The Physician Recruiter

72% of Maericans think Obamacare Unconstitutional, Go Figure!

2012-02-27T07:20:00.000-08:00

72% of Americansthink Obamacare unconstitutional

ByCharlie Spiering Commentary Staff Writer

Gallupis out with new number about President Obama's health care bill. According tothe poll, 47 percent favor a repeal of the law, should a Republican presidentget elected and 44 percent oppose it. Not surprisingly, Republicans favorrepeal by 87 percent and Democrats oppose it by 77 percent.

Moreimportantly, 72 percent of Americans believe that the law's individual mandateto purchase health insurance is unconstitutional, including 56 percent ofDemocrats.

It'sa bewildering conclusion. Democrats support Obamacare even though they thinkpart of it is unconstitutional? Perhaps the wording of the first clause,"If a Republican is elected president this November" throws Democratsinto defense mode.

Moreimportantly, should the Supreme Court rule the mandate unconstitutional, themost toxic part of the legislation will be removed.

Thismorning's USA Today polling numbers show that only 38 percent of voters inswing states view the health care law as a "good thing" while 53percent of voters think it is a "bad thing."

AsPhilip Klein has noted, that makes for some interesting presidential politicsthis fall.

H/T The Examiner, Washington

Patients, Physicians, or unelected Bureaucrats..My Healthcare...I'm going with my Doctor!

2012-02-22T07:59:00.000-08:00

Patients, Physicians, or unelected Bureaucrats….Who can makethe best decision on patient Health Issues? Me…I’m going with My physician andmy life experience when making my care decisions!

There are two competing visions forhealth care in America. One centralizes control in Washington DC, while theother empowers families and individuals – i.e. the patients. When people are incontrol of their own health care decisions, they are able to choose the bestcare options in a market where competition can breed excellence and lowercosts. Unfortunately, decades of centralized control has devastatedpatient-centered, low-cost health care, the destruction of which has beenhastened with the passage of “Obamacare.” This lack of personal control leadsto ever-increasing requirements to seek permission from either government orinsurance bureaucrats about what kind of doctor you can see, how often you cansee the doctor, what kind of procedures you are allowed to access, what kind ofinsurance policy you can purchase, what that policy will cost and what it willcover; virtually all health care decisions will be made by unelected,unaccountable bureaucrats.

Key Points

The American health care system was already broken before “Obamacare” came on the scene because individuals and families had minimal control over their health care decisions.

“Obamacare” makes the existing problems much worse because the “cure” it offers – more government control – is the cause of the disease.

The key features of “Obamacare” are the individual mandate, a budget-busting expansion of Medicaid, a huge expansion of the federal government, misuse of the Constitution’s Commerce Clause, the largest tax increase in American history that will affect all Americans, and job-killing costs and regulations.

Americans were promised they could keep their current health plan if they wanted to, and yet thousands of people have already been forced to change.

Decisions about health care, your child’s health care, and your elderly parent’s health care will now be in the hands of something called the Independent Payment Advisory Board (IPAB). It’s a board of fifteen bureaucrats, appointed by the President and unaccountable to you, who will have ultimate authority about all of our health care choices.

HAT TIP TTP

Physician’s believe Obamacare will destroy the American health system!

2012-02-15T09:53:00.001-08:00

A physician’s view ofPresident Obama’s budget

By Rep Bill Cassidy (MD)Published: 10:18 AM 02/15/2012 | Updated: 10:24 AM 02/15/2012

TheBudget President Obama released this week demonstrates the administration’sdetachment from our current fiscal situation. As a physician, I’m particularlyconcerned about the president’s refusal to offer a plan to reform Medicare soit will be here for future generations. The budget is a tremendous opportunityto create policy, yet the president’s budget of more spending, taxing, and debtwon’t prevent Medicare from going bankrupt. If that happens, people willinevitably be denied access to care. And instead of increasing freedom andchoice in the Medicare market, this budget focuses on increasing federalcontrol — a tactic that continually fails.

Theimportance of saving and strengthening Medicare through reforms cannot beoverstated. The Congressional Budget Office (CBO) recently announced that theMedicare Trust Fund will be exhausted by 2022. Republicans and Democrats haveacknowledged that the program is at a crisis level. The bipartisan Wyden-Ryanplan, similar to a plan proposed by Democratic Senator John Breaux during theClinton years, would strengthen and preserve Medicare for those who currentlydepend on it, as well as for future generations. The president ignores thisplan and offers no alternative, making only small and insignificant tweaks to asystem that all agree is going bankrupt fast. Even the president’s BipartisanDebt Commission reported that federal health care entitlements areunsustainable and unless restructured will bankrupt the United States.

Incredibly,the president’s budget not only ignores entitlement reform, it makes thingsworse by continuing to push the health care law passed in 2009. The health careoverhaul gutted $500 billion from Medicare to fund new entitlement provisions,ensuring Medicare’s bankruptcy even sooner, hurting America’s seniors today,and ensuring a diminished future for future generations.

Asa physician with the responsibility of treating Medicare patients, I’m worriedthat the president is using this budget to increase the power of theIndependent Payment Advisory Board (IPAB). This unelected panel of bureaucratshas the power to set rates paid to Medicare providers. IPAB sets a budgettarget and then cuts provider reimbursements until that target is achieved — ineffect denying care to America’s seniors. It’s a scary thought but it’s aboutto be a scary reality.

Theseare just some of the reasons the president’s budget falls well short of beingresponsible. It increases our national debt without resolving any of theunderlying problems associated with our entitlement system. It continues toincrease the debt at an astonishing rate, even though the president hadpromised to halve our deficits by his fourth year in office. Even with $2trillion in new taxes and significant military cuts, this budget stillincreases the deficit by almost $1 trillion — the fourth-straight year of trillion-plusdeficits.

Americadeserves more than political tactics as we seek to address our short-term andlong-term prosperity. This budget is the triumph of politics overresponsibility and it’s unfortunate. When the president was first elected, hespoke to the Republican House members. He said that he’d rather be a goodone-term president than a mediocre two-term president. This budget suggeststhat the president has changed his mind.

Rep. Bill Cassidy (M.D.) represents Louisiana’s SixthCongressional District.

Hat tip: DC Caller

Doctors say the Affordable Care Act, as written, will result in care “being rationed and more expensive.”

2012-02-13T05:03:00.000-08:00

Think Obamacare will lower insurance premiums? Think you get better care? Think you will see a doctor whenever you feel you should?

Think again.....

Obamacare architect:Expect steep increase in health care premiums

By Myles Miller Published:12:56 AM 02/11/2012 | Updated: 5:46 PM 02/11/2012

Medicalinsurance premiums in the United States are on the rise, the chief architect ofPresident Barack Obama’s health care overhaul has told The Daily Caller.

MassachusettsInstitute of Technology economist Jonathan Gruber, who also devised formerMassachusetts Gov. Mitt Romney’s statewide health care reforms, is backtrackingon an analysis he provided the White House in support of the 2010 AffordableCare Act, informing officials in three states that the price of insurancepremiums will dramatically increase under the reforms.

Inan email to The Daily Caller, Gruber framed this new reality in terms of thesame human self-interest that some conservatives had warned in 2010 wouldultimately rule the marketplace.

“Themarket was so discriminatory,” Gruber told TheDC, “that only the healthy boughtnon-group insurance and the sick just stayed [uninsured].”

“Itis true that even after tax credits some individuals are ‘losers,’” heconceded, “in that they pay more than before [Obama's] reform.”

Gruber,whom the Obama administration hired to provide an independent analysis ofreforms, was widely criticized for failing to disclose the conflict of interestcreated by $392,600 in no-bid contracts the Department of Health and HumanServices awarded him while he was advising the president’s policy advisers.

Gruberalso received $566,310 during 2008 and 2009 from the National Institutes ofHealth to conduct a study on the Medicare Part D plan.

In2011, officials in Wisconsin, Minnesota and Colorado ordered reports fromGruber which offer a drastically different portrait in 2012 from the one Obamapainted just 17 months ago.

“Asa consequence of the Affordable Care Act,” the president said in September2010, ”premiums are going to be lower than they would be otherwise; health carecosts overall are going to be lower than they would be otherwise.”

Gruber’snew reports are in direct contrast Obama’s words — and with claims Gruberhimself made in 2009. Then, the economics professor said that based on figuresprovided by the independent Congressional Budget Office, “[health care] reformwill significantly reduce, not increase, non-group premiums.”

Duringhis presentation to Wisconsin officials in August 2011, Gruber revealed thatwhile about 57 percent of those who get their insurance through the individualmarket will benefit in one way or another from the law’s subsides, an evenlarger majority of the individual market will end up paying drastically moreoverall.

“Afterthe application of tax subsidies, 59 percent of the individual market willexperience an average premium increase of 31 percent,” Gruber reported.

Thereason for this is that an estimated 40 percent of Wisconsin residents who arecovered by individual market insurance don’t meet the Affordable Care Act’sminimum coverage requirements. Under the Affordable Care Act, they will berequired to purchase more expensive plans.

Askedfor his own explanation for the expected health-insurance rate hikes, Grubertold TheDC that his reports “reflect the high cost of folding state high riskpools into the [federal government's] exchange — without using the money thestate was already spending to subsidize those high risk pools.”

Gruber’sWisconsin presentation previously available on the website of Wisconsin’sOffice of Free Market Health Care, disappeared from the state government’s Webservers shortly after Wisconsin Gov. Scott Walker issued a Jan. 18 executiveorder scrapping the agency’s mission.

Minnesotanshave already seen a 15 percent average rate increase because their stategovernment is spending approximately $100 million to subsidize those high-riskpools. Gruber said they, too, will see a premium increase — even aftersubsidies are factored in.

Inhis presentaion there in November, he estimated 32 percent of Minnesotans willface premiums hike similar to those of their neighbors in the Badger State.

Inhis Colorado analysis, which he delivered last month, Gruber wrote that whilesome may benefit from new tax credits folded into Obama’s health care overhaul,“13 percent of people will still face a premium increase even after theapplication of tax subsidies, and seven percent will see an increase of morethan ten percent.”

SallyPipes, president of the Pacific Research Institute in San Francisco, told TheDCthat the health care law’s mandates will ultimately result in far greater costsacross the board.

“If[instead] we change the tax code and allow a competitive market to build, andput doctors and patients in power, then that would really solve a lot of theproblem,” Pipes said.

Pipessaid she believes applying the Affordable Care Act, as written, will result incare “being rationed and more expensive.”

Doctors do not support Obamacare and tell the AMA "I quit"!

2012-02-08T09:46:00.000-08:00

Ms Pipes does some of the best work on this subjest! She is a true pro! Keep on reading!

Sally Pipes, Contributor

I cover health policy as President of the PacificResearch Institute

Op/Ed

9/26/2011@ 1:50PM |211,094 views

Doctors And AMA Split Over Contentious Issue Of ObamaCare

For more than 160 years, the American Medical Associationhas served as the self-appointed chief lobbying group for doctors. But theAMA’s lofty status has been under threat over the last several years — and isunder attack today. In fact, the AMA now only counts about 17% of doctors asmembers.

According to a new survey, the majority of doctors do notbelieve that the AMA represents their views and interests. Much of thatdissatisfaction stems from the organization’s support for President Obama’scontentious health care reform package.

That shouldn’t be surprising. The AMA declares that itscore mission is to “help doctors help patients.” But ObamaCare undermines thatpursuit by making life harder for physicians and driving down the quality ofcare available to patients.

The survey — conducted by physician recruitment firmJackson & Coker — is a brutal indictment of both the AMA and ObamaCare.Just 13% of doctors agree with their trade association’s support of the healthreform law.

Some doctors are even dissociating themselves from theAMA. Of those who have terminated their membership, 47% cited theorganization’s continued backing of the health care law as the primary reason.Increasingly doctors are turning to associations like Docs4PatientCare and theAssociation of American Physicians and Surgeons that actually do representtheir interests.

The Jackson & Coker survey joins a large stack ofresearch with similar findings. In February, the National Physicians Surveydiscovered that more than three times as many doctors believed that the qualityof American health care would “deteriorate” rather than “improve” underObamaCare. Nine of ten physicians think ObamaCare will have a negative impacton their profession.

There’s no doubt that it will.

Why? For starters, the law doesn’t address one ofdoctors’ most serious concerns — reimbursement rates for patients covered byMedicare and Medicaid. In fact, it stretches these programs’ shaky financeseven further.

On average, physicians treating Medicare beneficiariesreceive 81% of the rate private insurers pay. For Medicaid patients,reimbursements are even lower — just 56% of the private rate. In 2009,underpayments to hospitals amounted to $36.5 billion.

Cheerleaders for Medicare and Medicaid claim that thegovernment is just driving a hard bargain. But these underpayments end uphurting both healthcare providers and patients.

Doctors pocket about $20 for each Medicaid patient theysee. By contrast, an hour with a privately insured patient means payment of upto $260.

To compensate for lower government rates, doctors mustincrease their patient load. Every patient consequently spends less time withthe doctor.

In some cases, doctors are responding to lowreimbursements by refusing to see patients with public insurance. The AmericanAcademy of Family Physicians found that 13% of doctors did not partake inMedicare in 2009.

The numbers are even worse for Medicaid. The Houston Chroniclereported that doctors in Texas are leaving the program because of decliningreimbursements at an “alarming” rate, with more than 300 drop-outs between 2008and 2010. In Dallas, just 38.6% of physicians participated in 2009.

Given the paltry amount they’re reimbursed for seeing aMedicaid patient — and the cost of overhead — a doctor may actually lose moneyon each additional public patient he or she sees.

As the number of doctors who will treat them dwindles,beneficiaries of public insurance often must resort to costly alternatives likeemergency rooms (ER) — even if they only need routine care.

More than 30% of Medicaid enrollees visited an ER in2007, compared to the less than 20% of Americans with private insurance.

These visits exert a huge burden on the U.S. health caresystem. A 2009 study in the Annalsof Internal Medicine found that treatment for three commonillnesses cost an average of $166 at a general practitioner’s office. The verysame treatment could run upwards of $570 in an ER.

Up to 27% of visits to ERs across the country are fornon-emergency medical treatment. These unnecessary visits end up costing thecountry approximately $4.4 billion each year.

ObamaCare will only make these matters worse. By 2019,Medicaid will cover at least an additional 18 million Americans. All these newbeneficiaries may have nominal insurance coverage. But they’ll struggle tosecure a doctor’s appointment and will thus turn to already over-worked ERstaffs.

The AMA claims that its top priority is helping doctors.Yet the organization has backed a law that would force some physicians to worklonger hours for less pay and others to operate in perpetually overcrowdedemergency rooms.

If doctors — those on the front lines of American healthcare — don’t support this massive overhaul of our medical system, then who can?

Sally C. Pipes is President, CEO, and Taube Fellow inHealth Care Studies at the Pacific Research Institute. Her latest book is The Truth About Obamacare

You think Physicians make a lot of money?.....Read this and change your mind!

2012-02-03T06:55:00.000-08:00

Dr. Brown sure does know what he's talking about!

The Deceptive Income of Physicians

Doctors do notmake as much money as you think

By Benjamin Brown, M.D.

Physiciansspend about 40,000 hours training and over $300,000 on their education, yet theamount of money they earn per hour is only a few dollars more than a highschool teacher. Physicians spend over a decade of potential earning, saving andinvesting time training and taking on more debt, debt that isn’t taxdeductible. When they finish training and finally have an income – they aretaxed heavily and must repay their debt with what remains. The cost of tuition,the length of training and the U.S. tax code places physicians into a deceptivefinancial situation.

