By Travis Singleton 

It has been accepted wisdom in healthcare for some time now that hospital and other healthcare facility administrators and physicians look at things through very different lenses.

A new survey Merritt Hawkins completed on behalf of Trinity University’s Department of Healthcare Administration indicates that even in an era of physician/hospital alignment, that may not have changed.

The survey examines the morale and professional perspectives of over 400 alumni of Trinity University’s nationally prominent Master’s in Health Care Administration Program who now are in leadership roles in hospitals, medical groups and other healthcare facilities around the country.  In general, the survey found that morale and optimism among these leaders is high, even given the current challenges facing virtually all types of healthcare facilities.

Over 92% of survey respondents feel positively about being in healthcare administration today, over 87% described their morale as positive, 87% would recommend healthcare management as a career to young people, and 86% would select healthcare management if they had their careers to do over.  

These findings contrast sharply with a national survey of physicians Merritt Hawkins recently conducted on behalf of The PhysiciansFoundation.  In this survey, only 32% of physicians felt positively about the medical profession, only 42% described their morale as positive, only 42% would recommend medicine as a career to young people, and only 66% would choose medicine if they had their careers to do over.                        

For healthcare facility managers, the glass appears to be half full, while for physicians, it appears to be half empty.  Though the survey report outlines some reasons why this may be so, I would be interested in hearing what others think may be the cause for these contrasting view.  Those who would like a complete copy of survey results are welcome to email me at travis.singleton@merritthawkins.com.

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Travis Singleton is Senior Vice President of Merritt Hawkins, the nation’s leading physician search and consulting firm and a company of AMN Healthcare (NYSE: AHS).  He can be reached at 800-876-0500 or travis.singleton@merritthawkins.com.

Photo credit: ThinkStock Images

The “perfect storm” is Creating Demand for Health Professionals and AMN’s Workforce Solutions

By Mark Smith 

With the national shortage of physicians, nurses and allied health professionals, and with the onset of the Affordable Care Act, which will extend health insurance coverage to millions of people, who is going to take care of America’s aging and growing population? 

That is a question that Jim Cramer, host of the highly popular financial/investing program “Mad Money” recently posed to his national television audience.

Cramer, one of the most experienced and successful stock “handicappers” in the industry, invited Susan Salka, CEO of AMN Healthcare, on a recent edition of his show to address the question. 

During the interview, which can be viewed here, Cramer outlined how AMN Healthcare is uniquely positioned to service the needs of the healthcare industry during this time of historic change and transition.  He also provided Susan with the time to discuss the strategic initiatives AMN Healthcare has implemented, particularly as a managed services provider (MSP), that now positions the company as the industry innovator in healthcare workforce solutions.  

Since 2005, Merritt Hawkins has been proud to be a part of AMN Healthcare (NYSE: AHS), the largest healthcare staffing organization in the United States and the industry leader in innovative workforce solutions.  It is always a pleasure to see one’s company portrayed in a positive a manner in the media and to have its story told.

If any readers have had encounters with media they would like to relate – either positive or negative – I would be happy to hear about them.

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Mark Smith is president of Merritt Hawkins, the nation’s leading physician search and consulting firm and a company of AMN Healthcare.

By Steve Wehn, vice president, government and community relations 

One of the great things about working at AMN Healthcare is that our company not only cares about the world in which we live, but takes strategic action to make it a better place. Like healthcare itself, AMN’s commitment to social responsibility translates into positive, measurable outcomes for people who need help. 

That philosophy-in-action recently took us to the highlands of Guatemala, where AMN sponsored a team of physicians and nurses plus community service volunteers on a project organized by HELPS International, based in Dallas, Texas, to help improve the health of indigenous people.  We worked near the town of San Cristobal Verapaz, a place of coffee fields, green mountains, the native Pokomchi culture and relentless hardships.  

When we arrived at the rural hospital, hundreds of men, women and children were waiting at the gate, and they broke into spontaneous applause and cheers when the clinicians stepped off the bus. The clinicians immediately began walking through the crowd, triaging people who needed immediate help and scheduling those whose conditions could wait until later.  Then the medical team, totaling 30 people, got to work at the clinic and operating room, staffing round-the-clock shifts.

 

 

In six days, the team conducted 97 surgeries for conditions ranging from broken bones and eye disease to hernias and tumors; they also completed 546 clinic visits and nearly 100 dental treatments.

 

I took part in another kind of health service as a member of the “stove team.” Many homes in this part of Guatemala, and in similar impoverished rural areas around the world, use wood cooking fires that have no ventilation, creating dangerous conditions due to indoor smoke. This smoke causes many of the eye and respiratory diseases treated by our team of clinicians.

 

 

 

Together, the stove team installed 20 safely-ventilating stoves, which are proven to dramatically reduce poisonous indoor smoke; they also use 80% less wood, saving valuable resources. HELPS International has installed thousands of safe stoves in Guatemala. In addition to safe stoves, community development teams installed water purifiers in homes, to help prevent the widespread gastrointestinal illnesses that afflict adults and children due to impure water.

