Teresa LaMasters MD FACS John Magaña Morton MD MPH FACS FASMBS Background Nationally more physicians are becoming employed This is especially true in Bariatric surgery due to programmatic requirements and overhead ID: 912277
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Slide1
2013 Annual ASMBS Compensation Survey
Teresa LaMasters MD, FACS
John
Magaña
Morton, MD, MPH, FACS, FASMBS
Slide2Background
Nationally more physicians are becoming employed
This is especially true in Bariatric surgery due to programmatic requirements and overhead
There is a lack of valid benchmarking for physicians and hospitals to use when negotiating compensation
Slide3Background
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 bariatric surgery
Initial pilot survey sent to ASMBS members in 2012 – results on website
Further development and refinement of the survey was required
Slide4Objective
Determine compensation ranges and practice patterns for ASMBS members
Hospital employed
Private Practice
Slide5Who can Benefit?
All surgeons negotiating contracts with employers
New graduating fellows
ASMBS Leadership to better understand membership needs
All surgeons evaluating joining a practice
Surgeons who desire to see a snapshot of future career
Slide6Methods
Surveys sent out electronically 3 times by ASMBS in 2013 regarding data from 2012.
Survey was sent to ASMBS membership
Survey Monkey was utilized
Slide7Response Rate
Hospital employed
N = 66
Total sample used = 65
Exclusions
Part-time surgeon (n=1)
Data
from
62
respondents used in the compensation summary
The
3
respondents not used either did not provide compensation information or provided it in a form that was not feasible (e.g. a response of 500)
22 states represented
Private Practice
N=47
Total sample used =
46
Exclusions
Part-time surgeon (
n=1)
Data from 39 respondents used in the compensation summary
The 7 respondents not used either did not provide compensation information or provided it in a form that was not feasible (e.g. a response of 500
)
24
states represented
Slide8Hospital Employed Questions
Which of the following best describes your practice model?
How many years have you been in practice?
How much experience do you have performing bariatric surgery?
What is your career volume for bariatric surgery?
What is your employment status?
What percent of your time is dedicated to bariatric surgery?
In what state are you employed?
Did you complete a Fellowship? If yes, what type?
Select the method that most accurately reflects your current compensation model.
What is the amount of your total compensation?
What is your estimated annual retirement contribution?
Which
of the following benefits are provided to you and paid by your employer?
Slide9Hospital Employed Questions
Do you receive a bonus or incentive? If yes indicate what the bonus is based upon.
If your compensation is based on WRVU production, provide the amount paid per WRVU
Provide the threshold amount at which the incentive begins and the compensation amount per WRVU that you receive
How many work RVUs did you produce?
How many days a month do you take bariatric, general surgery and trauma call?
Are you paid for taking call? If yes, how much?
At how many hospitals do you operate?
How many bariatric practices are present at your primary hospital?
Provide volume for each of the procedures listed on the attached table
Slide10Demographics – Hospital
49 of 65 had a fellowship and 37 completed a bariatric fellowship
Slide11Demographics – Private Practice
28 of 47 had a fellowship and 18 completed a bariatric fellowship
Slide12Hospital Employed
Years in Practice vs Bariatric
n=66
In the previous survey (2012), there was a trend of a significant portion of surgeons starting in bariatrics later in their career around 5-10 years after they started their practice.
Years in Practice
Years Bariatric Surgery
0-5 years
5
-10
years
>10 years
0-5 years
19
0
0
5-10 years
2
14
0
10-20 years
1
4
15
>20 years
0
4
7
Slide13Private Practice
Years in Practice vs Bariatric n=47
Years in Practice
Years Bariatric Surgery
0-5 years
5-10 years
>10 years
0-5 years
8
0
0
5-10 years
2
8
0
10-20 years
0
2
15
>20 years
0
2
10
Slide14Hospital Employed
Time vs Surgeries n=64
Time Dedicated to Bariatric Surgery
Number Surgeries Performed
<50
50-150
150-500
500-1000
>1000
<20%
0.0%
3.1%
0.0%
0.0%
1.6%
21-50%
1.6%
6.3%
12.5%
7.8%
4.7%
51-80%
0.0%
1.6%
9.4%
6.3%
15.6%
>80%
0.0%
0.0%
3.1%
12.5%
14.1%
Slide15Private Practice
Time vs Surgeries n=44
Time Dedicated to Bariatric Surgery
Number Surgeries Performed
<50
50-150
150-500
500-1000
>1000
<20%
1 (2.3%)
1 (2.3%)
0
1 (2.3%)
0
21-50%
0
3 (6.8%)
0
2 (4.5%)
4 (9.1%)
51-80%
0
1 (2.3%)
0
2 (4.5%)
8 (18.2%)
>80%
0
0
2 (4.5%)
1 (2.3%)
18 (40.9%)
Slide16Hospital Employed – Call
Days
Bariatric
N=59
General Surgery
N=60
Trauma
N=51
0
1 (2%)
14 (23%)
41 (80%)
1-14
23 (39%)
45 (75%)
10 (20%)
15-30
35 (59%)
1 (2%)
0
Hospital employed bariatric surgeons are most likely to
take bariatric
and
general s
urgery call and least likely to take trauma call.
80% do not take any trauma call and 23% do not take any general surgery call.
Slide17Hospital Employed
>80
% Bariatrics– Call
Days
Bariatric
N=18
General Surgery
N=17
Trauma
N=17
0
0
9 (53%)
15 (88%)
1-14
8 (44%)
8 (47%)
2 (12%)
15-30
10 (56%)
0
0
Hospital employed surgeons who dedicate 80% of their time to bariatrics, are more likely to take bariatric call than general surgery call. In addition, they are least likely to take trauma call.
88% do not take any trauma call and 53% do not take any general surgery call.
Slide18All Private Practice – Call
Days
Bariatric
N=40
General Surgery
N=39
Trauma
N=36
0
2 (5%)
13 (33%)
30 (83%)
1-14
18 (45%)
23 (59%)
5 (14%)
15-30
20 (50%)
3 (8%)
1 (3%)
Private practice bariatric surgeons are most likely to take bariatric and general surgery call and least likely to take trauma call.
83% do not take any trauma call and 33% do not take any general surgery call.
Slide19Private Practice >80% Bariatrics– Call
Days
Bariatric
N=20
General Surgery
N=18
Trauma
N=17
0
2 (10%)
11 (61%)
15 (88%)
1-14
6 (30%)
7 (39%)
2 (12%)
15-30
12 (60%)
0
0
Private practice surgeons who dedicate 80% of their time to bariatrics, are more likely to take bariatric call than general surgery call. In addition, they are least likely to take trauma call.
88% do not take any trauma call and 61% do not take any general surgery call.
Slide20All Hospital Employed
N=65
Slide21All Private Practice
N=47
Slide22All Hospital Employed
22 Different States represented
N=65
Slide23All Private Practice
24 Different States represented
N=46
Slide24All Hospital Employed
N=64
Slide25All Private Practice
N=45
Slide26Hospital Employed
2012
Compensation
n=62
Total RVU
n=33
Retirement
n=51
RVU Incentive Threshold
n=19
Incentive Above RVU Threshold
n=12
Overall N=66
Mean
$445,032
8,279
$36,666
7,413
$48.9
Std. Dev.
$188,564
3,458
$35,280
2,484
$8.4
Minimum
$200,000
3,230
$10,000
5,000
$39.0
Maximum
$1,100,000
20,000
$240,000
16,000
$70.0
Percentiles
20
th
$301,000
5,440
$17,500
6,000
$42.3
50
th
$388,500
7,900
$28,000
6,500
$48.5
75
th
$497,750
9,000
$39,000
7,500
$52.2
90
th
$698,500
12,480
$60,000
10,000
$54.8
Slide27Hospital Employed
> 80% 2012
Compensation
n=20
Total
RVU
n=10
Retirement
n=17
RVU
Incentive
Threshold
n=7
Incentive Above
RVU Threshold
n=4
Overall N=20
Mean
$464,050
8,202
$41,176
6,809
$56.4
Std. Dev.
$219,404
3,773
$53,830
1,435
$9.0
Minimum
$283,000
3,230
$13,000
6,000
$51.0
Maximum
$1,100,000
14,995
$240,000
10,000
$70.0
Percentiles
20
th
$325,000
5,321
$17,100
6,000
$51.6
50
th
$386,000
8,100
$25,000
6,500
$52.4
75
th
$450,000
8,800
$36,000
6,853
$57.1
90
th
$761,200
14,100
$62,000
8,000
$64.8
Slide28Private Practice
2012
Compensation
n=39
Retirement
n=35
Overall N=47
Mean
$658,116
$40,593
Std. Dev.
$907,700
$24,745
Minimum
$200,000
$5,000
Maximum
$5,850,000
$125,000
Percentiles
20
th
$290,000
$21,900
50
th
$400,000
$40,000
75
th
$640,000
$50,000
90
th
$931,000
$54,600
Survey respondents reported their total compensation. It is possible this compensation may include revenue from non clinical sources. It’s also possible that, different from hospital employed physicians, private practice physicians are responsible for the payment of benefits (e.g. health insurance, malpractice insurance.
e
tc.) from this reported compensation. Hence the outlying maximum salary.