The road to becominga licensed and board certified physician is a long one. Physicians spend theequivalent of 20 years of full-time work just learning how to be a physician.First, one must earn a bachelor’s degree. Attending college full time, thiswill take about four years or 6,400 hours of work. 4 years x 40 wks/yr x 40hrs/wk = 6,400 hours. To be competitive for acceptance into medical school youwill likely spend far more than 40 hours per week studying, doing research andvolunteering. However, to keep it simple and consistent we will neglect thatextra time. After college future physicians must attend medical school. Medicalstudents spend about 80 hours per week for 48 weeks each year studying andtraining which amounts to 15,360 hours over four years. After medical school,physicians must complete post-graduate training known as residency. To practicemedicine in the United States physicians must pass all 3 parts of the UnitedStates Medical Licensing Exam (USMLE©) and complete at least the first year ofresidency, which is known as internship. Residents work long hours, weekends,nights and holidays. Most approach the legal work hour limit of 80 hrs/wk for50 weeks each year. Many residents exceed 80 hrs/wk studying and doing researchin addition to their clinical responsibilities. To become board certified,future physicians must complete an entire residency-training program and passall additional exams for that particular specialty. For example, to becomeboard certified in Internal Medicine, one must graduate from medical school,pass all 3 USMLEs, complete a 3-year Internal Medicine residency and pass theInternal Medicine board exam. A board certified Internal Medicine physicianwill spend about 34,000 hours training. To become board certified in Thoracic Surgery– one must graduate from medical school, pass all 3 USMLEs, complete a 5-yearGeneral Surgery residency, complete a 2-year thoracic surgery fellowship andpass the Thoracic Surgery board exams. A board-certified Thoracic Surgeon willspend about 49,760 hours training. The shortest residency training programs are3 years long and include the primary care specialties of Internal Medicine,Family Medicine and Pediatrics.

Spending 40,000hours of one’s young adult life learning how to be a physician is an admirablesacrifice, especially considering one must spend more money than one earns towork those 40,000 hours. The long hours don’t necessarily end after residency.In 2007, physicians from over 20 specialties were asked how many hours per weekthey generally work – the average was 59.6 hours per week.¹ So evenafter physicians finish their 40,000 hours of training they continue to workone-and-a-half times as much most Americans for the rest of their career. Inshort, physicians work two-full time jobs while in training and one-and-a-halffull time jobs when they are finished. They have to work nights, evenings,weekends, holidays and take call. For most physicians, there is no such thingas overtime or holiday pay.

Why does ithave to take so long?

There are noshortcuts to gaining the knowledge and experience one needs to be a competentphysician, they need to put in the time to get the experience. Because there isno shortcut to gaining the experience one needs to be a competent physician,decreasing resident work hours from 80 hours per week to 60 hours per week is aterrible idea. If such a change occurs, residency training would have to becomeyears longer in order to get the same experience. Making physician traininglonger will further increase student debt loads and decrease the number ofyears physicians are able to work after they are trained. It will increase thenumber of physicians in training and decrease the physician workforce.

Becoming aphysician is expensive. For the 2009-2010 academic year, the average totalstudent budget for public and private undergraduate universities was $19,338and $39,028, respectively.² If one attends an average pricedinstitution, receives subsided loans and graduates in four years they will haveabout $100,000 of student loan debt from college. For the 2009-2010 academicyear, the median cost of tuition and fees for public and private medicalschools was $24,384 and $43,002 per year, respectively.³ This doesnot include the cost of rent, utilities, food, transportation, healthinsurance, books, professional attire, licensing exams fees or residencyinterview expenses. Therefore, the average medical student budget is about$45,000 per year; $30,000 for tuition and $15,000 for living expenses. If oneattends an average priced medical school, receives 1/3 subsidized loans andgraduates in 4 years; at a 7% APR they will have $200,527 of debt from medicalschool at graduation. If one borrows $22,500 bi-annually and two-thirds of thisaccrues interest compounded bi-annually at 3.5% – their total student loan debtfor both college and medical school will then be $300,527. Forbearing this debtthrough 5 years of residency and paying it off over 20 years will cost about$788,880 of one’s net income.

Loan repaymentprograms such as those offered by the military are not a solution for themajority. Each year, about 22,000 medical students graduate from U.S.allopathic and osteopathic medical schools.^4,5 Each year themilitary matches 800 students into its residency training programs, becausethat is the military’s anticipated future need for physicians.

The U.S. taxcode allows taxpayers to deduct a maximum of $2,500 per year of student loaninterest paid to their lender. This deduction is phased out between incomes of$115,000 and $145,000.⁶ Therefore, this benefit is of no help tomost physicians. If one were to start a business, they could deduct nearly allof their expenses. Yet for unclear reasons, one cannot deduct the cost ofbecoming a physician; not the tuition or even the interest on the money theyborrowed to pay their tuition.

Duringresidency, if one makes payments of $1,753 per month, or $21,037 per year, topay off the accruing interest, thier debt will be still be $300,527 at the endof residency. However, they will have spent $63,111 over the course of a 3 yearresidency or $126,222 over the course of a 6 year residency to keep their debtfrom growing. Though paying off the interest during residency is theresponsible thing to do; coming up with $21,037 each year from one’s net pay of$40,000 may be quite difficult.

Time spenttraining, student loan debt and the U.S. tax code makes the income ofphysicians deceiving. A board certified internal medicine physician who ismarried with 2 children, living in California and earning the median internistannual salary of $205,441 will be left with $140,939 after income taxes and$106,571 after student loan payments.⁷ This is assuming a federalIncome tax rate of 28%, California state income tax rate of 6.6%, Social Securitytax rate of 6.2% and Medicare tax rate of 1.45%. You can go to www.paycheckcity.comto get an idea of what one’s net pay would be for different incomes, states ofresidence, marital status, number of children, etc. Paying off a debt of$369,425 over 20 years at a 7% APR will require annual payments of $34,368.Those student loan payments will continue to consume about $34,000 of their netincome for 20 years until they are finally paid off. What started off as$300,527 in student loan debt will end up costing $687,360. This debt thatconsumes one-fourth of their net income for 20 years wasn’t accrued becausethey bought a house they couldn’t afford – it is because they chose to become aphysician.

Believe it ornot, the amount of money reaching a physician’s personal bank account per hourworked is only a few dollars more than that of a high school teacher.

In order tomake this calculation we will neglect inflation of the U.S. dollar by assumingthat inflation will increase at the same rate as the purchasing power of theU.S. dollar decreases. We will also assume that physician incomes keep pacewith inflation. We will also assume that tuition costs, student loan interestrates, resident stipends, physician reimbursements and the U.S. income taxstructure are as described above and do not change.

The mediangross income among internal medicine physicians is $205,441.⁷ Themedian net income for an internist who is married with two children living inCalifornia is then $140,939. Internal medicine is a three-year residency, sothroughout residency they will earn a total net income of about $120,000 andspend about 35,000 hours training after high school. The total cost of trainingincluding interest, forbeared for three years and paid off over 20 years asexplained above is $687,260. One study reported that the average hours workedper week by practicing Internal Medicine physicians was 57 hours per week.⁸Another study reported the mean to be 55.5 hours per week.⁹ We willuse 56 hours per week and assume they work 48 weeks per year. If they finishresidency at 29 years old and retire at 65 years old they will work for 36years at that median income.

[(140,939 x 36)+ (120,000) – (687,260)] / [(56 x 48 x 36) + (34,000)] = $34.46

The adjustednet hourly wage for an internal medicine physician is then $34.46

The mediangross income among high school teachers, including the value of benefits butexcluding their pension, is about $50,000.¹⁰ The median net incomefor a high school teacher who is married with two children living in Californiais then $42,791. This is assuming a federal Income tax rate of 15%, Californiastate income tax rate of 6.6%, Social Security tax rate of 6.2% and Medicaretax rate of 1.45%. You can go to www.paycheckcity.com to get an idea of what one’snet pay would be for different incomes, states of residence, marital status,number of children, etc. Teachers spend about 6,400 hours training after high school,the amount of time it takes to get a bachelor’s degree. The total cost oftraining if one attends an averaged priced institution and pay off their debtover 20 years at a 7% interest rate is $186,072. At this income one would beable to deduct the interest on their student loans from their income taxes;however, those savings are not accounted for in the calculation below. Highschool teachers have about 10 weeks off each summer, 2 weeks off duringChristmas, 1 week off for spring break and 1 week of personal paid time off.Therefore, high school teachers who work full time average of 40 hours per weekfor 38 weeks each year. Yes, teachers spend time “off the clock” preparing forclass, correcting papers, etc. However physicians also spend time “off theclock” reading, studying, going to conferences, etc. If a high school teacherfinishes college at 22 years old and retires at 65 years old, they will workfor 43 years. Most teachers also receive a pension. We will assume their grossannual pension including the value of benefits is $40,000 which is a netpension of $35,507. If they die at 80 years old they will receive this pensionfor 15 years.

[(42,791 x 43)+ (35,507 x 15) – (186,072)] / [(40 x 38 x 43) + (6,400)] = $30.47

The adjustednet hourly wage for a high school teacher is then $30.47

The mediangross income among internal medicine physicians is $205,441.⁷ Themedian gross income among high school teachers, including the value of benefitsbut excluding their pension, is about $50,000 per year.¹⁰ Accountingfor time spent training, student loan debt, years worked, hours worked per yearand disproportionate income taxes – the net adjusted hourly wage of aninternist is $34.46 per hour, while that of a high school teacher is $30.47 perhour. Though the gross income of an internal medicine physician is 4 times thatof a high school teacher, the adjusted net hourly wage of an internal medicinephysician is only 1.13 times that of a high school teacher. Most people wouldargue that high school teachers are not paid enough, yet for some reason mostpeople would also argue that physicians are paid too much.

Isn’t takingcare of patients rewarding regardless of income?

Yes, takingcare of patients is rewarding. However, when physicians are unfairly reimbursedfor their services they feel exploited. This feeling of exploitation or beingtaken advantage of is what bothers physicians the most. Physicians spend 40,000hours training after high school and take out over a quarter million dollars inloans all so that when they are done they can work 60 hours per week, be paidless than they were expected, give about 40% of their income to the governmentin taxes and pay 25% of their net income to their student loan lender. Theyfeel exploited because after all that they have sacrificed they are enslaved tothe highly regulated healthcare industry, which unfairly pays them.

On June 18,2010 the Centers for Medicaid and Medicare Services (CMS) instructed itsMedicare contractors to start processing claims for physician payments at a21.3% reduced rate.¹¹ Should other payers follow Medicare, as theyso often do, physicians may have to find another line of work. Decreasing aphysician’s reimbursements by 21.3% doesn’t mean that a physician’s grossincome will go from $200,000 to $157,400 – it will likely decrease much, muchmore. Let’s say Dr. Smith, an internal medicine physician, spends 15 minutescaring for a Medicare patient and bills Medicare $100 for this service. Fromthat visit, Dr. Smith’s profit margin is say 40%, $60 to cover her overhead and$40 profit. Prior to this recent change, Medicare typically paid about 60 centson the dollar, which is why most physicians barely broke even caring forMedicare patients. The 21.3% decrease in physician reimbursements will likelybe 21.3% of that $60, so Dr. Smith will now be reimbursed only $47.22 dollarsfor that visit which is less than the $60.00 it cost Dr. Smith to see thepatient. Therefore, Dr. Smith will spend $12.78 to care for thatMedicare patient. This is generous of Dr. Smith and all, but it isunsustainable. It is unsustainable for Dr. Smith and unsustainable for thefuture of medicine.

In an era ofskyrocketing healthcare costs, an increasing need for healthcare services anddiminishing resources – Americans need to be cognizant of whom they exploit.Physicians want to work hard and do whatever they can for their patients. Andlike every other American, physicians also want to be appreciated and fairlycompensated for their time and financial sacrifice.

Addendum #1 – The Net Adjusted Hourly Wage of Dentistsand Nurses

The mediangross income among general dentists who work full time in a group practice is$220,000.(12) The median net income for a general dentist who is married withtwo children living in California is then $149,681. General dentists who workfull time in a group practice with partners work an average of 38 hours perweek, 1,727 hours per year.(12) Dentists spend about 17,920 hours trainingafter high school. The total cost of training if you attend averaged pricedinstitutions pay off your debt over 20 years at a 7% interest rate is $558,216.If you finish dental school at 26 years old and retire at 65 years old theywill work for 39 years.

[(149,681 x 39)– (558,216)] / [(1,727 x 39) + (17,920)] = $61.91

The adjustednet hourly wage for a general dentist is then $61.91

The mediangross income of a registered nurse is $62,450.(13) The median net income of aregistered nurse who is married with two children and lives in California isthen $51,787. To become a registered nurse via the associate’s degree routetakes 2 years, about 4000 hours of training. The average total student budgetat a public 2-year university is $14,285.(14) The total cost of becoming anR.N. is then $28,570. If that debt is paid off over 20 years at a 7% interestrate it will end up costing a total of $53,160. At this income you will be ableto deduct student loan interest costs from your federal income taxes, thesesavings are not included in the calculation below. If you finish nursing schoolat 20 years old and work until you are 65 years old you will work for 45 yearsat that median income. We will assume you work 40 hours per week, 50 weeks peryear.

[(51,787 x 45)– (53,160)] / [(40 x 50 x 45) + (3,200)} = $24.43

The adjustednet hourly wage for a registered nurse is $24.43

What if an R.N.worked as much as an internal medicine physician? Unlike a physician, an R.N.would receive overtime pay for the hours they worked in excess of 2,000 peryear.

Variables thatwill decrease a physician’s adjusted net hourly wage include: a shorter career,increased taxation, decreased income, working more hours for the same or lesspay, spending more than average on tuition, spending more time training anddecreased resident pay.

Variables thatwill increase a physician’s adjusted net hourly wage include: a longer career,decreased taxation, increased income, working fewer hours for the same or morepay, spending less than average on tuition, having less debt, paying off yourdebt early and increased resident pay.

Addendum #2.Residency Match Data.

Food forthought.

Data ofapplicants who successfully matched by specialty in 2009 (14-17)

(Calculationsinclude both U.S. Allopathic Seniors and Independent applicants)

Specialty	Average USMLE Step 1	Average USMLE Step 2	% US Seniors who were AOA	Average # Abstracts, Presentations and Publications
Plastic Surgery	242	242	42	9
Dermatology	240	248	51	7
Otolaryngology (ENT)	240	245	37	4
Neurosurgery	239	237	28	8
Radiation Oncology	238	241	35	8
Diagnostic Radiology	238	242	23	4
Orthopedic Surgery	237	240	28	4
Ophthalmology	235	-	-	-
Pathology	226	227	13	5
Neurology	225	229	12	4
Anesthesiology	224	230	10	2
Internal Medicine	224	229	15	3
General Surgery	224	230	12	3
Internal Medicine/Pediatrics	222	231	21	2
Child Neurology	221	-	-	-
Emergency Medicine	221	229	11	2
Pediatrics	218	227	12	2
Obstetrics & Gynecology	217	227	14	2
Physical Medicine & Rehabilitation	213	216	4	2
Psychiatry	213	217	4	2
Family Medicine	208	214	5	1

Physicians say OBAMACARE is wrong for America

2012-01-30T13:27:00.000-08:00

Salley Pipes

From FORBES 12/11

Doctors Say Obamacare Is No Remedy for U.S. Health Woes

America’s doctors have conducted a fullexamination of the president’s health reform law — and their diagnosis of itseffects on our healthcare system isn’t good.

Nearly two-thirds of doctors expect thequality of care in this country to decline, according to a new survey fromconsulting giant Deloitte. Just 27 percent think that the law will lower costs.And nearly seven of every 10 doctors believe that medicine is no longerattractive to America’s “best and brightest.”

Few people know more about ourhealthcare system than doctors working on the frontlines. Policymakers shouldpay heed to their indictment of Obamacare and revisit the disastrous law.

President Obama promised that hisreform package would begin to stymie the out-of-control growth in the cost ofAmerican health care. He pledged $2,500 in health insurance savings for thetypical American family.

But doctors don’t buy it. Only onequarter feel that Obamacare will reduce health insurance costs for consumers.Nine out of ten posit that insurers will raise premiums for employers andindividuals.

They have good reason to doubtObamacare’s cost-cutting potential. Healthcare spending is expected to reach$2.7 trillion this year — or about $1 of every $6 spent in our economy. By2020, health spending will account for a full fifth of America’s GDP.

That increase is in large part thanksto Obamacare. Instead of relieving high insurance premiums, the nonpartisanCongressional Budget Office estimates that American families in the non-groupmarket will see their premiums rise $2,100.

They’re already trending higher.According to the Kaiser Family Foundation, average family premiums in 2011topped $15,000 — a 9 percent increase from 2010. Prior to Obamacare’s passage —from 2009 to 2010 — premiums went up just 3 percent.

In April 2010, Richard Foster, theChief Actuary of the Centers for Medicare and Medicaid Services (CMS),concluded that American spending on health care through 2019 would be $311billion higher than if the law had never passed.

