ABC s of Private Practice and Academics: Your First Job

Transcription

1 ABC s of Private Practice and Academics: Your First Job Shamina Dhillon MD, FACG Partner, Shore Gastroenterology Associates NJ Clinical Assistant Professor of Medicine, Robert Wood Johnson Medical School

2 Discussion Outline What is Private Practice? Private Practice Relationships Goals of Job Search Private Practice Models Conclusions

3 Discussion Outline What is Private Practice? Private Practice Relationships Goals of Job Search Private Practice Models

4 Core of Private Practice PATIENT CARE Office visits, endoscopy, hospital consults, gi emergencies Teaching done in hospital and office settings Need affiliation with medical school hospital or residency program

5 My Typical Day-Office Hours Gerd New onset ulcerative colitis Hepatitis C Food impaction hospital follow up Bloating IBS Pregnant patient with positive HepBsAg

6 My Typical Day-Endoscopy Session Screening colonoscopy 2.5 cm ascending colon polypectomy Balloon dilation of GE junction APC of GAVE in chronic anemia

7 A Day in Private Practice Hospital Rounds Endoscopy Center Office Hours Teaching opportunities

8 Discussion Outline What is Private Practice? Private Practice Relationships Goals of Job Search Private Practice Models

9 Professional Relationships of Private Practice Patients Partners Office Employees Referring Physicians

10 Patients Communicate: return all of their calls in a timely fashion to alleviate their fears LISTEN EMPATHIZE Opportunity, not a burden, to talk to their family

11 Partners Seek mutual respect, service, and TRUST Practice culture contributes to work satisfaction Partnership is a professional marriage Income distribution and call distribution can destroy groups Have a defined managing partner: been there and done that

12 Employees Bad employees destroy a practice High turnover of support staff is a red flag A strong practice administrator equals a strong practice Insurance contracts, HR, expenses, payroll, attorney and accountant interface, billing, AR

13 Referring Physicians Never complain about too much work There are no stupid consults They are seeking your help! Be the path of least resistance Never criticize a doctor s care of a patient

14 How to be a Successful Consultant: Rules and Realizations of Dr. Sarles You are in a public relations business You are in control of how you are perceived People skills can often trump your medical skills

15 Discussion Outline What is Private Practice? Private Practice Relationships Goals of Job Search Private Practice Models

16 Goals of your job search Be fulfilled Enjoy going to work every day Stay at position for the long term

17 Why Do Physicians Change Jobs? Need for higher salary Long hours, busy call schedule Lack of autonomy/appreciation Under utilized medical skills Poor relations with hospital admin or partners Family uncomfortable in community Desire for another climate (Survey Wendy Abodo, Physican Practice: 2004)

18 Factors to consider when choosing Type of Practice Health and Stability of the Practice Culture of Practice Teaching opportunities Hospital and medical school affiliation Location and family desires

19 Discussion Outline What is Private Practice? Private Practice Relationships Goals of Job Search Private Practice Models

20 Private Practice is HETEROGENOUS

21 Private Practice Models Single Specialty Groups Multi-specialty Groups Hospital or System Employee Physician Owned

22 Physician Owned Practices Single Specialty and Multi-Specialty Initial Employee Contract PARTNERSHIP CONTRACT and STRUCTURE

23 Initial Employee Contract Length of Contract: ie how long to partnership contract Guaranteed salary; any productivity incentive Benefits Vacation/Scheduled Days Off Expense reimbursements Meeting attendance Sign on Bonus/Relocation expense Work with health care employment attorney

24 Employee Issues Teaching Opportunities/Medical School Affiliations Call schedule Needs of practice which are to be fulfilled Schedule of associate, start/end time ERCP/EUS coverage Sub specialty GI services: manometry etc Secretarial/ MA support Electronic Record

25 Employee Contract How many employee physicians have gone onto partnership Attrition Rate Any plans to merge groups

26 Employment Partnership

27 What Comes Next? PARTNERSHIP STRUCTURE

28 What Does Partner Status Mean? No longer an employee with a guaranteed set salary You generate more than your salary Access to the practice s collections and revenues Involved in decision making Perks : call schedule, vacation time, Amex card, days off, pension plans OWNER IN THE BUSINESS OF MEDICAL PRACTICE

29 What Do I Own?

30 How Do I Buy It?

31 What You OWN Patient visits and Procedure Fees Surgery Center (ASC) facility fee Total Income stream Pathology and Anesthesia

