November 2015 | Physician Magazine by Los Angeles County Medical Association

L A C O U N T Y S E E I N G S T R O N G G R O W T H I N H E A LT H CA R E - R E L AT E D J O B S

REPORTING ON THE ECONOMICS OF HEALTHCARE DELIVERY

A PUBLICATION OF PNN www.PhysiciansNewsNetwork.com

NOVEMBER 2015 L I A

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All financing is subject to credit approval. Business refinance program is for practice-related debt only. Existing Wells Fargo Practice Finance debt and revolving credit are not eligible for consolidation. © 2015 Wells Fargo Bank, N.A. All rights reserved. Wells Fargo Practice Finance is a division of Wells Fargo Bank, N.A. ECG-1436101 SBS60-0244

NOV EM B ER 2015 | TA B LE OF CONT ENT S

Volume 146 Issue 11

20 6 Employing Advanced Practice Providers: Balancing Benefits and Potential Malpractice Risks 8 The Army’s Health Professions Scholarship Program Can Help Medical Students Avoid Huge Debt

COVER STORY

& 12 RECRUITMENT OPPORTUNITIES

With the healthcare industry rapidly changing and fear of a physician shortage looming large, the recruiting of young physicians has become increasingly challenging and competitive. In this article, we will look at the current state of the recruiting process and provide tips for both those who are looking to hire new physicians and medical staff and for those residents who are seeking career opportunities. You’ll hear from experts in the healthcare industry and directly from physicians.

20 LA County Seeing Strong Growth in Healthcare-Related Jobs

FROM YOUR ASSOCIATION 4 President’s Letter | Peter Richman, MD 24 CEO’s Letter | Rocky Delgadillo

Physician Magazine (ISSN 1533-9254) is published monthly by LACMA Services Inc. (a subsidiary of the Los Angeles County Medical Association) at 801 S. Grand Avenue, Suite 425, Los Angeles, CA 90017. Periodicals Postage Paid at Los Angeles, California, and at additional mailing offices. Volume 143, No. 04 Copyright ©2012 by LACMA Services Inc. All rights reserved. Reproduction in whole or in part without written permission is prohibited. POSTMASTER: Send address changes to Physician Magazine,801 S. Grand Avenue, Suite 425, Los Angeles, CA 90017. Advertising rates and information sent upon request.

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efforts in both Los Angeles County and with the statewide California Medical Association, your physician leaders and staff strive toward a common goal– that you might spend more time treating your patients and less

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David Aizuss, MD Erik Berg, MD Robert Bitonte, MD Stephanie Booth, MD Jack Chou, MD Troy Elander, MD Hilary Fausett, MD Samuel Fink, MD Hector Flores, MD C. Freeman, MD Sidney Gold, MD Jinha Park, MD Stephanie Hall, MD David Hopp, MD Kambiz Kosari, MD Sion Roy, MD Paul Liu, MD Maria Lymberis, MD Philip Hill, MD Nassim Moradi, MD Vamsi Aribindi Ashish Parekh, MD Jerry Abraham, MD Po-Yin Samuel Huang, MD Michael Sanchez, MD Heather Silverman, MD Annie Wang Nhat Tran, MD Fred Ziel, MD

lenges of managing a practice. LACMA’s Board of Directors consists of a group of 30 dedicated physicians who are working hard to uphold your rights and the rights of your patients. They always welcome hearing your comments and concerns. You can contact them by emailing or calling Lisa Le, Director of Governance, at lisa@lacmanet.org or 213-226-0304.

SUBSCRIPTIONS Members of the Los Angeles County Medical Association: Physician Magazine is a benefit of your membership. Additional copies and back issues: $3 each. Nonmember subscriptions: $39 per year. Single copies: $5. To order or renew a subscription, make your check payable to Physician Magazine, 801 S. Grand Avenue, Suite 425, Los Angeles, CA 90017. To inform us of a delivery problem, call 213-683-9900. Acceptance of advertising in Physician Magazine in no way constitutes approval or endorsement by LACMA Services Inc. The Los Angeles County Medical Association reserves the right to reject any advertising. Opinions expressed by authors are their own and not necessarily those of Physician Magazine, LACMA Services Inc. or the Los Angeles County Medical Association. Physician Magazine reserves the right to edit all contributions for clarity and length, as well as to reject any material submitted. PM is not responsible for unsolicited manuscripts.

