Physician Career News – Past Issues

Today’s Hospitalist survey data found that 12-hour shifts are common for hospitalists, with most working 11.6 hours. Shifts vary in some parts of the country and tend to be longer at smaller groups and hospitals. See our online-only coverage for more details on shift lengths by employer type, training and more.

Primary care pay increase didn’t keep pace with inflation last year

While primary care physicians saw their pay increases double from 2.13% in 2021 to 4.41% in 2022, they still fell significantly behind the pace of inflation, which was 6.5% last year. That’s the bad news MGMA released in survey data last month. Surgical and non-surgical specialists saw their pay increases drop during the same time period. While surgical specialists saw a 3.89% increase in 2021, that dropped to 2.54% in 2022. Non-surgical specialists saw their increase fall from 3.12% in 2021 to 2.36% in 2022. The MGMA report found that between 2019 and 2022, hospitalists saw a 5.49% increase in their pay, compared to an 8.16% increase for general internists, a 7.30% increase for pediatricians, a 3.52% for ED physicians and a 5.37% increase for general psychiatrists.

A look at female physicians’ progress and the challenges they face

Women physicians have made big gains in medicine in the last few decades, but there are still big gaps. Those are the conclusions in a report in Urology Times written by a family physician who looks at data going back to 1970 on females in medicine. Women now account for about 36% of practicing physicians, and 35 specialties now have more than 1,000 female physicians. But the author noted that female physicians tend to be underrepresented in leadership positions and earn from 8% to 29% less than their male counterparts. The report looks at other disparities that affect women physicians.

The American College of Physicians is calling for performance metrics to make sure that telehealth visits meet the same criteria as metrics for in-person visits. In a policy paper published in Annals of Internal Medicine last month, the ACP offers six recommendations to measure the quality of care offered in telemedicine visits in an outpatient setting.  Among those recommendations, the ACP calls for metrics for in-person visits to be examined to make sure they’re appropriate for telemedicine visits. An analysis in HealthLeaders reports that another recommendation calls for information gathered in  telemedicine visits to be incorporated into patients’ medical records to avoid fragmentation of care. The ACP also calls for performance metrics to be tested and to examine the effects that telehealth is having on communities that lack digital access.

ED docs, consumers want to stop investors from owning medical groups

Emergency medicine physicians and consumer advocates are joining forces to stop the corporate ownership of medical practices. A report from Kaiser Health News notes that more than 30 states already prohibit corporations that are not owned by physicians from owning medical practices. The article notes that corporations, however, have figured out ways to sidestep those bans by giving physicians legal ownership of those practices—but giving them no authority in day-to-day operations. Opponents of the trend say the worst offenders are private equity investors, which own huge staffing firms in emergency and hospital medicine. The advocacy group Take Medicine Back has petitioned the North Carolina Attorney General to examine corporate ownership of physician groups. The Attorney General in that state also holds a senior position at the National Association of Attorneys General and may be able to shed national attention on the group’s complaint. And a Milwaukee emergency medicine group is suing Envision for setting up ownership structures that allow company officials, not physicians, to retain “de facto ownership” of medical practices. The lawsuit is scheduled to begin in January of 2024. Skeptics, however, point out that with nearly 70% of physicians employed by hospitals and corporations, the fight against corporate medicine may be too late.

Unionization in health care not common, but offers some benefits

While unionization in health care remains low, collective bargaining brings heath care workers some benefits. A study of unionization in health care in JAMA Network found that about 13% of workers, most of them nonphysicians, engage in some form of collective bargaining. Researchers found that unionized health care workers earned about 9% more than their nonunion colleagues and were more likely to have retirement benefits (58% vs. 43%). Unionized health care workers were also more likely to have employer-based health care (22% vs. 16%) and work more hours per week. The study said that while the numbers of health care workers who belong to a union didn’t change much from 2009 to 2021, the first half of 2022 saw a 57% increase in petitions to form unions in health care.

December 21, 2022

Survey: Americans ready for big changes in how they get primary care

New data say that younger Americans are ready and willing to embrace a dramatically different primary care landscape. A Wolters Kluwer survey found that 70% of millennials are ready to rethink where they get primary care. In the survey, 61% of Americans said they could see getting most of their care at a pharmacy or retail clinic instead of a PCP. While 70% of millennials agreed with that view, that number dropped to 43% for Baby Boomers. Survey respondents also said that if they could save money, they would trust pharmacists (56%), NPs (55%) and PAs (50%) to provide their primary care. Attitudes showed some division based on gender, with women more willing to trust NPs than men (65% vs. 45%). Women in the survey were also more willing to trust PAs than men (55% vs. 46%).

What the 2022 Word of the Year means for medicine

Merriam-Webster’s 2022 Word of the Year—and the negative attention it brings—is getting traction in health care. “Gaslighting” is this year’s top word, and while it may not be as health-centric as last year’s choice (vaccine), a report in Becker’s Hospital Review spells out how gaslighting is being discussed as an issue in health care. Merriam-Webster defines gaslighting as “the act or practice of grossly misleading someone, especially for one’s own advantage.” Becker’s points out that in April and August of this year, searches for the term “medical gaslighting” hit all-time highs. A New York Times article this spring used the term to describe physicians who are dismissive of patients’ symptoms, particularly with women and people of color. The article cited a young woman who was told she was “healthy and just lazy” after experiencing a drop in weight, hair loss and debilitating period pains. She eventually was diagnosed with Grave’s disease. Other media outlets that addressed medical gaslighting this year included the Today show, the Washington Post and Insider.

December 14, 2022

December 7, 2022

Which physicians are the most recruited for locum tenens positions?

Anesthesiologists and hospitalists are the most sought-after physicians for locum tenens positions, according to a report from a national staffing firm. An article in Becker’s Hospital Review says that an AMN Healthcare report found that 88% of health care facilities used locum physicians, NPs and PAs in the 12 months before the survey. Most health care organizations—70%—said they used locums as a stopgap measure while they tried to hire permanent staff. One-quarter said they used locums to meet rising patient demand, while 13% used them to squash provider burnout. The report found that psychiatrists are the third most popular type of locum physicians. Analysts say that the use of locum providers has accelerated because of the demands of the pandemic. A copy of the report is available following a brief registration process.

The pandemic hasn’t changed medicine’s work-while-sick ethos

Despite the pandemic—or perhaps because of shortages triggered by covid—coming to work sick remains a fact of life for most front-line health care workers. According to a MedPage Today report, factors like pride, guilt and not wanting to inconvenience colleagues and patients factor into the decisions of many health care providers to work while sick. Several physicians interviewed for the article said that they called out sick with covid only when they could not physically do their jobs. One nurse who was so sick with covid that she needed emergency care recalled that HR still called her every other day to ask if she was ready to come back to work. And as if confirming her fears to call out sick, the nurse said that some of her colleagues claimed that she was faking illness to avoid coming to work.

November 30, 2022

Do you want patients to call you “Dr.” or use your first name?

