Despite the huge challenges of COVID-19, including a drop in patient visits, cardiologists reported an average increase in income in 2020 and remain among the top earners in medicine, according to the 2021 Medscape Cardiologist Compensation Report.

Although 46% of cardiologists reported some decline in compensation, average cardiologist income was $459,000 in 2020 — up from $438,000 in 2019.

Cardiologist pay is the third highest of all specialties in the overall 2021 Medscape Physician Compensation Report, which covers US physicians as a whole and almost 18,000 physicians in 29 specialties. 

Only plastic surgeons ($526,000) and orthopedists ($511,000) earned more than cardiologists in 2020.

On average among cardiologists, self-employment yields a somewhat higher paycheck than does being employed ($477,000 vs $450,000).

Just like in last year’s report, nearly two thirds (61%) of cardiologists overall say they feel fairly compensated.

The average incentive bonus payment for cardiologists in 2020 was 14% of total salary, about the same as last year. Two thirds of cardiologists who earn an incentive bonus achieve more than three quarters of their potential annual payment, up from 55% the prior year.

COVID Challenges and the Road Back

The vast majority (92%) of cardiologists who saw a drop in income last year cited COVID-related issues such as job loss, working fewer hours and seeing fewer patients.

Close to half (48%) of cardiologists who suffered financial or practice-related ill effects as a result of the pandemic expect their income to return to normal this year; 38% believe it will take 2 to 3 years. Notably, 45% of physicians overall said the pandemic did not cause them financial or practice-related harm.

Physician work hours generally declined for at least some time during the pandemic — and some physicians were furloughed — but most are now working about the same number of hours they did prior to COVID-19.

Cardiologists are back working an average of 57 hours per week. Perhaps not surprising, intensivists, infectious disease physicians, and public health /preventive medicine physicians are pulling longer hours now, about 6 or 7 more per week than before.

Although working about the same number of hours per week now as they did before the pandemic, physicians overall are typically seeing fewer patients because of time spent on medical office safety protocols, answering COVID-19-related questions and other factors.

Cardiologists are seeing an average decline in weekly patient visits of about 6% — from 77 to 72 patients. Pediatricians are experiencing the largest average declines — from 78 patients per week prior to 64 now, an 18% drop.

Among self-employed cardiologists, 43% believe that a drop in patient volume of up to one quarter is permanent.

Most Cardiologists Remain Happy at Work

Despite COVID-19 and other professional challenges, most cardiologists (and physicians overall) continue to find their work rewarding.

Cardiologists say the most rewarding aspect of their profession is “being good at what I do/finding answers and diagnoses” (27%), followed by relationships with and gratitude from patients (26%), making the world a better place (23%) and making good money at a job they like (12%). A few cited pride in their profession (6%) and teaching (2%). These figures are in line with last year’s responses.

The most challenging part of practicing cardiology is having so many rules and regulations (22%), followed by having to work long hours (16%), working with electronic health records (13%), trouble getting fair reimbursement (11%), danger/risk associated with treating COVID-19 patients (11%), dealing with difficult patients (8%) and worry about being sued (7%).

Bureaucratic tasks continue to be a burden for physicians in all specialties. On average, cardiologists spend 17.4 hours per week on paperwork and administration, similar to last year (16.9 hours per week) and to physicians overall (16.3 hours).

Despite the challenges, 86% of cardiologists said they would choose medicine again, and 92% would choose cardiology again, about the same as last year.

Most cardiologists (83%) plan to keep Medicare and/or Medicaid patients; only 1% say they won’t take new Medicare or Medicaid patients and 16% are undecided.

Thirty-nine percent of cardiologists plan to participate in the Merit-based Incentive Payment System (MIPS) in 2021. 

“The stakes of the Quality Payment Program — the program that incorporates MIPS — are high, with a 9% penalty applied to all Medicare reimbursement for failure to participate,” said Elizabeth Woodcock, MBA, CPC, president of physician practice consulting firm Woodcock & Associates, Atlanta, Georgia.

“With margins already slim, most physicians can’t afford this massive penalty. It makes sense to protect your revenue by complying with at least the bare minimum,” Woodcock noted.

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