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Which Practice Structure is Best for Physicians, Hospitals, Patients?
31 August 2010
When seeking a practice opportunity, there are so many variables to consider, not the least of which is what type of practice structure you wish to join, or build. Which practice structure is the best? There is no one type of practice that meets everyone’s needs. You must weigh your professional strengths, skill set, career goals, and family needs with the benefits and drawbacks of each type of practice. Different doctors are more successful in different types of practice environments.
Solo/Private practice: Do you want to own your own business? Do you consider yourself someone who, in addition to being a skilled clinician, also has an entrepreneurial spirit? Do you thrive in an autonomous environment where you call the shots and make the big (and small) decisions? Then a solo private practice may be for you. One physician recently gave her account of why she is glad she chose private practice in her article “What I Didn’t Learn In Residency” .
The author not only outlines the rewards and benefits of private practice, but also notes the hard work, additional knowledge, and added stress that can come from owning and operating your own physician practice.
Group Partnership: In a private group practice, whether it’s a single-specialty group or multi-specialtiy group partnership, you are not the sole owner but a partial owner. You still have all the joys of ownership… as well as the headaches of ownership. In a group practice you have colleagues to help you shoulder the many responsibilities of owning and managing a practice, but you also have to share all the authority and decision-making with them as well. You still have authority but not the level of autonomy you have in your own solo practice. You and your partners can share call, share responsibilities, and consult on tough cases. Group partnership is great as long as all the group members are pulling their weight and getting along.
Hospital Employed, or Hospital-based Group Practice: Hospital employment is gaining popularity again in recent years. Many hospitals have learned from the mistakes of the employment and compensation models in the 1990s and are taking a different approach this time around. One of the approaches consists of an HBGB, or hospital-based group practice, that takes into consideration many of the physicians’ goals and needs, as well as the hospitals’ needs to stay financially sound to remain open for patients. This may become a popular model for many of the community hospitals that are employing physicians and absorbing physician groups. Some physicians do not wish to relinquish any autonomy over their practices, and opt for private practice.
As a physician, you have several options from which to choose the one that best fits your individual needs and professional goals.
So, of these, which practice model is best for the patient? The best model is the one that enables hospitals to stay open, and physicians to continue practicing high-quality medicine, while maintaining some degree of a healthy balance with their personal lives. Prosperous hospitals and satisfied, productive physicians are essential to the survival and quality of our healthcare system and the success of health reform.
Related posts:
- Physician Practice Preferences (Survey)
- White House: Health Reform Will Increase Hospital Employment of Physicians
- Follow The Medicus Firm: Twitter | Facebook | LinkedIn
White House: Health Reform Will Promote Hospital Employment of Physicians
26 August 2010
‘Economic Forces’ Prompted by Health Reform Will Cause Smaller Groups to Merge for Greater Efficiencies and Purchasing Power
White House healthcare officials published an article in the Annals of Internal Medicine this week, outlining the “opportunities and challenges” of the new Patient Care Act (PPACA).
The article provides an overview of the many ways medical practice is expected to change, and advises physicians to “embrace these changes” to insure maximum success in their medical practice, and the highest quality of care for their patients.
The authors include Nancy-Ann M. DeParle, JD, Counselor to the President and Director of the White House Office of Health Reform, and Dr. Ezekiel Emanuel, Special Advisor on Health Policy, Office of Management and Budget.
Among the accomplishments of health reform (according to the article) are:
- Increase the primary care physician workforce via a 10% payment bonus for Primary Care physicians as an incentive
- “Guaranteeing Access to Health Care for All Americans” by removing financial barriers such as the Medicare “donut hole”
- Removing barriers to high-quality care, thus improving the quality of healthcare overall
- Decreasing costs of healthcare by promoting preventive care, streamlining processes, and incorporating better technology such as EMR, etc.
Another by-product of health reform, according to the article is that economic forces will cause physicians to “organize themselves into increasing larger groups.” The authors acknowledge that smaller practices will not be able to afford to “make the necessary investments in information technology and management skills.”
