2010 Executive War College April 28, Latest Trends in Pathology Compensation, Productivity and Benefits

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1 2010 Executive War College April 28, 2010 Latest Trends in Pathology Compensation, Productivity and Benefits Presented by: Rich Cornell President Santé Consulting, LLC. St. Louis, MO Trend Topics The State of the Market- What Specialties are in demand Market Trends Compensation, Productivity and Benefits Trends

2 The State of the Market Candidate Pool* Total number of Board Certified Pathologists in the United States: 26,006 Anatomic and Clinical 16,885 Anatomic Only 6,705 Clinical Pathology 2,416 *2009 ABMS Certificate Statistics The State of the Market* (Continued) In 2008, of the 562 residents who completed training in AP/CP, Program P Directors knew of the plans of 487 (86.7%): 2: Average job offers received per resident 401 (82%): Decided to pursue additional fellowship training 159 (28%): Went into practice 68.2% went into Group Practice 50% In the same state as they trained 9.4% went into academics 2.7% went into military 0% in NHSC or underserved area.6% left the country.4% were unemployed There are approximately 440 Fellows Graduating every year. *AMA FREIDA Online 2010 Graduates career plans statistics

3 The State of the Market (Continued) Practicing Physicians: MGMA estimates 6% movement annually (1560 Total) 40% of Practicing Physicians change jobs in the first 5 Years. WHY? The State of the Market (Continued) Practice Setting Choices (In order of demand) Single Specialty Groups - Hospital Based (Experienced Anatomic Pathologist) - Free Standing Lab - In House SSG Practice (TC/PC) Model Commercial Laboratories Hospital Employed Academics Multi-specialty Group

4 The State of the Market (Continued) Top 5 Sub-Specialties Specialties in Demand* 1. Hematopathology 92 Fellows Graduate 1536 Board Certified (ABMS) 37.3 % Went into private practice 60% in the same specialty 16% in the same state 25.4% Pursued additional training 28.4% Went into Academics *AMA FREIDA Online 2009 The State of the Market (Continued) 2. Molecular Pathology 11 Fellows Completing Per Year 138 Board Certified (ABMS) 50% pursuing additional training 20% went into private practice 30% went into academics 3. Dermatopathology 62 Fellows Completing Per Year 1137 Board Certified (ABMS) 53.7% went into private group practice 38.9% went into academics 1.9 % pursuing additional training Approximately 25-30% are Dermatologists

5 The State of the Market (Continued) 4. Cytopathology 94 Fellows Completing Per Year 2747 Board Certified (ABMS) 29.3% went into private practice 33.3% went into academics 29.3% pursuing additional training 8.1% Other 5. Genitourinary Pathology (GU-Path) 8 Accredited Fellowships Privately Funded Fellowships 350 Fellowship Trained (EST) 20% went into academics The State of the Market (Continued) How has the state of the economy and housing market impacted recruiting? 1. Ability to move established physicians has changed 2. Geographic restrictions 3. Buyers or Sellers Market? 4. Healthcare slow down 5. Layoffs/Compensation

6 The State of the Market (Continued) How has healthcare reform impacted movement in the market? Groups are taking a wait and see attitude Hospitals/systems are looking at contractual and financial arrangements Increased retirements TRENDS

7 Hiring Trends Higher relocation packages More part-time time positions Spouse s s career Candidates are more restricted geographically Cautious environment Senior positions available Employed positions versus partnership Compensation Trends Conservative starting salary Terms less flexible Risk sharing models Higher workload volume expectations Decline in bonus structure (less defined)

8 Source Compensation Average MGMA $344,000 AAMC $331,842 AMGA $310,931 Slone Partners $318,636 Cejka Search $344,195 Santé Consulting $315,000 Overall Average $327,434 Starting Compensation By Sub- Specialty Hematopathology $260,000 HP- Molecular Path $300,000 Dermatopathology $327,500 Cytopathology $230,000 GI-Pathology $310,000 GU-Pathology $260,000 Experience AP with Directorship $375,000 AP / CP $250,000

9 Standard Benefits Based on 2009 Data 98% Relocation (avg:~ $10,427; Low:~ $2500; High:~ $25,000) 85% Signing Bonus (avg:~ $24,850) 96% CME (avg:~ $3121) 91% Health Insurance 94% Paid Malpractice Insurance 85% Retirement Benefits 75% Long and Short Term Disability Time Off Vacation Time Starting: Weeks Experienced: Weeks C.M.E. Starting: 5 Days Experienced: 10 Days Sick Days Average: 5 days Personal Days Average: 3

10 Expected Volume Trends Private Practice- Non Academic (Combined in/out patient) Surgicals Per FTE Concerns with Part-A A Compensation Models Commercial Labs Low: 18,000-24,000 Per FTE High: 24,000-36,000 Per FTE Variables: Types of cases, complexity, reporting system, quality of slides and efficiencies Employment Model Compensation Hospital Employed SSG Hospital Based SSG Private Groups Commercial TC/PC

11 Hospital Employed Base compensation $200-$275K $275K range 1-22 year contract term Bonus based on customer satisfaction Annual merit increase Standard benefits Single Specialty Groups Hospital Based Stability Ability to maintain all skills Interaction with clinical staff Committee work Partnership Access to the decision makers/ partners

12 Single Specialty Groups Compensation Typical starting salary is between $225-$300K $300K Small bonus for the first couple of years Excellent retirement savings Partnership offered in the year range Generous time off Car allowance, cell phone, pager and computer Single Specialty Group Partnership Buy in Hard asset plus percentage of A/R Paid through reduced earnings or bonus over a pre- determined period of time Bonuses are paid to the partners on either a monthly, quarterly of semi-annual basis Based on the earnings or profitability of the group, rather than personal production

13 Sub- Specialized Single Specialty Groups Employed Model Base compensation between $300-$350K $350K Bonuses paid out either by the case or by a percentage of the profits Partnership is not a given Same benefits as the partners Sub- Specialized Single Specialty Groups Independent Contractor Model Net income guarantee Paid by the CPT code (range of $13-$30) $30) Partnership not a given Contractor has to provide own benefits Expected volumes vary by sub-specialty specialty

14 Commercial Laboratories Salary Range of $225K-$350K based on experience, certification, sub-specialty and training. Example: A board certified dermatopathologist with 3 years of experience would be offered, typically, a base of $300K. Annual pay increases average between 2-10%. The variable is based on company and/or employee performance. Commercial Laboratories Incentive Pay Company requires a minimum daily sign-out volume (70-100) of cases per day. Some commercial labs count it by the part vs. case and use a factor of 1.4. Offer incentive pay of between $8-$15 per case/part for anything signed-out over the daily minimum.

15 Commercial laboratories Instead of incentive,they offer an annual bonus Many variables Percentages range from 1% up to 20% of annual salary No guarantees Variables Employee performance including QA/QC and sign out volume Overall company performance and meeting its targeted projections Local lab meeting and or exceeding its budget and/or projections Customer satisfaction Commercial laboratories Contract Terms At Will Employment Terminate with or without cause Contract open-ended and automatically renews annually Non-solicitation clause Liquidated damages clause Proprietary information clause 30 day written notice Employee pay back for relocation expenses clause

16 Questions? Sources AMA ABMS MGMA AMGA Cejka Meritt/ Hawkins Slone Partners Frieda Online Certificate Statistics Compensation Survey Compensation Survey Resident Tools Will the last physician In America Please Turn Off the Lights Compensation data

17 Rich Cornell President Santé Consulting, LLC Chesterfield Airport Road Suite: 200 Chesterfield, MO Office: Fax: