There is a boom in community health centers. The problem is, finding physicians to staff them:
Administration officials say they are doing their part, increasing health center funding by $645 million (about 48 percent) since the beginning of the 2002 fiscal year. Much of the money goes to hire and pay medical professionals, said James Macrae, associate administrator for primary health care in the Health Resources and Services Administration.“We have put a significant amount of money . . . to really support bringing physicians, nurse practitioners and certified midwives into underserved communities,” said Macrae, whose agency is part of the Department of Health and Human Services. “At the same time, we also recognize that there is a need for getting more people interested in providing care to the underserved.”
Try reimbursing primary care properly and the problem is solved. The answer really is that simple.
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- How building your brand can improve your medical practice
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{ 16 comments }
What’s a “proper” amount of reimbursement?
The article lists physician salaries of $120k in one area to 160k-220k in another. I’d say offhand this is fairly good compensation!
Since they’re salaried, I would assume that any costs of malpractice would be shouldered by the hiring institution and not by the physicians themselves.
I understand though that costs of financing their medical education might cause concern. Perhaps if loan forgiveness could be instituted this would help drive more primary care docs to the area.
Finally (and back to the idea of a “proper” amount of reimbursement) any public data out there as to the average salary for physician these days???
“Underserved” areas can be problems for reasons besides poor clincal service reimbursement. Spousal career opportunities, inadequate community schools and the lack of an attractive and interesting community all can undermine recruiting. Working by yourself, with few colleagues for support can become demoralizing. Paying off school loans doesn’t necessarily distinguish one opportunity from another; it just amounts to more money.
Sometimes it isn’t just a matter of money. You have to be happy with where you come home at night, and your family has to be happy with you.
“proper” reimbursement is the reimbursement that it takes to fill the position with the right person. Basic economics. If they aren’t filling the positions, the reimbursement is, by definition, inadequate.
“Proper” reimbursement is also what people in the same field as you are, are making: swz.salary.com has this to say about generalist physician salaries:
25th %ile: $127,211
Median: $145,466
75th %ile: $172,171
You make no allowances for location? And if we raise the salary in X location, doesn’t that raise the whole average? Does the top number stay constant or keep going up? When does the spiral up start?
anon 11:31’s got it right.
if they can’t fill the position, isn’t it simple enough? just keep raising the bar until someone bites (duh!)
for those who think it’s a very good living, they can go out and invest 12 yrs of their life & $300k, come out and take those jobs (assuming they are competitive enough academically). Undoubtedly they will still be available, as these kinds of salaried jobs typically have a very high turnover rate, attracting those right out of residency for a couple of years max.
As far as “getting more people interested in providing care to the underserved,” what a ridiculous statement. I remember just starting private practice, and meeting with the Cigna field rep for a “site visit” as part of the credentialling process. I chatted w/her about the low reimbursements nowadays, and her take on it was “this is really going to attract the right kind of people into medicine now, those that want to help people”!!!
I guess what she meant is “stupid people with no economic sense”.
Anon 2:57 – All I know is that if I was willing to work somewhere for 220k, and THEN found out that everybody else was making 300k in that area for the same work…I’d feel like I was being cheated.
If it is great heart-warming warm leaving you soul-satisfied down to the tips of your toes every night upon reluctantly returning home, then the job is acceptable to you even if the pay is below average.
But that is not what it is really like working in a public clinic serving the poor for most people. Some people can just get their cookies from the grateful and needful patients with out having their soul slowly killed by the equally large troops of manipulative drug addicts, disability malingerers, hostile, distrustful, non-compliant, and entitled.
The marketplace will tell us what the job is really worth when we see what salary they have to pay to fill the positions. Maybe it is less than average because of the emotional rewards. Maybe it is more than average because of the emotional drain.
In my community private school teachers make a lot less than public school teachers–yet they get great teachers doing a great job because it is not just about money. Compliant students, friendly parents,a safe working environment, and freedom from silly rules and bureacracy are all worth something.
