Luke Corbett, chair of the INTEGRIS Health Board of Directors, has announced that Stanley F. Hupfeld, president and CEO of INTEGRIS Health, will transition from his role as president and CEO of INTEGRIS Health to become chair of the INTEGRIS Family of Foundations, effective Jan. 1, 2010. The board has designated Bruce Lawrence, executive vice president and COO of INTEGRIS Health, to assume the role of CEO in January.
Cecil B. Wilson, MD, an internist from Winter Park, FL, was named president-elect of the American Medical Association. Following a year-long term as president-elect, Wilson will assume the office of AMA president in June 2010. First elected to the AMA Board of Trustees in 2002, Wilson served a one-year term as board chair in 2006-2007. He had previously chaired the AMA's Membership Committee for three years. Prior to being elected to the AMA board, Wilson represented Florida in the AMA House of Delegates for 10 years.
If you have a clogged sink, the money you pay a plumber to unclog it will depend—in part—upon how many plumbers there are in your area, and how many sinks they're already working on.
The formula looks something like this: Fewer plumbers + many clogged sinks = higher labor costs. It's the simple law of supply and demand and it is almost universally applied in our capitalist system with the notable exception of physicians in general and primary care physicians in particular.
Maybe it's the buzz about patient-centered care, medical homes, and the renewed emphasis on the gatekeeper function in coordinating healthcare. Or, maybe it's because there aren't that many of them. Whatever the reason, a new study by physician recruiters Merritt Hawkins & Associates affirms that primary care physicians are in greater demand than any other type of doctors.
The Irving, TX, firm bases its findings on more than 3,200 physician recruiting assignments it conducted in 47 states from April 1, 2008, to March 31, 2009. In that time, the company fielded more requests for family physicians than for any other type of doctor. Requests for primary care doctors—family physicians, internists, and pediatricians increased 23% over the previous 12-month period examined in the survey.
Despite growing demand, 2009 Review of Physicians Recruiting Incentives shows that huge salary disparities continue to exist between primary care physicians and subspecialties. The average salary offered to family physicians in the Merritt Hawkins study was $173,000, the lowest of any specialty. By comparison, cardiologists were guaranteed average base salaries of $419,000 a year, and orthopedic surgeons were guaranteed $481,000.
Those compensation figures are consistent with other studies, like the Medical Group Management Association's recently released Physician Placement Starting Salary Survey: 2009 Report Based on 2008 Data. The MGMA study found that median starting salaries for all primary care physicians grew by 7.4% between 2005-2008, to $150,000, while the median starting salaries for all specialists grew by 25% for the same period, to $275,000.
Ted Epperly, MD, president of the American Academy of Family Physicians, says the salary differential between primary care physicians and subspecialists exposes a fundamental flaw in the nation's healthcare delivery system. "It's a perversely incented system that overvalues procedures and imaging and undervalues the complex mental thinking needed to keep people well," he says. "We have a total reactive sick care system instead of a proactive healthcare system."
Epperly says medical school students—many of them saddled with between $140,000—$180,000 or even more in student loans—know they can more than double their income right out of medical school by gravitating toward subspecialties.
"The supply pipeline for primary care is just trickling. Only about 10% of medical school graduates are primary care physicians. We are making more and more of the wrong kinds of doctors in America," he says. "Medical school graduates are looking at what kind of doctor they can be and they're seeing they can make two or three or in some cases seven times more in the subspecialties than a family physician; it's becoming a no-brainer for them."
"We've made this point to Congress and big business. You must pay primary care physicians more or you won't get them produced from medical schools. The payment system must change in a way that values what primary care physicians do and pays for it."
President Obama made that point last week when he told the American Medical Association's annual meeting in Chicago that the practice of medicine has devolved into "a model that rewards the quantity of care rather than the quality of care; that pushes you, the doctor, to see more and more patients even if you can't spend much time with each, and gives you every incentive to order that extra MRI or EKG, even if it's not necessary. It's a model that has taken the pursuit of medicine from a profession—a calling—to a business."
Obama has called for compensation reforms that include bundled payments and bonuses that reward physician teamwork, and positive health outcomes, and enhanced financial incentives, like loan forgiveness, for medical students who choose primary care. Will that be enough? It's hard to say.
The Obama administration has also indicated that it's not willing to increase Medicare reimbursements, which would mean slicing the pie differently. Subspecialists wouldn't be happy about taking a smaller piece. But, if we're truly going to make healthcare more cost efficient, then we will have to take Epperly's observations seriously, remove the perverse incentives, and apply the laws of supply and demand.
