Higher Compensation in Less Competitive Markets

The Center for Studying Health System Change has completed a study on the average compensation for physicians in different marketplaces and geographic locations. The study found that Physicians and Hospitals in some markets can drive payment levels far above those paid in more competitive markets (larger metropolitan areas).

This study referenced that physician's actual compensation was less variable in different markets, however hospitals were paid nearly five times the Medicare rate for inpatient care and more than seven times the rate for outpatient care in some of the most extreme areas the study found.

Read the full article in American Medical News, or click here:

http://www.ama-assn.org/amednews/2010/12/06/bisc1210.htm

Physicians Opting out of Private Practice Because of Uncertainty

The Physicians Foundation has conducted a survey on physician's changing practice models. Concern about how health system reform and continuing instability in Medicare pay have an increasing number of physicians pondering changes in how they practice.

Many physicians are considering cutting back on hours, switching to concierge medicine, taking locum tenens positions or selling their practices to accept hospital jobs, according to the survey released November 19th.

Read the full article in American Medical News, or click here:
http://www.ama-assn.org/amednews/2010/12/13/bisc1213.htm

Physician Background Check: What Physicians Need to Know

All of the facilities, private practices, and academic institutions we work with require a background check to be completed on the candidate, usually prior to an offer being made. The New England Journal of Medicine has provided a good article on what a physician needs to know about the process of a third party obtaining a background check.

Although this article suggests some physicians need to complete a background check prior to the interview, we find it more common to complete a background and malpractice screen once the offer process has began typically after the first or second site visit. Either way, the background process is common and is not something a candidate should be overly concerned about.

Read the full article at http://www.nejmjobs.org/career-resources/physician-background-check.aspx

Physician Recruitment Today

This has been an interesting few years for physician recruitment. Of course we are constantly hearing of the physician shortage, but with the current economy and health care reform it has added a complicated factor in to recruiting physicians today.

The New England Journal of Medicine has published an article referencing 3 key findings to recruit and retain physicians.

To summarize the recommendations of the article, the NEJM suggests these 3 points to recruit and retain physicians:

• Offer compensation models competitive to today's physician: take in to consideration competitive compensation but also other factors that entice physicians such as quality of life, shared call, paid CMEs and malpractice, bonuses, etc.
• Offer leadership and/ or ownership potential
• Be competitive in offers regardless of the economic situation

The current physician shortage across not only primary care but all specialties will only increase. Retaining and recruiting physicians will become more competitive than ever, top candidates will be more enticed with competitive offers than they are today. However, as the needs of physicians change, hospital groups, private practices, and even academic facilities need to evolve to attract physicians in a changing marketplace with new employment preferences.

Read the full article in the New England Journal of Medicine, or click here:
http://www.nejmjobs.org/rpt/intentional-retention-starts-with-recruitment.aspx

Check List: Job Offer Incentives for Physician Candidates

During the negotiation process there are many factors to consider outside of salary/ compensation alone. There are many other considerations physicians can leverage during contract negotiations.

We found a good check-list from Med Center today; although this article is geared toward academic physicians, the same considerations can be applied to candidates considering hospital employed and even private practice opportunities.

Here are some suggestions the article recommends to discuss during employment contract negotiations:

• Moving Expenses
• Sign-on Bonuses
• Guaranteed minimum salary
• Contract terms
• Loan re-payment assistance
• Relocation Assistance

Many of the other suggestions are geared specifically towards physicians seeking careers with academic facilities. However candidates seeking all models of employment can also negotiate call, paid time off, paid expenses (licensing, training, CME, etc.), and many other factors outside of compensation contributing to the physician's total quality of life.

Read the full article in Med Center Today, or click here:

http://www.medcentertoday.com/checklist.php?id=66

Physician Employment: Leveraging Benefits with Hospitals

Hospitals have become very creative and flexible on how they are able to attract new physicians and also consider merging with current physician groups. If physicians are able to negotiate during the offer process they are often able to get the practice set-up and other benefits they want.

Not only are physicians able to negotiate for hospital employed positions, but hospitals can also be flexible with joint ventures, non-profit physician networks, and making EMS and other software available to community physicians at a discounted rate.

Other terms physicians can negotiate, particularly for hospital employment opportunities, are flexible schedules and workloads, benefits, paid CMEs and other continued training, vacation and paid time off, and call schedules.

Read the full article in American Medical News, or click here:
http://www.ama-assn.org/amednews/2010/11/15/bisa1115.htm

MGMA Annual Conference: Outlook Pending Healthcare Reform

The Medical Group Management Association has had their annual conference in New Orleans. Many of the speakers indicated healthcare reform has left a pending synopsis of the state of healthcare.

Throughout this year healthcare providers have seen many changes to current regulations as well as new implementations. Exactly what will happen when healthcare reform takes place is also undetermined.

According to speakers at the conference, there are 3 payment models to watch:

• Accountable care organizations

• Bundling of payments

• Value-based payment modifiers

Many sessions focused on general reform objectives – how to control spending, improve access, create incentives and enhance quality.

Read the full article at Healthcare Finance News, or click here: http://www.healthcarefinancenews.com/news/mgmas-outlook-still-waiting-reform

Private Practices: How to Survive and Thrive

With the changes in healthcare, IT, and government there has been a lot of press on the deterioration of the private practice; however in this environment as well as in the future private and small physician practices can still be very successful and fulfilling.

The key is for small practices to identify and acquire the tools needed to adapt and grow in changing times. Medscape Today has provided 3 actions small physician practices can take to help survive and thrive even though the rules of the game are about to change:

• Hire an NP or PA
• Adopt an EHR
• Get a Real Website

Private Physician practices can still be rewarding, both financially and in career fulfillment. If practices are run correctly with good administration and technology they will always be a competitive contender in the medical marketplace.

Read the full article in Medscape Today, or click here:

http://www.medscape.com/viewarticle/730497

Hospitals Lure Doctors Away From Private Practice

According to MGMA, in 2009 approximately 50% of new physicians hired were hired by hospitals. Currently, 1 out of every 6 physicians work directly for a hospital, and there is a significant increase in the percentage of physicians choosing hospital based positions.

Hospitals are more prepared to entice physicians to hospital employment models because of their business strategies. Hospitals project hiring more physicians as employees guarantees a more steady stream of patient referrals and improves patient care through better coordination of services.

Physicians, particularly young physicians out of training, are preferring hospital based and hospital employed positions because of the added security and benefit packages along with the better quality of life hospital practices tend to offer, call shared amongst several other physicians as well as not worrying about the time and expenses associated with a private practice such as leases, hiring administrative and medical staff, and billing.

Hospitals are being more competitive in their offers with not only salary options but also RVU (production) based incentives allowing physicians to be in better control of their income based on how much they wish to work.

One concern experts have is employing more physicians could give hospitals more negotiating power with health insurers, thus driving up health insurance prices.

Read the full article in Physicians News Digest, or click here:

http://www.physiciansnews.com/2010/10/14/hospitals-lure-doctors-away-from-private-practice/

Physician Shortage Increasing

The physician shortage continues to increase, with certain states affected more significantly by the current and impending shortage. According to the American Medical Association, the nationwide physician shortage is expected to reach as many as 159,000 physicians by 2025. At least 22 states and 15 medical specialties had reported physician shortages as of June this year.

Virginia is one of the states dramatically affected by the current shortage, mainly because of an increase in demands for specialty services for the aging population as well as coverage for the uninsured with healthcare reform.

According to the Association of American Medical College, Virginia ranks 31st nationally in retaining graduates, 61% of residents go to other states after completing their training.

Nearly all US States are experiencing physician shortages, and with healthcare reform pending the shortages are predicted to increase dramatically. Rural areas in Virginia as well as all states are experiencing a harder time retaining and recruiting new physicians.

Read the full article in American Medical News, or click here:
http://www.ama-assn.org/amednews/2010/10/04/prse1005.htm

Incentive Plans Playing Bigger Role in Physician Earnings

Many hospital employed opportunities as well as private practice salaries or shared earnings in partnerships are becoming more affected by incentive plans. RVU based incentives based on the individual physician's volume and revenue have played a part in physician compensation for awhile both in private practice opportunities and hospital employment positions, however now other incentive plans are also gaining popularity.

Particularly amongst hospital employment positions physicians are being compensated based on patient satisfaction, readmissions, clinical outcomes, and other performance metrics.

The Hay Group's "2010 Physician Compensation: Prevalence and Planning Report" found that 69% of the health care organizations surveyed used some kind of annual incentive plan in 2010 for employed physicians, which is up from 2008 which reported 49% of health care organizations based some physician compensation on annual incentives.

Physician's income, particularly in hospital employment positions, has become more of a base salary model with these types of incentives rewarded on top of base salaries.