 

As VP for community relations at a company with a true social conscience, I’ve done quite a bit of volunteer work. But this was a life-changing experience for me. So many people in this area of Guatemala live in extreme poverty, and their poverty is directly related to their health problems, which is true the world over.

  

FRONT FOUR: Stephan Petranker, MD; Debra Duhart, CRNA; Sherry Chisholm, MD; Ginny McKeon, CRNA.    BACK SIX: Sarita Satpathy, MD; Babak Rashidi, MD; Richard Gilliam, RN; Monica Rogers, RN; Zonna Rogers, RN; Tracy Stillwater, RN

 

AMN is very fortunate to have built a large network of talented clinicians and physicians from San Diego, Dallas and the rest of the country, many of whom were anxious to join this humanitarian effort.  I felt honored and privileged to sponsor and travel with these professionals. We played an integral role in a project that healed sick people, who otherwise would not have received treatment, while creating tangible change that will prevent disease in others. Objectives achieved. 

New Survey Shows Physician Generated Revenue Still a Key for Hospitals

By Phillip Miller 

Merritt Hawkins’ newly released Survey of Physician Inpatient/Outpatient Revenue indicates that, on average, physicians generate $1,448,458 in net revenue on behalf of their affiliated hospitals each year.  This number has stayed virtually constant since Merritt Hawkins first conducted the survey in 2002.   

Why is physician revenue data important?

One reason is that this number illustrates the central role physicians continue to play in today’s evolving health system.  Doctors in the U.S. handle about 1.3 billion patient encounters a year, according to the Center for Disease Control -- some 300 million of them in the ED. It is the result of these encounters that largely determines the quality and cost of care patients receive.  Through the hospital admissions they generate, tests and treatments they order, drugs they prescribe, and procedures they perform, physicians control 87% of healthcare spending, according to a Boston University School of Health study.  This is why many healthcare professionals continue to rank the “physician’s pen” as the most powerful tool in healthcare.

At some point in the future, hospitals and physicians may be compensated largely on quality and efficiency metrics.  The future has not yet arrived, however.  A March, 2013 report from the Catalyst for Payment Reform indicates that the great majority of payments made by commercial health plans to providers (89.1%) are still based on traditional fee-for-service models.  Merritt Hawkins’ new physician revenue survey offers further evidence that volume is still what drives the bus in healthcare.

A preview of the survey is available to readers of this blog. For a complete copy of the survey, and for an ongoing discussion of physician staffing and related issues, we invite you to join our LinkedIn Thought Leadership Discussion Group. You may also order the survey by emailing Shelby Ferrari at shelby.ferrari@merritthawkins.com.  If anyone is seeing similar or contradictory patterns in physician revenue generation I would be happy to learn of them.

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Phillip Miller is vice president of communications for Merritt Hawkins and Staff Care, companies of AMN Healthcare (NYSE: AHS).  He can be reached at phil.miller@amnhealthcare.com.

Photo credit: ThinkStock Images 

Annual Inpatient and Outpatient Revenue Generated by Physician Specialties

Physicians play a large role in their respective communities, providing care and generating economic development income. Not only do physicians generate income for their communities, but also for their affiliated hospitals. Just how much revenue do they generate? Which specialties generate the most? These questions and more are examined in Merritt Hawkins’ 2013 Physician Inpatient/Outpatient Revenue Survey, which reports the amount of revenue physicians in 18 different specialties generate annually on behalf of their affiliated hospitals. 

Now in its fifth year, this survey provides benchmark data hospitals can use to develop a “quantitative analysis” of their physician recruiting programs. In addition, this data is often useful in setting physician compensation levels or recruiting incentives through a cost/benefit analysis comparing the aggregate expense of recruiting physicians to the average revenue generated by physicians in various specialties. See this brief video conversation with Phil Miller, vice president of communications for Merritt Hawkins, as he discusses the background of this benchmark survey.

A Conversation with Phil Miller: Physician Revenue Generation

7 Steps to Successful Physician Recruitment

By Tom Florence 

Healthcare has dramatically changed in recent years, and physician recruitment has evolved with it.  Even with these changes, success in physician staffing still depends on a strategic plan that incorporates seven key elements:   

1. A verified need for physicians 
2. An analysis of the physician market 
3. A competitive financial package 
4. Create the contract
5. An extensive sourcing and screening effort  
6. Buttoned up interview and close process  
7. An effective retention plan

Physician Needs Analysis 

Starting a search without a verified need can lead to a lot of unwanted expense and opportunity cost.  There are a variety of ways to determine physician need including the GMENAC physician to population ratios, and consulting groups who can assist in determining how many and what types of physicians are needed in a service area.  This data can prove very persuasive to physicians being recruited to the area.