Even with all that additional moneyflowing through the system, doctors don’t think that the quality of care willimprove. Half of all doctors believe that access to care will diminish becauseof hospital closures prompted by health reform.

Further, nearly 70 percent of doctorsbelieve that long wait times will plague emergency rooms. A full 83 percent ofphysicians foresee increased wait times for primary care appointments.

That’s in large part because Obamacareis expected to extend government-subsidized insurance coverage to many folks —even as the supply of providers remains relatively constant.

The United States already faces a shortage ofprimary-care doctors. Medical schools today produce one such physician forevery two our country needs. By 2019, the American Academy of Family Physicianswarns that the United States will be short 40,000 doctors.

Expanding insurance coverage to millions more Americanswon’t do much good if they can’t get doctor’s appointments. Physicians believethat their ability to provide quality care will be further strained by thelaw’s attempt to change the way they’re paid — from a fee-for-service basis toa vaguely defined system of paying doctors based on patient health andoutcomes.

Nine out of ten physicians fear they will receiveinadequate payments and endure higher administrative costs. Fewer than aquarter of doctors expect their paperwork requirements to ease up. Time spentwading though paperwork is also time no longer available for actuallypracticing medicine.

American doctors’ negative view of Obamacare is telling.Proponents of the law may claim that their griping is misplaced, but as PaulKeckley, Ph.D., the lead author of the report explains, “Understanding the viewof the physician is fundamental to any attempt to change the health caremodel.”

In other words, if physicians aren’t on board withObamacare, it won’t work. A law that hinders the practice of medicine,obstructs access to care, and costs Americans more is clearly not the rightremedy for what ails us.

Sally C. Pipes is President, CEO, and Taube Fellow inHealthCare Studies at the Pacific Research Institute. Her next book — The Pipes Plan: The Top Ten Ways to Dismantleand Replace Obamacare (Regnery) — will be released in January 2012.

Physicians want to Supreme Court to kill Obama Care! They say this will give a huge boost to the economy!

2012-01-29T10:22:00.000-08:00

SupremeCourt Might Kill ObamaCare Before Election -- If Obama's Lucky

Larry Elder for Townhall.com

Why did the Obamaadministration, after dragging out the various court challenges to ObamaCare,suddenly step on the gas?

The administration surprised court watchers by passing up a chanceto slow down ObamaCare's long march to an eventual Supreme Court ruling. Infailing to request a hearing by all the appeals court judges of the 11thCircuit -- to overturn an anti-ObamaCare decision by three of its members --the administration now puts the matter on a faster track to the Supreme Court.

The court will likely agree to hear the case because two appellatecircuit courts, the 11th and 6th, have issued contradictory rulings -- onestriking down the individual mandate as unconstitutional, and the otherupholding it. This confusion practically guarantees a hearing by the top court,probably months before next year's election.

What provoked the administration's change of heart?

Obama supposedly did not want a Supreme Court decision so soonbecause, pro or con, the ruling figures to play large as a re-election issue.On the other hand, ObamaCare already is an issue, with the President'sopponent undoubtedly planning to hammer him with it.

But if the court strikes down ObamaCare -- especially with a 5-4split -- Obama can argue that with his re-election, the next opening getsfilled with another Sotomayor/Kagan-like liberal who would have supportedObamaCare. If the vacancy comes from the conservative side, Obama can fulfill aliberal dream of switching the court's majority from center-right -- fourconservatives and the Anthony Kennedy "swing" vote -- to a left-wingmajority.

Obama's new faster-track tactic might also turn on this: Obamaexpects the Supreme Court to side with him. If the President wins in court, hisRepublican opponent will still argue against the merits of ObamaCare. But he orshe could no longer flatly call it "unconstitutional," since thecourt would have just ruled otherwise.

So how would a Supreme Court defeat make Obama lucky in his bidfor a second term?

ObamaCare remains unpopular, with a plurality of Americans wantingit repealed. Unlike major historic safety-net legislation like Social Security,Medicare and Medicaid, ObamaCare received no opposition party Senate votes --none. A majority of state attorneys general either filed or joined lawsuits tooverturn the mandate that requires practically all Americans to purchase healthinsurance.

Romneycare, used as a model for ObamaCare, at best fails to liveup to its promises. True, most residents of Massachusetts support Romneycare,and Gov. Mitt Romney's successor praises it. An AP "fact-check" onRomneycare, relying on an MIT economist who helped design Romneycare, prettymuch pronounced it a success. But the free-market think tank National Centerfor Policy Analysis sees the Massachusetts health plan differently. Among itsfindings:

"There has been no apparent change in self-reported unmetneeds. Remarkably, one-third of adults within 300 percent of the federalpoverty level report that they were unable to meet a health care need withinthe past 12 months for 'any reason.' ...

"But (there has been) a statistically significant increase inER traffic among those within 300 percent of the federal poverty level! This isconsistent with a survey of 11 Massachusetts-area hospitals that found ER userose 4 percent. ...

"New patients must wait from a month to six weeks to see afamily doctor or an internist. Make that two months in Boston for a familypractitioner. ... About half of all family doctors and internists won't see newpatients or accept the insurance provided in the Commonwealth Connector(Massachusetts state authority's broker for private insurance). This was upsharply from 2006."

The Economist, a British center-left magazine, calls Romneycare"a legacy (Romney) can be proud of." But, the Economist points out:"He contrasts (Romneycare) with ObamaCare by claiming that (Romneycare)introduced no new taxes. This is pretty clearly a fib. The law wasn'timplemented until after he was gone, and the fact that he didn't raise taxes topay for it simply meant he refused to deal with the funding issue. Hissuccessor ... had to hike business fees by $100 million and to raise thecigarette tax by $1 a pack in 2008 to pay for the program's subsidies. In anycase, Commonwealth Care is funded partly through matching funds from thefederal Medicaid funding ... ." A legacy to be proud of?

Two-thirds of doctors, according to Investors Business Dailypolls, "oppose" ObamaCare and predict lower-quality health care. Apoll by the consulting firm McKinsey & Co. finds that nearly one-third ofbusinesses plan to drop heath insurance for their employees after 2014, when muchof ObamaCare goes into effect.

True, the American Medical Association supports ObamaCare. Butonly 17 percent of doctors belong to the organization, and many dropped theirmembership because of AMA's support of ObamaCare. Americans consistently rankphysicians among the most respected of professionals. Yet the President, a manwith virtually no private-sector experience, arrogantly ignores doctors'objections.

Obama, as with his fight to end Bush-era tax rates for the"rich," will also lose this battle -- if he is lucky. A Supreme Courtrejection of the ObamaCare mandate would immediately boost the economy and, byextension, Obama's prospect for re-election.

How ironic.

New Medical schools open! (But we still need many many more)!

2012-01-23T08:16:00.000-08:00

By ANEMONAHARTOCOLLIS

Published: February 14,2010

PeterAllen applied to 30 medical schools after graduating from the University ofPittsburgh last year. Twenty-eight said no.

Ofthe two that said yes, one had something in common with Mr. Allen: It, too, wasstarting out in medicine. He enrolled in the inaugural class of TheCommonwealth Medical College in Scranton, Pa.

“Iwas ecstatic that I had been accepted to a medical school,” Mr. Allen said,adding that he would have gone for a master’s in bioengineering if he had notbeen accepted. “It’s a giant sigh of relief; it secures your plans for the restof your life really.”

TheCommonwealth is one of nearly two dozen medical schools that have recentlyopened or might open across the country, the most at any time since the 1960sand ’70s.

Thesenew schools are seeking to address an imbalance in American medicine that hasbeen growing for a quarter century. Many bright students were fleeing tooffshore medical schools, or giving up hope entirely, when they could not getinto domestic schools. Meanwhile, American hospitals were using foreign-trainedand foreign-born physicians to fill medical residencies. During the 1980s and’90s only one new medical school was established.

“Hugenumbers of qualified American kids were not getting into American medicalschools or going abroad to study,” Dr. Lawrence G. Smith, dean of the proposedHostra University School of Medicine, in Hempstead, N.Y., which is not yetrecruiting students, said last week. “I think it was a kind of wake-up call.”

Theproliferation of new schools is also a market response to a rare convergence offorces: a growing population; the aging of the health-conscious baby-boomgeneration; the impending retirement of, by some counts, as many as a third ofcurrent doctors; and the expectation that, the present political climatenotwithstanding, changes in health care policy will eventually bring a tide ofnewly insured patients into the American health care system.

Ifall the schools being proposed actually opened, they would amount to an 18percent increase in the 131 medical schools across the country. (By comparison,there are 200 law schools approved by the American Bar Association.) And beyondthe new schools, many existing schools are expanding enrollment, sometimesthrough branch campuses. While The Commonwealth is an independent school, manyof the other new or proposed schools are affiliated with establisheduniversities, like Hofstra, which is teaming up with North Shore Long IslandJewish Medical Center; Quinnipiac University in Hamden, Conn.; the Universityof California, Riverside; Central Michigan University; and Rowan University inCamden, N.J.

Supportersof the expansion say that having more doctors will improve care, by gettingdoctors to urban and rural areas where they are needed, by shifting care toprimary and family practice physicians rather than expensive specialists, andby reducing long waits for people to see a doctor and get the care they need.

Butskeptics say that although many parts of the country do need more primary care,American doctors tend to congregate in affluent, urban and suburban areas thatalready have a generous supply.

Theysay that doctors create demand for their own services, and that nurse practitioners and physician assistantscould fill gaps in medical care at a lower cost.

“Whenyou add more physicians to an area, they just add more services, and theirsalaries don’t go down anywhere near in proportion to the increased supply,”said Dr. David Goodman, professor of pediatrics at the Dartmouth Institute forHealth Policy Practice , and a practicing physician who has studied work forceissues for 20 years. “More care may not be better, but it certainly is paidfor,” Dr. Goodman said.

Manyof the developing medical schools are well aware of such arguments, and arebilling themselves as different from traditional medical schools, more focusedon serving primary care needs in immigrant and disadvantaged communities.Administrators say that they expect that approach to be buttressed by a shiftin state and federal reimbursements from specialists to primary care doctors.

RiversideCounty, an inland area with a diverse population including immigrants andNative Americans that has expanded rapidly, has a deficit of about 3,000physicians, according to Dr. G. Richard Olds, founding dean of the Universityof California, Riverside School of Medicine.

Riversidehas applied for licensing, the first step toward becoming a medical school, andhopes to admit its first four-year class in 2012, and to have 400 students by2016, a typical size for the new crop of schools. Dr. Olds said his educationalfocus, building on his background as a tropical disease specialist, would be onprevention and “wellness.”

“Ithink we have to crank out different kinds of doctors,” said Dr. Olds, whostarted his new job Feb. 1.

Whetherthe demand for new medical schools exists among patients, it clearly existsamong prospective doctors.

Dr.Olds said that at his former job as chairman of medicine at the Medical Collegeof Wisconsin, 25 percent of the students came from California. “So obviouslythere’s a ton of California kids trying to get into medical school traveling along way.”

TheAssociation of American Medical Colleges, a trade group, has called for a 30percent increase in enrollment, or about 5,000 more doctors a year. Theassociation’s Center for Workforce Studies estimates that 3,500 more M.D.s willenter graduate training over the next 10 years, roughly half of the 7,000international medical school graduates now entering medical residencies in theUnited States every year, according to Edward Salsberg, director of the center.

AtQuinnipiac, the trustees last month approved plans for a new medical school, toopen in 2013 or 2014, if it passes accreditation. John L. Lahey, the universitypresident, said that the proposed school would build on the university’sexisting health sciences programs, and the hope was to recruit at least somestudents who had worked in health care and wanted to become doctors.

“Wecertainly think they will be what we tend to call nontraditional students,older, some minority,” Dr. Lahey said.

Sixdeveloping medical schools, including The Commonwealth, have receivedpreliminary accreditation, enabling them to begin recruiting students, and sixmore, including Riverside, have begun the application process, according to theLiaison Committee on Medical Education, which accredits American medicalschools. An additional 11, including Quinnipiac, have announced their intentionto apply for licensing, according to Mr. Salsberg.

Whateverthe expansion may mean for the cost of health care, it is a relief to aspiringdoctors like Mr. Allen, who took tough undergraduate courses and had a busyextracurricular life of mock trials, robotics and work as an emergency medicaltechnician. His pre-med adviser told him that with his 3.3 grade-point average,he should apply only to osteopathic schools, but he persisted, and was admittedto The Commonwealth and New York Medical College in Valhalla, N.Y.

Hewas one of 1,300 applicants for 60 positions (eventually class size willdouble) in the inaugural class at The Commonwealth, according to Dr. Robert M.D’Alessandri, the president and dean. Mr. Allen has a United States Navy scholarship, but for his classmates, the school took $20,000a year off the tuition, a reduction of about half, as an incentive to take therisk of a new school.

Giventhe pent-up demand, Dr. D’Alessandri said, he was not worried that he mightproduce too many doctors for the good of society. “We should worry about toomany lawyers,” he said dryly.

Obamacare or The New Healthcare Laws (whatever you call it) will cut Physician Compensation!

2012-01-13T05:01:00.001-08:00

Slashing doc pay

Making US ratesmore like Europe’s

By SCOTT GOTTLIEB

Last Updated: 12:18 AM, October 25, 2011

A key government panelvoted this month to whack what Medicare pays most doctors to treat patients.It’s an important step on the path to ObamaCare -- because the only way to makeEuropean-style health entitlements work in America is to pay US doctors lowerEuropean wages.

This is going to hurtdoctors -- and hit patients even harder, as American physicians scale downtheir medical practices to adapt to the lower pay rates. The vote by theMedicare Payment Advisory Commission involves slashing what the program forolder Americans pays medical specialists -- then freezing these lower rates foryears.

Everyone except primary-care docs would see payments for their services cut by5.9 percent a year for three years (totalling a 16.7 percent cut in income),followed by a seven-year freeze at the reduced levels. Primary-care providerswould have their reimbursement rates frozen at today’s pay levels for the wholedecade. All this is part of a larger effort to save Medicare upward of $300billion over 10 years.

This is no hollowthreat: ObamaCare set up an agency called the Independent Payment AdvisoryCommittee to fast-track these kinds of proposals into law by sidesteppingCongress.

We doctors have mostlyourselves to blame for this mess. Hoping to preserve some organized power forMDs, groups like the American Medical Association made two Faustian bargainswith Washington on behalf of physician members.

The first evolved in thelate 1990s. In a deal to cut the deficit, the Clinton administration joinedwith a Republican Congress to cap total payments to doctors and implemented asystem of price controls for their services. The AMA signed on to the scheme inpart because Washington agreed to leave it to an AMA-run process to decide howthe shrinking pie of money Washington spent would be carved up betweendifferent medical specialties.

The second Faustian dealwas ObamaCare. Doctors’ Washington lobbyists overlooked the fact that ObamaCarewould inevitably pay something close to (far below market) Medicaid rates formedical services. Nor did they fathom how much would need to be cut fromphysicians to pay for the plan’s costly mandates.

American doctors do earnmuch more than their European counterparts -- if US salaries aren’t adjustedfor the different wealth of nations. Some of the best data on these paydifferences appear in the September issue of the journal Health Affairs, in astudy done by one of the administration’s assistant health secretaries beforeshe took her government job.

Annual pre-tax income(net of practice expenses) for primary-care doctors was $95,000 in France in2008, compared to $186,000 in the United States. For specialists, thedisparities were wider -- with orthopedic surgeons averaging $154,000 in Franceand $208,000 in Canada compared to $442,000 in America.

The differences reflectlower rates for individual services. In France, for one, private insurance paysdoctors about a third of what US physicians earn for office visits -- $34 inFrance vs. $133 in America for a primary-care doctor. Even public programs likeMedicare pay twice what similar French programs offer.

In a view echoed aroundthe Obama administration, the analysis concludes that these bigger salaries“were the main drivers of higher US spending” on health care.

To bring Europeanhealthcare to America, these price differences always had to be sanded away.The only way ObamaCare is going to bring our health benefits and spending toEuropean levels is to also adapt European payment rates.

As a result, US doctorswill adjust their business models in ways that won’t be good for patients. Somewith busy practices in big cities will opt out of the government insurancesystems entirely, and go cash-only. Others will retire early. But most doctorswon’t have these opportunities available to them. So they’ll need to make up involume what they lose in margin for their individual medical services. Thiswill mostly mean hiring more nonphysician providers such as nurse practitionersto see most patients. Doctors will become managers of large clinical staffs,leaving more direct care to less-expensive providers.

