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PHYSICIANS: Cardiovascular surgeons and invasive cardiologists generate the most revenue

The amount of revenue generated by different specialties for the hospitals where they practice is analyzed every three years by Merritt Hawkins, a physician recruiting firm.  New data for 2019 edition show the following specialties to be the highest in revenue generation (these figures are rounded):

  • $3.7 million: Cardiovascular Surgery
  • $3.5 million: Invasive Cardiology
  • $3.4 million: Neurosurgery
  • $3.3 million: Orthopedic surgery
  • $3 million: Gastroenterology

Primary care physicians, as a group, generated about $2.1 million each for their hospitals.  There is also a cost/benefit analysis in this report, which compares the average revenue generated with the average salary for each specialty.

Source: Merritt Hawkins. (2019). 2019 physician inpatient/outpatient revenue survey.  Click here: https://www.merritthawkins.com/uploadedFiles/MerrittHawkins_RevenueSurvey_2019.pdf  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

COST OF HEALTH CARE: Specialist visits to hospitalized Medicare patients cost over $1.3 billion in 2014

What is the cost to the nation to bring in specialists to consult on hospitalized Medicare patients?  This question was studied based on analysis of over 700,000 discharges from over 4500 U.S. hospitals in 2014.  Medicare Part B payment for consultative care was found to represent 41.3 percent of all physician visits during the hospital stays.  The total dollar amount was estimated to be $1.3 billion.  These figures are thought to be underestimates because the patients studied excluded surgical patients and because there was no analysis of downstream costs – such as additional diagnostic testing and follow-up visits.  Characteristics of hospitals which were found to be more likely to have higher rates of consultative visits included those in the Northeast, those in urban areas and teaching hospitals.

Source: Ryskina, K.L., Association of Medicare spending with subspecialty consultation for elderly hospitalized adults. JAMA Network Open, 2(4).  Click here for full text:  https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2729802 Posted by AHA Resource Center (312) 422-2050 rc@aha.org

PHYSICIANS: Average salary offers to recruited specialists

For the eleventh consecutive year, family physicians topped the list of Merritt Hawkins’ 20 most requested recruiting assignments, underscoring the continued urgent demand for primary care physicians in an evolving healthcare system.”

Each year, the physician recruiting firm Merritt Hawkins provides aggregate data based on the many recruiting assignments completed during the previous year.  The data in this report cover nearly 3,300 search assignments from the first quarter 2016 to the first quarter 2017.

RECRUITING OFFERS:  Base Salary / Guaranteed Income (average) [Excludes production bonus; excludes benefits]

  • $120,000 Physician assistant
  • $123,000 Nurse practitioner
  • $231,000 Family Medicine
  • $240,000 Pediatrics
  • $257,000 Internal Medicine
  • $263,000 Psychiatry
  • $264,000 Hospitalist
  • $305,000 Neurology
  • $335,000 Obstetrics/Gynecology
  • $349,000 Emergency Medicine
  • $376,000 Anesthesiology
  • $390,000 Pulmonology/Critical Care
  • $411,000 General Surgery
  • $421,000 Dermatology
  • $428,000 Cardiology (non-invasive)
  • $436,000 Radiology
  • $468,000 Otolaryngology
  • $492,000 Gastroenterology
  • $563,000 Cardiology (invasive)
  • $579,000 Orthopedic Surgery

Source: Merritt Hawkins (2017). 2017 review of physician and advanced practitioner recruiting incentives.  Dallas: MH.  Click here: https://www.merritthawkins.com/physician-compensation-and-recruiting.aspx  Posted by AHA Resource Center (312) 422-2050 rc@aha.org

PROJECTIONS: Physician supply and demand in 2025

Physician manpower projections by specialty for the year 2025 have been prepared by the Health Resources and Services Administration (HRSA) using 2013 as a baseline year.  Here are the projections for 2025 giving the difference between supply and demand.  Note that a negative number means a projected shortage of physicians in that specialty.  Also note that these are FTEs – full time equivalents.  The largest shortages are projected in Family practice and General internal medicine, two key primary care specialties.

