Monday, December 19, 2011

Key Factors in Hospital Employment Contracts

Hospital Employment continues to be an increasing trend in physician employment models. However American Medical News recommends physicians keep in mind the following 7 items before signing a hospital employed contract:

1. Job Description
2. Restrictive Covenants
3. Outside Activities
4. Payment Recoupment
5. Tail Coverage
6. Call Coverage
7. Contract Termination

Before physicians sign any employment contract it is important they understand not only the terms of their compensation but key factors in the entire employment picture. If both parties have a comprehensive understanding of exactly what the incoming physician will be doing including all responsibilities, precisely how they will be compensated including any production or RVU based bonuses, and all other requirements of the position it will avoid confusion and possible unpleasantness after the contract has been signed.

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

Thursday, December 15, 2011

Physician Shortage: Not So Grim in Certain Locations

There has been a lot of press on the threat of the current and impending physician shortage; however not all states are experiencing the same concerns of physician shortages. On a national level, Scripps Howard News Service has reported that new research determines not all areas are under as much pressure for current physician demands as well as any new demands health care reform may require.

This is still a good market for most any specialty physician, surgeon, or family practice physician to find a job based on their personal motivators, but some areas are not as tight on physicians of all kinds as other locations. Rural areas and areas with a high percentage of retired patients are typically experiencing an increased demand for physicians compared to larger, metropolitan cities.

Another encouraging figure comes from the Association of American Medical Colleges (AAMC) which reports the number of medical school applicants is at an all-time high. First-time applicants increased 2.6% from last year to 32,654 students, and total applicants rose 2.8% to 43,919 applicants, AAMC said in an October report. Actual enrollment rose 3%, according to Scripps Howard.

Colorado is one of the states that isn't feeling too much pressure regarding the physician shortage, even considering health care reform, if it continues to move forward. However Oklahoma is concerned about the current and impending shortage; The University of Oklahoma and Oklahoma State University are even encouraging the state to recruit and train more physicians. South Carolina is another state that is concerned about the current and future demands for physicians.

Read the full article by clicking here:

Monday, December 12, 2011

100% Increase in Physician Practice Employment Expected in 2011

2011 has proven to be a strong year for employing positions in physician practices. With the year almost over, the Bureau of Labor and Statistics has reported that employment in physician practices will nearly double from figures last year.

The Bureau of Labor and Statistics does not track position titles, however based on classified and job board listings most of these positions are in clinician roles.

The physician shortage is still apparent, 2012 is looking to continue to be a strong year demanding physicians of all specialties in both hospital based and private physician groups.

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

Tuesday, November 15, 2011

End-of-year Tax Tips for Physicians

Some of these tips relate solely to your personal tax return, some pertain to physicians who own their practice and thus file a corporate return, and some could apply to either personal or corporate returns.

Here are some tips, "P" refers to personal returns and "B" refers to business:

1. Donate More to Your Hospital, Medical Research Charities, or Other Qualified Organizations (P, B)

2. Defer, Defer, Defer (P, B)

3. Set Aside More for Retirement (P, B)

4. Sell Stocks That Are Losers! (P)

5. Take a Business Trip for Continuing Education or to Broaden Your Clinical Horizons (P, B)

6. Add Up Any Job-Hunting Costs (P, B)

7. Buy More Business or Medical Equipment (B)

Some of these advantages may go away for 2012, now is the time to start taking advantage of any breaks for 2011 returns.

Read the full article in MedScape, or click here:

Monday, November 14, 2011

Physician Compensation Update

In most specialties physicians are seeing an increase in compensation from last year. According to MGMA data the specialties experiencing the most dramatic increases were dermatology, emergency medicine, neurology, orthopedic surgery, and pulmonary medicine. The few specialties experiencing a decline were invasive cardiology, urology, and ophthalmology.

Experts say the big picture will most likely cause physician compensation to flatten, but the ever-rising demand for services should have an upside offsetting effect.

Hospitals and medical groups are also becoming more open-minded in their employment offers, trying to stay competitive not only from a salary stand-point but also offering enticing benefit packages, relocation, paid vacation and CMEs, and other incentives to create a big-picture compensation package.

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

Monday, November 7, 2011

Changing Career Path: From Clinical to non-Clinical

For a variety of reasons some physicians seek to switch their clinical career to a non-clinical position. However once they make that change it is very difficult to shift back to even a limited clinical practice, so it is important if you are considering making this change to take all factors in to account. After more than 2 years of a non-clinical position, it is very difficult to switch back to a clinical career.

While making the transition the focus doesn't have to have a dramatic stop to clinical work, it can be a slow decrease over time of a less clinically focused practice. Many physicians continue to maintain their state licenses and also up to date CME requirements to keep a possibility of more clinical work in the future.

The switch to a non-clinical position is very desireable to many phsyicians both as a retirement alternative as well as a research outlet for younger physicians. However the consequences are severe if the decision is based on short-term objectives, it is crucial to be certain you are ready to make the switch prior to completely transitioning out of a clinical position.

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

The Art of Negotiating Physician Employment Agreements

Negotiating an employment contract prior to starting a new physician practice opportunity is paramount in ensuring a mutually beneficial long-term relationship with both the physician and the hospital. This is the only opportunity both parties have to ensure their respective needs are being met.

Whether you're the head of a medical practice inviting an experienced physician to join the group, or a resident contemplating a Letter of Intent, fair and effective negotiations are crucial to establishing a long-term working relationship.

Forethought, preparation, and the ability to listen are essential to success. Often times by the time most physicians realize that the terms of their Agreement are less than propitious it is usually too late. Most disputes between physicians and employers resulting in termination aren't related to medical competence. More often than not, physicians claim that their employers failed to inform them of, or misrepresented, working conditions, patient workload, call responsibilities, partnership potential, or the prospects for increased compensation.

During the negotiation process sometimes physicians become blindsided for lack of preparation and the failure to rank priorities effectively. It is important to consider a personal balance of long-term priorities over the course of your career including location, family, community amenities, and compensation.

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

Tuesday, November 1, 2011

Quality Incentives Become Bigger Factor in Physician Compensation

With the increase of employed physicians and hospital employed positions, hospitals are increasing their flexibility to offer multiple types of incentives in addition to salaries.

According to a recent study from the Hay Group, "2011 Physician Compensation Survey," 64% of health care organizations offer an annual incentive plan to physicians. Incentives in addition to salary vary in their scope and are sometimes specialty specific but are generally based on either volume based incentives or quality based bonuses.

Quality and patient satisfaction, which public and private insurers are pushing as an incentive over productivity, were key factors in determining incentive pay.

