How many patient encounters per shift is reasonable?

November 29, 2023

How many patient encounters per shift is reasonable?

Most hospitalists think they’re seeing two patients too many per shift, or about 14% more patient encounters per shift than is reasonable. That’s what data from this year’s Today’s Hospitalist survey found when we asked about patient volumes. We found some variation in the gap between actual and reasonable encounters, particularly when it comes to factors like employer type. We also found that even hospitalists with the fewest patient encounters per shift think they’re overworked. For more, see our online coverage.

Lee Health offers $29 telehealth visits with no face-to-face interactions

A Florida health care system is jumping into telehealth by offering $29 physician visits. Patients who use the new service from Lee Health in Fort Myers, however, won’t actually see a physician. They’ll instead answer a series of questions with no face-to-face interaction with a clinician. The asynchronous visits are being pitched as convenient for busy patients and for people who don’t want to talk to a physician. An announcement from Lee Health said that the questions will change and evolve based on how patients answer. A physician will then review the information submitted by the patient and come up with a diagnosis and treatment plan. Lee Health said the program is designed to treat minor conditions like colds, rashes, bladder infections, eye pain, ear pain and sinus problems.

November 22, 2023

A look at burnout on the frontlines of covid

A new memoir by hospitalist Dhaval Desai, MD, details the chaos and fatigue that swamped clinicians during repeated covid surges. The book points out that there was one silver lining, however: Dr. Desai describes how the experience helped him grow into a stronger advocate as a group leader in seeking out mental health resources and protecting clinicians and staff. See the Today’s Hospitalist online Q&A with Dr. Desai about his book, “Burning Out on the Covid Front Lines.”

Post-pandemic, docs spending more time working with EHRs

New research found that for every eight hours of patient visits, outpatient physicians are spending five-plus hours working with their EHR. The study, which was published in JAMA Network, looked at physicians working in the outpatient offices of a large academic medical center. Researchers found that since the pandemic, the average time physicians spend working with their EHR during an eight-hour day of scheduled patient hours jumped from 4.53 to 5.46 hours per day. During that same time frame, the amount of time physicians spent working with their EHR outside of scheduled patient hours jumped from 4.29 to 5.34 hours. The study also found that the volume of patient messages received by physicians per week jumped from 16.76 per week pre-pandemic to 30.33 per week post-pandemic. Messages sent to patients by physicians jumped from 13.82 to 29.83 per week. A report in Healthcare Dive pointed out that the increased time physicians are spending working with their EHR coincided with the rise of telemedicine and virtual care.

October 25, 2023

These factors are boosting physician compensation

Data from a new compensation survey found that physician shortages and changes in Medicare’s Physician Fee Schedule are boosting compensation for many physicians. SullivanCotter’s 2023 Physician Compensation Insights report found that compensation for PCPs jumped 9.5% in 2023, while compensation for hospital-based specialties jumped 8.7%. SulliverCotter noted that many physicians on the front lines of the pandemic, including hospitalists, intensivists and emergency physicians, saw the biggest increases. The report says that an anticipated shortage of PCPs will likely continue to push up pay for that group, as will changes in Medicare’s billing and documentation rules. As an example, analysts pointed out that PCPs had the biggest jump in relative work value units—7.4%—largely because of changes to the Physician Fee Schedule. The report found that about 70% of physician compensation plans factor in work relative value units, and about half use value-based or quality incentives to calculate physician pay. Those payments account for 8-9% of PCP pay and 6-8% of specialist pay. About one-quarter of organizations use team-based incentives in their compensation plans that account for 11% of physician pay. About half of those organizations included physicians and APPs on those teams.

September 20, 2023

AMA says these six specialties suffer the most burnout

A new AMA survey found that the highest rates of burnout among physicians occurred in the following six specialties:

• Emergency medicine: 62%.
• Hospital medicine: 59%.
• Family medicine: 58%.
• Pediatrics: 55%.
• Obstetrics and gynecology: 54%.
• Internal medicine: 52%.

The data are from an AMA report known as the Organizational Biopsy. The report looks at six key indicators: job satisfaction, job stress, burnout, intent to leave an organization, feelings of value and hours spent on work-related activities. More information on the report is on the AMA Web site.

What’s the average number of patient encounters per shift for hospitalists?

Data from our latest survey show that hospitalists on average report 16.4 patient encounters per shift, but that number is higher for adult hospitalists and lower for pediatric hospitalists. Our data also show that while there’s been a drop in average patient encounters since last year’s survey, the difference is so small that it may not be significant. For more on patient encounters per shift, see our online coverage.

September 13, 2023

Which specialties are seeing higher pay than before the pandemic?

New survey data from Medical Economics magazine look at average pay for primary care physicians before and after the pandemic. The results show that pay for internists rebounded in 2022, surpassing 2019 levels. Internists reported average pay last year of $253,000, a $44,000 bump from 2021. Before the pandemic, internists reported earning $243,000, making 2022 the first year that pay was higher than before covid. The news was not as good for pediatricians, who saw a smaller raise last year of only $6,500, giving them an average comp of $216,500. That leaves pediatricians earning less than before covid, when they reported an average of $231,000. Finally, family physicians saw a $5,000 raise last year, bringing their average pay to $245,000. That was slightly higher than their pre-pandemic average pay of $241,000.

How does working more shifts affect hospitalist pay?

It’s probably not a big surprise that hospitalists who work more shifts make more money, but our latest survey data show that’s not always the case. Most hospitalists working more than the average of 15 shifts a month report higher average compensation. (Hospitalists working more than 20 shifts report making a LOT more money.) But in several cases, hospitalists pulling the most shifts don’t see a commensurate gain in pay. See our online coverage for more numbers on shifts and pay.

