Red flags in employment contracts?

Red flags in employment contracts?

Physician career news and resources

September 2022
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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?

peer reviewWhat 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

rising-compensationIf 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

PCPs don’t have enough hours in the day to get everything done

physician-exhaustedA new study confirms what many primary care physicians already know: There simply aren’t enough hours in the day for them to do everything they’re supposed to do. To see an average number of patients and follow national guidelines, researchers found, PCPs would need to spend 26.7 hours per day. A University of Chicago article on the study says that an average workday would include 14.1 hours per day on preventive care, 7.2 hours per day on chronic disease care, 2.2 hours per say on acute care, and 3.2 hours per day on documentation and “inbox management.” The research concluded that “team-based care” could reduce that workload to 9.3 hours per day. The study also said that using the Comprehensive Primary Care Plus model would allow physicians to focus on advanced care and have medical professionals take over other duties. The study was done by researchers from the University of Chicago, Johns Hopkins University and Imperial College London.

Bad behavior by physicians is on the rise

A new Medscape survey finds that physicians’ reports of other physicians behaving badly at work are on the rise. In 2022, for example, 41% of surveyed physicians said they had seen physicians behaving badly at work. In 2021, by comparison, that number was 35%. Thirty percent of 2022 respondents said they had seen other physicians behaving badly on social media compared to 26% in 2021. An MDedge report says that the most common type of bad behavior identified in the survey is bullying or harassing clinicians, which was reported by 86% of physicians. Disparaging remarks about patients came in a close second, with 82% of physicians reporting that behavior. More than half (55%) of physicians reported hearing racist language used by colleagues, 44% reported seeing colleagues become physically aggressive with patients and staff, 43% witnessed inebriation at work, and 34% said they had seen physicians lying about their credentials. One bright spot: The number of physicians who remain silent in the face of bad behavior appears to be going down. While 35% of physicians responding to the 2021 survey said they kept quiet when witnessing bad behavior, that number dropped to 29% in the 2022 survey.

August 10, 2022

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

competition-big-dogPrimary 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

Physician groups are still facing tough financial times

Physician-CompensationPhysicians are facing rocky financial times, and times are particularly tough for physicians who own their practices. A MedPage Today report says that rising inflation and runaway operating expenses combined with a sluggish recovery from covid are challenging physician groups everywhere. A report from MGMA, for example, found that only 60% of medical practices hit their revenue goals in 2021. Another MGMA survey found that 90% of medical practices reported that costs have risen faster this year than revenue. And a report from KaufmanHall found that rising inflation and staff costs are chipping away at the small gains many groups have made. A statement from MGMA’s president said that finances are as tight for many practices as they were in the early lockdown months of 2020.

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 27, 2022

Productivity-based pay increases gender gap for PCPs

equal-payFemale 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

Report: Physician pay up, but demand softening for primary care

physician-pay-billsNew 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.

2022 Hospitalist Compensation & Career Survey data available

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 hospitalistspediatric 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 proposes ending pay for audio-only telehealth

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

Clinician pay may be up, but productivity is up even more

Clinician pay is up, but the data seem to show that doctors are working harder and not necessarily smarter. New data from the AMGA say that clinician compensation showed signs of returning to pre-pandemic levels in 2021, with median pay increasing 3.7% from 2020-2021. From 2019-2020, by comparison, compensation for clinicians rose only 0.1%. HealthLeaders reports that the bad news is that physicians saw those gains in pay by working harder. Physicians were paid 11% less for work RVUs in 2021 compared to 2020, but because their total productivity increased by a 18.3%, they were able to see overall gains in pay. Data says that some of that extra work was clinicians getting back to pre-pandemic levels, since productivity dropped 10.2% from 2019-2020.

In 2018, 139 oncologists collected $24 million in industry payments

One group of physicians that’s doing OK when it comes to compensation can consider itself in the top 1% of its specialty. MedPage Today reports that in 2018, a group of 139 U.S. medical oncologists, a number that represents 1% of the specialty, received general payments of more than $100,000, with a median payment of $154,613. Altogether, members of the group received a total of $24.2 million from consulting fees, speaking fees, honoraria and travel expenses. The data come from a study in JCO Oncology Practice, a Canadian medical journal. The lead author told MedPage Today that the members of the group are in important leadership positions, draft treatment guidelines and serve on journal editorial boards, which present obvious conflicts of interest.

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

Physicians in doc-owned practices more satisfied with EHR software

doctor-ehr It turns out that hatred for EHR software may vary by where physicians work. A study published this spring in JAMA Network Open looked at the results of a survey of nearly 1,400 physicians. Researchers found that 68% of respondents working in physician-owned practices said they’re satisfied with their EHR. That compares to 58% of physicians working for practices not owned by physicians. A report in Becker’s Hospital Review notes that survey respondents  working at physician-owned practices were also more likely to say that they had enough time for documentation and enough staff support. Study authors say that practice ownership can’t fully explain the differences in satisfaction levels and want future  research to look at other factors, including practice culture, workflow and EHR design. In a commentary in the same issue of JAMA, the president of the American Board of Internal Medicine suggests that the increased satisfaction rates likely have to do with “some version of collaborative design” taking place more frequently in physician-owned practices.

In New Jersey, 27 hospital workers a day report physical or verbal abuse

Health care workers have faced alarming levels of abuse in New Jersey for years, but it has somehow managed to reach even new, more extreme heights. A report from the New Jersey Hospital Association says that in 2021, hospital workers in the state experienced nearly 10,000 incidents of workplace violence, marking a 14.6% increase over the last three years. (In 2019, by comparison, the state’s hospitals reported 8,691 incidents of violence.) The report says that more than half of the incidents are related to physical abuse, which has seen an 11% increase since 2019. Nearly half (44%) are associated with verbal abuse, which has surged 25% since 2019. Patients were responsible for a whopping 84% of events, while co-workers accounted for 8.7% and family members were responsible for 7%. The report issued this alarming statistic: “On any given day, 27 hospital workers report some form of verbal or physical workplace violence.”

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

If malpractice claims are down, why are premiums rising?

claimsWhile 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.

Hotline helps physicians struggling with “empathy fatigue”

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

Disciplinary actions against docs fall for substance abuse, psychological issues

While disciplinary actions taken against physicians because of substance abuse have steadily declined since 2002, they still outnumber other types of disciplinary actions. A research letter in JAMA Health Forum found that 76.3% of disciplinary actions against doctors were for substance abuse, compared to 11.5% for psychological impairment and 12.2% for physical impairment. Actions taken because of substance abuse or psychological impairment tended to be more temporary than the permanent actions taken because of physical impairment. MedPage Today reports that researchers hypothesize that the lower number of actions taken for substance abuse could be a sign that physicians are getting help with substance issues before they become serious enough to warrant a disciplinary procedure. They also told MedPage Today that they hope the reduced number of actions for psychological issues is a sign that the stigma surrounding mental health is fading, which will give physicians the space they need to “stay healthy and stay in practice.”

A look at the specialties with the highest rates of burnout

In a recent report on burnout among physicians, 60% of emergency medicine physicians reported burnout, making their specialty the most burned out in a list published by Becker’s Hospital Review. That list ranked 29 specialties by burnout. Data found that in terms of burnout, critical care came in second, with 56% of physicians reporting burnout. Ob/gyn came in third (53%), and ID and family medicine shared fourth place, with 51% of physicians reporting burnout. Physical medicine/rehab came in fifth, with 50% of physicians reporting burnout. The data for the list come from the Medscape Physician Burnout & Depression Report 2022, which was published earlier this year. That report noted that from 2020 to 2021, the overall rate of physician burnout jumped from 42% to 47%.

June 1, 2022

Specialists and surgeons see pay gains, but PCPs lose a little ground

phsyician-salaryNew 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 competition for primary care patients heats up a little more

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

Are you ready for Nuremberg 2.0 (and other tales of medical misinformation)?

