ASMBS Compensa.on and Prac.ce Style Survey. Teresa LaMasters MD, FACS John Morton, MD, MPH, FACS, FASMBS

Transcription

1 ASMBS Compensa.on and Prac.ce Style Survey Teresa LaMasters MD, FACS John Morton, MD, MPH, FACS, FASMBS

2 Thank you Robin Blackstone, MD ASMBS Past President Georgeann Mallory, RD ASMBS Execu.ve Director Catherine Hacke6 Renner, PhD Director of Research Iowa Health- Des Moines

3 Background Na.onally more physicians are becoming employed This is especially true in Bariatric surgery due to programma.c requirements and overhead

4 Background There is a lack of valid benchmarking for physicians and hospitals to use when nego.a.ng compensa.on MGMA and AGMA models have been inadequate in the past and do not take into account specialized bariatric surgeons vs. general surgeons also involved in bariatrics

5 Objec.ve Determine compensa.on ranges and prac.ce paoerns for ASMBS members Hospital employed Private Prac.ce

6 Who can Benefit? All surgeons nego.a.ng contracts with employers New gradua.ng fellows ASMBS Leadership to beoer understand membership needs All surgeons evalua.ng joining a prac.ce Surgeons who desire to see a snapshot of future career

7 Methods Two survey tools were created One for hospital employed One for private prac.ce surgeons Surveys sent out 3.mes by ASMBS

8 Response Hospital employed n = 124 Total sample used = 117, 108 in compensa.on Exclusions Part-.me surgeons (n=4), non- US respondents (n=3), respondents with less than $200,000 annual compensa.on (n=9) 37 states represented Private Prac.ce n= states represented

9 Ques.ons How many years have you been in prac.ce? Which of the following best describes your prac.ce model? How much experience do you have performing bariatric surgery? What is your employment status? What percent of your.me is dedicated to bariatric surgery? In what state are you employed? What is the zip code in which you are employed? Did you complete a Fellowship? If yes, what type? Select the method that most accurately reflects your current compensa.on model. What is the amount of your total compensa.on? What is your es.mated annual re.rement contribu.on?

10 Ques.ons Which of the following benefits are provided to you and paid by your employer? If your compensa.on is based on WRVU produc.on, provide the amount paid per WRVU Provide the threshold amount at which the incen.ve begins and the compensa.on amount per WRVU that you receive What are your call requirements and compensa.on for the following? Provide volume for each of the procedures listed on the aoached table

11 Hospital- Employed Prac.ce Environment Demographics Time Devoted to Bariatric Surgery Regional Varia.on Call Requirements Bariatric Specialists (>80% devoted to Bariatrics)

12 Hospital Employed Prac1ce environment 42.6% academic, 34.3% mul. spec group, 17.6% single specialty, Few solo employed 5.5% 17.60% 5.50% 42.60% 34.30% Academic Mul. Spec Single Spec Solo

13 Demographics Hospital Employed Completed Fellowship with MIS or Bariatrics 41% 59% Yes No

14 All Hospital Employed Percent 1me dedicated to Bariatric Surgery 38% 35% 27% 0-50% 51-80% >80%

15 All Hospital Employed %.me in Bariatrics 51-80% 27% Regions represented overall 7% 25% Midwest Northeast 10 0 >80.me 41% South West

16 Hospital Employed Call Requirements Bariatric call - Average is 50% of.me General Surgery Call about 2/3 take some General Surgery call but not very much (14% of.me = 4 days/month) Trauma Call Very few (16%) take Trauma Call - spend <1 day/ month

17 Time spent on Call Comparison All Hosp Employed Bariatric Those taking General Surgery Call spend about 4 days a month Those taking Trauma Call spend about <1 day a month >80% Bariatrics Those taking General Surgery Call spend about 2 days a month Those taking Trauma Call spend about 1.5 day a month

18 Bariatric Specialists > 80% Time Dedicated to Bariatrics ½ (48.8%) in Faculty/ Academic prac.ce Prac1ce Model Faculty 22 % Mul.specialty Group 19.5% Single Specialty Group 9.8% Solo employed model 19% 22% 10% 49% Mul.- Specialty Group Single Specialty Group Solo Employed

19 Hospital Employed Comparison All Bariatrics Prac1ce environment >80 % Bariatrics Prac1ce Model 49% 18% 34% 5% 43% Academic Mul. Spec Single Spec Solo 19% 22% 10% Academic Mul.- Spec Group Single Spec Group

