This year marked the second Medscape report on staff pay, benefits, and raises. The first was published in 2013. Both were based on surveys of physicians across 25 specialties, who answered questions on how much they pay their staff, what benefits and raises they give, and what positions will be added and cut in the coming year. Included were clinical staff (nurse practitioners, registered nurses [RNs], physician assistants, medical assistants) and nonclinical staff (front desk, medical billers, medical coders, medical biller/coders, and medical records clerks). This year, the survey added coders to nonclinical staff members to help determine any effect from implementation of the 10th edition of the International Classification of Diseases (ICD-10). Physician-led practices report employing an average of three to five full- or part-time nonclinical staff members and five to seven clinical staff, with medical assistants (five full-time and two part-time) and registered nurses (four and two, respectively) employed in the greatest numbers across practices. Staff Salaries and Benefits Salaries As expected, most clinical staff members (nurses and medical and physician assistants) are more highly paid than nonclinical staff. Nurse practitioners receive $87,000 in compensation, followed closely at $85,000 for physician assistants. Registered nurses are third at $52,000. Medical assistant compensation is the lowest ($30,000). Of interest, the highest-paid nonclinical staff members are medical biller/coders, at $37,000. This amount is higher than compensation of medical assistants—a clinical position—indicating the current importance of medical biller/coders, possibly because of the ICD-10 challenges. Medical records clerks received the lowest average annual pay, at $26,500, with front-desk staff at a slightly higher salary of $28,000. Benefits Physician practices are providing benefits to full-time nonphysician and administrative staff at virtually the same rates they did in the 2013 survey. Although the Affordable Care Act (ACA) gives smaller practices the opportunity to receive tax incentives for making health insurance available to their employees,there was a decrease in paid health insurance: only 68% in the 2013 survey, and even less (65%) this year. It should be noted, however, that these percentages are still higher than the national current health benefits rates for small business in general (57%).Similar decreases were seen between 2013 and 2015 in practices providing health savings accounts (26% and 23%, respectively) and retirement plans with no employer match (22% and 19%, respectively). Four percent received "other" benefits, which, according to this year's respondents, include reimbursement for tuition and professional fees, profit-sharing, gym memberships, and discounts on a practice's services. Who Gets Raises? Slightly more physician practices reported giving annual raises to their staff in the 2015 survey (73%) than in 2013 (70%). Although the increase is slight, the results on both raises and benefits in the Medscape survey run counter to the national trend of increasing benefits rather than giving raises. The most important factor by far to physician practices in determining raises is good job performance, with over one half (55%) placing this in the top two out of five rankings for importance. Still looking at the top two ranks, hard work came next at 33%, and positive attitude was third at 29%. Less important factors include reliability and likeability among patients (15% chose top two ratings for both). Low salary and willingness to work extra hours are the least important factors. In this year's Medscape survey, just over one half of physician respondents who give raises reported average annual increases of 1%-2% (52%), whereas 43% gave 3%-5%. The minimum annual staff increase given by nearly 79% of these physicians was between 1% and 2%, with 58% reporting a maximum raise of 3%-5%. According to the Bureau of Labor Statistics, in 2014, the average increase in wages among healthcare providers and those in healthcare support occupations was much lower (0.2%) than reported here.Government data on industry in general have reported only a 2% increase in wages since 2004. Changes in Nonclinical Staffing: Front Desk Looking at nonclinical staff, 98% of physician practices have either full-time (78%) or part-time (20%) front-desk staff. The rate of full-time members of this staff is down from Medscape's 2013 survey (84%). Among physician practices planning full-time staff cuts, 26% say they are cutting this job. Nevertheless, the job prospect in this group is a bit rosier than in 2013, when 45% of physicians said they would cut this position. In addition, when asked what full-time staff members were on the list for hiring this year, 28% said they were adding front-desk clerks—the only nonclinical staff job in the top four. Coders and Billers ICD-10 compliance was required by October 1, 2015. The 2013 survey did not ask about coders specifically, although at that time, only 14% of physicians were concerned enough about ICD-10 to hire more staff. Although often clinical staff who treat patients select the codes from electronic health records, this year, 63% of physicians had staff whose job involved coding, either alone or as part of other tasks; 21% of physician respondents currently employ full- or part-time dedicated coders, and 42% have staff who handle both billing and coding. There's little difference between primary care physicians (PCPs) and specialists in their employment of this group, although specialists may rely more on coders than PCPs do. One third of both PCPs and specialists employ billers only. Slightly more specialists' practices hire either coders alone (19%), or staff who do both billing and coding (34%), than PCPs do (16% and 31%, respectively). Within the first 2 weeks of the ICD-10 mandate, large insurers were reporting that the transition was going fairly smoothly.Most staff hiring for