1. 2013 Annual ASMBS Compensation Survey
Teresa LaMasters MD, FACS
John Magaña Morton, MD, MPH, FACS, FASMBS

2. Background Nationally more physicians are becoming employed
This is especially true in Bariatric surgery due to programmatic requirements and overhead
There is a lack of valid benchmarking for physicians and hospitals to use when negotiating compensation

3. Background
MGMA and AGMA models have been inadequate in the past and do not take into account specialized bariatric surgeons vs. general surgeons also involved in bariatric surgery
Initial pilot survey sent to ASMBS members in 2012 – results on website
Further development and refinement of the survey was required

4. Objective
Determine compensation ranges and practice patterns for ASMBS members
Hospital employed
Private Practice

5. Who can Benefit? All surgeons negotiating contracts with employers
New graduating fellows
ASMBS Leadership to better understand membership needs
All surgeons evaluating joining a practice
Surgeons who desire to see a snapshot of future career

6. Methods
Surveys sent out electronically 3 times by ASMBS in 2013 regarding data from 2012.
Survey was sent to ASMBS membership
Survey Monkey was utilized

7. Response Rate Hospital employed Private Practice N = 66
Total sample used = 65
Exclusions
Part-time surgeon (n=1)
Data from 62 respondents used in the compensation summary
The 3 respondents not used either did not provide compensation information or provided it in a form that was not feasible (e.g. a response of 500)
22 states represented
Private Practice
N=47
Total sample used = 46
Data from 39 respondents used in the compensation summary
The 7 respondents not used either did not provide compensation information or provided it in a form that was not feasible (e.g. a response of 500)
24 states represented

8. Hospital Employed Questions
Which of the following best describes your practice model?
How many years have you been in practice?
How much experience do you have performing bariatric surgery?
What is your career volume for bariatric surgery?
What is your employment status?
What percent of your time is dedicated to bariatric surgery?
In what state are you employed?
Did you complete a Fellowship? If yes, what type?
Select the method that most accurately reflects your current compensation model.
What is the amount of your total compensation?
What is your estimated annual retirement contribution?
Which of the following benefits are provided to you and paid by your employer?

9. Hospital Employed Questions
Do you receive a bonus or incentive? If yes indicate what the bonus is based upon.
If your compensation is based on WRVU production, provide the amount paid per WRVU
Provide the threshold amount at which the incentive begins and the compensation amount per WRVU that you receive
How many work RVUs did you produce?
How many days a month do you take bariatric, general surgery and trauma call?
Are you paid for taking call? If yes, how much?
At how many hospitals do you operate?
How many bariatric practices are present at your primary hospital?
Provide volume for each of the procedures listed on the attached table

10. Demographics – Hospital
49 of 65 had a fellowship and 37 completed a bariatric fellowship

11. Demographics – Private Practice
28 of 47 had a fellowship and 18 completed a bariatric fellowship

12. Hospital Employed Years in Practice vs Bariatric n=66
Years Bariatric Surgery
0-5 years
5-10 years
>10 years 19 2 14
10-20 years 1 4 15
>20 years 7
In the previous survey (2012), there was a trend of a significant portion of surgeons starting in bariatrics later in their career around 5-10 years after they started their practice.

13. Private Practice Years in Practice vs Bariatric n=47
Years Bariatric Surgery
0-5 years
5-10 years
>10 years 8 2
10-20 years 15
>20 years 10

14. Hospital Employed Time vs Surgeries n=64
Time Dedicated to Bariatric Surgery
Number Surgeries Performed
<50
50-150
>1000
<20%
0.0%
3.1%
1.6%
21-50%
6.3%
12.5%
7.8%
4.7%
51-80%
9.4%
15.6%
>80%
14.1%

15. Private Practice Time vs Surgeries n=44
Time Dedicated to Bariatric Surgery
Number Surgeries Performed
<50
50-150
>1000
<20%
1 (2.3%)
21-50%
3 (6.8%)
2 (4.5%)
4 (9.1%)
51-80%
8 (18.2%)
>80%
18 (40.9%)

16. Hospital Employed – Call
Days
Bariatric
N=59
General Surgery
N=60
Trauma
N=51
1 (2%)
14 (23%)
41 (80%)
1-14
23 (39%)
45 (75%)
10 (20%)
15-30
35 (59%)
Hospital employed bariatric surgeons are most likely to take bariatric and general surgery call and least likely to take trauma call.
80% do not take any trauma call and 23% do not take any general surgery call.