CMA/Los Angeles County Medical Association sponsored Health Insurance Program

It’s the time of year to look at your off-exchange health insurance options for 2016! Whether you are an individual policyholder or a member of a group health plan, it’s time to think about your health coverage for 2016. The open enrollment period for individual and family plans starts on November 1, 2015. Many practices have open enrollment periods for small groups on December 1, 2015 or January 1, 2016. Did you know that you can get the right insurance though the CMA/Los Angeles County Medical Association sponsored Medical program with Mercer? If you are just covering yourself, or if you’re covering your family or employees, working with Mercer online or in person with a licensed agent, can get you the benefits you need, utilizing the physicians you want to see, at a price that fits your budget. All of the health plans offered outside of the health insurance exchange are available. It doesn’t matter if your current coverage is “Grandfathered,” “Grandmothered,” or already ACACompliant and Platinum, Gold, Silver or Bronze, Mercer can help you determine what’s best for you. Call today at 800-842-3761 or visit www.CountyCMAMemberInsurance.com.

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69967 (11/15) • Copyright 2015 Mercer LLC. All rights reserved. 777 South Figueroa Street, Los Angeles, CA 90017 800-842-3761 • www.CountyCMAMemberInsurance.com • CMACounty.Insurance.service@mercer.com

P RES IDEN T ’S LET T ER | P ET ER RIC H M AN, M D

G R A D UAT I N G R E S I D E N T S H AV E multiple modes of practice from which

to choose: solo, small group, medium group, large group, academic, Veterans Affairs, Public Health, hospital based and clinical research among others. Factors to consider in choosing include clinical autonomy, involvement in business decisions, personal time, income level, time to build a full practice, research opportunities, requirement for insurance authorization, financial buy-in, benefits (medical, dental, disability, malpractice, tail insurance, and pension payments) and the availability of colleague and specialty support. The decision-making process is personal. There is no one right answer for everyone. Furthermore, the initial decision is not fixed in stone. Many physicians alter their mode of practice during their career. It is important for the house of medicine to maintain a range of modes. Physicians and communities are all different and their needs should be addressed. With the recent passage of the SGR fix (the Medicare Access and CHIP Reauthorization Act), the Medicare payment system has been significantly altered. There is a 0.5% payment increase for the next four years, certainly less than expected inflation. For physicians participating in alternative payment plans -- for example, accountable care organizations -- there will be no financial penalties. In fact, there will be an initial 5% increase to the overseeing organization. For physicians remaining in the fee-for-service segment, there will be penalties and rewards, expense neutral to Medicare. The bottom 50% of fee-for-service physicians will be penalized to pay the reward for the “better performing” physicians. Initially the penalty/reward will be a 4% shift but it will rise to 9%. This scheme is designed to financially pressure physicians to move from the solo/small group setting into larger practices. Organized medicine needs to assure the diversity of practice modes. Graduating residents should have the choice to establish an economically viable solo practice. This will require appropriate practice tools, education and financial support (loans). Diversity of vibrant, competitive practice modes assures our patients’ needs are met and stimulates ongoing improvement in the delivery of care.

4 P H Y S I C I A N M A G A Z I N E | N OV E M B ER 2015

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800-356-5672 | CAPphysicians.com/ReputationPro

R I S K T IP | EM P LOYIN G ADVAN CED P RACT ICE P ROVIDERS

BY KATHLEEN MOON, ARNP, LHRM, PATIENT SAFETY RISK MANAGER, THE DOCTORS COMPANY

P R A C T I C E S A N D H O S P I TA L S that employ advanced practice providers (APPs), including

nurse practitioners and physician assistants, can experience many benefits, such as lower operating overhead, increased physician time with patients, and improved patient education and satisfaction. However, employers of APPs should consider implementing effective risk management measures to help ensure that the benefits of using APPs are not at the expense of increased liability exposure. An APP is often covered under the physician’s or hospital’s malpractice insurance policy under vicarious liability coverage. APPs can be held directly liable for their own acts or omissions, but, in addition, under the legal theory of vicarious liability, physicians and hospitals can also be held liable for the actions of their employees, including APPs. Therefore, the physician or hospital is often named in malpractice claims involving their APPs. To help decrease liability risks, the employing physician or hospital should have a written policy outlining the APP’s scope of practice. This policy should be signed by the APP and other staff members annually. In putting together this policy, it is important to know the laws in your state that govern the scope of practice of APPs. Other suggestions to decrease liability risks include:

Employers of APPs should consider implementing effective risk management measures to help ensure that the benefits of using APPs are not at the expense of increased liability exposure.

• • • • • •

Ensure that all newly hired APPs undergo orientation with the practice or hospital. When scheduling appointments, staff should inform patients when they are being scheduled with an APP. If that patient requests to see his or her physician, the staff should provide the patient with that option. Make certain APPs wear identification that indicates their name and their job title. Develop treatment guidelines and clinical triggers for physician consultation. Meet with the APPs regularly to discuss their roles and expectations within the practice, and document these meetings. Regularly review the charts, including prescription monitoring, of patients seen by the APPs. Make sure that all staff members, including APPs, have adequate professional liability coverage. For nonemployed APPs, liability coverage should be equal to what the physician or practice carries.