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

Thursday, October 20, 2011

Physicians to Receive Smaller Raises in 2012

Physicians in all specialties (including primary care) can expect to see smaller compensation increases in 2012 compared to 2011, but those in group practices won't be hit quite as hard, according to Hay Group's 2011 Physician Compensation Survey released this week.

In particular, the survey predicts physicians across all organizations to get pay increases of 2.5% next year, down from actual increases of 2.7% average in 2011. Physicians working in group practices, while also getting less than last year, are expected to earn slightly higher pay increases of 3.2% in 2012 versus 2.5% for those working in hospital-based settings.

According to the survey, physicians' pay increases, from best to worst, are predicted for 2012 as follows:

Group-based specialist--4.5 percent
Group-based primary care--3.3 percent
Group-based overall--3.2 percent
Hospital-based primary care--2.9 percent
Hospital-based overall--2.5 percent
Hospital-based specialist--2.4 percent

In addition, researchers found that annual incentive plans for physicians were less common in 2011 (64%) than they were in 2010 (69%). Amongst organizations that did pay incentives, amounts continued to be determined based on quality and patient satisfaction.

Read the press release from the Hay Group at Fierce Practice Management by clicking here:

Wednesday, October 12, 2011

Laws to Consider in Hospital-Physician Co-Management Agreements

One alternative some physicians are finding to hospital employment is a co-management arrangement between existing physician practices and hospitals.

Driven by changing payment arrangements, including Shared Savings through accountable care organizations and bundled payment models, many organizations are partnering through the alternative co-management model.

The hospital and members of the physician practice typically set up a jointly owned company to manage a service line, according to an article by law firm Akerman Senterfitt, LLP, released last week. The management company and the hospital sign a written agreement about specific job tasks and goals, as well as compensation.

However, the agreement comes with some careful considerations, in which it must follow healthcare statutes and regulations. The article suggests the following laws to consider while making this type of arrangement:

-The Stark Law is aimed at preventing a physician from making patient referrals to organizations in which he or she has a financial relationship. However, there is an exception to the rule if the hospital's compensation to the management company is steady and doesn't vary with patient volume or referrals, according to the article.

-The Anti-kickback Statute is aimed at prohibiting payment for referrals for reimbursable services. If the hospital offers the medical staff member an opportunity for ownership interest in the management company, it may violate the Anti-kickback Statute.

-The Civil Monetary Penalties Statute prohibits a hospital from paying a physician to cut services to patients who are entitled under federal benefits. Therefore, be careful that efforts to meet quality benchmarks do not violate the statute.

In the changing climate for healthcare it is more important than ever for both hospitals and physicians to be open-minded when considering employment models or other alternatives to increase the quality of patient care and to benefit both parties, the physicians and the hospital networks.

Read the full article from law firm Akerman Senterfitt, LLP by clicking here:

Wednesday, September 28, 2011

5 Current Trends in Physician Salaries

With the current trend heading towards more hospital employment for physicians, what does this mean for physician's salaries? Hospital employment typically provides more stability in an uncertain market, however how will this trend affect the physician's salaries and compensation packages?

SullivanCotter and Associates' 2011 Physician Compensation and Productivity Survey recently gathered data from more than 60,000 physicians, residents, mid-level providers and medical group executives.

According to the survey, here are 5 trends consistent with today's physician salaries and starting compensation packages:

1. Economics don't support significant increases in physician salary.
2. On-call pay is rising.
3. Different pay models are forming based on physician.
4. Sign-on bonuses favor specialists.
5. Relocation packages are increasing.

With these uncertain economic times and also the healthcare compensation industry heading for significant changes it is more important than ever to negotiate your starting compensation package based on your long term goals; not only the salary but also location, quality of life, long-term advancement potential, and running your personal practice the way you trained for and envisioned.

Read the full article in Becker's Hospital Review, or click here:

Wednesday, September 14, 2011

25 Statistics on Physician Salary and Compensation

This is an interesting article from Becker's Hospital Review, they have compiled 25 statistics across various specialties on physician compensation.

In all specialties there are huge variables in physician compensation: geographical areas, practice model, bonus structure, and call just being a few of many different factors.

During contract negotiations we can use compensation data as a benchmark, but there is no scientific method for determining what a fair market salary can be for any physician specialty. It is important to consider not only income but also other motivating factors that will make your job your ideal physician position, i.e. quality of life, location, benefits, security, marketing, and stability just to name a few.

Read the full article in Becker's Hospital Review, or click here:

Thursday, September 1, 2011

The Business 
of Physician Recruitment

Currently there are many pending changes that will affect the healthcare industry, both from the perspectives of patients and physicians themselves with doubts of Medicare reimbursement, government intervention, and of course the state of the economy.

The existing physician shortage will only increase with the continued retirement of baby boomers and the changes in availability of insured patients. Now it is more important than ever for all parties seeking physicians to be competitive and open-minded in physician recruitment.

It is important for private practices, hospitals, and even academic facilities to be flexible in creating compensation packages and attracting potential candidates. Not only a competitive salary and benefit package, but also other incentives that appeal to a physician's quality of life such as ownership, shared call, vacation days, and other big-picture factors that contribute to the quality of an employment contract.

According to the “2009 Physician Retention Survey,” conducted by the American Medical Group Association and Cejka Search, there are some ways in addition to making income packages more attractive to appeal to physician candidates.

With the uncertain times ahead of us in the healthcare industry stability and incentives are more important than ever to attract top talent.

Read the full article in, or click here:

Wednesday, August 24, 2011

6 Steps to Creating Successful Hospital- Physician Integration

Integrated hospital-physician arrangements, which align clinical and financial interests, will be critical to the future success of hospitals and health systems.

An article published in Trustee magazine by experts at Kaufman, Hall & Associates, Inc., a healthcare financial strategy firm in Skokie, Illinois, suggests the following guidelines to ensure successfull hospital-physician integration:

-Develop an integration plan between the physicians and the organization: This integration plan should be combined with the overall strategic plan around service lines, facilities and technology, among other things.
-Ensure sufficient capital: Remember to identify, quantify and prioritize the financial and time costs of alignment. For example, acquiring a practice can cost $500,000 to $1.5 million per physician, according to the article.
-Use a disciplined approach to acquisitions: Be open to saying "no" if the opportunity doesn't benefit the organization or service line.
-Use structured physician compensation programs: Provide appropriate compensation that is based on fair-market value and productivity to stay competitive, as well as reward physicians for achieving goals.
-Integrate clinicians in quality: Involve the medical staff to achieve quality goals because they will likely be at the heart of care initiatives.
-Manage employed physicians: Closely look at revenue, productivity and costs to assess quality performance, outcomes, market share and satisfaction after the partnership.

Read the full article in Trustee, or click here:

Thursday, August 18, 2011

Physician Employment Trend: Is it the Physician's or Hospital's Best Interest?

