{"id":1395,"date":"2014-02-15T16:03:19","date_gmt":"2014-02-15T05:03:19","guid":{"rendered":"http:\/\/blog.panicola.com\/?p=1395"},"modified":"2014-02-15T16:06:16","modified_gmt":"2014-02-15T05:06:16","slug":"1395","status":"publish","type":"post","link":"https:\/\/blog.panicola.com\/?p=1395","title":{"rendered":"Doctors move to salaried positions&#8230;"},"content":{"rendered":"<p><span style=\"line-height: 1.5;\">Spineless rent seeking psychopaths.<\/span><\/p>\n<p>http:\/\/www.nytimes.com\/2014\/02\/14\/us\/salaried-doctors-may-not-lead-to-cheaper-health-care.html?_r=0<\/p>\n<header>\n<div>\n<h1 itemprop=\"headline\">Apprehensive, Many Doctors Shift to Jobs With Salaries<\/h1>\n<div>\n<p>By\u00a0<a title=\"More Articles by ELISABETH ROSENTHAL\" href=\"http:\/\/topics.nytimes.com\/top\/reference\/timestopics\/people\/r\/elisabeth_rosenthal\/index.html\" rel=\"author\">ELISABETH ROSENTHAL<\/a><time datetime=\"2014-02-13\">FEB. 13, 2014<\/time><\/p>\n<div><\/div>\n<\/div>\n<\/div>\n<\/header>\n<div>\n<figure itemid=\"http:\/\/static01.nyt.com\/images\/2014\/02\/14\/us\/SALARY\/SALARY-master675.jpg\" itemprop=\"associatedMedia\" itemscope=\"\" itemtype=\"http:\/\/schema.org\/ImageObject\" data-media-action=\"modal\">\n<div><img decoding=\"async\" itemid=\"http:\/\/static01.nyt.com\/images\/2014\/02\/14\/us\/SALARY\/SALARY-master675.jpg\" itemprop=\"url\" alt=\"\" src=\"http:\/\/static01.nyt.com\/images\/2014\/02\/14\/us\/SALARY\/SALARY-master675.jpg\" data-mediaviewer-src=\"http:\/\/static01.nyt.com\/images\/2014\/02\/14\/us\/SALARY\/SALARY-superJumbo.jpg\" data-mediaviewer-caption=\"Dr. Suzanne Salamon, with a patient at Beth Israel Deaconess Medical Center in Boston, said she has had trouble filling a prestigious fellowship because of relatively low salaries.\" data-mediaviewer-credit=\"Katherine Taylor for The New York Times\" \/><\/p>\n<div>Launch media viewer<\/div>\n<\/div><figcaption itemprop=\"description\">Dr. Suzanne Salamon, with a patient at Beth Israel Deaconess Medical Center in Boston, said she has had trouble filling a prestigious fellowship because of relatively low salaries.\u00a0Katherine Taylor for The New York Times<\/figcaption><\/figure>\n<figure itemid=\"http:\/\/static01.nyt.com\/images\/2014\/02\/14\/us\/SALARY\/SALARY-master675.jpg\" itemprop=\"associatedMedia\" itemscope=\"\" itemtype=\"http:\/\/schema.org\/ImageObject\" data-media-action=\"modal\"><\/figure>\n<figure itemid=\"http:\/\/static01.nyt.com\/images\/2014\/02\/14\/us\/SALARY\/SALARY-master675.jpg\" itemprop=\"associatedMedia\" itemscope=\"\" itemtype=\"http:\/\/schema.org\/ImageObject\" data-media-action=\"modal\"><span style=\"line-height: 1.5;\">American physicians, worried about changes in the health care market, are streaming into salaried jobs with hospitals. Though the shift from private practice has been most pronounced in primary care,\u00a0<\/span><a style=\"line-height: 1.5;\" title=\"Related Times article\" href=\"http:\/\/www.nytimes.com\/2014\/01\/19\/health\/patients-costs-skyrocket-specialists-incomes-soar.html?_r=0\">specialists<\/a><span style=\"line-height: 1.5;\">\u00a0are following.<\/span><\/figure>\n<\/div>\n<p itemprop=\"articleBody\" data-para-count=\"259\" data-total-count=\"486\">Last year, 64 percent of job offers filled through Merritt Hawkins, one of the nation\u2019s leading physician placement firms, involved hospital employment, compared with only 11 percent in 2004. The firm anticipates a rise to 75 percent in the next two years.<\/p>\n<p itemprop=\"articleBody\" data-para-count=\"367\" data-total-count=\"853\">Today, about 60 percent of family doctors and pediatricians, 50 percent of surgeons and 25 percent of surgical subspecialists \u2014 such as ophthalmologists and ear, nose and throat surgeons \u2014 are employees rather than independent, according to the American Medical Association. \u201cWe\u2019re seeing it changing fast,\u201d said Mark E. Smith, president of Merritt Hawkins.