August 30, 2023

How do American PCPs compare to docs around the globe on satisfaction?

How satisfied are American PCPs compared with doctors in other wealthy countries? According to a Commonwealth Fund study of PCPs in 10 high-income countries, U.S. physicians have the fourth highest level of overall satisfaction (47%) compared to countries like Switzerland (66%), which had the highest level. A Medical Economics slideshow said the study found that 31% of American PCPs were “very” or “extremely” satisfied with their income, compared to Sweden (44%), Switzerland (41%) and the Netherlands (40%). Medical Economics also said that 23% of U.S. PCPs were “extremely” or “very” satisfied with the time they spent with patients, compared to Switzerland (33%) and France (24%).

Health care execs are expecting to spend more to recruit “talent”

If you’re feeling unappreciated as a physician by executives in your organization, you should know that a new study of health care leaders found that most are worried about acquiring and retaining talent—that means you—and possibly willing to pay more. A report from the consulting firm PwC found that because health care employment has not yet returned to pre-pandemic levels, health care organizations are paying particular attention to recruitment. A Healthcare Dive report said that during contract negotiations, executives expect physicians to seek “higher rate increases” at a “higher frequency.” The PwC report also said that health care executives expect staffing needs to lead to a 7% increase in medical costs in 2024. The report noted that the giant health care firm Universal Health Services is spending “roughly twice” the $60 million the organization budgeted for physician contract expenses.

August 23, 2023

Are unions becoming more popular with physicians?

There are signs that at least some physicians are beginning to view unions as a tool they can use to get better representation. More than 550 clinicians with Allina Health have filed to unionize, creating what some say could be the largest private-sector clinician union in the country. A MedPage Today report said the physicians hope to conduct a vote within the next two months. The move is somewhat unique because clinician unions have tended to draw more residents and fellows than practicing physicians. The Allina clinicians include physicians, NPs and PAs employed by primary care and urgent care clinics in Minnesota and western Wisconsin. The clinicians considering joining the union have complained that understaffing is creating concerns about safety. They also said that the corporatization of medicine is diminishing their decision-making and forcing them to prioritize profits over patients. And a report in Becker’s Hospital Review examined three organizations that have physicians unionizing or pursuing unionization. At St. Vincent’s in Portland, Oregon, 87% of about 70 practicing physicians, not residents and fellows, voted to join a hospitalist union. In a press release, a hospitalist said that the health system had put physicians’ concerns aside to meet corporate priorities.

August 16, 2023

Why can insurance companies withhold 5% of your payments?

According to a new ProPublica report, many physicians are stuck paying insurance companies a fee of up to 5% to get paid electronically. The report said that in August of 2017, the CMS posted a notice saying that insurance companies weren’t allowed to charge a fee when paying physicians for their work. ProPublica said that six months later, the notice was taken down because of lobbying efforts by the insurance industry. As a result, the report said, insurers now routinely require physicians to “kick back” up to 5% of payments that are made electronically. The report also found that even when physicians ask to be paid the full amount via check, some are still charged the 5% fee against their wishes. While some physicians told reporters that they’re trying to raise rates to counter the fees, others say it’s one more reason that small practices are folding.

More employers looking for NPs/PAs/CRNAs than PCPs

If your group is having a hard time finding NPs, you’re not alone. A new report from AMN Healthcare said that for the third year in a row, searches for NPs topped the company’s list of searches. AMN said that NP searches are up because of demand from “convenient care” providers like retail clinics, urgent care centers and telemedicine platforms. Average NP salaries jumped 9% from $138,000 last year to $158,000 this year. AMN also noted that it conducts more searches for advanced practitioners, which it defines as NPs, PAs and CRNAs, than it does for primary care physicians. Only 17% of its searches last year were for PCPs, compared to 19% for advanced practitioners.

How much do hospitalists make? See Today’s Hospitalist’s latest survey data

Data from the newest Today’s Hospitalist survey found that while compensation is up, the increases might leave some hospitalists disappointed. For full-time adult hospitalists, mean compensation for 2022 came in at $339,438, a gain of just over $2,000 from the year before. For more data on hospitalist pay, see our coverage on the Today’s Hospitalist Web site.

August 10, 2023

Do U.S. physicians really average $350,000 a year?

A Washington Post article published last week claimed that the average U.S. physician makes $350,000 a year and that “top doctors” make 10 times that amount. Those figures come from a working paper published by the National Bureau of Economic Research that analyzed 10 million tax records from nearly one million physicians over 13 years. The Washington Post article offered plenty of charts and data to back up its claims, which the authors noted had led some physicians to become “unglued” when the data were first presented three years ago. The paper, which concluded that U.S. physicians make more than anyone thought and more than any other occupation the team has measured, acknowledged that the highest earners in medicine tend to be concentrated in a handful of specialties and in small clusters. Doctors in the top 10% of earners, for example, averaged $1.3 million a year, and those in the top 1% averaged $4 million a year. The Washington Post article examined how public health policies that have led to a physician shortage may be pushing up physician income. The article also acknowledged that entire specialties don’t get anywhere near those levels of income, with family physicians making closer to $230,000 a year. And to counter the idea that says physician wages are a major driver behind health care costs, the report pointed out that physician wages account for only 8.6% of U.S. health care spending.