Read the full article in American Medical News, or click here:
http://www.ama-assn.org/amednews/2010/10/04/bise1004.htm

MGMA: Increase in RVU from Last Year

The results from MGMA’s “Cost Survey for Multispecialty Practices: 2010 Report Based on 2009 Data” have been released and it looks as if RVUs have experienced a slight increase from last year's data.

Over the last 5 years an almost 1% increase has been experienced by non-hospital/ IDS-owned medical groups in total RVUs, and almost 13% increase in work RVUs per patient.

Multi-specialty groups (hospital/IDS-owned) had slightly different results with just under 6% decrease in total RVUs and almost an 18% decrease in work RVUs per patient.

The report also provided specialty specific information. Family practice, Anesthesia and Orthopedic Surgery reported increases in total medical revenue after operating costs, while Cardiology, Pediatrics, Gastroenterology, and Urology reported decreases in the same category.

Over the last 10 years the study reports the average total operating costs as a percentage of total medical revenue increased over 3% for practices non-hospital/ IDS owned. Hospital/ IDS-owned practices' average total operating costs decreased almost by 1%.

Read the full article in Healthcare Finance News, or click here:

http://www.healthcarefinancenews.com/news/mgma-productivity-costs-and-revenue-affect-practice-ownership

The Changing Face of Academic Medicine

In an article from Med Center Today, Academic Medicine has been dominated by males across all specialties, however more women are entering in to the academic medicine setting. Women entering in to a male dominated territory run across obstacles in addition to the normal competitive nature of jobs in academic medicine.

It will take a combination of top-level leadership and females taking stronger rein over their own career development to help women find their place in academic medicine. Academic institutions are already competitive, although women may be a minority it is important for these programs to become more diverse and create more women mentors for new students entering training.

According to the AAMC, as of 2003, women represented 50% of first-year medical students, 41% of all residents and 30% of all faculty members. However there is a significant shortage of women in leadership roles in academic centers.

There is also an interesting article from JNS documenting women in and entering in to Neurosurgery. Read the full article by clicking here: http://thejns.org/doi/full/10.3171/JNS/2008/109/9/0378. Neurosurgery, like most surgery and specialties, is also largely dominated by men. However more women Neurosurgeons are entering in to the marketplace which creates more women mentors for new medical students selecting their specialties and even deciding to enter in to medical school.

Given the complexity of the challenge, medical schools are implementing a number of initiatives to raise the profile of women, including extending the timeline for gaining tenure and advancing to full professorship, and exploring policies for part-time faculty. There also are a number of steps women can take to enhance their own careers and help build a climate that encourages other women to pursue and stay in academic medicine.


Read the full article in Med Center Today, or click here:
http://www.medcentertoday.com/article.php?id=55&chapter_id=16&PHPSESSID=o43oa6516ph8i36khum81tugv0

Health Reform Losing Support

With elections coming up in November, voters are changing their opinions of health reform. While the proposition barely passed this spring, more voters are becoming opposed to the new law. According to the August Kaiser Health Tracking Poll 10% of voters are opposed to health reform since July.

Amongst voters health reform law's coverage expansions and consumer protections continue to be popular, however many are opposed to the requirement of having health insurance.

Some sources track more consistent results from American voters; Pollster.com, a compilation of national polls, has found that public opinion on the national health reform law has remained fairly steady since early summer, with nearly 48% opposing the law and 42% supporting it.

With elections coming up in November, health reform ranks approximately third of issues voters have a problem with. The economy and dissatisfaction with government are first and second respectively.

Read the full article at American Medical News, or click here:
http://www.ama-assn.org/amednews/2010/09/13/gvse0914.htm

Potential Tax Hikes for Physicians

The changing political environment not only affects healthcare reform and how hospitals and insurance companies will change from our current system, but tax laws also may change in the upcoming tax year for individual tax payers.

The tax cuts that were implemented in 2001 and 2003 lowered taxes for every American across the country and are set to expire at the end of this year. Because of their income potential, many physicians may be significantly affected by the potential changes.

There is currently much speculation as to what Congress and the Obama administration will try to change in the tax code prior to November. The current tax cuts will be effective through the end of the year and will not affect the 2010 tax year. We will have a better idea of what potential changes may take place after the November election, however we can only speculate as to what those changes may be until the administration makes the official changes and new laws effective at the beginning of the 2011 tax year.


Read the full article at Physician's News or click here:
http://www.physiciansnews.com/2010/09/16/physicians-should-be-prepared-for-potential-tax-hikes/

Healthcare Sector Employment Continues to Rise

According to the latest employment report from the Bureau of Labor Statistics the healthcare sector continued its rise last month.

Jobs in the healthcare sector have remained strong through the unsteady job market and current economy. In August healthcare jobs increased by just over 28,000 jobs.

The biggest increase in healthcare jobs is in ambulatory care services (primarily in physician offices) with hospital jobs directly behind.

The changes in healthcare and healthcare reform will create many new healthcare jobs for employees in all positions in healthcare. Physicians will see the current shortage increase, specifically for Primary Care physicians which are already experiencing a significant shortage.

Read the full article in Healthcare Finance News, or click here:
http://www.healthcarefinancenews.com/news/healthcare-still-hiring-hospital-employment-ends-summer-swoon

Physicians Running for Office

This has been a year of dramatic change in the healthcare sector. With healthcare reform pending, physicians are stepping up to contribute to the new laws and are running for office. According to AMPAC, American Medical Association's nonpartisan political action committee, more physicians are running in this election than in any other past election.

At least 47 physicians filed the paperwork necessary to run for a congressional seat and 15 physicians are running for re-election in Congress.

With all of the changes in healthcare reform it is important for physicians, who will be heavily impacted with these changes, can be a part of making the final decisions in the law making process.

Congress officials have decreased in popularity; 69% of American's have disapproved of lawmaker's performance. The economy has been a large factor in affecting voter's decisions and opinions. Many Americans don't believe that the stimulus act, health reform law, and other actions by the Congress have helped reduce unemployment.

Read the full article in American Medical News, or click here:
http://www.ama-assn.org/amednews/2010/09/06/gvsa0906.htm

NEJM: Part-Time Physician Practice on the Rise

According to an article published in The New England Journal of Medicine, physicians in part-time practices are increasing.

In 2005 part-time physicians made up 13% of the physician work force, now part-time physicians are at 21% of the workforce. The fastest growing segments of these physicians in the work force are men approaching retirement age and women in early to mid-career.

Quality of life is an increasing concern amongst physicians seeking new or modifying current practices. It is a consideration many new graduates are seeking in new opportunities. Mostly the change in schedule is driven by physicians also wanting an active family or home life.

Despite the physician shortage, facilities and private practice groups are compromising with existing employees or offering flexible schedules to prospective candidates to stay competitive and offer quality of life to their employees. Depending on the specialty, some practices simply allow the part-timers to work out their own schedules as long as other members of the group have equal coverage or options. Some groups or facilities require formalized arrangements with fixed schedules set well in advance. Multi-specialty groups like his are more amenable to nontraditional schedules.

Income typically is still based on a volume model, similar to full time physicians. Most part-time physicians are compensated on a prorated basis, depending on the number of hours they practice or the volume of cases they handle. Most groups also provide health and retirement benefits and offer little changes to CME benefits.

In this changing healthcare environment, many facilities and groups are being more accommodating to attract and maintain their physician workforce. Whether offering part-time employee options, partner/ job sharing, or other options, it is important to be flexible to maintain physicians.

Read the full article at The New England Journal of Medicine, or click here:
http://www.nejmjobs.org/part-time-physician-practice-on-the-rise.aspx

Healthcare Companies in Fortune's 100 Fastest Growing Companies

Fortune has published their annual "100 Fastest-Growing Companies: Rising Stars", and 21 medical companies made the list of 100 Fastest Growing Firms.

Among the medical companies making the list are 6 pharmaceutical companies, 4 medical device/equipment manufacturers, 3 home health care providers, and 2 Healthcare IT firms. Only one hospital system made the list, Community Health Systems, which owns and operates 123 community hospitals nationwide.


Read the full article in Fortune, or click here:
http://money.cnn.com/2010/08/16/news/companies/fastest_growing_rising_stars.fortune/index.htm

Highlights of MGMA's 2010 Physician Compensation Survey

With the current state of the economy and political changes in healthcare, physician’s compensation has been affected in many ways. MGMA has released their 2009 survey on physician compensation tracking the changes from 2008.

For the most part physician’s total compensation has increased slightly from the previous year, although the changes vary per specialty. Last year Primary Care Physicians experienced nearly 3% increase in their average income.

Specialty physicians in private practices averaged higher compensation than physicians in hospital owned practices. However physicians in hospital owned practices averaged higher compensation per case or RVU volume. Average compensation for private practice specialty physician’s was just over 25% than specialty physicians in hospital owned practices.

With the impending changes in healthcare and with healthcare reform the environment for physician compensation will greatly affect all physicians and specialties, particularly those in private practices. The surge in patients will also dramatically increase the current physician shortage, particularly for Primary Care Physicians in the coming years.