The Physician Market

With over 750,000 practicing physicians in the United States it may seem like there is large pool of candidates to choose from.  However, it is important to note how many physicians are available in the specialty that you need.  Where are these physicians located, and what are they looking for in a practice?  These questions must be addressed at the front end of the search process to help determine realistic candidate parameters.  Statistics show that at about 25% of the physicians are foreign medical graduates, and half of physicians prefer communities that have a population of at least 100k.  If your organization is seeking a physician, you should objectively measure your opportunity in the context of the national physician market.

Competitive Financial Package  

Often clients will mention that their financial package is locally competitive.  In today’s market, candidates have access to data that provides average salaries, benefits, etc. across the nation.  Much like a house that is listed above market price, your search could be overlooked if you are not staying competitive with the rest of the industry.  Four day work weeks, no call, and other quality of life benefits are helpful to promote if the finances cannot be changed.

Create the contract  

Taking a cue from Stephen Covey’s effective habits, begin with the end in mind.  Successful recruiters have always had the advantage of developing the physician contract prior to beginning the search.  A sample contract is important in both selling the opportunity and avoiding miscommunication after the interview.  As more physicians become employed, the contracts between hospitals and physicians should be less complicated than in years past.

Sourcing and Screening  

There are thousands of professionals today that earn their living by recruiting physicians.  There is approximately one physician recruiter for every 4 graduating medical residents.  The supply and demand is certainly on the physician’s side.  A strategic sourcing campaign incorporating direct mail, email, advertising, job boards, residency outreach and social media is a must.  Social media and other recent advances in recruiting based software have made the task of reaching physicians much easier.  However, contacting them is only half the battle.  Once sourced, physicians must be thoroughly screened so that all the financial and professional considerations are discussed.  Determining if they are the right match for you, and ensuring there is interest on the candidate side is both an art and a science.  The dedication to time on this step can make or break the search process.

Interview and Close Process  

When properly executed, the interview itself is an opportunity to confirm what has already been discussed with the candidate.  The details of the position, call schedule, financial package, administrative duties and other matters should be agreed upon before the visit.  When both the candidate and the client are highly informed of both situations, the interview becomes much more of a social match.  A surprise to the candidate or client during the interview generally results in a negative outcome.  Candidates and clients should never be pressured to make a decision after the interview.  However, it should be clear from the beginning of the process that a timely decision is expected.  Most clients and candidates know whether the opportunity is right for one another within days of the interview.  As a client you would not want to put an entire search process on hold for someone who is unwilling to make a timely decision.

Physician Retention  

Most employees want to feel appreciated, and physicians are no different.  In the Merritt Hawkins’ white paper “Ten Keys to Physician Retention” it is observed that the most important aspect of a physician retention program is the practice environment.  Physicians generally will stay in a setting where they have quick access to the equipment they need, patient data, reasonable schedules and professional colleagues.  Even perks as seemingly small as a parking space, can become an important piece of the retention puzzle.  In addition, communication between physicians and administration is essential.  

The steps above indicate the importance of the front end work that takes place before candidates are sourced.  Without this preparation most physician searches are bound to take much longer than necessary, or fail.  Organizations that start with a clear plan, including an understanding of the types of physicians they need, how much they need to offer, and how the candidates should be sourced and interviewed have a much better chance of success.

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Tom Florence is the Senior Vice President of Recruiting for Merritt Hawkins, an AMN Healthcare company and can be reached at tom.florence@merritthawkins.com. 

Photo credit: ThinkStock Images

Happy National Doctors' Day – Merritt Hawkins Thanks You 

By Phil Miller 

One of the privileges of working at Merritt Hawkins is that we are able to see physicians “from the inside.”

Over the last 25 years, we have placed thousands of physicians and have spoken to or met with tens of thousands more, getting to know intimately what they do and who they are.

After literally countless personal meetings and telephone calls, what do we think about the physicians practicing at the front lines of patient care today?

The answer is conveyed in a short video we have produced with our sister firm – Staff Care -- in honor of physicians on National Doctors' Day.  I hope you will take a moment to view it at the link below. 

Celebrating National Doctors’ Day - Video

If you know of any physicians who might appreciate this video message, please feel free to forward it to them, or to share it with anyone else who might enjoy this tribute to America’s doctors. 

If you have any comments or tributes of your own, I would be happy to review them and to share them with others.   

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Phillip Miller is Vice President of Communications for Merritt Hawkins and Staff Care, companies of AMN Healthcare (NHSE: AHS) and can be reached at phil.miller@merritthawkins.com. 

New Whiteboard Video Illustrates Physician Compensation Trends

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The Practice of Medicine, the Business of Medicine?

By Kurt Mosley 

A common comment we hear from the many physician residents we work with and advise every year is, “We are ready for the practice of medicine, but we don’t want to anything to do with the business of medicine”. I agree with the first part of the quote -- that our physicians are among among the best trained in the world and are ready for the practice of medicine, and that many new physicians today are less eager to be entrepreneurs than were doctors in years past.

