50 Largest U.S. Medical Groups

50 largest U.S. physician groups are ranked by the numbers of affiliated physicians in a regularly updated list from SK&A. The list includes the city and state location,  the number of physicians and offices, and the average count of physicians per office for each group listed.

Topping the list are Kaiser Permanente Medical Group, Cleveland Clinic, and Henry Ford Medical Group.

Also included with the ranking are separate statistics on:

• The distribution of all physician offices in the U.S. by the size, based on the number of physicians in each office.
• The top 20 physician specialties, with a count of physicians and office sites associated with each specialty.
• The distribution of physician practice sites by daily patient volume.

Source: SK&A’s 50 largest medical groups. SK&A, Jan. 24, 2013. http://www.skainfo.com/health_care_market_reports/largest_medical_groups.pdf

Posted by AHA Resource Center (312) 422-2050, rc@aha.org

How will health reform affect the physician supply?

A recent Congressional Research Service report looks at the physician supply and how the Affordable Care Act may affect it. The adequacy of the physician supply is examined from three dimensions: its size, composition [primary care vs specialties], and its geographic distribution.

The provisions of the Affordable Care Act that may impact physician demand are also reviewed; these include changes in physician training, compensation, and practice. How these ACA provisions will ultimately affect the physician supply is not yet known because the provisions are temporary or not yet implemented, will not have immediate effects, or rely on discretionary spending.

While the answer to the question about how health reform will affect the physician supply is still murky, the report provides useful background information. It concludes:

“The current and future physician supply may be inadequate. Some experts suggest that there are too few physicians overall, too few primary care physicians specifically, and that physicians are inadequately distributed throughout the United States. The ACA may intensify some of these concerns…[but] it is not yet known whether and how these provisions will affect physician supply.”

Source: Heisler EJ. Physician supply and the Affordable Care Act. Congressional Research Service, Jan. 15, 2013. http://op.bna.com/hl.nsf/id/myon-93zpre/$File/crsdoctor.pdf

Related Sources:

Huang ES and Finegold K. Seven million Americans live in areas where demand for primary care may exceed supply by more than 10 percent. Health Affairs 32(3):1, Mar. 2013. http://content.healthaffairs.org/content/early/2013/02/19/hlthaff.2012.0913.full.pdf+html

Petterson SM and others. Projecting US primary care physician workforce needs: 2010-2025. Annals of Family Medicine 10(6):503, Nov/Dec 2012. http://annfammed.org/content/10/6/503.full.pdf+html

Recent studies and reports on physician shortages in the US. Center for Workforce Studies, Association of American Medical Colleges, Oct. 2012. https://www.aamc.org/download/100598/data/recentworkforcestudies.pdf

Posted by AHA Resource Center (312) 422-2050, rc@aha.org

Trend Watch: Physician Practice Acquisitions, 2012-2013

Are hospitals actively acquiring physician practices, and if so, which specialties? That’s the question the first in a planned annual survey by Jackson Healthcare sets out to answer. Here are the key findings:

• Over half of reporting hospitals had acquired or were planning to acquire physician practices.
• Family practice and other primary care, including internal medicine and obstetrics/gynecology specialties, were of  top interest.
• Cardiology and general surgery specialties also ranked relatively high in acquisition interest.
• The top reason for a hospital acquiring a medical practice was physicians approaching the hospital, seeking to sell their practices. Hospitals bought them primarily to build/maintain a competitive advantage or as part of a physician recruitment strategy.

Source: Trend watch: physician practice acquisitions; tracking which physician practices hospitals are acquiring. Jackson Healthcare, 2013. http://www.jacksonhealthcare.com/media-room/surveys/trend-watch-physician-practice-acquisitions-2012-2013.aspx

Related resources:

Halley MD. Owning medical practices: best practices for sustainable results. AHA Press, 2011. More details for purchasing book: http://ams.aha.org/EWEB/DynamicPage.aspx?WebCode=ProdDetailAdd&ivd_prc_prd_key=48a43cee-9de8-49e8-b0fc-b3445003ff3b

Lister E and Sagin T. Creating the hospital group practice: the advantages of employing or affiliating with physicians. Health Administration Press, 2009. More details for purchasing book: http://www.ache.org/pubs/redesign/productcatalog.cfm?PC=WWW1-2135

Posted by AHA Resource Center, (312) 422-2050, rc@aha.org

AMA Principles for Physician Employment

The AMA has released general employment guidelines for physicians and their employers as they work together to provide high-quality and cost effective care for patients. The principles address conflicts of interest, patient advocacy, contracting, hospital medical staff relations, peer review and performance evaluations, and payment agreements.

