Hand Surgeons Indicate a Preference for Private Practice
Findings from the Recent “Hospitals Employing Physicians Survey”
By Cheryl Toth, KarenZupko & Associates
Initial findings from a May survey of ASSH members indicate that private practice is alive and well for hand surgeons – and most of them plan on things staying that way, even if a hospital comes knocking.
The survey was developed in partnership with practice management consulting and training firm KarenZupko & Associates, Inc. ASSH emailed a link to the online survey to 2,195 members - 491 of whom completed it; a response rate of 22%.
Autonomy Highly Valued
The majority of those who completed the survey - 75% - said they are in private practice. And they were quite vocal about their desire to stay independent. 67% said they would NOT consider hospital employment if they were approached. 80 of those respondents also filled in the optional comment field about whether they would consider employment. While a number of them noted that this would depend on salary, terms, etc. the vast majority stated a preference for continued independence. Lack of trust with hospital administrators was cited multiple times, but “LIVE FREE OR DIE!” and “My ethics are not for sale,” summed up the majority opinion.
Employment Brings Stability and a Focus on Care
25% of survey respondents said they are currently employed. 50% work for an academic medical center, 33% for a health system, 11% for an independent hospital, and 6% for a staff model HMO. Of these employed ASSH members, 58% have always been employed by a hospital or other organization.
Generally speaking, these surgeons have seen improvement since being employed – though clearly there is no unanimous agreement. Here is a breakdown of how respondents rate specific aspects of their practice since being employed by a hospital/healthcare organization:
In addition, summarized comments from these surgeons indicated the following perceived benefits:
• Financial security/stable income, good benefits
• Don’t have to worry about practice management or staffing
• Can focus on patient care
• Better contracting
• Better call schedule
But not all the grass is greener. Employed also surgeons mentioned a wide array of things deemed as “not working,” including: poor payor mix and collection rate, union impact on staff and physician productivity, loss of independence and control, bureaucracy, and an ‘institutional’ approach to patient care and problem-solving.
Additional findings about employment include:
• Ancillary revenues, such as physical therapy or x-ray, are included in the compensation agreements of only 14% of the respondents.
• 45% reported that their income increased after being employed by a Hospital/Healthcare Organization. 40% said it stayed about the same, and 15% reported a decrease.
• In 53% of practice acquisitions, the manager or administrator was not retained or employed in the deal.
A Growing Trend
35% of those employed and 44% of those not employed said “yes” when asked whether local or competing hospitals are buying surgical specialties. This may be the calm before the storm in ASSH members’ markets. Surveys of other orthopedic specialists and sub-specialists reveal that the hospitals in nearly 75% of their markets are buying surgical practices – orthopedics, cardiovascular, ENT, and general surgery among these. And a national uptick in healthcare mergers and acquisitions, as well as a growing number of feature stories in healthcare and consumer press, indicate that this trend is taking hold.
About the Data
491 ASSH members completed the survey and 98% of all respondents were surgeons. The respondents came from all regions of the country, with the greatest percentage (26%) from the Midwest. Respondents also came from a wide range of practices:
• 15% - 1 Physician
• 19% - 2-4 Physicians
• 29% - 5-9 Physician
• 13% - 10-15 Physician
• 8% - 15-20 Physicians
• 16% - 20+ Physicians
Cheryl Toth is a consultant with KarenZupko & Associates, Inc., a Chicago-based practice management consulting and training firm. She specializes in business management, technology optimization, and marketing for surgeons.