20 Group Characteris.cs Bariatric Specialists Years in Prac1ce 17% Years of Bariatric experience 0-5 years 24% 17% 5-10 years 46% 20% 0-5 years 42% years >20 years 34% 5-10 years >10 years About 20% started Bariatrics later in Career

21 > 80% Time Focus on Bariatrics 2/3-63.4% high volume group >1000 surgeries Career Volume 17.1% at % at % 7% > % at % 17% % have done more than 500 bariatric cases

22 Private Prac.ce Prac.ce Environment Demographics Time Devoted to Bariatric Surgery Regional Varia.on Call Requirements Bariatric Specialists (>80% devoted to Bariatrics)

23 Private Prac.ce: Time Alloca.on Percent of Time Dedicated to Bariatric Surgery 35% 32% 33% 0-50% 51-80% >80 %

24 Private Prac.ce: Experience Years in Prac1ce Years of Bariatric Surgery 32% 22% 0-5 years 5-10 years 36% 7% 26% 0-5 years 5-10 years 28% 18% years >20 years 31% years >20 years

25 Private Prac.ce: Prac.ce Sepng/ Training Prac1ce Model Completed Fellowship in MIS or Bariatrics 32% 4% 46% 18% Faculty Mul. Spec Single Spec Solo private 62% 38% YES NO Most in Single Specialty Group or Solo

26 Private Prac.ce: Financial Arrangement Posi1on in Prac1ce Owner Independent Contractor Employed associate/ non- owner 4% 19% 77%

27 Private Prac.ce: Volume Volume of Career Bariatric Surgery High Volume 43% 11% 17% % 72% >500 <500 29% >1000

28 Group Characteris.cs Bariatric Specialists Private Prac.ce Years in Bariatrics Years in Prac1ce 24% 13% 13% 0-5 years 5-10 years 34% 11% 13% 0-5 years 5-10 years 50% years >20 years 42% years >20 years >80% Bariatric Surgery Prac.ce about 13% started bariatrics later in career

29 Group Characteris.cs Bariatric Specialists Private Prac.ce Posi1on in Prac1ce Legal Organiza1on LLC 5% 16% 79% Owner Independent Contractor 50% 3% 42% Not- for- profit Partnership Employed associate/ non- owner 3% 2% Professional Corp Sole Proprietor >80% Bariatric Surgery Prac.ce most are owners

30 Group Characteris.cs Bariatric Specialists (>80%) Private Prac.ce Volume of Career Bariatric Surgery Prac1ce Model 2% 3% 21% % 3% 10% Faculty Mul. Spec 74% > % Single Spec Solo private 94% have >500 bariatric cases Most in Single Specialty Group or Solo

31 Private Prac.ce General Surgery with some Bariatric < 50% Bariatric Surgery Years in Prac1ce Prac.ce Years of Bariatric Surgery 28% 33% 0-5 years 5-10 years 18% 8% 40% 0-5 years 5-10 years 17% 22% years >20 years 34% years >20 years < 50% Bariatric Surgery Prac.ce more than half in prac.ce less than 10 years (55.5%) 78% with less than 10 years in Bariatric surgery

32 Private Prac.ce General Surgery with some Bariatric Volume of Career Bariatric Surgery Prac1ce Model 22% 22% % 2% 31% Faculty Mul. Spec 22% 34% > % Single Spec Solo private 44% more than 500 cases < 50% Bariatric Surgery Prac.ce fewer in solo than >80 group

33 Private Prac.ce summary N=108 More likely to have started Bariatrics later in career (more years in prac.ce than years of bariatrics) 2/3 in Group, 1/3 Solo Most are in LLC or Professional Corpora.on Less likely to have completed a fellowship in MIS or Bariatrics than Employed group 1/3 fellowship, 2/3 none Time dedicated to Bariatrics 1/3 <50% 1/ % 1/3 > 80% Not very many in the group with >20 years bariatric experience (<10%)

34 Data Restric.ons for Compensa.on Responses Number of survey respondents will change from year to year as well as across compensa.on measures because: Annual compensa.on of less then $200,000 was not included in the analyses Re.rement contribu.ons of $0 were not included in the analyses

