Physicians employed by hospitals want more say in hospital management, according to a survey by the consulting firm PricewaterhouseCoopers US. More than 90% of the physicians surveyed said they should be more involved in executive leadership and management of the hospital, including serving on the board of directors and outlining performance improvement initiatives.
Hospital leaders, however, think most physicians aren't ready for that big step.
The survey results are published in From Courtship to Marriage Part II: How Physicians and Hospitals are Creating Sustainable Relationships, a report released on Wednesday by PwC's Health Research Institute.
The report is the second in a two-part series on physician-hospital alignment. The findings are important because shifts toward healthcare reform, such as the move toward accountable care organizations make it financially attractive for physicians and hospitals to integrate their services. PwC's HRI's research focuses on three areas important to hospital-physician integration: Shared governance, aligned compensation, and changing physician-practice patterns.
The findings indicate that physicians and hospitals have more to work on as they explore ways to capitalize on health reform opportunities.
Hospital employment means physicians may have to give up control of how they practice to comply with standards that emphasize overall system quality and efficiency goals. Many physicians willing to make that transition, in return, want a seat at the management table.
Hospital leaders, however, aren't willing to cede to those demands just yet. Hospital leaders interviewed by PwC HRI for the report were of the opinion that most physicians lack the business management and leadership skills needed to be effective in positions of leadership and governance. The good news is that some hospital systems are providing continuing education to help physicians develop management skills.
About 66% of the physicians surveyed said they can devote time to leadership and management activities. To make sure they meet those obligations once they take them on, more providers are paying doctors to serve on committees and participate in administrative activities, especially to help create buy-in for new quality programs and cost reduction initiatives. Hospital leaders said they need physicians to not only help reduce supply and infrastructure cost, but also to generate additional revenue.
Physicians are very aware that healthcare is moving toward a payment approach that rewards doctors and hospitals for quality results over volume. In looking at compensation, physicians said that half of their compensation should be fixed salary with the remainder based on meeting a combination of productivity, quality, patient satisfaction, and cost-of-care goals, with upside earning potential for performance.
In HRI interviews hospital leaders said they are developing compensation models that will benefit their overall system. They acknowledge that physicians will be the key drivers in meeting clinical quality standards set for ACO participation. Providing the right mix of compensation could help hospitals increase revenue and avoid financial penalties.
- Some 45% of physicians who are considering hospital employment would expect to be paid more than they are now with increases ranging from 1.7% to 4.7% percent.
- Some 38% said they would expect no salary change.
- Expectations for compensation varied by physician specialty, with pediatrics, psychiatry and cardiology expecting the largest increase at 4.7%, 3.6% and 3.5%, respectively. General surgery, oncology, and emergency medicine expect the least at 1.9%, 1.7% and 1.7%, respectively.
Changing Physician-Practice Patterns
Physicians who have traditionally focused on volume will have to adjust to practice patterns that emphasize system quality and efficiency, the report suggests. Physicians also will be challenged to practice as part of a multidisciplinary team.
Hospitals are looking to develop clinical guidelines to help in this transition. While hospital executives expressed support for local guidelines, 62% of physicians surveyed preferred that nationally accepted physician practice guidelines be used. Only 30% preferred locally developed guidelines.
The report is based on a nationwide online survey of more than 1,000 physicians. Results are balanced by age, gender, practice type and specialty. In addition, HRI analysts conducted 28 in-depth interviews with thought leaders and executives representing healthcare providers, payers, and professional associations.
See Also:
ACO Proposed Rules Spotlight Physician-Hospital Alignment
HealthLeaders Media Industry Survey 2011: Physician Leaders
The Leap to Accountable Care Organizations
Margaret Dick Tocknell is a reporter/editor with HealthLeaders Media.