Patients will loseaccess to physicians -- and spend more time waiting in busier offices.

As for doctors, there’sstill some good news. With baby boomers aging, physicians will have plenty ofbusiness coming through their office doors. Of course, under ObamaCare, theyaren’t going to get paid much for seeing most of these patients.

Scott Gottlieb, aphysician and American Enterprise Institute resident fellow, was a seniorofficial at the Centers from Medicare and Medicaid Services.

Doctors are Going Broke! Costs are up...reimbursements are down!

2012-01-06T08:56:00.001-08:00

By Parija Kavilanz for CnnMoney

NEWYORK (CNNMoney) -- Doctors in America are harboring an embarrassing secret:Many of them are going broke.

Thisquiet reality, which is spreading nationwide, is claiming a wide range ofcasualties, including family physicians, cardiologists and oncologists.

Industrywatchers say the trend is worrisome. Half of all doctors in the nation operatea private practice. So if a cash crunch forces the death of an independentpractice, it robs a community of a vital health care resource.

"Alot of independent practices are starting to see serious financialissues," said Marc Lion, CEO of Lion & Company CPAs, LLC, whichadvises independent doctor practices about their finances.

Doctorslist shrinking insurance reimbursements, changing regulations, rising businessand drug costs among the factors preventing them from keeping their practicesafloat. But some experts counter that doctors' lack of business acumen is alsoto blame.

Loans to make payroll: Dr. William Pentz, 47, a cardiologist with a Philadelphiaprivate practice, and his partners had to tap into their personal assets tomake payroll for employees last year. "And we still barely made payrolllast paycheck," he said. "Many of us are also skimping on our ownpay."

Pentzsaid recent steep 35% to 40% cuts in Medicare reimbursements for keycardiovascular services, such as stress tests and echocardiograms, have taken asubstantial toll on revenue. "Our total revenue was down about 9% lastyear compared to 2010," he said.

"Thesecuts have destabilized private cardiology practices," he said. "Athird of our patients are on Medicare.So these Medicare cuts are by far the biggest factor. Private insurers followMedicare rates. So those reimbursements are going down as well."

Pentzis thinking about an out. "If this continues, I might seriously considerleaving medicine," he said. "I can't keep working this way."

Alsoon his mind, the impending 27.4% Medicarepay cut for doctors. "If that goes through, it will put usunder," he said.

Federallaw requires that Medicare reimbursement rates be adjusted annually based on aformula tied to the health of the economy. That law says rates should be cutevery year to keep Medicare financially sound.

AlthoughCongress has blocked those cuts from happening 13 times over the past decade,most recently on Dec. 23 with a two-month temporary "patch," thisdilemma continues to haunt doctors every year.

BeauDonegan, senior executive with a hospital cancer center in Newport Beach,Calif., is well aware of physicians' financial woes.

"Manyare too proud to admit that they are on the verge of bankruptcy," shesaid. "These physicians see no way out of the downward spiral ofreimbursement, escalating costs of treating patients and insurance companiesdeciding when and how much they will pay them."

Doneganknows an oncologist "with a stellar reputation in the community" whohasn't taken a salary from his private practice in over a year. He owes drugcompanies $1.6 million, which he wasn't reimbursed for.

Dr.Neil Barth is that oncologist. He has been in the top 10% of oncologists in hisregion, according to U.S. News Top Doctors' ranking. Still, he is contemplatingpersonal bankruptcy.

Thatmove could shutter his 31-year-old clinical practice and force 6,000 cancerpatients to look for a new doctor.

Changesin drug reimbursements have hurt him badly. Until the mid-2000's, drugs saleswere big profit generators for oncologists.

Inoncology, doctors were allowed to profit from drug sales. So doctors would buyexpensive cancer drugs at bulk prices from drugmakers and then sell them atmuch higher prices to their patients.

"Igrew up in that system. I was spending $1.5 million a month on buying treatmentdrugs," he said. In 2005, Medicare revised the reimbursement guidelinesfor cancer drugs, which effectively made reimbursements for many expensivecancer drugs fall to less than the actual cost of the drugs.

"Ourreimbursements plummeted," Barth said.

Still,Barth continued to push ahead with innovative research, treating patients withcutting-edge expensive therapies, accepting patients who were underinsured onlyto realize later that insurers would not pay him back for much of his care.

"Iwas $3.2 million in debt by mid 2010," said Barth. "It was asickening feeling. I could no longer care for patients with catastrophicillnesses without scrutinizing every penny first."

He'ssince halved his debt and taken on a second job as a consultant to hospitals.But he's still struggling and considering closing his practice in the next sixmonths.

"Theeconomics of providing health care in this country need to change. It's tooexpensive for doctors," he said. "I love medicine. I will find a wayto refinance my debt and not lose my home or my practice."

Ifhe does declare bankruptcy, he loses all of it and has to find a way to startover at 60. Until then, he's turning away new patients whose care he can nolonger subsidize.

"Irecently got a call from a divorced woman with two kids who is unemployed,house in foreclosure with advanced breast cancer," he said. "Themoment has come to this that you now say, 'sorry, we don't have the capacity tocare for you.' "

Small business 101: A private practice is like a small business. "The onlything different is that a third party, and not the customer, is paying for theservice," said Lion.

"Manytimes I shake my head," he said. "Doctors are trained in medicine butnot how to run a business." His biggest challenge is getting doctors torealize where and how their profits are leaking.

"Onaverage, there's a 10% to 15% profit leak in a private practice," he said.Much of that is tied to money owed to the practice by patients or insurers."This is also why they are seeing a cash crunch."

Dr.Mike Gorman, a family physician in Loganvale, Nev., recently took out an SBAloan to keep his practice running and pay his five employees.

"Itis embarrassing," he said. "Doctors don't want to talk about being indebt." But he's planning a new strategy to deal with his rising businessexpenses and falling reimbursements.

"Iwill see more patients, but I won't check all of their complaints at onetime," he explained. "If I do, insurance will bundle my reimbursementinto one payment." Patients will have to make repeat visits -- anarrangement that he acknowledges is "inconvenient."

"Thissystem pits doctor against patient," he said. "But it's the only wayto beat the system and get paid."

Uninsured illegal aliens occur massive cost to U.S. Healthcare

2012-01-04T15:48:00.000-08:00

Hospitals Stuck With Illegal Immigrants, Uninsured‘Permanent Patients’ at Massive Cost!

An unpleasant new report claims thatmany hospitals in major metro areas are struggling with the growing problem of“permanent patients.”

What’s a “permanent patient”?According to The New York Times theey are mostly illegal immigrants or peoplewho lack insurance or their own housing that the hospital cannot turn away.

The Times defines a “permanentpatient”:

…[someone who has] been languishingfor months or even years in…hospitals, despite being well enough to be senthome or to nursing centers for less-expensive care, because they are illegalimmigrants or lack sufficient insurance or appropriate housing.

Of course, having dozens of patientshanging around that long means these hospitals are absorbing the bill formillions of dollars in unreimbursed expenses annually.

Unsurprisingly, the majority ofthese “permanent patients” are illegal immigrants because, as mentioned in theabove, they have no housing or family in the area.

Medicaid often pays for emergencycare for illegal immigrants, but not for continuing care, and many hospitals inplaces with large concentrations of illegal immigrants, like Texas, Californiaand Florida, face the quandary of where to send patients well enough to leave,”writes Sam Roberts of the Times.

What kind of cost are we talkingabout here?

“Care for a patient languishing in ahospital can cost more than $100,000 a year, while care in a nursinghome can cost $20,000 or less [emphasis added],” Roberts reports.

Patients fit to be discharged fromhospitals but having no place to go typically remain more than five years, saysLaRay Brown, a senior vice president for New York City’s Health and HospitalsCorporation.

She says that there were about 300 patients in such a predicament throughoutthe New York City area alone, most in public hospitals or higher-priced skilledpublic nursing homes, though a few were in private hospitals, according to theTimes.

“Many of those individuals no longer need that care, but because they haveno resources and many have no family here, we, unfortunately, are caring forthem in a much more expensive setting than necessary based on their clinicalneed,” said Brown.

The report goes on to cite an example where one patient from Queens, NY, hasbeen at the Coler-Goldwater Specialty Hospital and Nursing Facility for 13years because the hospital has no place to send him.

The patient, who is in his mid-60s, has been there since an arterial diseasecost him part of one leg below the knee and left him in a wheelchair, accordingto the report.

Or another example:

Five years ago, Yu Kang Fu, 58, who lived in Flushing, Queens, and was acook at a Chinese restaurant in New Jersey, was dropped off by his boss at NewYork Downtown Hospital, a private institution in Manhattan, complaining of asevere headache. Mr. Yu was admitted to the intensive-care unit with a stroke.

Mr. Yu remained in the hospital for over four years until he was transferredlast spring to the Atlantis Rehabilitation and Residential Health CareFacility, a private center in Fort Greene, Brooklyn, after the federalgovernment certified him as a “permanent resident under color of law,”essentially acknowledging that he could not be returned to China and qualifyinghim for medical benefits.

“This gentleman cost us millions of dollars,” said Jeffrey Menkes, thepresident of New York Downtown. “We try to provide physical, occupationaltherapy, but this is an acute-care hospital. This patient shouldn’t be here.”

The fact of the matter is that hospitals in metro areas that host a largeillegal immigrant population are unable to turn away patients who have neitherinsurance nor proof that they are in the United States legally– two thingsnecessary for discharge purposes and reimbursements, said Chui Man Lai,assistant vice president of patient services at a New York state hospital.

“These patients often arrive in the emergency room acutely ill andunaccompanied, and we have to treat them until they can be discharged safely,”Ms. Lai said. “The hospital is required, by law and its mission, to care forthese patients.”

But even worse than “permanent patients,” those who essentially live inhospitals already operating on thin budgets, are what some refer to as “popdrops”: grown adults leaving their parents at the hospitals so that they can goon vacation.

“Hospitals are reluctant to complain publicly about such patients for fearof being perceived as callously seeking to dump nonpaying patients,” writesRoberts. “Elected officials are generally loath to be seen as encouragingillegal immigrants by changing reimbursement formulas. The issue was neveraddressed during the debate over national health care legislation.”

Doctor's say "NO" to Obamacare!

2011-12-27T06:12:00.001-08:00

Sally Pipes, Contributor (I cover health policy as President of the Pacific Research Institute )

Op/Ed

Doctors Say Obamacare Is No Remedy for U.S. Health Woes

America’s doctorshave conducted a full examination of the president’s health reform law — andtheir diagnosis of its effects on our healthcare system isn’t good.

Nearly two-thirdsof doctors expect the quality of care in this country to decline, according toa new survey from consulting giant Deloitte. Just 27 percent think that the lawwill lower costs. And nearly seven of every 10 doctors believe that medicine isno longer attractive to America’s “best and brightest.”

Few people knowmore about our healthcare system than doctors working on the frontlines.Policymakers should pay heed to their indictment of Obamacare and revisit thedisastrous law.

President Obamapromised that his reform package would begin to stymie the out-of-controlgrowth in the cost of American health care. He pledged $2,500 in healthinsurance savings for the typical American family.

But doctors don’tbuy it. Only one quarter feel that Obamacare will reduce health insurance costsfor consumers. Nine out of ten posit that insurers will raise premiums foremployers and individuals.

They have goodreason to doubt Obamacare’s cost-cutting potential. Healthcare spending isexpected to reach $2.7 trillion this year — or about $1 of every $6 spent inour economy. By 2020, health spending will account for a full fifth ofAmerica’s GDP.

That increase isin large part thanks to Obamacare. Instead of relieving high insurancepremiums, the nonpartisan Congressional Budget Office estimates that Americanfamilies in the non-group market will see their premiums rise $2,100.

They’re alreadytrending higher. According to the Kaiser Family Foundation, average familypremiums in 2011 topped $15,000 — a 9 percent increase from 2010. Prior toObamacare’s passage — from 2009 to 2010 — premiums went up just 3 percent.

In April 2010,Richard Foster, the Chief Actuary of the Centers for Medicare and MedicaidServices (CMS), concluded that American spending on health care through 2019would be $311 billion higher than if the law had never passed.

Even with all thatadditional money flowing through the system, doctors don’t think that thequality of care will improve. Half of all doctors believe that access to carewill diminish because of hospital closures prompted by health reform.

Further, nearly 70percent of doctors believe that long wait times will plague emergency rooms. Afull 83 percent of physicians foresee increased wait times for primary careappointments.

That’s in largepart because Obamacare is expected to extend government-subsidized insurancecoverage to many folks — even as the supply of providers remains relativelyconstant.

The United States already faces ashortage of primary-care doctors. Medical schools today produce one suchphysician for every two our country needs. By 2019, the American Academy ofFamily Physicians warns that the United States will be short 40,000 doctors.

Expanding insurance coverage to millionsmore Americans won’t do much good if they can’t get doctor’s appointments.Physicians believe that their ability to provide quality care will be furtherstrained by the law’s attempt to change the way they’re paid — from afee-for-service basis to a vaguely defined system of paying doctors based onpatient health and outcomes.

Nine out of ten physicians fear theywill receive inadequate payments and endure higher administrative costs. Fewerthan a quarter of doctors expect their paperwork requirements to ease up. Timespent wading though paperwork is also time no longer available for actually practicingmedicine.

American doctors’ negative view ofObamacare is telling. Proponents of the law may claim that their griping ismisplaced, but as Paul Keckley, Ph.D., the lead author of the report explains,“Understanding the view of the physician is fundamental to any attempt tochange the health care model.”

In other words, if physicians aren’t onboard with Obamacare, it won’t work. A law that hinders the practice ofmedicine, obstructs access to care, and costs Americans more is clearly not theright remedy for what ails us.

Sally C. Pipes is President, CEO, andTaube Fellow in Health Care Studies at the Pacific Research Institute. Her nextbook — The Pipes Plan: TheTop Ten Ways to Dismantle and Replace Obamacare (Regnery) — will bereleased in January 2012.

ObamaCare's Very Bad Year!

2011-12-21T14:29:00.000-08:00

Paul Connor, The Daily Caller.

2011was supposed to be a bad year for President Obama’s health care law, with HouseRepublicans taking aim and federal lawsuits snaking their way through thejudiciary. And although the House of Representatives has had limited success indismantling the overhaul, key portions began to unravel all by themselves.

Here’sa look at the Patient Protection and Affordable CareAct’s year in review.

–Jan. 14: Kansas announces its intention tobecome the 26th state to file suit against the federal government to stopimplementation of the health care overhaul.

–Jan. 19: The House of Representatives votes to repeal the healthcare law.

–Jan. 26: Illinois-based pharmaceutical company Abbott Labs cuts 1,900 jobs “inresponse to changes in the health-care industry, including U.S. health-carereform and the challenging regulatory environment.”

–Jan. 31: A second federal district judge rules that the law is unconstitutional.

–Feb. 2: All 47 Republican senators vote to repeal the Affordable Care Act, but themeasure fails.

–Feb. 16: Health and Human Services Secretary Kathleen Sebelius testifies before the SenateFinance Committee and admits that the CLASS Act, a key portion of the law thatwas touted as a $70 billion savings, is“totally unsustainable.” But not to worry: Sebelius says her department has theauthority to rework the legislation to make CLASS tenable.

–Feb. 18: The House votes to block federalfunding to implement the Affordable Care Act. The Congressional Budget Officealso estimates that repealing the law would add $210billion to the combined federal deficits from 2012 to 2021.

–Feb. 22: A federal judge tosses a lawsuit claiming that the AffordableCare Act violates the liberties of those who choose to rely on God to protectand heal them instead of buying health insurance.

–March 3: The House votes to end an unpopular tax paperwork-filingrequirement for businessestucked into the health care law.

–March 23: The law turns one year old. On the same day, the HouseCommittee on Energy and Commerce finds that the temporary Early RetirementReinsurance Program will spend its allotted $5 billion far earlier than itsJan. 1, 2014 expiration date.

–March 30: The CBO estimates that health carereform will cost $1.1 trillion, an increase of $90 billion from its Februaryestimate.

–May 17: The Daily Caller reports that 20 percent of new waivers from thelaw have gone to gourmet restaurants, nightclubs andfancy hotels in former House Speaker Nancy Pelosi’s district.

