title: Clinical academic rheumatology: getting more than you pay for.
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 predominantly 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 US dollars from 730 office visits. The total amount of downstream income from these office visits was 363,813 US dollars (47,386 US dollars from laboratory tests, 35,582 US dollars from radiologic studies, 8,159 US dollars from rheumatologic procedures, 261,584 from rheumatologic infusions, and 11,101 US dollars from initial consultations). Therefore, 10.02 US dollars of downstream revenue was generated for every 1.00 of office visit compensation applied to the academic rheumatologist's salary.
  
  
  CONCLUSIONS
  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 US dollars for every 1.00 US dollars they receive for an office visit.
authors.affiliation: University of Colorado Health Sciences Center, Denver, CO 80262, USA.
authors.forename: Pendleton
authors.initials: P
authors.lastname: Wickersham
authors.forename: Diane
authors.initials: D
authors.lastname: Golz
authors.forename: Sterling G
authors.initials: SG
authors.lastname: West
mesh_terms: D000046:Academic Medical Centers / Q000191:economics*; D005180:Faculty, Medical; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D012219:Rheumatology / Q000191:economics*; D012456:Salaries and Fringe Benefits / Q000191:economics* / Q000706:statistics & numerical data