Fall Issue of Neurosurgery Market Watch- Out Now

Our feature article is a comprehensive neurosurgery-specific article addressing technology and devices in the neurosurgery marketplace.  West Virginia University neurosurgeon Erich O. Richter, MD, FAANS, shares his views in our candidate profile, while  health lawyer Roderick Holloman addresses medical device and employment challenges in our Legal Corner column.  And don’t forget to check out our standing sections, the Featured Opportunity and the Practice Profile.

Click here to read the full issue: http://harlequinna.com/neurosurgery-market-watch/

60% of Physicians Still in Private Practice

According to a report by the American Medical Association the percentage of physicians who were practice owners decreased only 8% points from 2008-2012.  Becker's Spine Review has a recently published article stating 60% of physicians continue to work in practices wholly-owned by physicians.

So much media attention has been dedicated to the trend towards Hospital Employment and the dramatic decrease in the private practice employment model for physicians.  It's refreshing to see this data that there still is a place for physicians who respond better in a private practice model.

Access the AMA report by clicking here: http://www.ama-assn.org/resources/doc/health-policy/prp-physician-practice-arrangements.pdf

Read the related article in Becker's Spine Review by clicking here:
http://beckersspine.com/orthopedic-spine-practices-improving-profits/item/17508-eminent-hospital-takeover-not-just-yet-60-of-physicians-still-in-private-practice

What is job satisfaction for physicians?

This is an interested article from KevinMD.com, what is job satisfaction for physicians?  There has been a lot of media attention recently that physicians are unhappy, but what does it take to make physicians happy in their working environment and why are a large majority currently unhappy?


http://www.kevinmd.com/blog/2011/02/job-satisfaction-physicians.html?goback=%2Egde_917937_member_261700675

Physician Compensation Report: 2013

MedScape has released their 2013 Physician Compensation Report.  Overall, most physicians and specialists (both employed and in private groups) saw that income was increased from last year's report.  The report also noted that healthcare reform is making a definite impact on physicians practices.

In the annual report physicians revealed the number of hours worked, changes to their practice, and satisfaction with their compensation and the practice of medicine.

Access the report by clicking here:
http://www.medscape.com/features/slideshow/compensation/2013/public

Also, read 7 Statistics on Physician Compensation from Becker's Hospital Review based on the MedScape report by clicking here:
http://www.beckershospitalreview.com/compensation-issues/7-statistics-on-physician-compensation.html

How Private Practice Physician Attitudes are Changing

Physicians Practice's has published the results from their 2013 Great American Physician Survey.  The report with full data for this year’s survey will be available online in mid-August 2013 and in the September 2013 issue of Physicians Practice.

This year's survey has found that career satisfaction among private practice physicians has remained relatively stable since 2009.  There has been a trending towards hospital employment and hospital systems buying out or merging with smaller groups and private practices, however despite the changing healthcare environment and declining reimbursement private practice physicians have maintained their overall career satisfaction.

Results published in the article on Physician's Practice actually say the 2013 survey responses from partners/co-owners of private practices indicate that their level of career satisfaction may actually be increasing.  In 2013, more of these respondents than in previous years said they strongly agreed with the statement, "I like being a physician." More specifically, on a scale of one to five (with five being "strongly agree" and one being "strongly disagree") 62 percent of partners/co-owners said they strongly agreed with that statement. That's about 10 percent more than said they strongly agreed in 2009.

The 2013 survey findings also indicate that the number of private practices physicians that are happy with their career path has remained relatively stable over the past few years.  When asked, "If given the chance to go back in time and pick another career path, what would you do?" 60 percent of private practice respondents said they would do everything roughly the same way they did it the first time. That's about the same percentage as in previous years.

While most private practice physicians said they wouldn't change the past when it came to their career choices, more private practice physicians in 2013 said they would discourage their child from pursuing a career in medicine in the future. This year, about 18 percent of respondents said they would discourage a career in medicine. In previous years, only about 13 percent of private practice physicians said they would discourage it.

When other private practice physician responses to our 2013 survey findings are considered, it's not surprising that more physicians said they would discourage their children from seeking a career in medicine.

Over the past few years, private practice physicians have indicated that they are working longer hours, and more have also indicated that they feel they don't have as much time for their personal life as they think they should.

In 2013, for instance, 88 percent of private practice physician respondents told us that they worked more than 40 hours per week. In 2010, about 85 percent said they did. In addition, in 2013, 73 percent of private practice physician respondents said they don't have as much personal time as they think they should. That's up from 67 percent just last year.

