Nearly 6 in 10 physicians in a Deloitte Center for Health Solutions survey said they are concerned about the future of medicine, pointing to declining clinical autonomy and income.
Pessimism among physicians resulted in nearly 75% agreeing that “the best and brightest” may avoid a career in medicine. That number increased from 69% the year before.
Still, 7 in 10 physicians reported they were satisfied with their careers. The most satisfied groups were the nonsurgical specialists (67%) and physicians aged 25 to 39 (80%). Primary care physicians were the least satisfied division, at 59%.
Among other major findings:
Information from Industry
- Malpractice reform is a major concern: Only 10% of physicians believe that Congress will pass tort reform within 3 years. More physicians working in accountable care organizations (ACOs) believe it would pass in that time (19% ) than those not in ACOs (9%).
- Two thirds of all physicians expect that there will be an increase in consolidation of physicians into larger organizations in the next 1 to 3 years.
- Patient relationships drive satisfaction: Among physicians who say they are satisfied, nearly 4 in 10 say patient relationships are the most important factor behind that, followed by promoting patients’ health (32%) and intellectual stimulation (19%).
- Few believe the sustainable growth rate (SGR) will end soon: Only 26% see the SGR reimbursement formula being repealed within 3 years.
- Many saw pay slide: Four in 10 said their take-home pay declined from 2011 to 2012. Half (51%) think that physician incomes will fall substantially in 1-3 years. Of those who said their pay dropped by any amount in 2012, nearly 40% blamed the Affordable Care Act (ACA).
- Early retirements expected: Six in 10 physicians say it is likely many physicians will retire earlier than they had planned within the next 3 years because of the changes in medicine. This view changed little with age, sex, or medical specialty.
Physicians in the study agree that the current healthcare system is flawed, and only 31% give it a grade of “A” or “B.” As to whether the ACA can fix it, 44%, a number unchanged from last year, said it was a step in the right direction. The number who said it was a step in the wrong direction dropped from 44% to 38%.
The annual survey selects a random sample of primary care and specialist physicians from the American Medical Association’s (AMA’s) master file of physicians. This year, 613 physicians completed the online questionnaire. The researchers write that the data reflect the national distribution of physicians in the AMA master file by years in practice, sex, region, and medical specialty. The margin of error is +/- 3.89 at the 95% confidence level.
The Deloitte Center for Health Solutions is a nonpartisan health services research arm of Deloitte LLP.
By Carol Stryker: Unmotivated staff is a seemingly intractable problem for many medical practices. Direct consequences include a significant and negative impact upon practice profitability and physician satisfaction. Traditional remedies of cash and cash equivalents can be expensive, and any improvements in motivation are short-lived at best.
A lack of employee investment in and engagement with the job is the root of the staff motivation problem. The most effective motivators, therefore, are more closely related to the staff’s work than spot bonuses or gift cards. Cultivating staff engagement seldom involves any out-of-pocket expenses; it generally produces objective improvements in practice operations and engaged staff is equipped to reinforce its own good behaviors.
Here are three examples a physician can promote staff engagement in the work of the practice:
Suspend judgment, ask the motivation, and listen to the answer.
When someone has done something that makes no sense at all, the automatic response is often to ask: “What were you thinking?’ If the tone and volume indicate the actor is probably too stupid to survive in the modern world, a valuable motivational opportunity is lost. If, on the other hand, the question is more than rhetorical and genuinely seeks information, a conversation can begin.
Why it promotes staff engagement:
• The serious question assumes the staff member is competent and conscientious.
• It acknowledges that she just might have information the physician does not.
• In the exchange, the physician demonstrates that the staff person is worth an investment and her opinion is respected.
Ask for help.
Every office has things that are not working right. These can be great opportunities to improve office operations and give staff an opportunity for meaningful success.
NOTE: The projects are to be accomplished in addition to regular duties.
The physician, preferably with staff input, can define a project:
• What’s not working (charts cannot be located, phone messages are backing up, patient vitals are not reliably recorded, etc.)
• One or more specific, desired outcomes
• Constraints on any proposed solutions
• A deadline to report at least one proposed solution
Why it promotes staff engagement:
• The task is new and challenging.
• It engages staff as partners in improving practice operations.
• Success is a powerful, self-reinforcing motivator.
• Staff gets a type of visibility with the physician that is not generally otherwise available.
• Start small. Staff probably has little experience with formal problem solving.
• Require meaningful improvement.
• Be satisfied initially with something less than ideal. Refinement can come in successive iterations.
• Do not expect or demand that staff members come up with the physician’s solution. As long as they stay within the parameters, let them own the project.
In a complaint about a staff member, gather information before casting blame.
When a patient says the receptionist was rude, it is always appropriate to apologize and promise to look into it. What is ill advised is assuming the receptionist was rude without hearing her side of the encounter. She may have been rude, and the physician will need to deal with it. The important point, in terms of motivation, is that the receptionist was not in the wrong by definition.
Why it promotes staff engagement:
• People need to feel safe to do their best work and they are loyal to those who protect them from unreasonable attacks.
• The physician can use the opportunity to communicate what she would have preferred to happen in the encounter. Staff is generally grateful for information that makes them better able to meet expectations.
• It is an opportunity to reinforce the idea that we are all in this together.
Engaged medical practice staff are self-motivated. The most effective methods to engage staff in a medical practice are to respect their dignity and intelligence, to give them a chance to improve and contribute, and to demonstrate that helping them improve their work is worth an investment of time and attention.
None of these requires a cash outlay, but the monetary rewards to the practice are significant. The practice will be more effective, efficient, and profitable. After truly unsatisfactory staff has decided to leave, voluntary staff turnover will be all but eliminated. The practice, in general, will be a much happier place to be.