If having a competent support staff is not important to you (i.e. a staff that informs patients of abnormal lab results when directed, knows where patient charts are when the patient is being seen, can take phone messages, etc.), then a FQCHC is a great place to work.
But if you would be turned off by working in an incredibly inefficient environment that managed primarily by non-clinicians who care most about maximizing patient visits in order to boost revenue and who care little about and have no clue how to assess/measure quality of care, then you might want to consider other options.
These FQCHCs are having money pumped into them to provide incredibly inefficient care, and they end up having a tremendous competitive advantage (due to enhanced Medicaid reimbursement/FTCA) over private practitioners practicing in the same communities.
I pity the NHSC scholars who have no choice but to work in these settings.
I was a NHSC Loan Repayment recipient for two years. It was a long and hard two years. I signed a contract for two years and they agree to pay off 50K for that time.
If I had to do it over again, I would have just worked in private practice and paid off the amount myself. Of course if you want them to pay off more than 50K, then you must sign up for more punishment after your time is up.
The job choices are very poor, usually extremely rural locations or poor urban environments. When interviewing for the selected jobs, you are at an disadvantage because absolutely no one interviews at these jobs unless they are NHSC and they offer you low salary, little to no benefits and a punishing work load. They think you are their slave for two years and treat you accordingly.
As a physician, you are responsible for everything but have no authority. All the staff report to the non-clinical CEO/CFO and feel they don’t have to listen to you. Many of the staff’s attitude is ….I’m not here to work. You find yourself doing your job and everyone’s as well. You have liitle to no support from “upper level” supervisor(s) and many of them relish in being above the phyisician and putting the doctor in their place.
Those two years were the most stressful and demoralizing time thus far in my career. Everyday you fight a battle. After my 2 years, I had to take a mental break, and I also needed time to remove all the knives that were embedded my back. My salary was never 125K, no where near.
While I enjoyed the patients and felt like I was doing something significant, the price was too high mentally and emotionally. I changed sites (hard to do in NHS contract) to find a better working environment, but it was worse.
Every patient is a “train wreck” and all have significant social issues that you must help them with before even thinking about treating their medical problems. There are very few specialist that will take them on so as a primary doc you are managing complicated problems you would normally refer.
The problem with recruiting at many of these sites is the extremely poor treatment of physicians. Why work a site where you make less money than your peers, work much harder and get treated poorly.
I made a decision during the two years to live like a hermit and pay off the rest of my loans myself. Never again will I be “owned” and work somewhere that was so unhealthy. The sad thing is I enjoyed the patients and what I was doing and would have stayed in that line of work. Unfortunately, the environment for phyisicans is so toxic at many of these places, you can not stay.
I think I would greatly enjoy having a beer with you. Different experiences but with the same result—short of necessity to avoid actual starvation, i will never again give up my freedom and be owned.
Anonymous 7:53p.m. I would have that beer with you. Good for you in structuring your life where you could have the freedom to do as you choose. Due to my hard work and extreme delay of gratification, I have no educational debt, work as an independent contractor and am enjoying my life again. I don’t feel trapped by my medical training loans and I stay in medicine because I want to. This way I won’t burn out so fast like I see my fellow collegues and friends I graduated from residency (close to 5 years ago) doing.
I did what your friends did for five years and burned out on schedule. Got away for a while and got back in on different terms and found that it wasn’t medicine that burned me out but dealing with sociopathic MBA’s running the organization. No more.
Glad to hear Anonymous 10:28pm. I know a thing or two about sociopaths. I also know a lot about “just plain crazy”. I’m glad you’re in a good place. I’m a first generation physician, and I would have never thought that the world of medicine was so vicious and full of booby traps. Medicine is definitely not for sissies.
Correctional facilities are areas of “greatest need” as defined by HRSA in assigning HPSA scores for Mental health professionals. The HPSA score for mental health professionals which includes Psychiatrists (also Medical Doctors)is 19. Correctional facilities (state and federal) comprise at least 40% of thejob opportunities available for Psychiatrist who wish to serve as NHSC Scholars. Hmmmm…does that mean these facilities have a greater need than the general public?
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