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Senator Charles E. Grassley of Iowa said that the Senate Finace Committee would consider revisiting its version of healthcare legislation to gain more support. An initial price tag for the Senate Finance Committee's healthcare proposal came to $1.6 trillion, according to the Congressional Budget Office. That figure caused enough consternation that the chairman postponed a drafting session that was to have begun this week. The Finance Committee's plan is expected to attract more bipartisan support than legislation being written by the Senate Health, Education, Labor and Pensions Committee.
As the debate on overhauling the nation's healthcare system continues, virtually everyone still agreed on one point: There are not enough primary-care doctors to meet current needs, and providing health insurance to 46 million more people would threaten to overwhelm the system. The American Academy of Family Physicians predicts that, if current trends continue, the shortage of family doctors will reach 40,000 in a little more than 10 years, as medical schools send about half the needed number of graduates into primary medicine.
Americans overwhelmingly support substantial changes to the healthcare system and are strongly behind a government-run insurance plan to compete with private insurers, according to the a New York Times/CBS News poll. The poll found that most Americans would be willing to pay higher taxes so everyone could have health insurance and that they said the government could do a better job of holding down healthcare costs than the private sector.
Massachusetts General Hospital and Lahey Clinic Medical Center have invested millions of dollars on outpatient care and treatment in the northern suburbs of Boston. Knee surgery, treatment for sleep disorders, ultrasound, and cardiac stress tests are among the day surgeries and procedures that will be offered at the new facilities as two of the biggest names in Massachusetts healthcare square off in Boston's northern suburbs.
Ron Anderson, MD, CEO of Dallas-based Parkland Health & Hospital System, said his greatest worry is Congress will see less of a need for the public hospital when it passes a healthcare plan. His staff is now preparing for less local tax revenue and possibly operating as a for-profit hospital. House Democrats unveiled a healthcare bill that could mean a reallocation of where Americans' tax dollars are spent. It's unclear whether money would be taken away from public hospitals such as Parkland that treat a disproportionate share of poorer patients and allocated elsewhere. Parkland received $171 million in federal funds this fiscal year.
Abraham Verghese, Professor and Senior Associate Chair for the Theory and Practice of Medicine at Stanford University, says it doesn't pay to stay well in this article from the Wall Street Journal. Verghese says he has problems with the way President Obama hopes to pay for Obama's health reform package: Obama is counting on the "savings" that will come as a result of investing in preventive care and investing in the electronic medical record among other things, Verghese says, and "it's a dangerous and probably an incorrect projection."
President Barack Obama was joined today by two of the chairmen of the Senate panels overseeing healthcare reform legislation—Max Baucus (D-MT) and Chris Dodd (D-CT)—plus an AARP representative to announce the agreement with pharmaceutical manufacturers to spend $80 billion over the next decade to assist Medicare beneficiaries in defraying drug costs.
Under the deal, drug companies would pay as much as half of the cost of brand name drugs for lower and middle income seniors in the so called doughnut hole, which is a gap in prescription coverage in which the beneficiary pays the full price for medication without help from Medicare. The pharmaceutical companies also have agreed to pick up some of the costs of the president's health reform plan.
"The agreement by pharmaceutical companies to contribute to the health reform effort comes on the heels of the landmark pledge many health industry leaders made to me last month, when they offered to do their part to reduce health spending $2 trillion over the next decade," Obama said in a statement on Saturday.
In response to the announcement, National Community Pharmacists Association (NCPA) Executive Vice President and CEO Bruce T. Roberts, RPh, said Monday that community pharmacists want to lower drug costs, but also need to learn more about the agreement so "to ensure community pharmacies are treated fairly and can continue serving patients."
The NCPA's questions include: when will the program start, how will they calculate the discounts and who will pass them along, and how will pharmacists receive the full reimbursement for prescriptions.
"Community pharmacies must play an important role if health care reform and cost savings proposals such as this are going to be successful," said Roberts.
The deal with the pharmaceutical industry marked a small victory for Sen. Max Baucus (D-MT), chairman of the Senate Finance Committee, who has been negotiating with health industry groups as he was working on drafting health reform legislation with his committee.
Initially, a draft bill was expected from the committee last week. However, Congressional Budget Office questions over costs may have slowed that down; CBO had estimated on Tuesday that the costs of reform legislation may be closer to $1.6 trillion.
Baucus was pushing for the final price tag to be around $1 trillion. A draft summary that surfaced last week showed that the committee was still examining whether to create consumer governed nonprofit medical cooperatives. The committee was also reviewing how to limit the ability of workers to leave employer sponsored health plans in favor of subsidized insurance that would be offered through state exchanges. Mark-up is expected after the July 4 recess.
Meanwhile, hearings continued in the Senate Health, Education, Labor and Pension Committee. Mark-up for the committee had been scheduled for June 26. However, it may take longer than that.
Republicans seemed to be stepping up their resistance to the bill—criticizing Democrats for providing adequate time for reviewing the proposals related to creating insurance programs and restructuring the way providers are paid.