–June 8: A McKinsey & Company survey of over 1,300private sector employers found that 30 percent of employers would definitely orprobably stop offering insurance to their employees after the law isimplemented in 2014.

–June 18: HHS announces that it is axing waivers from the law.

–June 21: A glitch in the law, discovered after Obama signed it, would allow middle-class Americans to getsubsidized health care intended for poor people, the Associated Press reports.Medicare’s chief actuary says the policy “doesn’t make sense.”

–June 29: In the face of a constitutional challenge, the Sixth Circuit Court ofAppeals rules in favor of the law.

–July 18: An Employment Policies Institute report finds that the Affordable Care Act wouldincentivize employees to switch to a government-subsidized insurance exchangeeven if employers were to continue their health care coverage, costingtaxpayers “significant[ly].”

–July 19: The bipartisan “gang of six” puts forward a debt-reduction plan thatwould repeal the CLASS Act.

–Aug. 1: HHS issues a regulation requiring all group health insurance plans tocover FDA-approved “contraceptive methods, sterilization procedures, andpatient education and counseling for all women with reproductive capacity.”

–Aug. 12: The Eleventh Circuit Court of Appeals rules that the law’s individualhealth insurance mandate is unconstitutional.

–Sept. 8: The Fourth Circuit Court of Appeals rejects a pair of challenges tothe law on procedural grounds. It does not rule on the law’s constitutionality.

–Sept. 15: A bicameral Republican report accuses Democratic supporters of thehealth care law of recklessness for promoting the CLASS Act despite knowingthat the program would eventually blow up the budget.

–Oct. 5: The signatures of about 1.6 million petitioners pressing for the repealof the Affordable CareAct are delivered to Capitol Hill at a press conference.

–Oct. 13: A federal inspector general finds that the IRS ishaving trouble collecting the 10-percent federal tanning tax established by thelaw.

–Oct. 14: HHS completes its 19-month review of the CLASS Act, determining that “we do nothave a path to move forward,” Sebelius says. CLASS remains on the books, butthe administration essentially gives up on it.

– Nov. 4: Tennessee Rep.Phil Roe and 23 Republican colleagues send a letter to IRSCommissioner Douglas Shulman objecting to a new IRS rule authorizing subsidiesfor participants in the yet-to-be-created federal health care exchange program.They argue that the agency is seeking to rewrite legislation, something it isnot allowed to do. Conservative experts say the IRS rules are covering up aglitch in the original law that provides subsidies for people enrolled in stateexchanges, but not federal exchanges. Shulman does not agree with theiranalysis.

–Nov. 9: The National Federation of Independent Business releases a report saying that in 2012 the law’snew health insurance tax will reduce private sector jobs by between 125,000 and249,000.

–Nov. 10: The Beckett Fund for Religious Liberty announces it is suing HHSon behalf of Belmont Abbey College, a Catholic educationalinstitution. The lawsuit claims the Aug. 1 regulation violates the college’steaching on contraception, sterilization and abortion.

–Nov. 14: The Supreme Court agrees to hear arguments onthe Affordable Care Act.

–Nov. 16: Forty-seven percent of Americans favor repeal of the law, Gallup finds.

–Nov. 29: Massachusetts Democratic Rep. Barney Frank joins the effort to repeal the IndependentPayment Advisory Board, a key portion of the law that would “recommend levelsat which Medicare recipients, including seniors, can be reimbursed for healthcare expenses.”

–Nov. 30: The House energy committee votes to repeal the CLASS Act.

–Dec. 15: The Obama administration announces that the numberof young uninsuredAmericans has fallen by 2.5 million, attributing it to his law’s provisionpermitting young adults to stay on their parents’ health care plans until age26.

–Dec. 18: Health care experts doubt that the federal insurance exchange programwill be fully operational by the Jan. 1, 2014 deadline, since many states haverefused to implement the state exchange program, the Washington Post reports.

–Dec. 19: The Supreme Court announces it will hear anunprecedented week’s worth of arguments in March 2012 to determine whether thehealth care overhaul law is constitutional.

Medicare plans to cut reimbursements by 27% in 2012

2011-12-14T04:27:00.001-08:00

Doctorsfacing 27% cut in their Medicare fees

Arizona Daily Star | Posted: Tuesday,November 29, 2011 12:00 am

WASHINGTON - Politicians of both partiesoutdo each other vying for the approval of seniors, but their inability tocompromise on the federal budget has put Medicare in the crosshairs again.

Unless Congress acts before Jan. 1, doctorsface a 27 percent cut in their fees for treating Medicare patients. That couldundermine health care for millions of elderly and disabled beneficiaries.

Last year around the holidays doctors werelooking at a cut of about 20 percent.

The cuts are the consequence of a 1990sbudget law that failed to control spending but never got repealed. Congresspasses a temporary fix each time, only to grow the size of reductions requirednext time around. The supercommittee's breakdown leaves the so-called "docfix" unresolved with time running out.

A thousand miles away in Harlan, Iowa, Dr.Don Klitgaard is trying to contain his frustration.

"I don't see how primary care doctorscould take anywhere near like a 27 percent pay cut and continue tofunction," said Klitgaard, a family physician at a local medical center."I assume there's going to be a temporary fix, because the health caresystem is going to implode without it."

Medicare patients account for about 45percent of the visits to his clinic. Klitgaard said the irony is that he andhis colleagues have been making improvements, keeping closer tabs on those withchronic illnesses in the hopes of avoiding needless hospitalizations. Whilethat can save money for Medicare, it requires considerable upfront investmentfrom the medical practice.

"The threat of a huge cut makes it verydifficult to continue down this road," said Klitgaard, adding "it'salmost comical" lawmakers would let the situation get so far out of hand.

Physian's Pay may increase, Maybe!

2011-12-09T07:25:00.001-08:00

Doctors to see slight salary increases in 2012

October 18,2011 | Stephanie Bouchard, Associate Editor

PHILADELPHIA –Doctors can expect to see salary increases in 2012 but they’ll be smaller thanthose in 2011 says a physician compensation survey released this week by globalconsulting firm, the Hay Group. In 2011, physician salaries increased by 2.7percent but expectations are that in 2012 they'll increase only by 2.5 percent.

The size of thesalary increases is impacted by organization-specific things such as the salaryincreases provided to other employees, and, more importantly, reimbursements,said Jim Otto, senior principal in Hay Group’s healthcare practice. “Theprimary influences on these increases are likely to be flat or minimal increasein reimbursement for services rendered and flat or minimal increase in actualservices rendered that result in reimbursement,” he said.

Doctors workingin group-based practices are expected to see pay increases of 3.2 percent in2012 but hospital-based doctors are only expected to see increases of 2.5percent. More specifically, physician specialists working in hospitals mayexpect an increase of 2.4 percent and those in group practices may expect a 4.5percent increase. Primary care doctors in hospitals may expect a 2.9 percentsalary increase in 2012 while their peers working in group practices may expecta 3.3 percent increase.

The differencesin salary increases between hospital-based and group-based doctors are likelythe result of three things, Otto said: group income from ancillary servicesthat are part of a practice’s business lines and which are not part of ahospital-employed physician’s compensation; sharing in profit after expensesfor physician owners, which is also not part of a hospital-employed physician’scompensation; and employed physician increases being influenced by budget andsalary increases for the other employees of the hospital.

With the demandfor primary care physicians up, it’s not as surprising that they are expectedto have larger salary increases than specialists in 2012. “The expectedincreases to primary care physicians is a reflection of the importance of theirrole in the healthcare reform environment – for example, accountable forintegrated patient care models – the increase in reimbursement that is beingpaid by insurance companies and the government for primary care services, andthe decreasing reimbursement for other specialists,” Otto said. “This does notmean that the pay differences that you see in the market between primary carephysicians and specialists will evaporate quickly, but over time thesedifferences are expected to shrink.”

Other findingsfrom the physician compensation survey include:

• Whendetermining base pay structure, 50 percent of organizations set physician payon an individual basis, 28 percent establish formal salary ranges, 18 percentuse market rates and 1 percent use step-rate progression.
• The prevalence of annual incentive plans decreased slightly among allphysician participants in 2011.
• Measures for determining incentive payouts continue to be dominated byquality and patient satisfaction.

Follow HFNassociate editor Stephanie Bouchard on Twitter @SBouchardHFN.

Physician Salaries - Towns and Cities; Size does matter!

2011-12-05T08:17:00.001-08:00

How does Town Size and PopulationAffect Physician Salary?

By Andrea Santiago,About.com Guide

Question: How does Town Size and Population Affect PhysicianSalary?

A reader, who is a future physician, posedsome questions about physician salary as it relates to the size of thecommunity in terms of population. Do physicians earn more in small towns orlarge cities, and why?

Answer: In discussing physician compensation, the use of the term"salary" can be misleading, since many physicians are not employed,nor are they paid a base salary. Most physicians (more than 50%) are inbusiness for themselves, owning a private practice in full or in part, asopposed to being employed by a hospital or group. Even for physicians who areemployed, their compensation is controlled by many geographic, economic, anddemographic factors, such as managed care and insurance reimbursements, whichare set by third party organizations and government regulations.

According to the Medical Group Management Association(MGMA) which conducts extensive annual surveys and analysis of physiciancompensation, most physicians earn more money in communities which are wellunder one million in population. In many specialties, the highest earners arefound in towns of 50,000 to 250,000 in size, according the the MGMA statistics.

This disparity in compensation is due to several factors:

Competition: Insmaller to mid-sized communities, competition from other physicians is not asprevalent as in larger metropolitan areas, which tend to become “over-doctored”due to the tendency of doctors to flock to large cities due to family ties orperceived benefits of working in a larger city.

Reimbursements:Reimbursements from insurance companies tend to be higher in small- tomid-sized communities. Therefore, a physician in a big city and a physician ina small town could see the exact same amount and type of patients, and do thesame amount of work, and each physician could be reimbursed completelydifferent amounts based on the rates in their area, and often it’s thesmall-town doc that comes out ahead.

Overhead costs: Typically,costs of practicing as a physician, such as malpractice insurance, and officespace, are higher in larger cities. This is because larger cities tend to bemore litigious environments than smaller communities, and frequent lawsuitsdrive up the cost of malpractice insurance further.

Examples of high-earning physician specialties in smallertowns:

Orthopedic Surgeons These surgeons earn the most in towns of 50,000 or less,typically. For example, according to the MGMA Physician Compensation andProduction Report of 2009, orthopedic surgeons in the smallest towns earn amedian annual income of $502,195, and only $474,359 annually in in metro areaslarger than one million people in size. Their median income decreases furtherin towns with a population of 250,000-1,000,000, to about $393,402.

Gastroenterologists in smaller towns (under 50,000) earn an average of$467,927. Those physicians in towns of 50,000 to 250,000 earn $452,195 onaverage, which is a whopping 22% more than their counterparts in major metroareas (over one million population), who earn $370,673 annually on average.

Dermatologists earn the most in towns of 50,000-250,000 with a medianincome of about $395,159. In major metropolitan areas, dermatologists earnabout $50,000 less than that, with a median annual income of $340,317 in citieswith a population over one million. In towns under 50,000 in size, derms earn$356,624, according to the MGMA 2009 Physician Compensation and ProductionSurvey.

Cardiologists in small to mid-sized towns earn anywhere from 17% toover 25% more than those in major metro areas. Those increased earnings canequate to a difference of nearly $150,000 annually for some cardiologists insmaller communities! Interventional cardiologists see the most dramatic effectsof town size on income, for example, with median earnings of $609,041 in smalltowns (under 50,000 people), and $462,820 in major metro areas (over onemillion people).

Above are just a few examples. The list goes on, butthese are a few of the most dramatic examples. Not every specialty sees such asignificant difference, but nearly every specialty sees a gain in compensationin smaller towns, particularly those in the lucrative range of 50,000 to250,000 in population, which are the highest paying locations for mostspecialties. As an added bonus, in addition to earning more money each year,physicians in smaller communities get more for their money, obtainingadditional savings and improved financial situations for doctors who practicein small or mid-sized communities.

Medicare cuts again as Super Committee (read disengaged politicians) agrees to inaction!

2011-11-22T08:07:00.001-08:00

Super committee failure leaves Medicare pay cuts in place

Deficitpanel inaction will trigger a $1.2 trillion federal spending reduction thatcould cut Medicare pay even more starting in 2013.

By Charles Fiegl, amednews staff. PostedNov. 21, 2011.

Washington -- Roughly $1.2 trillion in automaticcuts over 10 years will hit federal programs, including Medicare, afterlawmakers on a special 12-person bipartisan deficit reduction committee failedto develop a consensus plan.

Leaders of theCongressional Joint Select Committee on Deficit Reduction announced on Nov. 21that they would not be able to reach an agreement on a spending cut plan by theNov. 23 deadline set by Congress. Organized medicine had hoped the committeewould strike a deal that not only met the panel's minimum goal but that alsofixed the long-term physician payment problems plaguing the Medicare program.Its failure means that unless lawmakers act to change the outcome, thesustainable growth rate formula will cut physician pay by 27.4% in 2012 and byan additional amount in 2013, and the automatic spending cuts will decrease payeven further starting in 2013.

AmericanMedical Association President Peter W. Carmel, MD, said lawmakers on thecommittee missed a unique opportunity to fix the SGR formula, avoid furthercuts to doctors and preserve beneficiary access to care.

"Thefailure of the deficit committee forces our nation to continue on anunsustainable path that puts current and future generations of Americans atrisk for harsh consequences," Dr. Carmel said. "Congress set upprocesses and procedures that could have charted a course to put our nation'sfiscal house in order. The stalemate in the deficit committee will triggerrobotic, across-the-board spending cuts, which will not address criticalstructural problems in the federal budget."

Congress hadcreated the panel, which many dubbed the super committee, as part of anagreement to raise the federal debt ceiling in August. The Budget Control Actgave the committee the task to develop a plan to reduce budget deficits by atleast $1.2 trillion between 2012 and 2021. Failing to agree on any plan wouldtrigger 10-year spending cuts equal to $1.2 trillion starting in fiscal 2013,divided roughly equally between defense spending and nondefense spending.

The actspecifically exempted Medicare patient benefits from being impacted by theautomatic spending cuts, meaning that Medicare pay to health professionalswould be on the chopping block. The statute does cap the amount of cuts fromMedicare as a whole to 2% per year, amounting to a $123 billion decrease inprogram spending over the decade, according to a Sept. 12 Congressional BudgetOffice report.

The projectedeffect of the automatic cuts on physician pay is not yet known. The White Housewould determine proportional budgetary reductions annually, and the presidentthen would order the necessary cuts, according to the CBO. Congress could voteto roll back some or all of the automatic reductions contained in the budgetact's fail-safe mechanism, and some lawmakers indicated that they might attemptto do that for certain defense spending and other priorities. But PresidentObama warned Congress against trying to escape its budgetary responsibilitiesand the White House indicated that he would be willing to veto such legislation.

Meanwhile, the federal governmentavoided its latest shutdown on Nov. 18 as Obama signed legislation to keepfederal agencies funded through Dec. 16. Another appropriations bill would beneeded to fund the government after that date.

Millions lose Employer-Sponsored Healthcare (Since Obamacare). That means they won't be coming to see the doctor!

2011-11-12T09:04:00.001-08:00

SinceObamacare’s Passage, Millions Have Lost Employer-Sponsored Health Insurance

4:42PM, Nov 11, 2011 • By JEFFREY H.ANDERSON

Throughout the Obamacare debate, President Obama repeatedly promised,“If you like your health care plan, you can keep your health care plan.” Now, Gallup reports that from the first quarterof 2010 (when Obama signed Obamacare into law) to the third quarter of thisyear, 2 percent of American adults lost their employer sponsored healthinsurance. In other words, about 4.5 million Americans lost theiremployer-sponsored insurance over a span of just 18 months.

This is not what theCongressional Budget Office (CBO) had predicted would happen. Rather, the CBOhad predicted that Obamacare would increase the number of people withemployer-sponsored insurance by now. It had predicted that, under Obamacare, 6million more Americans would have employer-sponsored insurance in 2011 than in2010 (see table 4, which shows the CBO’sprojected increase of 3 million under (pre-Obamacare) current law and anadditional 3 million under Obamacare). So the CBO’s rosy projections forObamacare (and even these paint a frightening picture)are already proving false.

Whether the declinein employer-sponsored insurance over the past 18 months is a product of Obamacareor of the Obama economy — and whether Obamacare is the principal cause of the anemic performance of the Obama economy —can be debated. But what’s clear is that, more than 25 months before Obamacarewould really go into effect — if it’s not repealed first — employers arealready dropping employees from their insurance rolls.

Take Walmart, forexample — a prominent Obamacare supporter. Gallupwrites,

“The nation's largestprivate employer, Wal-Mart, announced in October that new part-time employeeswho work less than an average of 24 hours a week would no longer be able to gettheir health insurance from the company. Wal-Mart laid out several other cutsto its health insurance offerings, including some workers’ ability get coveragefor their spouses. Other companies have already made and will likely continueto make similar changes to their health insurance benefits….

“If Wal-Mart'sdecision is a precursor of how employers intend to manage their healthcarecosts, the downward trend in employer-based healthcare will likely continue.”

Soin addition to costing about $2.5 trillion over its realfirst decade (2014 to 2023), looting nearly $1 trillion from Medicare over thattime (according to the CBO), forcing Americans to buy government-approvedhealth insurance under penalty of law, and amassing unprecedented power andmoney in Washington at the expense of Americans’ liberty — if Obamacare stayson the books, you may like your health care plan, but that doesn’t necessarilymean you can keep your health care plan.

It’s time to repealObamacare.

H/T The Weekly Stantard

Obama to cut Physician Pay by 50 percent! Big Physician Pay Cuts Coming!

2011-11-09T06:46:00.000-08:00

The worst fears about Obamacare are now being realized in a decision on Monday by the Medicare Payment Advisory Commission (MPAC) established by the law to supervise $500 billion in Medicare cuts. MPAC, whose decisions have the force of law, has voted to impose drastic pay cuts on all doctors under Medicare and, by extension, under Medicaid (which tends to follow suit). The cuts will effectively reduce the real pay for specialists by 50% over the next ten years — including a 25% reduction over the next three years — and cut general practitioners’ pay by one-third over ten years (and that assumes that inflation stays down at 3% a year).

MPAC has ruled that specialists must accept a 6% cut in their fees per year for each of the next three years followed by a seven year freeze in their fees without any adjustment for inflation. If inflation stays very low — at 3% per year — this cut amounts to an 18% cut in nominal pay and a 50% cut in real pay for specialists. General practitioners will face a ten year freeze on their pay, reducing their real compensation by one-third assuming ongoing low inflation. Higher inflation, of course, would make the cuts in real pay even more drastic.
The consequences of the MPAC decision will be immediate and drastic:
* Many physicians, and many more specialists, will refuse to treat Medicare patients. It will become very, very difficult to see a cardiologist or an oncologist or a gastroenterologist or OB-GYN specialist if you are on Medicare unless you are willing to pay out of pocket or have the kind of health insurance coverage from a private source that would reimburse for their care.
* More and more medical care will be turned over to nurses or physician assistants, and fewer people will ever get to see a doctor on Medicare.
* Private health insurers will follow in the footsteps of the Medicare program and likely slash their fees as well.
* Fewer students will enter medicine, and a major shortage of doctors will reduce the quality of medical care in America drastically.
The MPAC cuts will bring American doctors’ incomes more into line with European doctors who typically earn half or less of what their American counterparts earn — and deliver worse medical care as a result.

Hat tip to Dick Morris & Eileen McGann

States are cutting and limiting Medicaid Hospital stays

2011-10-24T11:11:00.000-07:00

By Phil Galewitz, Kaiser Health News

A growing number of states are sharply limiting hospital staysunder Medicaid to as few as 10 days a year to control rising costs of thehealth insurance program for the poor and disabled. Advocates for the needy andhospital executives say the moves will restrict access to care, force hospitalsto absorb more costs and lead to higher charges for privately insured patients.States defend the actions as a way to balance budgets hammered by the economicdownturn and the end of billions of dollars in federal stimulus funds thissummer that had helped prop up Medicaid, financed jointly by states and thefederal government. Arizona, which last year stopped covering certaintransplants for several months, plans to limit adult Medicaid recipients to 25 daysof hospital coverage a year, starting as soon as the end of October. Hawaiiplans to cut Medicaid coverage to 10 days a year in April, the fewest of anystate. Both efforts require federal approval, which state officials considerlikely because several other states already restrict hospital coverage. Private health insurers generally don't limithospital coverage, according to America's HealthInsurance Plans, a trade group. Rosemary Blackmon, executive vicepresident of the Alabama Hospital Association, said "for the most parthospitals do what they can" to provide care to Medicaid patients despitethe limits. In Arizona, hospitals won't discharge or refuse to admit patientswho medically need to be there, said Peter Wertheim, spokesman for the ArizonaHospital and Healthcare Association. "Hospitals will get stuck with thebill," he said. Driven by higher enrollment and medical costs, Medicaidspending was projected to rise an average of 11.2% in fiscal 2011, which endedin June, from $427 billion in 2010, according to the NationalAssociation of State Budget Officers. For fiscal 2012, theassociation estimated state Medicaid spending will rise 19%, largely because ofthe end of the federal stimulus dollars. The program served 69 million peoplelast year. Matt Salo, executive director of the National Association ofMedicaid Directors, said the hospital coverage limits reflect how states are"desperately looking for any and all levers to reduce Medicaid costs"within the law. The federal Centers for Medicare and Medicaid Services isworking with states to "provide them with flexibility to run theirMedicaid programs and reduce their costs," Medicaid director Cindy Mannsaid in a statement. At the same time, "we must also ensure the Medicaidprogram continues to meet the health care needs of the children, people withdisabilities and the elderly whom it serves."

Contributing: Kaiser Health News is an editorially independentnews service and a program of the Kaiser Family Foundation, a non-partisanhealth care policy organization. Neither KFF nor KHN is affiliated with KaiserPermanente.

Have Doctor's salaries increased or decreased?

2011-10-10T12:53:00.000-07:00

This is a representative short list of Physician Salaries! Problem here is that, first the chart is from 2007, second is JAMA is off the mark! Salaries have not been that low since 1990! Peds today are earning $160k to $195k, Neurology can go up to $300k, and Psychiatry is about $230 (on avg).

DOCTORS' STARTING SALARIES

2007 averages:

Radiology: $350,000

Anesthesiology: $275,000

General surgery: $220,000

Otolaryngology: $220,000

Emergency: $178,000

Neurology: $177,500

Psychiatry: $160,000

Internal medicine: $135,000

Family Medicine: $130,000

Pediatrics: $125,000

Source: The Journal of the American Medical Association

Family Practice Physicians! A coming Shortage

2011-10-10T12:46:00.001-07:00

By Janice Lloyd, USA TODAY

Family medicine is what Doug Dreffer has wanted to practiceever since he was a second-year medical student 14 years ago at Ohio State. He listened toa different drummer from the majority of doctors entering a workforce in which subspecialtiesgenerally are considered more glamorous — and lucrative.

"All the sexy showson TV are about ER work or surgeons," Dreffer says. "Grey's Anatomy. ER.Whatever it may be. There is no Marcus Welby on TV — 'cause it's just notcool."

Television aside,medical specialists cite an array of reasons why more medical students aspireto be Grey's Anatomy's McDreamy neurosurgeon Derek Shepherd (Patrick Dempsey), thanwise family practitioner Marcus Welby, played by Robert Young in the 1970sseries.

Longer days, lower pay,less prestige and more administrative headaches have turned doctors away indroves from family medicine, presumed to be the frontline for wellness andpreventive-care programs that can help reduce health care costs.

The number of U.S.medical school students going into primary care has dropped 51.8% since 1997,according to the American Academy of Family Physicians (AAFP).

Considering it takes 10to 11 years to educate a doctor, the drying up of the pipeline is a big concernto health-care experts. The AAFP is predicting a shortage of 40,000 familyphysicians in 2020, when the demand is expected to spike. The U.S. health caresystem has about 100,000 family physicians and will need 139,531 in 10 years.The current environment is attracting only half the number needed to meet thedemand.

At the heart of therising demands on primary-care physicians will be the 78 million Baby Boomers born from1946 to 1964, who begin to turn 65 in 2011 and will require increasing medicalcare, and the current group of underserved patients.

GENERAL PRACTICE: New doctorsavoiding most-needed, worst-paid field

SURGEONS: U.S. is short onthem, too

ONCOLOGY: Cancer doctorshortage expected

If Congress passeshealth care legislation that extends insurance coverage to a significant partof the 47 million Americans who lack insurance, the need for more doctors isgoing to escalate.

The primary-care doctor— a category that includes family physicians, general internists and generalpediatricians — has been held up as the gatekeeper in keeping people out ofemergency rooms and controlling health care costs. But medical analysts saygiving this limited pool of doctors responsibility for millions more patientsis problematic.

"That tsunami wave(of patients) is going to be huge," says Bruce Bates, interim dean atUniversity of New England's college of osteopathic medicine in Biddeford,Maine.

Finding a doctor willget increasingly difficult, waits for appointments will grow longer, and moresick people will turn to crowded emergency rooms, says Ted Epperly, presidentof the AAFP, an association that represents more than 93,000 physicians. Or, ifa patient goes to a doctor's office, he might not be treated by his doctor: Oneway overwhelmed family physicians have been dealing with patients is to haveoffice visits overseen by a nurse practitioner or a physician's assistant, someof whom can dispense certain prescriptions and recommend specialists, Epperlysays.

"At the time weneed family-care physicians the most, we are producing the least," Epperlysays. "The nation's medical schools are failing to produce a workforcethat is essential to caring for America's communities."

How the gap is filled

In March 2009, U.S.medical school graduates filled only 42% (1,083) of the 2,555 residentpositions for family medicine. More than 200 of the positions were leftunfilled nationwide. The majority of other spots were filled by non-U.S.citizens educated internationally (20.7%), graduates of colleges of osteopathicmedical schools (10.5%) and U.S. citizens educated internationally (18%).

Even the graduates ofinternational medical schools and colleges of osteopathic medicine are showingsigns of losing interest in primary care. Osteopathic training is nearlyidentical to traditional medicine but focuses more on the inner workings of themusculoskeletal system and puts a big emphasis on the importance of familycare.

Bates says only 26% ofthe University of New England's grads chose family practice this year, comparedwith 40% "when I started this institution 20 years ago."

The shortage, whichEpperly calls a "crisis," has gained the attention of the politicianslooking at revamping the nation's health-care system.

"Patients withaccess to quality primary care are more likely to remain healthy and preventcostly and distressing chronic diseases, but the current shortage ofprimary-care doctors prevents too many Americans from getting the care theyneed, especially in rural areas," says Sen. Max Baucus, D-Mont., whoplays a key role in Congress' health care debate as the chairman of the SenateFinance Committee.

Congress is looking atbills that could help doctors who choose primary care with loan forgiveness orother debt relief and payment increases for their services.

Medical school tuitionand expenses generally range from $140,000 to $200,000, according to MerrittHawkins & Associates, a leader in recruiting and placing physicians. Aprimary-care doctor usually makes $120,000 to $190,000 a year, compared with$530,000 and higher for those in neurosurgery, according to the Merritt Hawkinssalary survey from 2007.

Dreffer is still payingback his loans to Ohio State but says he made the right career choice.

"Absolutely. For meit's about why I came into family medicine," he says. "I consider it aprivilege. I like people. I like relationships. That's what family medicine isabout. It's not about doing procedures or a cool heart bypass. You get to bepart of your patient's life story."

He has seen interest infamily medicine change as the medical director of training programs at FamilyHealth Centers in Concord, N.H., and Hillsboro-Deering, N.H.

"More than half ofthe spots filled are by non-U.S. medical graduates," Dreffer says."Our pool used to be mostly U.S. medical graduates." One problem withusing foreign students is the draining of talent from their home countries.Another is their English-speaking skills, which might make communication withpatients more challenging. All are required to take stringent exams in the USA,however. An upside is their willingness to work in underserved areas oftenrejected by U.S. graduates, including rural areas and inner cities, accordingto studies done by the American MedicalAssociation.

Part of the reason U.S.medical school graduates are rejecting primary care, Dreffer and Bates say, isbecause some U.S. schools promote subspecialties or research, higher-paying careerswith more prestige.

"I would put a lotof weight on the culture of the school being a big influence," Bates says,adding that doctors pursuing family medicine often will hear, "you're toosmart to be in primary care."

Eleven of the topallopathic (conventional medicine) medical schools, including Harvard and Johns Hopkins, haveinternal-medicine departments but lack separate family-medicine departments.Most internal-medicine doctors get out of primary care and go on to specialtieswithin five years of leaving school, says AAFP's Perry Pugno, director of thedivision of medical education.

"I think the wayyou get exposure and cultivate it plays a role," he says. "In some ofthe bigger schools that generate more primary-care positions by percentage —some of the state schools and osteopathic schools — they have bettermentorships and exposures early on."

A shift in training

Training of family-carephysicians has been evolving as the supply of doctors decreases. The fictionalMarcus Welby symbolized an era in which many doctors handled nearly all aspectsof a patient's care. That is not always the case now.

Pippa Shulman, 35,completed two residencies at Dartmouth and begins her first year of familypractice Sept. 1 in Massachusetts for HarvardVanguard Medical Associates, where the team approach is practiced. She is agraduate of the UNE college of osteopathy.

Her residencies"tied into what is the hot topic now: the patient-centered medical homeand really creating a primary-care home for patients," she says.

The medical homeapproach surfaced in the '90s and delivers service that is supposed to bebetter-coordinated, family-centered and more accessible with expanded hours.Nurse practitioners and physicians assistants play bigger roles in officevisits and relieve physicians of other time-consuming tasks so they can focuson the continuity of quality care. "Home" implies continuous,preventive care rather than seeing the doctor only for acute problems.

Experts say getting moredoctors to be generalists is an uphill climb in a health care system thatrewards doctors based on the procedures they do.

"The biggestproblem is the payment model," says Sameer Badlani, an instructor at the University of Chicago'sschool of medicine. "The more procedures you do, the more money you make.That is why, in a procedure-based specialty, a physician can make about four tofive times the annual salary a primary-care physician can earn."

'There is hope'

And that's whyspecialists like Grey's Anatomy's McDreamy are envied and why fewerstudents will follow Shulman's path into family medicine, Epperly says.

"I really lovebeing a generalist," Shulman says. "Primary care is fun. I always sayI'm a generalist in a specialist's world."

Badlani urges studentsto consider primary care.

"I give a lectureto medical students basically on not letting debt affect your careerchoices," he says. "And my aim was just to convince one out of the100 students who attend. That's where I set my benchmark. If I can convincejust one person, I will have done my job.

"I have had threeor four students come back to me and tell me they did not want to go intoprimary care but now they will rethink. There is hope."

Obamacare (new healthcare law) will lower Physician compensation packages!

2011-10-02T16:48:00.001-07:00

How ObamaCare WillAffect Your Doctor

Expect longer waits for appointments asphysicians get pinched on reimbursements.

By SCOTT GOTTLIEB

At the heart of President Barack Obama's health-care plan is an insuranceprogram funded by taxpayers, administered by Washington, and open to everyone.Modeled on Medicare, this "public option" will soon become the singledominant health plan, which is its political purpose. It will restructure thepractice of medicine in the process.

Republicans and Democrats agree that the government's Medicare scheme forcompensating doctors is deeply flawed. Yet Mr. Obama's plan for a centrallymanaged government insurance program exacerbates Medicare's problems byredistributing even more income away from lower-paid primary care providers andmisaligning doctors' financial incentives.

Like Medicare, the "public option" will control spending by usingits purchasing clout and political leverage to dictate low prices to doctors.(Medicare pays doctors 20% to 30% less than private plans, on average.) Whilethe public option is meant for the uninsured, employers will realize it'seasier -- and cheaper -- to move employees into the government plan thancontinue workplace coverage.

The Lewin Group, a health-care policy research and consulting firm,estimates that enrollment in the public option will reach 131 million people ifit's open to everyone and pays Medicare rates, as many expect. Fully two-thirdsof the privately insured will move out of or lose coverage. As patients shiftto a lower-paying government plan, doctors' incomes will decline by as much as15% to 20% depending on their specialty.

Physician income declines will be accompanied by regulations that will makepracticing medicine more costly, creating a double whammy of lower revenue andhigher practice costs, especially for primary-care doctors who generallyoperate busy practices and work on thinner margins. For example, doctors willface expenses to deploy pricey electronic prescribing tools and computerizedhealth records that are mandated under the Obama plan. For most doctors thesecapital costs won't be fully covered by the subsidies provided by the plan.

Government insurance programs also shift compliance costs directly ontodoctors by encumbering them with rules requiring expensive staffing anddocumentation. It's a way for government health programs like Medicare tocontrol charges. The rules are backed up with threats of arbitrary probestargeting documentation infractions. There will also be disproportionate fines,giving doctors and hospitals reason to overspend on their back offices to avoidreprisals.

The 60% of doctors who are self-employed will be hardest hit. That includesspecialists, such as dermatologists and surgeons, who see a lot of privatepatients. But it also includes tens of thousands of primary-care doctors, thevery physicians the Obama administration says need the most help.

Doctors will consolidate into larger practices to spread overhead costs,and they'll cram more patients into tight schedules to make up in volume what'slost in margin. Visits will be shortened and new appointments harder to secure.It already takes on average 18 days to get an initial appointment with aninternist, according to the American Medical Association, and as many as 30days for specialists like obstetricians and neurologists.

Right or wrong, more doctors will close their practices to new patients,especially patients carrying lower paying insurance such as Medicaid. Somedoctors will opt out of the system entirely, going "cash only." Iftoo many doctors take this route the government could step in -- as in Canada,for example -- to effectively outlaw private-only medical practice.

These changes are superimposed on a payment system where compensation oftenbears no connection to clinical outcomes. Medicare provides all the wrongincentives. Its charge-based system pays doctors more for delivering more care,meaning incomes rise as medical problems persist and decline when illnessresolves.

So how should we reform our broken health-care system? Rather thanredistribute physician income as a way to subsidize an expansion of governmentcontrol, Mr. Obama should fix the payment system to align incentives withimproved care. After years of working on this problem, Medicare has only a fewtoken demonstration programs to show for its efforts. Medicare's failureunderscores why an inherently local undertaking like a medical practice isbadly managed by a remote and political bureaucracy.

But while Medicare has stumbled with these efforts, private health planshave made notable progress on similar payment reforms. Private plans are morelikely to lead payment reform efforts because they have more motivation thanMedicare to use pay as a way to achieve better outcomes.

Private plans already pay doctors more than Medicare because they competeto attract higher quality providers into their networks. This gives them everyincentive, as well as added leverage, to reward good clinicians whilepenalizing or excluding bad ones. A recent report by PriceWaterhouse Coopersthat examined 10 of the nation's largest commercial health plans found thateight had implemented performance-based pay measures for doctors. All 10 plansare expanding efforts to monitor quality improvement at the provider level.

Among the promising examples of private innovation in health-care delivery:In Pennsylvania, the Geisinger Clinic's "warranty" program, whereproviders take financial responsibility for the entire episode of care; or theexperience of the Blue Cross Blue Shield plans in Pennsylvania, Michigan andVirginia, where doctors are paid more for delivering better outcomes.

There are plenty of alternatives to Mr. Obama's plan that expand coverageto the uninsured, give them the chance to buy private coverage like Congress enjoys,and limit government management over what are inherently personal transactionsbetween doctors and patients.

Rep. Nydia Velazquez (D., N.Y.) has introduced a bipartisan measure, theSmall Business Cooperative for Healthcare Options to Improve Coverage forEmployees (Choice) Act of 2009, that would make it cheaper and easier for smallemployers to offer health insurance. Mr. Obama would also get bipartisancompromise on premium support for people priced out of insurance to give them awider range of choices. This could be modeled after the Medicare drug benefit,which relies on competition between private plans to increase choices and holddown costs. It could be funded, in part, through tax credits targeted tolower-income Americans.

There are also measures available that could fix structural flaws in ourdelivery system and make coverage more affordable without top-down controls setin Washington. The surest way to intensify flaws in the delivery of health careis to extend a Medicare-like "public option" into more corners of theprivate market. More government control of doctors and their reimbursementschemes will only create more problems.

Dr. Gottlieb, a former official at the Centers for Medicare and MedicaidServices, is a fellow at the American Enterprise Institute and a practicinginternist. He's partner to a firm that invests in health-care companies .

The upcoming Physician Shortage! It ain't gonna be pretty!

2011-09-25T11:21:00.000-07:00

DOCTOR SHORTAGE is a COMING!

I FOUND THIS ARTICLE WHILE SURFING THE NET. You have got to read it!

The United States is going to experience an absolutely devastating doctorshortage in the coming years. Even now it can be difficult to see a doctor inmany areas, and if you are fortunate enough to see one you will probably paythrough the nose. Medical bills have gotten absolutely insane in this country.Many Americans have gone to the hospital for a few hours, perhaps got to see adoctor for half an hour, and ended up being billed thousands of dollars.Unfortunately, it is not the doctors that are getting rich from thesenightmarish medical bills. Rather, "the system" is set up so that"the middle men" are the ones raking in most of the cash. In fact,thousands upon thousands of doctors are being chased out of the professionbecause being a doctor just isn't worth the trouble anymore. According to theAmerican Association of Medical Colleges, we were already going to be facing ashortage of more than 150,000doctors over the next 15 years even before Obamacare was passed. Obamacare isjust going to make the doctor shortage even worse. In fact, one poll found that40 percent of all U.S. doctors plan to get out of the profession over the next3 years. Of course not all of those disgruntled doctors will end up leaving theprofession, but even if 10 percent of them quit it is going to create a medicalcrisis of unprecedented magnitude in this country.
Look, it is no secret that I am not a big fan of the healthcare industry in the United States. But if I get into a caraccident or someone shoots me then I very much want someone to take me to thehospital and I don't want to wait a couple of hours to see a doctor.
Unfortunately, the way that the health care industry is set up today isabsolutely suffocating for doctors. The government is trying to tell them howto treat patients, lawyers are constantly looking to sue them and most of themoney ends up going to health insurance companies, big pharma and huge healthcare corporations.
In the old days, all you needed was a bed, a patient, a doctor and maybe anurse.
After all, how much does it really cost for a doctor to look you over, askyou a few questions and patch you up?
Unfortunately, a whole host of bad guys have gotten between the doctor andthe patient these days. They have all carved out a little bit of"territory" and they all have to be paid.
The health care industry used to be about helping people.
Today it is all about greed, and the system is coming apart.
As the economy collapses, an increasing number of Americans are being forcedto rely on programs such as Medicare and Medicaid.
For example, back in 1965 only one out of every 50 Americans was onMedicaid. Today, oneout of every 6 Americans is on Medicaid.
This is putting our doctors in a very difficult position. According to The New York Post,treating Medicare and Medicaid patients is a huge financial strain on U.S.doctors...
Estimates suggest that on average physicians are reimbursed at roughly78% of costs under Medicare, and just 70% of costs under Medicaid. Physiciansmust either make up for this shortfall by shifting costs to those patients withinsurance — meaning those of us with insurance pay more — or treat patients ata loss.
You understand what all that means, right?
Medical bills have to be jacked up on all the rest of us to make up for theMedicare and Medicaid patients.
But that is just one example of how the system is failing.
Today, it is quite common for medical school students to rack up hundreds ofthousands of dollars in student loan debt as they go through school. Then ittakes a number of years of really hard work before they become established andat a point where they can start making good money. Meanwhile, lawyers areconstantly circling them like vultures. Malpractice insurance premiums areabsolutely insane at this point and one really bad lawsuit can ruin a careerthat took decades to build.
In addition, now thanks to Obamacare and other ridiculous regulations thathave been passed in recent years, the government has a tremendous amount ofcontrol over how medicine is practiced in the United States. Doctors no longerhave the complete freedom to treat their patients as they see fit.
Sadly, a significant percentage of U.S. doctors have had enough and now wantto get out.
According to a Merritt Hawkins survey of 2,379 doctors for the PhysiciansFoundation that was conducted in August of last year, 40percent of all U.S. doctors plan to "retire, seek anonclinical job in health care, or seek a job or business unrelated to healthcare" at some point over the next three years.
When Obamacare was originally being debated perhaps we should have takensome time to ask our doctors what they thought about it first.
Now we could end up with a massive doctor shortage as our doctors vote withtheir feet.
Right now there are approximately 960,000 doctors in the United States.
What do you think our medical system will look like if even 100,000 of thembail out of the profession?
According to the same survey noted above, 74 percent of U.S. doctors plan tomake "one or more significant changes in their practices in the next oneto three years, a time when many provisions of health reform will be phasedin."
One big trend that we are seeing right now is the refusal to see certainkinds of patients. Under our current system, some patients are much more"profitable" than others. Many doctors have decided that they simplycannot afford to see many of the "unprofitable" patients any longer.
Our health care system is messed up beyond all recognition. In America, wepay much more for health care than anyone else in the world and what we get inreturn is a system that is literally falling to pieces.
It would have been nice if we would have gotten some real health carereform, but instead what we got was Obamacare - one of the worst pieces oflegislation that has ever been passed in all of modern American history.
An IBD/TIPP poll taken back in August 2009 found that 4 out of every 9 American doctorssaid that they "would consider leaving their practice or taking an earlyretirement" if Congress passed Obamacare.
Well, it passed anyway.
Now the doctor shortage is about to get a whole lot worse.
Survey after survey shows similar results.
According toa survey published in the New England Journal of Medicine,approximately one-third of all practicing physicians in the United Statesindicated that they may leave the medical profession because of the new healthcare law.
Are you starting to become alarmed yet?
We have a system that is broken and large numbers of doctors are now sayingthat they simply want to give up.
Sadly, Obamacare is also causing the cancellation of a lot of new hospitals.
According to the executive director of Physician Hospitals of America, thenew health care law has already forced the cancellation of at least 60 doctor-ownedhospitals that were scheduled to open soon.
Not that I am just getting on Obama and the Democrats. Bush and theRepublicans were a complete disaster when it came to health care as well.Thanks to both political parties we have a health care system that is a joke.
Today, approximately 40%of all U.S. doctors are age 55 or older. All of those old doctors are thinkingabout retirement. They are too old to be putting up with all of this garbage.
It is an open secret that our health care industry has become a giant moneymaking scam and that it is not favorable for either doctorsor patients.
According to one doctor interviewed by Fox News, "a gunshot wound tothe head, chest or abdomen" will cost $13,000 at his hospital the momentthe victim comes in the door, and then there will be significant additionalcharges depending on how bad the wound is.
So how much of that $13,000 do you think the doctor gets?
Not a whole lot.
There certainly are some wealthy doctors out there, but the truth is that"the system" gets most of the money.
I am sure almost everyone reading this has a medical bill horror story totell.
In America today, if you have an illness that requires intensive care for anextended period of time, it can be really easy to rack up medical bills that total over 1 million dollars.
In fact, most Americans are scared to even spend a single night in thehospital these days.
It is estimated that hospitals overcharge Americans by about 10 billion dollars everysingle year. In fact, one trained medical billing advocate says that over 90percent of the medical bills that she has audited contain "grossovercharges".
Basically, hospitals charge whatever they think they can get away with.Unlike most transactions, you don't get to see a "price list" firstwhen you go into the hospital. You just ask them to take care of you and you trustthem to bill you fairly later.
Why should it cost a half million dollars for a simple operation?
It's not that complicated - the doctor cuts you open, carves something outand then sews you back up.
So why should it cost so much?
Am I missing something?
Sadly, it is those that don't know how things work that get the worst of it.
It is not uncommon for insurance companies to get hospitals to knock theirbills down byup to 95 percent, but if you are uninsured or you don'tknow how the system works then you are out of luck.
You should always, always have health insurance if you can afford it. If youdo not have a health insurance company fighting the hospital then it can bereally hard to have your medical bills knocked down to a reasonable level.
In any event, as doctors start leaving the profession in droves it maybecome difficult to find quality medical care at all.
Perhaps even more of us will start going out of the country for medicalcare. According to numbers released by Deloitte Consulting, a whopping 875,000Americans were "medical tourists" in 2010.

Less Americans have Health Insurance as employers start cutting the insurance benefit!

2011-09-13T12:25:00.000-07:00

Less Americans insured means that less Americans will seek care. Just how it works! Those that do have coverage will have a scaled back version, so that also means they will not be seeking care! Just how it works!

U.S. claims bigger share of health coverage market

Paige Winfield Cunningham

Fewer people received insurance coverage through their employer in 2010 than in 2009, and the number of people covered through government insurance programs continued to rise, according to 2010 data reported Tuesday by the U.S. Census Bureau.

It's a trend that started a decade ago, as costs continue to rise and make it harder for employers to offer coverage to their workers. The Kaiser Family Foundation found that since 1999 family premiums for employer-sponsored health coverage have increased by 131 percent.

"Over the last 10 years, private health insurance has continuously decreased," said Brett O'Hara, chief of the Census Bureau's Health and Disability Statistics Branch. "The number of people covered by government programs has increased for the fourth consecutive year."

According to the data, employment-based coverage dropped by 1.5 million, while the number of people covered by government programs rose by 1.8 million and now stands at 31 percent of the population.

Census data also indicated that while the number of Americans without health insurance coverage rose to 49.9 million in 2010 from 49 million 2009, the percentage of uninsured remained steady at 16.3 percent. Similarly, the percentage and number of people covered by Medicaid — 15.9 percent and 48.6 million — did not change, despite the economic recession.

The census report covered health insurance, income and poverty.

The bureau found that the poverty rate has grown 2.6 percentage points since 2007, to reach 15.1 percent last year. It's the highest level since 1993.

It also marks the second-highest increase in poverty on record for a year after a recession ended, following the 1980 recession.

Stephen Dinan contributed to this article.

Who is going to pay for my Tail Coverage?

2011-08-25T11:30:00.000-07:00

Who is going to pay for my Tail Coverage?

If you are already familiar with the concept of what tail coverage is please feel free to skip to paragraph 4. If you are in the role of physician recruiter or in the process of recruiting a physician and are unfamiliar with the concept then do not worry, as we have seen many a physician, administrator, etc. who has never had to deal with either the arrival or departure of a physician and has therefore not encountered the term before.
To understand tail coverage, you must recognize that in the world of professional liability or “malpractice” coverage there are two types of policies; “claims made” and “per occurrence.” The full explanation between the difference between the two types, and the rationale for one over the other is beyond the scope or interest of this article. All that is needed to know is that a) “claims made” policies have become commonplace and “per occurrence,” while still available in some markets, has fallen into all but total obsolescence and b) with a “claims made” policy, in the event that a physician wants to seek employment elsewhere or leave their carrier for whatever reason, very often supplemental insurance or “tail coverage” is needed to cover the physician for any claims made after they have left their prior carrier but in which the alleged claim of malpractice actually occurred while they were covered by the prior carrier.
In other words, if Family Practitioner X is under a claims made policy while working for Family Practice Y and subsequently wants to terminate employment and join Family Practice Z, lest Family Practice Z has the same carrier as Family Practice Y and the carrier also provides for reciprocity between the two groups, Family Practitioner X will need tail coverage to protect both himself and his prior practice Y against any claims made after he has left, but in which the disputed event took place during his tenure with Family Practice Y. Also, note that tail coverage varies in price according to a number of factors, but generally speaking the largest factor is, as determined by an actuary, how prone their particular specialty is toward claims of malpractice. So, tail coverage for a primary care physician is going to be much less than, say, an obstetrician or perhaps an orthopedic spine surgeon. Now that you have been given a very cursory primer, the question remains…
Who pays for this? Is it the responsibility of the physician, the prior group or the new group? An argument can be made for all three: 1) It can reasonably be argued that the physician whose professional service that needs to be covered should pay for it since they could be potentially bankrupted absent a “tail” but 2) It can also be reasonably argued that the prior group has some responsibility because most plaintiffs attorneys seeking remedy on behalf of their client will not only sue the physician in question but also the group they belonged to since often the group as a whole is of much greater financial wherewithal than the individual but 3) It can also be reasonably argued that the entity the physician is joining should pay for the cost of tail coverage, since if they do not it is often the case that the physician cannot afford it on their own and the group they are leaving may very well not want them to leave.
The answer is not necessarily cut and dry, but our opinion as experienced and professional physician recruiters is that the hiring entity should take the stance with respect to all physician candidates that it is reasonable to make it easy for a physician to join your group but it is not your responsibility to make it easy for them to leave. In other words, you probably need to at least share in the cost of covering your doc’s tail, if not paying for it outright. Furthermore, you should stipulate in their employment contract that should they leave of their own volition, or if fired with cause then they are responsible for the cost of tail coverage. It is generally accepted that only in the case of a physician being let go without cause should the practice dismissing them be on the hook for tail coverage.
With that said, I am well aware that as a hiring entity, the prospect of paying for tail coverage can strike you as rather costly. Such is especially true if you are in a specialty prone to malpractice complaints; as physician recruiters we have seen plenty of six-figure tails. If you are in such a specialty, really one of the only ways around such an expense is by hiring someone right out of training, but as contemplated on another article on this website that strategy in and of itself can be problematic. Furthermore, you may want someone who is not right out training and/or it may not make sense to hire someone that green.
Here’s another proposition, which is generally considered as reasonable but will differ by specialty and with location. Perhaps cover their tail entirely, but structure it as a loan with, say, a two year forgiveness period. This will help encourage them to stay for at least the length of the forgiveness period. In other words, cover their tail but attach some strings that benefit you.