17. Hospital Employed >80% Bariatrics– Call
Days
Bariatric
N=18
General Surgery
N=17
Trauma
9 (53%)
15 (88%)
1-14
8 (44%)
8 (47%)
2 (12%)
15-30
10 (56%)
Hospital employed surgeons who dedicate 80% of their time to bariatrics, are more likely to take bariatric call than general surgery call. In addition, they are least likely to take trauma call.
88% do not take any trauma call and 53% do not take any general surgery call.

18. All Private Practice – Call
Days
Bariatric
N=40
General Surgery
N=39
Trauma
N=36
2 (5%)
13 (33%)
30 (83%)
1-14
18 (45%)
23 (59%)
5 (14%)
15-30
20 (50%)
3 (8%)
1 (3%)
Private practice bariatric surgeons are most likely to take bariatric and general surgery call and least likely to take trauma call.
83% do not take any trauma call and 33% do not take any general surgery call.

19. Private Practice >80% Bariatrics– Call
Days
Bariatric
N=20
General Surgery
N=18
Trauma
N=17
2 (10%)
11 (61%)
15 (88%)
1-14
6 (30%)
7 (39%)
2 (12%)
15-30
12 (60%)
Call patterns are similar for both Hospital Employed and Private Practice.
Private practice surgeons who dedicate 80% of their time to bariatrics, are more likely to take bariatric call than general surgery call. In addition, they are least likely to take trauma call.
88% do not take any trauma call and 61% do not take any general surgery call.

20. All Hospital Employed
N=65
Hospital- N=65

21. All Private Practice
N=47
Private – N=47

22. All Hospital Employed 22 Different States represented N=65
Hospital – N=65 (66 total with 1 blank)
22 Different States represented
N=65

23. All Private Practice 24 Different States represented N=46
Private – N=46 (47 total with 1 blank)
24 Different States represented
N=46

24. All Hospital Employed
N=64
Hospital – N=64 (66 total with 2 blank)

25. All Private Practice N=45
Bar graph shows within each region what percentage of bariatric time is being used. You would want the blue (0-50%) be the lowest and the green (>80%) to be the highest.
Private – N=45 (47 total with 2 blank)

26. RVU Incentive Threshold Incentive Above RVU Threshold
Hospital Employed 2012
Compensation
n=62
Total RVU
n=33
Retirement
n=51
RVU Incentive Threshold
n=19
Incentive Above RVU Threshold
n=12
Overall N=66
Mean
$445,032
8,279
$36,666
7,413
$48.9
Std. Dev.
$188,564
3,458
$35,280
2,484
$8.4
Minimum
$200,000
3,230
$10,000
5,000
$39.0
Maximum
$1,100,000
20,000
$240,000
16,000
$70.0
Percentiles
20th
$301,000
5,440
$17,500
6,000
$42.3
50th
$388,500
7,900
$28,000
6,500
$48.5
75th
$497,750
9,000
$39,000
7,500
$52.2
90th
$698,500
12,480
$60,000
10,000
$54.8

27. Hospital Employed > 80% 2012
Compensation n=20
Total RVU
n=10
Retirement n=17
RVU
Incentive
Threshold
n=7
Incentive Above RVU Threshold
n=4
Overall N=20
Mean
$464,050
8,202
$41,176
6,809
$56.4
Std. Dev.
$219,404
3,773
$53,830
1,435
$9.0
Minimum
$283,000
3,230
$13,000
6,000
$51.0
Maximum
$1,100,000
14,995
$240,000
10,000
$70.0
Percentiles
20th
$325,000
5,321
$17,100
$51.6
50th
$386,000
8,100
$25,000
6,500
$52.4
75th
$450,000
8,800
$36,000
6,853
$57.1
90th
$761,200
14,100
$62,000
8,000
$64.8

28. Private Practice 2012
Compensation
n=39
Retirement
n=35
Overall N=47
Mean
$658,116
$40,593
Std. Dev.
$907,700
$24,745
Minimum
$200,000
$5,000
Maximum
$5,850,000
$125,000
Percentiles
20th
$290,000
$21,900
50th
$400,000
$40,000
75th
$640,000
$50,000
90th
$931,000
$54,600
Survey respondents reported their total compensation. It is possible this compensation may include revenue from non clinical sources. It’s also possible that, different from hospital employed physicians, private practice physicians are responsible for the payment of benefits (e.g. health insurance, malpractice insurance. etc.) from this reported compensation. Hence the outlying maximum salary.

