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Keywords:

  • Downstream revenue;
  • Salary;
  • Academic medicine

Abstract

Objective

Rheumatology is among the least compensated specialties in medicine today. This is a significant problem for clinical rheumatologists in academic medicine who are often expected to earn their salaries through clinical practice alone. Additionally, academic rheumatologists usually cannot generate revenue through office laboratory monitoring, radiographs, or bone densitometry to supplement their income (i.e., downstream income). The purpose of our study was to examine revenue generated from downstream income to a university by a clinical-academic rheumatologist.

Methods

Consecutive outpatients (n = 127) seen predominately by one academic rheumatologist over one month of clinic were followed for 18 months. The total physician compensation for patient visits was calculated and compared with the revenue generated from laboratory tests, radiologic studies, consultations, and specific rheumatologic treatments and procedures performed or ordered. Medicare reimbursement rates for 2003 were used as compensation standards for all charges.

Results

Physician office visit billing generated $36,297 from 730 office visits. The total amount of downstream income from these office visits was $363,813 ($47,386 from laboratory tests, $35,582 from radiologic studies, $8,159 from rheumatologic procedures, $261,584 from rheumatologic infusions, and $11,101 from initial consultations). Therefore, $10.02 of downstream revenue was generated for every $1.00 of office visit compensation applied to the academic rheumatologist's salary.

Conclusion

Although academic rheumatologists struggle to bill their salaries through seeing more patients, they are clearly a bargain for a university hospital because they generate >$10.00 for every $1.00 they receive for an office visit.