To read case studies about employing APPs and for detailed risk management checklists, download The Doctors Company’s guide to an APP preventive action and loss prevention plan at http://ow.ly/OxqBm. Contributed by The Doctors Company. For more patient safety articles and practice tips, visit www.thedoctors.com/patientsafety.

6 P H Y S I C I A N M A G A Z I N E | N OV E M B ER 2015

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Activ. Fee: $36/line. Credit approval req. Early Termination Fee (sprint.com/etf): After 14 days, up to $350/line. SDP Discount: Avail. for eligible company employees, org. members or agency employees (ongoing verification). Discount subject to change according to the company’s, org.’s or agency’s agreement with Sprint and is avail. upon request for select monthly svc charges. Discount only applies to Talk 450 and primary line on Talk Share 700; and data service for Sprint Family Share Pack, Sprint $60 Unlimited Plan and Unlimited, My Way, Unlimited Plus Plan and Sprint Family Share Plus plans. Not avail. with no credit check offers or Mobile Hotspot add-on. Sprint Buyback: Offer ends 12/31/15. Limit of 5 returned devices per active mobile number during one 12 month period, 3 per transaction. Phone must be deactivated and all personal data deleted before recycling. Device will not be returned. Credit varies depending on phone condition and valuation. Credit applied to store purchase or account within 3 invoices. Also available at sprintbuyback.com. Other Terms: Offers and coverage not available everywhere or for all devices/networks. Restrictions apply. See store or sprint.com for details. © 2015 Sprint. All rights reserved. Sprint and the logo are trademarks of Sprint. Android, Google, the Google logo and Google Play are trademarks of Google Inc. Other marks are the property of their respective owners. N115880 MV1234567

T H E ARM ARM Y ’S Y H EALT H P ROF ES S ION S S C H OLARS H IP P ROGRAM

The Army’s Health Professions Scholarship Program Can Help Medical Students Avoid Huge Debt

BY COLONEL (DR.) THOMAS R. HUSTEAD, U.S. ARMY

L I K E M O S T P E O P L E , I understand the dedication, commitment, and stamina it takes to excel

in the medical profession. Unfortunately, the amount of money it takes to get the proper schooling can make those noble ambitions a pricey burden to bear long after school and training are complete. Let’s face it, if you have watched the news lately you know medical school costs, along with the cost of virtually any secondary education, are skyrocketing and show no signs of easing. A bright-eyed and eager medical school student can get so bogged down in debt, it can take decades of hard work to get out from under those loans. The ability to simply pay for medical school as you go just isn’t an option for most students. Sadly, the pursuit of a medical career has become synonymous with outrageous debt. However, the good news is there are alternatives to student loans for those who want to enter a number of medical fields. One alternative is the Health Professions Scholarship Program available from the United States Army. Before counting out the Army as a means of paying for medical training, look at the facts about student loan debt. (continued)

8 P H Y S I C I A N M A G A Z I N E | N OV E M B ER 2015

DISCOVER ONE OF THE MOST GENEROUS SCHOLARSHIP PROGRAMS.

The U.S. Army’s Health Professions Scholarship Program (HPSP) offers qualified medical, dental, veterinary, optometry, clinical psychology and specialty nursing students full tuition for a graduate-level degree at the school of your choice: • You’ll receive a monthly stipend, as well as payment for books, equipment and academic fees. • Medical and dental students may qualify for a sign-on bonus. • As you serve, you’ll enjoy the potential to train, perform research and grow as a leader. To learn more, call (310)216-4433 or visit Culver City Medical Recruiting Center 400 Corporate Point, Ste. 570 Culver City, CA 90230 Email: usarmy.knox.usarec.list.9e2c@mail.mil http://www.goarmy.com/amedd/education/hpsp.html

T H E ARM ARM Y ’S Y H EALT H P ROF ES S ION S S C H OLARS H IP P ROGRAM

The total amount a medical student ends up repaying can be upwards of $483,000 after interest is taken into consideration.