In addition, more private practice physician respondents this year said they often wish they could change workplaces. In 2013, 31 percent of respondents said they wished they could change workplaces. That's up from just 23 percent in 2010. In addition, the percentage of private practice physician respondents who said they plan to become hospital employed in the next five years doubled between 2013 and 2012 (from 3 percent to 6 percent).

Read the full article by clicking here: http://www.physicianspractice.com/blog/how-private-practice-physician-attitudes-are-changing?GUID=98C7CA21-2AF6-465B-A27F-FC956DFC383F&rememberme=1&ts=26072013

Private Practice: Still Providing Control and Autonomy

Although the trend is towards hospital employment and many private and solo physician practices are being bought out or merging with larger hospital systems, there will always be a place for the private practice physician.

Some physicians will always seek the control and autonomy that only a traditional private practice can provide.

American Medical News just published an article on how some physicians will never transition in to an employed model, the strength of the private practice will prevail for some physicians despite economic hardships and pressure from larger health systems.

Read the full article by clicking here:
http://www.amednews.com/article/20130624/business/130629978/2/?utm_source=nwltr&utm_medium=heds-htm&utm_campaign=20130624

MGMA Physician Compensation 2013

The Medical Group Management has released their 2013 Physician Compensation and Production Survey report.  Most physicians, specialists, and surgeons pay increases were largely flat, however the study finds physician compensation across all generalists, specialists, and surgeons is becoming more and more based on quality measures, including the quality of care they provide and whether their patients are satisfied.

With the Affordable Care Act kicking in on January 1, 2014, the MGMA study comes as physicians are gearing up for the potential of millions more paying customers.

According to a recent article in Forbes, the health law and trends in the private sector are also beginning to influence doctor pay because employers, government and private insurers are beginning to move away from fee-for-service medicine to reimbursement tied to quality measures.

Read the full article in Forbes by clicking here: http://www.forbes.com/sites/brucejapsen/2013/06/12/doctor-pay-rises-to-221k-for-primary-care-396k-for-specialists/

Another article in HealthLeaders also reviews the data on the MGMA report based on 2012 data, agreeing that quality measures are emerging as components in physicians' compensation.  This trend is expected to grow as value-based reimbursements gradually supplant fee-for-service, volume-based models.

Read the full article in HealthLeaders Media by clicking here: http://www.healthleadersmedia.com/page-1/LED-293270/MGMA-Physician-Compensation-Increasingly-Based-on-Quality-Measures?goback=%2Egde_1170587_member_250288846

Physician Career Move: Make a Priority List Before You Make the Move

When physicians are looking for new career options, compensation and location are generally the prime motivators in considering possible options.  However personalizing your search based on your individual short and long term needs is essential to identifying a long-term, sustainable job opportunity.

Writing a list of priorities before you begin your job search will help to identify what your individual job search will look like.  

Be honest in your answers during your evaluation of potential opportunities and also during the interviews.  Don’t be afraid to ask appropriate questions during the interview.  The more you make your job search about your individual criteria, the more likely you are to identify an opportunity that is sustainable long-term and ensures the potential to live the life you want to live, in and outside of work.

Read a recent article from American Medical News suggesting a 4-step process to writing down your job search priorities:

http://www.amednews.com/article/20130603/business/130609985/4/?utm_source=nwltr&utm_medium=heds-htm&utm_campaign=20130603

How Much Revenue Does Your Specialty Generate for Your Hospital?

Becker's Hospital Review has released data on how much physicians average bringing in to a hospital by their specialty.  The data is based on Merritt Hawkins 2013 Physician Inpatient/Outpatient Revenue Survey.

Here are their published results:

•    Orthopedic surgery: $2.68 million
•    Cardiology (invasive): $2.17 million
•    Family practice: $2.07 million
•    General surgery: $1.86 million
•    Internal medicine: $1.84 million
•    Hematology/oncology: $1.76 million
•    Neurosurgery: $1.68 million
•    Obstetrics/gynecology: $1.44 million
•    Urology: $1.43 million
•    Gastroenterology: $1.39 million
•    Psychiatry: $1.30 million
•    Cardiology (noninvasive): $1.23 million
•    Nephrology: $1.18 million
•    Pulmonology: $1.01 million
•    Otolaryngology: $825,757
•    Pediatrics: $787,790
•    Ophthalmology: $725,000
•    Neurology: $691,406

To read the full article from Becker's Hospital Review, click here:
http://www.beckershospitalreview.com/hospital-physician-relationships/which-physicians-generate-the-most-revenue-for-hospitals.html

MedScape's Physician Compensation Update 2013

Hospital Employment is on the rise, MedScape analyzes physician compensation changes in the last year.

Overall most physicians, specialists, and surgeons experienced increased in salary, the stronger economy impacting a positive addition to income.  However there are still uncertainties with changes in government and healthcare law and healthcare reform making an impact on physician practices.

MedScape's report also reveals other practice elements including how many hours physicians worked, other changes to their practices, and overall satisfaction and contentment with healthcare and medicine.

Access the full report by clicking here:
http://www.medscape.com/features/slideshow/compensation/2013/public

Physician Contract Language: Hospital Bylaws

In this hospital employment dominant environment it's more important than ever for physicians to have a good understanding of their employment contract prior to signing with the hospital.  Hospital bylaws are another factor to make sure you understand before signing the contract.

Bylaws of a hospital govern the terms of the hospital's medical staff, including staff membership and clinical privileges.  Physicians need to review both their employment contract as well as the hospital's bylaws to understand the full aspects of employment, including what would happen if the physician lost their job or their staff privileges.

American Medical News has an article addressing how to review both an employment contract and the hospital bylaws prior to signing.  Read the full article by clicking here:

http://www.amednews.com/article/20130513/business/130519968/5/?utm_source=nwltr&utm_medium=heds-htm&utm_campaign=20130513

Physicians: Other Alternatives to Hospital Employment

There has been significant attention lately to the increasing trend in hospital employment, however selling your practice to a hospital or becoming a hospital employee isn't the only option for successful hospital/ physician relationship.

There are several different options physicians have to integrate with hospitals while still maintaining their autonomy and more control over how they run their practice, while still allowing a successful relationship with the hospital.

Because of the physician shortage and demand for services, hospitals are often are willing to work out alternative arrangements to hospital employment.

There are many different options physicians have to integrate their practices with a hospital, however according to practice consultants there are 3 main categories- limited, moderate and full.

Limited: physicians provide specific clinical oversight duties 

Moderate: hospitals and physician groups work toward shared goals

Full: not full hospital employment, however the hospital maintains more control over the physician group

To determine the appropriate alignment for your specific group it is important to establish you or your group's core values.  Meet with the hospital to determine how the physician(s) and hospital hope to achieve from the alignment.  There will be many meetings involved, both with the hospital and the physicians as well as third parties, such as consultants and lawyers.

Both parties should determine the physician's group practice issues and common goals.

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

http://amednews.com/article/20130422/business/130429981/4/?utm_source=nwltr&utm_medium=heds-htm&utm_campaign=20130422 

Doctor-Owned Hospitals Prosper Under Health Law

Doctor-owned hospitals are earning many of the largest bonuses from the federal health law's new quality programs, even as the law halts their growth. The hospitals, many of which specialize in heart or orthopedic surgeries, have long drawn the ire of federal lawmakers and competitors. They say physicians often direct the best-insured and more lucrative cases to their own facilities, while leaving the most severely ill patients to others.


Some researchers say the doctors' financial interests encourage them to perform more tests and procedures, driving up the cost of care. The health law banned construction or expansion of these hospitals except in unusual circumstances.

But physician-owned hospitals have emerged as among the biggest winners under two programs in the health law. One rewards or penalizes hospitals based on how well they score on quality measures. The other penalizes hospitals where too many patients are readmitted after they leave. There are more than 260 hospitals owned by doctors scattered around 33 states. They are especially prevalent in Texas, Louisiana, Oklahoma, California and Kansas.

Of 161 physician-owned hospitals eligible to participate in the health law's quality programs, 122 are getting extra money and 39 are losing funds. Medicare is paying the average physician-owned hospital bonuses of 0.21 percent more for each patient during the fiscal year that runs through September. Meanwhile, the average hospital not run by doctors is losing 0.30 percent per Medicare patient.

Read the full article in Physician's News, or click here: http://www.physiciansnews.com/2013/04/16/doctor-owned-hospitals-prosper-under-health-law/?utm_source=4.16.13&utm_campaign=11713&utm_medium=email

Stronger Economy Stimulates Doctor Turnover

A recent Physician Retention Survey has determined many physicians are considering a new practice environment as a result of the strengthening economy.