When you talk to patients, do you use the title “Dr.” or do you refer to yourself using your first name? A Medscape article about the issue of “untitling” doctors found a variety of opinions among the physicians interviewed. One physician, for example, said he uses his first name to try to break down “paternalistic barriers” that have doctors making all the decisions about patient care. But another physician said he introduces himself as “Dr.” to make one thing clear: “I am not your friend.” That physician added that he finds it disrespectful to be addressed by his first name. Physicians also said they worried that factors like gender and ethnicity may be behind some patients’ decision to call doctors by their first names. A study published last month in JAMA Network found that female physicians were more than twice as likely as male physicians to be addressed by their first names in messages from patients. The study also found that PCPs and DOs were also much more likely to be addressed by their first name in patient messages.

November 16, 2022

Tired of medical misinformation online? Post your own (accurate) videos

If you’re discouraged by the volume of medical misinformation on social media, don’t walk away in disgust. That’s the advice of researchers who looked at some of the most widely viewed videos on colonoscopy for instances of mis- and disinformation. The study, which was published in Gastro Hep Advances, looked at colonoscopy videos on YouTube with more than 250,000 views. Researchers found that roughly half of the videos were inaccurate or low-quality. Some of the videos blatantly contradicted current guidelines (calling for annual colonoscopies, for example), while others overstated the risks of colonoscopy or generally tried to scare people away (“shock factor” videos showing worms moving around in colons of patients with parasitic infections, for example). While only 20% of videos created by non-health care providers were accurate, 83% of videos created by health care providers were accurate. Based on those data, the researchers concluded that more videos by health care providers could help restore the balance away from misinformation about colonoscopy—and other medical conditions. The researchers also called on professional organizations like the American Gastroenterological Association to outline best practices in video creation for health care professionals. They also recommended that health care providers partner with non-providers to improve the content of videos being published online.

Six EHR vendors paid nearly $400 million in fines for “suboptimal” products

A new study has found that six EHR vendors have paid nearly $400 million in fines since 2009 to settle allegations of kickbacks and misrepresentation of their products’ functionality. More than 75,000 clinicians were using the products during the research period. The study, which was published in JAMA Health Forum, lists all six vendors, the amounts that each vendor paid and the number of clinicians using their products. Topping the list is eClinicalWorks, which paid $155 million in 2017 to settle allegations that it misrepresented its product and paid kickbacks to certain customers for promotional purposes. The fines were levied because the vendors took advantage of federal incentives that rewarded products that were certified as meeting requirements adopted by HHS. By misrepresenting their products’ capabilities, the vendors opened themselves up to a Department of Justice investigation. Researchers said the misrepresentation is an issue because clinicians were using “suboptimal” products that could pose a threat to patient safety.

November 8, 2022

Faced with cuts of 4.4%, physician groups begging Congress to act

Physician groups are begging Congress to pause or cancel cuts to Medicare pay that could approach double digits in 2023. Medicare is slashing physician pay in 2023 by reducing its conversion factor by 4.4%, but that may only be the beginning. The AMA, for example, says that when inflated costs of doing business and other covid-related challenges are factored in, physicians could be looking at pay cuts that come to 8.5%. A Medscape article says the cuts are mandated by the Medicare Access and CHIP Reauthorization Act, also known as MACRA. The 2015 legislation was supposed to resolve budget struggles between physicians and members of Congress while also moving Medicare away from fee-for-service payments to value-based care. There is still hope that the cuts could be postponed or cancelled. A House bill to block the pay cuts has the support of more than 70 members of the House and physician organizations including the AMA, ACP and AAFP. A MedPage Today article quotes physician groups as saying that if allowed to take effect, the pay cuts will reduce access to care.

How many doctors go to work while they’re sick?

Do you go to work when you’re sick? A new Medscape survey found that even in the middle of a pandemic, the answer for most physicians is “yes.” The survey found that 85% of physicians said they went to work while sick in 2022, with about 70% going to work sick one to five times and 13% going to work while sick six to 10 times. A Medscape article on the survey results said that 48% of physicians who went to work sick had symptoms that included a runny nose, cough, congestion and a sore throat. Twenty-seven percent went to work with a fever; 7% came to work with strep and/or covid. Seventy three percent of physicians said they go to work sick because they feel an obligation to patients; 72% feel an obligation to their co-workers. Forty-five percent said their workplace expects them to come to work sick.

November 2, 2022

Telehealth use takes a steep dive as nontraditional settings gain

In 2020 and 2021, more than 70% of patients reported using telehealth within the previous year. But this year, that percentage has plummeted to only 45%—while 93% of patients report that their last appointment with their primary care physician was in person. Those are the findings of a new survey from Stericycle Communication Solutions, a company that works on strategies to increase patient engagement. The survey, which reached more than 1,000 people, reflects patient preferences, according to FierceHealthcare coverage, not any lack of available telehealth options. Younger adults (ages 18 to 34) were more likely to have used telehealth in the last year. They were also more likely to use nontraditional care venues like retail clinics and to have less provider loyalty than older groups. Telehealth use does remain high for behavioral health. The survey also found this sharp drop off: The number of people visiting the ED in 2022 was less than half the number in 2021.

How well does your practice treat patients with physical and other types of disabilities? A Health Affairs study found that some physicians whose office scales couldn’t accommodate patients in wheelchairs told them to go to places like supermarkets, grain elevators or even a zoo to be weighed. Some would simply tell disabled patients that their practice was closed, while others would politely suggest they visit a better-equipped facility. Some physicians talked about how much time treating patients with disabilities took and how it destroyed their schedule for the day, while others said that paying for services like translators made them lose money on patients. One of the researchers who has MS and uses a wheelchair told the New York Times that she was shocked by the results of the study. To get physicians to open up about they how they really felt about treating patients with disabilities, researchers gave them anonymity, and they never saw the researcher who uses a wheelchair.

October 26, 2022

Report: 117,000 physicians left workforce in 2021 

A jaw-dropping report from Definitive Healthcare found that more than 300,000 health care workers left the workforce in 2021. Of those workers, 117,000 were physicians, 53,000 were NPs, 28,000 were PAs, 22,000 were physical therapists and 16,000 were licensed clinical social workers. The report, which was created using billing data, found that internal medicine was the hardest hit specialty, losing 15,000 physicians in 2021. Family medicine lost 13,015 physicians and clinical psychology lost 10,874 providers. The Definitive report also looked at staffing shortages among the country’s hospitals. South Carolina was the hardest hit, with 29% of its hospitals experiencing “critical” staffing shortages. Georgia came in second, with just over 20% of its hospitals experiencing critical staffing shortages, followed by Vermont and Delaware (both 20%) and Michigan (19%).

When it comes to racism, patients and health care staff alike are targeted

A review of more than 500 patient safety incidents found that when it comes to bad behavior in health care involving race, there’s a lot of blame to go around. A report from ECRI found that 57% of incidents involved patients making inappropriate racial comments or exhibiting racist behavior. But in 42% of incident reports, staff were the ones being charged with racist behavior. On a partial list of racist incidents that were attributed to staff, 9% said that disparate care was being provided because of race or ethnicity, 7% said staff made inappropriate comments and 1% said that interpretation/translation services were not provided. Data were collected between July of 2019 and June 2020. The full report is on ECRI’s Web site.

October 19, 2022

Does “untitling” physicians show bias against certain types of docs?