There has been a lot of recent press on the increasing trend of hospital employment. However, employment models don't necessarily mean support from physicians or clinical integration, according to a new study released today by the Center for Studying Health System Change (HSC).

Following HSC's previous research that physician employment is on the rise, physicians reported feeling pressure to align with a hospital system. According to Accenture Health, by 2013, less than one-third of physicians will be in a private practice model, and instead will opt for employment under a larger health system.

However, under an employment model, physicians said they felt pressure to order more expensive tests or bring in more patients as part of a revenue- or volume-generating strategy.

Some physicians were deterred from employment because they wouldn't see the fruits of their labor. For instance, former independent physicians complained that, although their practice hadn't changed except for the hospital employment status, the hospital saw increased Medicare payments.

The report showed that physicians were attracted to hospitals that offered advantages such as financial security and work-life balance. For instance, the hospital could negotiate higher compensations with health plans that a private practice could not on its own.

Read the full report at The Center for Studying Health System Change, or click here:

Wednesday, August 10, 2011

4 Tips for a Strong Post-Recession Practice

Are we in a post-recession yet? Well hopefully if we aren't already we will be soon, so Fierce Practice Management has come up with 4 tips to strengthen your practice once we are officially out of the recession.

Because of the economic times, patients are struggling to pay their medical bills, making it continually difficult for practices to maintain healthy bottom lines.

Tough times like these call for tight policies, according to practice management experts. Although they may not all work for all offices, consider the following steps to help your practice emerge from the recession stronger than ever.

Collect patient responsibilities upfront. Although upfront collections have been the norm for some practices for years, more offices are making the switch now that patients' copays and deductibles are becoming more significant. Some practices even request patients provide their credit card numbers upfront to cover any uninsured fees.

Appeal denials. "Insurance companies make a lot of mistakes. And they count on (doctors) not appealing them," according to practice management consultant Judy Capko. As for public payers, she said, "Medicare denies approximately 11 percent, and 40 percent of these are never resubmitted. However, Medicare states that when a claim is appealed, 65 percent have resulted in increased payment."

Scrutinize overhead. For example, Dr. Kimberly Butterwick told ModernMedicine that she slashed marketing expenses by 12 percent and boosted patient flow at her aesthetic practice by offering two to three monthly specials through email blasts and by eliminating most of her print advertising. And Dr. Sanford J. Brown recently wrote in Medscape Today that he saves on rent by housing his practice in a residential fourplex, which he owns. The doctor converted one of the apartments to an office and rents out the other three for profit.

Fight fraud. Implement strong internal controls and convey a zero-tolerance message to employees about fraud, advised B.J. Hoffman in a recent column in Physicians News Digest. Based on data from the Association of Certified Fraud Examiners, a medical practice with a few employees and moderate income may well be suffering annual losses in excess of $10,000, he wrote.

Read the full article by clicking here:

Tuesday, August 9, 2011

Physicians Delaying Retirement Because of Recent Recession

Many physicians across all specialties have had to delay their retirement plans because of the recession starting in 2008. Unfortunately yesterday's news regarding the significant drop in the Dow doesn't show positive signs of the economy recovering, thus further delaying physician's retirement.

According to a survey released last week by Jackson & Coker, the number one reason why physicians are delaying retirement is the recession of 2008-2009, which wreaked havoc on their investment portfolios and net worth.

Of 522 physicians who completed the online survey, 52% said their retirement plans had changed since the onset of the recession. Of this group, which included physicians of all ages, 70% said they planned to work longer so they could make up for the downturn's pernicious effects on their investments.

The story is much the same for a subset of physicians who, just before the recession, had planned to hang up their stethoscope within 6 years, according to the Jackson & Coker survey. Fifty-five percent of them are postponing retirement on account of shrunken nest eggs. Another 4% who are working longer cite family or personal reasons, and 2% blame healthcare reform.

Read the full article in Medscape, or click here:

Highlights of MGMA’s 2011 Physician Compensation Survey

MGMA's "In Practice" Blog has summarized highlights from their recent 2011 Physician Compensation Survey.

MGMA collected data from nearly 60,000 providers. Some of the highlights include median compensation in Cardiology, Internal Medicine, and Emergency Medicine experienced an increase, while median compensation in Urology, Ophthalmology, OB/GYN, and Radiology experienced a decrease.

Read the full article at "In Practice," the Blog by MGMA, or click here:

Wednesday, August 3, 2011

Physicians To See Revenue Surge in 2014

Physicians will experience a revenue surge in 2014 when health insurance coverage dramatically expands under the Affordable Care Act (ACA), according to a study of healthcare spending by economists at the Centers for Medicare and Medicaid Services (CMS).

Public and private spending on physician and clinical services will grow by 8.9% that year compared with a growth rate of 5.6% in 2013 as individuals and small businesses begin to purchase health insurance with federal assistance through state-based exchanges, and Medicaid broadens its eligibility requirements. By 2020, an estimated 30 million individuals will gain coverage under the law.

Many of the newly insured will be younger and healthier, on average, than those already insured. Spending on hospital care, in fact, is expected to grow by only 7.2% in 2014.

Although 2014 will be a banner year for spending on physician and clinical services, annual growth of roughly 5% in this category from 2010 to 2020 will lag behind that for healthcare as a whole. What drags down this category is a Medicare pay cut of nearly 30% - triggered by the sustainable growth rate formula - that is set to detonate on January 1, 2012, unless Congress acts to avert it.

Read the full article in Medscape, or click here:

Friday, July 22, 2011

Improving Physician Integration Culture

With the trend of hospital employment and practice buy-outs, one sensitive aspect of the transition is the cultural clash that occurs between hospitals and physicians. To alleviate the challenges of hospital-physician integration, focus on leadership, teamwork, and communication; this according to a study by Healthcare Financial Management Association (HFMA) magazine.

According to a recent Accenture Health report, by 2013 less than 1/3 of physician practices will remain independent; in addition, healthcare mergers and acquisitions have hit an all-time high. Merger and acquisition deals are 26% more likely to be successful if all parties pay attention to resolving cultural differences during the negotiation and prior to the implementation of the new hospital group.

Culture can run the gamut of treatment of patients, referring physicians, and employees; decision-making process; performance rewards; risk; and quality and costs. Just as important is identifying who the leaders are in the physician practice and the hospital. The merging organizations should use these representatives to drive the process and communicate every step to each other.

A merger, buy-out, or lease of a practice can be more successful from the beginning if hospitals and physicians develop a measurable vision, understand the joint agreement, implement an organizational communication plan, analyze results, and measure cultural alignment.