Not everyone in health care is a fan of charging patients to message physicians

While hospitals and health systems started charging patients to send messages to physicians in part to reduce the volume of messages, there’s evidence that the strategy isn’t working. An NPR report said that while some patients are facing co-pays of $5 to $75 to message their doctors through patient portals, the fees seemed to have reduced the volume of those messages by only about 2%. A research letter published in JAMA found that only about 3% of physicians have been charging the fees, in part because of the time they have to spend generating the charges. A report in Becker’s Health IT said that physicians may not be the only ones who aren’t on board with charging patients for messages. While the report identified 17 health care systems that are charging patients for messages, it spoke to the leaders of several systems who don’t support the fees. One of them said that asking clinicians to decide which messages merit a charge is counterproductive because it gives physicians one more thing to do in their already-overloaded day.

August 2, 2023

What career sacrifices do women physicians make to have children?

A new study that looks at how female physicians juggle having and raising children with their careers found that two-thirds delayed starting a family by about five years—and that about half wish they hadn’t waited so long. The research looks at not only how that delay may be affecting fertility rates for women physicians, but also the sacrifices those women make to their careers while starting a family. For more, see our coverage on the Today’s Hospitalist Web site.

Study says hospitalists still change jobs more than any other specialty

A new study found that hospitalists lead all specialists when it comes to changing jobs, with 5.4% making a job change in an average year. By comparison, 4.5% of surgical specialists and 4.0% of PCPs switch jobs in an average year. A study in Annals of Internal Medicine found that physicians between the ages of 35 and 44 are most likely to change jobs, with 5.6% making the move in an average year. The research also found that among physicians 65 and older, only 2.6% switch jobs in an average year. Those older physicians, however, are much more likely to leave practice altogether, with nearly 10% leaving every year. The study also found that rural physicians were more likely to change jobs (5.1%) than urban physicians (3.9%) and that rural physicians were more likely to leave practice altogether (3.3%) than their urban counterparts (2.7%).

July 26, 2023

Why are more women leaving academic medicine than their male colleagues?

Female physicians are leaving their jobs at teaching hospitals at higher rates than their male colleagues, according to a new study in JAMA Network Open. After examining employment patterns at teaching hospitals, researchers found that after five years, 38.3% of female physicians had left compared to 32.4% of male physicians. The study also found that female physicians had higher attrition rates at all stages of their careers, although more women who had been practicing in a teaching hospital for less than 15 years left (40.5%) than women in any other time in their career. Researchers pointed out that while the number of women in academic medicine has been increasing, gender gaps in career opportunities and pay are still substantial and are likely behind women’s decision to leave. The study also noted that female physicians leaving teaching hospitals may have public health implications because of the unique perspectives that women bring to patient care. Women physicians may also help bring other women into medicine by serving as role models.

Survey: Less than 20% of PCP practices fully staffed

A new survey found that more than three years after covid, only 1% of primary care physicians say that their practice has fully recovered. A study by the Larry A. Green Center found that only 19% of PCPs said their practices are fully staffed, while 80% said they need more workers to meet patient needs. A Healthcare Dive report said that more physicians complained about staffing shortages this year than in 2022. The survey also found that about one-third of PCPs reported high levels of burnout, stress and moral injury. That’s likely related to the survey’s finding that PCPs are spending 15% more time on administrative tasks because of staffing shortages.

While academic programs have more than 50 physicians, the size of hospitalist groups varies widely by practice type and geography. We check in on data from our 2022 survey to break down the average number of physicians and advanced practice providers in this article on the Today’s Hospitalist Web site.

July 19, 2023

Industry groups rally against Medicare proposal to cut doc pay

Industry groups are calling on the Biden administration to reverse a proposed cut of more than 3% in Medicare’s physician fee schedule. In a press release, the Centers for Medicare and Medicaid Services predicted that overall physician pay would drop 1.25% from 2023 to 2024, but the agency acknowledged in that same press release that it wants to cut the conversion factor of 3.34%. In Medicare, the conversion factor determines the amount of pay allocated for relative value units. A Fierce Healthcare report said that Medicare is cutting overall physician pay to cover pay hikes for primary care and services for underserved populations, caregiver support and behavioral health. This week, another report from Fierce Healthcare said that major industry groups are lining up against the proposed cuts. Groups like the AMGA pointed out that physician practices are already dealing with increasing expenses and may ultimately have to cut back on the services they offer if Medicare cuts their reimbursement, which would hurt patient care. The MGMA criticized Medicare’s “robbing to Peter to pay Paul” approach to maintaining budget neutrality when expanding services and access to care.

Less than half of U.S. physicians work in private practices

It’s no secret that fewer physicians are choosing to work in private practice settings, but a new AMA survey shows just how many physicians are working for someone else. An AMA report found that the number of doctors working in groups owned by physicians fell 13% between 2012 and 2022, from 60.1% to 46.7%. During that same period, the percentage of physicians working in practices owned by a hospital or health system grew by 8%. The number of doctors working in hospitals bumped up 4% during that same period. The survey also found that the percentage of physicians in practices with 10 or fewer physicians fell from 61.4% in 2012 to 51.8% in 2022. The percentage of physicians in groups with 50 or more physicians, by comparison, jumped from 12.2% to 18.3%. A Healthcare Dive report said that four out of five physicians in the survey who sold a practice said they needed to negotiate higher reimbursement from insurers.

July 12, 2023

June 21, 2023

How are hospitalists using emojis in messages?

A study looking at how hospitalists use emojis in text messages to other hospitalists and health care professionals found that the symbols add to the conversation about one-third of the time. About 7% of messages between hospitalists and other health care professionals used emojis, and the most used emoji was the thumbs up symbol. For more, see our coverage on Today’s Hospitalist.