When do patients think it’s OK to address physicians by their first names, and is it a sign of disrespect? A study in JAMA Network Open looked at more than 90,000 e-mails between physicians and patients. It found that female physicians and DOs were more than twice as likely to be addressed by their first names. PCPs were 50% more likely to be called by their first names, and female patients were 40% less likely to address physicians using their first names than men. Researchers found that age and training status (whether physicians were residents) had no effect on how often physicians were addressed by their first names. Researchers concluded that their results show a “subtle but important form of unconscious bias” against physicians who patients address by their first names. They said “untitling” can lead to a “reduction in the formality of the physician-patient relationship,” which can lead to a lack of respect. The research references a previous study, which found that having “Dr.” on your name tag substantially reduces the incidents of potential bias.

No Surprises Act loading physician practices with more paperwork

An MGMA report says that the No Surprises Act is saddling physicians with more paperwork as they try to comply with a requirement to give patients good faith estimates of how much their care will cost. The legislation requires physicians to give cost estimates to uninsured or self-paying patients. MGMA’s annual regulatory burden report found that prior authorization was still identified as the most burdensome requirement physician practices face, with 81% calling it “extremely burdensome.” But good faith estimates were ranked as the second most burdensome requirement among 70% of respondents. A report in Fierce Healthcare says the survey found 82% of practices reported that the No Surprises Act has increased their administrative burden.

October 5, 2022

California law will punish doctors who spread covid misinformation

California will now punish doctors who spread disinformation about covid to their patients, but the new law has some concerned about freedom of speech issues. Gov. Gavin Newsom signed a bill into law last week that was co-sponsored by the California Medical Association. A Mercury News article says that the law will punish physicians who give patients information about covid that strays from medical guidelines or peer-reviewed, scientific evidence. Critics of the law argue that it will further erode trust in health officials and could have a chilling effect on what physicians tell their patients. Gov. Newsom said he understood free speech concerns, but he noted that the bill narrowly applies only to one-on-one discussions with patients about covid. It does not attempt to regulate communications like blogs or social media posts. Critics also noted that the science behind covid has been such a moving target that physicians could be punished for unintentionally communicating inaccurate information to patients.

Telehealth continues to gain in use and popularity among Americans

A new survey from JD Power finds that 67% of Americans have used telehealth within the past year, and 94% say they will definitely or probably use telehealth for medical services in the future. A HeathLeaders report said that 61% of survey respondents cited convenience as the main reason they use telehealth. The survey found that most respondents prefer telehealth for routine care like prescription refills (80%), medication reviews (72%), test result consults (71%) and mental health visits (57%). A Healthcare Dive report says that the use of telehealth rose nationally by 1.9% from June to July of this year, but that growth was much faster in parts of the country. A report from Fair Health says that in the West, for example, telehealth grew by 5.7% from June to July. In the South, use of the technology grew by 4.9% during those months. And finally, last month, Johns Hopkins Medicine announced that it had provided more than 1.5 million telehealth visits since starting its program. The system says it is currently providing 30,000 to 35,000 telehealth visits a month.

September 28, 2022

Check for these legal issues before you take a position as a medical director

If you’re considering becoming a medical director for a medical facility or a medical device company, proceed carefully! That’s the advice of a lawyer writing for Physicians Practice. He warns that these arrangements can strip you of your license and put you in jail by breaking the law. The red flags include provisions that pay you for patient referrals or overseeing care when you’re not overseeing anything. Other problematic language allows nonphysicians to direct patient care. The author suggests reviewing recent Department of Justice indictments to get an idea of how these arrangements can go bad, and he provides some high-profile examples.

For most specialties, appointment wait times continue to rise

Wait times for new appointments are up and continuing to rise in four specialties, according to new data from AMN Healthcare and Merritt Hawkins. A report in MedPage Today says that wait times in ob/gyn, cardiology, orthopedic surgery and dermatology are up 8% since 2017 and 24% since 2004 in 15 major metropolitan areas. In cities like New York, Los Angeles and Seattle, people have had to wait an average of 26 days for a new patient appointment. The only specialty to see a decrease in wait times was family medicine. Appointment waiting times for that specialty came in at 20.6 days, which represents a 30% decrease from 2017.

September 21, 2022

Adoption of digital tools by physicians is picking up steam

A new survey by the AMA finds that the use of digital tools, particularly those for virtual visits and home monitoring, are gaining traction with physicians. The survey found that the number of physicians using televisits/virtual care jumped from 14% in 2016 to 80% in 2022. The percentage of physicians using remote monitoring jumped from 12% in 2016 to 30% in 2022.The survey found that on average, U.S. physicians have gone from using 2.2 digital tools per practice in 2016 to 3.8 tools in 2022. The survey also found that two in five physicians plan to adopt augmented intelligence in the next year, while nearly one in five are currently using augmented intelligence in their practices.

What red flags should you look for in employment contracts?

When should you turn down a job offer based on language in the contract because it’s unacceptable? A Medscape piece written by a veteran health care attorney outlines the language in contracts that should serve as red flags. For example, probationary periods that give employers the right to evaluate whether you’re a good fit for them should usually be “offensive” to candidates, particularly those with other offers. The problem, the author says, is that companies can let you go immediately without cause or notice, and often without covering any tail costs and possibly enforcing noncompete clauses (even if you only worked at the job for a month or two). The analysis gives more information on issues with probationary clauses and other red flags in contract.

September 14, 2022

Another day, another virtual care program to compete with PCPs

Primary care physicians will have yet another new source of competition next year thanks to a new virtual primary care service. The large insurer Health Care Service Corporation is partnering with Teladoc to offer virtual primary care to midsize and large employer groups in Illinois and Texas in January of 2023. A Fierce Healthcare report states that the service will provide annual exams, preventive care, and diagnosis and treatment for health concerns and management of chronic conditions. Members will receive a welcome kit that comes with a blood pressure cuff and a heart rate monitor. The insurer recently launched a digital mental health program. The program is the latest in a growing line of digital care alternatives from companies like UnitedHealthcare, Anthem, Cigna and Aetna.

In this specialty, NPs have helped ease a critical physician shortage

With the U.S. facing a physician shortage, many health systems are turning to nurse practitioners to fill the gaps. Now a report from Harvard shows that in psychiatry, nurse practitioners are successfully helping mitigate a growing shortage of physicians. A Health Affairs study found that while the number of psychiatrists dropped 6% from 2011 to 2019, the number of psychiatric mental health NPs jumped by 62%. According to new data, that growth helped fill what was a growing hole in psychiatric services. While psychiatrist office visits dropped during that period by 29%, visits to psychiatric NPs jumped 111%. The number of visits to mental health prescribers who were psychiatric NPs rose from 12.5% to 29.8% from 2011 to 2019. That number approached 50% in rural regions and in areas where psychiatric NPs have a full scope of practice.

September 7, 2022

What does “quiet quitting” mean for physicians and hospitals?

What does the new term “quiet quitting” look like in hospitals? An article in Becker’s Hospital Review says that quiet quitting, which is typically defined as what happens when workers do the minimum amount of work with the least amount of effort possible, has been around in health care for a long time. But there are signs that a lack of engagement is on the increase in health care. A recent Gallup survey found that while the number of employees who are actually engaged at work is slipping across all industries, the number for doctors fell nine points from 2020-2021. Another difference is that quiet quitting in hospitals will likely be flagged by sinking patient experience scores. A health care HR executive quoted in the story said that when physician engagement falters, the performance of all staff is ultimately hurt. The HR exec also said that cost-cutting strategies that are a result of hospitals’ strained finances are likely adding to burnout and hurting employee engagement, particularly among physicians.