PHYSICIAN FTEs in 2025 (DIFFERENCE between supply and demand)

  • (-)   480  Allergy and immunology
  • (-)7,080  Cardiology
  • (-)1,810  Cardiothoracic surgery
  •         130  Colon/rectal surgery
  •      1,480  Critical care
  • (-)   430  Dermatology
  •         280  Endocrinology
  • (-)13,100 General and Family medicine
  • (-)12,960 General internal medicine
  • (-)2,970  General surgery
  • (-)1,630  Gastroenterology
  •         890  Geriatrics
  • (-)1,400  Hematology/Oncology
  •         210  Infectious disease
  •         140  Neonatal/Perinatal medicine
  •         130  Nephrology
  • (-)1,200  Neurological surgery
  • (-)4,930  Obstetrics
  • (-)6,180  Ophthalmology
  • (-)5,050  Orthopedic surgery
  • (-)1,620  Otolaryngology
  •      1,530  Pediatrics, general
  • (-)1,490  Plastic surgery
  • (-)6,080  Psychiatry, or (-)15,400 – two scenarios are given
  • (-)1,400  Pulmonology
  • (-)   280  Rheumatology
  • (-)3,630  Urology
  • (-)    520  Vascular surgery

Source: U.S. Department of Health and Human Services, Health Resources and Services Administration. (2017). Health workforce projections. Click here for access to free full text: https://bhw.hrsa.gov/health-workforce-analysis/research/projections  Posted by AHA Resource Center (312) 422-2050, rc@aha.org



WORKFORCE: U.S. physician supply and demand projections to 2025 – trends analysis

This is an analysis of U.S. national supply and demand for doctors published by an authoritative source.  Here are some findings:

  • Overall shortfall of between 46,100 to 90,400 physicians by the year 2025 – driven by steep increase in demand
  • Primary care shortfall of 12,500 to 31,100 physicians by the year 2025
  • Affordable Care Act (ACA) will ultimately increase demand for physician care that will call for 16,000 to 17,000 more doctors
  • The shortfalls projected in this study are a smaller than an earlier study done in 2010
  • Surgeons are going to be in greater demand because the analysts predict limited growth in the number of surgeons and also because there is limited ability to have other advanced practice clinicians take some of their workload

This study is also of interest because of the development of various planning scenarios.  Among the topics addressed include trends among:

  • Physician assistants
  • Immigration reform
  • Avoidable hospitalization
  • Concierge medicine
  • Technology development

There is an interesting table projecting demand in different care settings related to changing demographics in the U.S. compared to the effect of the expansion of coverage due to the ACA.

Growth in Demand by Location of Care: 2013 to 2025

Hospital inpatient days are forecast to increase 23 percent due to demographic shifts and only 1 percent due to the ACA.

Emergency department visits are forecast to increase 12 percent due to demographics and 0 percent due to the ACA.

Source: IHS, Inc. (2015, Mar.). The complexities of physician supply and demand: Projections from 2013 to 2025, final report. Washington, D.C.: Association of American Medical Colleges.  https://www.aamc.org/download/426242/data/ihsreportdownload.pdf

EMERGENCY DEPARTMENTS: What is a surgicalist?

Surgicalists are surgical hospitalists, surgeons who provide care to trauma patients and other patients who arrive in the emergency room with immediate need for surgery.  This new type of surgical position is helpful in resolving the long-standing issue of how to provide surgical coverage in the emergency department.  In many hospitals, general surgeons are required to be part of a rotating on-call schedule for the ED as a condition of medical staff membership.  This article describes how Sutter Medical Center (Sacramento, Calif.) established a surgicalist model.  This large community hospital staffs 24-hour shifts with 3.5 full-time general surgeons, who are on campus when they are on duty.  Among the positive outcomes were a decreases in: time from ED to OR, cost per surgery, length of stay, and complication rate.

Source: SooHoo, R., and Owens, L.J. (2015, June). Beyond surgical call coverage: Reaping the benefits of a surgical hospitalist program. HFM. Healthcare Financial Management, 69(6), 46-49. Retrieved from http://www.hfma.org/Content.aspx?id=31006  Posted by AHA Resource Center (312) 422-2005, rc@aha.org

EXTENSIVISTS: 300 patients per physician typical caseload

One trend that has been in effect for some time in the delivery of health care is standardization — in other words, using documented, evidence-based practices.  The authors discuss reasons why standardization has been a powerful trend.  They then contrast this with the trend toward experimentation — in the creative destruction [buzzword!] of existing business models.

