Compensation for specialists increased only 3.16% last year, or just 0.31% when adjusted for inflation, according to the latest MGMA compensation survey. “Although primary care physicians posted modest gains in compensation as a result of increased productivity and reweighting of evaluation and management codes, overall practice costs continue to rise at staggering rates,” said MGMA President and CEO William F. Jessee, MD, FACMPE, in a statement. “The continued uncertainty of the reimbursement environment creates an untenable situation for physician groups.”
Richard Friedman, MD, writes in the New York Times about his initial high hopes when he began giving patients his e-mail address and the inevitable problems that followed. Friedman notes that for all the convenience and clarity of e-mail, it can be perilous for a clinician. He also notes that e-mail must comply with the Health Insurance Portability and Accountability Act, which has complex rules to safeguard patient privacy and confidentiality. These and other problems are all obstacles that can present huge problems for psychiatrists, he says.
A study of the quality of care given by doctors while the pay-for-performance incentives were rolling out in Massachusetts shows they didn't make a difference. Researchers from Massachusetts General Hospital, Harvard, Harvard Pilgrim Health Care, and Massachusetts Health Quality Partners report that clinical quality got better in Massachusetts between 2001 and 2003 across the board. They studied doctors groups whose income was tied to a series of measures, such as how many patients got mammograms or had their diabetes monitored.
In an ideal world, you'd be able to hire an experienced professional marketing director to manage your program—that is if your practice is large enough and has room in the budget.
But if someone else handles marketing development, such as a physician, a practice administrator, or another executive, it is vital that the person is able to devote the appropriate time to the job. Ideally, this is an individual who understands the importance of relationship building and customer service. This individual will make sure that physicians are on time for appointments and that they follow up appropriately with referring physicians.
This is not an operations-only issue; it is a serious part of customer relations that can make or break a group practice.
"It's their job to find out what it is the patient needs," says Patrick T. Buckley, MPA, a healthcare marketing expert with more than 25 years of experience in the field. "Sometimes the follow-up is lacking."
One of their first goals should be to develop a marketing budget.
The budget is an expression of the manner in which the marketing program seeks to achieve its annual goals. It supports the group's ability to deliver needed clinical services to its patients. The budget must be adequately sized and appropriately spent to enable the group to rise above competitors who may offer similar services.
Consider the following factors when sizing your budget:
What are the practice's clinical growth goals?
What specific resources are required to attain those growth goals?
How much money must the practice spend to counter its competitors' efforts?
Depending upon the size of the group, the marketing manager may or may not have the ability to employ additional marketing staff members.
In comparison to hospitals, most physician groups have modest marketing budgets. The marketing director must make every cent count by determining what can reasonably be accomplished with the existing resources versus what will need to be outsourced.
This article was adapted from one that originally ran in The Doctor's Office, a HealthLeaders Media publication.
For the last 15 years, Merritt, Hawkins & Associates has been reporting on the salaries offered to recruit physicians, and our most recent Review of Physician and CRNA Recruiting Incentives reveals an interesting new development. In the last year, salaries offered to recruit certified registered nurses anesthetists (CRNAs) were higher than salaries offered to recruit primary care physicians. On average, CRNAs were offered $185,000 a year, compared to $172,000 for family practitioners. CRNAs also were offered more income, on average, than general internists, pediatricians and hospitalists.
The fact that nurses (albeit it those with advanced training) are paid more than some physicians is eyebrow raising and has sparked a good deal of heated online discussion. Some physicians argue that CRNA salaries demonstrate how relatively poorly doctors are paid, while non-physicians maintain that the six-figure salaries doctors earn are nothing to complain about regardless of what CRNAs make.
Do physicians who maintain that they are underpaid have a case? Or should doctors be happy with their current earnings?
First, consider average salaries being offered to physicians in various specialties as reported in Merritt, Hawkins' 2008 Review:
Orthopedic surgeons: $439,000
Radiologists: $401,000
Cardiologists: $392,000
Urologists: $387,000
OB/GYNs: $255,000
Psychiatrists: $189,000
Hospitalists: $181,000
General internists: $176,000
Family practitioners: $172,000
Pediatricians: $159,000
One point brought home by these numbers is the striking disparity between the pay of primary care physicians and surgical and diagnostic specialists. Current payment systems reward physicians who perform procedures at a higher rate than physicians who employ cognitive and consultative skills. This is one reason why fewer medical school graduates are choosing primary care, fueling a shortage of primary care doctors that some observers feel could soon reach crisis proportions.
Independent of disparities between specialists, most physicians earn upper middle class incomes, while a few doctors are outright millionaires. Apparently, some people are not happy with this state of affairs, since the pressure to cut physician reimbursement is unremitting. The government and private payers wouldn't find cuts quite so easy to impose if the public at large objected. There is little demonstrable outrage, however, over declines in physician reimbursement.
Maybe there should be.
Many doctors can argue with some justification that they are underpaid. Eleven or more years of collegiate and post-collegiate training set a high bar to professional entry, particularly when they result in $150,000 or more in debt, as often is the case. Once in practice, physicians shoulder an extremely high level of professional responsibility, are highly scrutinized and regulated, and are frequently sued by patients expecting results that cannot reasonably be achieved.
While some might question the value to society of stock brokers, lawyers, or even public relations executives like me, the benefits physicians bring to society are beyond dispute. By delivering, enhancing, and prolonging life, and by easing its passage, physicians provide a service worthy of considerable reward.
Of course, money itself is not the only, or even the primary, sticking point for many doctors—empowerment is. Unlike just about everyone else trying to earn a living, most of you reading this cannot raise yours fees when your cost of doing business rises. Unlike the rest of us, you cannot even submit a bill with any expectation that it will be paid. Perhaps most frustrating of all, you cannot suggest a course of treatment for your patients with the assurance that it will be approved by someone with far less medical training. Little wonder that many doctors feel powerless and marginalized.
The upshot is that a growing number of physicians are looking for a way out, either by retiring, finding non-clinical jobs, limiting access to their practices, working part-time, working as temps or circumventing third parties through direct-to-patient contracting.
Despite prevailing notions, medical practice today often is inequitable to doctors, and many physicians are not as well off as the public may perceive. For every plastic surgeon making millions from elective cosmetic procedures, there are dozens of primary care doctors unable to afford the cost of implementing electronic medical records or even raises for their staffs.
This is not a good prescription for attracting the best and brightest people society has to offer to a profession that eventually affects all of us in a profound way.
These reimbursement woes are one of the drivers of a looming nationwide physician shortage, and payment disparities have already made primary care physicians scarce in many areas.
If you believe physicians are overpaid now, wait until no one wants to be one. That is the point at which we will all be paying a high price, not only with our wallets, but with our health.
Phillip Miller is vice president of communications for Merritt, Hawkins & Associates, a national physician search firm and a division of AMN Healthcare. He can be reached at pmiller@mhagroup.com.
New York hospitals had higher rates of infection in surgical ICUs than any other state in 2007, according to a recent audit by the state Department of Health. Officials say the data found in the study will help hospitals to reduce health risks by identifying risk factors.