Auto repair proves to be great training for medical school

Last month, Carl Allamby, MD, began his first job as an attending emergency medicine physician in one of Cleveland Clinic’s hospitals in Cleveland. But Dr. Allamby, a 51-year-old Black American, took a very nontraditional route to medicine. MedPage Today reports that he grew up in one of Cleveland’s poorest suburbs and gave up on his dream of becoming a doctor early on, starting an auto shop instead at age 19. Many years later, when he decided to go to college for a business degree while he continued to work, he took a prerequisite biology course and was hooked again. By the time he enrolled in Northeast Ohio Medical University, he had liquidated his business of 25 years. “I had to work 25 years, essentially,” says Dr. Allamby, who still graduated with $300,000 in debt, “in order to afford my medical school.” He sees parallels between his former customers and his current patients: Both groups need something fixed quick, and customer service and shared decision-making come into play in both business and medicine. According to Dr. Allamby, early exposure to medical careers is crucial in underrepresented communities, and he wants to start a program at his hospital where high school students can shadow physicians.

August 31, 2022

Physicians in good position to see pay increases next year

If you’re wondering when you’ll get some relief from rising costs in your practice, the answer may be next year. Maybe. At a webinar on health care inflation conducted last week by the Kaiser Family Foundation, speakers said that physicians are in a good position to negotiate for higher compensation because their costs are rising so quickly. At the same time, insurers have seen a lower demand over the last couple of years for many services because of covid, and volume is not expected to return to normal. A MedPage Today report on the webinar said that experts predict rates from private insurers would go up more quickly than  Medicare rates. Those rates are scheduled to rise between 3.5% and 4% in the next fiscal year, which starts Oct. 1, but speakers at the webinar cautioned that physicians will find themselves on the low end of those increases.

Value-based care still accounts for small percentage of doctor pay

A new report from the Medical Group Management Association (MGMA) says that despite the gradual move from fee-for-service medicine to value-based care, most physicians are still seeing most of their income from fee-for-service medicine. A Fierce Healthcare article looking at the report says that value-based care accounts for only 7% of PCP revenue, 6% of revenue for surgical specialties and 15% of revenue for nonsurgical specialties. On average, the MGMA report found, physicians get about $31,000 of their income from value-based care. The report also noted that 42% of medical practices are linking quality metrics to physician compensation, a number that’s up from 26% in 2016. The report also found that patient volume for most groups has returned to 2021 levels or higher.

August 24, 2022

August 10, 2022

If you’re in primary care, get ready for competition

Primary care groups are probably going to see competition coming from large companies that buy their way into the market. News reports say that CVS may try to bulk up its presence in the primary care market by acquiring a large group (or groups). Healthcare Dive reports that CVS may be trying to catch up to competitors like Walgreens and Walmart, which in recent years have racked up huge partnerships and deals to enter the primary care market. CVS executives recently said they would take new steps into the market by the end of the year. And a report in the Wall Street Journal states that the pharmacy giant may try to buy Signify Health, which would be a sign of its intentions to enter the primary care market. Signify is a technology company that helps health care organizations provide in-home health care. Fierce Healthcare reports that by 2030, big companies like retailers, payers and startups could own 30% of the primary care market.

Residents see pay stagnate during pandemic

Resident pay took a hit during the pandemic, rising only about 1% between 2020 and 2022. Those data, which come from a Medscape survey, say that in 2022, residents earned an average of $64,2000. Only 27% of surveyed residents said they feel like they’re being paid fairly. Resident pay had climbed fairly steadily from 2015 through 2020, with annual raises coming in at about $2,000 a year for many of those years. A Healthcare Dive report says that one-quarter of residents who responded to the survey owe $300,000-plus in medical school debt and half owe more than $200,000. Healthcare Dive also notes that in this year alone, interns and residents at four hospital systems have won the right to union representation.

August 3, 2022

July 27, 2022

Productivity-based pay increases gender gap for PCPs

Female PCPs working under productivity-based compensation models may be financially penalized because they spend more time with patients. A study in Annals of Internal Medicine found that female PCPs conduct fewer but longer patient visits. They also provide more counseling and participate in shared decision-making than their male counterparts. Researchers found that under productivity-based pay systems, female PCPs earned nearly $60,000 less per year than their male colleagues. The gender gap was similar under capitated payment systems, but it actually got worse when capitated pay was risk-adjusted by only patient age and diagnosis-based scores.

Survey: About one-third of docs work side jobs 

A new survey says that just over one-third of physicians work side jobs, and about half of those physicians are motivated by money. A Medscape survey found that 37% of physicians say they have a side gig, a number that’s higher for men (65%) than women (33%). Just over one-quarter of docs with side jobs are involved with medical consulting, while 25% serve as expert witnesses and 25% do chart review. Relatively few physicians (16%) said their extracurricular work doesn’t have anything to do with medicine. The most popular non-medical side gigs were in real estate, investing and consulting. About half of physicians with side jobs said extra income was the goal; average income from side gigs was $25,300 per year. On average, physicians spend 16 hours per month on these activities.

Time magazine weighs in on the physician shortage

You know a problem is bad when Time magazine devotes a story to it. In its latest issue, Time turns its attention to the physician shortage. The article notes that more than 80 million Americans live in areas that have been designated a health professional shortage area. The magazine warns that those people can expect to feel the brunt of the shortage. The story lists all the usual causes of physician shortages, from the long and costly education and training that physicians must go through to the aging of the country, which is expected to increase demand for physician services. It also suggests all the usual solutions, from increased funding for training to debt relief. And while health care has been hearing dire warnings about physician shortages for decades, it’s not clear if anyone is listening. Data released last month by one of the country’s largest staffing firms found that searches by employers for primary care physicians had shrunk, and that searches for specialists were leading its list of physician searches. Time tries to end on an optimistic note by citing California’s success in reducing the number of residents living in shortage areas.

July 20, 2022

New survey data indicate that demand—and pay—for physicians is starting to bounce back to pre-pandemic levels, but demand also appears to be softening for primary care specialties. The annual compensation survey from physician staffing firm Merritt Hawkins found that physician starting salaries have rebounded, with 14 specialties seeing raises and only three seeing a drop. In terms of starting pay, internal medicine saw a 5% gain to an average of $251,000, while family medicine saw a 3% gain to an average of $255,000. Pediatrics saw a 2% drop for an average of $232,000. A MedPage Today report says that among the company’s clients, demand was highest for specialties, accounting for nearly two-thirds of the physician searches it conducted. Only 17% of searches were for primary care physicians, however, and 19% were for nonphysician clinicians. The Merritt Hawkins report speculates that the softening interest in primary care may be coming from health systems’ strategy to bypass primary care physicians in favor of more “convenient” settings like urgent care centers, retail clinics and virtual care.

The results of the 2022 Today’s Hospitalist Compensation & Career Survey are now available. View new data on compensation by type of group, region, patients per shift and shifts per month, as well as physician scheduling, productivity and satisfaction. Survey results also offer data on pandemic bonuses, pay differentials, patient load and pay rates for regular vs. extra shifts. Complete a brief registration to view free data on the Web. If you’re benchmarking hospitalist pay and workload, you might be interested in three new executive summary reports offering a full overview of pay and productivity for adult hospitalists, pediatric hospitalists and advanced practice provider hospitalists. Delve even deeper with a cross-tab Excel report with the survey’s full data set. That dataset allows you to drill down into specific information, such as compensation for academic full-time hospitalists who treat only adults and work 7-on/7-off, for example.

