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Finances and the Family Physician The Reality of Primary Care Compensation PowerPoint PPT Presentation


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Finances and the Family Physician The Reality of Primary Care Compensation. Emily Adams, BA, and John Wiecha, MD, MPH Boston University School of Medicine Department of Family Medicine – Boston Medical Center. What is the scope of Family Medicine?.

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Finances and the Family PhysicianThe Reality of Primary Care Compensation

Emily Adams, BA, and John Wiecha, MD, MPH

Boston University School of Medicine

Department of Family Medicine – Boston Medical Center


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What is the scope ofFamily Medicine?

American Board of Family Medicine Official Definition of Family Medicine

“Family medicine is the medical specialty which provides continuing, comprehensive health care for the individual and family. It is a specialty in breadth that integrates the biological, clinical and behavioral sciences. The scope of family medicine encompasses all ages, both sexes, each organ system and every disease entity.”

https://www.theabfm.org/about/policies.aspx


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History of Family Medicine

1946 AMA established a section on General Practice to give voice to the mounting problems and decreasing numbers of generalists. Section develops into American Academy of General Practice.

1966 Three independent reports supporting the value of the practice of family medicine were published: the Millis Report, the Folsom Report, and the Willard Report

They called for a “a physician who focuses not upon individual organs and systems but upon the whole man, who lives in a complex setting…”, and whose “relationship with the patient must be a continuity one”

https://www.theabfm.org/about/history.aspx


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History of Family Medicine(continued)

The specialty was formed because of the dwindling number of medical school graduates entering general practice and the difficulty of general practitioners without board certification acquiring hospital privileges

1969 The American Board of Family Practice was officially recognized in February as the 20th primary medical specialty with 15 pilot programs

1971 The American Academy of General Practice became the American Academy of Family Physicians

1984 Family Practice became the third largest residency with 380 programs

https://www.theabfm.org/about/history.aspx


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Training in Family Medicine

  • Residency Training – 3 years

  • 497 accredited programs (2005)

  • Broadest curriculum of all specialties

    Rotate through internal medicine, obstetrics, gynecology, surgery, emergency medicine, critical care, and psychiatry as well as other medical and surgical subspecialties

  • Includes training in both inpatient and outpatient care and a longitudinal patient load


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Total level of debt of Family Medicine Residency Graduates

Median Level of Debt = $163,000

American Academy of Family Physicians, Annual Residency Completion Survey, 2005


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Examples of Possible Fellowships after Family Medicine Residency

  • Community Health

  • Faculty Development

  • FM/Psychiatry

  • Geriatrics

  • Hospitalist

  • Integrative Medicine

  • Minority Health

  • Obstetrics

  • Palliative Care

  • Preventative Medicine

  • Research

  • Rural Medicine

  • Sports medicine

  • Substance Abuse

  • Urgent Care

  • Women’s Health


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Certificate of Added Qualifications

Adolescent Medicine

Geriatric Medicine

Hospice and Palliative Medicine

Sleep Medicine

Sports Medicine


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Procedures Done by Family Physicians

Non-Cosmetic Procedures

Cosmetic Procedures

Chemical Peel

Laser Hair Removal

Botox

Sclerotherapy

Microdermabrasion

Cryotherapy

  • Minor office surgery

  • Joint injection and aspiration

  • Surgical assisting

  • Intubation skills

  • Lumbar puncture

  • Chest tube placement

  • Thoracentesis

  • Anterior and posterior nasal packing

  • Tendon repair

  • Central line placement

  • Casting

  • EKG interpretation

  • Colposcopy

  • OB ultrasound

  • Cesarean sections

  • Vasectomies

  • Circumcisions

  • IUD insertion

  • Endometrial biopsy

  • Breast biopsy

  • Stress testing


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Geographic Distribution of ABFM Certified Doctors (August 2006)

https://www.theabfm.org/about/stats_us.aspx


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Practice Type of Family Doctors

https://www.theabfm.org/about/stats_practice.aspx


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In What Contexts Do Family Physicians Practice?

Most Family Medicine Residency Graduates are Office Based

Note: Based on a January 1, 2006 survey of 32,566 family medicine residency graduates.

Source: American Academy of Family Physicians


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In What Contexts Do Family Physicians Practice Versus Other Specialties?

Family Medicine

Pediatrics

Internal Medicine

Source: 2006 Practice Survey - Merritt, Hawkins & Associates

http://www.merritthawkins.com/pdf/MHA2006SurveyofPrimaryCarePhysicians.pdf


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Average number of patient contact hours per week by family physicians (October 2006)

Source: American Academy of Family Physicians, Practice Profile I Survey, October 2006

http://www.aafp.org/online/en/home/aboutus/specialty/facts/14.html


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Average number of family physician visits per week and average number of patients in various settings(October 2006)

Average Visits Per Week

Source: American Academy of Family Physicians, Practice Profile I Survey, October 2006

http://www.aafp.org/online/en/home/aboutus/specialty/facts/5.html


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How Are Family Physicians Paid?Six Models of Physician Compensation

http://www.aafp.org/fpm/981000fm/cover.html


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How Are Family Physicians Paid?Six Models of Physician Compensation(continued)

http://www.aafp.org/fpm/981000fm/cover.html


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What Do Family Physicians Actually Make?