The question of physicians’ business knowledge of medicine also came up when at the Wisconsin Healthcare Financial Management Association (WHFMA) where I presented last week. The consensus among the attendees was not that physicians need better business knowledge(a given), but when and where should physicians receive this training and knowledge?

Business skills are becoming increasingly important for physicians because as the effective start date of the Affordable Health Care approaches in 2012, the health care industry will become increasingly complex. Some additional comments I have heard on why physicians will need more business acumen include:

• The Psychology of business-financial statements 
• Negotiating skills-insurance negotiations
• Economic analysis-strategies for minimizing risk through economic loss (ACO’s, Medical Homes etc)

Physicians who want to be proactive have the option of enrolling in an MD/MBA program, enabling medical students to obtain both their business and medical degrees simultaneously.  There are currently over 54 MD/MBA programs across the United States with an estimated 500 dual degree graduates per year. Another option available to medical students is the “virtual physician office “ offered to medical students pioneered by the Texas Tech School of Medicine, in which medical students and residents can learn to run a virtual medical practice in a controlled environment. 

I believe that physicians with business knowledge and training  can achieve positive changes in the health care industry, rather than accepting what the markets dictates. I would appreciate any comments or examples readers could provide on ways in which medical students, residents and in-practice physicians are on improving their knowledge of the “Business Of Medicine.”

A Raised Hand will address the questions and concerns of healthcare facilities on emerging trends and offer practical solutions to some of the most pressing staffing challenges today. Kurt Mosley, Vice President of Strategic Alliances for Merritt Hawkins, an AMN Healthcare company, is nationally recognized as a leading authority on a wide range of health care staffing issues and trends.

Q: What Criteria is used to determine a work RVU?

In general, Work RVUs reflect the relative level of time, skill, training and intensity required of a physician to provide a given service. The metric is often used for tracking physician productivity as a methodology (instead of measuring patient encounters, or reimbursements for the physician’s professional services).  It is used by the Centers for Medicaid and Medicare Services (CMS) as a portion of a “Total RVU” which determines the overall CMS reimbursement per their Resource-Based Relative Value Scale (RBRVS) method.  That being said, the precise criteria for determining what constitutes a Work RVU can often depend on how it will be used, and upon your perspective as a provider, a practice employer, an insurance payer, or as a politician.   

Without knowing more about how you plan to utilize the information, the most accurate answer is, “The Relative Value Scale Update Committee (RUC) meets and reviews the respective Work RVU amount correlated to each CPT code.  The internal deliberations of the RUC are often not made public.  The RUC makes recommendations which are typically adopted in the CMS Physician Fee Schedule.”  Here is a link.   

 

The current Total RVUs, and the specific Work RVU associated with each CPT code, can be found as periodically published by CMS in their Relative Value Files update.  Both the CMS and American Medical Association (AMA) websites also have features which allow someone to input a particular CPT code in order to find out the respective Work RVU.  It’s important to note that a physician’s practice employment contract might not use CMS’s most current CPT to Work RVU rate.  A physician’s employment contract often has a productivity incentive feature which uses Work RVUs for calculating the bonus amount, but the language in these contract clauses will frequently reference a prior year of the Physician Fee Schedule for determining the Work RVU credited to the physician for each CPT code.  This occurs because the practice (e.g. the physician’s employer) might not be equipped to revamp their compensation methodology for employed providers each time CMS publishes a Relative Value Files update.   

If you have questions about RVU or other physician compensation structures, I would happy to address them.  Please contact me at peter.cebulka@merritthawkins.com. Peter P. Cebulka III is the Director of Recruiting Development & Training at Merritt Hawkins, an AMN Healthcare Company.

By Phil Miller 

According to the National Rural Health Association, about one thousand doctors retire or relocate from rural practice every year, and only 700 physicians take their place.  Partly as a result, the number of federally designated Health Professional Shortage Areas (HPSAs) has grown from under 3,000 some ten years ago to over 6,200 today.

For a variety of reasons, fewer physicians coming out of training are displaying an interest in rural medicine.  According to Merritt Hawkins’ most recent Survey of Final Year Medical Residents, less than 5% of newly trained doctors would prefer to work in a community of 25,000 or less.

“Country doctors” are important to their communities not just because of the medical services they provide but because of the central role they play in the viability of their communities.  When a small community loses its physicians, it may also lose its hospital – usually the first or second largest employer in town.  The domino effect from this event can be devastating to small towns.

Staff Care, the leader in locum tenens staffing which, like Merritt Hawkins, is a company of AMN Healthcare, has long recognized the vital contributions rural physicians make to their communities.  For 20 years Staff Care has sponsored The Country Doctor of the Year Award, in order to honor the spirit, skill and dedication of America’s rural physicians.  The award features two weeks of complimentary locum tenens coverage for the recipient.   More important, the award has brought national recognition to some extraordinary country doctors, such as Kenneth Jackson, M.D. of Kingman, Arizona, who flies a helicopter to the base of the Grand Canyon to care for an isolated Native American community, and Edward Lehman, M.D., of Mt. Eaton, Ohio, who maintained a practice of mostly Amish patients.  