Medicare has proposed dropping coverage for audio-only telehealth services, including visits conducted over the phone, in a move that is angering advocates for telehealth. According to a Healthleaders report, health care providers and telehealth advocates argue that audio-only telehealth is sometimes the only technology available in rural areas that lack high-speed Internet or access to hardware to make video visits work. During the pandemic, reimbursement rules for telehealth were loosened up to allow non-video visits for most services. (Some behavioral health services didn’t qualify for audio-only reimbursement.) Several organizations have come out in support of permanently reimbursing audio-only telehealth visits. If the fee schedule is passed as is, the change in reimbursement would take place 151 days after the end of the public health emergency. That emergency status was renewed last week for at least another three months, so telehealth reimbursement won’t change for at least eight months.

July 13, 2022

July 6, 2022

PCPs losing hundreds of thousands of dollars by underbilling for prevention, coordination services

Are primary care physicians leaving hundreds of thousands of dollars on the table because their coding and billing practices aren’t up to snuff? A study in Annals of Internal Medicine looked at physicians’ use of 34 billing codes focused on prevention and coordination services. Researchers found that if PCPs billed properly for those codes for only half of their eligible patients, they could bill an additional $124,435 in prevention services and an additional $86,082 in coordination services per physician per year. A HealthLeaders article noted the study found that individual PCPs could provide additional preventives services that would be worth up to $40,187 in additional revenue. The study found that on average, the median use of billing codes among PCPs was 2.3%, but that those same physicians appropriately provide those services to between 5% and 60% of their patients.

A look at docs who quit their jobs during the pandemic

A new survey of more than 500 physicians looks at the paths taken by doctors who quit their jobs during the pandemic. The survey from the staffing firm CHG found that of physicians who quit their jobs, 35% left to improve their work/life balance, 13% quit for better compensation and 11% wanted more flexibility. Of physicians who quit their jobs, 42% said the pandemic was very or extremely influential in their decision, while 36% said the pandemic was not at all or only slightly influential. Nearly half (40%) of physicians who said the pandemic influenced their career decisions said that burnout and stress levels were unsustainable. Just over one-third of physicians who quit (35%) said they were unhappy with how administrators responded to the pandemic, with nearly half of those physicians citing “poor leadership.” Finally, of physicians who switched jobs, 39% took a position in a different practice setting, 31% worked locum, and 25% took a job in a similar practice setting.

June 29, 2022

June 22, 2022

Is your hospital ready for “pronoun pins?”

Hospitals are beginning to embrace the movement to allow staff and patients to identify which pronouns they use by providing buttons and pins that they can wear. Earlier this year, VCU Health System in Richmond, Va., began giving clinicians pins that allow them to choose from four categories: she/her/hers; he/him/his; they/them/theirs; and “Ask me about my pronouns.” A story in Becker’s Hospital Review says that a couple of months into the initiative, the health system has given out more than 3,000 of the pins. And Northern Light Eastern Maine Medical Center in Bangor has been giving buttons to staff, patients and visitors allowing them to publicly proclaim the pronouns they’d like other people to use. The hospital has handed out more than 1,200 of the buttons. Representatives for both organizations say there has been a good reception for the initiative. VCU plans to order more of its pins this month.

Are telehealth visits with physicians in other states about to disappear?

Analysts have worried about how the tightening of telehealth regulations that were loosened during the pandemic will hurt access to care, but researchers say one group may be particularly hard hit: patients in rural areas getting care from physicians in other states. A Health Affairs study found that while interstate telehealth visits made up only about 5% of total telehealth visits, they accounted for nearly 10% of all outpatient visits, not just telehealth visits, in some states. Researchers found that most interstate telehealth visits provided care for established patients, not new patients, and they were particularly popular with patients in rural areas. A Fierce Healthcare article says that interstate telehealth visits may be on the brink of extinction because of changes in state law. When Medicare allowed interstate telehealth in the spring of 2020, states followed by passing licensure waivers so patients could get care from a physician in other states. Today, those licensure waivers are still in effect in only 15 states, and some think they may disappear in some of those remaining states.

June 15, 2022

While malpractice claims have declined, physicians are seeing drastic increases in their malpractice premiums. An article in MDedge looks at an ob/gyn whose insurance skyrocketed from $60,000 to $130,000 a year in the last two years. But at the same time, new malpractice claims hit historic lows, shrinking to nearly zero. One analyst said rising premiums are being fed by a rising severity of claims, which refers to high-dollar verdicts and settlements. That trend and an expected post-pandemic return of lower-dollar claims has insurers increasing their rates. One broker quoted in the article warns physicians to brace for rising premiums in 2022 and 2023.

A mental health hotline for physicians is trying to stave off “empathy fatigue” in clinicians who are burned out from working through two-plus years of a pandemic. A Medscape article about empathy fatigue catalogs some of the factors that have physicians losing hope, from fighting off disinformation about the pandemic to dealing with surges of patients. The hotline, which was founded by a psychiatrist in Philadelphia, dealt with sadness and grief from physicians earlier in the pandemic. More calls now deal with not only anger and frustration, but guilt and shame from clinicians who experience those emotions when caring for patients. The psychiatrist who runs the hotline said that physicians are often finding themselves put in a position of having to choose empathy or self-preservation. She encourages callers to not be ashamed of feeling those emotions because making that admission is the first step to dealing with those feelings.

June 8, 2022

June 1, 2022

New data say that physician pay for non-primary care physicians may have finally risen above pre-pandemic levels. Data from the newest MGMA survey found that compensation for nonsurgical specialists rose 3.12% in 2021 over 2020 levels, which amounted to a 1.79% increase over 2019 pre-pandemic pay levels. Nonsurgical specialists saw the biggest percentage drop in income from 2019 to 2020. According to HealthLeaders, the news wasn’t good for primary care physicians, who saw their income actually drop a little in 2021 from 2020 levels. Surgical specialists came out the best, at least in terms of compensation, in the survey. While surgeons took the second biggest hit to income during the pandemic, they saw the biggest jump in compensation—nearly 4%—from 2020 to 2021.

The increasingly crowded virtual market for primary care is about to see a giant enter the fray. In early 2023, CVS will launch a virtual care service that offers primary care, chronic condition management and mental health services. Fierce Healthcare says that CVS will make the service available to certain Aetna patients and CVS Caremark members. One twist is that patients will be able to see virtual or in-person providers, the latter at CVS MinuteClinics. Because both in-person and virtual providers will be linked by the same EHR, CVS says patients will be able to transition between in-person and virtual care easily. CVS joins a long list of payers and retailers that have launched or acquired virtual primary care services.