There have been uncertainties in sustainability with the changing healthcare environment and how changes in healthcare reform and reimbursements may affect net compensation for physicians.  With positive media attention on a strengthening economy, many physicians are seeking out new, more stable employment opportunities.

According to the recent survey physician turnover has increased by the largest amount in 8 years.  If the economy continues to increase, the physician turnover is also expected to increase.  Many physicians will seek different employment opportunities or retire, as many were forced to delay retirement with a more tumultuous economy.

Turnover will come at a time when there is already a significant physician shortage.  

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

http://amednews.com/article/20130401/business/130409979/2/?utm_source=nwltr&utm_medium=heds-htm&utm_campaign=20130401

5 Steps for Employed Physicians to Resolve Contract Disputes

With the increase in hospital employment, more and more physicians are finding themselves signing employee contracts.  If issues were not properly understood during signing, or if physicians have misconceptions about their employment after they have already started, American Medical News has offered 5 tips to resolve contract disputes to have both parties come to a mutual agreement.

The article offers a more thorough explanation of each tip, here are their 5 steps to resolve contract disputes:

1. Stay Calm
2. Review the Contract
3. Talk it Out
4. Write Letters
5. Consider a Lawsuit

Read the full article in American Medical News, or click here:
http://amednews.com/article/20130311/business/130319970/4/?utm_source=nwltr&utm_medium=heds-htm&utm_campaign=20130311

Will Hospital Employment Lead to Physician Strikes?

Hospital-employment means higher reimbursements and more stable schedules for doctors, but it also could lead to the creation of physician labor unions, according to The Wall Street Journal.

With an employed status comes the right to collective bargaining, wrote David J. Leffell, a practicing physician and former CEO of the Yale Medical Group.

Physicians provide a service that can't be outsourced, according to Leffell, and as service workers they can exercise the right to strike to help negotiate staffing, benefits and patient care issues.

The rise of unionized physicians would put more pressure on hospitals already facing strike threats from nursing unions-which, if carried out, lead to extra costs for temporary nurses and added security, as well as patient care disruptions. 

Moreover, it's already gotten easier for healthcare workers to unionize, after a decision in the "Specialty Healthcare" case was overturned in August 2011 and determined that a group of nursing assistants at an Alabama facility could form their own bargaining unit without other types of nursing home staff.

And while the move from private to hospital-owned practices makes it easier to regulate and monitor physicians, Leffell pointed out it may jeopardize access to care: "Office closed, doctors on strike."


Read the full article in The Wall Street Journal, or click here:
http://online.wsj.com/article/SB10001424127887323375204578270401138739978.html

Physician Job Search: How to Interview to get Your Dream Job

When physician's submit their CV for a prospective job opportunity, the CV speaks for itself and is crucial in getting to the next stage of the interview process.  However, once the interview process starts and physician's visit the facility and meet with the other physicians, interview skills, practical (not just clinical) knowledge, and personality really come in to play to get the job offer and move to contract negotiation.

Coming across as a team player, particularly for the current hospital-employed trending marketplace, is a very important factor in the interview process.  The site visit is an exploratory process for the physician to help determine if this may be a good fit, but it is also an interview and it's important not to forget it is an opportunity to showcase not only the physician's training and experience, but also his or her personality and compatibility.

A CV is a good way to get the process started, but the physician still needs to interview and prove they are not only a good clinical fit for the opportunity, but also have the right dynamic to fit in to the current group.

American Medical News has a recent article on the importance of the interview and also the incoming physician coming across as a team player.  Read the full article by clicking here:

http://www.ama-assn.org/amednews/2013/01/28/bisa0128.htm?utm_source=nwltr&utm_medium=heds-txt&utm_campaign=20130128

Tips for Physicians When Joining a New Practice

Physician's Practice has published an article on the do's and don'ts for physicians joining new practices from medical practice consultants and etiquette experts.

They have compiled a list of 10 do's and 10 don'ts for physicians joining a new medical practice.  They have asked medical practice consultants and etiquette experts to share their top recommendations for starting off on the right foot.

Read the full article by clicking here:

http://www.physicianspractice.com/blog/tips-doctors-when-joining-new-practice?GUID=98C7CA21-2AF6-465B-A27F-FC956DFC383F&rememberme=1&ts=25012013
 

Hospital Employment Contracts: Renegotiate After Term Expiration

With the increasing trend of hospital employment many physicians are now on a salary with their associated hospital.  However once the term ends they still have negotiating power when considering re-signing.