Staff Care recently announced the recipient of the 2012 Country Doctor of the Year Award – Dr. Neil Nelson of Gibson City, Illinois.  Known for his precise diagnostic skills, Dr. Nelson’s practice includes 5,000 active patients in a town of only 3,500.  He has drawn patients from 50 different zip codes and from as far away as 1,000 miles.  Dr. Nelson is on call for his patients 24 hours a day, seven days a week and has not taken a vacation in over 12 years.  He continues to make house calls and in his “spare time” serves as an auxiliary deputy, and as a local liaison physician for the Shriner’s hospital in Chicago.  Until recently, Dr. Nelson was still very active as a farmer.  Learn more about Dr. Nelson from a recent article that appeared in USA Today.  

Merritt Hawkins is proud to be part of an organization that is shining a positive light on the key role country doctors play providing healthcare to rural communities.  We would be pleased to hear about any outstanding country doctors you may know of and welcome you to nominate a physician for the 2013 Country Doctor of the Year Award by downloading the nomination form at www.countrydoctoraward.com.

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Phil Miller is vice president of communications for Merritt Hawkins and Staff Care and can be reached at phil.miller@amnhealthcare.com 

Physicians and Immigration Law FAQ: A Guide to IMG-related Visa and Employment Issues

By Phillip Miller 

The demographics of the U.S. physician workforce are rapidly changing. Today, about one quarter of all active physicians (and one quarter of medical residents) are international medical graduates. 

Though many IMGs are U.S. citizens or green card holders, others require visas to work in the United States.  

A new white paper prepared for Merritt Hawkins by prominent immigration attorney Carl Shusterman provides answers to frequently asked questions about IMG-related visa and employment issues.  The white paper walks through the visa process step-by-step, providing hospital and medical group administrators and physician recruiting professionals with a clear guide to this sometimes confusing process. 

If you would like a copy of the white paper, please contact Shelby Ferrari, Merritt Hawkins’ Senior Resource Development Specialist, at shelby.ferrari@merritthawkins.com or call (800) 876-0500. For more immediate access to Merritt Hawkins' surveys, white papers and other data, join our LinkedIn Discussion Group. 

Over the last several years, we have found an increasing acceptance of IMGs as recruiting candidates.  If anyone is still experiencing resistance to internationally trained physicians, could you share the circumstances?

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Phillip Miller is vice president of communications for Merritt Hawkins, a national physician search and consulting firm and a company of AMN Healthcare.  

Should Physician Incomes Be Cut?

By Phillip Miller 

 Photo courtesy of ThinkStock Images  

Bloomberg.com author, Christopher Flavelle, argues that physicians should be paid less in order to reduce health care costs. While he concedes that physicians are valuable to society, he contends that their incomes, particularly those of specialists, are too high, driving up the nation’s $3 trillion annual health care spending bill.

This argument reminds me (as many things do) of an episode of “The Simpsons.”  Springfield has been threatened by a comet that astronomers at the local observatory have revealed is hurtling toward the town.  The comet eventually burns up before any damage is done, but an angry mob nevertheless sets off to burn down the observatory to ensure that no comet ever threatens the town again.

Like one of Springfield’s many mobs, Mr. Flavelle appears to be somewhat confused as to cause and effect.  As Timothy Norbeck of The Physicians Foundation points out in the white paper “Drivers of Health Care Costs” payments to physicians account for less than 20% of overall health care spending.  One of the real drivers of health care inflation is the chronically ill.  Mr. Norbeck indicates that the sickest ten percent of the population accounts for 63% of total health care dollars in the U.S.  Other cost drivers include technological advances, administrative costs, waste, defensive medicine, fraud, and insurance benefits that do not encourage consumers to shop for value.  Trimming payments to doctors would do little to prevent the comet of runaway health care spending from colliding with us.

Mr. Flavelle’s column raises the bigger question of whether or not physicians deserve large incomes.  As has been noted elsewhere in this blog, when it is your health or the health of a loved one that is at stake, physicians are worth every penny they make.  Better access to preventive services, and better lifestyle choices by patients, will do more to reduce spending than pointing the finger at physicians.   

However, if you think I am missing something, or if you have additional points to add to the discussion, please post a comment.  I’m willing to concede that a man who gets all his analogies from “The Simpsons” may not have all the answers.

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Phillip Miller is vice president of communications for Merritt Hawkins and Staff Care, companies of AMN Healthcare.  He can be reached at Phil.Miller@amnhealthcare.com.

By Travis Singleton  

Change can be seen everywhere in the healthcare system today -- even in academic medicine where tradition often enjoys particular consideration and respect. 

 

An example of evolving practices and perspectives in academic medicine is apparent in the area of physician recruiting.  For years, the general approach to physician recruiting in academic settings has remained relatively static. The traditional approach features a search committee that oversees an often lengthy and ponderous recruitment process with a great deal of medical school/university involvement.   In addition, the prevalent practice among academic institutions has been to offer standard incentive packages that treat all physicians equally.  Salaries have been reasonably similar across entire departments.  