Even as the pandemic shows at least temporary signs of abating, misinformation about the virus and its vaccines seems to be picking up new steam and going in more extreme directions.

Exhibit A
Exhibit A can be found in a MedPage Today article. It talks about the theory that because covid vaccines are medical experimentation, anyone who promotes them—that includes doctors—should be held accountable, just like the Nazis were prosecuted during—and executed after—the Nuremberg trials. The promoters of this idea like to talk about “Nuremberg 2.0,” and while it’s often viewed as an empty threat, the MedPage Today article says some physicians are receiving violent threats.

Exhibit B
Exhibit B comes from another MedPage Today report. This one describes how Sen. Ron Johnson (R-Wis.) acknowledged that it “may be true” that covid vaccines cause AIDS. He was being interviewed with an anti-vaxxer lawyer who went farther, saying that “they purposefully gave people AIDS.” During the interview, Johson referenced—you guessed it—the Nuremberg trials and crimes against humanity. Johnson’s spokeswoman explained in a statement that the senator doesn’t believe covid vaccines cause AIDS, but it didn’t explain his comments.

Exhibit C
Physicians opposed to all things mainstream medicine are making sure that they don’t miss out on a chance to spread misinformation. A third MedPage Today article says that two highly visible right-wing political movements are crawling with physicians who have been accused of peddling misinformation. Defeat the Mandates and the ReAwaken America tour highlight how vaccines aren’t working and are not safe and argue that masks and social distancing don’t work. One of the featured speakers is Stella Immanuel, MD, who has said that venereal disease comes from “demon sperm.” Another one of the physicians is Simone Gold, MD, who has pleaded guilty to a charge stemming from her participation in the Jan. 6 storming of the capitol. One source in the article said that for some of these physicians, who have left or been kicked out of mainstream medicine, medical misinformation is part of their brand, so they can’t easily walk away from their arguments.

May 18, 2022

Is hospital medicine’s success hurting primary care?

future-health-careIt 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.

In closely watched case, nurse gets probation for fatal medication error

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?

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?

incentive-bonuscompilation 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

Physician pay rebounds in 2021, rising an average of 7%

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.

Should making a “Top Doc” list be important to you?

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

Study: Physician burnout doesn’t seem to hurt performance

peer reviewA 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.

Is “moral injury” a bigger problem in health care than in the military?

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

Nonphysician providers at one ACO increased costs of care

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A new analysis of an accountable care organization (ACO) in Mississippi has found that primary care provided by nonphysician providers was significantly more expensive than physician-provided care. A study of patients cared for at Hattiesburg Clinic, which employs 118 PAs and NPs, found that for a large group of Medicare patients, patients cared for by nonphysicians with independent panels under physician supervision cost an average of $43 more per member per month. The study, which was published in the Journal of the Mississippi State Medical Association, found that if all of the clinic’s patients were followed by nonphysicians, their care would end up costing an additional $10 million a year. An article on AMA’s Web site says nonphysicians spent more on care through increased testing, referrals to specialists and ED utilization. The data also showed that physicians had higher patient satisfaction scores and performed better on nine of 10 quality measures.

Nurses worry that sentence for Vanderbilt RN will have chilling effect

Since a Vanderbilt University Medical Center nurse was found guilty of homicide last month for making a fatal medication error and is facing up to eight years in prison, nursing groups have been attacking the decision as a “dangerous precedent” that will have a chilling effect on current and future generations of nurses. RaDonda Vaught has admitted that she contributed to the death of an impaired 75-year-old patient in 2017 by mistakenly giving the patient a wrong medication. Kaiser Health News reports that her conviction and looming sentence have nursing organizations crying foul. They’re predicting that it will make nurses more reluctant to report errors and near misses, which will hurt efforts to prevent future errors. Nursing organizations are also worried that the decision will hurt nursing recruitment efforts, which are already struggling to keep up with a shortage of RNs. Last week, quality improvement experts chimed in, saying that the case illustrates the need for health care organizations to reform systems that make errors all too likely. Fierce Healthcare reports that the Institute for Healthcare Improvement warned that the nurse’s conviction should be a “wake-up call” for health system leadership to protect both caregivers and patients when it comes to systemic problems in health care. The IHI says that instead of punishing individuals, health systems need to encourage the reporting of mistakes so organizations can learn from them. The IHI worries that the recent legal decision will discourage clinicians from coming forward.