Read the full article on MGMA's website, or click here:
http://blog.mgma.com/blog/bid/34089/Highlights-of-MGMA-s-2010-physician-compensation-survey

Six Different Models of Physician Compensation

This article is written by a Family Practice physician in a private practice adding another physician to his group.

Dr. Greenfield comes up with 6 different models for physician compensation:

Equal Sharing
Productivity
Salary
Salary plus Bonus
Productivity plus Capitation Mix
Capitation

Each model has its pros and cons, oftentimes giving incoming physicians a choice can optimize their happiness in the practice as well as benefit the practice as the compensation is based on how the physician works best figuring in quality of life.

Read the full article at AAFP, or click here:
http://www.aafp.org/fpm/981000fm/cover.html

Physician Re-entry: One Way To Address the Physician Shortage

Many are concerned about the current and impending physician shortage, particularly in primary care. With healthcare reform, the current physician shortage will be much more drastic.

According to this article in Physicians News, one way to address the physician shortage is to return inactive physicians to clinical practice. Returning a non-practicing physician to clinical medicine is appealing. First, it is significantly less expensive to re-train an inactive physician than to train a new one. Second, one can re-train physicians much faster than one can train new physicians, so more physicians would be available in less time. Also, in the current economic climate, many retired physicians are looking to return to medicine.

However, re-entry also has its limitations. Physicians wanting to return to clinical medicine face numerous challenges: low self-confidence in their skills, lack of professional networking possibilities, limited resources for gaining up-to-date skills and knowledge, and cumbersome regulations from licensing and credentialing bodies or employers. Of equal concern, programs offering reentry face financial and (educational) resource challenges.

Read the full article at Physicians News, or click here:

http://www.physiciansnews.com/2010/08/12/physician-re-entry-one-way-to-address-the-physician-shortage/

Median 2008 and 2009 Unrestricted Hourly On-Call Pay Rates

Sullivan, Cotter, and Associates, Inc. has published their annual physician and hospital executive salary averages. The New England Journal of Medicine has reported the survey documenting certain physician specialty's unrestricted hourly on-call pay rates.

Obviously these figures vary on geographical location, trauma, and specialty. However the survey provides a good starting point to estimate average paid hourly on-call.

Neurosurgery is one of the highest on-call paid specialties with Orthopedic Surgery and Anesthesiology coming in second and third.

See The New England Journal of Medicine's table here:

http://www.nejmjobs.org/rpt/unrestricted-hourly-on-call-rates.aspx

NEJM: Survey Quantifies Financial Impact of Adding Physicians

The New England Journal of Medicine has published an article tracking the direct impact physicians provide to a hospital financially. The survey examines revenue generated from direct hospital admissions, procedures, tests, and treatments in a variety of specialties.

The survey suggests physician recruiting can generate a positive return on investment, thereby ensuring that hospitals have the resources they need to provide quality care to the communities they serve.

However community need still needs to be determined in specific areas to ensure the incoming physicians will be busy enough. At our physician recruiting firm we work with many specialists and highly specialized physicians; a hospital just looking at the bottom line revenue of a certain specialty needs to consider competition in the community and determine what the demand is in their specific area to ensure the physician's success and therefore the revenue to the facility.

The average net revenue generated by all medical specialties was up slightly in 2010 over 2007. In 2010 the average net revenue is $1,543,788 and in 2007 it was $1,496,432.

The growing alignment of physicians and hospitals, often through hospital employment of physicians, may be an additional reason why overall average revenue generated by physicians for hospitals remained steady despite the recession. As physicians and hospitals become more aligned, revenue is more likely to flow to hospitals and less likely to flow to physician-owned surgery centers and other facilities.

Read the full article at The New England Journal of Medicine, or click here:
http://www.nejmjobs.org/rpt/survey-quantifies-financial-impact-adding-physicians.aspx?rpt=ja10

Job Growth in Physician Offices and Hospitals Expected in 2010

Regardless of the job market declining in many sectors, jobs in physician offices and hospitals is expected to grow this year. The outlook is that health system reform combined with some temporary increased stability in Medicare pay may lead to expansion.

In addition, the hiring freezes that some organizations put in place to survive the latest economic downturn also mean that some practices are staffed as low as they can go.

A total of 3,200 jobs were added to hospital payrolls in the first six months of 2010. This was more than the 1,600 created in 2009, and experts expect hiring to continue.

The anticipation of increased hiring also stems from the expectation that health system reform will lead to a rise in the number of people with health insurance, which in turn will lead to a greater demand for medical services.

Read the full article in American Medical News, or click here:
http://www.ama-assn.org/amednews/2010/07/26/bil20726.htm

Decrease in Solo Practices

Many physicians today, particularly physicians out of training, are seeking careers based on many factors not considered in the past. Motivators for jobs are quality of life, communities, security, and shared call amongst other factors. These shifts are also making solo practices less common.

Physicians in solo practices find that they are self employed and running a business in addition to practicing medicine. The back-end business including marketing, billing, administration, and running the office can lead to long hours and without shared call with other groups little vacation and time off. In addition, new pressures from the current economy and changes in Medicare can make running a solo practice even more challenging and less stable.

Physicians out of training are concerned with starting a solo practice because of the threat of getting in to more debt opening an office as well as lifestyle flexibility and quality of life outside of work.

This article in The Detroit News says even mid-career physicians in Michigan and across the country are giving up their solo practices and joining large and better-financed hospital systems as salaried employees.

The shift is ushering in a new era in medicine that improves the coordination of patient care between doctors and hospitals and further consolidates the health care industry. In 1997, about 40% of physicians were in solo or two-doctor practices. By 2008, that figure had dropped to about 30%.

Read the full article in The Detroit News, or click here:
http://www.detnews.com/article/20100720/BIZ/7200368/Doctors-find-solo-act-tough-medicine#ixzz0uKU2OlAL

U.S. News and World Report: Best Hospitals in US

U.S. News and World Report has published their annual top hospitals in the nation. The hospital evaluated nearly 5,000 hospitals by 16 different adult specialties.

This list is the magazine's Honor Roll, these hospitals all landed near the top in their specialty evaluation for at least 6 different specialties:

1. Johns Hopkins
2. Mayo Clinic (Minnesota Mayo Clinic)
3. Massachusetts General Hospital
4. Cleveland Clinic
5. Ronald Reagan UCLA Medical Center
6. New York-Presbyterian University Hospital of Columbia and Cornell
7. University of California, San Francisco Medical Center
8. Barnes Jewish Hospital/ Washington University
9. Hospital of the University of Pennsylvania
10. Duke University Medical Center
11. Brigham and Women's Hospital
12. University of Washington Medical Center
13. University of Pittsburg Medical Center
14. University of Michigan Hospitals and Health Centers

Read the article for a full report on all 16 specialties.


Read the full article at U.S. News and World Report or click here:
http://health.usnews.com/best-hospitals/rankings

New Factors Affect Physician Recruitment and Retention

There have been many recent changes in physician’s compensation and uncertainty with new laws and reform taking place. Healthcare reform, Medicaid cuts, and even economic challenges have made physician’s compensation potentially more volatile in the near future. These new pressures are also influencing how compensation is structured in both recruiting and retaining physicians.

Healthcare Finance News’s article suggests good ways to retain current physicians are integrating the physician and the physician’s family in to the community and developing packages that address both compensation and lifestyle.

With the future less certain now than it has been in the past, at Harlequin Recruiting we believe it is more important to constantly assess physician retention and be aggressive in developing income packages to attract new physicians. Recruiting new physicians isn’t always purely based on the income guarantee but also flexibility in schedule, benefits, and stability. Communicating with your current physicians as well as courting physicians is more important than ever.

Read the full article at Healthcare Finance News, or click here:
http://www.healthcarefinancenews.com/news/study-new-factors-affect-physician-recruitment-retention

NEJM: Physician Compensation Outlook: Mostly Positive

The New England Journal of Medicine has published an article forecasting the current and future compensation for physicians. According to the article, primary care physician's compensation is brightening considerably, but there may be hurdles ahead for certain specialties.

Because of the severe shortage of Primary Care Physicians as well as other certain specialties these doctors are able to negotiate better on their overall income and benefit packages and create bonus structures as enticement. Relocation, CME, training stipends, signing bonuses, loan payment assistance, and overall benefit packages are one way hospitals are attracting physicians experiencing shortages.

Median compensation in Primary Care increased between 7% and 10% from 2007 to 2008, according to data from the Medical Group Management Association (MGMA) 2009 Physician Placement Starting Salary Survey; and by 10% in specialties as a whole.

Also, income is becoming more consistent for both Primary Care and Specialists across the US. Previous regional income disparities are less common and physicians can experience more of a set income for any geographical area.

However the outlook on some specialty’s income may slightly decrease, such as Urology and Oncology. Factors are ranging from the unknowns about how the Obama Care health-reform provisions will play out in the marketplace, changes in Medicare reimbursements, to a growing array of national initiatives to reduce healthcare costs and streamline care.

For the moment, the compensation picture is generally stable overall for physicians. But is a bit of a mixed bag among specialties, for both established physicians and those starting out. Between 2004 and 2008, median compensation increased roughly 14% for both Primary Care and Specialties as a whole. In the 2009 Physician Compensation and Production Survey, all specialties with the exception of psychiatry, ophthalmology and urology saw increases, and the declines among the latter were modest.

Also the transition of hospital employment positions from private practice opportunities has created a change in overall compensation as a whole. Hospitals, integrated health systems and many large private groups are moving away from solely productivity-based compensation structures and toward quality-based incentive programs.

Read the full article in The New England Journal of Medicine, or click here:
http://www.nejmjobs.org/physician-compensation-outlook-2010.aspx

Proposition: Cut of Physician's Salary Instead of Medical School Tuition

The American Journal of Obstetrics and Gynecology has published an interesting article suggesting an alternative for significant student loan debt to physicians coming out of training. Instead of incurring hundreds of thousands of dollars in student loans, the article suggests medical schools taking a cut out of physician's salaries during their initial years in practice to pay for their education.

This is a very interesting proposition. There is major concern for the shortage in physicians currently and that need will increase exponentially with healthcare reform. Many medical schools are coming up with alternatives to address the shortage, such as Johns Hopkins offering significant financial aid programs for physicians entering primary care training. The proposition offered in the American Journal of Obstetrics and Gynecology would eliminate debt for medical students and allow doctors to choose their specialty based on desire rather than ability to pay back loans.

The rate for docs in public schools would be 5% of income; and 10% for those who go to private schools. These rates are across all specialties.

Having this program in place eliminates the need to constantly increase tuition and removes the economic impact on medical schools from the loss of tuition if a future decision is made to shorten the length of medical education.

Read the full article in Physician's News, or click here:
http://www.physiciansnews.com/2010/07/07/instead-of-tuition-medical-schools-should-get-cut-of-docs-salary/

1 in 9 US Jobs Supported by Hospitals

According to the American Hospital Association, 1 in 9 jobs are supported by hospitals. Overall, hospitals support 1 in 9 jobs in the U.S. based on a multiplier established at 2.8 jobs for every hospital job created. The AHA along with state hospital groups are releasing data as part of an effort to argue against cuts to Medicare and Medicaid reimbursements.

The AHA is stating hospitals are major contributors to the economy. The health care sector added $2.3 trillion to the U.S. economy in 2008, or 16.2% of gross domestic product. Hospitals accounted for $718 billion of that total; employed more than 5.3 million people, including physicians; and spent about $320 billion on goods and services from other industries, according to AHA data.

The Bureau of Labor Statistics puts hospital employment figures at 4.7 million nationally as of May 2010.

Read the full article in American Medical News, or click here:
http://www.ama-assn.org/amednews/2010/07/05/bisa0705.htm

Best Medical Schools in the World

Compiling a list of the best medical schools in the world can be very difficult due to the sheer number of medical schools there are in the seven continents that make up the world. Also with different educational systems prevalent, it is difficult to define standards for ranking them. This article lists the top ten medical schools in the world that figure on a majority of lists ranking the top medical schools in the world.

This list is a compilation of those colleges that feature on most lists of the best medical schools in the world and is partial to colleges in the American and European continents.

1. Harvard University
2. University of Cambridge
3. Johns Hopkins University
4. University of Pennsylvania
5. University of Oxford
6. University of California at San Francisco
7. Yale University
8. Karolinska Institute
9. Columbia University
10. University of Dundee

Read the full article at Buzzle.com, or click here:
http://www.buzzle.com/articles/best-medical-schools-in-the-world.html

More Physicians Needed to Counter Physician Shortage

We've all been hearing about the physician shortage, particularly the shortage of primary care physicians and also the increase in all physician shortages with impending healthcare reform. The AMA House of Delegates has adopted policies aimed at increasing the physician work force and staving off shortages.

Demand for doctors is expected to outpace supply by as many as 159,000 physicians by 2025. Currently, at least 22 states and 15 medical specialties have reported physician shortages.

The policies AMA has targeted call for promoting physician practice in underserved areas, expanding residency training, encouraging more people to become primary care physicians, and addressing a severe shortage of child and adolescent psychiatrists.

An AMA report adopted by delegates urges vigilance in seeking funding from a variety of sources for more residency slots.

The Department of Health and Human Services announced $250 million to strengthen primary care, including $168 million to create more primary care residency slots. The money is expected to help train more than 500 primary care physicians by 2015.

Read the full article in American Medical News or click here:
http://www.ama-assn.org/amednews/2010/06/28/prsk0628.htm

Physician Owned Hospitals: Will Healthcare Reform Make it Harder for them to Operate?

Physician-owned hospitals have long since been a profitable and well-run industry if operating correctly. However this may soon change with healthcare reform. A provision in the health reform law enacted in March placed major limits on physician ownership of hospitals.

Under healthcare reform, new doctor-owned facilities that are not certified as Medicare participants no longer will be allowed into the program. E xisting physician-owned facilities face immediate restrictions on expansion. Physician investors say those rules are so strict that virtually none of their hospitals will be able to grow.

Other new regulations include capping physician ownership, ending some exceptions to Stark self-referral bans and mandating more disclosure of physician owners' potential conflicts of interest when they send patients to their own facilities.

Physician-owned hospitals include specialty hospitals, surgery centers, acute care facilities, multi-specialty hospitals and even struggling community hospitals that have been propped up financially by physicians.

Until litigation, legislation or regulation direct otherwise, plans for new or expanded physician-owned hospitals will be in a holding pattern. Facilities also will need to make sure they don't run afoul of the law in their continuing operations.

Read the full article in American Medical News, or click here:
http://www.ama-assn.org/amednews/2010/06/28/gvsa0628.htm

More Hospital Deals with Healthcare Reform

One positive spin for hospitals with the impending healthcare reform is it is predicted there will be even more hospital buy-outs from larger firms or healthcare conglomerates in the future. Recently there has been a lot of press of larger organizations acquiring hospitals throughout the country.

With the changes in the healthcare sector because of healthcare reform, there are apt to be even more hospital buy-outs as well as aggregation of existing hospital companies, diversification into outpatient sectors, and more jostling among companies to pick up larger positions in local markets.

There has been news of many hospital buy-outs lately, namely Cerberus Capital Management has agreed to buy Caritas Christi Health Care in the Boston area and the Blackstone Group-backed Vanguard Health Systems is buying the Detroit Medical Center.

Read the full article in The Wall Street Journal, or click here:
http://blogs.wsj.com/privateequity/2010/06/23/one-impact-of-health-care-reform-expect-more-hospital-deals/?mod=rss_WSJBlog

Increase in Compensation and Roles of Physician Leaders

There has been a trend of physicians who have leadership roles within hospitals experiencing an increase in responsibilities and also in compensation for the additional roles and duties. Some of this is due to an increase in affiliations with academic facilities and hospitals.

Leadership positions in hospitals are becoming more fully developed and time-consuming than in the past, incorporating the financial aspects of the department, physician recruitment, coordination with academic medical centers, quality, and even marketing roles.

Compensation for different leadership roles varies by specialty and institution. However based on the findings of this article in Becker's Hospital Review, the increased roles and responsibilities of physicians in leadership positions will be compensated at a higher level. Also, healthcare reform is likely to accelerate this trend as more organizations adopt more fully integrated models such as accountable care organizations and also lead to more value-based compensation.

The complexity of leadership roles in hospitals typically requires the physicians to have a much more business-oriented skill set. Hospitals are responding by investing more in improving their physicians' leadership, business, and communication skills.

Read the full article in Becker's Hospital Review, or click here:
http://www.beckershospitalreview.com/physician-hospital-relationships-employment-jvs/physician-hospital-relationships-employment-jvs/roles-and-compensation-of-physician-leaders-in-hospitals-growing.html

Practice Management Firms Buying More Hospital-Based Physician Groups

There has been a recent increase in the trend of hospitals purchasing existing private practices. However practice management firms are also buying practices. This is beneficial to practices interested in being purchased because they can have competitive offers and additional options than just being bought out by a hospital.

Inpatient Specialists are the most likely types of private or hospital based practices to be purchased by practice management firms. There are also practices being purchased by private firms although these deals are not made public.

The practice management firms are focusing on hospital-based practices and are buying within certain specialties. Typically the purchased practices are already financially healthy and have long-term relationships with hospitals, but need a larger entity to grow, acquire technology or negotiate with third-party payers.

Unlike with a sale to a hospital, practice management companies don't always employ the physicians after buying the practice. Practice management companies handle administration, own the practice's contracts and take in the payments, a portion of which is then distributed to the practice. Physicians can be employees or independent contractors of the management company directly, or of the practice. How this is handled is usually dictated by local laws and styles of practice.