35 Compensa.on and Re.rement Profile: All Hospital Employed Compensa.on 2010 Compensa.on 2011 Re.rement 2010 Re.rement 2011 WRVU1st.er Incen.ve Start RVU Total N=108 n=93 n=100 n=75 n=79 n=27 n=21 Mean $410,731 $419,103 $38,115 $38, ,562 Mode $300,000 $350,000 $16,500 $50, ,000 Std. Devia.on $165,125 $169,872 $40,603 $40, ,423 Minimum $225,000 $190,000 $5,000 $1, Maximum $1,050,000 $1,050,000 $330,000 $333, ,600 Percen.les 20th $280,000 $286,110 $16,500 $16, ,110 50th $360,000 $360,000 $30,000 $30, ,200 75th $500,000 $497,500 $44,000 $45, ,000 90th $603,800 $630,358 $64,000 $60, ,900

36 Compensa.on and Re.rement Profile: Hospital Employed >80% Bariatrics Compensa.on Compensa.on Re.rement Re.rement WRVU Incen.ve st.er Start RVU Total N=41 n=33 n=35 n=26 n=28 n=12 n=8 Mean $429,696 $445,314 $51,346 $49, ,003 Mode $400,000 $350,000 $30,000 $30, ,200 Std. Devia.on $146,782 $173,965 $62,816 $62, ,305 Minimum $225,000 $225,000 $11,000 $5, Maximum $900,000 $1,000,000 $330,000 $333, ,000 Percen.les 20th 50th 75th 90th $296,000 $329,200 $23,200 $21, ,996 $400,000 $400,000 $35,500 $33, ,225 $522,500 $520,000 $50,000 $50, ,425 $600,000 $674,000 $97,500 $91,500 65

37 Compensa.on Profile: Hospital Employed by Region Compensa.on 2010 Compensa.on 2011 Total N (response n) North East 44(40) Midwest 27(22) South 29(24) West 8(7) North East 44(42) Midwest 27(25) South 29(26) West 8(7) Mean $385,362 $415,772 $449,854 $405,714 $402,612 $405,560 $454,102 $436,428 Mode $280,000 $500,000 $400,000 $230,000 $350,000 $325,000 $400,000 $240,000 Std. Devia.on $139,973 $141,768 $218,960 $161,462 $142,232 $168,765 $207,923 $188,430 Minimum $225,000 $230,000 $245,000 $230,000 $221,000 $190,000 $275,000 $240,000 Maximum $900,000 $700,000 $1,050,000 $605,000 $900,000 $1,000,000 $1,050,000 $650,000 Percen.les 20th $280,000 $280,000 $280,000 $236,000 $286,331 $271,000 $297,000 $243,000 50th $325,000 $382,500 $400,000 $430,000 $360,000 $360,000 $387,500 $460,000 75th $462,384 $505,000 $541,000 $600,000 $442,130 $495,000 $557,500 $610,000 90th $597,500 $672,500 $875,000 $600,000 $601,400 $615,600 $810,300 $610,000

38 Re.rement Profile: Hospital Employed by Region Re.rement 2010 Re.rement 2011 Total N (response n) North East 44(27) Midwest 27(21) South 29(20) West 8(7) North East 44(30) Midwest 27(22) South 29(20) West 8(7) Mean $43,629 $30,340 $36,475 $44,857 $41,865 $31,739 $36,825 $46,285 Mode $35,00 $16,500 $25,000 $60,000 $16,500 $16,500 $25,000 $60,000 Std. Devia.on $59,574 $18,661 $30,608 $20,383 $57,566 $20,553 $30,692 $23,026 Minimum $11,000 $10,000 $5,000 $20,000 $5,000 $1,760 $5,000 $20,000 Maximum $330,000 $75,000 $150,000 $75,000 $333,000 $80,000 $150,000 $85,000 Percen.les 20th $16,800 $16,440 $16,800 $24,200 $16,500 $15,600 $16,800 $24,200 50th $33,000 $20,000 $30,000 $40,000 $31,500 $27,500 $30,000 $40,000 75th $44,000 $41,000 $43,750 $60,000 $44,250 $46,250 $43,750 $60,000 90th $61,200 $66,000 $68,000 $60,000 $54,500 $67,500 $68,000 $60,000

39 Compensa.on and Re.rement Profile: Private Prac.ce* Compensa.on 2010 Compensa.on 2011 Re.rement 2010 Re.rement 2011 Overall N=108 n=22 n=102 n=70 n=72 Mean $329,272 $465,632 $51,542 $47,486 Mode $300,000 $500,000 $40,000 $40,000 Std. Devia.on $90,723 $289,169 $70,627 $40,491 Minimum $200,000 $200,000 $5,000 $5,000 Maximum $500,000 $2,200,000 $600,000 $300,000 Percen.les 20th $245,600 $253,741 $25,000 $24,600 50th $315,000 $420,000 $44,000 $44,000 75th $370,000 $532,375 $50,000 $49,000 90th $494,000 $735,000 $69,000 $70,700 *If the respondent was an owner they were asked for 2011 compensa.on informa.on only. If the respondent was a non- owner they were asked for 2010 and 2011 compensa.on informa.on. Re.rement for both years was requested regardless of ownership status.