<\/p>\n<aside data-marginalia-type=\"sprinkled\">\n<header>\n<h2>RELATED COVERAGE<\/h2>\n<\/header>\n<ul>\n<li>\n<article>\n<div><img decoding=\"async\" alt=\"Dr. Brett Coldiron removes suspected cancerous skin cells from a patient during Mohs surgery at The Skin Cancer Center in Cincinnati, Ohio.\" src=\"http:\/\/static01.nyt.com\/images\/2014\/01\/19\/us\/20140119PROCEDURES-1\/20140119PROCEDURES-1-thumbStandard.jpg\" \/><\/p>\n<div><\/div>\n<\/div>\n<h2>Patients\u2019 Costs Skyrocket; Specialists\u2019 Incomes Soar<time datetime=\"2014-01-18\">JAN. 18, 2014<\/time><\/h2>\n<\/article>\n<\/li>\n<\/ul>\n<\/aside>\n<p itemprop=\"articleBody\" data-para-count=\"422\" data-total-count=\"1275\">Health economists are nearly unanimous that the United States should move away from fee-for-service payments to doctors, the traditional system where private physicians are paid for each procedure and test, because it drives up the nation\u2019s $2.7 trillion health care bill by rewarding overuse. But experts caution that the change from private practice to salaried jobs may not yield better or cheaper care for patients.<\/p>\n<p itemprop=\"articleBody\" data-para-count=\"233\" data-total-count=\"1508\">\u201cIn many places, the trend will almost certainly lead to more expensive care in the short run,\u201d said\u00a0<a title=\"Papers by Robert Mechanic\" href=\"http:\/\/healthforum.brandeis.edu\/publications\/articles-papers.html\">Robert Mechanic<\/a>, an economist who studies health care at Brandeis University\u2019s Heller School for Social Policy and Management.<\/p>\n<p itemprop=\"articleBody\" data-para-count=\"270\" data-total-count=\"1778\">When hospitals gather the right mix of salaried front-line doctors and specialists under one roof, it can yield cost-efficient and coordinated patient care. The Kaiser system in California and Intermountain Healthcare in Utah are considered models for how this can work.<\/p>\n<p itemprop=\"articleBody\" data-para-count=\"502\" data-total-count=\"2280\">But many of the new salaried arrangements have evolved from hospitals looking for new revenues, and could have the opposite effect. For example, when doctors\u2019 practices are bought by a hospital, a colonoscopy or stress test performed in the office can suddenly cost far more because a hospital \u201cfacility fee\u201d is tacked on. Likewise, Mr. Smith said, many doctors on salary are offered bonuses tied to how much billing they generate, which could encourage physicians to order more X-rays and tests.<\/p>\n<p itemprop=\"articleBody\" data-para-count=\"265\" data-total-count=\"2545\">Mr. Mechanic studied 21 health systems considered good models of care \u2014 including the Mayo Clinic and the Palo Alto Medical Foundation \u2014 and discovered that many still effectively rewarded doctors for each procedure. \u201cIt doesn\u2019t make any sense,\u201d he said.<\/p>\n<p itemprop=\"articleBody\" data-para-count=\"330\" data-total-count=\"2875\">Hospitals have been offering physicians attractive employment deals, with incomes often greater than in private practice, since they need to form networks to take advantage of incentives under the new Affordable Care Act. Hospitals also know that doctors they employ can better direct patients to hospital-owned labs and services.<\/p>\n<p itemprop=\"articleBody\" data-para-count=\"271\" data-total-count=\"3146\">\u201cFrom the hospital end there\u2019s a big feeding frenzy, a lot of bidding going on to bring in doctors,\u201d Mr. Mechanic said. \u201cAnd physicians are going in so they don\u2019t have to worry \u2014 there\u2019s a lot of uncertainty about how health reform is going to play out.\u201d<\/p>\n<p itemprop=\"articleBody\" data-para-count=\"361\" data-total-count=\"3507\">In addition,\u00a0<a title=\"Recent and archival health news about Medicare.\" href=\"http:\/\/topics.nytimes.com\/top\/news\/health\/diseasesconditionsandhealthtopics\/medicare\/index.html?inline=nyt-classifier\">Medicare<\/a>\u00a0had reduced its set doctors\u2019 fees over the last decade, while insurers have become more aggressive in demanding lower rates from individual practices that have little clout to resist. Dr. Robert Morrow, a family doctor in the Bronx, said he now received $82 from Medicare for an office visit but only about $45 from commercial insurers.