March 31, 2022

EHR use, value-based purchasing raise doc time on documentation

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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.

Staff shortages (not just covid) increasing errors, hurting patient care

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

What do physicians really think of telehealth?

A new study by Optum found that while 64% of physicians are somewhat or extremely satisfied with the technology behind virtual care, most also think there’s room for significant improvement. When asked what technology they were using for televisits, 90% of physicians said they had used video, 80% said they had used the phone and 30% had used secure messaging. When asked about their frustrations with telehealth, 58% of physicians pointed to “the quality of care I can provide.” Just over half (55%) identified patients’ unrealistic expectations of what can be accomplished in virtual care, and 50% pointed to the quality of audio during televisits. Forty percent of physicians said better audio/video technology would help improve telehealth, and 35% said integrating virtual care with their EHR would help improve televisits. The survey found that primary care visits were most common, accounting for 75% of virtual care. Chronic care visits were a close second, accounting for 72% of visits, while prescription refills accounted for 64% of visits. The survey noted that while three quarters of survey respondents were PCPs, one third of respondents used virtual care to provide patients mental health support.

What young physicians want from their first job

While it’s no surprise that young physicians value work/life balance, a new survey found that it’s taken on even more importance in the last few years. A CHG Healthcare survey of physicians out of residency for two to three years found that 85% of respondents said that work/life balance was the No. 1 factor in choosing a first job. That’s significant because a 2018 survey by the same company found that 65% of respondents identified work/life balance as the top factor. Other factors highly ranked by physicians (“very” and “extremely” important) included location (83%), work schedule (83%), job/employer stability (79%) and salary (77%). The survey found that 23% of physicians started their job search before their final year of residency, 25% started during the first half of their last year of residency, and 19% started during the last half of their last year as a resident. More than two-thirds (68%) of residents said their residency program was “not highly helpful” in finding a job, and nearly 70% said they could have used help in negotiating the contract and compensation. Despite those comments, 70% of respondents said they were “somewhat” or “completely” satisfied with their first employment contract.

March 17, 2022

Will you lose patients to the new test-to-treat program?

lose-patientsThe 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.

Malpractice premiums continue to rise, but covid not necessarily to blame

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

telemedicineThe 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

A day in the life of the ED during covid: harassment, threats and assaults

How bad has it been working in emergency medicine during the pandemic? A perspective piece published by The Guardian tells a tale of patients threatening, harassing and assaulting ED staff. The author, an emergency medicine physician, recalls one patient who was physically dragged out of his ED by security and then threatened to return with a gun. Local police said that because they had checked the man’s apartment and found no weapons, they were powerless to restrain him— and too short staffed to station someone at the hospital. While the man never returned, the physician created a plan to evacuate patients in case he did come back. As one ED nurse who had been assaulted on the job told the author, “People will walk into the ER, throw their garbage at you, and walk out. They’ll just walk up to you, say ‘F you,’ and walk out.” The Guardian article says that statistics show that in 2021, health care workers were 50% more likely than people in other industries to have been bullied, harassed or hurt as a result of covid.

Neurosurgery, orthopedics lead the gender gap for pay in academia

equal-pay New data find that the gender gap among academic subspecialists begins as soon as these physicians enter the workforce. A JAMA Network Open study found that women had lower starting salaries in 42 of 45 subspecialties and lower salaries after 10 years of practicing in 43 of 45 subspecialties. Earning differences were most pronounced in neurosurgery, orthopedic surgery and cardiology. Researchers also found that it took female academic subspecialists a year longer to be promoted from assistant to associate professor, a delay that reduced their earning potential considerably. In a Medscape article on the study, physicians said they hoped making these data public would encourage female physicians to strive for pay equality. The article cites a Medscape surveythat found male physicians earn 35% more than their female colleagues.

February 23, 2022

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

happy-faceWhat 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

For first time in years, staffing issues are biggest worry for health care CEOs

staffing-helpFor the first time in 17 years, health care execs say staffing concerns are the biggest thing keeping them up at night. A survey by the American College of Healthcare Executives found that financial concerns, which had placed top on the survey since 2014, came in second among the 1,300-plus CEOs of community hospitals who responded. While 94% of the leaders said nursing shortages were most pressing, 45% said PCP shortages were on the top of their list of personnel issues and 43% said specialist shortages were most pressing. Becker’s Hospital Review reports that when it comes to financial issues, 87% of CEOs said costs for staff and supplies were the most concerning.

Have you seen prior auth problems put a patient in the hospital?

Prior authorizations are irritating for physicians and patients alike, but a new survey of physicians says that they can also cause patients physical harm. In the survey of 1,000 physicians, 24% of respondents said they had seen prior authorization issues cause a patient to be hospitalized, and 18% saw prior authorizations lead to a “life-threatening event.” Another 8% had a patient experience a disability or sustain permanent bodily damage–or even death–as a result of interference from prior authorizations. A MedPage Today article says that the survey, which was conducted by the AMA, found that 82% of physicians said prior authorizations can “sometimes” lead patients to “abandon” recommended treatment, and 30% said prior authorization criteria are rarely or never evidence-based.

February 11, 2022

What do malpractice lawsuits look like for internists and FPs?

malpractice-lawsuits

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 medical board. What do you do?

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

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While there’s been a lot of talk about shifting physician pay to value-based models, new research shows that more than 80% of primary care physicians and more than 90% of specialists are still paid based on volume. The study in JAMA Health Forum found that in 31 physician organizations affiliated with health systems, those systems are still giving physicians financial incentives to maximize their volume. A HealthLeaders article says that while financial incentives focusing on quality and cost are widely used, they account for relatively little percentages of physician income. Those bonuses account for only 9% of PCP income and 5% of specialist income. In about 70% of physician organizations studied, volume-based incentives accounted for more than two-thirds of compensation.

Which docs are spending the most time in their EHRs?

Most physicians would say they spend too much time with their EHR system, but new data say that factors like gender, specialty and geography have a big effect on how much time physicians spend on after-hours charting. A study by athenahealth found that physicians at larger organizations tend to spend about 8% more time with their EHR systems, in part because those organizations often have more complex documentation requirements. Specialty also matters, with primary care physicians averaging 23.3 hours per week on EHR time (the most in the report). Orthopedic surgeons, by comparison, spent an average of 17.9 hours per week on EHR time, the lowest in the report. Researchers also found that physicians in New England spent about 30% more time on EHR duties than physicians in the Southeast region of the country. And while there weren’t major differences in total hours spent on EHRs by gender, the report found that female doctors spent more EHR time outside of patient appointment hours. The data were collected in the first half of 2021.

January 26, 2022

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

money-get-paidA 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

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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.

What’s the biggest stressor for health care workers?

We’ve talked about how physicians are faring during the pandemic, but what about the nonphysicians who work with you? A new survey by the company Software Advice asked a wide range of health care workers—not just physicians—how they’re coping with stress during the pandemic. The top stressor is increased workloads due to turnover, which may explain why nearly half of respondents said their practice had seen between one and five people quit since the pandemic began. (Fear of getting infected with covid and discomfort from wearing PPE were the next two biggest stressors.) More than half of the workers interviewed said they had considered quitting because their jobs are so difficult, and 35% were considering leaving the industry altogether. The biggest factors that kept those people from quitting were pay and benefits, but loyalty to employers was also an important factor.

January 12, 2022

Hazard pay for health care workers: ready for prime time?

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.

Under omicron, delays in elective surgeries are returning

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.

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