Before selling, physicians should assess a company's viability as well as determine if the company is one they want to work with over the long term.

Read the full article in American Medical News, or click here:
http://www.ama-assn.org/amednews/2010/06/21/bisb0621.htm

Reimbursement to Blame for Primary Care Shortage

This is an interesting article from The Baltimore Sun stating low reimbursement for primary care physicians is the result of the shortage and medical schools are not to blame.

When physicians enter into medical school and residency training, additional fellowship training to become a specialist is tempting because of the dramatic increase in remuneration. Also taking in to consideration how much debt many students are in after completing their training makes a higher paid position seem worth the extra few years of training.

Some medical schools are trying to attract primary care physicians to their programs to contribute to the shortage of primary care physicians. According to the article Johns Hopkins offers many different financial aid packages to primary care students.

Whatever the cause of the physician shortage, the scarcity is a huge concern currently as well as the dramatic change the medical industry may experience with healthcare reform.

Read the full article in The Baltimore Sun, or click here:
http://weblogs.baltimoresun.com/business/hancock/blog/2010/06/blame_reimbursement_not_school.html

Healthcare Employment Increase

Despite the recession and the increase in unemployment and decrease in jobs in many arenas, healthcare jobs have increased over the last month and have been increasing or steady all year.

Employment in the U.S. healthcare sector increased by approximately 8,000 jobs in May, and healthcare has added 20,000 new positions per month over the last year.

According to the latest jobs report from the federal Bureau of Labor Statistics, the biggest healthcare job gains were in ambulatory care, where 8,700 jobs were added in May. Of the new ambulatory care jobs, 2,500 were in physician offices and 1,600 were in home healthcare services.

Read the full article in Healthcare Finance News, or click here:
http://www.healthcarefinancenews.com/news/healthcare-industry-hiring-steady-clip

15%+ of Physicians Change Jobs Annually

SK&A has completed a study on the percentage of physicians relocating annually for a new job. According to their study titled Physicians on the Move, the 3 year average of physicians that moved to a new location or practice is 15.2%. This figure also includes those physicians that retired or passed away.

Summer is an interesting time in physician recruiting; most of the residency and fellowship graduates have identified positions but there are still a lot of experienced candidates interested in making a move, and 2011 candidates are ready to begin interviewing. This article is interesting because it reveals the rate of change of office-based physicians by practice specialty, and is targeting established and experienced physicians.

We have found a high percentage of physicians changing their first job out of residency in the first 2 years of practice. Often times new graduates are attracted by high reimbursements or a large salary, and once they have signed with a facility either the promises made are not kept or physicians change their motivating factors, such as location, case load, trauma call, and community amenities. However this article states physician stability and job change has decreased over the last 3 years.

According to the article from SK&A, data from their study suggests that the move rate of physicians has declined steadily in the past 3 years, indicating recent stability among the specialties surveyed. The rate has gone from 18.2% in the 2008 reporting period to 15% in 2009 to 12.4% in the 2010 period.


Read the full article in Healthcare Finance News, or click here:
http://www.healthcarefinancenews.com/news/study-more-15-percent-physicians-move-annually

Hospital Owned Practices Attracted 65% of Physicians in 2009: MGMA

According to the Medical Group Management Association (MGMA), hospital-owned practices were the most successful in attracting physicians in 2009.

Candidates fresh out of training as well as experienced candidates seek hospital based and/ or hospital employed opportunities because they often times choose jobs based on quality of life and security. Where as at our physician recruiting firm our private practice opportunities can provide significant income and potential, some candidates believe hospital owned practices offer more stability, guaranteed income, and less and shared call.

Some candidates also believe hospital owned practices may provide more security with the uncertain future of healthcare reform.

According to the MGMA’s Physician Placement Starting Salary Survey: 2010 Report Based on 2009 Data, 65% of experienced/ established physicians changing jobs in 2009 selected hospital owned practices, and 49% of residency and fellowship graduates chose a hospital owned practice.

The survey also shows that first-year guaranteed compensation has decreased by 2.1% since 2006 for specialists in single specialty practices, whereas primary care first-year guaranteed compensation has increased by 17.4%.

Read the full article in Healthcare Finance News, or click here:

http://www.healthcarefinancenews.com/news/mgma-65-percent-established-doctors-are-hospital-owned-practices

Recruit and Retain Physicians

Now that summer is here and most of the 2010 residency and fellowship graduates have identified positions, we thought it would be appropriate to post an article from The New England Journal of Medicine on how to recruit and retain physicians.

In these economic times, hospitals and private practices have to be creative on how to attract the best physician candidates for their physician job openings. However, once the physician has signed the contract it is still important to actively work at retaining the physician.

How to retain a physician comes down to simple concepts: communication, follow-up, even asking if the physician is happy and how the circumstances of his or her position can be improved.

According to the NEJM, health care organizations that keep an eye toward the future and explore innovative ways to position their organizations to meet the needs of physicians throughout their career cycles will develop competitive advantages for recruitment and retention.

Read the full article by clicking here:
http://www.nejmjobs.org/rpt/recruit-and-retain-physicians.aspx

National Pediatric Specialty Physician Shortage

At our firm and in physician healthcare news we have heard a lot about the physician shortage, particularly the current and impending shortage in primary care. However other specialties are currently experiencing a shortage as well with the future predicting an increase in physician specialty shortages.

The New England Journal of Medicine has posted a table referencing the shortage of pediatric specialty physicians in their latest addition of Recruiting Physicians Today. The table shows what pediatric specialties are most in demand per US state.

According to their data, at least 16 US states lack at least one of 13 pediatric sub-specialty physicians.

See the full table here:
http://www.nejmjobs.org/rpt/specialist-shortage.aspx

Medical Office Buildings: Good Time to Sell?

If physicians who own a medical office building are interested in selling, they might have some big-monied investors as buyers, according to industry experts. Real estate investors scarred by the recent volatility of other investments are looking for stable places to put their money, but there are not enough of these types of buildings to meet demand.

The ability for hospitals to raise funds to build these kinds of projects is starting to return. Public and private real estate investment trusts have gathered significant cash and announced they are looking for investment opportunities. In the wake of the recent recession, assets that did not lose much value, such as medical office buildings, have a lot of appeal.

Large buildings on hospital campuses with long-term stable tenants traditionally have garnered the most interest. But smaller off-campus buildings also are becoming attractive, in part because there are not enough on-campus facilities to satisfy investor demand.

Read the full article at American Medical News, or click here:

http://www.ama-assn.org/amednews/2010/05/24/bisb0524.htm

Healthcare Employment Increased in April

Employment in the U.S. healthcare sector increased by approximately 20,100 jobs in April, although the national unemployment rate increased slightly to 9.9% according to the federal Bureau of Labor Statistics.
The biggest healthcare job gains were in ambulatory care, where 9,400 jobs were added in April, and in hospitals, which added 6,100 jobs.

Total healthcare employment has increased by 244,000 over the past year.

Read the full article at Healthcare Finance News, or click here:
http://www.healthcarefinancenews.com/news/healthcare-employment-increased-april

Med School Enrollment in 2015 Will Miss Goal

With a physician shortage looming in its sights, in 2006 the Association of American Medical Colleges set a goal of boosting first-year med school enrollment by 30% between 2002’s baseline and 2015.
It’s going to miss that target by a few years, the AAMC said today. In its 2009 med school enrollment survey, the group’s Center for Workforce Studies said enrollment will be up by 23% in 2015, to 20,281, and up a projected 30% in 2018. Enrollment at med schools and osteopathic med schools combined, however, will rise to 26,550 in 2015, up 36% from 2002.

That would seem to be good news for the physician shortage, but the real bottleneck for future doctors is the number of residency slots. U.S. med school graduates vie for those spots with international graduates and osteopaths, and that competition is likely to heat up, the AAMC report says.

Read the full article in The Wall Street Journal, or click here:
http://blogs.wsj.com/health/2010/05/10/med-school-enrollment-in-2015-will-miss-goal/

The Must-Haves in Academic Med Center Employment Contracts

Our firm has experienced a surge in academic positions. We are constantly working with physician candidates seeking academic positions, and there are many desirable positions available.

We thought it appropriate to include an article on what academic candidates can confirm is in their employment contracts. MedCenter Today has published an article on what academic contracts should include to protect the candidate and confirm they are getting a competitive offer.

According to MedCenter Today, many prospective faculty members fail to review the contract from the perspective of how well they are protected not only during employment but in the event they leave the organization.

Read the full article by clicking here:
http://www.medcentertoday.com/article.php?id=48&chapter_id=5

Physician Employment Contract: Ending a Practice Relationship

Exiting a process can be an emotional and complex transition. Professional liability insurance is a concern that needs to be addressed before a physician leaves a practice situation for any reason.

There are two main types of insurance policies for professional liability: claims-made and occurrence-based coverage, most medical practices maintain claims-made professional liability insurance coverage.

