“It’s interesting because as part of healthcare reform the government has been promoting ACOs for a couple of years and really they’re positive so about it for a couple of reasons which they are saying to physicians,” says Leslie Kane, executive editor of Medscape’s Business of Medicine. “One is the coordination so that one group of physicians will take care of a patient’s entire episode of care, but the other thing is that ACOs are a big opportunity to reduce healthcare costs by utilizing some new payment methods such as bundle payments.”
Bundle payments occur when there is one set of payments for a patient and all of the doctors in the ACO responsible for that patient receive a percentage of that payment. “The government has really been promoting this because it should lower healthcare costs and but also with ACOs there is the opportunity for doctors to potentially share in some profits,” Kane says. “If the ACO comes in under the budget for the allotted patient care, the physicians could theoretically receive a portion of those profits. It’s being heavily promoted and there are supposedly a lot of benefits that come from it. People have been jumping on the bandwagon,” Kane told Med Ad News.
Twenty three percent of physicians will drop insurers who fail to reimburse adequately. “All insurers are not equal,” Kane says. “Some insurers pay less, plus they also may be more difficult to deal with. They deny more claims, they are slower payers, and they create a lot more paperwork and documentation so doctors find that they are losing money with some insurers because of low pay. Plus, sometimes there is a lot of staff time lost trying to get claims reimbursed, etc. Sometimes it is a smart business move for physicians to not continue to use those insurers.”
According to the report, 19 percent of physicians now offer ancillary services to create more income opportunities for their practice. “There are a lot of changes in medical care just like these days some people are getting medical care at Walgreens,” Kane told Med Ad News. “Doctors in most specialties are extending and expanding the range of services they offer in a way of extending the boundaries of what each group traditionally did so doctors are looking for things that are related to their specialties, but not traditionally offered such as offering lab services, weight management, X-Ray services, and things that maybe in the past they did not offer, but are related, but are convenient, and are an opportunity to bring in some more income.”
Forty percent of doctors see between 25 and 75 patients per week, which very similar to findings in last year’s report. Another 35 percent of respondents see between 50 and 99 patients per week, compared with 29 percent last year and 40 percent the year before. The percentage of doctors who see a large number of patients has stayed fairly constant. In Medscape’s 2012 and 2013 reports, about 25 percent of physicians see over 100 patients per week. Those seeing such a large volume of patients are likely working in a clinic or hospital setting.
The majority of physicians (66 percent) saw patients for up to 45 hours a week. Another 18 percent of doctors spent more than 50 hours a week seeing patients, including 9 percent of pediatricians, 22 percent of internists, and 11 percent of family physicians. Among orthopedists, the highest-earning specialty, 27 percent of respondents saw patients for more than 50 hours per week. On the other end of the scale, about 4 percent of dermatologists saw patients for more than 50 hours per week.
Despite the fact that some situations encourage physicians to see a greater number of patients daily, doctors are still spending a meaningful amount of time with each of their patients, according to the report. The largest group of doctors (30 percent) spends between 13 and 16 minutes per patient, and 21 percent spend between 17 and 20 minutes. In total, 51 percent spend between 13 and 20 minutes per patient. In Medscape’s 2012 report, 47 percent spent between 13 and 20 minutes per patient.
The amount of time per patient excludes the patient’s time with the nurse practitioner, physician assistant, or medical assistant; it measures only time spent in the presence of a physician.
Overall, physicians are still doing well and income is on the rise overall. About one third (eight) of the specialties surveyed each earned a mean of over $300,000 annually. This year’s 3 top- earning specialties — orthopedics, cardiology, and radiology — were the same as in Medscape’s 2012 Compensation Report, although last year radiology and orthopedics tied for the number-one spot. On the other side of the scale, HIV/ID dropped to bottom position this year, which was last year occupied by pediatrics. For employed physicians, compensation includes salary, bonus, and profit-sharing contributions. For partners, compensation includes earnings after tax-deductible business expenses but before income tax. Compensation excludes non-patient-related activities (expert witness fees, speaking engagements, and product sales).
A large gap still exists between male and female physicians, although that gap is narrower in primary care. Overall, male physicians earn 30 percent more than women; in primary care that gap is 17 percent. One contributing factor involves choice of specialties. There are fewer women in some of the higher-paying specialties. For example, in orthopedics, only 9 percent of the survey respondents were women, whereas in pediatrics, 53 percent of survey respondents were women.
Despite the frustration over reporting requirements, malpractice risks, EHRs, and other new aspects of medical practice, more than half of physicians would choose to become doctors again. Although that is slightly down from 54 percent in 2012, it’s still a huge decline from the 2011 report in which a whopping 69 percent said they’d choose medicine again.
The specialties most apt to choose their own specialty again are dermatology (74 percent),
ophthalmology (61 percent), and urology (60 percent). Least likely to choose their own specialty again are internists (19 percent), family physicians (28 percent), and obstetricians/gynecologists (37 percent). The dissatisfaction with their specialty, among primary care physicians, is palpable.
“There are some challenges in morale because there is a lot more paperwork, a lot more reporting requirements, and working with EHRs and threats of lawsuits,” Kane told Med Ad News. “I think that is a lot of what is leading to burnout and kind of diminished morale. I think that the relationship with patients meant a lot to doctors and to some degree, is now challenged because during a patient visit the doctor has to talk to a patient while punching the information into an EHR or working longer or doing more reporting. I think that is kind of weighing on people, but even so, as we mentioned in the survey, a large proportion still think that medicine is a great profession, they are proud of being a doctor, they find it very gratifying, so they are feeling the challenges but are still enjoying what they are doing.”
REFERENCE: PharmLive; Mia Burns; 29 APR 2013