29. Private Practice > 80% Bariatrics 2012
Compensation
n=18
Retirement
n=17
Overall N=22
Mean
$856,196
$42,692
Std. Dev.
$1,290,743
$30,999
Minimum
$260,000
$5,000
Maximum
$5,850,000
$125,000
Percentiles
20th
$308,000
$16,000
50th
$418,500
$40,000
75th
$845,000
$49,500
90th
$1,188,500
$81,600
Survey respondents reported their total compensation. It is possible this compensation may include revenue from non clinical sources. It’s also possible that, different from hospital employed physicians, private practice physicians are responsible for the payment of benefits (e.g. health insurance, malpractice insurance. etc.) from this reported compensation. Hence the outlying maximum salary.

30. Hospital Employed 2011
Compensation
n=50
Total RVU
n=26
Retirement
n=45
Overall N=66
Mean
$420,235
7,780
$32,933
Std. Dev.
$153,595
3,281
$19,934
Minimum
$210,000
3,000
$11,000
Maximum
$850,000
19,000
$100,000
Percentiles
20th
$300,000
5,000
$16,900
50th
$400,000
7,350
$28,000
75th
$471,250
9,300
$40,000
90th
$650,000
10,000
$51,200
Approximately half of the respondents for annual salary and retirement gave the same value for the year of 2010 and Consequently it was assumed the values reflected 2011 and the previous year was potentially in error, for this reason we did not analyze 2010.
There was significant repetition of data from 2010 and 2011 suggesting possible error in reporting 2010 data. For this reason we did not analyze 2010.
The 2011 data was similar to previously reported 2011 data in the past ASMBS survey.

31. Hospital Employed >80% Bariatrics 2011
Compensation
n=17
Total RVU
n=6
Retirement
Overall N=20
Mean
$396,927
7,135
$28,088
Std. Dev.
$130,307
3,368
$14,895
Minimum
$275,000
3,512
$11,000
Maximum
$786,000
12,600
$60,000
Percentiles
20th
$302,000
4,000
$16,600
50th
$350,000
6,850
$20,000
75th
$425,000
8,550
$36,000
90th
$544,450
10,800
$50,800
Approximately half of the respondents for annual salary and retirement gave the same value for the year of 2010 and Consequently it was assumed the values reflected 2011 and the previous year was potentially in error, for this reason we did not analyze 2010.
There was significant repetition of data from 2010 and 2011 suggesting possible error in reporting 2010 data. For this reason we did not analyze 2010.
The 2011 data was similar to previously reported 2011 data in the past ASMBS survey.

32. All Private Practice 2011
Compensation
n=37
Retirement
n=33
Overall N=47
Mean
$617,751
$39,761
Std. Dev.
$657,527
$21,275
Minimum
$100,000
$10,000
Maximum
$4,000,000
Percentiles
20th
$302,000
$24,400
50th
$444,143
$38,000
75th
$640,000
$49,000
90th
$870,000
$54,600
Approximately half of the respondents for annual salary and retirement gave the same value for the year of 2010 and Consequently it was assumed the values reflected 2011 and the previous year was potentially in error, for this reason we did not analyze 2010.
There was significant repetition of data from 2010 and 2011 suggesting possible error in reporting 2010 data. For this reason we did not analyze 2010.
The 2011 data was similar to previously reported 2011 data in the past ASMBS survey.

33. Private Practice >80% Bariatrics 2011
Compensation
n=17
Retirement
Overall N=22
Mean
$763,928
$39,005
Std. Dev.
$916,368
$26,351
Minimum
$260,000
$10,000
Maximum
$4,000,000
$100,000
Percentiles
20th
$304,000
$18,600
50th
$444,143
$32,000
75th
$660,000
$47,000
90th
$1,350,000
$70,000
Approximately half of the respondents for annual salary and retirement gave the same value for the year of 2010 and Consequently it was assumed the values reflected 2011 and the previous year was potentially in error, for this reason we did not analyze 2010.

