Career and Life Planning Guidebook for Medical Residents

If I performwell, what is the income potential for the first, second, and third years? Do you anticipate acquiring any new systems that will impact and improve patient flow? What is the waiting period for new patients to see a physician in my specialty? How busy will I be from day one? Will the hospital help market my practice? If so, what is included in the marketing plan? What are my responsibilities in building a successful practice? How long do you estimate it will take to build a full practice? You’re probably thinking that there have to be instances where production shouldn’t be the primary indicator of effort. You’re correct! Shift-Based Practices – Certain physician specialties lend themselves to being more shift- based. In these instances, physicians provide on- site coverage regardless of the patient volume. Examples of these include emergency medicine, hospital medicine, and critical care medicine. These types of physicians are typically not in control of or able to predict the patient volume, the payer mix, or the payer contract associated with those patients. Additionally, the inherent nature of these types of practice settings is to be open and staffed 24/7/365 without regard to the commercial factors of demand as found in non-healthcare industries. Rural Practice Settings – We discussed in Section I that contributing factors to physician compensation include geographic location and demographic classification. These same factors influence physician productivity. Rural practice settings tend to contribute to higher levels of compensation and recruitment incentives due to supply and demand constraints. These rural practices tend to provide care to a smaller patient base spread over a wider geographic footprint as compared to practices in large metropolitan markets. Take for instance a medical center located in a rural county consisting of approximately 2,500 people that is located one to two hours from the nearest large town. Physicians practicing in this type of rural setting provide a level of care to the population base that would be otherwise inaccessible without significant travel. In this instance, physician services are at a premium while physician productivitymay not be the primary indicator of value. Other Production Factors: In any conversation regarding production there are other factors to consider including the application of CPT codes, payment modifiers, the use of internal coding reviews and audits, and comparison to CMS norms. Another influencer on production is the impact from practice recruitment and retention efforts. A physician practice will undoubtedly go through changes with new providers coming and going over the course of time. Understanding the impact and howyour compensation plan will handle these changes is critical. As we discussed earlier, healthcare is transitioning from volume to value. Essentially, payers are increasingly rewarding population health management and moving away from the traditional fee-for-service model of payment. This is aimed at improving quality and reducing the overall cost of healthcare market. CMS has adopted a framework dating back to 2007 to improve patient care, reduce healthcare costs, and improve population health. With the transition to value-based care, a fourth aim related to clinician experience has evolved. SECTION II: T MINUS TWO YEARS CAREER AND LIFE PLANNING GUIDEBOOK FOR MEDICAL RESIDENTS 234