Read the full article in Healthcare Financial Management Association magazine, or click here:

Monday, July 18, 2011

Rewards of Staying in a Private Practice

There has been so much reported on the decreasing number of private practices, it is refreshing to read about the rewards of staying in a private practice.

Although the hospital employment model has become more attractive to many physicians seeking new positions, the private practice model will always appeal to some physicians and there will be a market for the private practice, even in today's changing healthcare climate.

Some physicians, particularly those more entrepreneurial-minded, will always prefer to control how they wish to run their practice and not be 'owned' by a hospital which will dictate how they must operate their practice. They will deal with all aspects of running a practice including billing and overhead, however they can have 100% decision making power and elect how they wish to market and present their practice.

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

Monday, July 11, 2011

Hospital Employment Alternative: Lease Your Practice to a Hospital

There has been a lot of press on the trend toward hospital employment, driven from both physician candidates seeking new positions as well as hospital's desiring for employed physicians to be a go-to in-house resource.

This article from American Medical News provides an alternative to a typical hospital employment model: private practices can actually lease their practices to a hospital.

Although these terms can vary significantly, a private practice can often maintain most control over how their practice is run. Normally the hospitals lease hard-assets as opposed to purchasing the practice and creating a hospital employed situation for the physicians. Or, a lease can be an experiment for a private practice to see how it would be affected if the practice did decide eventually to sell to a hospital.

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

Wednesday, June 29, 2011

S&P: Outlook for Hospital Finances Bright

Standard & Poor's managing director of non-profit healthcare ratings has a generally positive outlook for healthcare facilities for the next couple of years. Martin Arrick, S&P's Managing Director, said in their annual conference many of the financial conditions of 2008 and 2009 have stabilized.

He added that S&P's upgrades outpaced downgrades by a significant margin in 2011. Many hospitals and systems that received downgrades in recent years have bounced back.

He observed that providers must negotiate a "new normal" of flat patient volumes and growth, which continues to pressure them to cut expenses. Also, the state governments will continue to cut Medicaid and other portions of their budgets that can affect the bottom lines of hospitals.

One thing that has yet to be determined is the affect health care reform will have on hospital's bottom line and how many new patients hospitals will see.

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

Wednesday, June 22, 2011

Physicians Still in Strong Demand

Despite the decrease in positions across the board in all industries and even now a slight increase in healthcare positions, demand for physicians in all specialties is still increasing. In fact, according to data released by the U.S. Bureau of Labor Statistics, medicine continued to be one of the few economic sectors still creating jobs in their June released report.

Physician positions appeared to have increased in all specialties with of course the most dramatic increase in primary care and internal medicine physicians.

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

Added Incentive to Recruit Recruit Elder Care Specialists and Physicians

Fewer than 400 geriatricians a year emerge from academic training programs, partly for perceptual reasons (students see it as a depressing field, though its practitioners find it very satisfying) but partly for financial ones. With virtually all their patients on Medicare, geriatricians are the least paid of all medical specialists. They are actually penalized for their decision to care for old people. After three years as internal medicine residents, their income drops by $15,000 if they complete the fourth year of training required to become a geriatrician. More training equals even less money.

Geriatrics specialists, incredibly, are not included in the federal law governing eligibility for the National Health Service Corps. The National Health Service Corps offers a loan forgiveness program to help pay off the staggering debt that many health professionals, including physicians, incur as students. Established to increase the supply of primary care practitioners, the corps allows geriatrics specialists to participate for now because of an intervention of the secretary of health and human services. But unlike professionals in family and internal medicine, and in pediatrics, the inclusion of geriatrics specialists is recent and impermanent. A future secretary could bounce them.

The Eldercare Workforce Alliance has proposed a modification to add geriatrics specialists to the corps' governing legislation. It's a simple bill, just 29 words long including the title, the Caring for an Aging America Act. It requires no additional expenditures, though if it succeeds in drawing more people into service, Congress might eventually decide to increase the corps' appropriation.

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

MGMA Report on Physician Compensation

MGMA will release their annual report next month, Physician Compensation and Production Survey: 2011 Report Based on 2010 Data. While the data obviously varies significantly by specialty, one common trend is geography. The report found that median compensation was highest in the southern states for both primary care physicians and specialists.

Another trend the report sited was the increase in physicians moving to hospital employed positions as opposed to starting solo practices or joining existing private practices. This has been discussed frequently over the last several months in multiple media outlets.

Whether physicians are looking for their first job out of training or looking to change positions, there are so many other factors aside from compensation they need to take in to consideration. Quality of life is a big factor many younger physicians are seeking in their job search. Shared call, guaranteed salary, vacation, and location are all important to provide physicians a balance in their life.

The private practice model is not completely dying out, there will always be a market for physicians who want to have full control over their practice and how they operate. It also doesn’t necessarily mean working 80+ hours per week to make decent income. Physicians can still enjoy a good quality of life in a private model with shared call and managed care organizations.

Whatever physicians today are seeking in their job search, there are many employment models to choose from. Models can sometimes be negotiated to in order to tailor to a physician’s preferences. It’s important with the changing healthcare environment both physicians and hiring organizations, whether they be hospitals, academic institutions, or private practices, are flexible in their negotiations to ensure both parties make a successful, long term placement.

Read the full article in HealthLeaders Media, or click here:

Friday, June 17, 2011

Physician Career Realties vs. Physician Career Expectations

This article is written highlighting Neurosurgery, although the same principals can be applied to other physician specialties.

In medical school and residency, training programs do a great job of teaching medical students clinical duties. However, how effectively do they teach future physicians real-life lessons on how to run or be a part of a practice?

At our physician recruiting firm we see higher percentages than even this article references, 50-60%+ of physicians changing jobs after their first contract out of training. It is so important for physicians to consider all of their motivating factors in their first job to avoid looking for another position once the first contract is up. This includes everything from call, location, community amenities, salary, bonuses, partnership, academic pursuits/ opportunities, and family.

To ensure physicians accept jobs out of training that fit what they are looking for not only in a position but also in a way of life and family they need to consider all factors in how they want to practice and how they want to live their lives.

Read the full article in the Congress of Neurological Surgeons, or click here:

Friday, May 27, 2011

Slight Increase in Academic Physician Compensation

Typically academic physician positions are compensated less than private practice and hospital employed physicians. Not only because more of their time is devoted to teaching and research, but also because the motivation to be an academic physician is generally based more on professional fulfillment and self actualization, in addition to contributing to the next generation of medicine. That is why it was inspiring that academic physicians experienced a slight increase in pay comparing 2009to 2010.

Academic faculty physicians in primary and specialty care enjoyed a slight boost in compensation according to Medical Group Management Association's (MGMA) report. Academic physicians that benefited from a slight increase were primary care, pulmonary medicine, and non-invasive cardiologists.

