The Vitals - September 2015
Internal Medicine Alert - Infectious Disease Alert - Clinical Cardiology Alert
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PCP Salaries Catching Up With Specialists, But Have Long Way to Go
ENGELWOOD, CO – Primary care physicians’ compensation rose faster in the past year than that of specialists, but their average salary remained more than 40% lower overall.
That’s according to the 2015 Provider Compensation Survey Report from the Medical Group Management Association (MGMA). The survey, conducted for more than 25 years, provides comparative data on nearly 70,000 providers.
The report notes that primary care physicians reported a median compensation of $241,273 last year, a 3.56 % increase since 2013, compared to $411,852 for specialists, a 2.39% increase since last year.
“As medicine migrates toward a value-based paradigm, we've began to see movement away from pure productivity-based compensation models. We hope to see physicians’ salaries remain healthy throughout this transition,” said Halee Fischer-Wright, MD, MGMA’s president and CEO. “With the release of this data, MGMA provides executives, administrators and physicians the resources they need to help their medical practices flourish. Using this data, physicians and medical practices have the opportunity to put patient relationships back into the practice of medicine and get paid for it.”
The MGMA Provider Compensation Survey Report includes data for physicians and non-physician providers in more than 170 specialties, including demographic categories ranging from geographic region and practice setting (in small, medium and large groups) to years in specialty and majority ownership.
Another long-time survey, the 22nd annual Modern Healthcare Physician Compensation Survey, found that, between 2013 and 2014, physicians' average pay increased among 20 specialties but declined among three specialties. The magazine analyzed compensation data from 12 healthcare organizations, including the MGMA and the American Medical Association.
The largest increases in compensation were in the following areas:
- Urology, 5%
- Invasive cardiology, 4.8%;
- Dermatology, 4.7%;
- Gastroenterology, 4.2%; and
- Radiation oncology, 3.9%.
On the other hand, according to the survey, physicians' compensation in 2014 declined by almost 2% for oncology/hematology, and slightly dipped for plastic surgery and obstetrics/gynecology.
Male Doctors Much More Likely to Face Medico-Legal Action than Females
LONDON – Physicians with Y chromosomes are nearly two and half times more likely to have medico-legal action taken against them than their female counterparts, according to a British study that looked at the issue globally.
The study, published online by BMC Medicine, suggests that a better understanding of why men are more likely to be the targets of everything from being sued to having their licenses revoked could improve patient safety and provide more support for doctors who need it.
“There was significant heterogeneity in the meta-analysis but this was not due to differences in the direction of the effects – no studies found that women were more likely than men to experience medico-legal action,” write the authors led by University College London researchers. “The size of the effect of sex on experience of medico-legal action remained roughly constant in all subgroup analyses, suggesting that the effect of sex is not influenced by the study design, the country the doctor is in employed in, or the outcome definition, and the effect seems stable over time.”
Background information in the article notes that the number of medico-legal actions taken against physicians is on the increase; between 2008 and 2012, the United States saw a 17% increase in the number of medical licenses that have been revoked, denied or suspended, while the United Kingdom reported a 64% increase in official complaints about doctor’s care between 2010 and 2013.
To look at differences in medico-legal action by sex on an international level and whether the trends had changed over time, the researchers conducted a systematic review and meta-analysis. Overall, 32 studies were identified, with 40,246 cases of medico-legal action.
For the research, medico-legal action was divided into six categories:
- disciplinary action taken against a doctor by a medical regulatory board
- malpractice claims/cases
- complaints received by non-regulatory bodies that investigate healthcare complaints
- criminal cases
- medico-legal matter with a medical defense organization, which grouped together several medico-legal action types
Study authors rejected the hypothesis that male doctors are more likely to experience medico-legal action because more of them are practicing medicine.
“The demographics of doctors in the UK and USA have been changing, with increasing numbers of women choosing to follow medicine as a career,” they write. “Our results suggest that the effect of male sex on experiencing medico-legal actions has remained fairly constant over the last 15 years (OR, 2.25–2.45), despite the increasing trend of women doctors … We therefore feel one can no longer argue that male doctors are more likely to face medico-legal action because there are more male doctors practicing. If this were the case, we would expect the effect size to diminish over time, to reflect the increasing number of female doctors.”
They call for more research to determine if there is any association with male physicians’ longer work hours and, therefore, more frequent interactions with patients.
Electronic Reminders Increase Tdap Booster Rates in Practices Using Them
ANN ARBOR, MI – Patients were significantly more likely to get a critical booster shot if their healthcare providers received an electronic nudge that they needed one, according to a new study.
Electronic reminders used at University of Michigan Health System clinics helped increase rates of the Tdap booster, which protects against tetanus, diphtheria, and whooping cough, reported the study published recently in the American Journal of Public Health.
Adolescents and adults ages 11 and up should receive a single dose of the Tdap vaccine for booster immunization even if they have had a tetanus and diphtheria vaccine within the past 10 years, practice guidelines state.
Thanks to the electronic prompt-and-reminder system, 76% of 31,195 patients ages 19-64 and 85% of 3,278 patients aged 11-18 were up-to-date on their immunization, according to study authors from the University of Michigan Medical School. That was compared to 59% of a similar cohort of adults during the same time period in clinics within the same health system that did not use the automated prompts.
"This research shows how technology can be used to dramatically change the way preventive services are delivered and improve preventative health care," senior author Grant M. Greenberg, MD, said in a University of Michigan Health System press release.
The electronic prompt-and-reminder system was developed at five U-M family medicine clinics to identify patients 11-64 years old who were in need of the Tdap booster vaccine between 2008 and 2011. Among patients visiting the clinics who had not received their boosters, Tdap vaccination rates increased from about 16% to 47%, while the clinics not using reminds saw increases from 14% to only about 30%.
"Today's primary care environment requires managing complex immunization schedules and meeting the growing demands of caring for a large and often sick patient population," explained lead author Cameron G. Shultz, PhD, MSW. "We found that when boosters were administered and documented automatically, as a routine part of care, this dramatically changed and improved preventive care services. These types of changes may potentially also help improve outcomes for other health initiatives, including preventive care, disease screening, and chronic disease management.”
Is Benefit of Internal Medicine MOC Worth the Time Cost, Fees?
STANFORD, CA – Meeting requirements to maintain medical board certification is both time-consuming and expensive. In light of that, according to a new study, higher quality evidence is needed to prove that the process actually improves clinical outcomes for patients.
The cost of implementing the most recent requirements for more than 250,000 physicians nationwide will be $5.7 billion over the next decade, according to the report published online by the Annals of Internal Medicine.
The study by Stanford University and University of California San Francisco researchers found that the value of the time physicians spend fulfilling requirements accounts for most of the costs associated with the latest maintenance-of-certification (MOC) requirements implemented for medical specialties by the American Board of Internal Medicine (ABIM). Fees payable to ABIM make up the rest.
“Cumulatively, 2015 MOC will cost $5.7 billion over 10 years, $1.2 billion more than 2013 MOC,” the authors write. “This includes $5.1 billion in time costs (resulting from 32.7 million physician-hours spent on MOC) and $561 million in testing costs.”
"This is a first attempt to gauge the costs of implementing the revised recertification programs, so that researchers can begin to better evaluate costs and benefits of this large investment in physician education in comparison with alternative strategies for improving healthcare quality," explained senior author Dhruv Kazi, MD, MSc, of UCSF. "Ultimately, we want to know whether these requirements offer a good return on investment for society."
Using a mathematical simulation model of the entire ABIM-certified workforce of internists, hospitalists and internal medicine subspecialists in the United States and estimated total societal costs over 10 years – including ABIM fees and the monetary value of physician time spent on fulfilling MOC requirements, researchers calculated that costs to individual physicians would average $23,607 over 10 years, with costs in some subspecialties exceeding $40,000.
Costs are higher for subspecialists than general internists because they must spend more time and money taking additional certification examinations.
"We estimate that ABIM MOC will cost 33.7 million physician-hours over 10 years,” said lead author Alexander Sandhu, MD, of Stanford and Veterans Affairs Health Services Research. “Efforts to reform MOC and lower its costs should focus on making the most efficient use of physician time."
Co-author R. Adams Dudley, MD, MBA, of USCF, added, "However, we found no high-quality studies examining the effect of the increased requirements on clinical or economic outcomes, so we were unable to model potential benefits."
Within the last few years, the ABIM, which was created early in the last century to develop uniform standards, changed its once-every-10-years MOC program to a more continuous one, gradually increasing the amount of testing required. In 2014, requirements and fees again were increased but, after mounting criticism from physicians and specialty societies, the ABIM temporarily suspended some of the new requirements in February 2015 while retaining the increased fees and number of modules. The latest requirements were evaluated in the new study.
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