American Medical News has just published an article with 5-steps to re-negotiate a contract before it expires to continue to make a long-term sustainable employment contract.  The article suggests these 5 tips to negotiate your new physician employment contract:

1. Know your renewal date

2. Use data to support your request

3. Consider how pay is structured

4. Ask about pay for nonclinical duties

5. Bring up retirement and other personal matters

Just because many physicians are now hospital employed doesn't mean they no longer have any negotiation power.

Read the full article in American Medical News, or click here:
http://www.ama-assn.org/amednews/2013/01/14/bisa0114.htm?utm_source=nwltr&utm_medium=heds-txt&utm_campaign=20130114

Physician Compensation Increase in 2013

With the increase in physicians being hospital employed, most working physicians are receiving a salary.  According to recent reports the average physician's salary should increase by 2.6% in 2013.

The business consulting firm, Hay Group, projects this physician salary increase based on surveys of 1,212 hospitals across the nation.

HealtheCareers, a leading physician job and market assessment site, has published an article on both the expected increase in physician's salaries as well as expectations for Allied Health in 2013.

Read the full article in HealtheCareers, or click here:

http://www.healthecareers.com/article/salary-trend-for-physicians-in-2013/171724?type=email&source=physician-010813

More Competitive Offers for Physicians in 2013

According to an article published today in American Medical News, 2013 is expected to be even more competitive for hospitals looking for physicians.  This means that if physicians are considering new employment opportunities, hospitals will need to be even more competitive to attract top talent.

The most common incentives seeing an increase are signing bonuses and student loan reimbursement  but in this climate with hospital employment at an all-time high, anything is negotiable in physician employment agreements.

With the impending changes in healthcare reform the physician shortage is expected to increase.  Physician retirements, more quality of life work balanced schedules, and an increase in physician demand will provide a competitive environment for physicians seeking employment opportunities.


http://www.ama-assn.org/amednews/2013/01/07/bisa0107.htm?utm_source=nwltr&utm_medium=heds-txt&utm_campaign=20130107

American Medical News also published an article on how volume-based incentives are dependent more on quality and patient care, as opposed to more volume-driven patient visits exclusively.  Read the full article here:

http://www.ama-assn.org/amednews/2012/12/31/bise0102.htm?utm_source=nwltr&utm_medium=heds-txt&utm_campaign=20130107

More Physicians in Congress

The healthcare market is very uncertain with all of the pending government changes, most notably healthcare reform and the medicare reimbursement potential changes.  Because of the uncertain environment many physicians are getting in to public service to be a part of changing healthcare for the better from everyone's perspective, including the physician.

After the latest election the House of Representatives currently has 17 physicians and the Senate has 3 physicians.  Getting involved in politics seems to be a way for physicians to voice their concerns for a realistic healthcare climate.

To read backgrounds and agendas for the latest MDs elected in to Congress, click on the link below or read the full article in American Medical News.

There will be 20 physicians in the 113th Congress, including 9 surgeons.  They are:

• Sen. John Barrasso (R-WY); Orthopaedic Surgeon
• Sen. Tom Coburn (R-OK); Family Physician
• Sen. Rand Paul (R-KY); Ophthalmologist
• Rep. Amerish Bera (D-CA)*; Family Physician
• Rep. Dan Benishek (R-MI); General Surgeon
• Rep. Charles Boustany (R-LA); Thoracic Surgeon
• Rep. Paul Broun (R-GA); Family Physician
• Rep. Larry Bucshon (R-IN); Thoracic Surgeon
• Rep. Michael Burgess (R-TX); OB/GYN
• Rep. Bill Cassidy (R-LA); Gastroenterologist
• Del. Donna Christensen (D-VI); Family Physician
• Rep. Scott DesJarlais (R-TN); Family Physician
• Rep. John Fleming (R-LA); Family Physician
• Rep. Phil Gingrey (R-GA); OB/GYN
• Rep. Andy Harris (R-MD); Anesthesiologist
• Rep. Joe Heck (R-NV); Emergency Room Physician
• Rep. Jim McDermott (D-WA); Psychiatrist
• Rep. Tom Price (R-GA); Orthopaedic Surgeon
• Rep. Phil Roe (R-TN); OB/GYN
• Rep. Paul Ruiz (D-CA)*; Emergency Room Physician

http://www.ama-assn.org/amednews/2013/01/07/gvsa0107.htm?utm_source=nwltr&utm_medium=heds-txt&utm_campaign=20130107