Posts Tagged physician

What Should You Consider When Planning Physician Compensation?

What Should You Consider When Planning Physician Compensation?

The changes in health care reimbursement and the rising costs of the health care business have prompted groups to look at options related to physician compensation. The addition of mid-level providers and ancillary services, the revenue and costs in a practice can look quite different than it did five to 10 years ago. A group may have adopted a compensation plan for collegiality based on keeping the group together long-term. This model is beneficial due to its simplicity, but only if the physicians worked at an equal pace and the costs were consistent among the group. It is rare to see this model, due to the fact that highly productive physicians want to be compensated for their work. Some physicians are more efficient and confident with electronic aids and can see more patients than their counterparts.

The ultimate goal in physician compensation planning is to ensure everyone believes the plan is fair, transparent and it rewards individual physicians for their work. Our team of accountants and consultants work to understand the goals of the group and the nuances that must be considered to arrive at a fair and compliant decision. The practice administrator’s opinion should be considered in compensation planning, but a trusted advisor is key to leading the effort due to the fact it is a sensitive subject that requires an objective opinion.

Six key issues are important when preparing for a change in physician compensation models. To begin, interview the physicians to get their thoughts on the current compensation structure and what should be considered in a new plan.  Secondly, review the segmentation of revenue by physicians and other billable providers. Dissect professional, technical and ancillary services and review for Stark Law implications related to physician compensation. Review employment contracts related to employed physicians or providers to assure the compliance of a proposed bonus structure.

In addition, analyze the overhead to assign costs as fixed, direct or variable categories. Fixed costs are consistent each month, such as; rent, administrative staff, equipment lease, etc. Variable costs change as the volume of service increases or decreases. Direct costs are those associated with each physician, such as individualized staff, equipment or other resources.

Fourthly, review nuances in the group related to medical directorships, mid-level supervision and lines of business, for example, Obstetrics vs. Gynecological services. Some groups are joining accountable care organizations or engaging is value-based contracts or capitated arrangements that require analysis to assure its effect on the compensation plan.

Fifthly, it is important to plan at least three options for the allocation of revenue, costs and bonus structure revealing the pros and cons for each arrangement. Place a quarter of historical data into a sample to reflect each option for every physician. This allows for questions and requested variations to arrive at the best decision for the group.

Lastly, the group and advisors should meet regularly after the new plan is implemented to address any unforeseen outcomes and continue the impact analysis of the plan.  As value-based revenue and other revenue streams evolve, it is reasonable to review the compensation plan at least every three years to assure practice changes aren’t adversely impacting the group.

Article contributed by Tammie Lunceford, Healthcare and Dental Consultant, Warren Averett Healthcare Consulting Group. Warren Averett is an official Gold Partner with the Medical Association.

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For the First Time, Employed Physicians Outnumber Self-Employed

For the First Time, Employed Physicians Outnumber Self-Employed

CHICAGO — For the first time in the United States, employed physicians outnumber self-employed physicians, according to a newly updated study on physician practice arrangements by the American Medical Association. This milestone marks the continuation of a long-term trend that has slowly shifted the distribution of physicians away from ownership of private practices.

Employed physicians were 47.4 percent of all patient care physicians in 2018, up 6 percent points since 2012. In contrast, self-employed physicians were 45.9 percent of all patient care physicians in 2018, down 7 percentage points since 2012. Changes of this magnitude are not unprecedented. Older AMA surveys show the share of self-employed physicians fell 14 percentage points during a six-year span between 1988 and 1994.

Given the rate of change in the early 1990s, it appeared a point was imminent when employed physicians would outnumber self-employed physicians, but the shift took much longer than anticipated. The AMA’s research notes this example and suggests “caution should be taken in assuming current trends will continue indefinitely.”

The majority of patient care physicians (54.0 percent) worked in physician-owned practices in 2018 either as an owner, employee, or contractor. Although this share fell from 60.1 percent in 2012, the trend away from physician-owned practice appears to be slowing since more than half of the shift occurred between 2012 and 2014.

Concurrently, there was an increase in the share of physicians working directly for a hospital or in a practice at least partly owned by a hospital. Physicians working directly for a hospital were 8.0 percent of all patient care physicians, an increase from 5.6 percent in 2012. Physicians in hospital-owned practices were 26.7 percent of all patient care physicians, an increase from 23.4 percent in 2012. In the aggregate, 34.7 percent of physicians worked either directly for a hospital or in a practice at least partly owned by a hospital in 2018, up from 29.0 percent in 2012.

Younger physicians and women physicians are more likely to be employed. Nearly 70 percent of physicians under age 40 were employees in 2018, compared to 38.2 percent of physicians age 55 and over. Among female physicians, more were employees than practice owners (57.6 percent vs. 34.3 percent). The reverse is true for male physicians, more were practice owners than employees (52.1 percent vs. 41.9 percent).

“Transformational change continues in the delivery of health care and physicians are responding by reevaluating their practice arrangements,” said AMA President Barbara L. McAneny, M.D. “Physicians must assess many factors and carefully determine for themselves what settings they find professionally rewarding when considering independence or employment. The AMA stands ready to assist with valuable resources that can help physicians navigate their choice of practice options and offers innovative strategies and resources to ensure physicians in all practice sizes and settings can thrive in the changing health environment.”