Hospitalist! Where are the saturated markets!

2011-08-22T08:56:00.000-07:00

No vacancy
Why hospitalists in some markets are (gasp!) having a hard time finding work
by Phyllis Maguire

Sam Bagchi, MD, recently did something that’s rare for him: He hired a hospitalist to fill a day-time slot.

Dr. Bagchi, director of the 15-physician hospitalist group at Emerson Hospital in Concord, Mass., hasn’t had many opportunities to hire daytime hospitalists over the last year or so. His program, like many others in the Boston area, is more or less fully staffed.

“I’m turning people away I wish I could hire,” says Dr. Bagchi. “That’s a luxury that well-established hospitalist groups in this area have.”

The economic downturn and hospitals’ current financial traits are having

a major impact on hospitalist recruiting in many markets. Some cash-strapped hospitals are telling their hospitalist programs to do the best with what they have until hiring budgets are flush again.

But in some very desirable markets—such as Boston, Seattle and southern California—hospitalist directors are using a word that hasn’t been heard before in hospital medicine: saturation. In those markets, they say, the days of frantic recruiting, complete with outsized signing bonuses and bidding wars, are over.

When groups do have a slot to fill, they now pick and choose who they even consider, let alone hire. During Dr. Bagchi’s search, for example, the selection process came down to two experienced hospitalists. The one who ultimately got the job used to direct another program.

“The rapid expansion of the past, at least here, has hit the wall,” Dr. Bagchi says. “Physicians still have opportunities to break into the Boston market, but they now have to be more creative.”

The end of the buyer’s market
In the last six months, physician-placement firms have reported a sharp decline in hospitalist recruiting in major metropolitan areas across the country. That’s according to Regina Levison, president of Levison Search Associates in El Dorado, Calif., who’s part of a partnership of 12 firms nationwide that places physicians for both hospitals and hospitalist staffing companies.

That slowdown has hit home, Ms. Levison says. Her firm now represents a bilingual hospitalist with three years of hospital medicine experience who wants to relocate from San Francisco to Los Angeles.

“Just a year ago, we would have been able to set up interviews for him with the first six hospitals we called,” Ms. Levison says. “Now, we’re not getting many bites.”

Ms. Levison’s colleagues have a unanimous answer for what’s behind that recruitment trickle: the economy. Hospitals and hospitalist companies struggling with reduced revenues, she says, have shelved plans to expand and opted for hiring freezes.

But Per Danielsson, MD, who directs the 31-provider hospitalist program at Swedish Medical Center in Seattle, has a different take. Swedish has certainly tightened its belt, he says, laying off 200 people in February. But the hospital also approved Dr. Danielsson’s plan to fill his one remaining nocturnist slot.

What’s changed in Seattle since last fall, he explains, is the fact that the buyer’s market for hospitalist candidates there is apparently over. Back in 2005, he recalls, he had to scrap the program’s three-year, tiered compensation plan in favor of one compensation package for new and experienced hospitalists alike. “The tiered compensation plan negatively affected our ability to recruit, and it had to go,” Dr. Danielsson says. “The market was that competitive.”

But today, instead of hiring five or more new physicians to start this summer, as he’s done for several years, he hired only two. Both were graduating residents who called last September, as did several of their fellow graduates, looking for a job.

“I had to turn down several strong candidates, but I kept hearing from them,” he points out. “They were still looking for positions in January and February.” Instead of the hospitalists hosting an annual bash for local residents, “we decided to cancel the dinner because we didn’t have positions to offer in early December.”

No more room to grow
What’s changed? According to Dr. Danielsson, the hospitalist patient volumes at Swedish grew rapidly between 2000 and 2007, and the hospitalists worked hard to keep up with that demand.

Over the past two years, however, “we’ve seen much slower growth, and our hiring reflects that.” Most primary care physicians have already turned their patients over to the hospitalist group, he says, “so we’ve just about exhausted that market.”

While his group plans to expand its scope of practice with palliative care services, observation-unit coverage and more surgical comanagement, Dr. Danielsson intends to start slow and initially use current personnel.

In Boston, Dr. Bagchi reports an even higher level of service saturation. The Emerson hospitalists already comanage ICU patients, as well as those of all medical specialties and orthopedics, caring for 95% of the internal medicine patients and 70% of the hospital’s entire volume. He might be able to eventually hire more FTEs to cover weekend rounding and night-time shifts, “but not to take on new services.”

For Burke Kealey, MD, assistant medical director of hospital medicine for HealthPartners Medical Group in St. Paul, Minn., the only new service lines his group could really add at this point would be comanaging more esoteric surgical subspecialties such as neurosurgery, urology, and ear, nose and throat. His 65-provider hospitalist group may also consider (and recruit more hospitalists for) comanaging psychiatric patients.

In the meantime, Dr. Kealey’s days of aggressively recruiting as many as 12 hospitalists a year are over. “All the hospitals in the metro area, which extends 30 miles around the city, now have hospitalist programs at homeostasis,” he says.

According to Ms. Levison, she and her associates still see robust hospitalist recruitment in the Midwest, the suburbs of the Southeast, and in smaller and rural areas throughout the country. She also reports a wide open market for hospitalist “subspecialists” such as laborists, surgicalists, and med-peds and pediatric hospitalists.

A high bar on quality
In Southern California, HealthCare Partners—a physician-owned multispecialty group with more than 80 hospitalists serving more than 15 facilities—is facing saturation in what Tyler Jung, MD, the hospitalist program’s medical director, calls “the more desirable areas.”

Those include not only beach communities like Long Beach and South Bay, he explains, but facilities with larger programs and more extensive infrastructure, including dedicated case managers.

While Dr. Jung used to go out of his way to get to know graduating residents, that’s changed in the past year or two. However, “if a hospitalist has experience, my eyes and ears are wide open, and I’ll do everything I can to actually meet him or her.” Likewise he adds, “you find me nocturnists, and I’ll find them a job.”

Hospitals in Miami have also reached saturation, says Tomas Villanueva, DO, director of the 25-physician hospitalist group at Baptist Hospital. Because most physicians who grow up in Florida have to train elsewhere, many are eager to return after residency. But many now find hospital medicine opportunities, at least in Miami, few and far between.

According to Dr. Villanueva, he has been sending the CVs of promising candidates to other program directors for more than a year. But the quality bar is now so high that among the recruits that he occasionally interviews, he finds very few who he considers to be strong candidates.

“We find a lot of people who want to leave private practice or come out of residency for a job that pays well and has a good work/life balance,” Dr. Villanueva says. The problem? They’re not strong communicators, leaders or patient-safety advocates.

“They may roll their eyes when you mention patient satisfaction scores or the need to call primary care physicians post-discharge,” he explains. While at one time his hiring criteria consisted of finding “physicians with a pulse,” he admits, he and his team now insist on “the right people.”

Future growth forecast

While Dr. Villanueva’s program is “tapped out” as far as hiring, he says that may change if the group opens up other service lines or signs contracts with more insurance plans.

In Southern California, Dr. Jung says that continued growth—in the form of covering more lives and/or more hospitals—may be just a phone call away. In California at least, the economic downturn is fueling a major wave of mergers and acquisitions among medical groups. Eventually, he says, the trend should drive more hospitalist recruitment and program growth.

Paradoxically, he adds, the economic downturn should also fuel—even in saturated areas—the growth of hospitalist programs that show utilization savings, not just more efficient billing. Many patients that his hospitalists care for are covered by managed care companies and independent physician associations.

“Hospitals know what type of utilization and efficiency we bring to patient populations, and the economy is actually pointing to the need to grow those hospitalist groups,” Dr. Jung says. “Many CEOs are concluding that left unchecked, hospitals that have a large panel of cash-only patients who aren’t mitigated by an efficient team of physicians will face staggering losses.”

Hard lessons learned

For now, both the downturn and what may be temporary saturation appear to be improving retention. Hospitalist programs are much less likely to try to raid each other’s physicians by dangling $10,000 or $15,000 pay differentials to lure them away.

That speaks to another factor contributing to saturation: more physicians are sticking with hospital medicine as a career.

According to Dr. Kealey, the fact that many urban markets now have stable staffing is a good thing. For one, it means that more hospitalists will start moving out to staff suburban and rural hospitals, extending the hospital medicine model.

And market saturation underscores the evolution of the field. “We’ve learned some hard lessons about how to create sustainable jobs as far as work hours and leadership training,” Dr. Kealey says. “People in these mature programs aren’t leaving as often.”

Phyllis Maguire is Executive Editor of Today’s Hospitalist.

Getting creative about finding a job

IT’S NOT THAT YOU CAN’T FIND a hospitalist position in Boston, says Sam Bagchi, MD, director of the hospitalist program at Emerson Hospital in Concord, Mass. It’s just that you can’t find a day-time slot in a stable group.

At Dr. Bagchi’s program, for example, he won’t even consider interviewing a physician who wants only a one- or two-year job before going on to a fellowship for a day-time position. And as for graduating residents, he talks to them only about working a year or two as a nocturnist, the one position he has to fill. (He filled a recent day-time slot, but that was a fluke, he points out, because he needed more administrative time and a colleague decided to go part-time.)

Physicians who get a foot in the door by working nights or weekends will be first in line when day-time positions open up, Dr. Bagchi adds. Or physicians who don’t mind initially putting in long hours at newly launched programs will likewise find opportunities.

But in areas like Boston, opportunities will be rare. “Boston area hospitals were right out in front of the hospitalist movement,” he explains. “There aren’t that many late adopters starting up.”

What is happening, Dr. Bagchi explains, is that programs switching business models—from hospital-employed physicians to a staffing company, for example—have to ramp up quickly. Such “fixer-upper” programs, as Dr. Bagchi calls them, often demand long hours.

To find jobs in metropolitan areas that have either frozen hiring or reached some level of saturation, “you’re going to have to pay dues either by shifts, money or distance,” says Regina Levison, president of Levison Search Associates in El Dorado, Calif. Ms. Levison says that she and her colleagues, who are part of a 12-firm nationwide recruiting partnership, still see many part-time and locum hospitalist positions available in major cities.

Hospitalists looking to break into a market should check in with specific hospitalist groups every two to three weeks and with hospital recruiters once a month, she says. If you’re determined to live in a specific metro area, consider working in a nearby suburban hospital to get established.

Or join a hospitalist company that has a presence in that city and work in another facility, letting it be known that you’d like to relocate when possible. Or consider a reverse commute. According to Dr. Bagchi, some hospitalists who live in the Boston area work in western Massachusetts or Connecticut.

To work in Miami, Tomas Villanueva, DO, offers this advice: Don’t use a headhunter because they’re too expensive. And find a way— through medical school contacts, for instance—to speak directly to the program director or the individual hospitalists within a group.

“By far, my best recruiters are my own docs,” says Dr. Villanueva, who directs the hospitalist program at Baptist Hospital. “They want people who they know will be team players, so they triage the physicians they suggest to me.”

In Seattle, Per Danielsson, MD, director of the hospitalist program at Swedish Medical Center, advises physicians to consider moonlighting at one or more hospitals. “If you can live without the benefits and with that uncertainly that comes with a moonlighting position,” he says, “it can be a great way to move into a market.”

ObamaCare will chase Primary Physicians from the profession...THAT MEANS YOU WAIT MUCH LONGER TO SEE DOCTOR AND GET WELL!

2011-08-03T13:23:00.000-07:00

ObamaCare's Most Frightening Consequence: Not Enough Doctors

by John Rossomando

08/02/2011

ObamaCare’s defenders promised the law would increase patient access to care, but a closer look shows that increased regulations combined with higher demand for health services could cause many physicians to give up practicing medicine.

“You are seeing a change that I haven’t seen in my over 30 years in the practice of medicine,” said Tennessee GOP Rep. Phil Roe, who worked as an OB/GYN before getting into politics. “I think what you are going to see is people going in to see a nurse practitioner, not a medical doctor, as has been the case for decades.”

According to Roe, Medicare will pay doctors less than Medicaid by 2020 should ObamaCare remain in place, which means that doctor who runs a solo practice with three employees and who grosses $300,000 could see a 30% cut in his reimbursements.

Doctor who use approximately half of their gross receipts on paying overhead costs would still have to do so even when their reimbursements are cut.

“His cut will be $50,000, meaning instead of making $150,000, he will only be making 50 or less,” Roe said. “It only takes a year or less of that to see why they are terrified of this.

“They have bills to pay. They have mortgages. They have school loans.”

Georgia GOP Rep. Tom Price, a fellow physician in the House Republican caucus, warns regulations will also cause doctors to change their minds about staying in medicine because they will make doctor-patient interactions more difficult.

“There will be limitations on medications that will be available, and shortages of medications through the FDA,” Price said. “Surgeries will have to postponed because of a lack of medications needed to put patients to sleep, damaging the quality of the care that is received.”

Price complains the regulations even come between patients and doctors when it comes to things as routine as how a doctor has to fill out paperwork to order oxygen tanks for patients who need them.

A November 2010 Physicians Foundation Survey underscored this when it found that 56% of doctors it surveyed anticipate the health care law will diminish the quality of care they can give their patients. A further 40% of physicians said they planned to retire, seek a nonclinical job in the health care field or leave the medical profession altogether.

A Galen Institute Study also found that ObamaCare’s regulations likely would force countless aspiring doctors to forgo entering the profession at a time when demand for care is on the rise.

“PPACA [ObamaCare] will strip away physician autonomy, drown doctors in bureaucracy and drain job satisfaction,” Dr. Jason Fodeman wrote in an April 2011 study for the Galen Institute. “As the profession deteriorates, older doctors will retire while younger doctors will look to switch careers.

“Many students considering a career in medicine will pursue other opportunities.”

According to Roe, only 4% of the nation’s students are getting into primary care fields.

A survey by the Associations of American Medical Colleges found the nation’s doctor shortage likely will increase the project shortfall of 62,900 doctors in 2016 to 91,500 in 2020.

“When these older doctors who are used to working 70 or 80 hours quit, I don’t know what we are going to do for internists and primary care,” Roe said.

The Galen Institute Study reports that Massachusetts, which many believe to be a precursor to ObamaCare, has seen a big reduction in doctor willingness to take on new patients. In 2007, the state’s Division of Health Care Finance and Policy Reported that 70% of general practitioners were willing to accept new patients in 2007, but that has declined to 60%. And today only 44% of internal medicine practitioners in the Bay State have indicated a willingness to take on new patients—down from 66% in 2005, before the state’s health care law took effect.

“Waiting times have increased even more since RomneyCare was passed,” said Cato Institute health care expert Michael Cannon. “And since government has inflated demand even more, it hasn’t done anything more to meet that quantity demanded versus the supply. Therefore, you get that sort of shortage.”

The Massachusetts Medical Society’s 2009 Physician Workforce Study found that the time needed to recruit physicians into specialties such as internal medicine, family medicine, orthopedics and neurosurgery had significantly increased in the three years following the implementation of the state’s health care reform law.

“It remains to be seen how the federal government will deal with this imminent fiasco on the national level,” Fodeman wrote. “Obviously the administration can’t make doctors practice, nor can it make people attend medical school.

“The likely solution will be a combination of rationing and an increased reliance on mid-level providers such as nurse practitioners and physician assistants.”

And the law’s defenders can only counter that the law provides for an increase of the number of graduate medical training positions, increases scholarships available for teaching centers in rural areas and provides state grants to increase access to care in rural areas.