Even candidate parameters have been fairly uniform. In the past, standard parameters have included a requirement that the candidate come with grant funding already established and have a minimum number of publication credits.  Candidates also have typically been required to possess a baseline of experience in academics, with a minimum of professorial rank from another institution and a pedigree in training.   

For a variety of reasons, many academic settings now are taking a different approach to physician recruiting.   This trend is examined in more detail in a new Merritt Hawkins’ white paper entitled, “The Changing Landscape in Academic Physician Recruiting.”

Those who would like a copy of the white paper are welcome to contact me at travis.singleton@merritthawkins.com.

Follow Merritt Hawkins on: Twitter | LinkedIn | Facebook 

 

1. The majority of Indian health program physicians surveyed (67%) work 50 or fewer hours per week. 

Many of the federally employed Indian health program positions limit physicians to the traditional work week of 40 hours. In addition, very few of these opportunities require a physician to take call on nights and weekends.

2. Indian health program physicians generally spend fewer hours on non-clinical “paperwork” duties than physicians in other settings. 

IHS hospitals & clinics, known as service units, provide a defined separation of duties to their providers. Each service unit employs a Physician Clinic Director, who completes non-clinical “paperwork” ensuring that physicians can spend time with patients.

3. The majority of Indian health program physicians (83%) see 20 or fewer patients per day, relatively fewer patients per day than physicians in other practice settings that Merritt Hawkins has surveyed. 

While the complexity of care required by the Indian health program patient base often causes physicians to spend more time with patients, productivity-based compensation does not exist within the IHS. As a result, providers are not driven by administration to see more patients.

4. Most (89%) of Indian health program physicians described their relationship with their local hospitals to be either sometimes supportive and positive or generally supportive and positive. 

A service unit within the IHS generally includes all aspects of patient care (outpatient clinic, emergency room, inpatient care, & sub-specialty care). The Clinic Director, therefore, oversees physicians in all aspects of care and can provide a supportive and positive environment as well as increased continuity of care.

 5. Physicians cited “malpractice climate” as one of the most satisfying elements of practicing in an Indian health program facility. 

Not only is malpractice insurance provided by the Federal government for IHS employed physicians, they also practice in an environment that is much less litigious than the private sector.

 

 

• Federal retirement benefits
• Federal healthcare insurance
• Option for compressed scheduling (2 weeks on/2 weeks off)
• Federally funded student loan repayment
• A mission-driven practice within the United States

Corporate Concierge Medicine

Improving Care, Empowering Physicians

By Jason Bishop 

• Have you ever wanted to practice medicine the old fashioned way, where the patient-physician relationship meant everything and physicians could deliver high quality care and service at the same time?
• Do you feel like productivity requirements prevent you from practicing medicine the way you want? 
• Have you ever thought about Concierge Medicine but didn’t have the right existing panel or weren’t in a position to take on the financial risk of a transition?

Well now there is a career option for you where you can have it all: a smaller panel where you spend as much time as you want with your patients without financial risk—Corporate Concierge Medicine.

According to a national survey of over 13,000 physicians conducted by Merritt Hawkins on behalf of The Physicians Foundation, 6.8% of physicians in the United States will embrace concierge/direct pay medicine in the next three years.  The American Academy of Private Practice (AAPP) reports that the number of concierge/direct pay practices has grown by 25% over the last year.

Why are physicians and patients turning to this growing style of practice?  

• Enhanced relationship with patients: With small patient panels limited to 500-600 patients, Corporate Concierge Medicine allows physicians an opportunity to do what they do best: treat patients.  
• Improved professional quality of life: Corporate Concierge / direct pay physicians do not bill insurance for the vast majority of the services provided, eliminating what many physicians consider to be a tremendous headache and impediment to the provision of care
• More flexible personal life:  Corporate Concierge / direct pay physicians are no longer chained to the clinic to see patients; by leveraging technology, the physician can be at home or at their child’s soccer game and provide better care and better service than in a traditional care model
• Increased, stable compensation:  Most Corporate Concierge / direct pay physicians see an increase in their take home compensation and because Corporate Concierge / direct pay medicine brings the patients to the table, there are none of the financial risks associated with the usual private concierge practice transition.

Corporate Concierge physicians are able to have individual patient visits without any time restrictions and are able to truly learn the story of each patient.  This information better prepares the physician to treat the patient as a whole and get them on the pathway of a healthier lifestyle.   The introduction of preventive medicine to the patient’s lifestyle is a critical component to keeping them healthy and lowering their employers overall health care expenditures.    

• Corporate Concierge / direct pay medicine offers patients access to their personal physician around the clock, whenever they are needed.