As in past AMA studies, physicians’ employment status varied widely across medical specialties in 2018. The surgical subspecialties had the highest share of owners (64.5 percent) followed by obstetrics/gynecology (53.8 percent) and internal medicine subspecialties (51.7 percent). Emergency medicine had the lowest share of owners (26.2 percent) and the highest share of independent contractors (27.3 percent). Family practice was the specialty with the highest share of employed physicians (57.4 percent).

Despite challenges posed by a dynamic change in the health care landscape, most physicians still work in small practices. This share has fallen slowly but steadily since 2012. In 2018, 56.5 percent of physicians worked in practices with 10 or fewer physicians compared to 61.4 percent in 2012. This change has been predominantly driven by the shift away from very small practices, especially solo practices, in favor of very large practices of 50 or more physicians.

The new study is the latest addition to the AMA’s Policy Research Perspective series that examines long term changes in practice arrangements and payment methodologies. The new AMA study, as well as previous studies in the Policy Research Perspective series, is available to download from AMA website.

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Legislation Introduced to Tackle Doctor Shortages

Legislation Introduced to Tackle Doctor Shortages

WASHINGTON, D.C. – U.S. Reps. Terri Sewell (D-AL) and John Katko (R-NY) have introduced legislation that would take critical steps towards reducing nationwide physician shortages by boosting the number of Medicare-supported residency positions. The Resident Physician Shortage Act (H.R. 1763) would support an additional 3,000 positions each year for the next five years, for a total of 15,000 residency positions.

“This week, medical students across the country will celebrate their match into physician residency programs, but many of their peers will be left without a residency due to the gap between students applying and the number of funded positions. At the same time, the United States faces a projected shortage of up to 120,000 physicians by 2030. We need to act now to train more qualified doctors,” Sewell said. “Increasing the number of Medicare-supported residency positions means increasing the number of trained doctors to meet growing demand. It also means giving hospitals and health centers the tools they need to increase access, lower wait times for patients and create a pipeline of qualified medical professionals to serve Americans’ health needs.”

To become a practicing doctor in the U.S., medical school graduates must complete a residency program. However, for the past two decades, an artificial cap on the number of residents funded by Medicare – which is the primary source of payment for residents – has limited the expansion of training programs and the number of trainees.

According to the Association of American Medical Colleges, the United States will face a physician shortage of between 42,600 and 121,300 physicians by 2030. As the American population grows older, the demand for physicians and other medical professionals will increase.

Earlier this year, the Medical Association empaneled the Manpower Shortage Task Force to develop and restore adequate health care manpower in all geographic areas in order to provide quality local health care for all Alabama citizens. Members of the task force have discussed a number of issues including fully funding the Board of Medical Scholarship Awards, scope of practice, physician pipeline programs, education and the possibility of GME expansion, recruitment and retention of physicians through meaningful tax credits and rural community support, and start-up business models.

“Naturally, there are a lot of concerns about health care shortages in rural areas, but our goal with the task force is a long-term solution,” said Medical Association Executive Director Mark Jackson. “The task force and the resolution stand as a reminder that Alabama ranks in the last five of 50 states in health status categories, and while primary care medicine is effective in raising health status, supporting hospitals and improving the economic status of disadvantaged communities, the state’s aging population is causing an escalation in need for primary care physicians. The Association would like to thank Rep. Sewell for introducing the bill and will work closely with her and her staff to help ensure its passage.”

Read the Resident Physician Shortage Act

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Senior Physicians: We Need Your Voices!

Senior Physicians: We Need Your Voices!

Any physician that has reached the age of 65 is considered by the American Medical Association and the Medical Association to be a Senior Physician, even if you are not currently working in a medical practice. That does not mean your voice cannot still work for the House of Medicine.

Did you know the Medical Association has a Senior Physician Section Representation on the Board of Censors? This is an elected office, and even though it is a non-voting position by statute, it is nevertheless an important platform for voicing the issues affecting older physicians in Alabama, such as requesting payment for services, malpractice coverage, new technologies, personal health issues, etc…

The position has benefits, too, such as reimbursement for travel to and from monthly board meetings, which are the second Tuesday and Wednesday of the month, and accommodations and food are also provided during your time in Montgomery. Your transportation, hotel and food expenses are covered for the two annual meetings of the AMA. In 2019, the meetings will be June 8-12 in Chicago and Nov. 16-19 in San Diego.

I have served as the Senior Physician Section Representative for the past year, and I will vacate the office during the next Annual Meeting in April 2019 when a new representative will be elected. I urge all Association senior physicians to attend because we are the ones who elect OUR representative – and practicing physicians can also earn CMEs for attending the conference.

I would recommend choosing someone who is still practicing medicine and would like to serve the Medical Association. This position requires someone that understand the difficulties that face all physicians and especially senior physicians in the current medical environment. If you have questions, please email Executive Director Mark Jackson.

Article contributed by Dr. Jim Alford, Senior Physician Section Representative, 2018-2019.