By Aubrey Westgate: Physician compensation is declining at steady and significant rates as a result of ongoing reimbursement declines. In fact, 20 percent of you experienced compensation declines of more than 10 percent between 2011 and 2012, according to our 2012 Physician Compensation Survey.
Though there’s little you can do about declining reimbursements, some of you are finding other ways to boost revenue.
Revenue Booster #1: Telemedicine
Internal medicine physician Robert Galamaga decided to pursue a fellowship in transfusion medicine after three years of practicing in primary care. He’s currently a third-year fellow in hematology and oncology.
“It’s especially pertinent for me to find new revenue sources because, for physicians in training, compensation tends to be more limited, just based on how the structure of our training is,” says Galamaga, who is based near Chicago.
His previous attempts to supplement his income include covering extra shifts in the ER and some clinic coverage. But he says his latest venture, telemedicine, is by far the most convenient.
“Honestly it was a lot easier than I thought,” Galamaga says of getting involved in the web-based patient consultations three years ago. After a couple of training sessions on Consult A Doctor’s telemedicine platform, he signed on as a consultant with the company.
Essentially, that means Galamaga receives a phone call when a potential patient needs a consultation within his scope of practice. He can then choose to perform the consultation, or if it’s not convenient for him, he can turn it down and the patient will be referred to another doctor.
“Basically you work as much as you want to and it’s not such that you’re wholly committed; if you have things that come up, that’s fine,” says Galamaga, who has participated in as many as 17 consultations per day and as few as one or two. “All it takes is a couple of minutes out of my day from doing whatever I might be doing, whether I’m home, traveling, sitting in a coffee shop, or somewhere where I can step aside and talk for a few minutes with a patient,” he says.
Overall, telemedicine has “significantly supplemented” his income, even helping him pay off his student loans while in training, says Galamaga. “If a physician is available to take consultations and can speak to three to five patients per day, you could potentially increase your income by several thousand per month.”
Revenue Booster #2: In-House Dispensary
Adding an in-house pharmacy is another great revenue booster — and it’s not as difficult as it sounds, says practice-management consultant Owen Dahl.
“There are companies that will actually help set up dispensing for you,” he says, noting that practices have to give a portion of their related profits to such companies. “They have dispensing units, almost like vending machines, where you can have your stock of drugs and they handle the quantities and shipping very easily.”
But in-house dispensing is not right for every practice. First, Dahl says, interested practices need to determine if they generate the amount and type of prescriptions necessary to support the cost of implementing and operating a dispensary. “If the volume is there, then you go the next step,” he says.
Prior to setting up any kind of in-house dispensary, talk with your state board of pharmacy and state board of medical examiners, cautions Dahl. Pay attention to licensure restrictions and ensure that your dispensing plans comply with your state’s laws relative to prescribing, administering, and dispensing drugs. “The cost can be relatively high if the state requires that you have a pharmacist in the practice,” Galamaga says.
But if you find that dispensing is the right fit for you, it’s something to seriously consider, says Dahl, noting that one two-physician primary-care practice he worked with brought in an additional $6,000 per month by in-house dispensing.
“That’s not a small number for a two doctor primary-care practice,” he says. “That’s a nice big number.”
Revenue Booster #3: Medical Legal Consulting
Nonpracticing pediatrician Gene DeBlasio is founder of National Medical Consultants, P.C., a firm that provides attorneys with expert medical opinions. He started the company in an effort to increase his own compensation. Now, he helps many other physicians do the same.
“I was fed up with dealing with HMOs and I was making about one-third of what I was making pre-HMO and I decided there had to be a better way,” says DeBlasio. “A friend of mine who’s a nurse asked me to review a couple of defense cases she was working for a defense firm, and I said, ‘Well this is fun, I enjoy doing it.'”
That experience eventually led him to start up the only doctor-owned and doctor-run medical expert consulting firm in the country.
Physicians who serve as expert consultants often keep their day jobs while providing honest, objective opinions about medical cases on the side, says DeBlasio.
“In terms of earning extra money, it’s probably the easiest and best way to do it,” says DeBlasio, noting that his consultants earn up to $375 per hour for reviewing cases, and $6,000 a day plus expenses if a case goes to trial.
The other great perk about serving as an expert consultant is that it’s less stressful than other revenue-boosting options, like moonlighting, he says. “You do it in your leisure time, you don’t have to worry about medical malpractice because you’re just giving an opinion, and it also makes us a better doctor by reviewing how people are dealing with certain situations.”
Revenue Booster #4: Wellness Programs
The Affordable Care Act is ushering in many changes for physicians, some of which could present revenue boosting opportunities, says Dahl.
“One of the things that I’ve been encouraging my clients to do is to look at a wellness program,” he says, noting that as emphasis on preventative medicine increases, and more employers shoulder the burden of providing insurance to employees, such programs will become more popular.
Here’s how that could help you.
In 2014, businesses with 50 or more full-time employees will be required to provide health insurance to their employees or pay a fine.
Practices, or even sole physicians within practices, could look to affiliate with nutritionists for dietary programs, and fitness centers for exercise programs, says Dahl. The goal would be to develop a partnership with these individuals, then target employers who might be interested in paying for these wellness services.
The demand will be there because these large employers will want to take steps to keep their employees healthier in order to reduce their health insurance costs.
“There might be some way that those entities could work together, and then go to employers and offer employers package deals that would say, ‘We will give your employees a physical, we will help monitor their nutritional components, and we will help monitor their exercise activity,’ and they’d do that for a certain fee,” says Dahl. “I think there’s a lot of room for some affiliations and some program development.”