Steve Marsh, managing partner of The Medicus Firm physician search notes “Hospital employment is already a growing trend. Apparently, based on this article, the trend will be intensified by the new health reform laws.” Marsh adds that physicians in smaller groups need not panic. “Keep in mind that health reform is being implemented gradually over ten years or more. Therefore, physicians may not want to make any sudden, drastic career changes solely based on this report.”
The authors also briefly address the issue of physician reimbursement, and the lack of a permanent “doc fix” for the “Medicare Meltdown” also known as the sustainable growth rate formula (SGR):
“The uncertainty surrounding the sustainable growth rate policy is a distraction and potentially a barrier for some physicians to embrace the Affordable Care Act,” the article states.
Certainly, physicians who are currently practicing medicine see the large looming pay cut as much more than a “distraction”. For many physicians, the cut could represent a complete disruption in their medical careers, if it is allowed to take effect.
The article winds down with a call to action, for physicians to “embrace the changes” and “accept the challenges”. The authors even imply that physicians have a “moral” obligation to do so, because the PPACA provides better quality of care for their patients, and physicians are morally obligated to provide the highest quality of care possible.
Reactions to the report in the Annals of Internal Medicine were strong. Many readers who left comments online indicated that they don’t agree with the message of the article, and/or they do not believe that the PPACA and its effects were accurately represented.
Many readers of the article may wonder why government health care officials feel that it was even necessary to publish this report. The article certainly has a “sales pitch” feel to it, as if the White House is realizing that there is a lot of discontent and disagreement among the physician workforce about the new laws, and is still trying to convince physicians that the PPACA will be good for them and their patients.
Finally, readers of the abstract are then directed to participate in a poll: “Which objectives will the Affordable Care Act succeed in achieving?”. The Medicus Firm conducted a very similar survey earlier this year, as part of our annual physician compensation survey. We asked physicians to rate the new law (PPACA) on each of the objectives and predict how effective they expect the new health reform laws to be in achieving each of those objectives. We reported the results here on DocHunterDiary.
What do you think of the White House health officials’ appeal to physicians to “embrace” the changes and “accept the challenges” of the health reform act? Feel free to share your thoughts below.
If “Fear of Falling Leads to Falls”, Fear of Failure Leads to . . . ?
24 August 2010
The British Medical Journal recently published the results of a study on fear of falling in the elderly. As reported in HealthLeadersMedia, the BMJ study states:
“Excessive fear of falling can lead to needless restriction in participation and social activities, resulting in physical deconditioning, poor quality of life, social isolation, depression, and psychological distress.”
In other words, individuals who are afraid of falling, limit their movement and physical activity to the extent that they actually make themselves physically and mentally weaker, thus increasing their likelihood of falling down. Their fear, in a sense, becomes a reality, and falling then becomes a self-fulfilling prophecy.
The same could be said for the fear of failure and its effect on one’s career. As professional recruiters, we work with so many physicians and other medical professionals who remain stuck in dead-end practices, afraid to move on to a better situation, for fear of change, fear of the unknown, fear of failure…fear of “falling”.
Starting anew is not the easiest option. Things worth accomplishing are rarely attained via the easy route or short-cut. You must weigh the benefits and potential outcomes of a new opportunity against the known lack of growth and advancement you’re experiencing by staying in your current situation. Is the short term pain (closing a practice, selling a house, relocating your family) worth the long-term gain of reaching for your goals? You, and only you, can determine if the fear is going to paralyze you and weaken you until you do fail to achieve your career goals, or if you’re going to overcome the apprehension to make yourself stronger by going, doing, and moving forward with your action plan until you work past the fear, and get to where you want to be in your medical practice career.
“The ‘interested’ do what’s convenient; the ‘committed’ do whatever it takes.” ~John Assaraf
Whether it’s a better quality of life you seek, improved financial situation, or higher quality of practice, are you “interested” in finding a new, better practice opportunity, or are you “committed” to achieving your career goals?