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Can I Get a Witness? Do You Use Chaperones in the Exam Room?

Can I Get a Witness? Do You Use Chaperones in the Exam Room?

In 2018, the world of sports was rocked with the revelation that Larry Nassar, a physician for USA Gymnastics, used medical examinations as a pretext to molest nearly three hundred female gymnasts over a twenty-year period. Many of these young athletes were abused while their parents were in the examination room. News coverage of the scandal caused many physicians to reexamine the professional safeguards that exist to protect a patient during one of his or her most intimate and vulnerable experiences, the physical examination.

In fact, the medical community addressed this concern long before the Larry Nassar scandal brought the issue into the public consciousness. The American Medical Association promotes the use of chaperones to provide a comfortable and considerate atmosphere for the patient and physician to respect a patient’s dignity.  Am. Med. Ass’n Code of Med. Ethics, Op. 1.2.4 (1998). While Alabama has yet to act legislatively to require the use of chaperones during a physical examination, many states have. For instance, Georgia’s Composite Medical Board defines “unprofessional conduct” to include “conducting a physical examination of the breast and/or genitalia of a patient of the opposite sex without a chaperone present.” Ga. Comp. R. & Regs. 360-3-.02(12). While adopting a chaperone policy in your practice is not yet obligatory in Alabama, there are many reasons why doing so is in the physician’s best interest.

First, the presence of a chaperone during a sensitive examination can help put the patient at ease. Patients who have had very few interactions with a physician may not yet fully trust the physician. Offering the patient a chaperone may ease any patient anxiety arising from unfamiliarity with the physician and helps demonstrate the physician’s respect for cultural or personal sensitivities.

Second, a chaperone may serve as a deterrent to improper patient behavior. The presence of a disinterested third party can help prevent false claims of sexual assault by the patient. In some cases, boundary violations may be initiated by patients. For example, patients may initiate boundary violations in order to gain an advantage over the physician. The manipulative patient may use the threat of a medical board complaint or a lawsuit to demand controlled substances or other special treatment. Thus, having a chaperone present can help protect the physician and other medical staff by discouraging abusive patient behavior.

Third, a chaperone serves as a witness to events occurring during the patient interaction. As a defendant in a malpractice suit, the physician will benefit from an additional witness to the physician-patient exchange. The chaperone can serve to corroborate the physician’s testimony, rendering the physician’s version of events more believable to a jury.

Before undertaking any sensitive examination or procedure, the physician should explain the specific components of the physical exam, and offer the patient the option of having a trained chaperone of the gender of the patient’s choice present. Document clearly in the patient’s chart whether the patient consented to the examination, and whether he or she elected to have a chaperone present. Write a note in the chart identifying all individuals present during the exam. Ideally, a practice should train at least one male and one female staff member to serve as a chaperone; however, patients often decline a chaperone when the physician and patient are of the same gender. As the Nassar scandal revealed, lay chaperones such as family members are not trained to observe the examination in a way that best protects the physician and the patient. Additionally, it may be awkward and uncomfortable for a patient to have a family member present during a physical exam. Thus, the presence of a trained, uninterested observer is the most effective means of ensuring a safe and respectful physical examination.

Occasionally, it will not be possible to accommodate a patient’s desire to have a chaperone present. If your practice does not have a chaperone available on the date of the examination, consider rescheduling the patient’s routine physical examination for a date when a chaperone will be available. If your practice lacks the capability to accommodate the patient’s chaperone request, discuss transferring the patient’s care to a physician better suited to make those accommodations.

Physician boundary violations portrayed in the media are increasing calls for mandatory use of chaperones. Rather than viewing this procedure as an unnecessary regulatory response to a few bad actors, physicians should embrace the protections provided by a chaperone policy. An effectively implemented chaperone policy helps physicians to become more responsive to patients’ sensitivities, ultimately strengthening the physician-patient relationship.

Article by William T. Ashley, III, JD, Risk Resource Advisor, ProAssurance. ProAssurance is an official partner of the Medical Association.

Posted in: Legal Watch

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REPORT: Nearly Half of Resident Physicians Report Burnout

REPORT: Nearly Half of Resident Physicians Report Burnout

ROCHESTER, Minn. – Resident physician burnout in the U.S. is widespread, with the highest rates concentrated in certain specialties, according to research from Mayo Clinic, OHSU and collaborators. The findings appear in the Journal of the American Medical Association. Physician burnout is a dangerous mix of exhaustion and depersonalization that contributes to physicians making mistakes while administering health care.

The study found 45 percent of respondents experienced at least one major symptom of burnout, with those in urology, neurology, emergency medicine and general surgery at the highest risk. Regardless of specialty, high levels of anxiety and low levels of empathy reported during medical school were associated with burnout symptoms during residency.

“Our data show wide variability in the prevalence of burnout by clinical specialty, and that anxiety, social support and empathy during medical school relate to the risk of burnout during residency,” says Liselotte Dyrbye, M.D., a Mayo Clinic researcher and first author of the article.