In last two years, 40% of health care workers experienced violence

A new survey has found that about 40% of people working in U.S. health care experienced workplace violence in the last two years. The survey, which was conducted by Premier and the Agency for Healthcare Research and Quality, found that violence is most common among nursing staff, with two-thirds of reports coming from bedside nurses. More than half of the reported incidents involved combative patients. A HealthLeaders article said that among females who reported experiencing violence, half of the incidents involved emotional or verbal abuse and half involved physical or sexual abuse. In incidents with combative patients, 62% of incidents reported biting, scratching and hitting. Another 21% of incidents involved the patient throwing something, 14% reported sexual abuse and 1% involved patients firing a gun.

June 14, 2023

These physicians are using ChatGPT to talk to patients

While some physicians are thinking about using AI tools like ChatGPT to perform mundane tasks such as writing appeals to insurance companies, others have started using the technology to talk to patients. A New York Times report found that from academic internists in Austin to a rheumatologist in Houston, some physicians are finding that AI can be a surprisingly empathetic way to communicate with patients. A team of researchers, for example, was having trouble finding a way to compassionately talk to alcoholic patients in a study about their substance abuse. When ChatGPT was given the task, it instantly produced a script that the team is now using. And another physician looking for information to help a friend with advanced cancer found the technology offered compassionately worded answers to her questions, including the exact words to use when talking about the lack of treatments for her cancer. To the physician’s surprise, ChatGPT then offered him ways to deal with his own grief and stress as he talked to his friend.

How not to respond to a bad online review

Physicians are routinely advised to dispute negative reviews on social media, but a recent example serves as a reminder to steer clear of patient information when disputing a bad review. A MedPage Today article said that a psychiatric group in New Jersey has agreed to pay the HHS Office for Civil Rights $30,000 over allegations that it revealed protected health information when replying to a negative review posted on Google. In April 2020, a patient who posted the review complained that the group divulged confidential health information when responding to the review. Part of the problem, investigators found, was that the group had no policies in place to prevent HIPAA violations. Investigators also found three other similar disclosures of protected information. A health care attorney quoted by the MedPage Today report said that while the HHS may not investigate all complaints, “hot topics” like social media postings often get the agency’s attention. Experts suggest that when responding to bad online reviews, physicians stick to more general statements that don’t even acknowledge that the person complaining was a patient.

June 12, 2023

Survey data: How long are hospitalist shifts?

May 31, 2023

Why are women physicians sued less than male MDs?

When the AMA released data on malpractice lawsuits involving physicians, one of the more noticeable trends was the fact that female physicians are about half as likely to be sued as their male colleagues. An opinion piece in MedPage Today from a practice management consultant looks at data behind that trend and tries to find an explanation for it. He notes that lawsuits are more common against surgeons, and because most surgeons are male, that will help drive up the number of lawsuits against male physicians. He also notes that in general, women physicians have fewer patients than their male colleagues, which will also lead to more opportunities for lawsuits against male doctors. The author also noted that female physicians have better patient satisfaction rates, which can help tamp down lawsuits.

Physicians say they’re reluctant to work in states with abortion bans

With physicians saying they’d prefer not to practice in states that have banned or restricted abortions, those states are likely to face a crisis in women’s health that goes beyond abortion. Kaiser Health News reported that a survey of 2,000 current and future physicians found that 76% said they would not apply to work or train in states with abortion restrictions. States with abortion bans have already seen a larger decline in Match applicants than other states, and the decrease in ob/gyn residencies was down twice as much in those states as in others. The Kaiser report also found that when clinics in states with abortion bans shut down out of fear of breaking the law, women lose access to services like regular exams, breast screenings and preventive services.

May 24, 2023

Mass. hospitals join together to fight abusive patient behavior

A coalition of Massachusetts hospitals has endorsed a “common set of principles” that hospitals are being urged to adopt to prevent a rising number of physical assaults, verbal abuse and threats against hospital employees. In a new report, the Massachusetts Health and Hospital Association identifies key principles for a hospital code of conduct. It also calls on the state’s legislators to work to find a solution. The group defines problematic behavior as “disrespectful, aggressive, abusive or violent behaviors and actions toward staff, patients and visitors.” Its code of conduct suggests asking abusive patients to leave and limiting their ability to get non-emergency care in the future. The report found that while health care organizations in the state experienced an “abusive incident” once every 57 minutes in 2020, that number jumped to once every 38 minutes in 2022. For more on what hospitals are doing to tackle bad patient behavior, see the May-June issue of Today’s Hospitalist.

Journal’s entire editorial board quits to protest publishing fees

The editorial board of a neurology journal, including professors from Oxford University and other British universities, have quit to protest what they say is the greed of publishing giant Elsevier. The entire academic board of Neuroimage quit to protest the huge profit margins in academic publishing, which largely come from the publishing fees researchers are charged. An article in The Guardian said that academics often pay more than $3,000 to have their work published with companies like Elsevier. Many of the journals charging these fees use an open access model and get most of their revenue from the fees, but the editorial board members said the publishers’ costs don’t justify what they say are exorbitant charges.

May 17, 2023

Malpractice data show physicians’ risk of being sued

A policy paper from the AMA looks at trends in malpractice lawsuits filed against physicians. The report, which was based on data from surveys conducted between 2016 and 2022, found relatively few physicians—about 2.4%—had been sued in a one-year period between 2014 and 2018. That number dropped to 2.1% in 2020 and to 1.8% in 2021. The report said that while the differences may seem like good news, they aren’t statistically significant.

Longer term data show the higher risk physicians face of being sued over the course of their careers. In 2022, 31.2% of physicians said they had been sued at some point in their career. That number dropped from 2016, when 34% of physicians reported being sued at some point in their career.