And Which Family Physicians

Make More?


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Salary in Residency

Average salaries offered (in dollars), 2002-2003

http://www.aafp.org/online/en/home/aboutus/specialty/facts/23.html


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Median and Mean 2005 Income of Family Physicians(Before Taxes)

  • Data collected October 2006

  • Presented by Demographic Categories

  • Data includes Full-time and Part-time Physicians

  • http://www.aafp.org/online/en/home/aboutus/specialty/facts/15.html


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Salary by Census Division (2005)

http://www.aafp.org/online/en/home/aboutus/specialty/facts/15.html


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Salary by Practice Type (2005)


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Salary by Gender (2005)


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Salary by Practice Location (2005)

http://www.aafp.org/online/en/home/aboutus/specialty/facts/15.html


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Salary by Age of Physician (2005)

http://www.aafp.org/online/en/home/aboutus/specialty/facts/15.html


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Yearly Salary by Different Practice Traits (2005 Physician Salary Survey Report)

Low, median and high represent the 25th, 50th, and 75th percentiles.

Copyright 2005 - Hospital & Healthcare Compensation Service and John R. Zabka Associates


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Distribution of Family Physician Incomes (After Expenses)2002 AAFP demographic survey


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Comparison of National Annual Incomes of Family Practice vs. General Practice2005 Physician Salary Survey Report

Low, median and high represent the 25th, 50th, and 75th percentiles.

Copyright 2005 - Hospital & Healthcare Compensation Service and John R. Zabka Associates


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Factors that Increase Earning in Family Medicine

From a survey of 730 active AAFP members

who had been out of residency five years or

longer and worked at least 40 hours per week.

  • High-earners: Those with 2003 pre-tax individual incomes of more than $160,000 after expenses

  • Low-earners: Those with 2003 pre-tax individual incomes of less than $160,000 after expenses

www.fotosearch.com


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Factors that have a Large Association with High EarningIn order of significance

1) Providing more patient visits(high-earners saw a mean number of 122 patients per week; low-earners saw 84)

2) Practicing the full scope of family medicine in the hospital setting

3) Being in larger practices(which may be related to the next four factors)

4) Providing clinical lab, physical therapy, occupational therapy and imaging services in-house

5) Viewing negotiations with payers and evaluating contracts as very important


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Factors that have a Large Association with High EarningIn order of significance (continued)

6) Participating in quality improvement, marketing, strategic planningand benchmarking

7) Having in-house billing and collections

8) Seeing more Medicare patients (nationally, may vary by state)

9) Working more hours

10) Being paid based on productivity

11) Planning to purchase an EHR


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Factors that Do Not Have a Significant Impact on EarningIn no particular order

  • Current use of an EHR

  • Number of staff meetings

  • Practice management courses for physicians or staff

  • Educational level of in-house billing staff

  • Fee-for-service versus capitated revenue

  • Percentage of co-payments collected at the time of service

  • Aging of accounts receivable


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How does Compensation in Family Medicine compare to other Primary Care Specialties?

What is the current demand for Primary Care Doctors?


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Primary Care Internal Medicine

Comparison between Different Specialties All Physicians vs. Starting Physicians2006 AMGA Compensation Survey

http://www.cejkasearch.com/compensation/amga_physician_compensation_survey.htm


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Primary Care

Internal Medicine

Comparison between Different Specialties (By Region) 2006 AMGA Compensation Survey

http://www.cejkasearch.com/compensation/amga_physician_compensation_survey.htm


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Primary Care

Internal Medicine

Income Trends by Specialty - 2005Presented by Percentage of Physicians in Income Brackets


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Current Demand for Family Physicians

“MOST WANTED

For the first time in six years, general internists and family physicians are at the top of the ‘in demand’ list for hospitals and medicals groups, according to a review of 2,840 Merritt, Hawkins & Associates’ listings. Here by year are the number of physician searches by specialty starting in 2002-03 and continuing through 2005-06.”

AMA News

June, 2006


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Current Demand forFamily Physicians

“According to Merritt, Hawkins & Associates’ 2005 Survey of Hospital Physician Recruiting Trends, more hospitals are actively engaged in recruiting family physicians than any other type of physician.”

- Leslie Champlin – AAFP News Now (7/25/06)


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Future EarningPotential

“It isn't unusual for students to hear that physicians working in family medicine don’t make enough to pay off their loans. However, the truth is that family physicians make enough money to pay off student loans and have the lifestyle they want.”

“In the future, incomes for family physicians are projected to increase as much as 25% in practices that use new technologies and new care models, such as chronic disease management.”

Debt Management – Publication of American Academy of Family Physicians, 2007

http://www.aafp.org/online/en/home/publications/otherpubs/debtmgmt.html


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