Residents with burnout had more than a threefold increase in odds of regretting their decision to become a physician. When asked, “If you could revisit your career choice, would you choose to become a physician again?” those in pathology and anesthesiology were also most likely to respond “definitely not” or “probably not.” Similarly, the higher the level of anxiety reported during medical school, the greater the chance of regretting becoming a physician.

Previous research has shown physician burnout has some relation to gender and ethnicity. Residents who identified as female had a higher risk of burnout symptoms, matching studies of later-career physicians.

Although the problems facing female physicians have been reported, the study illustrated the less-studied plight of residents who self-identified as Latino or Hispanic. These individuals were more likely to regret their specialty choice. While the study did not examine the cause directly, the authors speculate that minority physicians often are pressed into participating in various institutional diversity initiatives that overtax their schedules compared to nonminority physicians.

Not all of the study’s findings were negative. The majority of residents are satisfied with their career choice and specialty. In particular, participants who reported high empathy scores during medical school appeared to be more resilient to burnout during residency. This is counter to the common narrative that physicians need “thick skin” or an emotional aloofness to perform.  Similarly, high empathy scores during medical school were associated with a willingness to choose the same specialty again. In addition, participants who reported higher emotional social support during medical school were generally happier with their specialty choice.

Other burnout studies have focused on physicians-in-practice. This was the first national study to longitudinally follow medical trainees from the beginning of medical school into residency to explore predictors of burnout. The study included nearly 3,600 participants who were surveyed in the fourth year of medical school with follow-up in second year of residency. It was derived from a larger study of medical students called the Cognitive Habits and Growth Evaluation Study that has tracked a group of students from their first year of medical school through the last year of residency.

About 50 medical schools were included in the research. Residents were asked to provide information about their specialty, ethnicity, educational debt and other demographic characteristics. They then completed surveys that have previously been developed to measure anxiety, emotional social support, empathy and burnout.

The study was supported by a grant from the National Heart, Lung and Blood Institute, and the Mayo Clinic Department of Medicine Program on Physician Well-Being. Researchers from Mayo Clinic, Syracuse University, University of Minnesota, Yale University, Stanford School of Medicine, and OHSU distributed, collected and analyzed the surveys. Michelle van Ryn, Ph.D., OHSU School of Nursing was the principal investigator.

 

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Let’s Talk About Physician Burnout

Let’s Talk About Physician Burnout

According to Medscape’s 2018 Annual Physician Lifestyle Report, Burnout and Depression Section, 42 percent of physicians surveyed have reported burnout symptoms in the last year. Fifteen percent of physicians admitted to experiencing either clinical or colloquial forms of depression. The National Institute of Mental Health reports 6.7 percent of all American adults suffered at least one major depressive episode in the past year.

To say that burnout and depression have reached epidemic proportions among the medical community is an understatement.

The Medscape report also revealed a higher percentage of female physicians — 48 percent — suffered from symptoms of burnout than their male counterparts — 38 percent. Age may also be a factor. According to the report, about 35 percent of young physicians feel some sort of burnout whereas about half of physicians ages 45 to 54 feel the pinch.

The report also showed that while physicians in all specialties are susceptible to feelings of burnout, some medical specialties tend to show higher rates of burnout:

  • Critical Care — 48%
  • Neurology — 48%
  • Family Medicine — 47%
  • Obstetrics/Gynecology — 46%
  • Internal Medicine — 46%

What is burnout?

The dictionary defines burnout as exhaustion of physical or emotional strength or motivation usually as a result of prolonged stress or frustration. But for a physician, burnout is much more…with much more at stake.

Physicians are trained to endure long hours and stressful situations. However, practicing medicine in today’s highly charged political climate filled with intrusive government regulations tends to take a toll with not only the lives of the patient, but quite possibly the physicians, hanging in the balance. There are symptoms of burnout which can easily be missed or overlooked. These include excessive fatigue, insomnia, depression and anxiety. Unfortunately, prolonged exposure to these symptoms may lead one to self-medicate with alcohol or prescription medications…or worse.

Part of the problem is that few in the medical community want to talk about burnout. However, talking about burnout is not only the beginning of a solution but can also save lives.

Fighting burnout begins with a conversation.

Physicians dealing with mental, emotional and physical exhaustion become less able to provide quality care to their patients and find themselves leaving the medical profession altogether…or worse. It’s the “or worse” scenario that worries Dr. Debbie Booher Kolb of Madison.

As president of the Madison County Medical Society, Dr. Kolb wanted to make a difference in the lives of her colleagues. Together with a wellness committee she chairs, they began to formulate a plan to help physicians in their area who felt overwhelmed in their medical practice and to help everyone achieve a better work-life balance. They had no idea the vast support they would have for the Physicians Resource Network Wellness Program.

“My father is a retired radiologist,” Dr. Kolb explained. “I remember being in school and hearing about a friend of my fathers who changed careers. I was mystified by that. I didn’t know that was even an option. I’d never heard of a physician changing careers. It’s not even on your radar once you’re in the medical profession. If you do change careers, it’s to go into pharmaceuticals, medical directorships, or to be a life coach. For physicians, it’s truly a business decision once you leave the profession. It’s sad really to think you could burn out so badly that you leave the profession you loved so much completely behind you.”