Each year, the amount of money the average medical student needs to borrow goes up by about 15%. In fact, the average debt at the end of four years of medical school was $180,000 in 2014. The cost of public medical school for 2015 will average roughly $216,000 in tuition and fees, according to the Association of American Medical Colleges website. Depending on the medical school, that debt can be significantly higher. If you plan on attending a top U.S. medical school, you can expect to borrow roughly $224,000 to $236,000 before you even begin your career. This is just for tuition and fees for most students; the cost of living and other expenses will be in addition to those figures. Also, according to the Association of American Medical Colleges, the cost of repayment of those loans can be a hardship for young medical professionals. After a residency is complete, a medical professional could be looking at a monthly payment of roughly $2,700 a month. This doesn’t include the overinflated cost of malpractice insurance. The total amount a medical student ends up repaying can be upwards of $483,000 after interest is taken into consideration. The Health Professions Scholarship Program provides a way to avoid lifelong student loan debt. The HPSP entails full payment of tuition at accredited medical schools. Those who are pursuing degrees in the medical, dental, veterinary, optometry, or clinical psychology fields may qualify to have tuition paid, along with receipt of a monthly stipend of over $2,100. The benefit of 100% tuition coverage at the graduate level also includes most academic fees, which can be pricey at many accredited schools. For some, a $20,000 sign-on bonus is an added benefit, a benefit that the student can use however he or she wishes. As if the benefit of tuition coverage and no student loan debt was not enough of an incentive to find out more about the Health Professions Scholarship Program, recipients of the scholarship also earn Army officer’s pay while in training as a member of the Army healthcare team. This pay includes a housing allowance, specialty pay, and other pay perks. Now you may ask, “What’s the catch?” Some may be naturally skeptical and wonder how much time of service will be required if they ap-

ply and get accepted as an HPSP recipient. The obligation of service is one year of service as an Army officer for each year you get the scholarship. The benefits of service to your country may be countless on a personal level, but on a professional level, it makes perfect sense. Army medical providers do not have to worry about malpractice insurance premiums. If anyone has researched malpractice insurance, this alone is a benefit worth thousands of dollars each year. Rank in the United States Army is also a benefit. After graduation, you will be commissioned as a Captain, which has its own perks and personal rewards. While serving, you can count on all the benefits enjoyed by otheroldiers, including healthcare, dental, and invaluable privileges at any military installation. You would serve in a ready-made practice—no costs to you for hiring staff, leasing a building, or billing patients. Army medical professionals serve around the world in modern facilities, with access to the latest technology and research. In addition, you will have opportunities for worldwide travel, participation in humanitarian missions, and some of the best residency/fellowship programs in the U.S. And serving our nation’s heroes and their family members is its own reward. You have to meet certain criteria to receive an HPSP. These criteria include being a U.S. citizen with a baccalaureate degree from an accredited school, enrollment or proof of acceptance to a graduate program, being a full-time student during your training, and meeting the specific qualifications of being an officer in the U.S. Army. I believe and know from experience that service in the U.S. Army is a source of pride and honor in its own right. For those in the medical profession or aspiring to be a medical professional, the Army can offer opportunities to learn, share, and experience medicine on a level unattainable in the civilian world. By being accepted into the Health Professions Scholarship Program, you can enjoy the personal rewards of service to your country and the professional rewards of starting your medical career debt-free, unlike the majority of your civilian counterparts. I encourage anyone pursuing a medical career to further explore the benefits of the Health Professions Scholarship Program as means of paying for medical school without the burden of unmanageable debt for years to come.

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F EAT U RE | REC RU IT M ENT & OP P OR T U NIT IES 1 2 P H Y S I C I A N M A G A Z I N E | N OV E M B ER 2015

try rapidly changing and fear of a physician shortage looming large, the recruiting of young physicians has become increasingly challenging and competitive. In this article, we will look at the current state of the recruiting process and provide tips for both those who are looking to hire new physicians BY MARION WEBB

and medical staff and for those residents who are seeking

career

opportunities.

Youâ&#x20AC;&#x2122;ll hear from experts in the healthcare industry and directly from physicians and get a glimpse of the changing face of American medical education, a subject that will be covered in depth in the February 2016 issue.

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REC RU IT M ENT & OP P OR T U N IT IES | F EAT U RE

With the healthcare indus-

Studies have shown that as more physicians retire and more patients enter the healthcare system nationwide, the number of students graduating from medical school isn’t keeping pace with the demand for physicians by hospitals and health systems. Young doctors, in turn, express concerns about paying off tens of thousands of dollars of debt for medical school and practicing in a changing healthcare environment with lower reimbursements. And, compared to older generations of doctors, Millennials desire more of a work-life balance. Meanwhile, hospitals and health systems are in fierce competition with one another to find the family doctors and specialists needed to serve the rising influx of patients.