40 Compensa.on Profile Comparison: Hospital Vs Private Prac.ce 2011 Hospital Employed n=108 (100 repor.ng) Private Prac.ce Owner n=83 (79 repor.ng) Private Prac.ce Non- Owner n=25 (22 repor.ng) Mean $419,103 $509,297 $315,652 Mode $350,000 $500,000 $250,000 Std. Devia.on $169,872 $309,466 $118,228 Minimum $190,000 $50,000 $200,000 Maximum $1,050,000 $2,200,000 $700,000 Percen.les 20th $286,110 $318,000 $229,000 50th $360,000 $490,000 $270,000 75th $497,500 $600,000 $360,000 90th $630,358 $772,000 $480,000

41 2011 Compensa.on Profile: Private Prac.ce by Region Compensa.on 2011 Re.rement 2011 Total N (response n) North East 21(21) Midwest 24(21) South 47(45) West 16(15) North East 21(14) Midwest 24(15) South 47(31) West 16(12) Mean $430,523 $477,275 $465,549 $498,733 $43,964 $41,566 $57,870 $32,166 Mode $500,000 $450,000 $500,000 $600,000 $40,000 $40,000 $40,000 $44,000 Std. Devia.on $200,475 $150,551 $336,617 $392,566 $30,614 $15,906 $54,747 $18,837 Minimum $200,000 $225,000 $200,000 $200,000 $7,500 $5,000 $10,000 $10,000 Maximum $1,900,000 $800,000 $2,200,000 $1,700,000 $130,000 $71,000 $300,000 $70,000 Percen.les 20th $294,000 $333,800 $250,000 $254,000 $16,000 $28,000 $28,800 $12,700 50th $400,000 $490,000 $420,000 $365,000 $40,000 $45,000 $45,000 $32,500 75th $505,000 $560,000 $552,750 $600,000 $51,750 $50,000 $50,000 $44,000 90th $741,600 $747,600 $720,000 $1,280,000 $100,000 $60,800 $120,000 $63,400

42 Conclusion ASMBS members are a diverse group Case volume Years of Experience Percent of Time Dedicated to Bariatrics Prac.ce Environment should be considered in compensa.on discussions

43 ASMBS Compensa.on and Prac.ce Style Survey Teresa LaMasters, MD John Morton MD, MPH October 2012

44 Background Na.onally more Bariatric Coordinators with variable creden.als are being employed This is especially true in Bariatric surgery due to programma.c requirements and overhead

45 Background There is a lack of valid benchmarking for Bariatric Coordinators and hospitals to use when nego.a.ng compensa.on MGMA and AGMA models have been inadequate in the past and do not take into account the creden.als of Bariatric Coordinators

46 Objec.ve Determine compensa.on ranges and prac.ce paoerns for Bariatric Coordinators APNs, PAs, RDs Other: RN, BA, BSN, CBN, CGRN, CRNFA, CRNP, LCSW, LPN, Masters in Organiza.on, MBA, MSN, Physical Therapist

47 Methods A survey was distributed na.onwide to employees with various posi.ons in their bariatric program Surveys were sent out 3.mes by ASMBS

48 Response Hospital employed Total Responders: 206 Bariatric Coordinators: 178 RNs: 108 APNs: 24 PAs: 6 RDs: 19 Other (Including employees with mul.ple creden.als): states represented

49 Hospital Employed Ques.ons What is your posi.on in the bariatric program? If you are the Bariatric Coordinator, what are your creden.als? If you are the Bariatric Coordinator, which of the following are included as part of your job responsibili.es? How many years have you been in bariatrics? Which of the following best describes your employment? What is the amount of your compensa.on? What percent of your.me is dedicated to bariatrics? In what state is your program located? Which of the following benefits are provided to you and paid by your employer? If a re.rement plan is offered, what is your es.mated annual re.rement contribu.on?