But, it’s happening more and more to physicians. With the added pressures of government regulations, such as MACRA, electronic health records, ICD-10, and Medicaid funding, the practice of medicine has become even more complicated today than it was just a decade ago. Unfortunately, these pressures have caused physicians to burnout and not only voluntarily leave the profession of medicine, but also to lose their medical license for inappropriate behavior, or died by suicide.

Dr. Kolb’s mission is to help her colleagues prevent burnout by learning how to cope with its symptoms and finding a better work-life balance. Her mission began in 2014 at the annual meeting of the American Academy of Family Physicians where she first met Dr. Dike Drummond, better known as The Happy MD, and discovered his book, Stop Physician Burnout. Dr. Drummond’s website is www.thehappymd.com.

“This book transcends medicine, and his website is great, too. I was so impressed with his actionable advice. What he taught was good nuts-and-bolts information that made me want to bring him to Huntsville so my colleagues could hear him locally. We’ve had three physician suicides in two
and a half years in Madison County alone. It became more and more apparent that we needed to do something. This is heartbreaking and preventable. All of this coalesced to really be something that we could all get behind.”

And everyone did. Laura Moss, executive director of the Madison County Medical Association, said it wasn’t difficult to get everyone on board with the idea to make the physician wellness initiative a continually evolving priority for Madison County.

“Physician burnout is a trending topic because it’s a huge problem among those in health care. Our hope is that the more we talk about it, and the more solutions such as coaching, counseling and workshops we offer, the more intentional our physicians will become about the decisions they make regarding their own health,” Moss said. “We also hope the more it’s out in the open, the less physicians will feel alone and turn to addiction or worse — suicide. This is not something many physicians were taught about in medical school, and we want to be here to offer ways to help prevent or overcome burnout in a healthy way. MCMS is excited to be focused on taking care of the caregivers and to be giving back to our members in a meaningful way.”

As Dr. Kolb and her colleagues admit, everything begins with a discussion. Little did they know how many lives they were about to touch when they rolled out the first component of the burnout program. The first step was an evening event with Dr. Drummond, which sold out 200 seats and had a waiting list for attendees. Burnout Proof LIVE was a huge success, and it’s just the beginning.

“Burnout transcends specialties, and that’s why our physicians have been so appreciative of this program. After the event with Dr. Drummond, we had people commenting and sharing their stories on social media. That’s what we’re trying to do — effect a paradigm shift in the culture of medicine. We really want to let our colleagues know this is more common than they may realize because physicians just don’t talk about it. We want to start talking about it,” Dr. Kolb said.

How can physicians get help for burnout?

The program in Madison County is an excellent start for awareness and healing, according to Rob Hunt, D.Min., director of the Alabama Physician Health Program, but there’s still more work to be done.

“More programs like the one in Madison County that get people in the medical community talking about burnout is a good start. Unfortunately, there are still so many doctors who don’t understand the warning signs, especially medical students. Female residents are among the biggest burnout populations. I think the key is education. The more they can learn about what burnout is and how to avoid it early in their careers, the better it will be on our physicians and our medical system,” Dr. Hunt said.

APHP is a member benefit for physicians of the Medical Association. It is a confidential clinical resource for physicians, physician assistants, residents and medical students created in 1990 by state law to provide a program for early detection and treatment of medical professionals with problems related to possible impairment due to alcohol, drugs, psychiatric disorders or behavior. About 90 percent of physicians who enter the APHP successfully complete the program and return to their medical practices and see patients.

“Most don’t truly understand exactly what APHP can do until they become part of the program as participants. We are here to help them, and we advocate for them to help them keep their medical licenses. We try to keep or get them healthy and keep them in their medical practice and in the State of Alabama. Our opinion is that a doctor who has gone through APHP as a participant and is being monitored is a safer physician, a better physician, than those who have problems and haven’t gone through our program,” Dr. Hunt explained.

According to Dr. Hunt, most physicians may not even realize they are burning out until the situation becomes substance abuse, disruptive behavior, or other issues that stem from being burned out. It’s these overt signs that APHP can help physicians treat.

“Physicians work as much as 80 or more hours a week easily, and they’ve done that for years and years,” Dr. Hunt said. “Some take medications to cope with that stress. They may not know it, but it gets out of control, and they become addicted. What we see are more middle-aged physicians. Older physicians have learned to cope with that stress. We’ve seen many doctors retire because of EMR, ICD-10 and other government regulations. They just refused to put up with it, so they took that step and closed their practices. It was too much stress. It’s still happening with more and more government regulations that physicians have to navigate. It takes them away from the one thing they trained their entire lives for — medicine.”

Still, if more physicians can learn about what burnout is and how to avoid it early in their careers, the better it will be for our physicians and our medical system.

Could YOU have burnout?

There are specific signs of professional burnout. Ask yourself these questions:

  • Am I overly cynical or critical at work?
  • Do I have to drag myself to work or have trouble getting started once I arrive at work?
  • Am I irritable or impatient with co-workers or patients?
  • Do I lack the energy to be productive at work?
  • Does work consistently satisfy me?
  • Am I disillusioned by the practice of medicine?
  • Have my sleep habits or appetite changed?
  • Do I have headaches, backaches or other physical complaints that don’t subside with rest?
  • Do I use food, drugs or alcohol to feel better or to simply not feel at all?

