Specialists are quietly under fire in the new proposed health care bill. In it, the most highly paid doctors are asked to take a 5% pay cut, which is even more formidable than it sounds since Medicare dollars are worth 83 cents on the private dollar. When these figures are collated, it amounts to a pay cut of roughly 20% for specialists under the new health care bill.

The devil is in the details. According to a recent article in the Wall Street Journal:

    “Beginning in 2015, Medicare would rank doctors against their peers based on how much they cost the program—and then automatically cut all payments by 5% to anyone who falls into the 90th percentile or above.”  The War on Specialists, WSJ October 6th, 2009

This formula automatically penalizes specialists, as it is they that will invariably fall into the 90th percentile of that formula. Specialists become specialists for a variety of reasons, not least of which is the potential for a higher income. If their wages are stripped towards parity with general practitioners, will specialists still want to be specialists?

The common theory running through the health care bill is that the high costs of specialists will be defrayed if patients have better and more frequent access to general practitioners. However, the above formula simply penalizes specialists for doing what they do disregarding any other measures that have been put in place.

In addition, the health care plan goes after diagnostic tests. Echocardiograms and catheterizations have been reduced by 42% and 24% respectively. These diagnostic tests are vital to understanding what is going on with patients and their discouragement through the health care bill is a misplaced effort to trim costs. Cancer doctors are hit especially hard through slices to the CT and MRI pie, both of which are vital tools in cancer diagnosis and treatment. Payments for antitumor radiation therapy will fall off by up to 44%.

While the cuts referenced don’t actually cut any spending, they definitely shift the money from one area to another. In its quest to make the specialist less of a driving force to the patient than the general practitioner, the health care bill is cutting too close to the bone where specialists and their diagnostic equipment are concerned.

For decades, the U.S. healthcare system was the envy of the entire world. Not coincidentally, there was far less government involvement in medicine during this time. America had the finest doctors and hospitals, patients enjoyed high quality, affordable medical care, and thousands of private charities provided health services for the poor. Doctors focused on treating patients, without the red tape and threat of lawsuits that plague the profession today. Most Americans paid cash for basic services, and had insurance only for major illnesses and accidents. This meant both doctors and patients had an incentive to keep costs down, as the patient was directly responsible for payment, rather than an HMO or government program.

We should remember that HMOs did not arise because of free-market demand, but rather because of government mandates. The HMO Act of 1973 requires all but the smallest employers to offer their employees HMO coverage, and the tax code allows businesses – but not individuals – to deduct the cost of health insurance premiums. The result is the illogical coupling of employment and health insurance, which often leaves the unemployed without needed catastrophic coverage.

Ron Paul, excerpted from Examiner Article

The first article in this series explored how we compare with other countries, in particular with the Japanese health care system. This portion of the series will look at the “good old days” of American health care, and examine if there are lessons to be learned from the past or if we are better off moving on into the future. Despite Paul’s claims, American health care costs rose almost every year between 1940 and 1990. In the 1990’s, health care costs stopped growing as substantially as they had in the past. The introduction in 1965 of Medicare and Medicaid was responsible for a more significant increase.

In 1990, most were forgoing health care spending for other purchases, as the majority of the “boomer” generation was still quite young and in good shape. Now, those boomers are older and obesity rates are much higher, making for much higher health care costs overall. Problems can no longer be ignored and most boomers go to see the doctor rather than buying a new car, as they may have done in the 1990’s.

There is a call from some quarters for the US to return to the Hill-Burton standard for American healthcare, and an end to the HMO system that so many feel is a drain on our resources. Even though there was an increase in spending, under the Hill-Burton standard this money actually went towards some useful items. The four principles of the standard, enacted under FDR, were:

1. Ensure an infrastructure of necessary facilities and medical personnel, either public or private, to meet certain minimum standards of availability for the public.
2. Provide care to those in need, regardless of their ability to pay, and worry about the costs afterwards.
3. Depend upon the growing wealth of a productive, industrial economy to make sure that sufficient resources, financial and otherwise, are being created to provide for health care needs, and associated public health needs.
4. Carry out special programs to attack and treat leading dangerous diseases, in the interest of the general welfare.
From: http://american_almanac.tripod.com/hillburt.htm

Under the Hill-Burton standard, there were about 4.5 hospital beds per 1000 people, a far cry from the overcrowding of today. It is no wonder, given the principles and the lack of crowding, that most wish for a return to simpler times.

The problem is that times are not that simple anymore. There is a possibility that the new EHR program may streamline our health care system significantly, but the realities that we are dealing with today are much more complex than those that we faced under FDR. New diseases such as AIDS and swine flu, a dated infrastructure that is groaning under the weight of the extra population, and emergency rooms packed with people who need treatment. While a revisit to the Hill-Burton principles can’t hurt, I think we can all agree that a total rehaul is in order.

Experts believe that we are facing a physician shortage over the next 15 years. One study in particular was published by Edward Salsberg, a respected specialist in issues related to the physician workforce. It states that there will be a shortage of 200,000 physicians by the year 2020 if current trends continue in the health care marketplace. This study effectively ended the arguments of those who were arguing that there was a physician surplus.

Most notably, The Council on Graduate Medical Education endorsed the Salsberg report in 2003. This council of healthcare experts reports to Congress on issues that effect healthcare on a regular basis. The AMA has also abandoned its position that there is a surplus of physicians.

Now that everyone agrees on the fact that there will be a physician shortage, the question is exactly what to do about it. 85% of hospital organizations report that they are actively recruiting physicians, something that the remaining 15% probably want to consider doing as well. The shortage has changed how health care human resources departments do business. Where in the past the assumption was that you were lucky to get a job as a physician, the skew is now towards the need to attract physicians to your organization.