The report also found differences by gender. When asked if they had been sued in the previous year, 2.8% of men answered “yes” compared to 1.6% of women. Over the course of their careers, by comparison, 36.8% of male physicians compared to 23.8% of women had been sued. The report also found that 65% of claims that were closed between 2016 and 2018 were dropped, dismissed or withdrawn. Data also found that of the 6% of claims that were decided by a trial verdict, 89% were won by defendants.

May 10, 2023

Can AI chatbots answer patient questions better than physicians?

Artificial intelligence just racked up another victory in medicine, this time when it comes to providing empathetic responses to patient questions. A study in JAMA Internal Medicine asked three health care professionals to evaluate responses to patient questions posted on a Reddit forum. An AI-powered chatbot assistant got better ratings on quality and empathy than physicians. Researchers said that physician responses were shorter, as demonstrated by a patient wondering whether she would go blind from splashing bleach in her eye. While the doctor said, “Sounds like you will be fine. You should flush the eye…”, the chatbot responded, “I’m sorry to hear that you got bleach splashed in your eye. It’s important to rinse the eye…” A related commentary warns that by bringing AI into health care, the profession has opened “Pandora’s Box” and must help drive how the technology is used.

How two physicians got public pushback over their tweets

Recent weeks brought more evidence that social media can be a tricky place for physicians, particularly when nonphysicians weigh in.

• A tweet by Amy Faith Ho, MD, an emergency medicine physician and writer, asked a simple question: “How do you tell a medical doctor?” She said that “real doctors” are reluctant to identify themselves, while nonMDs/DOs “take every opportunity to say they are a doctor.” She added that because MDs/DOs shy away from white coats, most people wearing them are probably chaplains, pharmacists, therapists and other nonphysicians. Dr. Ho appeared to be expounding on a tweet from a physician explaining how physicians are often reluctant to identify themselves as doctors in public settings, but that seemed to be lost on people replying to her thread. “That’s the most privileged & snobby opinion I’ve read on this website,” said one commenter. “What pharmacist hurt you?,” asked someone else.

• Mark Tykocinski, MD, dean of the medical college at Philadelphia’s Thomas Jefferson University, got into hot water after using his Twitter account to “like” tweets that questioned the science behind covid vaccines, called gender reassignment surgery child mutilation and criticized diversity offices on college campuses, among other things. A Philadelphia Inquirer article said Dr. Tykocinski thought that “liking” the tweets would simply bookmark them so he could find them later. The Yale-educated molecular immunologist explained that he didn’t understand that by liking a tweet, he would appear to be endorsing the viewpoint of the author. Despite that explanation, the newspaper ran a detailed article about Dr. Tykocinski’s history of tweeting and examined the tweets on controversial topics that he “liked.” In a follow-up article, the CEO of the health system stated that Dr. Tykocinski’s use of Twitter was “careless” and that someone at his level “should have known better.”

May 4, 2023

ACP calls for better telehealth metrics

April 26, 2023

Survey data: Nocturnists get better pay but fewer perks

Nocturnists may make more money for working fewer shifts, but data from our latest survey show that they don’t get all of the same perks as their daytime colleagues. While nocturnists report a mean compensation that’s 8.5% higher than daytime hospitalists—that number is even higher for nonacademic nocturnists—they get significantly smaller bonuses. Nocturnists were also less likely to receive a pandemic bonus, and nocturnists who did receive pandemic bonuses received smaller amounts than daytime hospitalists. For more on trends in compensation and other perks for nocturnists, see Today’s Hospitalist’s online survey coverage.

April 12, 2023

April 5, 2023

Docs bill commercial insurers average of $4 million a year

Individual physicians bill commercial insurers an average of $3.8 million a year, according to a new report from AMN Healthcare, a national staffing organization. The report tracked commercial claims submitted by 18 different specialties as well as claims billed by NPs and certified registered nurse anesthetists. Not surprisingly, general surgeons had the highest amount of annual claims among the specialties: $11.7 million a year. Pediatricians, by contrast, had the lowest average for claims billed: $1.3 million. And doctors who practice diagnostic, surgical and internal medicine subspecialties generated $1.7 million in claims per year to commercial payers. CRNAs were found to submit an average of $1.8 million in commercial claims per year, while NPs were found to bill an average of more than $770,000.

Do patients and physicians prefer in-person visits over telehealth?

What do physicians and patients really think about telehealth? While the use of telemedicine exploded during the pandemic, new research published by Health Affairs found that an overwhelming majority of primary care doctors (80%) prefer in-person care. That sentiment was echoed by patients, with only 36% of patients saying they’d prefer care via phone or video. (Older patients particularly came down on the side of in-person visits, with 85% preferring an office visit over a virtual one.) Asked about their preference for in-person visits, 60% of physicians felt telehealth was inferior to in-person care, with both patients and doctors citing the lack of a physical exam. Medscape coverage of the study points out that perceptions of telehealth quality varied by the type of care provided, with both patients and doctors saying that virtual care was just as good or better than in-person care for mental health visits or for triaging covid symptoms. One possible dissatisfier for patients that’s in the news this week: Patients using telemedicine provided by specialist clinics owned by hospitals are being billed for facility fees as well as physician professional fees, even though they haven’t physically been inside the clinic or hospital. Medscape reported that at least eight states are moving to restrict facility fees for virtual visits.

March 29, 2023

Doximity survey: Physician pay dropped 2.4% from 2021-2022

A new Doximity report found that average compensation for doctors dropped 2.4% in 2022. From 2020 to 2021, by comparison, Doximity found that physician pay jumped 3.8%. The report says that the drop in physician pay comes as Medicare cuts physician reimbursement rates by 2% for the current year. The report also quotes an AMA calculation that between 2001 and 2021, physician pay when adjusted for inflation was down 22%. Emergency medicine fared considerably better, seeing a 6.2% increase. Several pediatric subspecialties also saw gains of 2% to 4%. A Healthcare Finance article said the Doximity data found that male physicians earned an average of $110,000 more than their female colleagues. While 92% of women said they “overwork,” the number was significantly lower for men: 83%.