Can You Afford To Retain a Physician Search Firm?
19 August 2010
Can you, or your facility, afford to retain a physician search firm to expedite your physician recruiting efforts? That depends… do you need to hire physicians? If so, then the answer is yes, you can afford to retain a search firm. If you are not sure how that could be, consider this:
Depending on the medical specialty, physicians generate anywhere from about $700,000 to over $2.8 million in annual revenue for their hospitals where they provide care and refer patients.[1]
If you need to add just one doctor, (which is conservative, as most hospitals are recruiting multiple physicians), each day that passes without that doctor practicing in your draw area costs you anywhere from $2,000 per day for an ophthalmologist or nephrologist, to about $4,500 per day for a primary care physician. If you are lacking an orthopedic surgeon or neurosurgeon, your facility loses about $5,800-7,700 per day without that physician on staff.
With our total search and placement fees averaging at about $23,000 – $30,000 per physician, our physician recruiting service pays for itself within a matter of a few days of the physician’s start date.
Therefore, perhaps the question to ask is: can you afford not to retain a physician search firm?
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[1] Wall Street Journal, Health Blog, “Putting a dollar figure on a doctor’s worth to a hospital” March 17, 2010.
Physician Recruiting “More Difficult”, Sourcing Qualified Candidates Most Challenging
17 August 2010
2010 Survey of Staff Physician Recruiters
Each year The Medicus Firm surveys staff physician recruiters (recruiters who are employed by a hospital as opposed to working for a recruiting agency) regarding their experiences and perspectives on physician recruitment over the past year. The latest results from the 2010 surveywere revealed this week at the annual ASPR convention in San Antonio, TX, as the survey respondents were also members of the ASPR.
Many of the trends that were observed in last year’s survey were continued into this year. For example, successfully recruiting physicians and meeting physician recruiting goals is becoming increasingly difficult, according to the survey. 73% of respondents agreed that physician recruiting has become “more difficult” over the past year, which is a 4% increase over last year’s results.
Most of the recruiters surveyed (61%) felt that the additional challenges in recruiting physicians have been due to the increased demand in relation to the supply of candidates, as well as the economic recession (16.4%).
How Hospital/Staff Recruiters Source Physician Candidates:
When asked to identify the greatest challenge facing them as physician recruiters, 31% felt that not being able to “source enough qualified candidates” is one of the biggest hurdles. Competing with other practice opportunities was also a top choice, with 27% selecting that as their greatest challenge. A lack of responsiveness by the administration was the third greatest challenge in recruiting physicians, with 21.6% selecting that answer.
How do they source physician candidates? Internet job boards are again a favorite resource this year, with 51% selecting that as their “most effective” method for sourcing candidates. “Working with physician recruiting firms” was the second most popular choice; 20% selected recruiting firms as their most effective source of physician candidates. Identifying candidates via networking and referrals from existing physician staff was a close third with 17% response.
Utilization of Search Firms:
91% of staff physician recruiters surveyed utilize contingent recruiting firms, up from 83% last year. 42% of all respondents also use retained firms, up from about 38% last year. About half of all respondents utilize locum tenens staffing firms, which was down a few percentage points from last year.
Those who utilize contingent firms do so primarily due to the no-risk fee structure, which was overwhelmingly selected as the characteristic liked most about contingent firms (72.5%). However, 0.0% of respondents indicated that they like the “market insight” or “level of accountability” or “proven search process” of contingent firms.
Respondents who utilize retained firms most like the “thorough search process/candidate screening” (24.3%) and the “quality of candidates” (12.9%). 33% of respondents indicated that the fee structure of retained search firms is what they like least about such firms.
Which Firm to Use? Ultimate Deciding Factor…
When asked how they decide upon a search firm, 37% of respondents rely first upon “positive recommendations/referrals from other clients”. ”Proven search process / success rate” was a close second with 35.7%. Only 15% of respondents indicated that “cost per placement” is the most important factor when deciding upon a firm to hire.
