November 24, 2021
Does telehealth make it harder to spot signs of drug abuse?
A new survey found that almost 70% of physicians worry that they may have missed signs of drug abuse during the pandemic, and the rise of virtual visits didn’t help. Quest Diagnostics found that 75% of physicians believe that telehealth limits their ability to spot signs of drug abuse. While 91% of physicians think they can spot signs of drug abuse during in-person visits, only 50% say the same thing about telehealth visits. A Fierce Healthcare report notes that the survey results come on the heels of news last week that a record number of Americans died of drug overdoses in 2020.
Virtual visits: more patient interactions, same follow-ups
Two new reports say that virtual visits lead to more patient interactions with health care providers, and that those patients are no more likely to need follow-up care. A survey by the telehealth company Good Rx found that 29% of patients interacted with providers more frequently because of telehealth and 11% interacted much more frequently. The survey also found that telehealth was preferred by 58% of patients, while 27% preferred phone calls. Another study in JAMA Network Open found that video and phone visits generated similar numbers of follow-up visits (about 25%) as in-person visits and no increase in ED visits or hospitalizations. The study also found that rates of prescriptions and ordering were lower for telehealth visits, with medications prescribed during 60% of in-person visits and 39% of video visits. Researchers found, however, that the utilization of resources at return office visits was slightly higher after video and telephone visits.
November 18, 2021
Women physicians suffered more depression during the pandemic
A new study shows that physicians who are also mothers bore more of the burden of family life during the pandemic than physicians who are fathers, with more physician mothers in the group reporting depression. A study published by JAMA Network Open Researchers found that physician mothers were 30 times more likely to be in charge of household tasks than physician dads, and they were twice as likely as men to work primarily from home and to reduce their work hours. The study concluded that gender disparities around the house likely increased during the pandemic, affecting physician mothers more significantly than physician fathers. Medscape coverage of the study noted that in families in which both parents were physicians, none of the men said they stepped up and were primarily responsible for managing additional demands caused by the pandemic. A 2018 survey didn’t show a significant difference in depression rates between male and female physicians.
Provider pay was largely protected during the pandemic
While health care organizations suffered financial bleeding during the pandemic, many groups made sure to protect the compensation of their providers. An MGMA report found that provider compensation as a percent of net revenue dropped slightly (from 24.2% to 22.8%) last year, but it was a small drop that allowed overall pay for clinicians to hold steady. Compensation levels for providers remained steady even as their productivity dropped because of falling volumes. Compensation wasn’t the only thing that groups protected for their providers: About 60%-70% of the groups said they trimmed costs by furloughing or reducing hours for clinical staff, but not providers. Healthcare Dive coverage notes that when provider pay is calculated as a percent of net revenue, it actually rose from 72% to 85%, but that’s primarily because revenue fell so far during the pandemic.
November 11, 2021
Watch for these traps in your employment contract
The pandemic has seen some health care employers adding language to their employee contracts to give them more flexibility to deal with unforeseen events. That language sometimes means that physicians can be terminated from their jobs with little to no notice. An MDedge report examines language like the “force majeure” clause, which allows employers to terminate employees or reduce their compensation in the event of a natural disaster, which can include pandemics. Other practices, particularly those owned by private equity firms, give employers the right to unilaterally change compensation or bonus targets. Analysts say this change may have come about because of the financial problems practices faced during the pandemic. The article gives physicians practical advice to negotiate over these and other tricky contract provisions.
Which patients are likely to have a successful video visit?
New research has identified patients who are most likely—and unlikely—to have a successful video visit with their physician. A study of more than 130,000 video visits at an academic health system in 2020 found that 90% of the visits were successful. The study, which was published in JAMA Network Open, found that video visits were more likely to be converted into telephone visits when the following factors were present: clinicians weren’t comfortable with the technology; patients were older (66-80); patients came from a lower socioeconomic background, which included a lack of high-speed Internet access); and belonging to a racial or ethnic minority. A HealthLeaders report notes that patients in higher income brackets ($75,000-$213,000) were associated with successful video visits, as were patients using a laptop or tablet.
October 27, 2021
Is it OK to refuse to care for the unvaccinated?
Is it wrong to refuse to treat patients who refuse to receive a covid vaccination? If you’ve asked yourself (or your colleagues) that question, you’re probably not alone. A report in MDedge says that while physicians can’t turn away patients because of their disease state, the decision to accept a patient can be affected by the risk to the physician and office staff of treating that patient. So if you think that treating unvaccinated patients might pose a risk to you and your staff, you might have an ethical reason for refusing those people care. In a commentary piece on Medscape, medical ethicist Arthur Caplan, PhD, argues that while outpatient physicians have a right to refuse to treat unvaccinated patients based on that kind of risk analysis, inpatient physicians have to approach the question much differently. For one, hospitals are legally bound to stabilize patients before discharging them. But Dr. Caplan says that inpatient physicians can potentially give unvaccinated inpatients less preferential treatment when resources are limited and an unvaccinated patient has a lesser chance of survival. If physicians can use vaccination status as a predictor of possible outcomes, he says, basing care on vaccination status may be acceptable.
Beware: Scammers targeting physicians attending medical meetings
If you’re thinking about hitting the conference circuit in the near future, beware of scammers targeting physician attendees. A MedPage Today article says that hackers are increasingly trying to trick meeting attendees into turning over personal information and access to their e-mail accounts. One of the more common tricks is to offer physicians an advance list of attendees at these meetings. Those e-mails are often a phishing scam that are trying to get into your e-mail account. Scammers have also created fake Web sites and are sending out fake messages that are allegedly from association presidents and other leaders. One way to spot fake messages? They often use flattery and flowery language to overstate the significance of the meeting and urgently demand a reply. Officials with medical societies say that while the attacks aren’t necessarily new, they are getting more aggressive. At least one association official speculated that because in-person meetings have been so rare, scammers are looking to make up for lost time.
October 20, 2021
Are doctors “donating” free labor to their employers?
When you have to spend time after hours on charting and documentation, do you think of it as time that you’re “donating” to your group or employer? A psychiatrist writing in STAT thinks of the after-hours work she performs in exactly those terms and rails against it in an opinion column published last week. The problem for her is so bad that every time she schedules some down time on nights and weekends to study for her board exams—the very exams that she needs to pass in order to continue caring for patients—she ends up spending most of the time on after-hours work for her job. She says that she regularly receives e-mails from other physicians in the middle of the night and quotes a 2016 study that found American physicians spend up to two hours of personal time after every workday completing patient care tasks. The author also talks about physicians she knows who have chosen to “fail” at tasks like returning e-mails, billing and documentation as one way to deal with the unforgiving volume of these tasks.
One in five physicians wants to leave clinical medicine
New data find that more than one in five (22%) physicians are considering leaving their jobs to pursue a nonclinical career. A Medscape survey found that 34% of those physicians blamed burnout, but not necessarily from the pandemic, for their interest in leaving their jobs. One-fifth of those physicians said they wanted to work fewer hours. A Becker’s report says that more than half of physicians considering a career change are planning to make a move within three years, and 80% are actively looking for other options. Education was the biggest area these physicians are exploring. The survey found that women physicians were more likely to cite burnout than men (39% vs. 30%) in their decision to leave medicine. Men, on the other hand, were more likely to cite work hours (22% vs. 17%).
October 13, 2021
Young docs see steady compensation from 2019-20
In 2020, young physicians neither gained nor lost ground when it came to compensation. A Medscape survey of compensation for young physicians, which it defines as doctors under 40, found that young PCPs averaged $242,000 in 2020, while young specialists averaged $344,000. Those amounts are strikingly similar to 2019 averages, which came to $243,000 for PCPs and $346,000 for specialists. When viewed by practice setting, solo office-based physicians had a slight edge in terms of compensation (an average of $305,000) over young physicians practicing in hospital settings (an average of $295,000). Overall, the survey found that young physicians earn less than their older colleagues, and that the biggest difference in pay by age is seen in outpatient clinics. But the survey also found that in specialties like emergency medicine, younger physicians were more satisfied with their compensation than older physicians. In emergency medicine, for example, 69% of young physicians were happy with their income compared to 60% of their older colleagues. The increased satisfaction with pay may or may not have something to do with the fact that only 14% of younger physicians are self-employed compared to 29% of older physicians.
Women physicians still lagging behind when it comes to pay
Two new reports show that women in medicine are still receiving less pay than their male colleagues. A report released last week by the Association of American Medical Colleges found that female physicians and scientists are paid significantly less than their male colleagues, earning as little as $0.72 for every dollar paid to men. While the report found that gender was a primary factor behind pay inequity, it also found that white men were more highly paid than men of other races and women of all races and ethnicities. And research published last month in JAMA Cardiology found that female cardiologists receive dramatically smaller Medicare payments than their male colleagues. A Medscape article says the study found that median Medicare payments for inpatient cardiologists were higher for men ($62,897) than women ($45,288). Payments in the outpatient setting were even farther apart. The Medscape article notes that while cardiology is one of three specialties in which women’s median salaries don’t reach 90% of men’s compensation, the new data don’t reflect gender discrimination from Medicare, but differences in the types of charges being submitted. When common inpatient and outpatient charges were compared, there was no difference in payments made to men and women. But data also show that male cardiologists submitted more unique billing codes than women.
October 6, 2021
How many physicians have closed up shop during the pandemic?
A research letter is questioning the idea that a lot of physicians have left—and will continue to leave—the profession because of covid. The research letter, which was published in JAMA Network Open, found that “practice interruption rates” (a month in which a physician dropped to zero Medicare billings) spiked in April 2020, but have been fairly consistent before and after that one month. In April of 2020, researchers found an “interruption” in 34,653—6.93%—of practices. By comparison, 1.43% of practices experienced an interruption in April of 2019. While 6.93% of practices stopped billing Medicare in April of 2020, most—5.79%—rebounded within six months. Just over 1% of practices, however, closed shop for good, and those practices tended to be staffed by older physicians, female physicians, physicians in smaller groups, and physicians working in metropolitan areas. An MDedge article points out that several surveys released last year found much higher rates of physicians leaving the profession. A Physicians Foundation Survey released in August of 2020, for example, concluded that 8% of physicians had already closed their practices because of covid and 4% planned to close their offices in the next year.
With 80% of physicians burned out now, are we in a crisis?
A new survey of physician burnout conducted by Medical Economics magazine finds that four out of five physicians say they’re burned out right now. On a nine-point scale, physicians on average rated their level of burnout a 6.8, with a score of nine representing “the worst burnout I’ve ever felt.” When asked about individual factors fueling their burnout, 31% identified the category of paperwork/regulations. Too many hours/poor work-life balance was a factor for 24%, and EHRs were a top factor for burnout in 11% of respondents. The covid pandemic was a top factor for 9% of physicians. When asked what strategies they use to manage burnout, 18% of respondents said they aren’t coping effectively. A slideshow has more data and quotes from physicians who responded to the survey.
September 30, 2021
One side effect of the pandemic: too many messages from patients!
Do you ever feel like you get way too many digital messages from patients? New data show how the pandemic may have contributed to that feeling. A Politico article reports that since the first 11 weeks of 2020, roughly the beginning of the pandemic, the number of messages from patients to doctors grew 151%. Those data come from the EHR giant Epic, which also notes that patients using its MyChart portal have doubled in the last two years. The Politico article cited a 2020 study which found that clinicians in the top quartile of message volume were over six times more likely to report “high exhaustion.” Experts quoted in the story say the trend is causing physicians to put in more hours of unpaid work every day. One potential solution may be artificial intelligence to help physicians cope with the volume.
