 2017 to 2021. And this is fantastic, right? Well, sort of. The reason it's not so good is because we've had such high inflation over this time, and it's only getting worse. And that has essentially negated all the salary growth physicians have experienced. And unfortunately, our non subspecialized colleagues have bared the brunt of all of this. If you pay attention to the economy at all, you may have noticed that the Fed was slowly starting to raise increased rates and they plan on making the first rate hike in March and things have kind of slowed down in Wayne because no one really knows what's going on given the whole conflict going on in Western Europe, Western Europe, Eastern Europe. I always do radiology. Like the problem is that when I look at a map now, radiology has screwed me up by the way, because everything's opposite. So when I see Eastern Europe, I think Western Europe because I'm thinking I'm like in the map because that's what radiology has done to me. So if I said Western Europe earlier, the whole conflict going on in Western Europe currently, I've had Eastern Europe. So let me rephrase that. So we were actually headed down the right path. The feds were about to raise interest rates in March to kind of start slowing down the inflation rate. But then this whole conflict in Eastern Europe happened and there's a lot of uncertainty. And usually in times of uncertainty and events happening in like what's going on in Russia and Ukraine, inflation tends to creep up a little higher. But this whole conflict in Eastern Europe has essentially slowed rate hikes and we don't really know what to expect going forward. And this really isn't good for anybody. And if you look at historical data on what happens during large conflicts or wars, usually inflation creeps a little higher during these times. So nobody really knows what's going to happen, but I'm not too optimistic because I think inflation is going to keep creeping a little higher before it comes back to normal. I am however optimistic about the easing of the COVID restrictions about the United States, which will hopefully help boost the economy a little bit. And most importantly, relieve some of the pandemic-related challenges that so many health care workers and physicians have experienced. Like I always mentioned, the physician reimbursement rate is multifactorial. But the point of this video was to shed some light on things that you may not think about when it comes to reimbursement. Hopefully this video will shed some light on how important it is to keep your eye on inflation, especially in the current economic environment. As always, hopefully you all enjoyed this video. I know it's a little different than what I usually do. We were a little in the weeds with the numbers, but hopefully you all followed. Let me know if you have any questions. I will try to answer them. As always, make sure you smash that subscribe button, follow me on Instagram and TikTok if you don't already. And as always, I'll see you all on the next video. Bye.