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Physician Compensation Trends

Physician Compensation Trends. Paul Evans DO, FAAFP, FACOFP Dean and Professor of Family Medicine. Objectives. Review Compensation Trends 2002-2007 Primary Care Physician Specialty Care Physicians Present Trends Impacting Physician Practice Physician Responses

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Physician Compensation Trends

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  1. Physician Compensation Trends Paul Evans DO, FAAFP, FACOFP Dean and Professor of Family Medicine

  2. Objectives • Review Compensation Trends 2002-2007 • Primary Care Physician • Specialty Care Physicians • Present Trends Impacting Physician Practice • Physician Responses • “Hot” Specialties (now and long-term) • Discuss Physician Recruiters (friend or foe?)

  3. References Compensation data and graphs excerpted from 1.8.2009 SOMA GA-PCOM presentation by: Douglas T. Cardinal, RN, FACHEPresident, DT Cardinal Consulting(770) 622-5799dcardinal@dtcardinalconsulting.com

  4. Introduction Factors influencing practice decisions: • High student loan burden • Loan debt in excess of $200,000 • “Life style” vs. compensation • predictable call , weekends off • time off to have families • collegial nature of larger groups

  5. Lower Reimbursements- Now What? Physician Response • Increasing “production” • 2000 FP Relative Value Unit = 3,834 • 2007 FP Relative Value Unit =4,600 (up 20%) • Compensation for ER and house call • Medical Directorships • Embracing “alternative” health and lifestyle modalities • CAM, Acupuncture • Medical “spas”, aesthetic procedures • Concierge medicine

  6. Lower Reimbursements- Now What? • Institutional Response • Hire physicians into hospital owned or controlled medical groups • Changing physician compensation formulas from fixed salary or gross charges to: • Net collections less actual and allocated expenses • Compensation per Work Relative Value Unit produced

  7. Lower Reimbursements- Now What? • Government Response • Auditing physician-hospital compensation relationships of all kinds – more denial payments • CMS OIG • Compensation must be “reasonable” and “fair market value” • Physician recruitment incentives • Payments for relocation - actual move of practice • Physicians within the first two years of practice exempt

  8. Medical Specialties of Interest to PCOM Students Primary Care Medical Specialties,Subs Allergy/Immunology Cardiology, Pediatric, Invasive Interventional and Noninvasive PM&R (Physical Medicine & Rehabilitation) Rheumatology Hematology/Oncology, Pediatric and Adult Pediatric Endocrinology Neurology, Movement Disorders Psychiatry Dermatology Infectious Diseases Pulmonology Interventional Radiology Emergency Medicine • Family Practice, Sports Medicine • Internal Medicine • Pediatrics

  9. Medical Specialties of Interest to PCOM Students Surgical Specialties and Subspecialties Specialties Without Reliable Compensation Data Pediatric PM&R Osteopathic Manipulative Medicine • Orthopedic Surgery, Hand Surgery, Sports Medicine • General Surgery • Urological Surgery • Anesthesiology, Anesthesiology Pain Medicine • Cardiothoracic Surgery • Gastrointestinal Surgery • Neurosurgery • Pathology

  10. Specialty Selection

  11. Compensation Comparisons Median = 50 percentile Midpoint of all specialists Average age is now about 50-55 Starting from residency may be less 90th Percentile Top earners Most productive (80-100 hours per week) Most experienced (20 + years in practice) Most business savvy Scarcity / geographic considerations important

  12. Primary Care Trends Median Compensation 2003 through 2007

  13. Primary Care Trends 90th Percentile Compensation 2003 through 2007

  14. Medical Sub Specialty Trends Median Compensation Medical Sub Specialties 2003 through 2007

  15. Medical Sub Specialty Trends 90th Percentile Medical Sub Specialties 2003 through 2007

  16. Medical Sub Specialty Trends Median Compensation Medical Sub Specialties 2003 through 2007

  17. Medical Sub Specialty Trends 90th Percentile Medical Sub Specialties 2003 through 2007

  18. Hospital Based Physician Trends Median Compensation 2003 through 2007

  19. Hospital Based Physician Trends 90th Percentile Compensation 2003 through 2007

  20. Surgical Physician Trends Median Compensation Surgical Sub Specialties 2003 through 2007

  21. Surgical Physician Trends 90th Percentile Surgical Sub Specialties 2003 through 2007

  22. Surgical Physician Trends Median Compensation Surgical Specialties 2003 through 2007

  23. Surgical Physician Trends 90th Percentile Compensation Surgical Specialties 2003 through 2007

  24. Demographic and Economic Trends • For the next 19 years, 70 million new aging Americans. • Life expectancy: • In 1959-1961 • Males 66.8 Medicare eligibility 1.8 years • Females 73.24 Medicare eligibility 8.24 years • In 2004 at age 55 • Males 79.04 Medicare eligibility 14.04 years • Females 83.3 Medicare eligibility 18.3 years • Boomers have more money to spend on Healthcare • Demand quality care and are willing to pay for it

  25. Hot • Specialties for the next two decades are those specialties that focus on diseases of ageing: Medical Specialties Surgical Specialties • Internal Medicine • Geriatrics • Hospitalist • Pulmonary Medicine • Rheumatology • Cardiology • Endocrinology • Hematology/Oncology • Physiatry (PM&R) • Geriatric Psychiatry • Orthopedic Surgery • General Surgery • Surgical Oncology • Vascular Surgery • Urology

  26. Physician Responses • Physicians /residency programs slow to respond • Some physicians close to Medicare (opt out). • Some physicians are leaving medicine. • Primary care physicians = more ambulatory patients only (hospitalists). • Opening “concierge” practices

  27. Physician Responses Physician Responses by age group: 35 to 45-Expand practice or retrain to take advantage of older population 45 to 55-Expand practice, look at opportunities to use experience in alternative ways 55 to 70-Hang on and plan for eventual retirement

  28. Physician Recruiters - Friend or Foe? • Recruiters bombard you the second year residency • Critically evaluate • Location • Lifestyle • Practice Style • Loan forgiveness packages • Eliminate those offers that do not fit into your goals • Never pay a recruiter (they will come to you). • Recruiters work for the hiring organization, not you. • Never pay for visit to a potential practice location. • Last year of the residency allows for short absences for recruiting trips.

  29. Conclusion • Physicians still make a good living • Important day is the Residency Match Day (FEB/MAR in 4th year). • Know your goals, and make flexible decisions based on these whenever possible

  30. Physician Recruiters - Friend or Foe Resources National Association of Physician Recruitershttp://www.napr.org Merritt Hawkins and Associates1-800-876-0500http://www.merritthawkins.com Cejka Search1-800-678-7858http://www.cejkasearch.com/ Health Management Associates1-239-552-3636http://www.hma.com/

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