Physician moms reported much higher levels of pandemic stress
While the pandemic has been hard on all physicians, new data show that it may have taken the toughest toll on female primary care physicians with children. MDedge reports that a study in the Journal of Mother Studies examined the experiences of 89 of female physicians with kids and found that 67% of respondents with kids said the pandemic had a “great” impact on their home life. (The study was conducted by the Robert Graham Center and the American Board of Family Medicine and asked respondents about their experiences from May to June 2020.) By comparison, only 25% of physicians without children rated covid’s impact as great. And physician mothers were more likely to feel the impact of the pandemic outside of the workplace than their colleagues without children. While 41% of physician mothers said that covid had “greatly” affected their home life, only 17% of female physicians without kids said the same. Researchers noted that besides dealing with the same stresses as other physicians, physicians with children also had to cope with childcare and homeschooling needs that popped up during the pandemic.
September 22, 2021
Unless Congress acts, Medicare pay for docs will be cut
Unless Congress makes some last-minute changes, physicians are facing a cut in Medicare of 4% or more in the federal government’s next fiscal year, which begins Oct. 1. A report in MDedge explains that Medicare Fee Schedule is poised to bring a 4% pay cut, and a gimmick to balance the budget known as sequestration is back at the beginning of 2020 after being put on hold. That will bring Medicare pay for physicians down another 2%. Many are hoping that Congress will toss out both pay cuts for physicians due to the ongoing pandemic and recent surges in covid. A decision from Congress is expected in early November. The good news in the world of Medicare pay is that more telehealth services will be covered in the next fiscal year and some specialties (like family medicine) will see a modest increase.
Meet the physicians spreading misinformation—and (mostly) getting away with it
While state licensing boards have threatened to punish physicians who are spreading misinformation about covid, relatively few physicians have actually felt any repercussions. According to Becker’s Hospital Review, an NPR investigation found that of 16 physicians who were spreading copious amounts of misinformation online, all but one still had their licenses. (It wasn’t clear if the license of the other physician had expired or was revoked.) Ohio recently renewed the license of a physician who discussed the idea that covid vaccines make recipients magnetic. (A portion of her testimony is online.) And in Pennsylvania, a physician posted on his Web site and his practice’s Facebook page a blanket mask exemption letter that anyone in the state could present to their local school district so their child wouldn’t have to wear a mask. MedPage Today reports that the physician blasted physicians who have abandoned patients in their “hour of greatest need” by not providing exemptions for masking and vaccines. There is one story, however, in which a physician has been punished for spreading misinformation about covid. Oregon revoked the license of a physician who refused to wear a mask while treating patients and who spread misinformation about masking. A Medscape report says the physician told patients that masks can’t contain the spread of covid and ignored other covid precautions, from taking the temperature of patients visiting his office to asking if they had been in contact with people who had symptoms of covid. The licensing board also claims that the physician, who specialized in pain management, had mismanaged patients he was treating for pain or opioid addiction.
September 15, 2021
How peer review can go sideways: Conversations with the reviewers
No one likes the idea of peer review, but an article in MDedge provides an idea of what can go on—and what can go wrong—during peer reviews. Several current and former peer reviewers interviewed for the article talked about the ways peer review can be derailed, often by the physicians serving on the review panels. One challenge can be dealing with the biases of reviewers, which can happen when a peer reviewer happens to be the biggest competitor of the physician under examination. In many of these cases, the reviewer attacks every action the physician took in the case. Sometimes hospitals that have an axe to grind with a doctor may even stack the review panel with unfriendly doctors to try to force the physician out. Other reviewers may be the opposite of aggressive and fail to do their jobs. They put off their review duties for so long that the case gets old and memories begin to fade. One physician who has served on numerous case review panels offered a tip to help physicians in the event that they undergo a peer review: Watch how much information you include in your notes. The family physician recalled the time he was reviewing the case of an elderly patient with a low-grade fever. The notes contained pages and pages of unnecessary information. After reading the notes several times, the reviewer was finally able to find the section where the physician talked about the likely cause of the fever. If reviewers can’t follow your thinking, the physician-reviewer explained, it’s difficult to determine whether you acted reasonably.
Telehealth in the hospital accounts for 20% of medical visits
Virtual visits in the hospital account for about 20% of total medical appointments, a number that appears to be levelling off. According to a recent survey of hospital executives, virtual visits in the hospital are most widely used for primary care and behavioral health. Fierce Healthcare reports that while hospital leaders expect to see continued growth in virtual care in those two areas, they are also planning for virtual care to have a growing presence in chronic pain management and urgent care. One survey estimates that telehealth utilization for office visits and outpatient visits may have peaked in April 2020, when virtual volumes were 78 times higher than they had been in February of the same year, just before the pandemic hit. By June of 2021, however, telehealth volumes started to fade as much as 10% per month according to some sources.
September 8, 2021
States are tightening telehealth rules. Will access to care tighten as well?
A new report warns that telehealth options available to patients during the pandemic may be coming to a close as regulators tighten the rules for virtual medicine. During the pandemic, most state licensing boards (and Medicare) waived the requirement that physicians be licensed in the state where their patients were located. But some of those relaxed rules are being rolled back. Kaiser Health News reports that in Baltimore, for example, Johns Hopkins Medicine has had to notify more than 1,000 of its patients in Virginia that they could no longer see their Baltimore-based physicians via telemedicine because of a change in Virginia law. The health system estimates that about 10% of its 300,000 patients who were served by telehealth during the pandemic will lose access to virtual visits. At least 17 other states are similarly rolling back rules that made it easier for patients to “cross” state lines virtually to see a physician.
Faced with surging volumes, hospitals offer new benefits to lure workers
Hospitals are trying to lure employees by increasing health benefits and offering new types of benefits like tuition reimbursement, flexible work options, cash-out vacation policies and child care. Healthcare Dive reports that a survey of more than 1,000 hospitals employing 2.4 million employees also found that three-quarters of hospitals plan to pay for 76% or more of their workers’ health coverage. In the survey, 36% of hospitals said they’re conducting normal hiring, but 40% are conducting “accelerated” hiring to meet surging demand.
September 1, 2021
Why physicians need to have a (strong) online presence
When it comes to online reviews for physicians, more really may be better. An analysis by the data management company Reputation examined nearly 350,000 health care reviews from more than 100,000 physicians and health care organizations. It found that physicians who had more online reviews had higher “reputation scores” and more “patient engagement.” (The report defines patient engagement as clicks on the organizations’ Google business listings.) A Medscape report notes that the company also surveyed adults about how they choose a physician. In 2020 (after the start of the pandemic), more than two-thirds of respondents said they went online at some point to get information about a health care provider. That number is up significantly from 22% in 2019 and 9% in 2018. The full report is available free of charge on the Reputation Web site after completing a brief registration.
Now you can chill out to videos of pharmacy techs counting pills
You’ve probably heard of the Internet phenomenon known as ASMR, short for autonomous sensory meridian response, which fans say produces a sense of total relaxation. While ASMR is often induced online by video or audio pieces featuring voices speaking in a hushed tone or people completing mundane tasks (turning the pages of a book, for example), health care is now getting a turn in the phenomenon’s limelight. MedPage Today reports that ASMR videos of pharmacy employees sorting and organizing pills and medicines have been getting tens of millions of views on TikTok. One 30-second video of a woman and the clacking sounds of pills being sorted has been viewed more than 65 million times (and “hearted” by more than 10 million). While the videos may bathe viewers in simple tasks, cranks on the Internet have taken to the comments section to criticize the video for things like depicting a pharmacy tech who isn’t wearing gloves or a hairnet and for trivializing what pharmacists really do.
August 25, 2021
Physician comp remained stagnant during the pandemic
Another report on physician compensation found that pay in 2020 remained stagnant while productivity plummeted because of the pandemic. The report from AMGA looks at compensation for physician groups employing nearly 200,000 of the country’s physicians. Fierce Healthcare says that the report found that overall physician pay went up less than 1% (0.12%) last year, a big drop from the 4% gain the group saw in 2019. Among PCPs, median compensation grew 0.40%; for specialties, pay increased 0.39%. One bright spot was family medicine, which saw a gain of 1.27%. Pay for surgical specialties dropped 0.84%.
New certification program available for telemedicine
You can now get a certification in “teleprimary care.” An online (of course) program from the American Board of Telehealth gives physicians information on best practices in telemedicine and helps them navigate issues in reimbursement, set-up costs and competition from retail clinics and urgent care centers. According to HealthLeaders, the program gives physicians strategies to optimize teleworkflow while maintaining care standards and examines legal and ethical considerations in telehealth. The course is being offered for $349.
August 18, 2021
Half of physicians experience “inappropriate” covid anger, anxiety
A year-plus into the pandemic, large numbers of physicians report that they’re suffering from covid-related stress. In a survey conducted by The Physicians Foundation earlier this year, more than half of physicians said that they’ve had inappropriate feelings of anger, tearfulness or anxiety because of the pandemic. Nearly half have withdrawn or isolated themselves from others, and just over one-third reported feelings of hopelessness or purposelessness. Since the pandemic began, 14% know of a physician who considered suicide, 4% know of a physician who attempted suicide, and 7% know of a physician who died by suicide. In addition to the mental health effects, nearly half of physicians lost income because of the pandemic, while 18% switched to a primary telemedicine practice. As the pandemic drags on, physicians said they’re seeing an increase in more serious health conditions among their patients and fewer physicians working in independent practices.
Telehealth visits stabilize, get good reviews from patients
While telehealth’s fortunes have gone up and down during the pandemic, there are signs that use of the technology is starting to stabilize. HealthLeaders reports that while telehealth’s percentage of claims had dropped earlier this year, it appears to have leveled off for now, at least, at about 5%. The South and the West have experienced the largest gains in the use of telehealth, while the Northeast and Midwest saw declines in the use of the technology. Another survey from the Bipartisan Policy Center found that one-third of adults reported using telehealth for a visit for themselves or a dependent in 2020, with 80% saying they were likely to use telehealth for routine and preventive health care during the pandemic. Medicare beneficiaries reported having the most telehealth visits.
August 11, 2021
Docs who spread covid misinformation could lose their license
Know a doctor who’s spouting covid misinformation? You might want to make a call to your state’s licensing board. Physicians and health care professionals who spread misinformation about covid vaccines could lose their medical licenses, according to the Federation of State Medical Boards. Becker’s Hospital Review says a statement from the organization, which serves as an umbrella organization of state medical boards, says that licensed physicians possess a “high degree of public trust and therefore have a powerful platform” to spread information. The organization says that physicians have a responsibility to act in the best interests of their patients and “must share information that is factual, scientifically grounded and consensus-driven for the betterment of public health.”
Can hospitals revoke your privileges to give someone else an exclusive contract?
Is it legal for a hospital where you work to revoke your privileges because it wants to give an exclusive contract to another physician or physician group? This type of “economic credentialing” is often justified by hospitals on the grounds that it’s more efficient to work with a single group of physicians, and it’s fairly common in specialties like hospital and emergency medicine. But a Medscape article says the practice can also be used to squeeze out physicians, like a group of cardiologists who have built their own imaging center that competes with a hospital’s facilities. Taking away those cardiologists’ privileges and giving exclusive privileges to another group—one that doesn’t own its own imaging services—effectively eliminates a source of competition, but is it legal? Analysts say that hospitals often prevail in these instances, but there are cases where physicians have won, and some states have limited the ability of hospitals to drop physicians’ privileges.