Overall, physician recruiting remains challenging, as always, and many predict it will continue to get more competitive, and more difficult in the future as demand increases and the population grows and ages. Therefore, hospital recruiters and physician executives are doing the right thing by valuing results over price when considering search firms, to ultimately meet their physician staffing needs, which are vital to the financial stability and success of the hospital.
How Do You Retain Physicians in Non-Metro, or Rural Locales?
12 August 2010
Recruiting physicians to smaller towns or even rural areas can be a challenge, and it’s only half the battle of physician staffing. Another key factor to maintaining a successful physician staff is retention, which can be even more difficult in some areas than in others.
Earlier this week, the Washington Post covered the story of one rural community in Virginia. Many physicians, like the family physician highlighted in the story, are attracted to jobs in rural areas due to the monetary incentives offered from the government for working in an under-served area. The majority of a physician’s student loans can be reimbursed, or “forgiven” after working in a medically underserved community for a few years after training, usually 3-5 years.
But then what happens after the three years? In the Post story, the young doctor seems ready to bolt on the last day of the third year. But she also has many reasons to stay, and her new colleagues are trying to help her realize the long-term potential for a satisfying life in a (very) small town.
Do you have a retention plan for your physicians? Below are a few tips – some are from the article, while others are from other hospital systems:
Physician satisfaction surveys – some hospitals utilize surveys to help analyze their physicians overall satisfaction with their careers and lifestyle. The surveys help the hospitals identify what they’re doing right, and where they can improve. Also, they can plan ahead for possible turnover - if a physician indicates they are very dissatisfied, the hospital can work with the physician while also making plans to recruit if needed.
Mentoring – by pairing up the new physician with another physician in the community, especially someone who has similar interests, you can help new physician form ties in the civic community and in the medical community as well. In the Post story, the young doctor’s mentor was a physician who had lived in the area for a very long time, so she can help the newcomer get more involved.
Retention Bonuses – some hospitals offer substantial retention bonuses to help physicians stay a bit longer even after their government/student loan benefits have been maximized. For example, if the government tenure requirement runs out in 3 years, the hospital may offer an additional bonus two years later, and then maybe another one down the road to keep the physician there long enough to the point where he or she will have made a life there and want to stay indefinitely.
Community Involvement / Networking, etc. – this may also fall under the mentor’s responsibility, but everyone can help the newer physicians get involved in local events, politics, hobbies, and social groups. In the Post article, colleagues even went so far as to set up the physician on a date with a man from a nearby town! The practice featured in the article truly is going the extra mile to help retain their physicians.
What measures does your facility have in place to help retain physicians? What other tips would you provide for reducing physician turnover?
What Questions Can Recruiters Legally Ask International Physician Candidates?
10 August 2010
Many recruiters often ask us about interviewing international physician candidates. Physician recruiters and hospital executives must be careful not to ask any questions in the interview process that could be potentially discriminatory. Could you be asking illegal questions in your interview when talking to international candidates? Several laws protect international candidates, including physicians, from discrimination, and therefore you are legally restricted from asking certain questions about their origin. So, if you are interviewing an international physician, what questions are you allowed to ask? Legally, you’re allowed to ask about their work status, as this would be a condition of the candidate’s legal employment.
According to an article on Lexology.com, by Gregory Adams of Dinsmore & Shohl legal office, recruiters can ask the following two questions legally, as they are considered “safe” and non-discriminatory:
1. Are you legally authorized to work in the United States?
2. Will you now or in the future require sponsorship for employment visa status?
Furthermore, Adams states that the government’s Office of Special Counsel (OSC) for Immigration-Related Employment Practices has recently loosened up its restrictions to include a (slightly) more detailed question:
“Will you now or in the future require sponsorship for an immigration-related employment benefit?”
This question encompasses H1-B, O-1, and E-3. For more information, read the full article or contact a lawyer specializing in immigration law and/or employment law.