32 What You Buy Partner Buy In Component Office Practice Surgery Center (ASC) Buy In

33 Office Practice Buy In Office visit and hospital income Physician procedure fees Hard assets Anesthesia and path Sweat Equity or Money Healthcare Accountant and Attorney

34 Partner Buy In Component Office Practice Surgery Center (ASC) Buy In

35 Ambulatory Surgery Center Physician owned center with multiple OR s Control of staff and scheduling Efficient Facility Fee Anesthesia and Pathology National surgery center organizations

36 Income Based on Site of Procedure Hospital Physician Procedure Fee Surgery Center Physician Fee Facility Fee Anesthesia/Pathology

37 ASC Buy In How many current owners Limited to practice or open to outside physicians What percentage ownership is available to new partner Methodology of buy in: all at once or gradual ownership Calculation of buy in Obtaining funds for buy in Buy in based on multiple of annual earned income Stark Law

38 Private Practice Models Single Specialty Groups Multi-specialty Groups Hospital or System Employee Physician Owned

39 Multi Specialty GI Group Advantages of multi specialty referral source; reimbursement Employment contract to partnership How is income from other specialties shared

40 Distribution of Partner Income Equal distribution of all revenue Purely productivity based Hybrid models: set base and remainder productivity based

41 Productivity Based Will there be appropriate opportunity to earn Payor mix SCHEDULE What is the measure of productivity? RVU vs Collections Access to ancillary services incomes Possibility of internal competition

42 Hybrid Models of Income Distribution Set base for all partners What percentage beyond is productivity Division of ancillary service income

43 Private Practice Models Single Specialty Groups Multi-specialty Groups Hospital or System Employee Physician Owned

44 Hospital Employee Employee Contract with Hospital or System No responsibility of managing staff, contracts, ASC, etc: No ownership Guaranteed income for three years RVU used as measure of productivity

45 RVU Relative Value Unit Reflects the level of time, skill, training, and intensity required for physician to provide given service Related to the monetary compensation for a service by insurance company Each CPT code has RVU assigned to it EGD with Biopsy (43239)

46 RVU Physician work RVU: time, skill training, and intensity to provide service Practice Expense RVU: cost of maintaining a practice including rent, equipment, supplies, and non physician costs Malpractice RVU: smallest component; payment for professional liability expenses

47 GPCI Geographic Practice Cost Indices (GPCI): accounts for geographic differences in cost of practice across country Reviewed every 3 years

48 Conversion Factor Converts RVU s into actual dollar amount Updated on an annual basis

49 RVU Compensation (Dollar Value)of a service: RVU * GPCI* CF

50 Hospital Employee Contract Productivity measured by number of RVU s generated by your services Paid x dollars per RVU generated Can generate 8,000-12,000 RVU per year Average pay per RVU can be $55-$65

51 Hospital Employee Contract What happens if you fall short of RVU needed for salary? Is there a salary cap? What if you generate RVU beyond your income?

52 Academic Medicine What is FTE Understanding Academic Rank Path to Promotion

53 FTE= Full-Time Equivalent 1.0 FTE= 100% time worked Mon Tues Wed Thurs Fri AM 10% 10% 10% 10% 10% PM 10% 10% 10% 10% 10%

54 Effects of Working Part-Time If you plan to work part-time: Talk to others to decide best FTE for you Find out ability to change FTE later Investigate the effects on your benefits Salary Vacation and trip days Pension fund Health insurance

55 Levels of Academic Rank Instructor of Medicine Assistant Professor of Medicine Associate Professor of Medicine Professor of Medicine

56 Academic Rank: What You Need to Know Do you have tenure, and is it linked to academic rank? If so, find out details. Time to reach the rank? Adjusted if part-time? Annual reviews to check progress? What are institutional differences with each rank? Salary, benefits Future leadership roles Realize academic rank differs place to place.

57 Academic Rank With Associate and Professor levels: Notable # of papers (the commodity!) National/international presence Support/letters from others: Cannot have worked with them Cannot have collaborated with them This is where networking is KEY!!!

58 Promotion Tracks Institution may have both: Traditional promotion track Educational promotion track Traditional track: Papers, funding, mentoring, recognition Educational track: Papers, curriculum, talks, running a course/clerkship, roles, mentoring, recognition

59 Conclusions Private Practice is patient care! Private Practice is heterogeneous Understand the model of physician owned vs hospital employee contracts Work with a healthcare attorney!! Understand FTE, Academic Rank, and Promotion

60 Thank You and Good Luck!!