Read the full article in Fierce Practice Management, or click here:

In fact, academic physicians are Maryland's top earners, even considering athletic and top government incomes. Read the full article in the Baltimore Sun or click here:,0,4888916,full.story

Tuesday, May 24, 2011

Why Physician Compensation Plans Fail

The number one reason physicians leave their practice is discontent over their compensation. During the signing and negotiating process, many long-term compensation issues are not addressed and it leaves the physician unsatisfied with the compensation terms and less likely to re-sign a similar contract with the same group. Also, physicians are often not communicated with during their contract term and these issues are either not brought up prior to the contract completion or are not taken seriously enough to make changes that may keep the physician for another contract period.

MedScape has published their 2011 Physician Compensation Survey which provides data on many different specialty's compensation tracking geographic location, specialty, and even gender. View the results by clicking here:

They have also offered some guidelines on how to create compensation plans that work, not only during the negotiation process but also long-term once groups have signed physicians.

Here are some of their suggestions:

-Create a Compensation Plan with a goal of Preserving the Physician Group
-Annual Review of the Compensation Plan
-Structure Compensation Plans Specific to each Separate Physician Partner/ Associate

Read the full article at MedScape or by clicking here:

Thursday, May 19, 2011

Hospital Employed Physicians vs. Private Practice Physicians

The trend towards hospital employment is obviously increasing, but what does this mean to the individual physicians working with each other regardless of their employment model? Hospital experts predict hospital employment will increase from 10% currently to 25% by 2013, but how will this affect the general medical climate and for private practice physicians and hospital employed physicians working together?

Hospital employment is an increasing trend because many physicians desire to be paid a guaranteed salary and maintain a quality of life outside of practicing. However some physicians still migrate towards a more traditional guarantee or private model and feel they are able to maintain more control of running their own practice, and depending on the specialty, also receive income from other ancillary services.

With this increase in hospital employed physicians, will it widen the gap between private practice physicians? Also, how will the increase in hospital employed positions ultimately affect the hospital's bottom line?

MedScape has published an article referencing how the increase in hospital employed physicians may affect hospital probability as well as the general economy and medical climate, and also how different employment model physicians can work together.

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

Thursday, April 28, 2011

Physician Compensation Report: 2011 Results

Despite the economy, a majority of physicians across all specialties reported compensation increasing or remaining stable over the past year. More than 15,000 physicians nationwide took part in Medscape's 2011 Compensation Survey. Twenty-two specialists (including primary care) participated in the survey.

Orthopedic surgeons and radiologists (median compensation: $350,000), anesthesiologists and cardiologists ($325,000) were the top earners, as primary care ($159,000) and pediatricians ($148,000) brought up the rear. If they had to do it all over again, primary care doctors were least likely to choose the same specialty (43%), followed by pulmonologists (52%) and ob/gyn's (53%). While pediatricians were lowest on the income rung, 61% would choose the same specialty again.

Some physicians have seen the financial wisdom of investing in their own surgery/clinical procedure centers. Among specialists who've already taken this step, gastroenterologists lead the way (40%), followed in descending order by urologists, plastic surgeons, orthopedic surgeons, and ophthalmologists. For at least a portion of such doctors, though, this train may have already left the station, especially anyone considering investing in an ambulatory surgical center. Doctors thinking about setting up their own ambulatory surgical center face the prospect of lower reimbursements and rising costs for construction and related expenditures.

Sometimes the best way to boost practice income during tough times is simply to cut expenses. Of the roughly 15% of respondents who followed this game plan in 2010, most said they'd cut expenses by up to 10%. Among this group of cost-cutters, the best represented specialties are plastic surgery (29%), urology (23%), gastroenterology (20%), and cardiology (19%). Psychiatrists ($175,000) are not the top income earners but low operating costs may put them on an equal financial footing with many of their higher-earning specialist colleagues.

Read the full report on Medscape, or click here:

Wednesday, April 20, 2011

Increase in Physician Turnover

As the economy perks up, it appears that physician turnover rates rise with it. For the first time since 2008, physician turnover has increased, reminding medical groups of the delicate balance between physician supply and demand.

Cejka Search and the American Medical Group Association completed their 6th annual survey tracking physician retention. In 2010 total turnover was 6.1%, compared to 5.9% in 2009, and appears to track with reports of modest improvement in the U.S. economy.

Other findings from the survey:

Part Time Practice Continues to Grow - Since 2005, the part-time workforce has grown by 62%. This trend tracks with the change in profile of today's medical workforce, in which the two fastest growing segments are female physicians entering the practice and male physicians approaching retirement.

Mentoring Makes a Difference in Reducing Turnover - The majority of medical groups (73.8%) believe mentoring reduces turnover, but just more than half (56.1%) assign a mentor to newly hired physicians. For those who do assign a mentor, a formalized program makes a difference. The turnover rate was 1% lower (5.3%) for groups that have written goals and guidelines compared with those who do not assign a mentor (6.3%).

Medical Groups Are Hiring Physicians - The consensus from the medical groups responding to the survey indicates that the hiring of physicians and advanced practice providers will accelerate through 2011. The majority of medical groups (83%) will hire more or significantly more primary care physicians, indicating that an already competitive physician market may become more so. Nearly as many said they will be hiring more or significantly more specialists (79%) and advanced practitioners (78%).

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

Friday, April 15, 2011

Significant Increase of Physician Hiring in Physician Offices

In the first quarter of 2011 positions hired in physician practice offices increased by 3 times compared to the first quarter of 2010. The Bureau of Labor and Statistics reported increases in both physician offices and hospitals. Physician offices added 16,500 jobs in the first quarter of 2011 and hospitals added 19,600 jobs. Both are significant increases to the number of jobs added from the first quarter of 2010. Read the full article in American Medical News, or click here:

Thursday, April 14, 2011

20 Statistics on Physician Compensation and Incentive Offers

Merritt Hawkins' has comprised 20 statistics on percentages most commonly offered to physicians in employment offers in their 2010 Review of Physician Recruiting Incentives. These apply to hospital employed physician contracts.

The 2010 Review is based on the 2,813 permanent physician search and advance allied professional search assignments between April 1, 2009 and March 31, 2010. Here are some of the statistics:

Type of Incentive Offered

  • Salary: 12%

  • Salary with bonus: 74%

  • Income guarantee: 13%

Type of Income Guarantee Offered

  • Net collections guarantee: 88%

  • Gross collections guarantee: 12%

Term of Income Guarantee Offered

  • One year: 55%

  • Two years: 36%

  • Three years: 9%

Signing Bonus: popularity and amount

  • Signing bonus offered: 76%

  • Signing bonus not offered: 24%

  • Average amount of signing bonus: $22,915

CME: Popularity and Amount

  • CME offered: 93%

  • CME not offered: 7%

  • Average amount of CME pay: $3,335

Other Benefits Offered

  • Health insurance: 98%

  • Malpractice: 99%

  • Retirement: 90%

Read the full article at Becker's Hospital Review, or click here:

Tuesday, April 5, 2011

Increase in Hospital Employment Positions

The New York Times and The New England Journal of Medicine have both recently published articles on the increasing trend of physicians seeking employed opportunities. The articles both reference physicians being motivated by a higher quality of life offered by employed positions, presumably as compared to private practice.

