The Squeeze on Doctors’ Productivity — What Now?

The recent Chart of the Week, “The Squeeze on Doctors’ Productivity”, hit the nail right on the head. As the data show and our experience supports, we work harder for less compensation than we used to in years past. In my opinion, this trend is partly fueling the drive of private practice physicians to sell to private equity firms. This is the infamous “race to the bottom” that we preached from our advocacy pulpits for the last decade or so.

Problem is, no one cares. No one thinks that doctors are underpaid, and no one wants to spend more money for healthcare to restore the previous work-life balance of physicians. Speaking of advocacy, a quick way to turn off Congress is to complain that we work more for less compensation. We must seek the answer from within ourselves or resort to drastic measures few of us are willing to entertain.

Admittedly, many of us have been sloppy in terms of running our businesses. As a shareholder in two very well-run private practices before taking my current job, I can easily recall undisciplined expenses that we tolerated as surgeon-owners. I am familiar with one practice that actually paid people to come in and water plastic plants in the office since the contract hadn’t been cancelled after the real plants were replaced!

Here are some tips that have helped my practices earn more, without working harder:

1. Carefully do a line-by-line review of the expenses of your practice. Look at everything — I am positive you will find costs that will shock you.
2. The greatest expense in every practice I have seen is “personnel expense.” Make sure that you really need all the staff you employ. I’m all about loyalty, but we don’t run charities. Many practices have a few overpaid employees who are not providing a needed service.
3. Change your perspective to running your practice like a business. It’s not about giving everyone what they want. Professional businesses demand value from every dollar spent.
4. Focus hard on your payer contracts and review them regularly.
5. Lastly, if you are hospital-employed, remember that your current compensation level is dependent on what local private practice physicians make. Hospital-employed orthopaedic surgeons’ compensation often is pegged in some way to what they could earn in private practice. Know what the competition is earning so you can negotiate effectively.