<\/p>\n<p itemprop=\"articleBody\" data-para-count=\"344\" data-total-count=\"3851\">Dr. Cathleen London practiced family medicine for 13 years outside Boston, but recently took a salaried job at a Manhattan hospital. She said she accepted a pay cut because she could see that she was losing ground in her practice. \u201cI think the days of what I did in 1999 are over,\u201d she said. \u201cI don\u2019t think that\u2019s possible anymore.\u201d<\/p>\n<div id=\"SponLinkA\"><\/div>\n<p itemprop=\"articleBody\" data-para-count=\"274\" data-total-count=\"4125\">The base salaries of physicians who become employees are still related to the income they can generate, ranging from under $200,000 for primary care doctors to $575,000 in cardiology to $663,000 in neurosurgery,\u00a0<a href=\"http:\/\/www.beckershospitalreview.com\/compensation-issues\/7-trends-in-hospital-employed-physician-compensation.html\">according to Becker\u2019s Hospital Review,<\/a>\u00a0a trade publication.<\/p>\n<p itemprop=\"articleBody\" data-para-count=\"200\" data-total-count=\"4325\">Because of the relatively low salaries for primary care doctors, Dr. Suzanne Salamon said that for the last two years she has had trouble filling a prestigious Harvard geriatrics fellowship she runs.<\/p>\n<p itemprop=\"articleBody\" data-para-count=\"320\" data-total-count=\"4645\">Dr. Howard B. Beckman, a geriatrician at the University of Rochester, who studies physician payment incentives, said reimbursements for primary care doctors must be improved to attract more people into the field. \u201cTo get the kinds of doctors we want, the system for determining salaries has to flip faster,\u201d he said.<\/p>\n<aside data-marginalia-type=\"sprinkled\">\n<header>\n<h2><span style=\"font-size: 15.555556297302246px; font-weight: 400; line-height: 1.5;\">Doctors can become employees by practicing in a hospital building, or by selling their multispecialty practice to a hospital, so their office becomes part of a network. That has attracted specialists, including many cardiologists who took up such offers several years ago after Medicare reduced physician payments for cardiac procedures like the placement of\u00a0<\/span><a style=\"font-size: 15.555556297302246px; font-weight: 400; line-height: 1.5;\" title=\"Recent and archival health news about stents.\" href=\"http:\/\/topics.nytimes.com\/top\/news\/health\/diseasesconditionsandhealthtopics\/stents\/index.html?inline=nyt-classifier\">stents<\/a><span style=\"font-size: 15.555556297302246px; font-weight: 400; line-height: 1.5;\">\u00a0to hold open clogged arteries. The fraction of cardiologists employed by hospitals rose to 35 percent in 2012, up from 11 percent just five years earlier, according to the American College of Cardiology.<\/span><\/h2>\n<\/header>\n<\/aside>\n<p itemprop=\"articleBody\" data-para-count=\"301\" data-total-count=\"5516\">Dr. Joel Jacowitz, a cardiologist in New Jersey, and his 20 or so partners decided to sell their private practice to a hospital. In addition to receiving salaries, that meant they no longer had to worry about paying malpractice premiums themselves or finding health insurance for their staff members.<\/p>\n<p itemprop=\"articleBody\" data-para-count=\"419\" data-total-count=\"5935\">Dr. Jacowitz said that the economics drove the choice and that the only other option would have been to bring in more revenue by practicing bad medicine \u2014 ordering more heart tests on patients who did not need them or charging exorbitant rates to people with private insurance. He said he knew of one cardiologist in private practice who charges more than $100,000 for a procedure for which Medicare pays about $750.<\/p>\n<p itemprop=\"articleBody\" data-para-count=\"223\" data-total-count=\"6158\">\u201cSome people are operators and give the rest of us a bad name,\u201d he said, adding that he had changed his opinion about America\u2019s fee-for-service health care system. \u201cI\u2019m fed up \u2014 I want a single-payer system.