Canadians report results of first physician executive compensation survey.

The Canadian Society of Physician Executives (CSPE) conducted a confidential physician executive compensation survey in February 2005. CSPE worked with MD Management's Practice Solutions (a Canadian Medical Association affiliate) group to ensure that the survey would capture the information necessary to support members in their negotiations for personal compensation packages.

The survey was mailed to 588 current and previous CSPE members. There were 180 valid responses for a response rate of 32 percent.

Here's a look at some of the findings.

Current position

The top five physician executive positions were: medical director, department/division chair or manager, chief of staff, vice president medical affairs, and consultant. Respondents were asked to indicate their current executive activity status as full-time (43 percent), part-time (52 percent) or other (2 percent). It should be noted that no definition of full- or part-time was given. This will be refined in future surveys.

When asked whom they reported directly to:

* 30 percent of respondents indicated the CEO 

* 25 percent indicated the vice president

* 20 percent indicated the board of directors

* 31 percent answered other (e.g., chair/head/chief of department)

Responsibilities and activities

Respondents were asked whether they were responsible for a variety of activities. They could check off more than one activity. Physicians in leadership positions reported spending the majority of their time dealing with direct physician issues:

* Physician resource planning, including physician recruitment and retention (70 percent)

* Physician leadership development (62 percent)

* Physician performance review/management (60 percent)

* Physician discipline (57 percent)

* Physician privileging, credentialing (57 percent)

* Physician health and wellness (31 percent)

* Other (40 percent) e.g., research funding/administration

Other administrative functions or activities were reported as areas of responsibility. These areas are external activities (53 percent); other health professionals (52 percent); and hospital or institution-wide quality of care (43 percent). "Other" includes laboratory management, finance and medical policy development.

The findings suggest that physician executives are not closely involved in information technology (IT); only 2 percent reported being responsible for work in this area.

Clinical background

Specialists represented 62 percent of all respondents, whereas general and family practitioners (GP/FPs) accounted for 36 percent.

Specialists were represented in the following areas: anesthesia (11 percent); general surgery (10 percent); psychiatry (8 percent); and internal medicine/emergency medicine and obstetrics/gynecology (7 percent). The substantial representation in these specialties may reflect the fact that their practice profile or style allows them to free up time for administrative responsibilities.

We continue to see the trend of family physicians leaving hospital patient care responsibilities. By spending less time in hospitals and opting out of their hospital privileges, GP/FPs may not be "visible" or available and, therefore, not considered for administrative positions by their peers and others.

Management training

Most respondents indicated that they had received administrative/management training in addition to their MD degree. This additional training included: Canadian Medical Association Physician Manager Institute (PMI) training, 39 percent; MBA. 7 percent: MHA/MHS, 6 percent; American College of Physician Executives CPE designation, 3 percent; and LLB, 2 percent.

The data suggest that a physician wanting a career in a full-time administrative role may find better opportunities in larger hospitals. A total of 36 percent of respondents indicated that they are in hospitals with 100 or more physicians on staff; 31 percent are in hospitals with budgets of $100 million or more; and 31 percent are in hospitals with 2000 or more employees.

Compensation

Over 60 percent of respondents reported spending 50 percent or more of their time in administrative activities.

It appears that many physicians, whether employed or receiving a stipend do receive a substantial amount of their total income for their administrative responsibilities.

This may indicate that recognition of administrative responsibilities is as important as clinical responsibilities in terms of compensation. More than 50 percent are receiving an administrative income of $100,000 or more; the median administrative income reported was $137,000.

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Severance packages

When asked whether their current position included a severance package, a very high percentage (67 percent) of respondents reported that it did not. Physicians need to consider such support as short-term bridging compensation when returning to full time clinical practice.

Also, contracts need compensation clauses that would apply for those who are dismissed from their position. Of those reporting severance packages, 82 percent indicated it was a long-term package; 15 percent receive a bridging-concept package and 2 percent a short-term package.

This is the first of what CSPE hopes will be a regular compensation survey to assist members in their contract negotiations during this time of rapid and fundamental Canadian health system change.

Chris Carruthers, MD, MBA, FRCS, FAAOS, CHE is president of CSPE. He can be reached at [e-mail]

Acknowledgements Analysis of the data was conducted by Lisa Snidal of Snidal Consulting. The CSPE would like to thank MD Management's Practice Solutions for partial funding of this report.

By Chris Carruthers, MD, MBA, FRCS, FAAOS, CHE