Category Archives: Physicians
Physician Compensation Patterns Pose Challenges to Efforts to Incentivize Changes in How Care Is Delivered
Salary is the most common type of compensation for physicians in non-solo practice settings, many of whom are paid through a blend of methods, according to a new American Medical Association (AMA) Policy Research Perspectives report that says it provides a “rare glimpse” into how non-solo physicians are paid.
Just over 53 percent of non-solo physicians reported that all or most of their compensation came from salary, while nearly 32 percent said all or most of their compensation was based on personal productivity. The report points out that this breakdown “suggests that it may be difficult to align practice-level incentives that encourage judicious use of resources with physician-level incentives that do not.”
Ideally, the report says, financial and other incentives would encourage physicians to make the best care decisions possible for patients, providing them “the right care, in the right place, and at the right time,” but current incentives often do not encourage that approach.
In a survey of more than 31,000 U.S. physicians for Medscape’s 2014 Physician Lifestyle Report, dermatologists emerged as the specialists who are happiest both at home and at work. Seventy percent of dermatologists said they are very to extremely happy at home, slightly behind ophthalmologists. But at 53 percent, dermatologists topped the list by a considerable margin in reporting a high level of happiness at work.
Among the least happy specialists are family and emergency medicine physicians, with only 36 percent reporting great happiness at work, followed at 37 percent by internists and radiologists.
Arthur Kellermann, MD, MPH, FACEP, an alumnus of the Robert Wood Johnson Foundation (RWJF) Clinical Scholars and Health Policy Fellows programs, is dean of the F. Edward Hébert School of Medicine at the Uniformed Services University of the Health Sciences. He wrote an article in the November issue of Health Affairs calling for a new class of health care provider—the primary care technician—to improve accessibility to and affordability of primary care.
Human Capital Blog: What is the thrust of your idea?
Arthur Kellermann: We’ve had a decades-long shortage of primary care physicians in this country and, up until now, it has defied solution. One definition of insanity is to continue to do the same thing over and over again and expect a different result. My article suggests a rethinking, and literally a reengineering, of how we deliver primary care in this country. It makes the case for a new class of providers—primary care technicians (PCTs)—who would work remotely, under the online supervision of primary care physicians or nurse practitioners (NPs), to manage stable chronic disease patients, treat minor illnesses and injuries, and provide basic preventive services. These PCTs would make primary care more accessible, more convenient, and more affordable to Americans, wherever they live.
Human Capital News Roundup: Demand for minority physicians, ADHD treatment, anxiety and strokes, and more
Around the country, print, broadcast, and online media outlets are covering the groundbreaking work of Robert Wood Johnson Foundation (RWJF) leaders, scholars, fellows, alumni, and grantees. Some recent examples:
Newly insured patients need time to adjust to not using emergency care as a primary medical service, Sara Rosenbaum, JD, recipient of an RWJF Investigator Award in Health Policy Research, told the New York Times. A study co-authored by Amy Finkelstein, PhD, MPhil, also a recipient of an RWJF Investigator Award, found that newly insured Medicaid recipients in Oregon went to the emergency room (ER) more often than people without insurance. The finding raises doubts about whether expanded insurance coverage will help control ER costs, at least in the short term. This story was also covered by NPR, NBC News, and CBS News.
Doctors who are Black, Hispanic, and Asian provide the most care to minority patients, and demand for their services may increase as the Affordable Care Act provides health insurance coverage to those who are currently without it, Bloomberg News reports. The story is based on a study co-authored by Steffie Woolhandler, MD, MPH, an RWJF Health Policy Fellows alumna. It was also covered by WBUR in Boston and The Charlotte Post.
Given near-universal concern over rising health care costs, are new physicians being taught to keep costs in check?
Not enough of them, according to a research letter published in JAMA Internal Medicine in December. Lead author Mitesh Patel, MD, MBA, a Robert Wood Johnson Foundation (RWJF) Clinical Scholar at the University of Pennsylvania, and his research team analyzed survey responses from nearly 300 U.S. internal medicine residency programs. They found that fewer than 15 percent have curricula designed to teach residents to be more cost-conscious.
“Evidence shows that physicians who recently completed residency training practice medicine at a higher cost than more experienced physicians,” Patel and his team wrote. Among 295 programs that responded to a questionnaire on cost-conscious care in a 2012 survey from the Association of Program Directors in Internal Medicine, 14.9 percent indicated that they had a formal curriculum in cost-conscious care; another 49.8 percent responded that they did not, but were working on it.
The Robert Wood Johnson Foundation (RWJF) Human Capital Blog published nearly 400 posts in 2013. Which were your favorites? Today and tomorrow, as the year comes to an end, we’re taking another look at the posts published on this Blog in 2013 that attracted the most traffic.