While professional liability insurance may not be the first thing on a physician's mind when joining a practice, it most definitely is a key concern when leaving a practice. In order to prevent unexpected surprises, both parties need to be sure to have the liability insurance provision of their employment agreement solidified such that all parties are on the same page in the event of one of the physician's departures, or the dissolution of the practice itself.

Read the full article at American Medical News, or click here: http://www.ama-assn.org/amednews/2010/05/03/bicb0503.htm

Healthcare Spending Slows, Still Outpaces the National Economy

National health expenditures grew in 2008 at the slowest pace in nearly 50 years yet still outpaced economic growth at large, according to a new report from the California HealthCare Foundation.

Despite these findings, CHCF projections suggest that the recession-driven contraction in the economy, coupled with a modest increase in healthcare spending, will raise healthcare's share of the economy for 2009.

Read the full article at Healthcare Finance News, or click here:
http://www.healthcarefinancenews.com/news/healthcare-spending-slows-outpaces-national-economy

Increase of Medical School Graduates Matching to Primary Care Residencies

The number of U.S. medical school seniors who will enter residency training in family medicine rose 9% over 2009, according to the National Resident Matching Program (NRMP).
This is positive news as there has been a concern over an upcoming shortage of all physicians, particularly those in Family Medicine and Primary Care.

In 2009, the number of U.S. medical school seniors placed in family medicine residencies dropped by 7%. This year, 2,608 training slots in family medicine were offered, 73 more positions than last year. U.S. seniors filled 1,169 of those positions, compared to 1,071 in 2009.

According to the NRMP, this was the largest Match in history: 30,543 applicants participated, 655 more than last year and 3,800 more than in 2006.

The New England Journal of Medicine has published an article detailing the match results. Read the full article here: http://www.nejmjobs.org/rpt/more-medical-school-grads-match-primary-care.aspx

Physicians: What to Consider When Making a Career Move

Summer is quickly approaching and most of our 2010 residency graduates and fellowship candidates have signed employment contracts. However, there are still some candidates available and many positions available to them.

Obviously a lot of job movement takes place for recent graduates, however many of the candidates we work with are experienced and are looking for a job change for a number of reasons including leadership, climate, change in employment model, and income. An estimated 40% of newly practicing physicians choose to leave their initial practice opportunity within two years of joining the group.

The New England Journal of Medicine has published an article on what physicians need to consider when making a career move. To read the full article, click here:
http://www.nejmjobs.org/career-resources/career-move-issues.aspx

MGMA: Physician Recruiters Are Filling Vacancies More Quickly and Efficiently

MGMA has published a report indicated internal physician recruiters are filling physician vacancies quicker compared to previous years. The survey focused on cost, duration, location and frequency of physician searches, as well as physician turnover as reported by internal physician recruiters.

At our physician recruiting firm, many of the hospitals and larger facility corporations we use utilize a combination of agency firms and in-house (internal) recruiters. We work on a contingency and find this a very effective way to utilize several resources to provide the most qualified and experienced physician candidates to our clients.

The MGMA’s report, “In-House Recruitment Benchmarking Survey: 2010 Report Based on 2008 Data,” showed that most specialties reported a decline in the cost and number of resources associated with filling these positions.

Read the full article at Healthcare Finance News, or click here:
http://www.healthcarefinancenews.com/news/mgma-physician-recruiters-are-filling-vacancies-more-quickly-efficiently

Health Industry Continues to Hire as the Economy Recovers

Several reports released in March and April suggest demand for health care jobs is growing. Many of these jobs are in health care support roles, such as RNs, PTs, OTs, and Speech Pathologists. In our firm we have read one alternative to the shortage of physicians, particularly with health care reform, is hiring additional support staff and even potentially giving some positions, such as nurses, more responsibilities.

The number for health care practitioners and technical workers, a category that includes physicians, grew by more than 88,000 to 627,300 ads in March from 539,200 in February. Ads in March were at their highest level since April 2008.

Read the full article in American Medical News, or click here:
http://www.ama-assn.org/amednews/2010/04/19/bisd0419.htm

Doctors Pursue House and Senate Seats

USA Today reports that 47 physicians - 41 Republicans and six Democrats - are running for the House or Senate this year, three times the number of doctors serving in Congress today. An influx of doctors to Congress could alter the landscape for future debates over Medicare and rising insurance premiums months after lawmakers approved President Obama's 10-year, $938 billion health care law.

Physician candidates start with at least one political advantage: voter confidence. A Gallup Poll in March found 77% of Americans trust doctors to do "the right thing" on health policy, compared with 32% for Republican leaders and 49% for Obama. "Physicians just have a different mind-set toward problem solving," said Larry Bucshon, a Republican heart surgeon running for a House seat in Indiana. "It's very good training for being a congressman." Sen. Tom Coburn, R-Okla., a doctor and opponent of the health care law, said more physician input may have led to a better law. "The physician perspective was ignored during the last year and a half," he said.

Read the full article in USA Today, or click here:

http://www.usatoday.com/news/washington/2010-04-19-doctors_N.htm

Health Plan Pushes for Help for Small Physician Practices

At our physician recruiting firm we receive a lot of feedback on the government assistance with updating physician records to electronic records. Although the updates are proven to provide better information more easily accessible to physicians and to share amongst physicians and other specialists and proven to save money, the process of updating all patient records can seem overwhelming to a physician practice, particularly a smaller physician practice without as many administrative resources.

A managed care health insurer wants to help regional health IT extension centers with their support of small physician practices that it fears could fly under the radar.

The Office of the National Coordinator for Health IT has awarded grants to set up 60 extension centers across the nation to offer hands-on help to providers in putting EHRs into practice. One of ONC's goals is to give small providers the technical resources they need to meet meaningful use requirements in order to qualify for incentive payments under the HITECH Act.

Read the full article in Healthcare IT News, or click here:

http://www.healthcareitnews.com/news/health-plan-pushes-help-small-physician-practices

U.S. Faces Shortage of Doctors

The Wall Street Journal reports that there won't be enough doctors to treat the millions of people newly insured under the law. At current graduation and training rates, the nation could face a shortage of as many as 150,000 doctors in the next 15 years, according to the Association of American Medical Colleges.

The greatest demand will be for primary-care physicians. These general practitioners, internists, family physicians and pediatricians will have a larger role under the new law, coordinating care for each patient. The U.S. has 352,908 primary-care doctors now, and the college association estimates that 45,000 more will be needed by 2020. But the number of medical-school students entering family medicine fell more than a quarter between 2002 and 2007.

Read the full article in The Wall Street Journal, or click here:
http://online.wsj.com/article/SB10001424052702304506904575180331528424238.html

Healthcare Market to be 'Bullish' Over the Next Decade

A new report issued by PricewaterhouseCoopers suggests that the healthcare industry will be a promising place in which to work and invest over the next decade.

PwC's "HealthCast" report, which analyzed the influence of consumerism, genomics, and the Internet on healthcare, concludes that healthcare jobs, including new positions such as healthcare navigators, health educators and care coordinators, will be in high demand. There should also be an increasing need for primary care physicians, nurses, and physician's assistants, according to researchers.

The article continues on the trends we are constantly reading about in our firm: the impending physician shortage and how hospitals can retain and attract physicians and remain competitive.

Read the full article in Healthcare Finance News, or click here:
http://www.healthcarefinancenews.com/news/healthcare-market-be-bullish-over-next-decade

2010 Match

AMA Graduate Medical Education has published the 2010 match results.

According to AMA, the results of the 2010 Match provide some answers but leave many questions unanswered.

Are more unmatched US medical school graduates sitting it out for a year or two? Doing what?
What happens to those who match or scramble into a preliminary or transitional year but don't secure a position in a core ACGME program? Since US medical school graduates can enter practice in most states after just one year of GME, do they?

What about the large and growing number of IMGs (including US citizens) who fail in their attempts to enter GME?

Since we face a national physician shortage, can we afford to delay the training or lose the expertise of any qualified residency applicant?

Perhaps most important for our patients' sakes, will the career choices reflected in these results ensure an adequate, well-trained, competent, diverse, and well-distributed medical workforce?

Please read the tables in the AMA eNewsletter; out of all specialties provided there were 25,520 available, 24,378 filled, and 1,142 left unfilled.

Read the full article in AMA, or click here:

http://www.ama-assn.org/ama/pub/education-careers/graduate-medical-education/gme-e-letter.shtml

Forging a New Partnership with Physicians to Increase Satisfaction and Reduce Turnover

This article from The New England Journal of Medicine was published a few years ago, but we find the topic relevant, particularly because some of our recent topics like "More doctors giving up private practice" have generated so much discussion.

Working with our hospital clients it isn't important just to attract a physician and get them to sign an employment contract, but to continually analyze the relationship to make sure the physician and hospital are continuing a mutually beneficial partnership.