August 4, 2021
While PCPs fret about the future, independent practices are optimistic
Two surveys of physicians paint very different pictures of how U.S. physicians are gearing up to bounce back from the pandemic. Data from the Larry A. Green Center and Primary Care Collaborative found that even as health care ramps up its response to deal with a resurgence of covid, the mood among primary care physicians is grim. In a survey, 40% of PCPs predicted that primary care will be gone in five years, and 21% said they plan to leave the profession within three years. In comments, respondents complained about layoffs and pay cuts resulting from the pandemic and generally poor reimbursement unrelated to covid. Half of surveyed PCPs said the federal government needs to protect primary care as a “primary good.” Nearly half called for a move away from fee-for-service payments for primary care. A second survey of independent medical practices from a variety of specialties offered a much more positive picture, with practices saying they feel “stronger, resilient and positive” about their future.” Two-thirds of respondents expect their volumes to grow this year, and only 6% predicted their volumes will shrink. (In a 2019 survey, by contrast, 14% of practices said they were anticipating their volumes to shrink.) Healthcare Dive says the survey data indicate that many independent medical practices have stabilized their finances in 2020, with 51% reporting an increase in patients. One bright spot has been the promise of building patient volumes through telemedicine. Just over one-third (36%) of practices said they conduct at least half of their patient visits remotely.
Want more respect? Put on the white coat
If you want more respect from your patients, wear the white coat. A survey of nearly 500 Americans found that physicians wearing white coats were viewed as significantly more experienced, professional and friendly compared to physicians wearing fleece or softshell jackets. A study in JAMA Network Open found that conclusion was even more true for female physicians, who were rated by respondents as appearing less professional no matter what they were wearing. Women physicians will not be surprised to hear that survey respondents were also more likely to mistake them as PAs or nurses. MedPage Today says that because white coats are sometimes viewed as a “relic” of the old medical hierarchy, many physicians choose to wear more casual attire. But the study found that a white coat over business attire beat all other attire.
July 29, 2021
Less pay, fewer article citations for women in academic medicine
It’s been a rough few weeks when it comes to news for women in academic medicine. A research letter in JAMA Internal Medicine reports that women teaching internal medicine specialties are paid significantly less and are less represented in leadership positions. Healthcare Dive reports the study found that women earn 90% of the pay of men in 10 of the 13 specialties studied (or about $25,000 less per year). They earned an even lower percentage in cardiology, gastroenterology and critical/intensive care. Women also account for fewer (24%) of more senior faculty positions like professor and chief. Another study in JAMA Internal Medicine found that journal articles with women at the helm as primary and senior authors received nearly half as many citations than research authored by men. Researchers pointed out that women tend to have smaller professional networks than men and a narrower reach on social media and other virtual platforms.
A look at the side jobs that physicians work
It turns out that a lot of physicians work side jobs to supplement their incomes. A Medscape survey found that 37% of physicians had a side job. Some of the jobs aren’t very surprising, like medical moonlighting, expert witness and chart review. Others, like medical podcasting and medical cannabis consulting, are decidedly more modern. Nonmedical side jobs include real estate, investing, sports and raising/breeding/training animals. Physicians working side jobs reported spending an average of 16 hours a month on their side hustle, and about half said the main objective was to earn extra money. On average, respondents said they earned just over $25,000 per year from their side gig. Less than half (45%) said financial hardships under covid led them to take up a side gig.
July 21, 2021
Are noncompetes on the way out for physicians?
An executive order from the Biden administration asking the Federal Trade Commission to ban or limit noncompete agreements has put physicians, for whom noncompetes is a fact of life, under the microscope. While roughly half of private-sector employees live under some aspects of a noncompete, surveys say that closer to 90% of physicians have signed one of the agreements. Healthcare Dive says it’s unclear how quickly and how broadly the Federal Trade Commission will act to tackle noncompetes, but it notes that the agreements are becoming more prevalent among physicians because so many work for large companies. Provider groups and large health care organizations, however, argue that the agreements are needed because they pour so much time and money into training physicians. Fierce Healthcare notes that large health care organizations say that many states already limit the scope of noncompetes to keep from being overly broad, which limits the usefulness of a one-size-fits-all policy from the federal government.
Which specialty spends the least time working with EHRs?
What primary care specialty spends the least time working with electronic health records? A research letter published in JAMA Network Open found that while family physicians and internists each spend two hours a day working on EHRs, pediatricians spend about 20 minutes less. EHR time ranged from 94.7 minutes per day for pediatricians to 121.5 minutes per day for internists and 127.8 for family physicians. Researchers also found that pediatricians spend 34 minutes less on EHR duties during the workday and eight minutes less after hours. After-hours time spent on EHR duties was 23.6 minutes among pediatricians, 31.2 minutes among family physicians and 34.4 minutes among internists. Researchers concluded that the differences in time spent on EHR duties had nothing to do with patient volumes: Pediatricians recorded the highest number of patient encounters per day at 12.9 for pediatricians vs. 11.5 for internists and 12.8 for family physicians. The data did find that pediatricians spent half as long on in-basket messages and two-thirds as much time on clinical review and orders. Pediatricians also received one-fifth as many prescription messages, one-third as many patient messages and one-half as many team messages as their colleagues in family and internal medicine.
July 14, 2021
Court says health workers can’t be punished for speaking to media
Health care workers who go public with complaints or comments about their employers recently got a boost from the courts. In May, a U.S. Circuit Court of Appeals ruled that a hospital had violated federal labor law by firing an employee who had raised concerns about staffing shortages and safety concerns in a letter to her local newspaper during the pandemic. The ruling, which upheld a decision by the National Labor Relations Board in 2020, likely means that health care organizations can’t punish employees who talk to news media or post on social media. A Kaiser Health News article says that the labor board views “concerted activity” like speaking up about safety issues or joining with co-workers to address work-related problems as a protected activity. The appeals court affirmed the labor board’s ruling that barring contact between employees and the media is illegal.
How much money will you need to retire comfortably?
A Medscape article written by an internist who now works as a financial advisor to physicians tries to answer that question. While the author says there is no one-size-fits-all formula that will work for all physicians, he lays out some goals to achieve when planning to retire. He says he has clients who are happy living on $50,000 a year and others who need $250,000 a year. As a rule of thumb, however, the article says that mid-career physicians should put aside 20% of pre-tax income for retirement. The comments section offers some interesting perspectives on retirement from active and retired physicians.
July 7, 2021
Jobs offering doctors, nurses sign-on bonuses up sharply
The sign-on bonus appears to be making a comeback. A Becker’s Hospital Review article found that on Indeed, the number of all jobs (not just those in health care) featuring sign-on bonuses has doubled since July of 2020. The number of job searches for all jobs that include terms like “hiring bonus” has also doubled. (Those numbers come from an analysis conducted by Indeed.) For physicians and surgeons, the number of jobs on Indeed that feature sign-on bonuses is up 8%; for nurses, it’s up 11.3%. Because the job market is particularly hot for nurses, employers are offering sign-on bonuses of up to $30,000 in some locations. An article in Today’s Physician explores what to look for in sign-on bonuses.
While many return to normal, weary clinicians struggle at work
While much of the country returns to a pre-pandemic normal, many in health care are still weary from the last 18 months–and some are already bracing for the next wave of covid as the Delta variant begins to surge. A New York Times article takes a look at staff working at CoxHealth Medical Center in Springfield, Mo., where a spike in covid cases forced the health system to re-open a covid unit it had just closed in May. A physician quoted in the article says that staff are not only tired and feel unappreciated for their efforts, but disappointed that so many Americans have “started the end zone dance before we cross the goal line.” The article talks to physicians in other areas like South Dakota and Wyoming that are already seeing a spike in covid fueled by the Delta variant.
A Washington Post article talks about the stress and anger among nurses who deal with covid deniers who accuse them of being part of a hoax. Whether it’s talking to relatives who insist their intubated loved had “only the flu,” not covid, or fending off accusations that hospitals were falsely diagnosing covid in an attempt to boost revenues, these nurses are struggling to deal with conspiracy theories and misinformation about covid that are directed at them personally. When one nurse got vaccinated as part of an educational campaign at her health system, for example, she had to endure comments on Facebook suggesting that she was paid by Pfizer or that the needle didn’t actually contain the vaccine.
For some physicians, the challenges of working are exacerbated by changes in their actual organization. A small survey by the medical services company Athenahealth found that about half of physicians have been through an “organizational change” that is hurting how they view their work. About one-quarter of physicians reported a temporary furlough, while 14% reported layoffs. Those physicians were more likely to report burnout and isolation.
June 30, 2021
Hospital revenues and doc pay rebounding, but still behind 2019 levels
Physician compensation and hospital revenues are showing signs of bouncing back, but they still remain below levels seen in early 2019, a full year before the pandemic. A HealthLeaders article says that data from two reports issued by consultants Kaufman Hall found that physician compensation at employed groups was up only 1.1% from early 2020. One bright spot in the report was that patient visits at those groups are on the rise. In the hospital, by comparison, patient discharges are up 9.1% over 2020 levels, but still down 7.1% when compared to 2019. ED visits are stuck at about 2020 levels and remain significantly below 2019 levels. And while hospital revenue is up nearly 6% over 2019 levels, expenses are up by a whopping 17%.
A radiologist’s advice on how to handle bad online reviews
Are bills for your services causing patients to leave bad online reviews. In a MedPage Today article, a radiologist explains that her specialty is “infested” with bad Yelp reviews, in part because patients surprised by a radiology bill often lash out on social media. Her ideas to minimize bad reviews? For one, she suggested asking patients who actually pay their bills with little to no drama to leave reviews on a platform like Google. (Platforms like Yelp may actually penalize businesses that actively solicit reviews from customers, one comment on the article pointed out.) The radiologist also urged physicians to be careful to avoid disclosing protected information when replying to a bad review or complaint online. Her advice: Take the conversation offline as quickly as possible to avoid HIPAA fines that can start at $100 and go up to $50,000 for each breach.
June 23, 2021
Research documents how scribes can help a practice’s finances
You might think that medical scribes can help boost a medical group’s bottom line by allowing clinicians to see more patients, but new research shows that they can improve finances in other, more subtle ways. A Journal of Family Practice study found that clinicians working with a scribe were more likely to bill a higher level of service, more likely to include a hierarchical condition category code in their documentation, and more likely to order screening measures that are commonly tracked—and rewarded—by payers. Researchers found a 10% increase in clinicians billing a 4 or 5 level of service when working with a scribe, for example, and a 4%-5% increase in the number of clinicians ordering screening for breast cancer and colon cancer.
A downside of virtual care: clinician distraction
While many have extolled the virtues of virtual care during and after the pandemic, there are downsides. For a “significant” number of therapists, that challenge is to avoid becoming distracted during online sessions with patients. According to a survey of 600 therapists conducted by OnlineTherapy.com, 39% of respondents admitted that they check e-mails and social media during online therapy sessions, and 16% admitted to abusing substances before and during sessions. One-third admitted that they provided lower-quality care during virtual sessions. A MedPage Today article notes that respondents to the survey said that virtual sessions offered benefits like increased availability to patients because of flexible schedules and the ability for therapists to get a window into patients’ daily lives. But just over half said that patients are also easily distracted during sessions, and half also said that technological presented issues during online sessions.
June 16, 2021
Who were the financial winners and losers in the pandemic?
The pandemic produced decidedly mixed financial results for physicians, according to a new Medscape report on physician wealth and debt. On one hand, the Medscape survey found that 56% of respondents reported having a net worth of more than $1 million in 2020, up from 50% in 2019. But that gain was balanced by the fact that one-third of physicians reported suffering a financial loss in 2020. According to a Fierce Healthcare article, the report found that overall, physician incomes remained relatively stable during the pandemic. Primary care physicians saw their average income drop only $1,000 in 2020 (to an average of $242,000), while specialists saw their pay drop only $2,000 that year (to an average of $344,000). The Medscape report says that physicians’ income was probably helped out by the rising value of real estate and stock portfolios, which spiked upwards during the pandemic.
The primary care practices with the least burnout are…
According to a Health Affairs study, the primary care practices that have the least burnout are owned by physicians and practice old-school medicine (as opposed to practices that get involved in “transformative” models like ACOs). According to an MDedge article, 30% of physician-owned primary care practices reported zero burnout, and solo practices were five times as likely as groups with 6-10 clinicians to report no burnout. Researchers also found that the busiest physicians in smaller practices were much less likely than those in larger practices to report burnout, and that the volume of Medicaid patients a practice saw seemed to have no bearing on rates of burnout. Researchers also concluded that EHRs were not linked to higher or lower levels of burnout among physicians in the study.
June 9, 2021
Report summarizes covid’s impact on group practices
A new report from MGMA may not offer many surprises, but it summarizes the financial impact covid had on physician groups. The organization, which represents group practices of all stripes, found an unexpected surge in physician retirement last year. (One-third of practice leaders reported seeing that trend in their groups.) A HealthLeaders article says that nearly every group saw a drop in patient volume in April 2020, and 71% said they saw a drop of 50% or more. By June 202, however, a recovery was underway, with practices reporting higher levels of work RVUs in that month than they had seen in February and March of 2020. Despite that recovery, more than 80% of practice leaders said that some or all of their providers saw their compensation take a hit.
Who has the most paperwork, administrative tasks?
According to new Medscape report, infectious diseases physicians spend more time on paperwork than their colleagues in any other specialty, and by a large margin. According to the Medscape Infectious Diseases Physician Compensation Report, ID physicians spend 24.2 hours per week outside of patient visits on tasks including EHR documentation, administrative and managerial work. That’s significantly more time than public health physicians, who ranked second in terms of administrative time at 20.7 hours per week. Internal medicine came in fourth place on the report with 19.7 hours per week spent on paperwork and administration, while family medicine came in 10th place with 17 hours per week. The report also found that ID physicians are working more hours than before the pandemic (60 vs. 52) and seeing more patients (78 vs. 66).
May 26, 2021
Who is thinking of leaving health care because of pandemic stress?
A survey of 5,000 clinicians found that about one in five is considering leaving the workforce because of the stress of the pandemic, and another 30% say they are considering cutting back their hours. The study, which was published in April in JAMA Network Open, found that half of respondents who are parents said that parenting and managing virtual schooling for their children were big stressors. Researchers also discovered that while 27% of respondents thought their productivity had increased during the pandemic, 39% thought it had dropped, which caused stress. A Medscape article notes that respondents who were younger, married, part of a racial/ethnic minority and worked in a clinical setting were more likely to consider leaving the workforce. Female trainees were also more likely to consider leaving the workforce than their male counterparts.
Responding to bad online reviews? Don’t forget about HIPAA
You’ve gotten a bad online review, and you’re dying to defend yourself by posting a rebuttal. The advice from health care attorneys, however, is clear: Don’t do it. An MDedge article says that hashing out the details of a sour review online is a bad idea because any information you provide could be a breach of HIPAA laws. The article points out that in 2013, a California hospital paid a $275,000 penalty when it responded to a bad online review. The article notes that even responding to good reviews can land you in trouble, as a physical therapy group found out after posting patient testimonials without first getting HIPAA authorizations. That practice ended up paying a $25,000 fine. So what’s the best way to respond to any kind of online review? The MDedge article says the best advice is to simply ignore it, but you can also try to solicit positive reviews to outnumber the negative comments.
May 19, 2021
New physicians seeing fewer (but still a lot) of job offers
A new survey finds that physicians looking for their first job are getting fewer job offers than in the pre-covid world, but that doesn’t mean that recruiters aren’t courting them. A Merritt Hawkins survey found that new physicians are still receiving a lot of job offers, with 62% saying they received 26 or more recruiting offers in their final year of residency training. (Only four years ago, by comparison, 86% of new physicians got 26 or more recruiting offers.) When broken down along gender lines, 70% of female residents received 26 or more recruiting offers, compared to 54% of male residents. Female physicians, however, aren’t expecting that interest to convert into more money. While 38% of female residents expected to earn $251,000 or more in their first job, 76% of male residents expected to earn that kind of money. The survey also found that covid has not caused many new physicians to rethink their choice to work in medicine. Only 3% “strongly agreed” that covid had caused them to rethink their career plans, while 49% “strongly disagreed.”
Why do women physicians get less out of social media?
When it comes to networking via social media, women are finding that their efforts don’t pay off nearly as much as men’s efforts in terms of invited lectures and scholarship opportunities. A JAMA Network Open study found that while similar numbers of men and women use social media for professional networking, female physicians were less likely than their male colleagues to report that social media expanded their research portfolio (36% of women vs. 48% of men), resulted in a speaking engagement (30% vs. 39%), or led to a scholarship opportunity (21% vs. 25%). Researchers found that while women were more likely than men to use social media to build a support network (73% vs. 55%), women were less likely to report using social media to learn about research (68% vs. 83%) or clinical topics (76% vs. 86%). Another study previously found that female physicians tended to have fewer followers, retweets and likes, which the authors think may have something to do with the limited impact of women physicians’ activity on social media.
May 12, 2021
Shift by doctors to work for someone else accelerating
Data from the AMA show that in 2020, less than half of U.S. physicians were working in practices owned by physicians, a number that is steadily shrinking. A Fierce Healthcare article covers the AMA’s latest survey data, which show that 49% of nearly 3,5000 physician respondents are working at physician owned practices, a number that is down 5% from the last time the organization asked the question in 2018. It’s also the largest drop the AMA has seen since it started surveying doctors in 2012. The survey also found that the number of respondents working in groups with 50 or more physicians jumped from 14.7% in 2018 to 17.2% in 2020. Women and younger physicians were more likely to work as employees, and pediatricians and family physicians topped the list of specialties whose physicians were employed.
Burnout related to EHR support, after-hours charting
A study in the Journal of Informatics in Health and Biomedicine looked at the link between physician burnout and two factors: the support physicians receive when it comes to using health records and the time they spend on after-hours charting. Researchers found that physicians who spent five or fewer hours per week on after-hours charting were twice as likely to report lower levels of burnout than physicians who spent six hours or more a week on after-hours charting. They also found that physicians who think their organization has done a “great job” with EHR implementation, training and support were twice as likely to report lower burnout scores. The study found that the specialties with the highest rates of burnout were family medicine (34% ), hematology/oncology (33%) and internal medicine (32%). Specialties with the lowest burnout rates were psychiatry (22%) and anesthesiology (24%).
May 5, 2021
Health care workers not born in U.S. work more nights, hours?
New data show that health care workers who were born outside of the U.S. work longer hours and in underserved areas more than their U.S.-born counterparts. An analysis of Census data found that the 17.3% of health care workers born outside of the U.S. worked 32 to 72 hours more per year, were more likely to work at night and in skilled nursing and/or home health settings, and were more likely to live (and likely work) in medically underserved areas. The study found that Asians account for the largest group of foreign-born health care workers (43%), and 68% were women (compared to 78% of U.S.-born workers). The data also show that major metropolitan areas in California, New Jersey, New York and Texas had nearly twice as many foreign-born health care workers than other parts of the country.
Study of critical care nurses looks at link between stress, errors
A new study of critical-care nurses points to a link between mental well-being and medical errors. The study found that nearly two-thirds of critical care nurses had reported having made medical errors in the past five years, and that there were significantly more errors among nurses who reported experiencing mental health issues. A HealthLeaders article notes that nurses who reported worse mental and physical health had a 31% to 62% higher likelihood of making a medical error. Researchers also found that nurses working at organizations that they thought emphasized their well-being made fewer medical errors and were twice as likely to be in better overall health. The study surveyed nearly 800 nurses between August 2018 and August 2019. A study of RNs working at New York University’s Langone Health System similarly found that nurses say that institutional resources such as training on how to use PPE and supportive co-workers go a long way to reducing stress and anxiety.
April 28, 2021
Intensivists feeling stress of working in pandemic
While the pandemic shows signs of easing up in some parts of the U.S., there are signs that critical care physicians are continuing to struggle with stress and PPE shortages. A study published last month in Critical Care Medicine found that as of November 2020, 51% of intensivists were still reporting moderate to extreme levels of stress and that women working in the ICU reported even levels of stress that were about 10% higher. Nearly half (46.5%) of respondents said they were still facing staffing shortages, and while reports of shortages of materials had been cut in half from earlier surveys, 20% of respondents were still reporting shortages of N95 masks, a shortage researchers said was substantial. The data are viewed as relevant because some parts of the country have seen a resurgence of cases in the spring rivalling caseloads seen in the fall.
Are your patients getting second opinions yet?
If you haven’t had to deal with a patient getting a second opinion, you might want to prepare yourself. While the business of second opinions has been growing for years, one of the country’s best-known teaching hospitals has now entered the market. Since Cleveland Clinic launched a virtual second-opinion service 18 months ago, 72% of the patient cases it has seen have resulted in changes to treatment plans and 28% have produced a change in diagnosis. A HealthLeaders article notes that the program doesn’t technically render a second opinion or diagnosis, but instead offers an “educational consult” that gives both patients and original physicians treatment options and information they may not already have. The program doesn’t say how many cases it handles, but its business has doubled in the last month. The program is popular with people seeking second opinions because Cleveland Clinic offers 24-48 hour access to specialists in more than 550 advanced specialties.
April 21, 2021
Physician income (for some) rebounds from last year’s low
When it comes to physicians’ income, 2020 was a volatile year. But according to a new report, doctors’ compensation for many specialties has rebounded. Based on responses from more than 18,000 physician across 29 specialties, the 2021 Medscape Physician Compensation Report finds that primary care incomes stayed more or less steady while specialists’ dipped only slightly (around $2,000). Almost half of respondents (44%) reported a drop in patient volumes, while close to one in four reported working fewer hours as a result of the pandemic.
So what drove the rebound in income? Several factors, including the much broader use of telehealth, government relief and patients returning for needed services after the lockdown have contributed to the recovery. Plastic surgeons reported a 10% increase in income over the previous year, driven by what FierceHealthcare coverage called the “Zoom boom.” Oncologists also saw their income rise (7%), as did cardiologists (5%). Internal medicine and emergency medicine, however, saw a 1% reduction in income from the previous year, and the lowest earners included those in public health and preventive medicine, family medicine and pediatrics.
What does career satisfaction look like post-pandemic?
Compensation wasn’t the only thing that took a hit during the pandemic. A survey of 2,000-plus clinicians found 43% of respondents said that covid had a significant or moderate negative impact on their career satisfaction. For physicians and nurses working in “frontline” care, which included internal medicine, critical care and hospital medicine, 67% reported a negative impact. For physicians and nurses working in emergency medicine, 57% said they had felt a negative impact. The survey, which was conducted by the staffing firm CHG Healthcare, found that most clinicians (69%) felt like their employers did a good job overall responding to the pandemic, but there were complaints. Only 51% of clinicians felt their employers had adequate staffing levels, and only 45% of clinicians felt that their pay was equal to the work they were asked to do during the pandemic. Most clinicians, however, said they felt like their jobs were secure.
April 14, 2021
For older patients, online factors not so important for choosing a doc
How important is an online presence for older patients who are choosing a physician? A new study in Annals of Internal Medicine of patients between 50 and 80 years old found that 20% of respondents said that online ratings and reviews are very important, but more people—23%—said that word-of-mouth recommendations are just as important. But a HealthLeaders article says that the top three factors for older adults were acceptance of insurance (93%), time to get an appointment (61%), and convenience of office location (59%).
Working nights alters “circadian rhythmicity of genes”
We all know that working nights stinks, but new research yields data on how night work may increase your risk for cancer. An MDedge article says that researchers found a simulation of night work changed “the normal circadian rhythmicity of genes,” which can lead to hallmarks of cancer. The study, which appeared in the Journal of Pineal Research, concluded that night work reduces the ability of the body’s RNA to repair genes affected by working at night. During the simulation, some of the genes of participants lost their normal day-shift rhythmicity. The study also found that night work increases endogenous and exogenous DNA damage.
April 7, 2021
Which state has the most disciplinary actions against docs?
Your chance of getting in trouble with your licensing board may depend largely on what state you live in. Data released by the advocacy group Public Citizen found that between 2017 and 2019, Kentucky had the highest rate of “serious” disciplinary actions against physicians, with 2.29 cases per 1,000 physicians in the state. The lowest rate of disciplinary actions came from Washington D.C., which had only 0.29 actions per 1,000 physicians. That means that Kentucky had eight times as many disciplinary actions as the nation’s capital. Overall, 32 states had half as many disciplinary actions as Kentucky. California, which has the most physicians in the country, ranked 33rd on the list with 0.85 serious disciplinary actions per 1,000 doctors. Public Citizen would like to see more disciplinary actions against physicians, claiming that such actions protect the public from “dangerous doctors.” The data used to create the report come from the National Practitioner Data Bank.
“Open notes” is officially here: What does it mean for you?
Now that health care organizations are required to give patients access to notes (along with test results and lab reports), how will those notes be affected? As of April 5, the federal government began requiring health care organizations to provide “free, full and immediate electronic access” to notes and other documentation. A Medscape article says that physicians don’t necessarily have to change their style of documentation, but the reality is that some health systems are asking clinicians to do just that. Physicians quoted in the Medscape article suggest that clinicians write their notes using a similar style and tone they use when speaking to patients in person. Some physicians expect that patients with chronic health conditions will be most likely to read their notes, and other physicians have found that patients tend to actually enjoy reading their notes. The Medscape article also notes that it’s OK to keep certain information out of patients’ notes if there’s evidence that withholding information will “reduce the risk of harm” to patients or third parties.
March 31, 2021
Malpractice premiums on the rise after period of relative rate stability
The relative stability in medical malpractice insurance premiums that many physicians enjoyed in the 2010s seems to have come to a halt, with 2020 seeing a greater increase in premiums than any year other than 2005. According to research from the AMA, more than 30% of premiums increased from 2019 to 2020. That followed a similar jump in premiums from the year before, when 26.5% of premiums rose. (In 2018, by comparison, 14% of premiums rose.) The good news is that in some specialties in some states, premiums have dropped significantly in the last decade. The report shows that some Pennsylvania internists, for example, have seen their average premium drop from the high $30,000 range to the high $20,000 range. More detailed numbers about premium charges for three specialties (ob/gyn, internal medicine and general surgery) in a limited number of geographic areas are available in the report.
Busted! Health care workers bragging about fake vax cards
Health care workers hitting social media to brag about their ability to obtain fake proof of vaccination (yes, it’s a thing) are being called out over their efforts. There was the pharmacy tech who bragged on TikTok that she “grabbed a bunch of blank” vaccination cards for her and her husband. There was the nurse who asked the pharmacy tech if she could have some of the cards. And documenting it all were two other TikTok users (one of them a pharmacist) who have made it their mission to track down this type of activity by health care professionals. According to an article in the Daily Beast, the two have posted more than half a dozen videos on TikTok drawing attention to health care workers who are forging or trying to forge vaccine cards. The two are forwarding the evidence they find to local medical boards. Public health experts interviewed for the article say that health care workers talking about forging vaccination cards undermines the faith the public has in medical institutions and their ability to keep people safe. And the two TikTok users who are hunting down vax card forgers have themselves faced pushback, with one of them having to change her phone number after she began receiving harassing phone calls.
March 24, 2021
Almost half of all health care workers have not been vaccinated
While health care workers have been at the front of the line to receive vaccine, a new poll indicates that more than four out of 10 health care workers have not been vaccinated. The poll, which was put out by both the Kaiser Family Foundation and the Washington Post, finds that just a bare majority (52%) of health care workers across the country have received at least one dose of covid vaccine. While an additional 19% were either scheduled to be vaccinated or planned to be, 18% did not plan on being vaccinated while another 12% remained undecided. More than one in three surveyed health care workers reported not being confident that the vaccines were safe and effective. The survey, which was held mid-February to early-March, gathered responses from more than 1,300 health care workers. In related news, Kaiser Health News reports that new covid cases among nursing home staff members have plummeted by more than 80%. That’s despite the vaccine hesitancy felt by many staff members, with some nursing homes reporting that only half their staff have been vaccinated so far.
A drive-in Match?
It was once again a remote Match Day last Friday for more than 33,000 medical students and the more than 2,600 candidates around the world looking for residency slots. It was also an historic one that offered the most positions in Match history, with the number of slots up 3% from last year. MedPage Today reports that the need to hold a virtual Match Day led many medical schools to become creative, with at least one school holding a drive-in Match ceremony while another sent bottles of champagne or cookies to students’ homes. As for remote matching, students noted that not being able to travel to in-person interviews allowed them to apply to more programs. Internal medicine drew one-quarter of all applicants, with the number of internal medicine positions up 25% over five years ago. Over that same time frame, the number of family medicine positions increased 44%.
March 17, 2021
Are employed physicians having second thoughts about their career choice?
While huge numbers of physicians have decided to work for large employers, new data show that a considerable number of those physicians may be questioning that decision in part because of the pandemic. A survey by Jackson Physician Search found that 69% of employed physicians said they are “actively disengaged” from their employers and that half are considering looking for a new employer. Slightly more than half (54%) said that the pandemic has changed their employment plans, 21% may retire early, and 15% are thinking about leaving the practice of medicine. The survey also found a startling disconnect between the views of physicians and administrators. While 69% of physicians say they’re disengaged, surveyed administrators estimated that only 35% of their physicians felt disengaged. Similarly, while 83% of surveyed physicians said their employers have no retention plan, only 30% of administrators said that they have no retention program. A Medscape article notes that when it comes to retention, 63% of physicians said the most important factor was increased pay, while 12% identified additional time off, 8% pointed to reduced call, and 4% identified paid sabbaticals.
Independent physicians see some relief, but feel left out of vaccination effort
While employed physicians may be having second thoughts about their decision to work for someone else, many of their colleagues in independent practices are finally coming up for air after struggling for their financial survival during the pandemic. An article in Healthcare Dive says that the good news is that for many of the practices that survived the pandemic, many have shored up their finances and are no longer facing an imminent threat of going out of business. The article says that interviews with practices found that patient volumes have returned to some semblance of normal, but that expenses—particularly for PPE—remain high. But one sore spot that remains, particularly for primary care physicians, is the fact many have been shut out of the vaccine efforts. Physicians interviewed for the article say that excluding independent practices from the vaccine effort makes no sense, particularly because those practices administer about half of all vaccines during normal years.
March 10, 2021
ABIM extends deadline for MOC requirements until end of 2022
If you can’t complete your recertification MOC requirements this year, the ABIM will give you a break. For the second time since the pandemic began, the ABIM has extended its deadline for completing the MOC. The ABIM says that physicians will not lose their board certification if they aren’t able to complete MOC requirements, and that physicians who had an assessment, points or an attestation requirement due in 2020 or 2021 now have until the end of 2022 to complete those items. More information is available online.
Will virtual primary care compete with the nation’s PCPs?
As U.S. insurance companies launch virtual medicine services, some physicians are worried that technology will end up separating patients from their local primary care physicians. An article in MDedge raises the possibility that mega-insurers could take advantage of loosened telemedicine regulations to encourage patients to get more care from virtual panels of physicians, in part to cut their costs. (Some data show that fewer prescriptions and tests are ordered in telehealth visits.) Physicians say that while telemedicine is appropriate for one-off visits for acute care, primary care visits benefit from in-person visits, particularly when it comes to patients with chronic conditions. Local PCPs not only develop long-term relationships when seeing patients in person, the thinking goes, but they also know the specialists in their area and help patients choose the best one. Data published by HealthLeaders show that telehealth grew from 0.22% of commercial insurance medical claims in December of 2019 to 6.51% of all medical claims in December of 2020. In a sign that telehealth continues to grow, commercial insurance medical claims also grew 8.3% from November to December of 2020.
March 3, 2021
Physicians affiliated with health systems take home more pay
Physicians who are affiliated with hospitals and health systems tend to earn considerably more than physicians working for independent groups. A MedPage Today article says that researchers found that physicians affiliated with a health system earned an average of $114,000 more than non-affiliated physicians. Researchers found that primary care physicians on average can make $63,000 more if they’re integrated into a hospital or health system, while specialists can earn an average of $178,000 more. Surgeons integrated with a health system can earn on average $150,000 more. Differences in pay by specialty ranged from $363,000 more for urologists to $15,000 for psychiatrists. The study also found that the higher pay rates were associated with a “modest” probability that physicians would integrate with health systems, and that PCPs and specialists were more likely to integrate with health systems because of pay than surgeons. The Medscape article says the pay differences stem from Medicare’s outpatient payment policies. The data were published by the journal Health Services Research.
One quarter of physicians personally attacked on social media
A pre-pandemic survey found that nearly one-quarter of respondents felt they had been personally attacked on social media. While there were no substantial differences in the number of attacks by gender, women were much more likely to report online sexual harassment (16.4%) than men (1.5%). Respondents said that themes like advocacy on topics like vaccines, abortion and smoking were associated with attacks, but even topics like patient care and personal information were associated with attacks. The data, which appeared in JAMA Internal Medicine, was based on a small survey of less than 500 people, which led researchers to call for a larger study. In a separate article, one of the study’s authors predicted that if the survey were conducted again today, many more physicians would report personal attacks because of the politicization of health care information during the pandemic.
February 25, 2021
Is state-based physician licensure due for a post-pandemic change?
Will the boom in telemedicine during the pandemic make the recent flexibility physicians have seen in state licensure permanent? A perspective piece in the New England Journal of Medicine says that while changes like states and Medicare recognizing out-of-state licenses is a positive development, health care needs to do more to make physician licensure more flexible. The authors say that legislation encouraging states to participate in the Interstate Medical Licensure Compact could help lead to licensing reciprocity. (A MedPage Today article says that less than 1% of U.S. physicians have made use of that compact.) The authors of the NEJM piece also note that they support a state-based system of licensure, in part because disciplinary actions can be best administered locally.
Physician moms at high risk of burnout in the pandemic
Physicians who are also mothers are facing extreme levels of anxiety during the pandemic. In a survey of more than 1,800 physicians conducted in April by the Physician Moms Group, 41% of respondents had scores that indicated moderate to severe anxiety, and 18% indicated that they suffer from severe anxiety. Anxiety was higher for physician moms who were frontline workers (46%) than for respondents who weren’t frontline workers (37%). The data were published in a letter in the American Journal of Psychiatry. The authors noted that in the past year, about 19% of American adults experienced any type of anxiety disorder. Researchers noted that data from China found that female health care workers experienced a disproportionate amount of anxiety during the pandemic.
February 17, 2021
Report: How PCPs have survived the pandemic
Despite dramatic reductions in patient volume due to the pandemic, the nation’s primary care practices are finding ways to survive. That’s according to a new report from the Robert Wood Johnson Foundation, which is based on a review of published data and interviews with 16 PCPs. The report found that the PCPs researchers interviewed were able to survive by embracing shifts in business models (think telemedicine) and by taking advantage of government assistance (PPP loans) when available. The physicians who participated in the report said that those two developments were critical to the survival of their practices. A HealthLeaders article says that moving forward, many primary care practices may be more willing to explore consolidation and acquisition, and others may be more willing to consider capitated agreements.
IMs, FPs show changing views on medical ethics
New data show that internists and family physicians may be showing signs of changing their thinking on some major ethical issues. A Medscape report found that a growing number of internists and family physicians think it’s OK for a physician to have a romantic or sexual relationship with a patient once the patient has no longer been receiving care for six months. Nearly one-third (31%) of internists think it’s OK (up from 22% in 2018), while 33% of family physicians agreed (up from 28% in 2018). Another example: While upcoding was supported by 17% of physicians 10 years ago, that number has dropped to just 8% today. Internists were a little more flexible on the topic, with 15% responding “it depends.” (One internist said upcoding could be justified if it would help patients obtain necessary services.) The data come from a series of surveys conducted by Medscape.
February 10, 2021
Which specialties did, and didn’t, embrace telehealth in 2020?
Researchers looking at how telehealth exploded in 2020 have compiled a list of the specialties that were the most—and least—likely to use the technology during the early months of the pandemic. A Health Affairs study found that nearly one-third of patient visits in late 2020 spring/summer took place via telehealth, which constituted a 23-fold increase in the use of the technology. Specialists that used telehealth the most (defined as using the technology at least once) included endocrinologists (67.7%), gastroenterologists (57.0%), neurologists (56.3%), pain management physicians (50.6%), psychiatrists (50.2%) and cardiologists (50.0%). Specialists that used telehealth the least included orthopedic surgeons (20.7%), ophthalmologists (9.3%), physical therapists (6.6%) and optometrists (3.3%). During the pandemic, six specialties conducted about half of all visits via telehealth: psychiatry, gastroenterology, endocrinology, social work, psychology and neurology. Researchers also found that despite the rise in patients using telehealth, overall patient volumes during the first six months of last year fell 35%, although specialties that embraced telehealth saw smaller drops in volume. A Fierce Healthcare report on the study says that nearly 80% of patients who used telehealth were commercially insured and nearly 90% lived in an urban area. The study found that patients in areas with higher poverty rates were less likely to use telemedicine; in those areas, 28% of patients did not use telehealth.
New data show how the gender-based pay gap is tied to specialty
When trying to explain why female physicians are paid less than men, analysts have often noted that women tend to work in lower-paying specialties (think pediatrics). New research has been able to quantify just how much less physicians make in specialties dominated by women—and how that wage difference applies to both male and female physicians. A study published in JAMA Pediatrics looked at the salaries of 120,000 academic physicians in U.S. medical schools. Researchers found that for every 10% of women who work in a specialty, there was an $8,255 decrease in mean salary for all physicians (both men and women). When researchers drilled down deeper, they found that the wage gap hit women twice as hard as men. While men in specialties with a large percentage of women earned $7,465 less than the mean compensation, women earned $15,003 less than the mean. The data led the researchers to conclude that “The days of devaluing women’s work should be long behind us; yet, in the medical profession, the work has hardly begun.”
February 3, 2021
Report names most hazardous technology in health care
An annual list of the top 10 hazards in health care that result from technology run amok puts a special focus on the unintended consequences of workarounds created to deal with the covid pandemic. ECRI, a national patient safety organization, said that the FDA’s move to temporarily authorize hundreds of devices during the pandemic was the No. 1 threat to patient safety, because the temporary approval process uses a lower standard when an emergency use authorization is granted. According to a Medscape article, another pandemic-related technology threat includes the rapid adoption of telehealth, which ECRI says could compromise not only patient care, but the confidentiality of patient information. The report says other hazards include inadequate PPE imported from other countries, consumer-grade products like pulse oximeters, and the hasty deployment of disinfection technology.
Physician compensation down 4.5% from 2019-20
New data show that compensation for physicians dropped nearly 5% in 2020 because of the pandemic. The report, which was issued by the consulting firm KaufmanHall and contains data from practices employing 68,000 physicians, says that after seeing patient volumes crash during the early months of the pandemic, many practices saw those volumes rebound in the summer and fall. The good news was that physician compensation jumped 1.5% between July and October, but those gains weren’t enough to offset losses earlier in the year. As a result, compensation per work RVU was still down 4.5% for the year. The report notes that many practices have reported a lull in patient visits and a slowdown in hospital diagnostic services and procedures over the last few months, a trend that KaufmanHall predicts will continue throughout the first half of 2021.
In related news, a report issued jointly by the Medical Group Management Association and Humana found that by April of last year, 97% of physician practices had reported a drop in care volume. The report found that 87% of patients said they skipped appointments due to concerns about safety. Another 9% blamed a loss of jobs and/or insurance. A Fierce Healthcare article looks at the ways that telehealth was used to fill in those gaps in patient visits.
January 27, 2021
How much of a pay cut would you take to be happier?
How much of your salary would you sacrifice to be happier outside of work? According to a new Medscape survey, nearly half of physicians said they would take a cut in exchange for being happier. About one-third of physicians said they would take a cut of $10,000-$20,000, and another third would take a cut of between $20,000 and $50,000. Not surprisingly, there’s evidence that those numbers are being driven by the stress of the pandemic. According to a Medscape article, the survey found that the number of physicians who said they’re very happy outside of work dropped dramatically in the last year, from 43% before the pandemic to only 20% post-pandemic. The survey looked at many other issues, from physicians’ happiness in marriage to how much vacation they take.
The challenges medical practices faced in 2020
A series of surveys focused on medical practice leaders sheds some light on the biggest challenges groups faced in 2020 because of the covid pandemic. Over the course of 2020, MGMA polled the leaders of medical practices about the challenges facing their organizations. Here’s a summary of the results of those surveys published by MDedge.
- Provider income. In May, 82% of practice leaders said that some or all of their providers’ incomes had been affected by the pandemic. About 62% said that all of their providers’ incomes had been affected.
- Staffing shortages. In March, 40% of practices said they were experiencing staff shortages. As a result, the following month, 53% of practice leaders said they were trying to address the mental health of providers and all staff.
- Billing & coding. The top billing and documentation challenges for practices came in the form of billing for telehealth and telephone visits during the pandemic. Respondents said the top three billing issues were inconsistent rules from payers, the accuracy of payment, and the documentation of virtual visits.
- Vaccines. While delays in the covid vaccine are on everyone’s minds, a September poll found that medical practices were having trouble getting their hands on the flu vaccine. That survey found that one-third of practices were experiencing delays in getting the flu vaccine.
January 20, 2021
Video can be effective follow-up tool for low-risk surgeries
Telehealth has been particularly popular in specialties like mental health, but new data show that it might be a growth area for surgeons. A study in JAMA Surgery found that surgeons had similar levels of success conducting follow-up for patients who have had low-risk surgeries via video as with traditional in-hospital visits. One encouraging sign was that while the video visits were shorter (20 minutes for video vs. almost 50 minutes for in-person), patients still got the same amount of time with their surgeons (about eight minutes.) A MedPage Today article says one barrier to the video calls was working with non-English speakers. Interpreters were available for the calls, but the video platform itself was still in English, which created some obstacles.
A colleague is being disruptive during a meeting. What do you do?
How can you handle a colleague who insists on being disruptive during committee meetings? It may be easier to try to acquiesce to the behavior to make it go away, but you risk encouraging the behavior by rewarding it. A HealthLeaders article offers strategies that physicians in a group can use to help the offending physician understand what’s wrong with the behavior. The article suggests one strategy is to ask the physician if she or he believes everyone on the committee should go along with his or her thoughts even if they disagree with them. If the answer is yes, they need to ask the physician if he or she would find that acceptable if the tables were turned. Other strategies focus on ways to find common ground or to show the disruptive physician how much other members of the group disagree with his or her position. Finally, the article states, if the physician’s behavior is really offensive, a last resort is filing a formal complaint.
January 14, 2021
Health care job market takes hit, but still popular
While the job market in health care suffered a body blow in 2020, careers in health care are still considered desirable by the public. First, the bad news. Bureau of Labor statistics show as a whole health care shed just over a half a million jobs in 2020. Since February, hospitals lost 70,000 jobs, ambulatory services lost 173,000 jobs and residential care homes lost 264,000 jobs. Things may be turning around; in December, hospitals added back 32,000 jobs and ambulatory services brought back 21,000 jobs.
Despite that trend, health care jobs occupied 42 of the top 100 slots on the U.S. News & World Report’s 2021 “100 Best Jobs” list. The No. 1 job on the list was physician assistant. Nurse practitioner came in at No. 3 and physician came in at No. 5. It’s probably no coincidence that health care jobs were also well-represented on the publication’s list of the highest-paying jobs. The top job on that list was anesthesiologist, which reported a median salary of $208,000.
And rather than being deterred from a career in medicine by the pandemic, there are signs that more are interested in working as a physician. Data from 2020 found that applications for allopathic medical schools were up 14% and applications for osteopathic medical schools were up nearly 18%. A Medscape report quotes industry analysts as saying that the pandemic was likely causing an increase in interest in working as a physician from people who wanted to help. They may have been spurred to act by the recent attention given to physicians treating covid patients.
Programs try to help medical workers cope with covid stress
The stress on clinicians from caring for covid patients has led several health systems to create programs to try to help. Researchers at The Ohio State University Wexner Medical Center found that a mindfulness program helped reduce burnout by 27%. Participants in the eight-week program spend an hour a week doing reflective writing exercises, watching videos on interventions, talking about their responses, and meditating around a weekly theme. A HealthLeaders article says that staff might write about a moment they had experienced with a patient or co-worker where they felt “totally present.” Researchers also found a significant increase in clinicians’ resilience and in their work engagement.
At Mount Sinai Medical Center in New York City, the Center for Stress, Resilience and Personal Growth was launched in June to help staff members counter the stress of working during the pandemic. A Medscape report says that during the weekly workshops, staff have talked about their trouble being hailed as heroes during the early days of the pandemic because they felt like they weren’t effectively treating covid patients. The program screens participants to identify people who are at the highest risk of PTSD and has trained moderators give staff tools to build resilience and process their experiences. Mt. Sinai officials believe that up to 40% of health care workers will suffer from post-traumatic stress because of the pandemic.
Finally, a report from The Daily Beast details the pharmacologic lengths that some health care workers are taking to get a good night’s sleep to combat stress. There’s a story of one ED doc who at one point tried taking seven Benadryl tablets to get a good night’s sleep (it didn’t work) and tales of physicians trying drugs like trazodone, CBD, CBD with THC, antidepressants and “obsessive knitting while watching Star Wars.” The story details the stress that’s preventing these physicians from sleeping at night and how they’re coping with a chronic lack of sleep.
January 6, 2021
Job market: ED residents have trouble finding jobs
While there’s a shortage of physicians in the United States, many ED residents are facing an exceptionally tough job market. A Washington Post article describes one resident who can’t find a full-time job in his hometown of Houston and talks to experts about problems facing other young ED physicians. One of the problems is that staffing companies, which run about 60% of U.S. emergency rooms, are losing contracts with financially stressed health systems and therefore cutting back on hiring physicians. Experts quoted in the Post article estimate that at least one-quarter of third-year ED residents are having trouble finding work. Many have had their contracts changed or had job offers rescinded altogether.
Patients want to handle billing with text messaging
If you’re looking for new ways to make patients happy, you might consider looking into text messaging for billing. A new study says that skyrocketing numbers of patients are not only embracing text messaging for health care billing but are willing to leave physician practices that don’t allow them to handle billing via text messages. The use of billing-related text messaging has grown more than 200% in the last year, but nearly one-third of patients don’t think their current providers have done enough to improve billing and payment.
December 23, 2020
You spend a lot more time with your EHR than non-U.S. docs
According to a new study in JAMA Internal Medicine, U.S. physicians spend an average of 90 minutes a day working with an EHR compared to 59 minutes for physicians in other parts of the world. The study also found that U.S. physicians spend significantly more time on four activities: notes, orders, messages, and clinical review. That probably explains why U.S. physicians composed more automated notes than their non-U.S. colleagues; 77.5% of text by U.S. physicians is automated, compared to 60.8% of text by non-U.S. physicians. U.S. physicians also received more messages per day than their non-U.S. counterparts (33.8 vs. 12.8).
One more thing to worry about when it comes to surgery
A new study gives some evidence that patients over 65 may want to avoid having surgery on their surgeon’s birthday. Research in the BMJ found that patients over 65 who underwent one of 17 emergency surgical procedures had a higher 30-day mortality rate when it was the surgeon’s birthday (6.9% vs. 5.6%). Researchers said the evidence behind the trend wasn’t clear but speculated that one explanation may be that the surgeons were distracted by their birthday. The researchers also said they were not recommending that patients avoid surgeries on the surgeon’s birthday, which would be difficult to do with emergency surgery. They said further research is needed to establish a meaningful relationship between surgeons’ birthdays and mortality rates.
December 16, 2020
Can hospitals require workers to take the covid vaccine?
Health care workers are slated to be among the first Americans to receive the covid vaccine, but what happens for workers who don’t want the vaccine—and refuse? According to a health care attorney writing in MDedge, the closest analogy is the laws surrounding influenza vaccines. Based on that body of the law, hospitals likely have the right to force workers to get the covid vaccination. Short of exceptions based on religion or disabilities, the courts have been fairly consistent in allowing health care employers to require vaccinations. And people who receive an exemption are generally required to take other measures to protect patients. The author did say that workers who refuse the vaccine probably won’t be fired immediately, as long as they take other measures like masking to mitigate the spread of the virus.
Terrible patients: Can private practice physicians fire terrible patients?
Can private practice physicians fire an “extremely unpleasant” patient? A MedPage Today article by a physician/lawyer points out that while institutions like hospitals are required to care for all comers, no such law exists for physicians. The only catch, the author says, is that if physicians “fire” patients and those people have no other care options, the courts may rule against the physician. The article offers examples of physicians who fired difficult patients and had to face legal challenges.
December 9, 2020
Are women leaving medicine faster than men during the pandemic?
The stress of working as a physician during a pandemic especially hard for female physicians? A Medscape article points to evidence that the pandemic is causing women to leave medicine in disproportionately high numbers. Experts interviewed say that longstanding complaints like inequitable pay and a difficult path for promotions are insurmountable when combined with the challenges of working in a pandemic. A survey of physician mothers in April found that just under half of respondents scored above the threshold for moderate or severe anxiety. The article points out that caregiving duties during the pandemic are also putting significant stress on many female physicians.
How speaking out during the pandemic went wrong for two clinicians
Two stories from this week’s news illustrate the perils of speaking up during the pandemic. The first story involved an Oregon family physician who bragged during a Trump rally that he and the people who work in his office refuse to wear masks. The Web site of the state’s medical board says it issued an emergency suspension of the license of the physician due to “concern for the safety and welfare of current and future patients.” Oregon state law requires health care providers to wear face masks in health care settings. At the rally, the physician urged attendees to remove “the mask of shame,” adding that the purpose of masks is to “shut down the American people.”
At the other end of the political spectrum is a nurse who was fired after raising concerns about the safety of the scrubs that nurses wore at a hospital in St. Paul, Minn. When the hospital instructed nurses to wear and launder their own scrubs, the nurse, Cliff Willmeng, RN, instead wore hospital-issued (and laundered) scrubs and issued a complaint with OSHA, alleging that the policy was unsafe for providers and patients alike. A MedPage Today story says that when Mr. Willmeng was fired in the spring for violating the hospital’s dress code, he sued the hospital for whistleblower retaliation and wrongful termination. Now the state’s licensing board for nurses is investigating Mr. Willmeng’s conduct, putting his license at stake. According to the MedPage Today story, a union steward at the hospital says that nurses are still required to wear and clean their own scrubs.
December 2, 2020
Hospital nurses are part of “a national bidding war”
It’s a staffing problem that hospitals are struggling with: an exodus of nurses being lured away to other facilities or to traveling-nurse agencies by lucrative incentives. An article from Kaiser Health News describes what its authors call a national bidding war as nurses—especially those who feel they’re not adequately protected against covid in their hospitals—easily find higher-paying opportunities elsewhere. The article quotes one nurse who quit a full-time job in a suburban Denver hospital where PPE was reused until it fell apart; as a traveling nurse, she saw her salary jump from $800 a week to $5,200, with a contract that guaranteed adequate PPE. Job postings, particularly for slots in Plains and Rocky Mountain states looking for ICU nurses, are offering up to $10,000 a week. Rural and urban safety-net hospitals can’t begin to afford such salaries and have the most to lose.
How one medical group uses Uber Eats to combat burnout
Would restaurant deliveries to your house, along with laundry and dry-cleaning services, help alleviate some of the burnout you’re probably feeling during these dark days of the pandemic? A group with more than 2,000 clinicians outside of Boston found that offering those perks, along with other services like a personal concierge, help with childcare and free access to Peloton workouts, was able to reduce clinician burnout by 20%. A FierceHealthcare article says the physician group also made workplace-based changes, such as reducing the number of clicks needed to navigate EHR software. The effort to reduce burnout began before the pandemic, but the group quickly changed direction once the pandemic began affecting physicians and other clinicians.
November 25, 2020
Big changes are coming to CPT in 2021
Are you ready for changes to the physician fee schedule that take effect in just over a month? According to an article in HealthLeaders, major changes in 2021 include the elimination of CPT code 99201, and a system of choosing CPT codes based on either time or medical decision-making (instead of elements of the history and physical exam). The article also explains that the Medicare conversion factor, which plays a major role in physician reimbursement, is scheduled to drop by about 11%, which will hurt physician fees across the fee schedule.
Update: How are PCP offices faring during the pandemic?
As the country enters the latest surge of coronavirus, primary care physicians report that their situations have improved somewhat since the spring, but most say they are still struggling. A new survey found that only 33% of PCPs said they had enough cash to function for four weeks, and 60% said they were seeing a rise in covid in their communities. The good news is that the financial troubles faced by PCPs have eased, with only 6% of practices saying that they are unable to pay some bills. But 35% of practices reported trouble hiring staff, 27% said they had permanently lost members of their practices (in part because of illness and early retirement), and 23% said that they feel unsafe because they are being forced to reuse PPE.
November 18, 2020
How is your mental health during the pandemic?
Several articles in this week’s press paint a dismal picture of not only the country’s surging number of coronavirus cases, but the mental health state of physicians and clinicians caring for patients.
Closing practices and retiring physicians
An article in the New York Times looks at outpatient physicians who are being forced to close or sell their practices because of financial pressure generated by the pandemic. Plummeting patient revenue and difficulties finding protective gear are making it impossible for some smaller practices to survive. The article quotes one study that found about 8% of physicians had closed their offices earlier this year and another 4% planned to close in the next year. Another study found that 20% of PCPs said someone in their practice had already retired early or was planning to retire early because of covid.
Staff shortages and stress
An article in The Atlantic, “No one is listening to us,” paints a grim picture of hospital staff trying to care for patients as the pandemic rages out of control. Hospitals are trying to keep up by adding beds and covid units, but staff shortages are pushing physicians and nurses to the breaking point. One Iowa nurse facing an ED with 25 covid patients—but not enough nursing staff to care for them—said that while managing the pandemic was “doable” in the summer, the recent surge in coronavirus patients is leaving clinicians feeling overwhelmed and burned out.
Nurses and PPE shortages
Finally, a Medscape article says that 11 months into the pandemic, many U.S. hospitals are still struggling to get their hands on adequate supplies of PPE. In a survey of nurses around the country, more than 80% say they are still re-using single-use PPE; 20% report that their employers have recently limited the use of N95 masks because of shortages. Just under half of the nurses (42%) said that staffing shortages have gotten worse, leading to feelings of stress among 80% of nurses, anxiety among 75% and feelings of sadness and depression among 62%. Registration is required to read the full article on Medscape.
November 11, 2020
What kind of lawsuits should you worry about?
When it comes to malpractice lawsuits, do you know the types of claims that are commonly filed? An article from MD Edge says that in frivolous claims, patients lack any evidence of injury or damage. In nonmeritorious lawsuits, injury or damages are suffered, but not because of negligence. And in fake claims, patients are making things up to shake you down for a few dollars. The good news is that of about 18,000 liability claims filed between 2016 and 2018, 65% were dropped. The MD Edge article looks at the difference between different types of liability lawsuits and offers a quick primer on malpractice law for physicians.
Fewer docs receive industry payments, but dollar amount remains the same
While a system that reports on industry payments to physicians seems to have slowed the number of physicians taking those payments, the total value of those payments has stayed relatively the same. Researchers found that in 2018, 45% of physicians received at least one payment from industry. In 2014, by contrast, that number was 52%. A HealthLeaders article says that from 2014 to 2018, physicians received nearly 50 million payments from industry totaling $9.3 billion. Most physicians–90%–received less than $10,000. Between 2014 and 2018, the total value of industry payments remained the same in all specialties except for primary care, which saw a dip in total payments.
November 4, 2020
More clues about the wage gap between male and female doctors
It’s been a busy week or so when it comes to data on the gender gap in wages for male and female physicians. Three reports offer more data on the wage gap—and an interesting explanation about its origins.
- A new survey from Doximity found that the wage gap between male and female physicians grew to 28% in 2020. The report found that female physicians make $115,000 less than male physicians.
- Last week, another report found a slightly smaller, but still significant, gender gap in physician wages. The drug discount company SingleCare found that female specialists earn $89,000 less than their male colleagues ($375,000 for men vs. $212,000 for women). Among primary care physicians, the gap was $52,000 ($264,000 for men vs. $212,000).
- Finally, a study says that female physicians may be paid less because they spend more time with patients during visits. The research article in the New England Journal of Medicine, which looked at nearly 25 million primary care office visits, found that female physicians spent 16% more time with patients than their male colleagues and that they generated 11% less revenue per year. HealthLeaders reports that researchers concluded that female physicians’ lower wages were driven “entirely” by differences in volume, and that the lower volume was not explained by female physicians working fewer days.
Are your patients too distracted—or drunk—to do telehealth right?
While upwards of 50% of Americans have used telehealth this year, not all of them are paying close attention to what you discuss. A survey from the health care tech company Dr. First found that patients are routinely distracted during telehealth visits by Web surfing, checking e-mail and texting (24.5%), watching TV or movies (24%), checking on social media (21%) and eating (21%). If that’s not bad enough, consider that just under 10% of patients admitted to having a cocktail (a “quarantine”) or some other type of alcoholic drink during televisits. The survey found that telehealth was most widely used for annual checkups (38% of respondents said they had used a televisit for this purpose), mental health therapy (25%) and specialist visits (21%).
October 30, 2020
Are you voting?
Given this year’s record turnout in early voting, a new research letter delivers this surprising news: Physicians are less likely to vote than the general population. The authors looked at voter registration and turnout among physicians in California, New York and Texas, the three states with the highest number of doctors. They found that only 37% of eligible physicians between 2006-18 voted vs. 51% of the general public. Further, half of all physicians aren’t even registered to vote. Why? “(L) ow participation,” the authors write, “may be because of the fear of seeming political while practicing medicine, in addition to other administrative and psychological barriers.” The same authors also published results of a single-site survey they did of close to 200 residents. The majority of residents cited their long work hours as a barrier to voting, while close to one in four believed their individual vote didn’t have much impact.
October 28, 2020
Physicians fight claims that they’re overcounting covid cases for money
Medical groups this week struck back against President Trump’s claims that physicians are overreporting fatalities from covid to increase their reimbursement. According to a Medscape article, groups like the AMA and ACP lashed out against those claims. In a statement, ACP said the president’s comments are “a reprehensible attack on physicians’ ethics and professionalism.” The Society of Hospital Medicine said that hospitalists are “selflessly placing their lives at risk” during the pandemic. The Medscape article notes that a growing body of research shows that fatalities from covid are likely being undercounted, not overcounted.
Covid has physicians working more for less money
A new survey shows that a variety of specialties are working harder and longer during the covid pandemic, with 31% of specialists saying they’re working more hours for little to no extra compensation. Seventy percent of ED physicians reported that they have suffered a “negative economic impact” from covid, and 63% of anesthesiologists say they’re suffering because covid patients have squeezed out elective surgery patients. About 36% of respondents said they’ve taken on new tasks during the pandemic; 49% have taken on an advisory role, and 29% have worked as an investigator in covid studies.
October 21, 2020
Telehealth services: CMS expands what it will pay for
The CMS this month announced that it is adding close to a dozen telehealth service lines that it will pay for during the pandemic. On that list of 11 new services: cardiac rehab and intensive cardiac rehab, with and without exercise, and pulmonary rehab with exercise. Other services that will now be covered include in-person ventricular assist device interrogation and several types of electronic analysis of implanted neurostimulator pulse. With the new additions, the CMS has since March OKed payment for more than 130 telehealth services for Medicare beneficiaries, including initial inpatient visits and ED visits. The CMS also announced that it plans to boost support to state Medicaid and CHIP programs to expand access to telehealth. In other virtual care news, a Seattle-based start-up that relies on a text-based primary care platform is attracting big investors. The on-demand service, called 98point6, just received $118 million in funding for a total of $247 million. Boeing and Sam’s Club are among the startup’s partners.
Why the hate for DOs?
The high profile given Sean Conley, DO, the president’s physician, had this unintended and ill-informed consequence: It produced a lot of disparaging remarks about doctors who train in osteopathic medicine. Apparently, many members of the media and the public mistakenly assume that DOs aren’t fully qualified, licensed physicians. In response, the American Osteopathic Association pushed back, targeting media figures and social media as well as connecting reporters to prominent DOs. And in a commentary published on KevinMD, two prominent hospitalists—both of whom are DOs—likewise rallied support for their colleagues. “(W)hen someone challenges the validity of a legitimate medical degree,” they write, “the entire house of medicine is under attack.”
October 7, 2020
Women increase their numbers in specialties, but pay gap persists
While more women are practicing medicine in specialties like rheumatology and dermatology, they are earning less than their male colleagues. A compensation report from Medscape focusing on female physicians found that since 2015, three specialties have seen dramatic increases in the number of women in their ranks. Rheumatology saw its number of female physicians skyrocket from 29% to 54%. Dermatology saw its number of women physicians increase from 32% to 49%, and family medicine saw a jump from 35% to 43%. That report noted that those gains, however, have not leveled the playing field when it comes to compensation. In primary care, men still make 25% more than women ($264,000 vs. $212,000). And in specialties, men make 31% more than women ($375,000 vs. $286,000). The report offers a detailed look at how much women earn compared to men by specialty, practice setting, percent of income from incentive bonus, number of work hours, and more.
These payers are changing telehealth reimbursement
Oct. 1 marked a significant change in coverage for telehealth—which became ultra-popular during the pandemic—when several private insurers began to no longer fully pay for virtual visits under certain circumstances. UnitedHealthcare terminated a benefit that fully covered patients’ virtual visits with their in-network clinician for any non-Covid-19 issue. Anthem stopped waiving the cost of copays, coinsurance, and deductibles for virtual visits not related to Covid-19. Many patients have become reliant on virtual visits during the pandemic, especially older individuals and those with disabilities that made traveling to and from appointments difficult. “For many patients, it’s their lifeline right now — it’s the only way that they’re feeling comfortable or safe receiving care,” one expert tells STAT’s Rebecca Robbins and Erin Brodwin. One recent report estimates that during the pandemic, the number of people who had at least a single telehealth visit grew by 57%. That report, from Doximity, also predicted that 20% of all medical visits in 2020 will be conducted via telehealth.
September 23, 2020
One-quarter of physicians know a doc who has committed suicide
A new report says that 22% physicians know another physician who has committed suicide and that 26% know a colleague who has considered suicide. The report, which was released by The Physicians Foundation, says that 8% of physicians have had thoughts of self-harm as they cope with the effects of covid on their practices and that a stunning 58% of physicians say they’ve shown signs of burnout. Half of physicians say they’ve been angry, cried or been anxious because of the pandemic’s effects on their practices. To cope, 18% of physicians said they have increased their use of medications, alcohol or illegal drugs. The report was released last Thursday to coincide with National Physician Suicide Awareness Day.
Avoid these malpractice risks when seeing patients via video
While the increased use of telehealth is often viewed as one of the positive changes made to medicine as a result of the covid pandemic, telemedicine visits can pose risks to physicians. A Medscape article looking at the risks of video visits points out that physicians’ inability to actually see or touch patients can put them at a disadvantage that can lead to legal problems. The article describes the case of a man with swelling of the leg that turned out to be a fatal DVT. His family sued the ED physician who saw the man via video, claiming that the DVT could have been detected and treated if the physician had seen the patient in person. One insurer found that 66% of malpractice claims involving telemedicine were related to diagnoses. The article also looks at issues with documentation and consent when it comes to video visits.
September 16, 2020
What’s the future of medical meetings?
Are you looking forward to the day when meetings for physicians are once again in-person, and not virtual? In a Medscape article, one physician looks at the upsides and downsides of virtual meetings—and concludes that he, for five distinct reasons, prefers virtual meetings. The physician argues that because virtual meetings provide greater access to physicians and let them digest content more efficiently, the medical profession shouldn’t necessarily rush back to in-person meetings once the covid pandemic subsides. Comments on the article offer their own perspectives on the merits of virtual vs. in-person meetings.
September 11, 2020
Will primary care survive the financial impact of covid?
A new survey found that 20% of primary care physicians were considering leaving primary care because of the financial fallout of covid, and 13% were unsure of their futures in medicine. The survey, which was conducted by the Larry A. Green Center and Primary Care Collaborative, also found that in August, 2% of primary care practices have closed and another 2% were considering bankruptcy. According to coverage from FierceHealthcare, 21% of the physicians surveyed have had layoffs of furloughs, 28% have seen a revenue drop of 30%-50%, and 24% have shut down quality initiatives that started before the pandemic.
Survey data finds physician pay rose 4% in 2019
New survey data found that physician pay grew by just under 4% in 2019, up from the 2.92% increase in pay recorded the year before. According to HealthLeaders coverage, survey data from the American Medical Group Association found that primary care specialties saw an increase of 4.46% and medical specialties saw an increase of 3.52%. Coverage in Becker’s Healthcare reports that internal medicine saw a 5.65% increase, family medicine saw a 3.75% increase, and pediatrics saw a 5.06% increase. The data also show that despite a rise in compensation, physician productivity remained relatively flat, rising just 0.56% over the previous year. Analysts worry that raises in compensation without similar gains in productivity may point to an unsustainable trend in physician pay. Data are not available for pay trends since the beginning of the covid pandemic.
AMA proposes changes to simplify outpatient E/M codes
Changes to outpatient evaluation and management (E/M) codes announced last week by the AMA are being lauded by primary care groups as a step in reversing what they see as the undervaluation of E/M services and in streamlining documentation requirements. The revisions eliminate the history and physical exam as the basis for selecting codes. The changes also permit code levels to be based on either medical decision-making or total time. The AMA said that the changes, which represent the first time E/M codes have been changed in 25 years, were designed to make coding for office visits more flexible. The AMA is proposing that Medicare implement the changes, which include 206 new codes, 54 deletions and 69 revisions, on Jan. 1, 2021.
Physicians experience EHR-induced fatigue in as little as one minute
In a finding that will shock few physicians, research released this spring found that 80% of physicians experienced fatigue after working with EHR systems for as little as 22 minutes.
A study in JAMA Network Open looked at data from a study of 25 physicians who reviewed simulated cases of four ICU patients using EHR software. All physicians in the study were fatigued at some point during the simulation, with 36% experiencing fatigue in the first minute and 64% experiencing fatigue at least in the first 20 minutes. By 22 minutes, 80% of the subjects had experienced some fatigue. Researchers also found that once physicians had experienced fatigue, the next case they reviewed took more time, more clicks of the mouse and more screen visits.
Physicians struggle to adapt to less telehealth
With physician offices around the country opening up, telehealth has lost some of its popularity with patients and physicians alike. That’s leaving many medical offices struggling to adjust to a new normal where patients are being seen by a combination of virtual and in-person visits.
According to an article from STAT, telemedicine visits shrank from 69% of all patient encounters in April to 21% by the middle of July. Practices that switched all visits to virtual back in the spring are now struggling to move some—or most—of their visits back to in-person encounters, but it has not always been an easy switch. Administrators have to determine in advance which patients should be in-person vs. via teleconferencing, for example, and they need to decide how to most efficiently split the time of physicians between the two visits. The STAT article notes that telehealth visits for mental health services is still growing, and that while the number of telemedicine visits has shrunk since the spring, there has still been a drastic increase in the number of patients receiving care via telehealth.