Objectives: Academic surgery departments increasingly rely on clinical revenue to support research and education. The purpose of this study was to determine if academic surgeons are satisfied with their compensation in this era of financial cross-subsidization.
Methods: Members of 3 academic surgery societies (n=3100) were surveyed on demographic parameters, practice characteristics and attitudes about financial compensation. Univariate and multivariate logistic regression analyses were performed.
Results: Of 1,038 (33%) respondents, only 51% were satisfied with their compensation. Length of career, administrative responsibility for compensation and membership in the ASA or SUS were predictive of salary satisfaction on univariate analysis. Frequent emergency call duty, increased clinical activity, and greater perceived difference between academic and private practice compensation were predictive of salary dissatisfaction. On multivariate analysis, increased clinical activity was inversely associated with both salary satisfaction [AOR 0.77 (0.64,0.94), p=0.009] and amount of compensation willingly sacrificed for an academic practice [AOR 0.71 (0.61,0.83), p<0.0005]. Relative to private practice, the highest percentage of respondents would accept a 10%-20% reduction in salary to support research and education. However, the actual difference was thought to be more than 25%-50%. Increased salary satisfaction correlated with acceptance of a greater salary differential (p=0.0001).
Conclusions: Increasing reliance on clinical revenue to subsidize nonclinical academic missions is disaffecting a large percentage of academic surgeons. Redefined mission priorities, enhanced nonfinancial rewards, utilization of nonclinical revenue sources (e.g. philanthropy, grants), increased efficiency of business practices and/or redesign of funds flow may be necessary to sustain recruitment and retention of young academic surgeons.