In the article, Press Ganey Associates’ 2008 Hospital Check-Up Report — Physician Perspectives on American Hospitals highlights a number of opportunities to improve relations with the medical staff, increase physician engagement with the hospital, and reduce the risk that doctors will open competing facilities.

Read the full article in The New England Journal of Medicine, or click here:
http://www.nejmjobs.org/rpt/reduce-physician-turnover.aspx

Private Practice Physicians vs. Academic Physicians

Healthcare Finance News has published an article on the compensation of private practice physicians vs. academic physicians. Not surprisingly, private practice physicians tend to make more money than academic physicians.

Many of our candidates are interested in academic careers; we find the motivation to be an academic physician is based more on professional fulfillment and self actualization than monetary remuneration. Individual candidate character, intellectual pursuit and teaching capacity, and personal vision, are the dominant features that inspire many of the candidates we work with seeking academic positions. Plus, the opportunity to teach the physicians of tomorrow and to be a part of research which will contribute to medicine as a whole is very fulfilling.

Read the full article from Healthcare Finance News here:
http://www.healthcarefinancenews.com/news/private-practice-physicians-make-more-those-academic-practices

State Medical Boards Discipline More Docs in 2009

Each year, the Federation of State Medical Boards publishes the Summary of Board Actions, a compilation of disciplinary actions initiated by its 70 member medical boards. In addition to providing disciplinary data, the report includes information about the context in which each board operates, including standards of proof required when prosecuting cases and the health care professions regulated. This year's report includes disciplinary data for each board from 2005-09.

During 2009, state medical boards took 5,721 actions against physicians, an increase of 342 actions over 2008. The FSMB also provides Summary of Board Actions reports since 1990. Because states operate with different financial resources, levels of autonomy, legal constraints and staffing levels, the FSMB discourages using data from this report to compare or rank states. The Summary of Board Actions is most useful in tracking trends in physician discipline within each state over time.

Read the full article in PhyisiciansNews, or click here:
http://www.physiciansnews.com/2010/04/02/state-medical-boards-discipline-more-docs-in-2009/

Social Media and Physicians

The New England Journal of Medicine has commented on the increasing trend of social media use amongst physicians. As usage grows among doctors, benefits, challenges, and liability concerns are emerging. Doctors are not only blogging about their views on health care or political issues; they’re also creating Facebook pages and jumping into the fray of Twitter.

A Manhattan Research survey published in early 2009 reported that 60% of U.S. physicians are either actively using social media networks or are interested in doing so. In the ensuing year, during which health care reform and pressing public health issues such as H1N1 containment took center stage, physician participation in blogs and on the popular networking communities Facebook, MySpace, and Twitter has likely grown significantly.

The last two years have also spawned several new networking sites devoted to physicians, and social media has made its way into virtually every aspect of the health care delivery realm. Hospitals are developing Facebook pages and establishing Twitter presences, and physicians in training have even “Tweeted” from the operating room to share their experiences with other physicians.

However, despite the potential professional benefits of social networking participation, some physicians are approaching the social media realm with trepidation, for fear that personal and professional presences will overlap in a manner that increases liability exposure. On the downside of the social media trend, studies such as one published in the September 23 to 30, 2009, edition of the Journal of the American Medical Association have shown that medical students have used the forums inappropriately to discuss individual patients.

Read the full article in The New England Journal of Medicine, or click here:
http://www.nejmjobs.org/career-resources/social-media-and-physicians.aspx

Impending Physician Shortage: New Medical Schools are Opening, Shortage Still Concerning

The Association of American Medical Colleges predicts a shortage of at least 125,000 physicians by the year 2025. The number of residents and fellows increased 8% from 1987 to 2007, according to an AAMC report, but that growth rate will not be enough to match the loss of baby boomer physicians set to retire soon; one in three active physicians currently practicing is 55 or older.

However some experts on work-force issues say new schools are not enough to significantly alleviate the upcoming physician shortage. We have also heard from many of our candidates that with the uncertain future for the medical community because of health care reform many potential applicants are not applying for medical school or changing from pre-med to other disciplines.

Without more federal funding for residency slots or changes in the doctor payment system, the schools are unlikely to avert an overall work-force shortage or address the undersupply of primary care physicians and general surgeons.

Since 2007, more than a dozen allopathic schools have started the Liaison Committee on Medical Education accreditation process. Another 10 are under discussion, and five osteopathic medical colleges have opened.

There are 13 allopathic schools in the accreditation process, with at least 10 more in the planning stages. In addition, five new osteopathic schools have opened across the country. Educators and physician leaders hope that the graduates of the new schools will help ease a predicted physician shortage, but they add that more funding and residency positions will be needed to avert future holes in the overall work force.

Read the full article in American Medical News, or click here:
http://www.ama-assn.org/amednews/2010/03/29/prl20329.htm

Hospital Employed Positions for Physicians Increasing

Hospitals & Health Networks has published an interesting article on the increasing trend of physician employment. Many of the hospitals we recruit for are changing models from income guarantees to full hospital employment, and many of the physician candidates we work with request hospital employment positions.

H&HN agrees, physician employment by hospitals is increasing. According to their article, the American Medical Association reports that the total number of physicians employed in community hospitals increased 24% between 2003 and 2007, while the number of physicians nationally increased only 8%.

In addition, a recent survey by the Society for Healthcare Strategy and Market Development indicated that health care leaders across the nation believe the percentage of physicians on hospitals' active staffs who are employed will increase from 10% today to 25% by 2013.

Read the full article in Hospitals and Health Networks, or click here:

http://www.hhnmag.com/hhnmag_app/jsp/articledisplay.jsp?dcrpath=HHNMAG/Article/data/09SEP2009/090922HHN_Online_DeBoer&domain=HHNMAG

More Doctors Giving Up Private Practices

Traditionally, American medicine has been largely a cottage industry. Most doctors cared for patients in small, privately owned clinics - sometimes in rooms adjoining their homes. However an increasing share of young physicians, burdened by medical school debts and seeking regular hours, are deciding against opening private practices. Instead, they are accepting salaries at hospitals and health systems. And a growing number of older doctors - facing rising costs and fearing they will not be able to recruit junior partners - are selling their practices and moving into salaried jobs.

As recently as 2005, more than two-thirds of medical practices were physician-owned - a share that had been relatively constant for many years, the Medical Group Management Association says. But within three years, that share dropped below 50%, and analysts say the slide has continued. The process feeds on itself because doctors who remain in private practice worry that as their peers sell out, their own options become more limited and the prices for their own practices fall.

The trend away from small private practices is driven by growing concerns over medical errors and changes in government payments to doctors. But an even bigger push may be coming from electronic health records. The computerized systems are expensive and time-consuming for doctors, and their substantial benefits to patient safety, quality of care and system efficiency accrue almost entirely to large organizations, not small ones.

Read the full article in The New York Times, or click here:

http://www.nytimes.com/2010/03/26/health/policy/26docs.html?ref=health

Twitter Becoming Essential Tool Amongst Physicians

Healthcare IT News tracks more physicians utilizing Twitter, so much in fact it is becoming an essential communication tool.

Doctors don't generally use Twitter to give medical advice but to guide the public and other physicians and colleagues to reputable sources of information or share breaking medical news.

Twitter will soon be an essential tool for medical practices according to a poll conducted by Case Western University, an independent research university in Cleveland.

Fifty-nine percent of those who participated in the poll voted "yes" that Twitter would become an integral part of the way doctors communicate with patients and other medical professionals.

Read the full article in Healthcare IT News, or click here:

http://www.healthcareitnews.com/news/twitter-becoming-essential-tool-docs

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Physicians: Selling Your Practice

Whether you are planning to start a new employed position or retiring, selling your current practice is a very important consideration.

Medical practice sales experts recommend that doctors follow a series of steps, ideally beginning the process two or three years before the desired time of sale. These measures include getting financial records in order, making the practice visually appealing, setting realistic price expectations, communicating the interest to sell and planning the transition.

Read the full article in American Medical News, or click here:

http://www.ama-assn.org/amednews/2010/03/15/bisa0315.htm

Physician Recruitment Income Guarantees Ease Hiring Of New Docs

Many of the larger facilities we work with offer new physician employees income guarantees as part of their employment package. Recently, physician income guarantee agreements are enjoying a resurgence.

What is an income guarantee? The facility guarantees that the new physician will earn a set amount of total income in the first 12-24 months of employment. If the cases completed do not reimburse the physician according to the guarantee level, the facility pays the additional income to the physician, thus 'guaranteeing' a certain amount of income. Technically, this is a “loan” to the doctor, but the “loan” is forgiven if the physician remains in practice in the hospital’s service area for 2-4 years after the guarantee period.

Income guarantees are becoming more common in new physician employment offers. The income guarantee serves to alleviate the concerns of the group or facility that if it hires the new physician, the senior doctors will be forced to take a pay cut to fund the new doctor’s salary, as that doctor ramps up his or her practice.

Income guarantee agreements are complex, and there are generally many strings attached, i.e. potentially no non-compete for group, taxes issues, and liability issues.