May 26, 2022

May 18, 2022

It may not be breaking news, but the embrace of hospital medicine by young internists suggests that a workforce crisis is looming in outpatient medicine. Research in Annals of Internal Medicine says that while it’s well-known that hospital medicine has grown as a field, no research has formally studied career choices by internists in over a decade. A May 17 study looking at nearly 70,000 internists who became board-certified between 1990 and 2017 found that by 2018, 71% of newly board-certified internists practiced as hospitalists. That compares to 8% who practiced only in the outpatient setting. Data also show that by 2018, 40% of the internist workforce was employed as hospitalists. And from 2008 to 2018, the number of internists practicing in both inpatient and outpatient settings dropped by 56%, from 52% to 23%. Authors say that as older physicians retire, there could be a critical shortage of outpatient internists.

RaDonda Vaught, the former nurse from Tennessee who made a fatal drug error that killed a patient, will serve no jail time for her mistake. Fierce Healthcare reports that Vaught was sentenced last week to three years of supervised probation. Vaught admitted administering an incorrect medication that contributed to the death of a 75-year-old woman in 2017. The case was being closely watched by nurses and other health care providers who worried that her conviction would set a dangerous precedent that could hurt nursing recruitment efforts. MedPage Today reports that health care experts wondered why Vaught was being criminally prosecuted (not pursued by an administrative board) when just about everyone agreed there was no malice on her part. MedPage Today notes that the prosecutor’s motives have been questioned. He’s up for re-election this summer and may have not wanted to look weak by not prosecuting Vaught.

May 12, 2022

One in four physicians cite mistreatment at work in the last year

Nearly 25% of physicians say they’ve experience mistreatment at work within the last year. A survey of more than 1,500 physicians at Stanford published in JAMA Network Open found that patients and visitors were the most common source of mistreatment, and that women were twice as likely as men to experience mistreatment (31% vs. 15%). Other physicians were ranked as the second most common source of mistreatment. Researchers found that perceptions mistreatment was associated with a 1.13-point increase in burnout on a scale of 1 to 10. Mistreatment was also associated with a 129% increase in intent to leave a workplace. When physicians feel that there their workplace has no mechanisms in place to protect them, researchers found a 2.41-point increase in burnout and a 711% increase in intent to leave.

Can a “secret” medical expert make legal trouble for you?

A Medscape article examines the frustration felt by physicians who are inappropriately named in malpractice suits by anonymous medical experts. The report says that some states allow malpractice cases to go forward based on the certification of a single anonymous medical expert. That can be frustrating for physicians inappropriately named in these cases because they can’t question the credentials of the “expert” who authorized the case to move forward. While a number of states give these anonymous experts a fair amount of power in driving malpractice lawsuits, at least one medical society is thinking of fighting back to protect its physician members.

May 4, 2022

What specialties have the highest incentive bonus?

A compilation of salary by Becker’s Healthcare Review found that orthopedics has a significantly higher incentive bonus ($126,000) than any other specialty. The specialty’s average bonus is a full 26% higher than the second highest average bonus for ophthalmology ($100,000), and it’s more than four times higher than the average bonus reported by internists ($29,000). Family medicine reported an average incentive bonus of $30,000, while pediatrics reported an average of $28,000. Psychiatry reported an average incentive bonus of $33,000.

When money isn’t everything: Negotiating beyond salary

A MedPage Today article by a family medicine resident looks at other factors that physicians should consider negotiating when interviewing for jobs. When it comes to sign-on bonuses, her advice is simple: Don’t accept the first amount you’re offered, since it’s probably not the best and final amount the organization is willing to offer. Another big ask the author suggests? Automatic, annual pay increases, which can take the form of cost-of-living increases (to help offset inflation). The author also suggests asking for increases to reward staying with an organization for a certain amount of time or for hitting certain revenue targets.

April 27. 2022

Physicians unhappy with EHRs much more likely to want to quit

A new survey finds that clinicians’ dissatisfaction with their EHR is associated with those people wanting to leave their organization. In a survey of more than 59,000 clinicians, the research group KLAS found that burnout was the No. 1 factor associated with clinicians saying they were likely to leave their organization. But the survey found that dissatisfaction with an organization’s EHR was about half as powerful as burnout in pushing clinicians to the point that they felt likely to leave. Of clinicians who are specifically unhappy with EHR implementation, training and support, one-third say they are likely to leave within the next two years. HealthLeaders reports that clinicians who are very dissatisfied with their organizations’ EHR are almost three times as likely to say they plan to leave as physicians who are very satisfied with their EHR.

Physicians continue to embrace employment, even (or especially?) during the pandemic

The number of physicians employed by large organizations showed no sign of slowing down during the pandemic. In 2021, 73.9% of physicians were employed by hospitals or corporations. That number was up from 62.2% at the start of 2019, according to data from the Physicians Advocacy Institute. Those numbers mean that almost 110,000 physicians have jumped to an employed position since January 2019, with 58,000 working for hospitals and 50,000 working for other entities. The report found that the South saw a 94% increase in the acquisition of physician groups by corporations, and the Midwest continued to have the highest percentage (63.5%) of physicians employed by hospitals and health systems.

April 21, 2022

Medscape’s 2022 physician compensation report says that average income for all physicians rose in 2021 by 7% to an average of $339,000. In 2020, by comparison, average physician pay came in at $299,999. Internists reported an average of $264,000, pediatricians reported $244,000, emergency medicine physicians reported $373,000, and psychiatrists reported $287,000. Just about every specialty reported a gain in pay over 2020, but less than half of physicians in many specialties say they feel like they’re fairly paid. Fierce Healthcare notes that the survey found wage gaps along gender and ethnic/racial lines that have persisted for years. Male PCPs earned 23% more than females, and male specialists earned 31% more than their female colleagues.

How important is it to make a “Top Doc” list? A Medscape article looks at the pros and cons of these lists, but most commenters on the article come down pretty hard against participating in them. The article, for example, says that some of the surveys rely on recommendations from other physicians to identify top-performing physicians, but many veteran physicians say they’ve never been asked to recommend a colleague for the lists. Several commenters also said they knew terrible doctors who somehow made it onto these lists. One commenter said two doctors who made these lists were actually barred by their hospitals from patient care. The article also notes that the lists may be more popular among specialists than PCPs, who often have more patients than they can handle. And one commenter noticed that in the years he made one of these lists, he received huge volumes of junk mail as a result.

April 14, 2022

A new study found that there’s no evidence that being burned out negatively affects the quality of care physicians provide. If anything, the data found, patient outcomes for burned out physicians seem to show that they provide slightly better care than their colleagues. The study in Health Affairs started with a hypothesis that physicians who report frequent burnout would also have higher Medicare costs of care, higher rates of preventable visits to the ED and 30-day readmissions. Researchers instead found that physicians who reported the highest levels of burnout had “generally lower rates of undesirable outcomes.” Healthcare Dive reports that the study looked at Medicare claims for 1,000 family physicians to see if there was any relationship between how physicians ranked themselves on seven categories of burnout and how they performed on measures that looked at ambulatory care, ED costs and readmissions. Researchers emphasized that their study does not mean that burnout is a good thing and say their findings simply suggest that “the relationship between burnout and outcomes is complex and requires further investigation.” The study did find, however, that the 2.4% of physicians who reported “daily callousness” did have worse outcomes.