If you feel you are suffering from symptoms of burnout and would like to get help, please contact the Alabama Physicians Health Program at 1-800-239-6272. APHP is a member benefit of the Medical Association. If you live in Madison County and would like more information about the Physician Wellness program, call (256) 881-7321.

Article written by Lori M. Quiller, APR, Director of Communications, and Mikala McCurry, Communications Assistant.

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Demand for Non-Physician Providers Rose to Make Up for Physician Shortage

Demand for Non-Physician Providers Rose to Make Up for Physician Shortage

The Medical Group Management Association has released its 2018 MGMA DataDive Provider Compensation Survey revealing primary care physicians’ compensation rose by more than 10 percent over the past five years. This increase, which is nearly double that of specialty physicians’ compensation over the same period, is further evidence of the worsening primary care physician shortage in the American health care system.

A closer look at this data shows this rise in compensation is not necessarily tied to an increase in productivity. When broken down by primary care focus, family medicine physicians saw a 12 percent rise in total compensation over the past five years, while their median number of work relative value units (wRVUs) remained flat, increasing by less than one percent. Practices offered more benefits to attract and retain physicians, including higher signing bonuses, continuing medical education stipends, and relocation expense reimbursements.

“MGMA’s latest survey has put strong data behind a concerning trend we’ve seen in the American healthcare system for some time—we are experiencing a real shortage of primary care physicians,” said Dr. Halee Fischer-Wright, President and Chief Executive Officer at MGMA. “Many factors contribute to this problem, chief among them being an increasingly aging population that’s outpacing the supply of chronic care they require. And with a nearly two-fold rise in median compensation for primary care physicians over their specialist counterparts and increased additional incentives, we can now see the premium organizations are placing on primary care physicians’ skills to combat this shortage.”

Further supporting this trend, the new survey identified meaningful growth in compensation for non-physician providers over the past 10 years. Nurse practitioners saw the largest increase over this period with almost 30 percent growth in total compensation. Primary care physician assistants saw the second-largest median rise in total compensation with a 25 percent increase.

“In many communities that we visit, nurse practitioners and other advanced practice providers provide immediate care and same day access. These providers play an important role in today’s health care system. It’s more efficient and less expensive than visiting the emergency room,” said Nick Fabrizio, Principal Consultant at MGMA.

Based on comparative data from over 136,000 providers in over 5,800 organizations, the 2018 MGMA DataDive Provider Compensation is the most comprehensive sample of any physician compensation survey in the United States. The survey represents a variety of practice types including physician-owned, hospital-owned, academic practices, as well as providers from across the nation at small and large practices.

Other highlights from the survey include:

  • Over the past five years, rises in median compensation varied greatly by state. In two states, median total compensation actually decreased for primary care physicians: Alabama (-9 percent) and New York (-3 percent). Many states saw much larger increases in median total compensation compared to the national rate, the top five being Wyoming (41 percent), Maryland (29 percent), Louisiana (27 percent), Missouri (24 percent) and Mississippi (21 percent).
  • Current median total compensation for primary care physicians also varies greatly by state. The District of Columbia is the lowest paying with $205,776 in median total compensation. Nevada is the highest paying state with $309,431 in median total compensation.
  • Over the last five years, looking beyond just nurse practitioners, overall non-physician provider compensation has increased at a rate of 8 percent. Looking at the changes over the past 10 years, that rate has doubled to 17 percent. As non-physician providers have increasingly become patients’ primary care providers over the past 10 years, combined with a subsequent shortage of non-physician providers, compensation rates continue to grow for nurse practitioners and primary care physician assistants.
  • The difference in compensation between the highest-paid state compared to the lowest ranges between $100,000 and almost $270,000 for physicians depending on specialties, and $65,000 for non-physician providers.

The 2018 MGMA DataDive Provider Compensation is the most trusted compensation survey in the U.S., undergoing a rigorous evaluation and inspection. Learn more at www.mgma.com/data.

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What If No One Was On Call [at the Legislature]?

What If No One Was On Call [at the Legislature]?

2018 Recap of the Regular Session of the Alabama Legislature

In times of illness, injury and emergency, patients depend on their physicians. But what if no one was on call? Public health would be in jeopardy.  However, the same holds true for the Legislature. During the 2018 session alone, if the Medical Association had not been on call advocating for you and your patients, unnecessary and costly standards of care would have been written into law, lawsuit opportunities against physicians would have increased and poorly thought out “solutions” to the drug abuse epidemic ─ that could’ve made the problem worse ─ would have become law. Keep reading to find out more.

Moving Medicine Forward

The 2018 Legislative Session is over, but continued success in the legislative arena takes constant vigilance. Click here to download our 2018 Agenda.