The sooner your organization department jumps on the need to recruit, the better off you will be. In the coming years, other health care organizations will be stepping up recruitment efforts and if you aren’t careful, your organization will be left behind. There is still a battle raging in many health care boardrooms over whether or not there is a physician shortage, mostly because it is easier to be a buyer in a buyer’s market than it is to be a seller. If you have colleagues that still maintain that there is a surplus of physicians, present them with the relevant studies that have made the AMA and COGME change their minds in order to get them on to the same page.

Some key reasons that there is a physician shortage are:

-Population Growth
-Aging Population
-Economic Factors
-Dimishing Supply through attrition and fewer new entrants
-More temporary physicians

There are more that are referenced in the study, but these are some of the major factors that are contributing to the shortage.

New Technologies

eMatchPhysicians and other new technologies can keep your organization on the leading edge of recruitment. eMatchPhysicians can deliver potential candidates to your inbox while you attend the other duties that we all know are filling your schedule. You may also want to consider technologies that allow you to interview candidates remotely through videoconferencing such as GoToMeeting.com and Skype. Many candidates may not be willing to travel to every opportunity they hear about, but they may be willing to entertain more opportunities through video conferencing. Then if they do choose to visit, you will already have established a strong, genuine interest.

With the economy at an all time low, and unemployment now reaching nearly 10%, it seems as though ever industries has felt the impact.  However, not only has the healthcare industry maintained strong, it continues to grow.  Healthcare exhibited higher numbers of employed professionals last month than previous months and The Bureau of Labor Statistics stated that more healthcare jobs were introduced in May than in any other market.  Not only were 23,500 jobs added, but the healthcare industry “stayed in line with its average monthly job growth for 2009″.  According to ModernHealthcare.com, “nearly every other sector of the economy lost jobs”.

With an aging population, the need and demand for healthcare professionals continues to rise.  We will always need medical attention for our illnesses and pains during the entire course of our lifetime.  Therefore, we will always turn to those with medical experience to treat those pains.  In order to accommodate the growing number of patients seeking medical attention, more jobs will open up not only for doctors but also on every level in healthcare to ensure efficient and quality care.  So it’s no wonder that the healthcare industry is one of the fastest growing industries in the country.   Money is being allocated to healthcare research, services, and treatments to meet our needs, and the opportunities generated by this investment are numerous and expanding constantly.  And with more hospitals and medical groups competing for the best and most skilled health professionals, physicians are presented with more and more options to pursue the best path for their practice.

Although some physicians are in higher demand than others, depending upon their specialty, adjustments are made on all levels to relieve shortages to include residency program enrollment, government funding and recruitment budgets.  When more and more money is poured into one area of healthcare, physicians follow, and then there becomes a surplus of physicians causing the demand to lessen.  However, the good news still remains.  Every area of healthcare is growing and despite the specialty area you choose to practice, you can be sure that you will grow with it over time and benefit from such a strong and stable industry.

Quality ratings for hospitals come in two flavors – professional and public. As can be expected, the professional quality ratings are the ones that can be trusted, but they are not as easy to access as the public rating systems. Public rating systems can be skewed towards a positive outcome by advertising, or skewed towards a negative outcome due to one complaint. Professional rating systems are often fairly done through industry reports and surveys, and thus can be more trusted. Patients should be discouraged from using internet healthcare rating systems, even if they are favorable towards your organization. What then are the professional quality ratings that you can trust, and how do they work?

The first thing to note is that even hospital quality rankings that are considered top in the industry can be considered flawed when placed under a microscope, such as the rankings of the US News and World Report, a frequent go-to guide for hospital rankings. These reports are generally meant to be overall rankings and may not take into account representative samples or all statistics that are available. In the end, there is no one way to denote “the best” hospital for a certain surgical procedure. Most hospitals and medical professionals are created equal and while some surgeons and physicians may be considered subject matter experts, there is no guarantee that this expertise will translate into better patient care.

The US News and World Report uses the four following criteria to rank hospitals:

1. Having intensive care units staffed by specially trained doctors

2. Having computerized order-entry systems for medications and other orders with error-prevention measures

3. Performing procedures such as cardiac catheterization and caring for certain high-risk neonatal conditions4. Having practices such as those designed to control hospital-related infections and cut down on medication and treatment errors.

While these are lofty goals, what about overall patient satisfaction surveys, or other criteria that medical professionals and patients alike can start rattling off? The reason is simple – these four are really the only universally measurable criteria for most organizations. Until there is a better source of information, such as the new EHR’s that the Obama administration wants to see in place, the US News and World Report is the best source for quality ratings of health care organizations.

Manufacturing and construction are the hardest hit sectors in the current economy. Health care jobs, however, appear to be holding steady. According to employment data released for January, health care jobs grew on average by 3% across both hospitals and practices for the year ending in January. Hospitals added approximately 137,000 workers to their rolls from January 2007-January 2008. Physician’s offices claim to have hired 66,600 workers in the same period.

In the month of January physician’s offices added about 7200 jobs while hospitals were responsible for 8000 new jobs. At the same time, American unemployment numbers reached epic levels. These statistics are proof positive that anyone considering a switch in their careers should consider it a no-brainer to retrain in the health care field. Current health care workers can also feel secure in their jobs where their neighbors may not be as fortunate.

If you’re a practice seeking physician or hiring organization looking to fill physician jobs, eMatchPhysicians.com can help you.