RISING DEMAND FOR HEALTHCARE WORKERS, ESPECIALLY DOCTORS | To many in the healthcare field, it comes as no surprise that hospitals have not only stepped up their efforts to reach graduating doctors earlier than ever before, but they have also become more creative in those efforts. According to preliminary figures by the Bureau of Labor Statistics, released the day before the Labor Day weekend, employment across the entire healthcare industry jumped by 8%, to 40,500, in terms of the number of healthcare jobs added in July. Physician offices, outpatient centers, and other ambulatory sites created 21,100 of those jobs. Another trends survey, by Health eCareers Network, based on 565 healthcare employers in 2014 to gauge hiring challenges for 2015, showed that in 2014, employment growth in healthcare averaged 26,000 jobs per month vs. 17,000 per month in 2013. And while this strong employment growth for healthcare workers continues — driven by the aging population and Americans’ increased access to healthcare through the Affordable Care Act — employers said their biggest recruiting concern is the shortage of physicians. According to the Association of American Medical Colleges’ (AAMC) Center for Workforce Studies, in the next decade, there will be 45,000 too few primary care and specialist physicians to care for the aging and growing population and 46,000 too few surgeons and medical specialists. “Our country is aging fast,” AAMC President Darrell G. Kirch was quoted as saying in a 2013 Association of American Medical Colleges article. “The population of older Americans will double between 2000 and 2030.” Specifically, employers said they have the most difficulty hiring in the areas of family medicine, psychiatry, internal medicine and other specialties. A few years ago, the hard-to-fill positions were cardiology and OB/GYNs. STATE OF RECRUITMENT | Planning for the anticipated shortage is left to recruiters. And according to recent reports, today’s recruiting efforts have become not only more aggressive but also more innovative. 1 4 P H Y S I C I A N M A G A Z I N E | N OV E M B ER 2015

RECRUITING TOOLS AND STRATEGIES | To attract candidates, Health eCareers found that recruiters need to recognize and respond to doctors’ changing needs and desires. Nhat Tran, MD, a 41-year-old solo practitioner who specializes in physical medicine and rehabilitation with a subspecialty in pain management and who chairs the Young Physicians Committee of the Los Angeles County Medical Association (LACMA), agreed that the rising doctor shortage has created more competition in the hiring process. “We will have a shortage of doctors with roughly 33 million new patients coming into the healthcare system nationwide and don’t have the infrastructure to generate enough doctors to accommodate patients,” Dr. Tran said. “That’s why it’s key to start a relationship with them early on to recruit them.” Some experts also suggest helping doctors pay off medical school bills, which are a huge burden for most new doctors. Barkley Davis, senior director of physician recruitment for LifePoint Hospitals, told FierceHealthcare that, foremost, recruiters need to look beyond salary to find and retain doctors by providing debt-relief. He also agreed with Dr. Tran that recruiters need to look for candidates a year or two out to fill jobs, because the market will tighten again. According to Health eCareers, 45% of recruiters have begun using nontraditional methods, including digital marketing, social media, candidate data tracking and mobile strategies, to reach MEDICAL PRACTICE PURCHASES, SALES AND MERGERS candidates. Eighty percent of recruiters report they use job boards, and 48% post openings to social media sites, including sending tweets and emails, and almost half of employers surveyed said they use LinkedIn as part of their recruiting efforts. While many employers said it’s important to have a mobile-friendly career page and application process, many don’t have them. Others said they don’t Assisting physicians with believe that their applicant tracking syslegal issues for over three decades. tem software is accurate.

MEDICAL BOARD HOSPITAL STAFF F R A U D / A B U S E MEDI-CAL/M E D I C A R E

NEW EXPECTATIONS OF MILLENNIALS | Another aspect to consider when recruiting is that, according to the Merritt Hawkins study, today’s candidates have different expectations and concerns

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REC RU IT M ENT & OP P OR T U N IT IES | F EAT U RE

A recent survey — conducted by Merritt Hawkins, a national physician search firm and a company of AMN Healthcare — of more than 1,200 medical residents about to complete their training found that more than 60% of 2014 final-year medical residents received 50 or more job solicitations during their training, while 46% received 100 or more job solicitations. “Unlike virtually any other type of professional in today’s economy, newly trained doctors are being recruited like blue chip athletes,” said Mark Smith, president of Merritt Hawkins, in a press release. “There are simply not enough physicians coming out of training to fill all the available openings.” Smith also attributed the large number of job solicitations to a national doctor shortage.

F EAT U RE | REC RU IT M ENT & OP P OR T U NIT IES

When asked about what level of compensation residents expect to earn in their first year of practice, 78% said they expect to make at least $176,000, while the remaining 22% said they expect to make less. EXPECTED STARTING SALARIES:

Primary care: $199,000 Internists: $198,000 Pediatricians: $188,000 Orthopedic surgeons: $488,000 Gastroenterologists: $454,000 General surgeons $354,000

than young doctors of previous generations. For instance, the study revealed that the majority of residents identified geographical location or communities of 50,000 people or more, personal time and lifestyle as their most important considerations when evaluating a medical practice opportunity. Also, the great majority of residents, 92% according to the survey, said they would prefer employment with a salary in their first practice rather than independent practice income guarantee or loan. Having free time is one of their greatest concerns, and many younger doctors would prefer flexible and more regular hours with minimal oncall time and even working part time, according to recruiters’ reports. And, Millennials expect to be paid top dollar. When asked about what level of compensation residents expect to earn in their first year of practice, 78% said they expect to make at least $176,000, while the remaining 22% said they expect to make less, according to the Merritt Hawkins survey. The expected starting salaries for primary care physicians was $199,000 compared to $198,000 for internists and $188,000 for pediatricians; orthopedic surgeons expected a starting salary of $488,000; gastroenterologists $454,000; and general surgeons $354,000. “These high incomes are in part a reflection of the fact that physician shortages are not confined to primary care but are present in many specialty areas as well,” according to the survey.

TIPS FOR RESIDENTS EVALUATING OPPORTUNITIES | When it comes to evaluating post-residency opportunities, there are some common mistakes to be aware of and tips to follow. According to one recruiter, many residents often don’t know their worth and, thus, don’t negotiate well. Recruiters advise residents to do their research and find out what they can expect to make before negotiating and also not to be afraid to ask for things they want. According to the Merritt Hawkins survey, more than one-third of residents said they are unprepared to handle the business side of medicine,

1 6 P H Y S I C I A N M A G A Z I N E | N OV E M B ER 2015

“Being employed brings other challenges, and many young doctors are not aware to deal with the business end of medicine and with a corporate structure.”

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REC RU IT M ENT & OP P OR T U N IT IES | F EAT U RE

and the majority said they received no formal instruction during their medical training regarding such key issues as contracts, compensation arrangements, compliance, coding and reimbursement methods. Dr. Tran said he knew early on that he wanted to run his own practice, so he made it a point to develop key relationships and learning opportunities. “I have always been very entrepreneurial, and I like the freedom and autonomy I have in the way I practice,” he said. He admitted that running a solo practice comes with its own challenges and believes that many residents today like the idea of employment because they don’t want to deal with the business side of medicine. But he warned that residents will experience new challenges in today’s changing healthcare environment. “They will have opportunities in terms of jobs, but autonomy-wise it will be difficult for them,” Dr. Tran predicted. “Being employed brings other challenges, and many young doctors are not aware to deal with the business end of medicine and with a corporate structure.” He said that residents may lose some autonomy, but they will gain stability. He added that some may not realize that reimbursement for providing health services is shrinking, which will also make it harder to pay off their debt. For residents thinking about going into solo practice, he said perseverance was a big part of his success. “You have to think outside the box and keep your eyes and ears open for new opportunities,” he said. However, even solo practitioners may encounter contract problems, such as with other physicians when sharing overhead. For instance, some contracts have a non-compete clause, which could include a wide radius that is designed to prevent doctors from leaving the practice. Ideally, a contract shouldn’t have a non-compete clause, and if it does, it should be as narrow as possible, experts advised. Malpractice insurance tail coverage is another key issue. Tail coverage covers malpractice claims that are made after a doctor leaves a practice, which is important. Doctors also should be careful about taking an extended post-residency vacation, which can backfire if the student gets out of the habit of studying and then has to face the board exams and panics, the experts warned.

F EAT U RE | REC RU IT ING & OP P OR T U NIT IES

CHANGING FACE OF MEDICAL EDUCATION | The good news is that medical education is already starting to see key changes that will help prepare the next generation of physicians for the clinical and business side. According to Kaiser Health News, a recent survey by AAMC, which helps medical schools develop curricula, found that 129 of 140 medical schools offered a required course on the cost of healthcare during the 2013-2014 school year. Nearly 40% of the schools said they also present the subject as elective courses. Dr. Tran noted that networking with other physicians and joining LACMA were critical to his career success. “I want the young generation of doctors to be aware of their political surroundings,” he said. “With knowledge comes power so they can make better career choices, and by joining LACMA they can get some knowledge.” Joining LACMA’s Young Physicians Committee is a great first step. The committee held its first-ever Physician Career, Networking and Resource Fair at the Sofitel Hotel in Beverly Hills in September. Some 100 residents, young physicians and medical students attended workshops on prospective career paths, including one on the loan forgiveness program by the U.S. Army. LACMA is in the process of creating other resources to help young physicians or those looking to transition into practice or begin a new career venture. In March, it launched its Career Center & Job Board in partnership with the National Healthcare Career Network, spanning over 180 specialty and professional healthcare associations. And it is planning to host career and development events around employment issues that range from contract reviews and negotiations to continuing medical education. Look for updates at lacmanet.org/professionaldevelopment. The Young Physicians Advisory Committee is also working on launching a mentorship program for medical students and residents looking for a real-world perspective. Information is online at lacmanet.org/mentorship. As chair of LACMA’s Young Physicians Committee, Dr. Tran takes great pride in mentoring the next generation of doctors, but also enjoys learning from them. “We are always looking for more committee membership so we know how we can cater to their needs and wishes,” he said. “The more involvement we get from them, the more we can help them.” For more on the changing face of medical education, check back in February when Physician Magazine will cover this topic in detail. 1 8 P H Y S I C I A N M A G A Z I N E | N OV E M B ER 2015