Source: AMA principles for physician employment. American Medical Association, 2013. http://www.ama-assn.org/resources/doc/hod/ama-principles-for-physician-employment.pdf

Related resource: Welch SS and others. AMA annotated model physician-hospital employment agreement. American Medical Association, 2011. [Free to AMA members at http://www.ama-assn.org/ama/pub/about-ama/our-people/member-groups-sections/organized-medical-staff-section/physician-employment.page?; available for sale to others at http://amascb.pdn.ipublishcentral.com/product/annotated-model-physicianhospital-employment-agreement

Posted by AHA Resource Center, (312) 422-2050, rc@aha.org

Hospital Employment by Occupation

Ever wonder about the types of workers employed by hospitals? The U.S. Bureau of Labor Statistics tracks the number of employees by occupation that work in various industry sectors. Using the BLS’ Occupational Employment Statistics Query System, you can learn that hospitals employed the following numbers nationwide as of May 2011:

• Chief executives: 6250
• Human resources managers: 4270
• Marketing managers: 1420
• Public relations and fundraising managers: 2000
• Compliance officers: 5270
• Social and community services managers: 3560
• Food service managers: 1690
• Chefs and head cooks: 1030
• Bakers: 250
• Dishwashers: 1440
• Biomedical engineers: 1150
• Clergy: 6760
• Mental health and substance abuse social workers: 17,110
• Lawyers: 830
• Librarians: 1290
• Interpreters and translators: 4400
• General dentists: 1220
• Pharmacists: 63,180
• Surgeons: 6870
• Photographers: 250
• Registered nurses: 1,642,900
• Podiatrists: 430
• Respiratory therapists: 93,190
• Surgical technologists: 66,670
• Nuclear medicine technologists: 13,560
• Nursing aids, orderlies and attendants: 410,690
• Medical transcriptionists: 30,120
• Medical secretaries: 137,830
• Maids and housekeeping cleaners: 119,320
• Laundry and dry-cleaning workers: 11,680
• Pest control workers: 80
• Landscaping and groundskeeping workers: 3110
• Construction managers: 640
• Training and development managers: 1550
• Fitness trainers and aerobics instructors: 3700
• Cashiers: 7770
• Customer service representatives: 33,770
• Shipping, receiving and traffic clerks: 2930
• Eligibility interviewers, government programs: 1040
• Insurance claims and policy processing clerks: 1610
• Carpenters: 2710
• Electricians: 3530
• Parking lot attendants: 1680
• Taxi drivers and chauffeurs: 3510
• Ambulance drivers and attendants except emergency medical technicians: 2250
• Commercial pilots: 100

Employment data for these and many more occupational categories are available for the hospital sector [select NAICS code 62 for the health care and social assistance sector and then 622000 for hospitals] from the BLS web site.

Source: U.S. Bureau of Labor Statistics. Occupational Employment Statistics Query System. Report generated Mar. 5, 2013 at http://data.bls.gov/oes/

Posted by AHA Resource Center, (312) 422-2050, rc@aha.org

Volunteering in the U.S. – 64.5 million points of light

In his 1989 inaugural address, George H. W. Bush invited Americans to volunteer – to become one of a “thousand points of light”.  America was listening! According to data from the U.S. Bureau of Labor Statistics, there were 64.5 million volunteers who provided service at least once between September 2011 and September 2012. Most volunteers put in time through a religious or education/youth service organization; however, 7.8% – or approximately 5 million individuals – provided service in a hospital or health care setting.

The report, available online, provides a number of statistical analyses:

• Demographics: age, gender, race/ethnic group, educational attainment, marital status, employment status, parents of children under the age of 18 (it makes a difference!)
• Hours of volunteer service provided: almost 6% of all volunteers reported 500+ hours of service in the year; the median was 50 hours
• Number of organizations for which one volunteers
• Type of primary organization for which one volunteers: civic/political/professional/international, educational/youth service, environmental/animal care, hospital/health care, public safety, religious, social/community service, sport/hobby/cultural/arts, other 
• Main volunteer activity: the greatest number (10.9%) collected, prepared, distributed, or served food
• How volunteers become involved: self-directed, asked by someone else (boss, relative/friend/co-worker, someone in the organization, etc.)

The summary portion of the report also includes historical data back to September 2008.

Source: U.S. Bureau of Labor Statistics.  Volunteering in the United States – 2012.  [press release]  February 22, 2013.  http://www.bls.gov/news.release/pdf/volun.pdf   Earlier reports (back to 2002) are available at http://www.bls.gov/schedule/archives/all_nr.htm#VOLUN.

Leading Practices for Addressing Clinical Manager Span of Control in Ontario Hospitals

How many direct reports should a hospital manager have? It’s a recurring question with no easy answer. The Ontario Hospital Association is out with a report addressing clinical management span of control in health facilities. The report provides an overview of the literature, shares the results of a span of control survey sent to chief nursing officers of Ontario hospitals, the executive directors of community care access centers, and the care directors of long term care homes in the province, and summarizes interviews with key informants.The survey looked at the impact of span of control on 9 dimensions:

1. Effectiveness and frequency of communication
2. Manager accessibility to staff
3. Staff retention
4. Staff attendance/absenteeism
5. Staff injury rates
6. Staff engagement
7. Staff satisfaction
8. Patient safety
9. Patient satisfaction

Recommendations are made for defining span of control, leading practices are shared to address the issues, and measurement of the impact is discussed. Sample documents are appended.