A study of “moral injury” finds that health care workers in the age of covid may have a higher risk of certain types of the problem than post-9/11 military combat veterans. Moral injury is generally defined as the impact of either perpetrating, failing to prevent or witnessing acts that violate a person’s moral beliefs. While burnout generally describes the effects of ongoing stress, moral injury tends to refer to damage done to a person’s identity or conscience. The study, published in the Journal of General Internal Medicine, found that 51% of health care workers reported experiencing potential moral injury from the actions of others. That number was slightly higher than the number of military vets—46%—who similarly reported potential moral injury from the actions of others. Under one-fifth of health care workers (18%) reported experiencing potential moral injury from their own actions compared to 24% of military vets. Becker’s Hospital Review says the study found that both types of moral injury were linked to symptoms of depression and worse quality of life among both veterans and health care workers.

April 6, 2022

March 31, 2022

A new study finds that physicians of all specialties who use EHRs spend an average of 1.84 hours a day outside of office hours on documentation. By comparison, physicians who don’t use EHRs spend 1.10 hours a day outside of office hours on documentation. The study, published in JAMA Internal Medicine, found that among respondents in primary care, surgery and medical specialties, 64% said they were happy with their EHR and 64.5% found documentation to be easy. Despite that, 58% said they spent an inappropriate amount of time on documentation, which reduced time with patients. The study also found that physicians who participated in value-based purchasing spent even more time outside office hours on documentation: 2.02 hours per day. Physicians who didn’t participate in value-based purchasing, by comparison, spent 1.58 hours per day outside office hours on documentation. The study also found that the use of scribes didn’t seem to affect the time physicians put into documentation.

More than one-third of physicians in countries hit hard by the pandemic say they’ve seen an increase in medical errors because of staff shortages, and three-quarters are worried about the quality and safety of care those shortages are causing. A report from Survey Healthcare Global collected data from physicians in the U.S., France, Germany, Italy, Spain and the U.K. A Medical Economics article says the survey found that while covid is the biggest reason for staff shortages in five of those six countries, burnout was cited as the second biggest reason, with 40% of respondents noting that shortages began before the pandemic. Eighty percent of respondents said that staff shortages are creating longer wait times, 69% said shortages are decreasing the quality of care, and 72% say their patients have had their access to treatments delayed. More than half of physicians said those delays have hurt their patients’ health.

March 24, 2022

March 17, 2022

The Biden administration’s new test-to-treat program is raising concerns as it tries to direct patients who think they have covid to get a diagnosis and prescription from pharmacists instead of physicians. The Advisory Board reports that hundreds of locations, many of them the local outlets of large chains like CVS, Walgreens and Walmart, will begin participating in the program this month. On the physician side, the AMA has voiced concerns that cutting PCPs out of the loop could lead to problems when pharmacists who don’t have any in-depth knowledge of patients prescribe a new treatment. Medscape reports that on the pharmacist side, 14 pharmacy groups are unhappy that only pharmacies with on-site clinics will be able to prescribe and administer covid therapies. They want the program expanded so more pharmacies can care for covid patients. Supporters of the program praise its focus on making it easy to quickly get covid drugs, particularly given that the two available antiviral therapies need to be taken within five days of the onset of symptoms. Physicians counter that potential interactions between a drug like Paxlovid and other therapies are “not trivial,” concerns supported by a report in Annals of Internal Medicine earlier this month. That perspective piece looked at interactions between Paxlovid and common therapies for conditions other than covid.

For the third year in a row, physicians have seen a huge surge in malpractice premiums, but analysts say that the fallout of covid hasn’t yet made its mark on insurance rates. A new AMA report says that after remaining relatively stable from 2010-2018, about 27% of malpractice premiums increased in 2019. (That number was almost double the percent of premiums that increased in 2018.) Then in both 2020 and 2021, an even bigger number of malpractice premiums (30%) increased. The report also notes that 12 states reported large numbers of double-digit increases last year. In Illinois, for example, nearly 60% of premiums jumped 10% or more. Other states with large percentages of premiums that jumped by 10% or more included West Virginia (42%), Missouri (30%), Oregon (20%), South Carolina (17%) and Idaho (11%). AMA analysts note that premiums are rising for multiple reasons that include “deteriorating underwriting results” and “lower returns on investment.” The report notes, however, that the pandemic’s long-term effects on malpractice premiums are not yet clear. Analysts note that for now, at least, base malpractice premiums have not been affected by covid.

March 10, 2022

After a shaky 2021, telehealth showed big gains in late 2021

The stats are in for 2021, and after some ups and downs, telehealth finished off the year strong. A report in Healthcare Dive says that while telehealth had a rocky 2021 and hit a record low percentage of medical claims in October, it rebounded at the end of the year. Data found that telehealth claims grew more than 11% from November-December 2021, accounting for 4.9% of all medical claims. While mental health topped the list of telehealth diagnoses, covid was No. 2 in December and No. 3 in November. A Fierce Healthcare report says that another survey found the physicians it surveyed appear to be bullish on telehealth, particularly when it comes to primary care. The survey, which was conducted by the tech company Wheel, found that 63% of surveyed physicians expect virtual primary care to bypass in-person care within five years. For some, that may be good news: Two-thirds of surveyed physicians said that hybrid practice environments fit with their lifestyles better than in-person only care.

Two physicians’ thoughts on caring for—or firing—difficult patients

With incivility seeming to be at an all-time high, physicians are wondering how to deal with difficult patients.

A dermatologist writing in Medscape recalls the recent patient who was livid when he refused to give her a letter for work excusing her from getting a vaccine, something he says was neither medically indicated nor ethical. As his department’s chief of service, the physician is often called on to mediate with patients who want another opinion or to talk to someone who’s in charge, but he says the requests are getting more unreasonable. There was the patient who wrote a complaint about a physician who she thought was a foreign medical graduate (the physician was Ivy-League trained) and the patient who wanted a refund after a biopsy came back negative. But this patient was in the exam room jabbing her finger in his chest and calling him a “(expletive) terrible doctor.” The solution? He told the patient he needed to leave the room to retrieve a dermatoscope, which gave the patient time to calm down. On his return, he told the patient that she can’t verbally abuse staff at the practice. She apologized—and insisted that he should still write the note.

What about patients that won’t cool off or back down? In a piece about dismissing patients, a veteran physician says he can count on two hands the patients he has had to fire in his 40-plus years of practice, but he says that it is sometimes necessary. Writing in Physicians Practice, the urologist suggests a handful of steps to try to make the process of dismissing a patient crystal clear and painless. That includes notifying the patient in writing (certified mail with a return receipt to confirm the patient received the letter), but not necessarily giving the patient a specific reason. Explain in the letter that you’re making the move so the patient can “find another physician who can provide you with the medical attention that you require.” The physician also suggests giving a deadline for the termination (30 days) and offering to give a copy of the records directly to the patient or to the new physician who will be caring for the patient.

March 3rd, 2022

February 23, 2022

What do the people you work with think of their jobs?

What do the people you work with think of their jobs in health care? According to a new poll commissioned by USA Today, the good news is that 80% say they are somewhat or very satisfied with their jobs, and 73% agree with the statement, “I love working in health care.” The bad news is that while 59% say they’re hopeful about their work, that number is down almost 20 points from a survey conducted last year. USA Today coverage of the survey notes that one in four respondents say they are likely to leave health care, and 52% say they are burned out. It’s no surprise that nurses are often bearing the brunt of the downsides of working in a pandemic, but a new survey by McKinsey says that 32% of RNs are considering leaving their current jobs. That’s a 10-point increase since the question was asked in February of 2021. About one-third of nurses who are thinking of leaving want to go into non-patient care roles, while about 20% plan to leave the workforce altogether to retire or for family reasons.