The United States is in the midst of a growing physician shortage, and patients are having a harder time accessing a physician.  According to a Merritt Hawkins survey, the average wait time to see a family physician in major cities across the U.S. is three weeks.  And despite the high cost of health care, many studies indicate the quality of care patients receive can be inconsistent at best.

 
EDITOR’S NOTE 

Merritt Hawkins has partnered with two of the leading Corporate Concierge Medicine firms in the United States that are pioneering a more personalized form of medical practice.   

These health care service firms offer some of the most attractive concierge/direct pay practice opportunities in the country.  With all of the support and none of the hassles, these firms are offering ready-made, turn key concierge practice settings to qualified physicians in a variety of markets.  To learn more about physician opportunities, please contact Jason Bishop of Merritt Hawkins at Jason.bishop@merritthawkins.com.  

Tacoma, WA 

Columbia, SC  

Racine, WI 

Beaver Dam, WI 

Green Bay, WI 

Oak Creek, WI 

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Merritt Hawkins to Testify Before Congress

By Mark Smith 

During the last 25 years, Merritt Hawkins has spoken before literally thousands of hospital executives, board members, health professional associations and other groups.

We have never, however, addressed members of Congress.

That will change on Thursday, July 19, at 10 a.m. ET when I will have the honor of serving as an expert witness before the House Committee on Small Business/Subcommittee on Investigations, Oversight, and Regulations. The Subcommittee is holding a hearing on “The Decline of Solo and Small Medical Practices” to examine why the solo/independent practice model is becoming a thing of the past.

Merritt Hawkins will submit written testimony for this hearing. I will provide oral testimony and answer any questions members of the Subcommittee may have. The hearing can be viewed live on streaming video and I hope followers of this blog will have an opportunity to watch it here.

Merritt Hawkins was selected for this distinction based on the years of research and analysis we have conducted on physician practice trends, including our physician surveys and white papers. Some of this research has been in partnership with The Physicians Foundation, a non-profit group of physician and medical society leaders dedicated to empowering physicians and improving healthcare.

I would welcome any comments readers may have on the hearing and would be happy to forward Merritt Hawkins’ written testimony when it becomes available to the public later this month.

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Mark Smith is president of Merritt Hawkins and can be reached at mark.smith@merritthawkins.com

Follow Merritt Hawkins on: Twitter | LinkedIn | Facebook 

By Travis Singleton  

It runs to 127 pages and includes over one million data points. It combines responses from some 14,000 physicians to 48 questions, many of them featuring multiple response categories. It generated written responses, some of them paragraphs long, from 8,000 physicians.    

And it is accurate. According to statistical response experts at the University of Tennessee it has a less than one percent margin of error.

I am referring to  A Survey of America’s Physicians: Practice Patterns and Perspectives, a new report completed by Merritt Hawkins on behalf of The Physicians Foundation, a non-profit group of physician and medical association leaders committed to enhancing the medical practice environment.

The scope of the survey report is ambitious: to provide a “state of the union” of the medical profession revealing the current morale levels of physicians, their practice metrics and their practice plans.  The survey was sent by email to over 80% of all practicing physicians in the United States, giving the majority of the nation’s physicians an opportunity to have their voices heard. 

What the survey reveals is both startling and sobering: 

• Physicians are working 6% fewer hours than they were four years ago, resulting in a loss of over 44,000 FTEs nationwide.
• Physicians are seeing close to 17% fewer patients per day than they were four years ago, a reduction of over 100 million patient encounters.
• Physicians spend more than 22% of their time on non-clinical paperwork, resulting in a loss of some 165,000 FTEs.
• Physicians are disillusioned with the practice of medicine – 84 percent believe their profession is in decline.
• The majority of physicians – 57.9%  – would not recommend medicine as a career to their children and over 60 percent would retire today if they could.

Why do physicians feel this way and how are they changing their practice patterns?  These questions also are addressed in the survey report, which includes survey responses broken out in multiple ways, including by physician age, gender, and employed status.  Other points of interest revealed by the survey:

• Employed physicians see 17% fewer patients per day than practice owners.
• Female physicians see 13.7% fewer patients per day than male physicians.
• Even many young physicians (47%) would retire today if they could. 

This new survey report is one of the most comprehensive and detailed examinations of physicians ever undertaken in the United States. I believe it is a critical source of information for healthcare executives, policy makers, academics and others interested in the current state of the medical profession.

Those who would like a summary of the report may contact me at travis.singleton@merritthawkins.com or may call Shelby Ferrari of Merritt Hawkins at 800-876-0500.  I look forward to hearing your response to this groundbreaking new study.

 ** 

Travis Singleton is Senior Vice President of Merritt Hawkins, the nation’s leading physician search and consulting firm and a company of AMN Healthcare (NYSE: AHS). 

Follow Merritt Hawkins on: Twitter | LinkedIn | Facebook 

A New, Hospital-Specific Model for Assessing Physician Staff Requirements

By Richard “Buz” Cooper, M.D. 

How many physicians in various specialties are appropriate for a given population?   

