Published 6/1/2014

Second Look—Advocacy

Physician employment
A report released by Medscape compares survey data on employed (defined as a physician who does not run a private practice) and self-employed physicians. The survey of more than 4,600 physicians found that 38 percent of employed physicians indicated “financial security/less risk” as their primary reason for choosing employment. Additional reasons included “fewer administrative responsibilities” (29 percent), “better hours/work-life balance” (19 percent), and “other” (15 percent). Cited negatives to physician employment included “limited influence in decision-making” (45 percent), “more limited income potential” (44 percent), “too many rules” (34 percent), and “less control over work/schedule” (32 percent).

ASCs, quality, and cost savings
Findings published in Health Affairs (May) suggest that ambulatory surgery centers (ASCs) offer an efficient approach to meeting predicted growth in demand for outpatient surgeries and may reduce costs while improving the quality of healthcare delivery. U.S. Centers for Disease Control and Prevention data on 52,000 surgical visits across 437 facilities over 4 years were reviewed. Procedures performed in ASCs took 31.8 fewer minutes than those performed in hospitals—a 25 percent decrease—and patient costs were $363 to $1,000 lower per procedure in ASCs, while outcomes were similar in both ASCs and hospitals.

A report released by the U.S. Department of Health and Human Services Office of Inspector General (OIG) recommends that the Centers for Medicare & Medicaid Services (CMS) take steps to reduce hospital outpatient department payment rates to match ASC payment rates, for certain “ASC-approved” procedures. Medicare generally saves when outpatient surgical procedures that do not pose significant risk to patients are performed in an ASC instead of an outpatient department. OIG estimates that CMS could potentially save $15 billion from 2012 through 2017 by reducing outpatient procedure payments to match those of ASCs and argues that Medicare beneficiaries would also save through reduced cost sharing. CMS did not concur with the OIG recommendations.

Training for EM physicians
Findings published in the Journal of Orthopaedic Trauma (April) suggest that additional resources should be committed to the training of emergency medicine (EM) physicians in the area of musculoskeletal medicine. A survey of 23 EM residents and 21 attending physicians working at a Level 1 trauma center found that 35 percent of residents and 43 percent of attending physicians failed to demonstrate proficiency on a validated musculoskeletal medicine competency examination. Overall, 23 percent of respondents indicated that they were dissatisfied with their musculoskeletal education.

Physician compensation report
According to the Medscape “Physician Compensation Report 2014,” orthopaedists are the highest compensated physicians, with an average of $413,000 per year. Cardiologists are second, at $351,000 per year. Orthopaedics also leads other specialties in offering ancillaries, with 33 percent of responding orthopaedists offering such services.