Slide29Private Practice
> 80% Bariatrics 2012
Compensation
n=18
Retirement
n=17
Overall N=22
Mean
$856,196
$42,692
Std. Dev.
$1,290,743
$30,999
Minimum
$260,000
$5,000
Maximum
$5,850,000
$125,000
Percentiles
20
th
$308,000
$16,000
50
th
$418,500
$40,000
75
th
$845,000
$49,500
90
th
$1,188,500
$81,600
Survey respondents reported their total compensation. It is possible this compensation may include revenue from non clinical sources. It’s also possible that, different from hospital employed physicians, private practice physicians are responsible for the payment of benefits (e.g. health insurance, malpractice insurance. etc.) from this reported compensation. Hence the outlying maximum salary.
Slide30Hospital Employed
2011
Compensation
n=50
Total RVU
n=26
Retirement
n=45
Overall N=66
Mean
$420,235
7,780
$32,933
Std. Dev.
$153,595
3,281
$19,934
Minimum
$210,000
3,000
$11,000
Maximum
$850,000
19,000
$100,000
Percentiles
20
th
$300,000
5,000
$16,900
50
th
$400,000
7,350
$28,000
75
th
$471,250
9,300
$40,000
90
th
$650,000
10,000
$51,200
There was significant repetition of data from 2010 and 2011 suggesting possible error in reporting 2010 data. For this reason we did not analyze 2010.
The 2011 data was similar to previously reported 2011 data in the past ASMBS survey.
Slide31Hospital Employed
>80% Bariatrics 2011
Compensation
n=17
Total RVU
n=6
Retirement
n=17
Overall N=20
Mean
$396,927
7,135
$28,088
Std. Dev.
$130,307
3,368
$14,895
Minimum
$275,000
3,512
$11,000
Maximum
$786,000
12,600
$60,000
Percentiles
20
th
$302,000
4,000
$16,600
50
th
$350,000
6,850
$20,000
75
th
$425,000
8,550
$36,000
90
th
$544,450
10,800
$50,800
There was significant repetition of data from 2010 and 2011 suggesting possible error in reporting 2010 data. For
this reason we did not analyze 2010.
The 2011 data was similar to previously reported 2011 data in the past ASMBS survey.
Slide32All Private Practice
2011
Compensation
n=37
Retirement
n=33
Overall N=47
Mean
$617,751
$39,761
Std. Dev.
$657,527
$21,275
Minimum
$100,000
$10,000
Maximum
$4,000,000
$100,000
Percentiles
20
th
$302,000
$24,400
50
th
$444,143
$38,000
75
th
$640,000
$49,000
90
th
$870,000
$54,600
There was significant repetition of data from 2010 and 2011 suggesting possible error in reporting 2010 data. For this reason we did not analyze 2010.
The 2011 data was similar to previously reported 2011 data in the past ASMBS survey.
Slide33Private Practice
>80% Bariatrics 2011
Compensation
n=17
Retirement
n=17
Overall N=22
Mean
$763,928
$39,005
Std. Dev.
$916,368
$26,351
Minimum
$260,000
$10,000
Maximum
$4,000,000
$100,000
Percentiles
20
th
$304,000
$18,600
50
th
$444,143
$32,000
75
th
$660,000
$47,000
90
th
$1,350,000
$70,000
Approximately half of the respondents for annual salary and retirement gave the same value for the year of 2010 and 2011. Consequently it was assumed the values reflected 2011 and the previous year was
potentially in error,
for this reason we did not analyze 2010.
Slide34Incentive Bonus
Hospital Employed
Private Practice
Receive
Incentive Bonus
44
20
Mean Bonus
$65,750 (n=22)
$121,883
(n=6)
Slide35RVU Target
Hospital Employed
Private Practice
RVU Target
30
5
Mean Target
6998
6500
(n=2)
Slide36Medical Directorship
Hospital
Employed
(N=66)
Private Practice
(N=47)
Medical Directorship (n)
13
4
Mean Compensation
$54,167
$82,000
Slide37Benefits
Hospital (N=66)
Hospital
%
Private
(N=47)
Private %
Malpractice Insurance
63
95.5%
29
61.7%
CME Allowance
59
89.4%
26
55.3%
Med
Insurance: Employee
Only
15
22.7%
6
12.8%
Med
Insurance:
Employee
Dependents
51
77.3%
24
51.1%
Disability Insurance
49
74.2%
16
34.0%
Life Insurance
48
72.7%
12
25.5%
Dental Insurance
54
81.8%
16
34.0%
Vision Insurance
49
74.2%
11
23.4%
Slide38Benefits
Slide39Quality Metrics
Hospital Employed N=33
Private Practice
N=7
Participate in QI Projects
5
1
Patient Satisfaction
11
3
Use EMR
9
1
Clinical Outcomes
5
2
Access
1
0
Peer Review
2
0
Slide40Compensation Model
Hospital Employed
N=66
Private
Practice
N=46
Base Salary Plus Incentive
39
12
Production Model
6
27
Straight/Guaranteed
Salary
21
3
Revenue minus
Expenses or % of collections
NA
4
The most common model for employed surgeons was base salary plus incentive. The most common model for private practice respondents was a production model.