A Closer, More Dispassionate Look at Obesity RWJF Scholar in Health Policy Research alumna Abigail Saguy, PhD, discusses how fatness went from being considered a fashion problem to a social problem, a medical problem, and finally the public health crisis we see it as today. She says social perceptions of weight have affected medical interpretations, and shares her concern that some efforts to promote healthy lifestyles will exacerbate weight-based discrimination. Saguy’s interview was also the post most-shared on social media this year, generating more than 2,200 “likes” on Facebook.
A Chief Nursing Officer Who Does Not Have a BSN-Only Hiring Policy in Place In a blog that is both personal and provocative, RWJF Executive Nurse Fellow alumnus Jerry Mansfield, PhD, RN, shares his journey to become a nurse, the setbacks he overcame, and how he has fulfilled his commitment to lifelong learning. He also addresses how he reconciled his support for the Institute of Medicine’s future of nursing education recommendations with the steps he had to take to meet demand for nurses at his institution. Mansfield is chief nursing officer at University Hospital and Richard M. Ross Heart Hospital, and a clinical professor at Ohio State University College of Nursing.
Newly minted physicians who train in underserved health facilities are much more likely to continue practicing in such facilities after completing their residency training, according to research by the Robert Graham Center for Policy Studies in Family Medicine and Primary Care, an independent research unit of the American Academy of Family Physicians (AAFP).
The study, “Do Residents Who Train in Safety Net Settings Return for Practice?,” found that up to half of medical residents who trained in rural health clinics, critical access hospitals, and federally qualified health centers—which serve most of the nation's uninsured and underinsured patients—returned to practice in those settings. The study is published in the December issue of Academic Medicine.
“Overall, between one-third and one-half of the residents we identified in any of these settings during training were also identified as practicing in these same settings after training,” writes Robert Phillips, MD, MSPH, and his co-authors.
What’s on the minds of this year’s medical school graduates? Among top concerns for the country’s future physicians are uncertainty about health care reform, practice choices, and debt repayment, according to the 2013 Medical School Graduation Questionnaire administered by the Association of American Medical Colleges (AAMC). Overall, most medical students say they are satisfied with their education.
The 2013 graduates in the new survey report an average premedical education debt of $11,849, which is about eleven percent more than students reported in 2012. This ends a four-year trend in which the average premedical debt had been decreasing. In addition, the 2013 graduates report an average medical education debt of $135,084—an increase of two percent from 2012 graduates. Nearly two in five graduates this year (38.1%) say they plan to enter a loan-forgiveness program.
Fewer than 2 percent of 2013 graduates say they plan to go into full-time solo practice. Twenty percent have their sights set on a group practice of three or more. Nine percent expect to pursue hospital work.
Ryan Greysen, MD, MHS, is an alumnus of the Robert Wood Johnson Foundation (RWJF) Clinical Scholars program, and an assistant professor of medicine at the University of California, San Francisco (UCSF), Division of Hospital Medicine. He works closely with the Global Health Hospitalist program at UCSF to help train fellows and conduct research in quality improvement for hospitalized patients in developing settings. Phuoc Le, MD, MPH, is an assistant clinical professor of medicine and pediatrics at UCSF. He co-directs the Global Health-Hospital Medicine Fellowship at UCSF, directs the Global Health Pathway for the Pediatric Residency, and is director of international rotations for the Internal Medicine Residency.
U.S. medical education has entered a golden era of growth in global health interest and involvement, but surprisingly little is known about global health after training is completed. In 1978, only 6 percent of graduating medical students reported experiences in global health (GH), but today more than 25 percent participate in global health activities during medical school, and 66 percent plan to participate in GH work during their career. Since this "surge" has started with trainees, many of the recent studies on global health work have focused on medical students or residents.
Interestingly though, we have much less information on what happens after the trainees become full-fledged physicians. Do they continue to engage globally either as professionals or volunteers? If so, do they focus on clinical work, education, research, or health policy? We recently conducted a pair of surveys to answer these questions in two specific groups of doctors: those who have received research and leadership training through the longest- program of this kind in the U.S. (the RWJF Clinical Scholars program) and those who have joined the ranks of the medical profession's fastest-growing sub-specialty: hospitalists.
The website Physicians Practice has released its annual Physician Compensation Survey, which for the third straight year shows that a majority of U.S. physicians view the income from their medical practice as “disappointing.” In 2013, 54 percent defined their net income this way, the same number as a year earlier, but 5 percent more than those who took the survey in 2011.
Physicians Practice surveyed 1,474 physicians and staff for the survey, asking about personal income, practice overhead, practice outlook, and other financial issues. For the first time, the survey acknowledged the shift from volume-based reimbursement to value-based reimbursement, asking respondents to share how much of their income is tied to factors other than the number of patients they see.
Thirty-three percent of respondents said a portion of their compensation is tied to value (quality and cost of care provided), with 8.5 percent of that group saying this was the only factor in their pay. Furthermore, 24 percent of respondents said a portion of their compensation was tied specifically to patient satisfaction.
However, productivity remained the dominant factor in physician compensation, with 28 percent of survey respondents saying that their entire compensation package was factored on productivity alone. Another 37 percent said it made up a portion of their annual pay.