If no one was on call…increased state funding for upgrading the Prescription Drug Monitoring Program (PDMP) would not have occurred. Working with the Governor’s Opioid Task Force, the Medical Association proposed increased funding for the PDMP, to allow it to be an effective tool for physicians. As a result, the Task Force made the request its number one recommendation to the Governor and the 2019 budget for the Alabama Department of Public Health (the PDMP administrator) has a $1 million increase for making a long-overdue upgrade to the user-friendliness of the drug database.

If no one was on call…legislation helping veterans at-risk for drug abuse get the care they need and also leverage technology to combat the drug abuse epidemic would not have occurred. Through enactment of SB 200, the prescription information of VA patients will be shared between the VA and non-VA physicians and pharmacists who are outside the VA system, the same kind of information sharing of prescription data that exists for almost all other patients. Passage of SB 200 also establishes a mechanism for vetting requests for release of completely de-identified PDMP information that can be used to spot drug abuse trends and help state officials better allocate resources in combatting this epidemic. The proposals that resulted in the drafting of SB 200 originated with a recommendation from the Governor’s Opioid Task Force, one the Medical Association supported.

If no one was on call…the concerns of physicians regarding the current state of affairs surrounding the Maintenance of Certification program would not have been heard. A formal recommendation from the Medical Association’s MOC Study Committee resulted in the enactment of SJR 62 by Senators Tim Melson, M.D., Larry Stutts, M.D., and the entire Alabama Senate. The resolution was signed by Gov. Kay Ivey. SJR 62 vocalizes Alabama physicians’ frustrations with MOC and urges the American Board of Medical Specialties to honor its commitment to help reduce the burden and cost of MOC. Pursuit of a legislative resolution was just one of several recommendations from the Association’s MOC Study Committee this year.

If no one was on call…the Board of Medical Scholarship Awards could have seen its funding reduced but instead, the program retained its funding level of $1.4 million for 2019. The BMSA grants medical school loans to medical students and accepts as payment for the loan that student’s locating to a rural area to practice medicine. The BMSA is a critical tool for recruiting medical students to commit to practice in rural areas. As well, the economic footprint of every physician is at least $1 million, which improves both community health and local economies.

If no one was on call…Medicaid cuts could have been severe, possibly reducing access for patients within an already fragile system in which less than 20 percent of Alabama physicians participate. The 2019 budget has sufficient funds available for Medicaid without scheduled cuts to physicians. However, increasing Medicaid reimbursements to Medicare levels could further increase access to care for Medicaid patients and remains a Medical Association priority.

Beating Back the Lawsuit Industry

While Alabama’s medical liability laws have fostered fairness in the courtroom and improved the legal climate, each year personal injury attorneys seek to undo parts of the very law that helps keep “jackpot justice” and frivolous suits in check.

If no one was on call…bill language that could have pulled physicians into new lawsuits targeting opioid drug makers and opioid wholesale drug distributors could have been included in the final version of the legislation, whose subject matter was originally limited to placing new criminal penalties on unlawful possession, distribution and trafficking of Fentanyl. After the liability language was added on the House floor, a committee of the House and Senate removed the new cause of action language that could have affected physicians. Additionally, an unsuccessful attempt was made to amend this same bill to give law enforcement the authority to determine what is the unlawful “prescribing” or “dispensing” of prescription drugs. The final bill that passed contained neither of these elements that would have been problematic for physicians.

If no one was on call…physicians and medical practices could have been forced to provide warranty and replacement coverage for “assistive medical devices.” As originally drafted in the bill, the term “assistive medical devices” was broadly defined to include any device that improves a person’s quality of life including those implanted, sold or furnished by physicians and medical practices like joint or cochlear implants, pacemakers, hearing aids, etc. However, the Medical Association successfully sought an amendment to remove physicians, their staff and medical practices from having any new warranty or assistive device replacement responsibility under the act, and the final version doesn’t expand liability on doctors.

If no one was on call…legislation granting nurse practitioners and nurse midwives new signature authority outside of a collaborative practice and for some items prohibited under federal law – thereby significantly expanding liability for collaborating physicians – could have become law. The Medical Association successfully sought to ensure that all new signature authority granted to CRNPs and CNMs was subject to an active collaborative agreement and all additional forms or authorizations granted were consistent with federal law, protecting collaborating physicians from new liability exposure. The final bill was favorably amended with this language.

If no one was on call…physicians could have been held legally responsible for others’ mistakes including individuals following or failing to follow DNR orders on minors. The language of the final bill does not expand liability for physicians.

Protecting Public Health and Access to Quality Care

Every session, various pieces of legislation aimed at improving the health of Alabamians are proposed. At the same time however, many bills are also introduced that endanger public health and safety, like those where the Legislature attempts to set standards for medical care, which force physicians and their staffs to adhere to non-medically established criteria, wasting health care dollars, wasting patients’ and physicians’ time and exposing physicians to new liability concerns.

If no one was on callcollaborative practice in Alabama between nurse practitioners, nurse midwives and physicians could have been abolished. The legislation did not pass. Read the joint statement on the bill from the Medical Association and allied medical specialties here. The bill may return next session.