34. Incentive Bonus Hospital Employed Private Practice
Receive Incentive Bonus 44 20
Mean Bonus
$65,750 (n=22)
$121,883 (n=6)
Private Practice had almost twice the amount of bonus opportunity

35. RVU Target Hospital Employed Private Practice RVU Target 30 5
Mean Target
6998
6500 (n=2)

36. Medical Directorship Hospital Employed (N=66) Private Practice (N=47)
Medical Directorship (n) 13 4
Mean Compensation
$54,167
$82,000

37. Benefits Hospital (N=66) Hospital % Private (N=47) Private %
Malpractice Insurance 63
95.5% 29
61.7%
CME Allowance 59
89.4% 26
55.3%
Med Insurance: Employee Only 15
22.7% 6
12.8%
Med Insurance: Employee Dependents 51
77.3% 24
51.1%
Disability Insurance 49
74.2% 16
34.0%
Life Insurance 48
72.7% 12
25.5%
Dental Insurance 54
81.8%
Vision Insurance 11
23.4%
Employed surgeons appear to be offered benefits through the practice more often than in private practice

38. Benefits
Same information just given in a graph layout

39. Quality Metrics Hospital Employed N=33 Private Practice N=7
Participate in QI Projects 5 1
Patient Satisfaction 11 3
Use EMR 9
Clinical Outcomes 2
Access
Peer Review
PP less likely to use quality metrics while Hospital most commonly used patient satisfaction

40. Compensation Model Hospital Employed N=66 Private Practice N=46
Base Salary Plus Incentive 39 12
Production Model 6 27
Straight/Guaranteed Salary 21 3
Revenue minus Expenses or % of collections NA 4
The most common model for employed surgeons was base salary plus incentive. The most common model for private practice respondents was a production model.

41. Compensation Model
Same information just given in a graph layout

42. Visits Hospital Employed Private Practice Clinic Visits N=31 N=18
Average Per Year
1500
1600
Estimated Per Week 29 31
New Patient Visits
N=32
300
925 8 18
It appears that total visit numbers were similar however private practice had a much higher percentage of visits centered on new patients.
Total visit numbers were similar for employed and private practice surgeons.
Private practice had a higher number of new patient visits.

43. Hospital Employed– ProceduresN
1-25
26-50
51-75
76-100
>100
min
median
max
Upper GI Endoscopy 42 8 6 4 10 50
4,500
Lower GI Endoscopy 38 26 1
120
Laparoscopy: Gastric Bypass with Roux enY 66 19 9 13 7 36
228
Laparoscopy: Place Adj. Gastric Band 30 32
350
Laparoscopy: Sleeve 18 15 16 5 25
185
Laparoscopy: VBG
Laparoscopy: BPD/DS 60
Laparoscopy: Revision/Conversion of Band 24 2 3 75
Laparoscopy: Revision/Conversion of Gastric Bypass 41
Laparoscopy: Revision/Conversion of Sleeve 46 20
Laparoscopy: Revision/Conversion of VBG
Laparoscopy: Revision/Conversion of BPD/DS 62
102
448

44. Private Practice – ProceduresN
1-25
26-50
51-75
76-100
>100
min
median
max
Upper GI Endoscopy 29 5 6 2 1 13
100
500
Lower GI Endoscopy 24 10
150
Laparoscopy: Gastric Bypass with Roux enY 47 15 7 8 40
214
Laparoscopy: Place Adj. Gastric Band 20 18 75
Laparoscopy: Sleeve 14 11 3 21
305
Laparoscopy: VBG
Laparoscopy: BPD/DS 44
Laparoscopy: Revision/Conversion of Band 50
Laparoscopy: Revision/Conversion of Gastric Bypass 28 16 36
Laparoscopy: Revision/Conversion of Sleeve 39
Laparoscopy: Revision/Conversion of VBG 27
Laparoscopy: Revision/Conversion of BPD/DS

45. Conclusion
The response level is lower than optimal for this survey, however it is equivalent to the response rate for the MGMA survey. Useful and important data is present.
ASMBS members are a diverse group
Case volume
Years of Experience
Percent of Time Dedicated to Bariatrics
Practice Environment should be considered in compensation discussions

46. Contributing Members Chair - Samer Mattar MD, FACS
Co-Chair- Teresa LaMasters MD, FACS
Member Ashutosh  Kaul MD, MS, FRCS, FACS Member  John D.   Scott MD Member  Eric  S. Bour MD Member  Stephen D.  Wohlgemuth MD
Member Marina Kurian MD
President ASMBS John Magaña Morton, MD, MPH, FACS, FASMBS

47. Support Provided Jennifer Wynn Georgeann Mallory, RD
Director of Committee Affairs 
Assistant to Executive Director
ASMBS
Georgeann Mallory, RD
Executive Director ASMBS
Kristen Danielle Hahn
Research assistant UnityPoint Health, Des Moines IA
Catherine Hackett Renner, PhD
Director Office of Research
UnityPoint Health, Des Moines, IA