This question has challenged healthcare planners for decades.  The answer has generally been expressed as a national ratio of physicians-to-population, based either on estimates of the burden of disease (a “needs-based” methodology) or on estimates of the economic capacity to purchase services (a “demands-based” methodology).  These estimates have proven to be useful for national planning and international comparisons.

However, ratios often have been applied across the board, on the assumption that the number of physicians required per population in all areas of the United States is the same.   This simply does not reflect the operational reality of hospitals and other facilities serving various diverse populations.   Resources vary among population groups, depending on economic and demographic factors.  Clearly, physician requirements in a predominantly young, economically disadvantaged area of South Texas will not be the same as requirements in a predominantly older, economically robust area of South Florida.

I was therefore intrigued when Merritt Hawkins invited me to develop a methodology for assessing physician requirements on a case-by-case, hospital service area-specific basis.   After a period of data-gathering and refinement, the result of our efforts is the Hospital-Specific Physician Requirements Model, a new way of assessing the number and type of physicians hospital service populations can sustain.

The Model is built on a layered approach that begins with national projections, extends to historic regional differences, and considers local economic and demographic circumstances.   The Model allows hospitals to develop an objective picture of the projected physician services that will be demanded by the patients they serve and to adapt such estimates to evolving practice structures and personnel changes.        

Using demographic and payer mix information regarding a specific service area, the Model estimates the demand for patient care physicians, excluding residents, based on the levels of healthcare services that are likely to be purchased, which are partially driven by market forces and partially by a community’s response to unmet services.   

The Model therefore does not assess “need” (i.e., what might be most desirable in terms of the burden of illness in the area).  Rather, it assesses demand (i.e., the services the community can actually support).  Specific numbers generated per specialty by the Model can be textured through consultation regarding local trends in physician gender, age, practice patterns and the potential use of non-physician clinicians.

I believe this new Model offers a more practical, real-world approach to assessing physician requirements than models based on generic, national ratios and may be useful to medical staff planners, physician recruiters and others.  It may be particularly useful as part of a Community Health Needs Assessment (CHNA), which not-for-profit hospitals will be required to conduct once every three years starting in 2013.  I welcome your insights into this topic and would be happy to learn of any methodologies you are using to assess community physician requirements.

**

Richard “Buz” Cooper, M.D. is a Senior Fellow in the Leonard Davis Institute of Health Economics at the University of Pennsylvania (a jointly sponsored by Penn’s Medical and Wharton Schools) and Director of the Center for the Future of the Health Care Workforce at New York Institute of technology.  He is a national authority on the physician workforce and author of the “Trend Model” for projecting the future requirements for physicians and other healthcare providers.  Dr. Cooper assists Merritt Hawkins in assessing Hospital-Specific Physician Requirements for its clients. 

Compensation per Physician Work RVU

An Examination of How Work RVU Benchmarks are Derived and Utilized

By Peter Cebulka 

Some of the most frequent requests generated by Merritt Hawkins’ Candidate Corner Blog pertain to compensation per Physician Work RVU (sometimes referred to as wRVU).  Many inquiries come from physicians or employers requesting financial benchmarking data pertaining to typical Compensation to wRVU Ratios for their specialty or region.  Other inquiries are for recommendations associated with the proper structuring of an RVU compensation model.  

 
 Previously, Merritt Hawkins published a white paper titled RVU Based Physician Compensation and Productivity, Ten Recommendations for Determining Physician Compensation/Productivity through Relative Value Units.  Recently, we’ve expanded our coverage of the topic to include two new YouTube videos:  

 What is an RVU or Relative Value Unit

Top Ten Recommendations for RVU Physician Compensation

The video Top 10 Recommendations for RVU Physician Compensation  provides key principles for physician employment agreements.  Also, reference video What is an RVU or Relative Value Unit for a brief general overview of RVUs and their increased significance in healthcare staffing.   

 
Since 2007, the prevalence of RVUs as a metric in determining physician income has roughly doubled.  Presently, a majority of medical practices and physicians utilize RVUs in their compensation methodology.  Below is a table with recently released data from the 2012 report by the Medical Group Management Association (MGMA) showing total compensation and wRVU data from 2011 for selected Primary Care and Specialty Care physicians.   

It is important to note how these figures are derived.  Compensation per wRVU can only be calculated for those medical practices and physicians who track and report the number of wRVU they generate.  Physician compensation per wRVU is a metric that is often misunderstood.  It is a representation of how much a physician has been paid per wRVU over the course of the year, “when it’s all been said and done!”  The ratio is derived by taking the total compensation of a physician and dividing it by the number of wRVU they’ve generated over the course of the year.  

Do Doctors Really Drive Up Health Care Costs?

By Phillip Miller 

The “experts” are wrong. They are simply flat wrong.

That’s the only conclusion I believe a reasonable person can draw after reviewing the data and analysis compiled by Richard “Buz” Cooper, M.D., an oncologist and an internationally noted authority on physician supply and health care utilization studies.

No More Marcus Welby