If no one was on call…legislation to give law enforcement the authority to determine what is the unlawful “prescribing” or “dispensing” of controlled substances (and making violations a Class B Felony) could have become law. The Medical Association sought changes to the bill to require prosecutors to have to prove beyond a reasonable doubt that a physician knowingly or intentionally prescribed controlled substances for other than a legitimate medical purpose and outside the usual course of his or her professional practice, and also to ensure sufficient qualifications for expert witnesses. The sponsor however – arguing that expert witness testimony for prosecuting a physician should not be required – asked the bill not be passed and instead “indefinitely postponed it,” killing the bill for the 2018 session. The bill will return next session.

If no one was on callmarriage and family therapists could have been allowed unprecedented authority to diagnose and treat mental illnesses without restriction. The legislation would also have deleted numerous prohibitions in current law including prescribing drugs, using electroconvulsive therapy, admitting to a hospital and treating inpatients without medical supervision, among other things. The Medical Association offered a substitute bill that (1) ensures all diagnoses and treatment plans made by MFTs are within the MFT treatment context; (2) ensures MFTs cannot practice outside the boundaries of MFT services; (3) prohibits MFTs from practicing medicine; and, (4) ensures all the current prohibitions in state law regarding prescribing of drugs, electroconvulsive therapy and inpatient treatment remain intact. The final bill that is now law contains all of these elements.

If no one was on call…legislation creating a new state board with unprecedented authority over medical imaging could have passed. The legislation would have required x-ray operators, magnetic resonance technologists, nuclear medicine technologists, radiation therapists, radiographers and radiologist assistants to acquire a new license from a new state board, a board granted total control over the scope of practice for each licensee. Quality and access to care concerns abounded with this legislation that many saw as unnecessary. The legislation did not pass, but is likely to return next session.

If no one was on call…proposals to move the PDMP away from the Alabama Department of Public Health and instead under the authority of some other state agency or even to a private non-profit organization could have been successful. In working with the Governor’s Opioid Task Force, the Medical Association stressed the Health Department was the proper home for the PDMP and the Task Force did not recommend that the PDMP be moved elsewhere.

If no one was on call…legislation to place new requirements on and increase civil liability exposure on referring physicians under the Women’s Right to Know Act could have become law. The legislation aimed to provide a woman seeking an abortion with notice that she can change her mind at any time and be entitled to a full refund for not going through with the abortion. The Medical Association sought to fix a longstanding problem that places information-provision requirements on referring physicians under the Women’s Right to Know law. While the Association’s language was adopted, the bill failed to pass. The bill is expected to return next session.

If no one was on call…state law could have been changed to require mandatory PDMP checks on every prescription. Attempts to change this are expected in 2019.

If no one was on call…law enforcement could have been granted unfettered access to the prescriptions records of all Alabamians. Attempts to change this are expected in 2019.

Other Bills of Interest

Rural physician tax credits…legislation to increase rural physician tax credits and thereby increase access to care for rural Alabamians did not pass but will be reintroduced next session.

Infectious Disease Elimination…legislation to establish infectious disease elimination pilot programs to mitigate the spread of certain diseases failed to garner enough support to pass this session.

Data breach notification…relating to consumer protection, is known as the “data breach bill.” In the event of a data breach by a HIPAA-covered entity, as long as the entity follows HIPAA guidelines for data breaches and notifies the attorney general if the breach affects more than 1,000 people, the HIPAA-covered entity is exempt from any penalties. Now, only North Dakota lacks a “data breach” notification statute. The bill was signed by the Governor.

School-based vaccine program…a Senate Joint Resolution urging the State Department of Education and the Alabama Department of Public Health to encourage all schools to participate in a school-based vaccine program passed in 2018. The Medical Association, Alabama Academy of Pediatrics and Alabama Academy of Family Physicians issued a joint statement in opposition to the resolution.

While we remain committed to increasing vaccine rates in Alabama for the very reasons outlined in the “Whereases” of the resolution, we are very concerned about the potential disruption that a widespread school-based program could bring to local practices and the likelihood of detrimental effects of adolescents not visiting the doctor-their medical home–during the critical teen years,” the joint statement from the medical societies reads.

While Gov. Ivey did not sign the resolution, it was ratified under state law without her signature.

Workers comp…legislation to penalize an individual from obtaining workers comp benefits by fraudulent means was introduced this session. The Medical Association successfully sought an amendment to require notice to the physician of termination of a worker’s benefits and to ensure continued payment of claims submitted by a physician until that notice is received. The bill failed to see any action this session.

Genital mutilation…legislation criminalizing the genital mutilation of a minor female was introduced this session. The Medical Association successfully sought an amendment to exclude emergency situations and procedures. The bill died in the Senate during the last days of the session. It is expected to return next year.

If the Medical Association was not on call at the Legislature, countless bills expanding doctors’ liability, placing standards of care into state law, lowering the quality of care provided and diminishing the practice of medicine could have passed. At the same time, positive strides in public health – like new funding for a much-needed PDMP upgrade, better data-sharing with VA facilities and the resolution on MOC – would not have occurred. The Medical Association is Alabama physicians’ greatest resource in advocating for the practice of medicine and the patients they serve.

Questions? For more information contact Niko Corley at ncorley@alamedical.org

Posted in: Advocacy

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