The New England Journal of Medicine documents the increase in hospital employed positions, rising from just over 20% in 2002 to over 50% in 2008, the last year for which the study had data.

The New York Times article highlights the dramatic changes in physician employment as being driven by doctors' evolving professional and personal goals. The Times article chronicles the lives of three generations of Pennsylvania doctors: starting with the grandfather, a family physician in the 1940s who worked 80+ hours per week, and ending with a granddaughter, a hospital-based ER doctor named Kate Dewar, who works 36 hours per week so she can be home with her new twins.

In the 1990s, hospitals pushed to hire doctors to fill out their referral networks, as managed care took over. Now, the trend is "more physician-driven" as doctors choose to forego the "hassles of private practice" such as insurance and government billing requirements and the administration of a large office.

However we feel there will also be a place for private practices, both to offer options to patients and maintain quality of care. Physician offices also provide good jobs in local economies, and physicians can still enjoy a good quality of life with shared call, business and billing consultants, and can control how they would like to run their practice.

Read the article in the New York Times by clicking here:

Read the article in the New England Journal of Medicine by clicking here:

Monday, April 4, 2011

Hospitals' New Physician Leaders: Doctors Wear Multiple Medical Hats

A new trend in hospitals is employing physicians in both administrative and clinical roles. A new generation of physicians are combining clinical care and executive leadership concurrently. There are more of these positions as hospitals and large health systems prepare for the implementation of health reform and recognize the need for greater alignment with physicians. Physician leaders are viewed as more important than ever to closing the divide between clinicians and the administration as they try to create accountable care organizations, reduce readmissions, improve care, and implement electronic medical records. Physicians playing an executive role feel they have more control of patient care and hospital regulations. They are working to improve quality in their every day clinical atmospheres; they feel they can trust initiatives more and have representation on the board. Also the trend has created new titles available to accommodate new administrative needs. The chief medical officer remains a common leadership position, but hospitals are creating positions such as chiefs of physician relations, integration, and medical informatics. These new positions incorporate some duties that until now physicians traditionally would have carried out as volunteers as part of the medical staff or various committees. Read the full article in American Medical News, or click here:

Office-based Doctors Support 4 Million Jobs

As other industries are slowing down and unemployment is continuing at record highs, office based physicians are bringing jobs to their communities. Medical Group Management Association researchers have devised national and state-specific multipliers to determine the value of a physician's contribution to local economies, including jobs created, spending at nearby businesses, and taxes generated. According to these figures office based physician practices contributed to over 4 million jobs in 2009. With unemployment still rising, the number of jobs at physician offices has continued to increase. These jobs pay well and offer strong benefit plans; also they offer a stable environment and more job security than many other industries. These figures confirm that physician offices are a large contributor to the economy; having physician offices in a community is economically healthy for the local area. Numbers vary by physician practice and specialty, however on an individual level, physicians support an average of 6.2 jobs each, including their own. One physician leads to about $100,000 in state and local tax revenue and $2.2 million in overall financial activity. Read the full article in American Medical News, or click here:

Friday, April 1, 2011

10 Current Healthcare Employment and Compensation Trends

Becker's Hospital Review has reported 10 trends physicians and hospitals noted last year in employment and compensation. The trends provide good insight in to what to expect this year and also in to the future regarding hospital employment and compensation.

Here are the trends reported:

1. Nursing enrollment is rising

2. Female physicians earn less

3. More medical students choose primary care

4. Physician compensation in academic settings increased in 2010

5. Staffing levels affect mortality rates

6. On-call pay has increased in half of hospitals

7. Critical care employees report lowest job satisfaction

8. Employed physician salaries are expected to increase

9. Nurse provider shortage decreases

10. Feb. 2011 saw higher employment than Jan. 2011 and Feb. 2010

Read the full article on Becker's Hospital Review, or click here:

Monday, March 28, 2011

NEJM: Physician Shortages in the Specialties Taking a Toll

The physician shortage has not been lacking in recent press, particularly with the impending changes healthcare reform promises to contribute to the current shortage. Although most of the press has targeted the primary care shortage, there is a shortage in specialists and surgeons as well. The aging population and retirement of the baby boomers is one factor that will contribute to the increase in specialists, particularly those that specialize in older adult care. Some of the obvious specialties that care for older adults are Cardiology, Critical Care, Diagnostic Radiology, Oncology, and Orthopedic Surgery. Shortages in Dermatology, General Surgery, Neurology, Psychiatry, Urology, and Vascular Surgery are also predicted to increase in demand and therefore shortage. There is also a significant shortage amongst pediatric physicians in nearly all specialties. The shortage of specialists has translated to more competitive employment offers, particularly in underserved areas. In its June 2010 report on non-primary care specialty shortages, AAMCs Center for Workforce Studies ventured a dire prediction for the decade ahead: a current deficit of 33% in surgical specialties, and an undersupply of 33,100 surgeons and other specialists by 2015, increasing to 46,100 by 2020. In addition, one third of U.S. practicing physicians are expected to retire over the next decade. Suggestions for how to address the specialty shortage range from training incentives to early medical students to government assistance. Read the full article in the New England Journal of Medicine, or click here:

Monday, March 21, 2011

Physician Shortage to Quadruple within Decade

According to an Association of American Medical Colleges (AAMC), the physician shortage we are currently experiencing will be nothing compared to what the future holds.

From the AAMC report, U.S. specialties will reach a shortage of 91,500 doctors by 2020. The AAMC predicts Americans will need an estimated 45,000 primary care physicians and 46,000 surgeons and medical specialists, a higher estimate than other studies have previously reported.

The most affected areas will likely to be rural regions and inner-city areas, according to the report. Factors contributing to the increase in the physician shortage include physicians retiring, the aging population of the American public, and healthcare reform. According to the Census Bureau, the senior population is estimated to grow by 37%.

There are currently 709,700 physicians (in all specialties) for a demand of 723,400 physicians, with an existing shortage of 13,700. By comparison, in 2020, there will be 759,800 physicians (in all specialties) for a demand of 851,300 physicians, essentially a shortage of 91,500 too few doctors.