50 Employee Response by Creden.al 3% 11% 9% RN 14% 63% APN PA RD Other RN includes those with dual degrees Other includes: BA, BSN, CBN, CGRN, CRNFA, CRNP, LCSW, LPN, Masters in Organiza.on, MBA, MSN, Physical Therapist, RYGP pa.ent

51 Employee Response by Region 13% 20% 35% 29% MIDWEST NORTHEAST SOUTH WEST

52 Employee Response by Region: West 0% 3% 20% 77% APN/PA Bariatric Coordinator Registered Die..an Other

53 Employee Response by Region: South 4% 5% 15% 75% APN/PA Bariatric Coordinator Registered Die..an Other

54 Employee Response by Region: Northeast 8% 5% 20% 67% APN/PA Bariatric Coordinator Registered Die..an Other

55 Employee Response by Region 13% 20% 35% 29% MIDWEST NORTHEAST SOUTH WEST

56 All Hospital Employed Percent 1me dedicated to Bariatric Surgery 3% 14% 82% <20% 21-50% >80%

57 APN/PA: Percent.me dedicated to bariatric surgery 3% 0% 15% 82% <20% % 51-80% >80%

58 Bariatric Coordinator: Percent.me dedicated to bariatric surgery <20% 21-50% 51-80% >80%

59 Registered Die..an: Percent.me dedicated to bariatric surgery <20% 21-50% 51-80% >80%

60 Other: Percent.me dedicated to bariatric surgery <20% 21-50% 51-80% >80%

61 Percent Time Dedicated to Bariatric Surgery Divided by Region <20%.me in bariatrics 21-50%.me in bariatrics 51-80%.me in bariatrics >80%.me in bariatrics MIDWEST NORTHEAST SOUTH WEST

62 Group Characteris.cs Bariatric Specialists Years of Bariatric Experience <1 year 1-5 years 6-10 years years >20 years

63 Compensa.on Profile Total n (Responses) APN/PA 34 (28) Bariatric Coordinator 148 (126) Registered Die11an 11 (10) Other 9 (6) AVERAGE $100, $81, $57, $87, STANDARD DEVIATION $30, $24, $12, $33, MODE $110, $70, $55, N/A MIN $41, $ $43, $40, MAX $162, $185, $85, $114, TH PERCENTILE $76, $64, $47, $48, TH PERCENTILE $97, $78, $55, $106, TH PERCENTILE $125, $95, $62, $109, TH PERCENTILE $140, $109, $68, $112,000.00

64 Insurance Benefits Profile APN/PA (n=34) Bariatric Coordinator (n=148) Registered Die11an (n=11) Other (n=12) Medical insurance: Employee only Medical insurance: 23.5% 34.5% 27.3% 25.0% Employee plus dependents 70.6% 62.8% 45.5% 50.0% Disability insurance Life insurance Dental insurance Vision insurance 61.8% 62.2% 54.5% 33.3% 79.4% 73.6% 36.4% 25.0% 76.5% 75.0% 63.6% 41.7% 61.8% 64.2% 54.5% 41.7%

65 Miscellaneous Benefits Profile APN/PA (n=34) Bariatric Coordinator (n=148) Registered Die11an (n=11) Other (n=12) Con1nuing educa1on allowance 85.3% 70.9% 45.5% 25.0% Vaca1on 1me Sick 1me Re1rement plan 91.2% 95.3% 72.7% 58.3% 76.5% 85.8% 45.5% 50.0% 88.2% 74.3% 54.5% 50.0%

66 Annual Re.rement Profile Total n (Responses) APN/PA 34 (21) Bariatric Coordinator 148 (83) Registered Die11an 11 (6) Other 12 (5) AVERAGE $4, $6, $6, $8, STANDARD DEVIATION $3, $6, $6, $5, MODE $5, $2, N/A N/A MIN $0.00 $0.00 $2, $3, MAX $15, $36, $18, $16, TH PERCENTILE $2, $2, $2, $3, TH PERCENTILE $4, $4, $4, $5, TH PERCENTILE $5, $9, $8, $11, TH PERCENTILE $7, $14, $13, $14,520.00

67 Conclusions The majority of all posi.ons dedicate >80% of their.me to bariatric surgery na.onwide Registered die..ans have lower salaries and fewer benefits than their APN/PA and Bariatric Coordinator counterparts