In 2022, expect pay raises in health care to be small and rare

One factor that may make it tough for health care organizations to hang onto employees may be money—or the lack thereof. An article in Becker’s Hospital Review reports that only one-third of health care employers in a new survey would commit to giving raises of over 3%, putting health care on the bottom of the list of 15 different industries. (Outside of health care, 44% percent of employers said they plan to raise worker pay by more than 3%.) Additionally, 43% of health care organizations responding to the survey didn’t give pay raises in 2021 and they don’t plan to in 2022. More than half of health care employers said they were going to shift compensation structures and strategies in 2022, perhaps because 87% said they faced hiring challenges last year.

February 17, 2022

February 11, 2022

What do malpractice lawsuits look like for internists and FPs?

What do malpractice lawsuits look like for internists and family physicians? A Medscape survey of internists and family physicians found that 42% said they had been named in a malpractice suit either by themselves or with other parties. The biggest reason for the lawsuit (cited by 41% of respondents) was a failure to diagnose or a delay in diagnosis. The second most common reason (26%) was a poor outcome of progression of disease. Nearly two-thirds of respondents (63%) were “very surprised” and 28% were “somewhat surprised” by the lawsuit. Most (84%) thought the lawsuit was not warranted, and 35% said it was settled before trial. The survey found that about one-quarter of internists and  family physicians pay between $5,000 and $10,000 a year for malpractice insurance.

A patient has filed a complaint with your state medical board and an investigator has showed up at your office and is asking to come in so you can answer questions. Do you need to let the investigator into your office and drop what you’re doing to have a conversation? The answer is probably no, according to lawyers interviewed for a Medscape article that looks at the 10 things you should not do when you’re being investigated by your medical board. While you need to keep your cool with medical review board officials, these lawyers say that you don’t necessarily want an investigator poking around your office looking for other problems. The article suggests that physicians try to schedule an interview at a lawyer’s office, providing a safe place to meet and time to prepare. Other advice in the article focuses on how to respond to complaints thoroughly but without providing too much information, and how to handle an offer to end the case with a consent agreement.

February 2, 2022

Value-based what? Volume still rules physician pay

January 26, 2022

How would you like to get paid for replying to patient e-mails?

A health system in San Francisco is conducting an experiment that allows clinicians to bill for responding to patient e-mails. STAT reports that a program at UCSF has been up and running since November of last year to allow clinicians to bill payers for handling patient e-mails that take longer than a couple of minutes to respond to or that require medical evaluation. During the pandemic, Medicare allowed reimbursement for these messages, and most of the payers UCSF works with have allowed the policy as well. While it’s unclear how much payment is actually reaching clinicians, UCSF says it has seen payment of about $65 per e-mail. Most or all of that reimbursement comes from payers, not patients.

ED docs top the list of the most burned-out physicians

While the pandemic has been hard on all physicians, ED physicians top the list of burned out physicians according to a new Medscape survey. The survey found that 60% of ED physicians say they’re burned out, a steep rise from the 43% of ED docs who reported burnout in last year’s survey. Just under half of all physicians (47%) reported being burned out this year, which is a 5% jump from last year’s survey. Critical care physicians were the second most burned out group in the survey (56%), followed by ob/gyns (53%). Women also report higher levels of burnout (56%) then men (41%). The highest source of burnout was bureaucratic tasks (identified by 60% of respondents) and a lack of respect (identified by 39% of respondents). More outpatient physicians (58%) said they were burned out than hospital physicians (48%). A Healthcare Dive report says the survey also found that 20% of physicians surveyed said they were depressed, with about one-quarter of those respondents saying they were clinically depressed.

January 19, 2022

The pandemic continues to make physicians less happy outside of work

New data show that the pandemic is continuing to take a toll on physicians. A Medscape survey found that about 60% of physicians say they’re happy outside of work, a steep drop from the 80% who reported being happy outside of work before the pandemic. The survey also found that about 60% of female physicians and 53% of male physicians said they would take a pay cut to have a better work-life balance. Nearly half of female hospitalists say they’re either conflicted or very conflicted as parents by their work demand, compared to 29% of men. Healthcare Dive reports that most physicians surveyed (83%) are married or in a committed relationship, although that number is higher for men (89%) than women (75%) physicians.

January 12, 2022

In a New York Times opinion piece, a cardiologist says that health care workers entering the third year of the pandemic who “have confronted more death and sickness than ever before in our careers” deserve one thing: more money. To offset burnout in the middle of staffing shortages in yet another surge, the author calls on federal and state governments to provide hazard pay to workers on the front lines of the pandemic. He notes that under labor law, federal workers handling “virulent biologicals” (like a virus) may already qualify for hazard pay that amounts to a 25% bonus. While the cardiologist acknowledges that hazard pay won’t necessarily cure burnout in the ranks of health care workers, he says it would at least recognize the outsize burdens those workers have faced during the pandemic. Democrats and Republicans have proposed federally funded hazard pay for health care workers, but the efforts went nowhere.

Faced with a surge in omicron, hospitals and health systems are once again postponing elective surgeries. Fierce Healthcare reports that Illinois, Massachusetts and New York have recommended or implemented delays in surgeries and that health systems in about half of all states have postponed elective procedures. Orthopedics appears to be taking the biggest hit, while cardiac surgery and nonelective general surgery appear to be unaffected for now. The Web site CalMatters reports that with one-third of California hospitals facing critical staffing shortages, a number of elective surgeries have already been canceled. The state’s health department is considering postponing elective surgeries in which patients wouldn’t suffer immediate harm. The Fierce Healthcare article has a list of health systems that have shut down elective surgeries.

January 05, 2022

EHR time went down, then up, during the pandemic

If you’re like most physicians, you found yourself spending less time on electronic health records at the beginning of the pandemic. But by the summer of 2020, you likely found yourself spending more time than ever working with your EHR. That’s the conclusion of a new study in the Journal of the American Medical Informatics Association published last month. A report in Becker’s Hospital Review says that on average, clinicians spent about 80 minutes per day using EHR systems before the pandemic, but that number dropped to about 65 minutes during the early days of the pandemic. By early July 2020, however, that number had bumped back up to 86 minutes per day. The study found that the increase was due in part to increased time in clinical review and in-basket messaging. By early July of 2020, clinicians were receiving about 4% more in-basket messages than before the pandemic

Survey finds burnout, verbal abuse on the rise for nurses

A new survey finds that about 20% of nurses personally know a health care provider who has died of covid, 30%-40% are less happy working as a nurse, and one in five are burned out or very burned out. The survey, conducted by Medscape, found that 31% of nurses had experienced emotional abuse at work in the last year, with managers/administrators the most commonly cited source of abuse. About 20% of RNs and LPNs suffered physical abuse at work in the last year, the survey found, and at least 40% of nurses said they had experienced verbal abuse in the last year. Patients were the most common source of verbal abuse, with the exception of CRNAs, who said that most verbal abuse came from physicians. One-fifth of nurses said the least satisfying aspect of their job is administration/workplace politics. The most rewarding aspect was helping people and making a difference in people’s lives.