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

Wednesday, March 16, 2011

Increase in Academic Physician Compensation

According to a new report from the Medical Group Management Association there has been an increase in academic physician compensation in 2009 and 2010.

Typically the motivation to be an academic physician is based more on professional fulfillment and self actualization than monetary remuneration. However it's important for academic facilities to stay competitive in the marketplace.

In addition to contributing to the next generation of medicine, academic facilities also offer physicians a stable working environment with set pay and full benefits where they can also continue their training.

Read the full article at FierceHealthcare, or click here:

Monday, March 7, 2011

Increase in Permanent and Locums Physician Jobs

In a recent survey by Staff Care, there has been a documented increase in the number of physician jobs. Because many of these permanent positions are difficult to fill, there has also been a significant increase in utilizing locums physicians.

There has been a lot of media attention on the physician shortage; however this continued increase in physician jobs can also be attributed to an economic recovery. There is an increase in the lack of physicians to fulfill the number of openings.

The physician shortage is mostly in primary care, however many specialists and surgeons are also in short supply. Utilizing locums has allowed hospitals to continue consistent patient care, behavioral health physicians were the largest specialty utilized for locums with primary care coming in second.

Physicians are favoring locums positions over permanent positions for several reasons including earning extra income, having more flexibility and a better quality of life, or to fill in gaps from other commitments such as military or even employed positions.

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

Friday, March 4, 2011

Job Offer Incentives for Physician Candidates

This article in Med Center Today was written primarily for academic physician candidates, however the checklist can also be used by physician candidates seeking hospital employment and even private practice opportunities.

There are many other important factors other than salary to consider when reviewing a contract, many of these negotiable.

Standard incentives offered in most contracts include sign-on, relocation, salary or income guarantee, and support. However other factors some candidates don't think of in the negotiation process are loan repayment assistance (particularly for new graduates), additional support, education for the candidate's children, assistance for spousal employment, and housing assistance in either selling a previous house or in buying a new house.

It's important to consider an offer in it's entirety to see not only how much you will be paid but also what other factors can contribute to both your clinical practice and family/ quality of life. Salary and income aren't the only negotiations to consider in a potential offer.

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

Monday, February 28, 2011

Physician Re-Entry in to a Clinical Practice

Many of the physicians we work with are looking to re-enter in to a clinical practice. Whether the physicians have been in research or teaching exclusively, working in pharmaceuticals, or in executive administration, a lot of hospitals have policies that are unable to consider physicians if they have been out of a clinical practice for more than 2 years.

There is also state re-licensing and board recertification involved in most cases as well. Often times it is difficult to identify opportunities for physicians wishing to re-enter in to a clinical practice.

The American Medical Association, in collaboration with the Federation of State Medical Boards and the American Academy of Pediatrics, issued recommendations on January 25th calling for a comprehensive and transparent regulatory process for physicians to come back to medicine. The organization wants policies ensuring that re-entry programs are of high quality and that physicians who complete them are ready to practice.

This is a good article highlighting what a physician can do in a non-clinical practice to keep up with regulating authorities as well as some licensing requirements per state. Read the full article in American Medical News, or click here:

Monday, February 21, 2011

Physician Recruitment for Private Practices

There has been a lot of press recently on the trends of physicians selecting hospital employed practice opportunities, however private practices still offer a niche attractive to many physicians out of training and with experience.

Private practices and smaller groups offer a model that is attractive to many physicians exploring job opportunities. In a group with a few partners, private practices can still offer good quality of life and also more income potential. Smaller groups tend to have less politics involved in practicing medicine and offer more autonomy and control. Many physicians feel they have better connections with their patients in a smaller group setting.

According to experts, attracting new physicians to smaller groups can be successful if they utilize some of the same incentives larger institutions use, also while playing up the advantages of the community and geographic location.

Another way smaller groups can attract new physicians is by making their practices stable. A good reputation, updated technology, good support, and ensuring that various office systems run smoothly will provide similar stability to opportunities in larger groups or hospital settings.

Many physicians out of training choose hospital employed opportunities because of a guaranteed salary, benefit package, and oftentimes loan repayment assistance. Private groups can still present attractive compensation plans and include partnership and ancillary service partnership. Guarantees and volume based incentives can still provide the security offered by hospital groups, and oftentimes the compensation potential is greater over several years than with a hospital employed position.

The small group and private practice will always provide a need to a community and attract potential partners. In this time it's important to effective market your private practice opportunity and evolve offers to stay competitive to hospital based physician jobs.

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

One key in this type of marketing is connecting with physicians that want to work in the area of the practice.

Tuesday, February 15, 2011

Hospital Budgets Rise to Prepare for Higher Demand

Many hospitals have increased their budgets for 2011, mostly due to the anticipated increase in demand largely from healthcare reform.

More than half of the increase will be devoted to hospital information technology. Other items to be included in the budget increase will be dedicated to medical devices and general facilities spending.

Read the full article at

Thursday, February 10, 2011

Predictors of Neurosurgical Career Choice Among Residents and Residency Applicants

According to this article most Neurosurgeons choose academic careers for their first position out of training, however many change to private practice or hospital models after spending a few years in an academic practice.

The article was researched and written for academic institutions to learn how to better retain academic Neurosurgeons to continue their careers and pursuits in academics. Although the article was written studying Neurosurgeons specifically, the same principles can be applied to multiple academic disciplines.
Read the full abstract at

Wednesday, February 2, 2011

Prioritizing the Work-Life Balance

Many of the physicians we work with prioritize quality of life in their job search. This is a very good article written by Dr. Jennifer Frank on prioritizing the work-life balance.

Read the full article in Physicians Practice, or click here:

Thursday, January 27, 2011

Physician-Generated Revenue and Average Salaries by Specialty

Merritt Hawkins' "2010 Inpatient-Outpatient Survey" has compiled average numbers nationally for physician's salaries and also the revenue generated from a certain specialty to the hospital.

Another factor important to mention is community need and competition in the area. In considering a new position it's important for physicians also to be aware of other physicians in the area practicing the same specialty; sometimes hospitals think there is a need for a certain specialty but don't consider competition in the area. They think that they can add another physician and bring a certain amount of revenue in to the facility just by adding a given specialty, but the physician finds themselves at war with other physicians in the area or there isn't enough volume in the community to add another provider.

However here are the results from Merritt Hawkins' survey.

