Are you missing a physician??

Wednesday, March 4, 2015 | Joel Sauer

Are you missing a physician??

My guess is that you’d be surprised how early in a cardiologist’s career productivity starts to taper off.  I know I was.  The 2014 MedAxiom Annual Survey data on this point are quite startling and have a huge impact on your strategic, succession planning and workforce development directions. 

Check out Figure 1 below.  When measuring work RVUs . . . I know, not perfect, but still the gold standard for physician production . . . productivity for a cardiologist peaks between 44 – 48 years of age.  After that it starts to drop – and precipitously once a physician passes through 59 years old. 

Here’s something else to consider.  According to this same survey for the entire population of physicians nearly 30 percent of cardiologists are over the age of 59 (see table 1) and the median sized group is 17 physicians.  The math now gets disquieting.  If the average group out there fits the population as a whole, it will have nearly five physicians out of the 17 over the age of 59.  Assuming a normal distribution of the rest, those five cardiologists are producing a whole FTE (full time equivalent) less than their younger partners in terms of work RVUs. 

Now let’s look at call participation, another significant group dynamic as partners age.   Figure 2 demonstrates that nearly one in five cardiologists is now taking less than full time call.  This percentage will likely increase in the coming years given the age distribution cited above.  Call participation, for myriad reasons, has a substantial impact on work RVU production.  In Figure 3 we see a precipitous drop (33%) in production once a physician takes less than full call. 

Interestingly, the data in Figure 4 suggests that most of these physicians are still working fully during “normal” business hours, given the very small delta between the two cohorts on “half days worked”.  This dynamic can really stress groups as they try to balance call responsibilities with keeping physicians fully and satisfactorily productive.  Based on the energy this topics receives at our meetings, this balance is incredibly difficult – and delicate – to achieve. 

Once a physician leaves the call rotation entirely, Figure 4 shows that there is a strong correlate with also cutting back on daytime hours.  This can be an important metric for groups trying to plan for the future. 

Nothing in the above data and observations are meant as passing judgment on senior physicians. Quite the contrary, physicians with long seniority tend to be primary rainmakers for cardiology group and have deep relationships with both patients and community. The intent here is simply to shine a light on the issue and provide some insight into predicting your own situation.

I’ll leave you with this:  the majority of cardiology programs nationwide will be facing physician slow-down in the near future.  Prospective planning dramatically increases the likelihood that this difficult transition can be navigated without fracturing the group. There are several very specific data points that can help in this process, including age, work RVU production and call participation – both current and future (obtained through surveys or face-to-face interviews). 

The best time to start this planning process is before anyone asks and the exercise turns personal.  The second best time is today!

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