Slide41Compensation Model
Slide42Visits
Hospital Employed
Private Practice
Clinic Visits
N=31
N=18
Average Per Year
1500
1600
Estimated Per Week
29
31
New Patient Visits
N=32
N=18
Average Per Year
300
925
Estimated Per Week
8
18
Total visit numbers were similar for employed and private practice surgeons.
Private practice had a higher number of new patient visits.
Slide43Hospital Employed– Procedures
Hospital Employed: Procedures
N
0
1-25
26-50
51-75
76-100
>100
min
median
max
Upper GI Endoscopy
42
8
8
6
4
6
10
0
50
4,500
Lower GI Endoscopy
38
26
4
6
1
0
1
0
0
120
Laparoscopy: Gastric Bypass with Roux enY
66
19
9
13
7
8
10
0
36
228
Laparoscopy: Place Adj. Gastric Band
66
30
32
1
1
1
1
0
1
350
Laparoscopy: Sleeve
66
18
15
16
8
4
5
0
25
185
Laparoscopy: VBG
66
66
0
0
0
0
0
0
0
0
Laparoscopy: BPD/DS
66
60
4
1
1
0
0
0
0
60
Laparoscopy: Revision/Conversion of Band
66
24
38
2
2
0
0
0
3
75
Laparoscopy: Revision/Conversion of Gastric Bypass
66
41
25
0
0
0
0
0
0
25
Laparoscopy: Revision/Conversion of Sleeve
66
46
20
0
0
0
0
0
0
10
Laparoscopy: Revision/Conversion of VBG
66
50
16
0
0
0
0
0
0
7
Laparoscopy: Revision/Conversion of BPD/DS
66
62
6
0
0
0
0
0
102
448
Slide44Private Practice – Procedures
Private Practice: Procedures
N
0
1-25
26-50
51-75
76-100
>100
min
median
max
Upper GI Endoscopy
29
5
6
2
1
2
13
0
100
500
Lower GI Endoscopy
24
13
5
2
0
2
2
0
10
150
Laparoscopy: Gastric Bypass with Roux
enY
47
15
7
7
5
5
8
0
40
214
Laparoscopy: Place Adj. Gastric Band
47
20
18
5
0
2
2
0
2
75
Laparoscopy: Sleeve
47
14
11
6
3
5
8
0
21
305
Laparoscopy: VBG
47
47
0
0
0
0
0
0
0
0
Laparoscopy: BPD/DS
47
44
3
0
0
0
0
0
0
20
Laparoscopy: Revision/Conversion of Band
47
20
24
3
0
0
0
0
2
50
Laparoscopy: Revision/Conversion of Gastric Bypass
47
28
16
3
0
0
0
0
0
36
Laparoscopy: Revision/Conversion of Sleeve
47
39
8
0
0
0
0
0
0
15
Laparoscopy: Revision/Conversion of VBG
47
36
10
1
0
0
0
0
0
27
Laparoscopy: Revision/Conversion of BPD/DS
47
44
3
0
0
0
0
0
0
2
Slide45Conclusion
The response level is lower than optimal for this survey, however it is equivalent to the response rate for the MGMA survey. Useful and important data is present.
ASMBS members are a diverse group
Case volume
Years of Experience
Percent of Time Dedicated to Bariatrics
Practice Environment should be considered in compensation discussions
Slide46Contributing Members
Chair -
Samer
Mattar
MD, FACS
Co-Chair- Teresa LaMasters MD, FACS
Member
Ashutosh
Kaul
MD, MS, FRCS, FACS
Member John D. Scott MD
Member Eric S.
Bour
MD
Member Stephen D.
Wohlgemuth
MD
Member Marina
Kurian
MD
President ASMBS 2014-2015 John
Magaña
Morton, MD, MPH, FACS, FASMBS
Slide47Support Provided
Jennifer Wynn
Director of Committee Affairs
Assistant to Executive Director
ASMBS
Georgeann
Mallory, RD
Executive Director ASMBS
Kristen Danielle Hahn
Research assistant UnityPoint Health, Des Moines IA
Catherine
Hackett Renner, PhD
Director Office of Research
UnityPoint Health, Des Moines, IA