Daniel M. Bernick is an Attorney and Principal of Health Care Law Associates and has provided an article explaining income guarantees and also 7 core legal and business pointers about the guarantee agreements.

Read the full article in Physicians News Digest, or click here:

http://www.physiciansnews.com/2010/01/14/physician-recruitment-income-guarantees-ease-hiring-of-new-docs/

NEJM Physician Survey: Health Reform May Lead to Significant Reduction in Physician Workforce

The New England Journal of Medicine has published a physician survey determining the impact of health reform on physicians and ultimately on medicine as we know it today.

The BLS (Bureau of Labor and Statistics) predicts a more than a 22% increase in physician jobs during the ten-year period ending in 2018. This places physician careers in the top 20 fastest-growing occupations from 2008 to 2018. Meanwhile, nearly one-third of physicians responding to this survey indicated that they will want to leave medical practice after health reform is implemented.

The Medicus Firm, a national physician search firm based in Dallas and Atlanta, conducted a survey of over 1,000 physicians to determine their expectations as to the impact of health reform on their practices, income, job satisfaction, and future career plans.

Although it's probably unrealistic that nearly half of the current practicing physicians will exit the medical practice industry after a version of health reform were implemented, even if a much smaller percentage such as 10, 15, or 20% are pushed out of practice over several years at a time when the field needs to expand by over 20%, this would be severely detrimental to the quality of the health care system.

The survey indicates that doctors do want change in our current healthcare system. Only approximately 4% of physicians surveyed feel that no reform is needed. However, only 28.7% of physicians responded in favor of a public option as part of health reform.

What does this mean for physician recruiting? It’s difficult to predict with absolute certainty, but one consequence is inevitable. After health reform is passed and implemented, physicians will be more in demand than ever before. Shortages could be exacerbated further beyond the predictions of industry analysts.

Read the full article in the New England Journal of Medicine, or click here:

http://www.nejmjobs.org/rpt/health-reform-may-reduce-physician-workforce.aspx

Percentage of Physicians Practicing in the State Where They Completed Training

The New England Journal of Medicine has published an article tracking the percentage of residents and fellows that ended up accepting positions in the states where they completed training.

According to the NEJM, after completing training in an ACGME-accredited program, 47.6% of physician graduates either stayed or returned to the state where they completed GME. Retention rates were highest for physicians who completed both UME and GME in the same state. Two thirds of the physicians who completed UME and GME in the same state accepted positions in the same state.

Six of the top ten states with the highest GME retention rates were in the West. In terms of overall retention, 8 of the top 10 states were n the South and West.

The New England Journal of Medicine has created a map tracking GME retention. Read the map on their website, or click here:

http://www.nejmjobs.org/rpt/acgme-retention-rates.aspx

Healthcare Sector Job Growth: Continued Increases Expected

The Healthcare Sector has created additional jobs in January reports, slightly impacting the economy as a whole. The Bureau of Labor Statistics reported on the national employment situation on February 5th an increase in healthcare jobs, and the organization along with other reports suggest the trend in an increase of healthcare jobs will continue.

According to the Bureau of Labor Statistics, January reported an increase of healthcare jobs of 15,300 new jobs in ambulatory medical centers, including 5,600 in physician offices. Another 5,000 were added to hospital payrolls. More jobs were created this past January in the health care industry than at this time last year.

Experts say this is being driven by the fact that, although some areas of the country are experiencing shortages of medical professionals, there are more physicians entering the marketplace, and very few, if any, end up working alone. According to MGMA data, a physician needs an average of 4.5 support staff, although this can vary by specialty.

Other surveys supported the idea that health care is driving job creation and will continue to do so. A report by the Conference Board issued February 1st found that the number of jobs advertised online increased 382,000 and topped 4 million for the first time since November 2008. Listings for health care professionals increased by 24,500, bringing the total for this category to 567,800. About 6,500 additional ads were placed for medical support staff for a total of 119,000.

Read the full article in American Medical News, or click here:

http://www.ama-assn.org/amednews/2010/02/22/bisc0223.htm

Physician Employment Contracts

Once our candidates have decided they would like to move forward with one of our opportunities, the contract negotiation process begins. While many candidates believe the decision has been made and they have confirmed where they will be practicing, the contract can be the most difficult, and the most essential, part of the entire job search process.

Physician employment contracts have become increasingly complex. While candidates may initially focus on contract provisions that define income, benefits, and working conditions, they must also recognize the importance of other business-related stipulations. These include partnership requirements, termination clauses, and non-compete agreements.

The New England Journal of Medicine has provided some good suggestions and information to consdier before officially penning your name on an employment contract. While the publication offers very good advice, it is crucial you also run any contract by your own lawyer and even your accountant. As always, your recruiter can also help you with this process.

Here are some tips the article suggests:

-Ask, and answer, key questions before moving to contract negotiations.
-Strike a fair non-compete clause by obtaining pertinent information first.
-Avoid discussing compensation or other key terms before seeing a contract, even a “sample” one.
-Request practice financial documents early on in contract discussions, and beware of practices that won’t produce them.


Read the full article in the New England Journal of Medicine, or click here:

http://www.nejmjobs.org/career-resources/physician-job-contracts-update.aspx

2009 Health Spending Increase

National health spending may nearly double by 2019; 2009 saw the largest recorded one-year increase in health spending as a percentage of the economy, and it's only going up according to CMS actuaries.

A shrinking economy combined with greater public health spending in 2009 produced a 1.1% point increase in national health spending as a share of gross domestic product, the largest single-year jump since records began in 1960. This was largely because of a spike in Medicaid spending and relatively low growth in private spending. Spending on doctors is expected to reach 6.6% by 2017 as the economy recovers.

A Medicare physician payment cut scheduled to take effect March 1 would significantly impact spending on doctors, according to the report. Under the cuts, total spending on physicians and clinics would increase by 1.5% in 2010. If prevented, such spending would increase by 4.1%.

Read the full article in American Medical News, or click here:

http://www.ama-assn.org/amednews/2010/02/15/gvsf0218.htm

Physician Practices: Competing in the Marketplace

Our firm works with many private practices, and even several solo practices looking to add one other physician. The American Medical Association provides strong tools and resources to add the most value and profit to any practice, particularly smaller practice models.

"Competing in the Marketplace" provides a practical and pragmatic overview of the integration options- ranging from mergers to a wide variety of other contractual arrangements. Running a small or solo practice can prove extremely financially rewarding if operated correctly, however many changes in the marketplace have placed sever financial strains on physicians that can only be addressed by some form of integration.

To help physicians choose for themselves a level of integration that makes sense given their specific goals, the AMA identifies many of the benefits and drawbacks of several integration arrangements in the attached resource.

Please read the full article in AMA, or click here:
http://www.ama-assn.org/ama1/pub/upload/mm/368/competing-in-market.pdf

Physician Survey: How Recession has Affected Practices, Shortage in Primary Care Physicians

About 9,000 primary care physicians nationwide are being surveyed to examine work force matters, medical homes, and other practice issues. One goal is to help determine whether there are enough primary care physicians to tend to the nation's needs, especially if insurance coverage is extended to more people in a reformed health system.

Questions on the four-page survey include asking whether physicians plan to work longer hours or hire more staff if they experience an influx of new patients. The survey also is assessing physicians' readiness to establish patient-centered medical homes, asking if electronic medical records or disease registries are part of their practice.

Primary care physicians and subspecialists in pediatrics and internal medicine received the surveys, Salsberg said. Collaborating on the effort with the AAMC are the American Medical Association, American College of Physicians, American Academy of Family Physicians, American Academy of Pediatrics, and American Assn. of Colleges of Osteopathic Medicine.

Read the full article in American Medical News, or click here:

http://www.ama-assn.org/amednews/2010/02/08/prsd0210.htm

New U.S. Medical Schools to Open

Medical school applications are hitting an all-time high. The proliferation of new schools is also a market response to a rare convergence of forces: a growing population; the aging of the health-conscious baby-boom generation; the impending retirement of, by some counts, as many as a third of current doctors; and the expectation that, the present political climate notwithstanding, changes in health care policy will eventually bring a tide of newly insured patients into the American health care system. For several years many potential students have been attending offshore medical schools, or giving up hope entirely, when they could not get into domestic schools.

The United States has recently opened, or has impending openings, of nearly two dozen medical schools, the most at any time since the 1960's and 1970's. These new schools are seeking to address an imbalance in American medicine that has been growing for a quarter century. Meanwhile, American hospitals were using foreign-trained and foreign-born physicians to fill medical residencies. During the 1980s and '90s only one new medical school was established. If all the schools being proposed actually opened, they would amount to an 18 percent increase in the 131 medical schools across the country. (By comparison, there are 200 law schools approved by the American Bar Association.)

Read the full article in the New York Times, or click here:
http://www.nytimes.com/2010/02/15/education/15medschools.html?ref=health