Cigna has a computer algorithm, not humans, denying claims

A ProPublica report found that the giant insurer Cigna is using technology that allows it to reject claims without having a human even open the files to review them. Sources for the report said that Cigna medical directors do not have to view patient records or use their clinical judgment on claims that are processed this way. An algorithm flags tests and procedures that the insurer considers “unacceptable” for common conditions. Medical directors then sign off on denials in batches without ever viewing the details. One source said that by using the technology, medical directors can reject 50 claims in 10 seconds. The ProPublica report said that not all claims go through this system, but it’s not clear what percentage are and are not processed this way. A HealthLeaders report said that over a two-month period last year, Cigna used the technology to deny more than 300,000 payment requests.

March 23, 2023

New report looks at what physicians think of retirement

A new report looks at what physicians are thinking about when it comes to retirement. The report by the physician recruiter Jackson Physician Search found that while 38% of physicians have delayed retirement because of financial considerations, more than half of the 24% of physicians who decided to retire early because of covid are still planning to do so. Nearly 60% of Gen X physicians plan to retire by age 60, with data showing that 12% of physicians between 51 and 60 have already moved to part-time work. When asked what factors would cause them to delay retirement, 58% of physicians identified being able to work part time, 52% identified flexible schedules and 42% identified reducing or eliminating call. The report also found that there’s confusion among health care administrators about when and why physicians are going to retire. While half of health care administrators think physicians look mainly at age when making retirement decisions, burnout is the biggest factor for 25% of physicians.

Why are outpatient visits being billed using higher-level codes?

Outpatient physicians are billing their visits at higher intensity levels. A Peterson-KFF Health System Tracker report found that the share of level 3 codes in physician offices, urgent care centers and EDs dropped from 60% in 2004 to less than half (45%) in 2021. At the same time, level 4 claims jumped from 19% to 37%, and level 5 codes doubled from 3% to 6%. The report found that the average patient age remained the same during the study period, but the health status of the group was not measured. The authors noted that the increased use of higher-level codes could be explained by increased clinical acuity, changes in service, or care shifting from inpatient to outpatient settings. A Health Leaders report said that while the increased use of higher codes isn’t necessarily the result of upcoding, it is leading to higher outpatient health care spending.

March 15, 2023

Proposal to eliminate noncompetes pitting docs against hospitals

A proposal from the Biden administration to ban noncompete agreements may be pitting physicians against the hospitals and other organizations that employ them. A report in Roll Call reported that lobbying giants like the American Hospital Association oppose any changes to noncompetes, saying the move would exacerbate an already-difficult staffing environment for hospitals. Hundreds of physicians, however, have filed comments in support of the rule. Many commenters have relayed horror stories of being stuck in jobs because they couldn’t work for “competitors” within the same city or even state. The change to noncompetes, which was proposed in January by the Federal Trade Commission, would prohibit such agreements moving forward and void existing noncompetes. The FTC said that because the clauses can increase industry consolidation, eliminating them could save nearly $150 billion a year in health care costs.

Three-quarters of health care workers worry about violent patients

A new survey by Motorola Solutions found that while 68% of health care workers feel “extremely or very safe” while at work, personal safety is definitely on their minds. When asked about their biggest safety concern, 72% of respondents said their top concern was patients becoming violent. The impact of burnout/mental health came in second at 61%, and active assailants came in third at 42%. A report in Security magazine said that just under half of respondents (41%) said they would worry about their personal safety if asked to deliver care to patients in their homes, and 40% were concerned about the threat of active assailants at their workplaces. Just over one-quarter (26%) of respondents said that workplace safety is among their highest priorities when looking for a job, and 54% said they would be “at least somewhat likely to quit” if they experienced a violent incident at their workplace. The survey polled 500 health care workers including doctors, nurses, techs and administrators between December 2022 and January 2023.

March 8, 2023

A new Medscape survey has found that 24% of physicians said they’re depressed, 9% have thought of but not attempted suicide, and 1% have attempted to kill themselves. The survey found that younger physicians have had suicidal thoughts (12% among physicians between 27-41 vs. 8% among physicians between 57-75). Suicidal thoughts were highest among otolaryngologists (13%) and lowest among rheumatologists (5%) and pulmonologists (4%). Fierce Healthcare coverage says one bright spot is that the percentage of physicians with suicidal thoughts dropped from 13% in Medscape’s 2021 report to 9%. The bad news is that 9% is still higher than the 4.9% of the general population that has considered suicide. The survey also found that 42% of physicians suffering from depression don’t want to risk disclosure to their medical board. That’s a 110% increase from Medscape’s 2021 survey.

Will the growing volume of texts from patients push health care organizations to embrace concierge medicine? That’s a question asked in a MedPage Today piece that looks at the possible fallout of charging patients for text communications. The author, a medical student, says that because clinician burnout is already rampant, uncompensated messaging with patients isn’t sustainable. But as some groups begin to charge patients for increased access to physicians—a hallmark of concierge medicine—some will likely see the benefits of more fully embracing a concierge model. The author warns that if concierge medicine becomes more widely accepted, it will lead to some issues for American health care. For more, read the full text of the article on the MedPage Today Web site.