\u201d<\/p>\n<p itemprop=\"articleBody\" data-para-count=\"368\" data-total-count=\"6526\">Dr. Kirk Moon, a radiologist in private practice in San Francisco, also sees advantages for the nation when doctors become employees. \u201cI think it\u2019s pretty clear that sooner or later we\u2019re all going to be on salary,\u201d he said. \u201cI think there\u2019ll be a radical decrease in imaging, but that\u2019s O.K. because there\u2019s incredible waste in the current system.\u201d<\/p>\n<p itemprop=\"articleBody\" data-para-count=\"368\" data-total-count=\"6526\"><span style=\"line-height: 1.5;\">Various efforts to change incentives for doctors and hospitals are being tested. An increasing number of employers or insurers, for example, pay health systems a yearly all-inclusive payment for each patient, regardless of their medical needs or how many tests are dispensed. If doctors order unnecessary tests, it costs the hospital money, rather than bringing it in.<\/span><\/p>\n<p itemprop=\"articleBody\" data-para-count=\"487\" data-total-count=\"7381\">And instead of offering bonuses for productivity \u2014 doctors cite pressures from hospital employers to order physical therapy for every discharged patient or follow-up M.R.I. scans on every patient who got an X-ray \u2014 some hospital systems are beginning to change their criteria. They are providing bonuses that reward doctors for delivering high quality and cost effective care, such as high marks from patients or low numbers of patients with asthma who are admitted to the hospital.<\/p>\n<p itemprop=\"articleBody\" data-para-count=\"287\" data-total-count=\"7668\">\u201cThe question now is how to shift the compensation from a focus on volume to a focus on quality,\u201d said Mr. Smith of Merritt Hawkins. He said that 35 percent of the jobs he recruits for currently have such incentives, \u201cbut it\u2019s pennies, not enough to really influence behavior.\u201d<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Spineless rent seeking psychopaths. http:\/\/www.nytimes.com\/2014\/02\/14\/us\/salaried-doctors-may-not-lead-to-cheaper-health-care.html?_r=0 Apprehensive, Many Doctors Shift to Jobs With Salaries By\u00a0ELISABETH ROSENTHALFEB. 13, 2014 Launch media viewer Dr. Suzanne Salamon, with a patient at Beth Israel Deaconess Medical Center in Boston, said she has had trouble filling a prestigious fellowship because of relatively low salaries.\u00a0Katherine Taylor for The New York Times American &hellip; <a href=\"https:\/\/blog.panicola.com\/?p=1395\" class=\"more-link\">Continue reading <span class=\"screen-reader-text\">Doctors move to salaried positions&#8230;<\/span> <span class=\"meta-nav\">&rarr;<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[14,9,22,6],"tags":[],"class_list":["post-1395","post","type-post","status-publish","format-standard","hentry","category-complex-adaptive-systems","category-healthcare","category-policy","category-politics"],"_links":{"self":[{"href":"https:\/\/blog.panicola.com\/index.php?rest_route=\/wp\/v2\/posts\/1395","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blog.panicola.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blog.panicola.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blog.panicola.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/blog.panicola.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=1395"}],"version-history":[{"count":3,"href":"https:\/\/blog.panicola.com\/index.php?rest_route=\/wp\/v2\/posts\/1395\/revisions"}],"predecessor-version":[{"id":1397,"href":"https:\/\/blog.panicola.com\/index.php?rest_route=\/wp\/v2\/posts\/1395\/revisions\/1397"}],"wp:attachment":[{"href":"https:\/\/blog.panicola.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=1395"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blog.panicola.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=1395"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blog.panicola.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=1395"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}