This whole article is interesting, but I’d like to highlight a small portion given to a discussion of extensivists, also called ambulatory intensivists at one integrated delivery system studied by the authors.  First of all, what are extensivists?  Probably actually a team, led by an internist and staffed by physician extenders.  The team’s goal is “to keep the sickest 10 percent of a population out of the hospital.”  Think about that for a minute.

Going back to my days working for consultants, I’ve always enjoyed finding actual, real, useful numbers in the health care literature, so here is the one that I especially like in this article:

  • “The patient load per physician [extensivist] generally is low, with about 300 being typical.” (page 43)

Source: Moore, K.D., Coddington, D.C., and Eyestone, K.M. (2014, Nov.) The assault on common care models. HFM. Healthcare Financial Management. 68(11), 42-44, 46. Retrieved from https://www.hfma.org/Content.aspx?id=25747  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

HOSPITALISTS: How many are there and what is their role?

The term “hospitalist” was coined by Dr. Robert Wachter in the mid-1990s.  Today, there are an estimated 44,000 hospitalists in the United States.  This is a self-designated specialty, there is not yet board certification specifically for hospital medicine.  This articles provides a brief overview of the dual role of hospitalists in many hospitals – caring for inpatients and also serving as experts to promote more efficient processes and best practices in the hospital setting.

Source: Rohde, M. (2014, May-June). The role of the hospitalist. Health Progress. 95(3), 27-30.  Click here for access to article: http://www.chausa.org/docs/default-source/health-progress/the-role-of-the-hospitalist.pdf?sfvrsn=2   Posted by AHA Resource Center (312) 422-2050, rc@aha.org

Top 10 physician specialties that will grow the most by 2025

Growth in Number of Physician Specialists: 2010 to 2025

Important note: This source EXCLUDES primary care physicians.  The analysis was for non-primary care specialists only.

  • 64 percent increase: Physical medicine
  • 55 percent increase: Pediatric subspecialites
  • 54 percent increase: Emergency medicine
  • 40 percent increase: Neurology
  • 35 percent increase: Dermatology
  • 34 percent increase: Neurological surgery
  • 32 percent increase: Radiation oncology
  • 26 percent increase: Vascular surgery
  • 25 percent increase: Radiology
  • 23 percent increase: Endocrinology, Hematology-oncology, Infectious disease, Otolaryngology (all tied at 23%)

Specialties expected to DECREASE in number of physicians by 2025 include:

  • (-) 37 percent: Occupational medicine
  • (-) 24 percent: Thoracic surgery
  • (-) 11 percent: Critical care medicine

Source: U.S. Department of Health and Human Services, Health Resources and Services Administration, National Center for Health Workforce Analysis. (2014, July). Projecting the supply of non-primary care specialty and subspecialty clinicians: 2010-2025. Retrieved from: http://bhpr.hrsa.gov/healthworkforce/supplydemand/usworkforce/clinicalspecialties/clinicalspecialties.pdf  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

2014 Survey of America’s Physicians: Practice Patterns and Perspectives

The Physicians Foundation is out with its latest biennial survey of physicians in the country, looking at work satisfaction, practice patterns, and other attitudes of over 20,000 survey participants. Key questions addressed in the survey include these:

  • Are they seeing more or fewer patients?
  • Do they continue to accept Medicare and Medicaid as a form of payment?
  • How do they grade the Affordable Care Act?
  • How many are part of an ACO?
  • What effect have electronic medical records had on their practice?
  • Are they independent practice owners or employees?
  • Do they plan to retire, work part-time, practice concierge medicine, seek hospital employment, or pursue some other option?

And here are some of the answers from physicians:

  • 38% do not see Medicaid patients or limit the number of Medicaid patients seen.
  • 46%  give the Affordable Care Act a failing grade.
  • 26% participate in an ACO, but only 13% think ACOs will improve quality or lower costs.
  • 85% have adopted electronic medical record,s but 46% say they detract from their efficiency.
  • 53% describe themselves as employees, up from 44% in 2012.
  • 44% plan to take steps that could impact the physician supply and patient access, such as retiring, closing their practices to new patients, cutting back on the number of patients seen, or seeking a non-clinical job.

Source: Merritt Hawkins. 2014 survey of America’s physicians: practice patterns & perspectives. Physicians Foundation, Sept. 2014. http://www.physiciansfoundation.org/uploads/default/2014_Physicians_Foundation_Biennial_Physician_Survey_Report.pdf

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