Social Media and Healthcare – Making News This Week
6 August 2010
Social media is here to stay, and the utilization and impact of various forms of social media within the healthcare industry are increasing at a very rapid pace. Many skeptics thought that social media was a fad, or just a blip on the radar. Not only is social media here for the long-term, it is making huge inroads in the healthcare industry, an industry which many did not initially think would be conducive for social media.
Currently, social media is being used in the healthcare field largely as a marketing and communications tool:
- Hospitals marketing services to patients
- Physicians marketing themselves to patients
- Recruiting firms marketing jobs to candidates and services to hospitals
- Providers and health professionals sharing information, news and ideas with one another regarding medical practice or industry news
- Providers and facilities passing along health information to the public
Many health industry experts see social media as an excellent vehicle for public health messages – and many accounts of physicians, providers, and hospitals are already tweeting and sharing positive health advice, tips, and ideas to the public. However, this is only the tip of the iceberg for how social media may be used in the healthcare industry. Social media could be used eventually for other types of communications between practices, hospitals, and patients – to schedule appointments, follow up from appointments, remind patients of treatment times or medications needed, or even monitoring patient vital signs to report confidentially back to the providers.
This week has been a big week for social media in healthcare, including several “firsts” for the industry:
- The Mayo Clinic, one of the nation’s leading hospitals, and a pioneer for the use of social media in healthcare, announced the opening of its Social Media Center this week. This center is the first of its kind amongst all of the nation’s thousands of hospitals. Read more about the center, and the services that are planned for delivery via a staff of eight professionals, in this local news report, or visit the website of the Mayo Clinic Center for Social Media.
- This week, the FDA became involved in regulating the social media practices of a pharmaceutical company – Novartis. Read more about the warning that was issued to Novartis in the Wall Street Journal. ”It’s the first time the FDA has issued an enforcement letter over a Facebook widget,” according to the WSJ report, which adds that the FDA was concerned about the accuracy of information being sent to users’ facebook pages when using the “Facebook Share” widget.
- A hospital employee in the Detroit, Mich. area was fired after she posted disparaging comments about a high-profile patient (local police-shooting suspect) on her facebook page, from her personal computer. Read the report on MyFoxDetroit.com (WJBK) This is not the first time a health professional has been in trouble for a social media transgression, but it may be the first report of someone being terminated for it.
More:
- 20 Top Social Media Resources for Healthcare
- Follow The Medicus Firm on Twitter
- The Medicus Firm on Facebook
Study: Medical Care from Internationally-Trained Physicians on Par with American-Trained Doctors
4 August 2010
A recent study conducted in Pennsylvania by the Foundation for the Advancement of International Medical Education and Research (FAIMER) found that the quality of care provided by internationally-trained physicians is equal to that of the care provided by American Medical Graduates (AMGs).
The study followed 244,153 hospitalizations of heart patients in PA, analyzing care provided by family practitioners, internists, and cardiologists including American- and Internationally-trained physicians. Length-of-stay, patient outcomes, and death rates were tracked. Here are the highlights of the findings, according to the press release posted on FierceHealthcare.com:
- No significant difference in death rates was reported amongst patients treated by AMGs vs. IMGs.
- Patients of American-born physicians who graduate from foreign medical schools had higher rates of in-hospital deaths than foreign-born IMGs.
- The study found that patients of AMGs had the shortest lengths-of-stay.
- Board-certified physicians produced lower mortality rates.
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“Physician performance declined over time, with mortality rates and length-of-stays increasing with the number of years since graduation from medical school”.
Learn more and read the complete press release at FierceHealthcare.com. What are your thoughts on these findings? Do you feel that they accurately represent the physician population? Do the findings correspond what you’ve experienced at your hospital?
Is There An ‘Easy Button’ For Recruiting Physicians?
3 August 2010
Imagine going to the doctor, with a major issue of some sort that needs medical attention – it could be anything. You are in dire need of a treatment, a cure, something to ease the pain and discomfort. You’ve tried letting it go away on its own, but the problem (whatever it is – you fill in the blank) just gets worse. You know it’s serious, and it’s affecting your day-to-day life. You don’t like going to the doctor, but it is the only option left.