Physician Career, Networking and Resource Fair Some 100 residents, young physicians and medical students attended workshops on prospective career paths at LACMA’s Young Physicians Committee’s first-ever Physician Career, Networking and Resource Fair at the Sofitel Hotel in Beverly Hills in September.

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REC RU IT M ENT & OP P OR T U N IT IES | F EAT U RE

LACMA’S YOUNG PHYSICIANS COMMITTEE

LA County Seeing Strong Growth in Healthcare-Related Jobs BY EMMET PIERCE

Due to the increasing demand for health services, the Los Angeles County region is seeing strong growth in many healthcare-related jobs. According to preliminary data from the Bureau of Labor Statistics (BLS), the year-over-year job growth for Los Angeles hospitals was 16,000 in July of this year.

Citing the most common LOS ANGELES COUNTY HEALTHCARE JOBS fourth quarter 2014, the BLS reported: · 105,453 workers in general medical and surgical hospitals · 82,955 in doctors’ offices · 43,974 in nursing care facilities · 26,375 in outpatient care centers · 14,242 in residential mental health facilities · 24,395 in home healthcare settings

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The report said job growth in the offices of doctors outpaced growth in hospitals between 2004 and 2014. The number of new jobs in physician offices grew by 22%, while hospital jobs increased by 6%. A Sept. 28 report in Examiner.com cited a 2014 survey of nurse employers in California that found 18% of respondents reporting a high demand for nurses and difficulty in filling open positions. The greatest need for nurses was in Los Angeles and Central California. Statewide, the California Employment Development Department has projected that the number of healthcare and supportive jobs will increase by nearly 23% to 442,400 positions between 2012 and 2022. A key factor in healthcare job growth is California’s aging population and the need to care for seniors. According to the State Department of Aging, the percentage of the increase in the population of people age 60 and older in Los Angeles County for the 1990 to 2020 study period is projected to rise by 50% to 99.9%. The population of the very old — people age 85 and older — is projected to rise by 50% to 149.9%. What’s happening in Southern California is trending around the country. With more Americans insured under the federal Affordable Care Act (ACA), there has been an infusion of cash into the industry, which has led to more jobs. According to the BLS, national healthcare reform has reduced health costs to employers while increasing resources for healthcare jobs and wages. The growth in health insurance coverage has triggered greater demand for preventative care as well as routine treatment.

LA County Occupational Employment and Wage Estimates (May 2104)

Estimates are calculated with data collected from employers in all industry sectors in Los Angeles-Long Beach-Santa Ana. MEAN HOURLY WAGE

MEAN ANNUAL WAGE

129,780

$15.90

$33,070

Home Health Aides

13,490

$12.71

$26,440

Nursing Assistants

39,560

$13.99

$29,110

Orderlies

1,260

$16.63

$34,600

Occupational Therapy Assistants

730

$33.36

$69,390

Occupational Therapy Aides

490

$16.04

$33,360

Physical Therapist Assistants

1,900

$31.44

$65,390

Physical Therapist Aides

2,120

$13.59

$28,270

Medical Assistants

29,080

$16.26

$33,820

Medical Transcriptionists

1,190

$23.91

$49,730

Healthcare Support Workers, All Other

3,980

$18.60

$38,690

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EMPLOYMENT

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THE RIGHT ATTORNEY FOR THE RIGHT DOCTORS: Choose your Attorney with Patience and Wisdom SPONSORED CONTENT | BY STEPHEN BRODSKY

Medical malpractice or negligent conduct during the course of your duties as a physician is not the only way to get into trouble with the California Medical Board. Any form of criminal conduct, whether it is merely an accusation or a conviction, can initiate a licensing investigation and turn your life as a physician upside down. Merely getting arrested for driving under the influence of alcohol or a controlled substance can result in a medical board licensing investigation. Even if the charges ultimately are dismissed or rejected by the local prosecuting authority, the California Medical Board can proceed with its investigation and ultimately recommend adverse disciplinary action to the California Attorney General’s Office. Other criminal investigations involving such crimes as sexually inappropriate conduct with a minor, embezzlement, assault, domestic violence, prescription fraud, drug abuse and burglary can also lead to licensing board investigations. The first thing you should do when faced with such adversity is to find a competent and experienced criminal defense lawyer who ideally has experience representing physicians in both licensing board investigations and in the criminal prosecutions or investigations. How do you find a good lawyer with these qualities? If you get a personal referral from a friend or knowledgeable acquaintance, that is where you should start. If you do not have a personal referral, there are numerous criminal and licensing defense lawyers in your area that you can consult for excellent and competent representation. Like all other problems you face in life, it is always good to get at least two or three different opinions. Thus, you