Bottom line findings: There’s still no easy answer. The span of control depends on the frequency and the relationship between manager and staff, the complexity of the work, and the capabilities of both manager and staff.

Source: Leading practices for addressing clinical manager span of control in Ontario. Ontario Hospital Association, Feb. 2011. http://www.oha.com/Services/HealthHumanResources/Documents/Span%20of%20Control%20%28Final%29.pdf

Related sources:

Perspectives in staffing and scheduling annual survey of hours report – 2012. Labor Management Institute, 2013. http://www.lminstitute.com/1864/1948.html This annual nurse staffing benchmark report includes benchmarking data on nurse manager span of control.

Benchmarking hospital span of control: data, insights, and application framework. Advisory Board, HR Investment Center, April 2011. Report available only to subscribing members, but free brief summary is available at http://www.advisory.com/Research/Human-Resources-Investment-Center/Studies/2011/Benchmarking-Hospital-Span-of-Control

Neilson GL and Wulf J.  How many direct reports?  Harvard Business Review 90(4):112-119, Apr. 2012.  See blog post at http://aharesourcecenter.wordpress.com/2012/04/05/span-of-control-is-7-the-magic-number/

Posted by AHA Resource Center, (312) 422-2050, rc@aha.org

ATLAS: Surgeons/100,000 population by state and county

The American College of Surgeons has sponsored a website where you can view the distribution of surgeons by specialty on a color-coded map by state and by county.  The state-level maps displays surgeons per 100,000 population for different specialties.  The county-level maps compare the “per population” ratios for surgeons as a group, for physicians as a whole, and for primary care physicians as a group.  These maps, with their accompanying data points, are based on 2011 data from the American Medical Association Physician Masterfile. 

Why do I like this?  It’s free!  It has data points, not just color-coded comparisons.  It comes from an authoritative data source.

Follow-up: I had a conversation with a Katie Gaul, cartographer at the ACS Health Policy Research Institute about whether this atlas includes OSTEOPATH physicians (DOs) or whether it is limited to ALLOPATHIC physicians (MDs) .  She said that osteopaths are included.  [Telephone conversation Jan. 2013.  (919) 966-6529
k_gaul@unc.edu]

Source: American College of Surgeons, Health Policy Research Institute.  Atlas of the Surgical Workforce.  Click here to access the site: http://www.acshpri.org/atlas/ Posted by American Hospital Association Resource Center, (312) 422-2050, rc@aha.org

STAFFING: Formula for determining number of security staff

Formulas that can be used to estimate the total security staff FTEs, as well as the FTEs needed for security officers dedicated to patrol and response functions, are given in this article.  The formulas take into account key predictors of the need for security, such as whether the hospital has a psychiatric unit and trauma center, the number of beds, and the annual number of security calls.

Source: Vellani, K.H., Emery, R.J., and Parker, N.  Staffing benchmarks: a model for determining how many security officers are enough.  Journal of Healthcare Protection Management;28(2):1-11, 2012.  Click here for the publisher’s website: http://www.iahss.org/Info/Member-Content.asp  Posted by AHA Resource Center, (312) 422-2050, rc@aha.org

 

PHYSICIAN SUPPLY: About 1 doctor per 1,000 population

Each year, the National Center for Health Statistics takes a survey of nonfederal physicians in office-based practice called the National Ambulatory Medical Care Survey.  This sample survey results in estimates of the number of practicing physicians, which are reported as counts of physicians per population.  Here are some interesting national figures for the period 2009-2010:

• 472 generalist physicians / million population (or 0.472 / 1,000 population)
• 636 specialist physicians / million population (or 0.636 / 1,000 population)
• 1,663 visits to generalists / 1,000 population / year
• 1,719 visits to specialists / 1,000 population / year
• 3,521 visits / generalist physician / year
• 2.704 visits / specialist physician / year

Generalists are defined as including general practice, family practice, internal medicine, and pediatrics.  Specialists include all other physicians. 

Conclusions that can be drawn from the above?  There are more specialists than generalists.  There are more visits to specialists than to generalists.  However, generalists have a higher rate of visits per year.

This report also compared generalists and specialists as far as willingness to accept new patients — about the same across all payer types EXCEPT for Medicare.  Specialists were more likely to accept new Medicare patients.  Generalists were twice as likely to work evening or weekend hours.  Generalists were also much more likely to have same-day appointments available than specialists. 

Source: Hing, E., and Schappert, S.M.  Generalist and specialty physicians: supply and access, 2009-2010.  NCHS Data Brief;105, Sept. 2012.  Click here for the full text free: http://www.cdc.gov/nchs/data/databriefs/db105.pdf  Posted by AHA Resource Center, (312) 422-2050, rc@aha.org