The doctor examines you, and narrows your ailment down to a few issues, all of which are fairly common and treatable, if caught early enough. After a few tests, the issue is diagnosed it’s determined you’ve caught it early, and your doctor prescribes a treatment that includes a medical procedure and some drug therapy.
What? You don’t want to pay for drugs or surgery, you tell the doctor – those things cost extra money, and they may cause additional discomfort…
The doctor wonders: ‘How did this patient expect me to treat them for this serious condition? By waving a magic wand, or casting a spell?’ While some health issues may be cured by diet or lifestyle changes, your particular issue is not one of those things, the doctor explains – yours is a common, but potentially serious condition, and needs to be handled right away…
You leave this doctor, determined to go find another doctor who will find a way to cure you without the additional expense of time and money. Two other doctors prescribe the same exact course of treatment, so you keep looking.
Finally, upon your fourth try, you find a doctor who doesn’t prescribe any of those things that could cost you more money. Not only that, Dr. #4 is so sure of his treatment methods, he won’t charge you anything unless you are cured! He explains that he has a new, quicker, cheaper, better, faster, easier way to fix your problem.
Dr. #4 spends about 5-10 minutes with you and recommends some special exercises, plus a few dietary changes and sends you home… You leave, pleased that you won’t be spending any additional money or time on surgery or drugs, but not feeling any better physically.
One of two things could happen now – you could either be cured by the lifestyle changes, or not. If you are cured, congratulations! On the fourth try you found the one doctor out of four who was right, and the other three were wrong – not great odds for the doctors in your town. It’s probably unlikely that out of four physicians, three were basically wrong (although it could happen, and certainly it has to many patients with rare conditions!)
On the other hand, the more likely scenario is that the dietary changes could prove to be insufficient – and your problem worsens. You go back to Dr. #4 – he says you may need some more aggressive treatment. However, Dr. #4 does not perform surgery as part of his practice, so he is unable to help you any further. You’re situation is becoming more urgent – no more time to scout out new, additional doctors.
So you return to Dr. #1 – your original doctor… only to be informed that your situation has since worsened. Dr. #1 finds that, instead of a minor procedure and some medication, you are now going to need major surgery, which will be more costly in both time and money, than if you had done the procedure originally. You now reluctantly agree, as time is now running out for you… Ultimately, you have the surgery and are cured, after a very long recovery, and tens of thousands of dollars in medical bills…
So, by now you’re probably wondering: what the heck does this story have to do with physician recruiting?
Our clients, much like the patient in the above story, come to us with a need – they need physicians. We, as providers of recruiting services, can provide a course of “treatment” which often includes a combination of a variety of methods – including email marketing, direct mail marketing, phone sourcing, and advertising.
Direct mail, advertising, and other ancillary fees seem to cause many potential clients a great deal of discomfort initially – the thought of it seems to cause pain and anxiety: Is advertising really necessary? Direct mail costs too much, it doesn’t work, we just want to get our doctors placed without all that “extra stuff” (e.g. ‘surgery’ and ‘medication’.) In fact, a recent survey we conducted of in-house recruiters showed that what many staff recruiters dislike most about working with retained recruiting firms is paying for direct mail and other ancillary recruitment costs during the course of the search.
However, as a physician search firm, our sourcing methods, including direct mail, are proven – they work, and they work well. Glancing through our placements from the past 2 months, about 60% of the physicians placed were sourced via a direct mail campaign for the position where the physician signed. Probably about 30-40% of our total placements are obtained from direct mail campaigns, if not more – that’s a conservative estimate.
The initial uncertainty and anxiety about retaining a search firm and investing in search campaigns up front is understandable – especially in the economic times we find ourselves in at the moment. But the results of retained search, including direct mail and our other marketing and sourcing methods are real. Don’t you think that perhaps the ‘pain’ of a direct mail campaign (and other recruiting costs) is minimal, as compared to the much more severe pain and expense of a gaping hole in your physician staff, from which revenue continues to hemorrhage out of your facility?