Neurosurgery: $2,815,650 revenue; $571,000 salary
Cardiology (invasive): $2,240,366 revenue; $475,000 salary
Orthopedic surgery: $2,117,764 revenue; $481,000 salary
General surgery: $2,112,492 revenue; $321,000 salary
Internal medicine: $1,678,341 revenue; $186,000 salary
Family practice: $1,622,832 revenue; $173,000 salary
Hematology/Oncology: $1,485,627 revenue; $335,000 salary
Gastroenterology: $1,450,540 revenue; $393,000 salary
Urology: $1,382,704 revenue; $401,000 salary
OB/GYN: $1,364,131 revenue; $266,000 salary
Cardiology (non-invasive): $1,319,658 revenue; $419,000 salary
Psychiatry: $1,290,104 revenue; $200,000 salary
Pulmonology: $1,204,919 revenue; $293,000 salary
Neurology: $907,317 revenue; $258,000 salary
Pediatrics: $856,154 revenue; $171,000 salary
Ophthalmology: $842,711 revenue; $282,000 salary
Nephrology: $696,888 revenue; $240,000 salary

Do you consider this to be accurate? Please post your opinions.

Read the full article in Becker's Hospital Review, or click here:

Wednesday, January 19, 2011

Physician Compensation Models: Big Changes Ahead

The New England Journal of Medicine has published an article on the changes ahead for physician compensation models. There have been many recent changes in healthcare, most notably healthcare reform and Medicare reimbursement changes. Also the implementation of EMR systems and new hospital employed opportunities will soon effect how physicians are compensated on a larger scale.

Most of these changes will take place in the coming years and won't dramatically impact physicians today or this year. However new models are being established to determine physician compensation.

Currently quality based compensation and volume based bonus/ incentive are used to determine some of how physicians are paid in hospital employment models. These trends will likely continue and even expand. Hospitals are becoming more creative to attract and maintain physicians; in a new environment it is important to understand and evaluate the practice employment options.

NEJM has noted it’s important to understand the models’ differences, upsides, and downsides, especially in this still volatile economic environment.

Read the full article in NEJM, or click here:

Wednesday, January 12, 2011

MGMA Report: Most Financially Successful Practices

According to an MGMA survey there are 4 performance management categories which separated financially successful practices from less successful practices.

Successful physician practices demonstrated management behaviors that may be the key to their financial success. The 4 performance categories according to the survey are:
  • Profitability and Cost Management
  • Productivity, Capacity, and Staffing
  • Accounts Receivable and Collections
  • Patient Satisfaction
Many successful practices use patient surveys to determine their satisfaction and also what areas may need improving in the practice. Better-performing practices also tended to spend more on IT operating expenses and reported less bad debt to fee-for-service activity per physician partner.

Other factors that contributed to most of the successful practices surveyed are lower total operating costs, more cases per practice partner, and lower total accounts receivable.

For the full article click here or read on Healthcare Finance News:

lower total operating costs, more cases per partner, total A/R

Tuesday, January 11, 2011

10 Key Trends for Hospitals in 2011

Becker's Hospital Review has posted 10 trends for hospitals in the coming year. They received their information from 2 hospital CEOs, 3 association executives, and 2 consultants.

Here is what they came up with:

1. Lower Reimbursements
2. RACs gather momentum
3. More uncompensated care
4. Political gridlock
5. Uncertain fate of Healthcare Reform
6. Anticipated ACO rules may open the floodgates
7. Greater focus on experimentation
8. States will further cut Medicaid spending
9. Healthcare IT payments start
10. More hospital consolidation likely

Read the full article in Becker's Hospital Review, or click here:

Thursday, January 6, 2011

2011: Evolution of the Private Practice

We are hearing constant reports of the death of the private practice so we found it refreshing to read this article from Physicians Practice about the evolution of the private practice.

Although the current healthcare climate is forcing changes to today's and even yesterday's typical private practice model, the private practice will always be an alternative for entrepreneurial physicians who want to control their own practice. According to the article although healthcare economics have changed, federal regulations now impact office operations, and the workforce has dramatically changed, there is still and will always be a need for private practices and a profitable way to run them; particularly for larger single or multi-specialty practices that can afford professional management and have diversified their services (such as through ancillary services) so that they can benefit from revenue that does not require physician effort.

Key factors for the survival of private practices in the future are implementation of new technology and EMR, operating under lower overhead, and hiring adequate support staff (both administrative as well as medical). The stereotype for private practices is that these physicians work longer hours and have little to no vacation; while this might still prove to be true in today's private practice physicians can still control their practice and income while having a good quality of life with adequate support from partners and PAs/NPs.

Although a lot of hospitals will be acquiring groups and employing physicians, private practices can still negotiate different types of terms and models with hospitals while still maintaining control of their practice.

According to the article, if physicians are able to accept new ways to run a private practice than private practices will survive any healthcare and economic climate.

Read the full article in Physicians Practice, or click here:

Monday, January 3, 2011

2011: The Current State of Physician Integration

With the cuts in Medicare reimbursement and the unknown status of healthcare reform, many physicians and hospitals are coming up with new ways to form employment relationships and work together.

Hospital Employment has been a trend we have previously discussed, but there are also many alternative ways hospitals and physicians can work together to create a mutually beneficial model that makes sense for both parties financially. Hospitals are being more creative in ways to maintain and develop relationships with their physicians. Many are embracing a variety of strategies, such as employing physicians and acquiring group practices, creating co-management roles for physicians and giving them greater say in governance of the organization.

A recent PricewaterhouseCoopers survey found that 44% of physicians are already employed by some entity, from hospitals to group practices, and 46% are interested in pursuing this model in the next two years. Hospital employment provides a guaranteed salary for a physician and the physician can focus on caring for patients instead of running a practice and worrying about payment and reimbursements. Hospital employment can cover lower reimbursements and also integration and new administrative requirements physician practices are subject to, such as installing electronic medical records.

The PricewaterhouseCoopers survey found that physicians practicing in large groups are 2-3 times more likely to express interest in hospital alignment than solo practitioners.

Hospitals have also implemented Management Services Organizations. The hospital and practices share expenses for functions such as purchasing supplies, practice management services, and some aspects of managed care contracting and electronic health records.
Another model that has been explored and implemented is a Co-Management Arrangement. In a co-management arrangement, a physician or group of physicians is paid to carry out management work for the hospital. The physicians are paid for the cases they handle, but responsibilities can also include administrative tasks like writing up protocols for establishing a physician-integration model.

Co-management and similar payment arrangements are catching on as alternatives to employment. The PricewaterhouseCoopers survey found that 24% of physicians are currently aligned in this model and 51% of physicians are interested in pursuing it over the next two years.
Another model that has been explored is a Governance Model. In a Governance model, the hospital has set up an internal physician committee made up of physicians. The physician members participate in hospital decision-making separate from the hospital medical staff and serve as a joint operating committee.

Hospitals and physicians need to keep an open mind in this quickly changing medical and health care climate. Hospitals need to be flexible and open to different options to attract the best physician candidates and maintain the best quality of care for their patients.

Read the full article at Becker’s Hospital Review or click here: