Category Archives: Physicians
Ryan Greysen, MD, MHS, is an alumnus of the Robert Wood Johnson Foundation (RWJF) Clinical Scholars program, and an assistant professor of medicine at the University of California, San Francisco (UCSF), Division of Hospital Medicine. He works closely with the Global Health Hospitalist program at UCSF to help train fellows and conduct research in quality improvement for hospitalized patients in developing settings. Phuoc Le, MD, MPH, is an assistant clinical professor of medicine and pediatrics at UCSF. He co-directs the Global Health-Hospital Medicine Fellowship at UCSF, directs the Global Health Pathway for the Pediatric Residency, and is director of international rotations for the Internal Medicine Residency.
U.S. medical education has entered a golden era of growth in global health interest and involvement, but surprisingly little is known about global health after training is completed. In 1978, only 6 percent of graduating medical students reported experiences in global health (GH), but today more than 25 percent participate in global health activities during medical school, and 66 percent plan to participate in GH work during their career. Since this "surge" has started with trainees, many of the recent studies on global health work have focused on medical students or residents.
Interestingly though, we have much less information on what happens after the trainees become full-fledged physicians. Do they continue to engage globally either as professionals or volunteers? If so, do they focus on clinical work, education, research, or health policy? We recently conducted a pair of surveys to answer these questions in two specific groups of doctors: those who have received research and leadership training through the longest- program of this kind in the U.S. (the RWJF Clinical Scholars program) and those who have joined the ranks of the medical profession's fastest-growing sub-specialty: hospitalists.
The website Physicians Practice has released its annual Physician Compensation Survey, which for the third straight year shows that a majority of U.S. physicians view the income from their medical practice as “disappointing.” In 2013, 54 percent defined their net income this way, the same number as a year earlier, but 5 percent more than those who took the survey in 2011.
Physicians Practice surveyed 1,474 physicians and staff for the survey, asking about personal income, practice overhead, practice outlook, and other financial issues. For the first time, the survey acknowledged the shift from volume-based reimbursement to value-based reimbursement, asking respondents to share how much of their income is tied to factors other than the number of patients they see.
Thirty-three percent of respondents said a portion of their compensation is tied to value (quality and cost of care provided), with 8.5 percent of that group saying this was the only factor in their pay. Furthermore, 24 percent of respondents said a portion of their compensation was tied specifically to patient satisfaction.
However, productivity remained the dominant factor in physician compensation, with 28 percent of survey respondents saying that their entire compensation package was factored on productivity alone. Another 37 percent said it made up a portion of their annual pay.
The Association of American Medical Colleges (AAMC) has released its 2013 State Physician Workforce Data Book, a biennial report that examines current physician supply, medical school enrollment, and graduate medical education in the United States.
Between 2008 and 2012, there were small increases in the state median number of active physicians and active patient-care physicians, the state median percentage of female physicians, and the percentage of physicians age 60 or older. While the median number of students enrolled in undergraduate medial education has increased relative to the population, the number of students enrolled in graduate medical education per population has remained flat.
Among key findings, in 2012 there were 260.5 active physicians per 100,000 population in the United States, ranging from a high of 421.5 in Massachusetts to a low of 180.8 in Mississippi. The states with the highest number of physicians per 100,000 population are concentrated in the Northeast.
Rural counties throughout the United States may be hardest hit by the country’s anticipated shortage of primary care physicians (PCPs), according to a new study from the WWAMI (Washington, Wyoming, Alaska, Montana, and Idaho) Rural Health Research Center at the University of Washington School of Medicine.
Researchers point to several factors that have implications for rural counties: PCPs deliver the majority of health care in those areas; a substantial percentage of primary care providers in the United States are approaching retirement age at the same time that fewer new medical school graduates are opting for primary care specialties; and demand for health care services is expected to increase as the population ages and millions gain health insurance coverage as a result of the Affordable Care Act.
The study, which used data from the American Medical Association and the American Osteopathic Association 2005 Physician Masterfiles, found a higher percentage of PCPs near retirement in rural counties than in urban ones, with the percentage increasing as the degree of rurality increased. (Physicians 56 or older in 2005 were considered to be near retirement and were the primary focus of analysis.) The 184 counties in the top 10 percent of near-retirement PCPs were characterized by lower population density and lower socioeconomic status, as measured by low education, low employment, and persistent poverty.
More students than ever applied to and enrolled in the nation’s medical schools this year, according to data released by the Association of American Medical Colleges (AAMC).
Compared with last year’s figures, the total number of medical school applicants grew by 6.1 percent to 48,014, surpassing the previous record, set in 1996, by 1,049 students. Another important indicator of interest in medicine is first-time applicants, and they increased by 5.8 percent to 35,727 this year. The number of students enrolled in their first year of medical school exceeded 20,000 for the first time (20,055), a 2.8 percent increase over 2012.
“At a time when the nation faces a shortage of more than 90,000 doctors by the end of the decade and millions are gaining access to health insurance, we are very glad that more students than ever want to become physicians,” AAMC President and CEO Darrell G. Kirch, MD, said in a news release. “Students are doing their part by applying to medical school in record numbers. Medical schools are doing their part by expanding enrollment.” Kirch pushed for an expansion of residency training to accommodate the greater number of students studying to become physicians.
The health care sector has created 166,800 new jobs so far this year, according to data from the Bureau of Labor Statistics—but that’s down from the 266,400 new jobs created in the first nine months of 2012. The sector created 6,800 jobs this September, compared with 36,600 in September of last year.
Experts note that these numbers have yet to reflect any slowing demand for physicians and other clinicians.
With health reform taking effect, consolidations and other changes in the health care industry, “what you are seeing is simple action-reaction,” Travis Singleton, senior vice president at the health care staffing firm Merritt Hawkins & Associates, told Health Leaders Media. “[A]nytime you have mass change to an industry you are going to get a reaction.” Singleton says that Merritt Hawkins saw a 14 percent increase in its physician and advanced practice recruiting assignments from 2012 to 2013, and he expects recruitment and hiring to continue to increase, especially in nursing.
Doctors, nurses, and other health professionals are increasingly taking on top leadership positions at hospitals, Fierce Healthcare reports, likely because of the changing health care delivery system.
The trend is taking root in several states. In Texas, Baylor All Saints is headed by a former surgeon. The president of Texas Health Harris Methodist Fort Worth is a former intensive care unit nurse, and her immediate superior who oversees operations for 12 regional hospitals is a physician, the Forth-Worth Star-Telegram reports.
Presence Saint Francis Hospital and Presence Saint Joseph Hospital in Illinois announced this month that a physician and board-certified specialist in infectious diseases would take over as president and CEO, according to Fierce Healthcare. Portsmouth Regional Hospital in New Hampshire is run by a registered nurse, Foster's Daily Democrat reports.
Among the Robert Wood Johnson Foundation (RWJF) scholars in top leadership positions at hospitals is RWJF Executive Nurse Fellow Kim Moore, RN, MSN, FACHE, the president of Saint Elizabeth Regional Medical Center in Lincoln, Nebraska.
Tammy Chang, MD, MPH, MS, is an assistant professor in the Department of Family Medicine at the University of Michigan Medical School and an alumnus of the Robert Wood Johnson Foundation Clinical Scholars program.
Over kitchen tables as well as on Capitol Hill, the discussion continues over the Affordable Care Act including who will benefit and what it means for everyday Americans.
To shed light on this debate, my co-author Matthew Davis, MD, MAPP, and I recently published a study that describes the characteristics of Americans potentially eligible for the Medicaid expansion under the Affordable Care Act. The study, published in the Annals of Family Medicine, uses a national source of data used by many other researchers who look at national trends—such as high blood pressure and obesity—called the National Health and Nutrition Examination Survey (NHANES).
Although more hospitals and health care systems have been hiring physicians in recent years, more than half of the nation’s physicians are still self-employed. A survey from the American Medical Association finds that 53.2 percent of physicians were self-employed in 2012 and 60 percent worked in practices that were wholly owned by physicians.
The survey also found that only 5.6 percent of physicians were directly employed by a hospital. Twenty-three percent worked in practices that were at least partially owned by a hospital.
Although the researchers conclude hospital employment is part of a national trend, the data “offers an update on the status of physician practice arrangements, and allows for a nationally representative response to the numerous articles of the past several years that have highlighted a surge in the employment of physicians by hospitals and the ‘death’ of private practice.”
The data comes from the 2012 Physician Practice Benchmark Survey, a nationally representative random sample of post-residency physicians who provide at least 20 hours of patient care per week.
This is part of a series of blog posts introducing programs in the Robert Wood Johnson Foundation (RWJF) Human Capital Portfolio. The RWJF Clinical Scholars program develops physician leaders to improve health and health care in the United States while preserving a commitment to service and patients.
A number of university professors and deans, hospital CEOs, health commissioners, 45 members of the Institute of Medicine, and even RWJF’s president and CEO have one thing in common: their shared experience as alumni of RWJF’s oldest program, the Clinical Scholars.
“For anyone who wants to be a catalyst for change in the health and health care of our country, the Clinical Scholars program is an excellent opportunity to do so.”
- Risa Lavizzo-Mourey, MD, MBA, president and CEO, Robert Wood Johnson Foundation (Penn Clinical Scholars program ’83–’86)
Founded in 1969 and adopted by RWJF in 1972, the Clinical Scholars program was created to foster the development of physicians who are leading the transformation of U.S. health and health care through positions in academic medicine, public health, and other leadership roles.
Through this post-residency program which provides two years of master’s degree study, Clinical Scholars learn to conduct innovative research in health policy, health services research, and community-based participatory research (CBPR). In addition, scholars work with communities, organizations, practitioners, and policy-makers on issues important to the health and well-being of all Americans.