March 1, 2023

Survey: Physician happiness takes a post-pandemic hit

A new report from Medscape on physician happiness says that—unsurprisingly—happiness levels among physicians have dropped since the pandemic. Before the pandemic, for example, 75% of physicians said they were very/somewhat happy. Today, by comparison, only 48% of physicians are very/somewhat happy, and 36% are very/somewhat unhappy (compared to 14% before the pandemic). The survey also found that conflicts between work and parental demands are rampant, particularly among women, and that only 40% of physicians say they look after their own health and wellness always/most of the time. And more than half of physicians (53%) said they would take a pay cut for better work-life balance. The survey also looks at physicians’ drinking habits, time spent online, marital status and the kinds of cars they drive.

Should guidelines consider physician time in their recommendations?

An analysis in BMJ calls on clinical guidelines to take into a consideration a new factor: clinicians’ time. The authors of the analysis say that quantifying the time it takes clinicians to meet  recommendations might help shape those guidelines so clinicians can prioritize patient care goals. A New York Times article interviewed the lead author of the analysis, who said that the cumulative burden of meeting guidelines is “absurd.” The article points out that if properly followed, Norway’s blood pressure guidelines would lead to so many follow-up visits that the country would need to hire more clinicians for that task alone. And while British guidelines say that physicians should spend about 15% of patient visits assessing physical activity, there’s no evidence the guidelines improve patient health.

February 22, 2023

Key Senate committee looking at workforce shortages in health care

The workforce shortages that are ravaging health care have finally caught the attention of a Senate panel that says it is looking for solutions. At the Senate’s HELP Committee hearing held last week, the committee’s chair, Bernie Sanders (I-Vt.), acknowledged that workforce issues were a problem before the pandemic, and that they have only gotten worse. Fierce Healthcare reports that Sen. Sanders estimated the country will need 450,000 nurses in the next two years. He also said that the country is facing a shortage of 120,000 physicians over the next decade. Members of the committee suggested changing training requirements to speed up the entry of nurses into the workforce and expanding the number of residency slots offered for doctors. In related news, the CEO of Baystate Health in Springfield, Mass., recently warned that workplace shortages in health care could present a public health crisis. Becker’s Hospital Review reports that Mark Keroack, MD, said that in his state’s acute care hospitals, there are currently 19,000 full-time vacancies. Baystate alone has 1,650 open positions, two times more than before the pandemic.

Private equity’s next target in health care: cardiology?

Private equity has made considerable inroads into U.S. health care, but there are signs that it’s next target may be cardiology groups. A MedPage Today report says that the trend has the potential to affect a large number of Americans because more than 20 million Americans have heart disease. MedPage Today estimates that 12 private equity firms are currently investing in cardiology groups, but analysts expect that number to rise sharply in the coming years. Cardiology may be attractive to investors because of the aging of the American population and the number of cardiac procedures covered by Medicare. The MedPage Today report noted that while physicians in other specialties who sell typically lose all ownership of their practices, many of the cardiology arrangements have private equity taking ownership for terms of five to seven years. At the end of those terms, ownership reverts to the physicians, who stand to benefit if the practice has grown in value.

February 15, 2023

Which ED staffing firm is cutting back on doc staffing to save money?

Does it seem like there are fewer doctors in your hospital’s ED? If your emergency department is run by a staffing firm owned by a private equity firm, you may not be imagining things. A report from NPR produced in conjunction with Kaiser Health News says it found evidence that one ED staffing firm owned by private equity, American Physician Partners, has been cutting back on physician staffing as a strategy to save money and boost earnings. The company admitted as much in a statement to NPR, saying that its “blended model” allows it to keep all of its EDs fully staffed by allowing all personnel to provide care “at their fullest potential.” The NPR report doesn’t offer evidence that other ED staffing firms owned by private equity are using this strategy, but other sources said that the increased use of NPs/PAs has risen with the surge of private equity ownership of ED staffing firms. The report does note that one study of VA EDs, which allow NPs to practice without physician oversight, found that NP-only care in the ED boosted costs by 7% and LOS by 11%. A co-author of that study noted that the results aren’t an indictment of using NPs/PAs in the ED but should help guide how to best deploy them.

Are past malpractice claims an indicator of more claims ahead?

Do malpractice claims beget more malpractice claims for physicians? A JAMA Health Forum study found that physicians who had a paid malpractice claim in a previous five-year period were three to four times more likely to have additional claims. While 3.3% of physicians with no prior malpractice claims had one or more claims, 12.4% of physicians with a single previous claim had one or more additional claims. The numbers were worse for physicians with multiple previous claims; 22.4% of those with two previous claims had one or more additional claims, and 37% of physicians who had three previous claims had one or more additional claims. A MedPage Today report says researchers found that a claim that had occurred in the previous five years was associated with a 3.1 times higher risk of another claim for high-risk specialties and a 4.2 times higher risk of another claim for lower-risk specialties. Researchers say the numbers likely show that malpractice claims don’t happen randomly or as the result of bad luck.

February 8, 2023

Overwhelmed by your EMR? Try handling it when you have OCD

If your inbox gives you anxiety, try coping with a flood of patient messages, test results and useless notifications from your EHR when you have a diagnosis of OCD. In an opinion piece in STAT, a Los-Angeles-based internist, pediatrician and HIV specialist says that while getting through residency was difficult, training and working with a good psychiatrist for his OCD diagnosis didn’t prepare him for life as a PCP in the age of the electronic medical record. While he’s not asking for a return to paper records, he writes electronic medical records have led to too much “noise” and “click fatigue.” The author acknowledges that it’s not just people with OCD who are overwhelmed. During a recent weekend shift, he found a Monday-through-Friday colleague who had come in on his day off to try to get ahead of his inbox to prepare for the next week. The author’s OCD diagnosis has forced him to work hard to come up with some solutions, which he shares in his piece. For one, he now requires any patient who asks a question that needs more than a one-sentence answer to come in for a follow-up. He does the same for abnormal labs and imaging.

