Category: Physicians

Fifty Percent Increase in Share of Physicians Owned By Hospitals in Three Years

Confident DoctorsA new survey by the Physicians Advocacy Institute and Avalere Health, a consulting firm, shows a significant increase in the number of physicians leaving independent practice and joining hospital-based health systems:

  • From July 2012 to July 2015, the percent of hospital-employed physicians increased by almost 50 percent, with increases in each six-month period measured over these three years.
  • In 2012, one in four physicians was employed by a hospital.
  • By 2015, 38 percent of physicians were employed by hospitals.

Good or bad? Well, color me skeptical. This acquisition spree is driven by new payment models which seek to reward providers for “accountable” care (which I suppose is better than unaccountable care.) So far, the results of payment reform in Medicare have been trivial.

Is Your Doctor a Happy Camper?

PhysicianIncome2016Physician is arguable the profession with the highest average pay for all those pursuing it. Yes, some doctors lament that investment bankers often earn much more. But investment banker isn’t a profession; it’s a high-paid specialty in the area of banking. The average banker does not enjoy the income the average physician has come to expect.

A ‘Free Health Clinic’ for Montana State Employees

Before he left office, then-Montana Gov. Brian Schweitzer decided Montana’s 11,000 state workers, retirees and their dependents needed an employee health clinic. Before leaving office he had one created without consulting the legislature. For those of you who have not heard of the concept, it’s sort of like the school nurse, except there are doctors and real medical equipment involved. At most employee health clinics, physician visits are either free or involve no cost-sharing. Montana employees aren’t required to use the clinic; they can continue to see their own doctors with the normal cost-sharing.

Accelerated Medical Degree may Boost Primary Care Supply

About six years ago I wrote about the merits of a 3-year medical degree. This involves medical students essentially skipping the rotation that occurs in their fourth year of medical school and beginning residency training. At the time, there were only three universities in the United States and Canada that offered a program that allowed doctors to begin residency after only three years of medical school. Now there are about a dozen according to Robert Grossman and Steven Abramson, writing in the Wall Street Journal.  Nearly one-third of medical schools have (or are) considering ways to speed up medical training programs.  Is probably a good idea.

Electronic Health Records Software Often Written without Doctors’ Input

We’ve written in the past about health information technology, including a doctor’s impression of electronic medical records (EMRs) and physicians declining satisfaction with EMRs.

A recent study found out why EMRs are so frustrating for physicians: the software is often written without doctors’ input.


“Current guidelines and industry standards suggest that new EHR software should be tested by at least 15 end users with a clinical background to make sure they are usable and safe before they get federal certification.

But a new study finds that many certified products did not actually conduct this user testing, or did so without clinical testers.”

That raises another question. Can you imagine Microsoft or a hardware/software developer at Apple beta testing new products on only 15 users?  Furthermore, isn’t it beyond imagination that managers at Apple or Microsoft would ever say, “Hey, let’s not bother with testing this on 15 people, that’s just a waste of time.”


Physicians Relatively Happy with Their Careers

How happy are physicians with their careers?

In a recent survey of 1001 physicians,

• About 84% said they like being a physician.
• Nearly as many were happy with their choice of specialty.
• Yet, two-thirds said they used to enjoy being a physician much more than they do today.

More than half do not regret anything about their choice of a career path. However, one-in-five would choose a career outside of medicine if they could go back and do it all over again.

What bugs doctors?

• Four-in-ten believe there is too much interference by third-parties;
• Nearly 14% believe their ability to practice independently is slipping.
• Nearly three-quarters have no interest in becoming a patient-centered medical home.

About 10% are working in a direct-pay practice, while 43% are considering it. Yet, nearly 40% believe high deductible health plans and cost-sharing are a barrier to good health care for their patients.

Most docs are workaholics

• Only one-quarter work fewer than 40 hours per week,
• About 46% work more than 50 hours per week.
• Understandably, 70 percent don’t have as much personal time as they wish they had.

Only about half believe they have a good work/life balance. Just over half do not believe they can afford to sacrifice income to work less.

Physicians Report Declining Satisfaction with EHRs

This post is excerpted from an article, Physicians Report Declining Satisfaction with EHRs, from the American Academy of Family Physicians. The report was sent to us by Dr. Larry Pivnick, who authored a report on electronic health records.

“During the past decade, America’s physicians — particularly, family physicians — have invested lots of money and countless hours in implementing electronic health record (EHR) systems. Some physicians eagerly dived into the EHR pond; others were pushed by government initiatives, such as meaningful use, that were intended to spur technology uptake but that have become increasingly burdensome to physicians.”

[I]n 2010, 61 percent of respondents said they were “satisfied” or “very satisfied” with their EHRs, compared with just 34 percent in 2014.
Of physicians who responded to the 2014 survey,

  •  55 percent said it was difficult or very difficult to use their EHR to improve efficiency,
  •  72 percent said it was difficult or very difficult to use their EHR to decrease workload,
  •  54 percent indicated that their EHR system increased their total operating costs, and
  •  43 percent said they had not yet overcome productivity challenges associated with implementation of their EHR.

“From the physicians’ perspective, it appears that the significant investment in EHR system(s) over the past few years in the United States is failing to offer significant returns. Far from helping physicians to operate efficiently and have more time to spend with patients, the opposite appears to be the case.”

Source: Physicians Use of EHR Systems 2014

Doctors and Guns

By Lawrence N. Pivnick MD JD

Something is rotten with the state of medicine today. Well, more than one thing actually, but today’s complaint concerns the fact that your doctor has been conscripted by the federal government to spy on your gun closet. This has occurred despite the fact that as Obamacare moved its way through Congress, gun rights proponents, fearing the establishment of a federal firearm registry, acted to ensure that the program could not be used as a legal basis for mandating inquiries about gun ownership.

Medicare Accountable Care Organizations Cut Spending Two Thirds of One Percent

man-in-wheelchairThe Center for American Progress, previously a very pro-Obamacare organization, has published a study summarizing results of one of Obamacare’s most hyped tools to wring savings out of Medicare:

We first calculated overall savings by the Pioneer ACOs, finding that they reduced overall spending by 0.67 percent compared with the target amount of spending in the model’s second year.

Underwhelming, to say the least, don’t you agree?

In Forbes, Sally Pipes of the Pacific Research Institute cuts through the promotional rhetoric on ACO’s:

In the Obamacare case, the administration hand-picked the providers that could participate in the ACOs to maximize the chance of success. And even then, 13 of the original 32 organizations dropped out as a result of the program’s punishing complexity and costly regulations.

Most providers refused to join in the first place. Organizations such as the Mayo Clinic and the Cleveland Clinic — hospitals that President Obama has touted as excellent models of integrated care — declined to participate.

No wonder doctors are deeply skeptical of this model. A survey from the Physicians Foundation found that only one in ten actually think ACOs can improve quality while cutting costs.


The Physician Specialty Shortage

Many experts agree that the U.S. is about to face a serious shortage of physicians. At NCPA, we have endorsed broadening the scope of practice of nurse practitioners (NPs) and physician assistants (PAs).

However, these allied health professionals are most likely to be found working in primary practice. What can be done about the shortage of other specialists?

In an article at RealClearPolicy, NCPA Senior Fellow Thomas A. Hemphill and Gerald Knesek recommend changes to the training of allied health professionals:

PA programs vary in their length, and some don’t require a formal post-graduate specialty education. The basic PA curriculum should be standardized to two years, followed by one year for post-graduate didactic and clinical training in a certificate-awarded specialty, with the National Commission on Certification of Physician Assistants overseeing the process.