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should always make sure you schedule at least two or more professional consultations. What do you ask the attorney during the consultation? First question you should ask is for the attorney to describe his background, education, training and actual experience in the field of defending criminal and licensing cases. Ask the attorney for several references from past clients as well as case names and numbers that you can use to verify the lawyer’s representations about his or her experience in this type of defense. Finally, ask the attorney for his strategy for defending you. If the case is being investigated, ask the attorney what steps he or she would take to protect your professional qualifications. If the case is actually been charged and is being prosecuted as a crime, ask the attorney the strategy he will prepare in your defense. Ask about why a certain strategy will be utilized and what other alternative strategies may exist. Always prepare a comprehensive list of questions for any attorney you decide to consult. Remember, your career, you future and your life are at stake, and you cannot afford to be anything less than completely meticulous in the manner in which you select your defense attorney. No question is too stupid to ask, and you have a right to make sure that every question you came prepared to ask the attorney was answered in a manner that demonstrates the attorney’s proficiency in his or her profession. Remember, get at least two or three opinions from different attorneys and make sure you have prepared yourself to ask the questions that really matter to you as a physician. By Stephen Brodsky, Esq. | 213-703-1015

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AS S OC IAT ION H AP P ENINGS | LAC M A NEWS

CEO’s LETTER

F A L L S E A S O N I S H E R E , and with the cooler outside temperatures this is a great time for celebrations, networking and continued education. At LACMA, we celebrate the recognition of physician leadership. We are excited to announce that Dr. Vito Imbasciani, president-elect of LACMA, was appointed by Governor Jerry Brown as the new chief at the California Department of Veterans Affairs. Dr. Imbasciani, who earned his medical degree from the University of Vermont College of Medicine, was the State Surgeon for the California Medical Army National Guard from 2006 to 2014, and a surgeon in the U.S. Army Medical Corps from 1986 to 2014. Dr. Arthur Lurvey, a 42-year-long LACMA member, was recently honored with the Lifetime Achievement Award. The Beverly Hills endocrinologist, who is only the third honoree to receive this prestigious award, earned his medical degree from the University of Illinois and conducted his postdoctorate and fellowship training at the Los Angeles County-USC Medical Center. We congratulate both Dr. Imbasciani and Dr. Lurvey on receiving these outstanding recognitions and thank them for their exemplary service to the physician community and the public. In the coming weeks, LACMA physicians will see two great opportunities to expand their own horizons. The IMQ Professional Program for Physicians (from 8-9 a.m. on Nov. 7 and 8), established by the Medical Board of California, was developed specifically for physicians and physician assistants to help them address the legal and ethical issues in today’s rapidly changing medical environment. Learn how to comply with the Board’s requirements as well as key resources to address current and future problems. This interactive course is limited to 12 participants, so you want to sign up early. Learn more by visiting imq.org/education. The event will take place at Hilton Garden Inn, 2100 E. Mariposa Ave., El Segundo. The upcoming workshop “Evaluations of Health Care Professionals,” presented by the CPPPH, offers physicians key insights into the latest trends and studies on substance use disorders and addictions, age-related changes in cognition, psychiatric diagnoses and physical limitations. This all-day workshop will take place from 8:30 a.m. to 5 p.m. on Dec. 5 at the USC Medical Center, 2051 Marengo St. Earn up to 6.5 AMA PRA Category 1 Credits from the California Medical Association/ Institute for Medical Quality; 7.0 continuing education credits from the National Association of Medical Staff Services. Our marquee event of the year, the L.A. Healthcare Awards, will take place on Nov. 19 at The California Club, 538 S. Flower St. Visit lahealthcareawards.org to sign up and help support the Medical Student Scholarship Program and the Marshall Morgan Scholarship Fund. In LACMA’s proud tradition to forge alliances with other physician groups, longtime LACMA leader and former LACMA president Dr. Robert Bitonte, along with LACMA Treasurer Dr. William Averill, recently hosted a luncheon for the A-Bomb Survivors Exam Team Members from Hiroshima, Japan, during the team’s biannual visit. We look forward to continuing our efforts to unite physicians from all over Los Angeles and the world to forge alliances and networking opportunities. This November, we also look forward to spending time with our loved ones. We want to wish everyone a wonderful Thanksgiving holiday. Regards,

Rocky Delgadillo Chief Executive Officer

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