Burnout, depression reach five-year high among physicians

Physicians are exhibiting the highest percentages of burnout and depression in five years in a new Medscape survey. More than half—53%—of physicians said they’re burned out, a big jump from the 42% who reported burnout five years ago before the pandemic. Just under one-quarter (23%) said they’re depressed, a spike from the 15% of physicians who said they were depressed in the 2018 report. Emergency medicine physicians had the highest burnout rate (65%). Internal medicine ranked second on the burnout scale (60%), and pediatrics was a close third (59%). Women were more likely to be burned out (63%) than men (46%), and 65% of all physicians said that burnout affects their personal relationships. Physicians said they’re quicker to anger and that they have no time for anything outside of work, which frustrates their spouses and their children.

February 1, 2023

Violence against health care workers on the rise

Several reports say that growing violence in the hospital is changing how hospitals function and may be affecting the career plans of some providers. A survey of ED physicians found that 85% say violence in the emergency room has increased over the last five years. That has some hospitals looking at solutions to track and prevent violence. A Health Leaders report profiles how a hospital in Attleboro, Mass., is using its EHR to identify patients with a history of threatening behavior. The hospital can use that information to alert physicians and nurses, and to bring in behavioral health specialists to work with challenging patients. In related news, a global survey of critical care workers found that 73% of respondents said they’ve experienced workplace violence in the last year. The issue is so bad that 25% have considered quitting. A Becker’s Hospital Review report says that the survey results, which were presented last month at the Society of Critical Care Medicine’s annual conference, were based on data from 69 countries, but most responses came from the U.S. and India. The most common complaint was verbal abuse like threats (63%) and physical abuse like slapping or punching (39%). Survey data said that patients and family members were the most common source of abuse.

Will hospitals follow med schools in leaving U.S. News rankings?

With eight medical schools having backed out of U.S. News & World Report’s rankings, some are wondering whether hospitals and health systems are next. A MedPage Today report says that several medical schools are saying their decision to withdraw from the rankings will not necessarily affect the decisions of their affiliated hospitals. The article says that because the hospital rankings use publicly available data from Medicare, as opposed to the survey data that drive the magazine’s medical school rankings, most hospitals are expected to keep participating. U.S. News & World Report typically releases medical school rankings in March and hospital rankings in July.

January 26, 2023

Physician happiness plummeted after the pandemic

A new report says that physician happiness dropped during the pandemic by 22%, while the number of doctors saying they were somewhat or very unhappy jumped 188%. The Medscape Physician Lifestyle and Happiness Report 2023 found that 60% of physicians said they were very or somewhat happy, a drop from 80% before the pandemic. Another 26% said they were unhappy, a jump from 9% before the pandemic. In terms of parenthood, 49% of women felt conflicted or very conflicted compared to 28% of men. As for marriage, just under 90% of male physicians and just over 75% of female physicians are married or cohabitating. Most (81%) physicians describe those relationships as good or very good. When it comes to vacation, 43% of physicians take three to four weeks a year; 28% take one to two weeks per year.

A look at how the physician workforce is changing

A new report from the Association of American Medical Colleges is shedding light on demographic changes in the physician workforce. AAMC data show that in 2021, about half (47%) of U.S. physicians were 55 or older, and female physicians accounted for 37.1% of U.S. physicians. A report in Becker’s Hospital Review said that percentages of women by specialty ranged from a high of 65% (pediatrics) to a low of 5.9% (orthopedic surgery). More than half (63.9%) of physicians identified as White, 20.6% identified as Asian, 6.9% identified as Hispanic and 5.7% identified as Black. A second report in Becker’s Hospital Review found that the three fastest growing specialties in 2021 were sports medicine (up 42.5%), pediatric anesthesiology (up 37.7%) and interventional cardiology (up 32.6%).

January 19, 2023

January 11, 2023

How will proposed rule on noncompetes affect physicians?

A proposed rule from the Federal Trade Commission that would ban most noncompetes has health care industry experts debating if the rule will be turned into law and how it will play out for physicians. A report in Fierce Healthcare quotes one health care attorney who says that because the rule falls under an act that bans unfair methods of competition, it will likely not apply to nonprofit organizations. As a result, nonprofit health care systems would be exempt from the rule. The Fierce Healthcare report also says that about 45% of PCPs have a noncompete in their contract. While the U.S. Chamber of Commerce has called the proposed rule “blatantly unlawful,” a number of states have already started to rein in noncompetes in their jurisdictions.

Medical groups are pushing back against an HHS rule requiring that patients get their test results and other health care information as quickly as possible, often via patient portals. The problem, they say, occurs when patients get the news before their physician has a chance to explain what the data or test results mean. A report in Politico says that the HHS implemented the rule in 2021 to promote data-sharing and patient access to data. The agency created an exception that allows physicians to not divulge information if it would harm the patient, but physicians say the exception is too narrow and leaves patients receiving life-altering news without being able to consult their physician. Patient advocates support the new rule, saying that getting bad news sooner allows patients to begin looking for resources like a clinical trial or second opinion sooner rather than later. Groups like the AMA say they’re asking for a delay of only a few days so doctors can deliver bad news themselves and not let patients try to interpret it on their own. The AMA also cites survey results showing that two-thirds of patients want their doctor to talk to them about “life-changing” results. The Politico report notes that a handful of states have passed laws giving physicians a little more time to review information before having to release it to patients.

January 4, 2023