these coding tasks has been done. When asked specifically whether they were hiring additional staff to handle tasks related to ICD-10, a large majority (81%) of respondents said they were not. Nevertheless, a combined 27% of respondents say they will need medical biller/coders (13%), just coders (8%), and just billers (6%) in the coming year. One can assume that 21% need additional coders and 19% need more billers, either doing one of these tasks or both together. In the 2013 Medscape survey, about one third of respondents planned to cut medical billing staff. This year, only 13% of practices are getting rid of their billers. Medical Records Clerk The percentage of practices employing a full-time medical records clerk remained steady at 25% between 2013 and 2015. When asked whether they would be hiring any clerks this year, only 2% intended to do this. Among all office staff, medical records clerks are at the bottom of the hire list this year. On the other hand, only 8% of respondents plan to cut medical records clerks this year, among the lowest rates of all clinical and nonclinical staff. Changes in Clinical Staffing According to the two Medscape surveys, physicians are employing fewer RNs in 2015 compared with 2013. There is very little difference over this period in the employment of medical assistants (about two thirds both years) and physician assistants (about one quarter) (Table). Of interest, when looking at how specialists and primary care physicians employ clinical staff this year, 74% of PCP practices and 62% of specialist practices employ medical assistants, whereas more specialists (31%) than PCPs (25%) have registered nurses on staff. Most likely, this may be due to the need for more specialized clinical assistance among specialists and the inability of PCPs to pay the higher RN salaries. About one quarter of both PCPs and specialists hire nurse practitioners (26% and 27%, respectively) and physician assistants (26% and 25%, respectively). Table. Changes in Full-Time Clinical Staff Positions Between 2013 and 2015 Medical Assistants Among clinical positions, medical assistants are at a slightly greater advantage. Practices in general are most likely to employ them (85%), with two thirds (67%) of these positions being full-time—about the same as in 2013 (65%). These staff members are also the most sought-after of all in 2015, with 38% of practices looking to employ more medical assistants. Although about one quarter (24%) of respondents intend to cut medical assistants, as with front-desk clerks, this is a far lower percentage than those cut in 2013 (40%). One can guess that the practice needs for these positions have now leveled off. Registered Nurses This year, 29% of physician practices employed full-time RNs, which is down from 37% in 2013. In addition, only 12% of practices are looking to hire RNs this year, less than any other clinical staff member. Nurse Practitioners Twenty-seven percent of practices had full-time nurse practitioners on staff, down from 31% in 2013. About the same percentage of practices (30%) intend to hire nurse practitioners this year. Only 8% of respondents plan to cut nurse practitioner jobs this year. Physician Assistants The percentage of practices with full-time physician assistants rose only slightly, from 24% in 2013 to 26% this year. Nearly the same percentage (23%) is seeking to hire physician assistants in the coming year. Hiring Staff, and Letting Them Go Sixty-three percent of respondents do not plan any changes in the number of staff they employ, a decrease from 67% in the 2013 Medscape survey. Of those who are reporting changes, the good news is an increase in the percentage of physicians who plan to add staff in the coming year (24%, up from 17% in 2013) and a decrease in those who plan to cut staff (6%, down from 9% in 2013). There was no change from 2013 in the percentage of physicians who plan to both add and cut staff (steady, at 7%). Why Are Practices Hiring? Ensuring adequate staffing to manage the workload, current and predicted, is the predominant concern among respondents who plan to add full-time nonphysician providers and administrative staff. In this year's report, 45% of practices recognize that their current staffs simply aren't large enough to manage the work. Of interest, in the 2013 survey, 47% said they were adding staff in anticipation of the ACA. This year, patient volume from the ACA is responsible for adding staff in only 18% of practices, whereas 41% said they needed staff to handle a higher patient load unrelated to the ACA. Other significant reasons for hiring among respondents who plan to add staff are employee turnover and transitioning to ICD-10, both at 24%. Twenty-one percent of these respondents cited the need to increase patient volume to offset declining reimbursements. Why Are Practices Cutting Staff? Clearly, the most important reason for cutting staff is due to declining reimbursements from insurers. Of interest, there was very little difference in percentages between private and government payers. Thirty-nine percent accused commercial payers, and 36% government payers, of declining reimbursement, and 41% selected both as a reason for cutting staff. (Because physicians were able to choose as many options as they wanted from this question, there was some overlap among these responses.) Although the universally loathed sustainable growth rate formula was replaced in April, it is still uncertain whether the new changes in reimbursement will increase practice income significantly in the future.Twenty-three percent of respondents are hiring part-time or remote employees for other support services, and 17% are outsourcing them. Twelve percent of respondents plan to cut staff as a result of transitioning to ICD-10. Deciding Who to Cut, Who to Keep? Physicians were asked to rank factors in importance from 1 to 5 that they would use to determine whether to retain or let a staff member go. Percentages used in the following sections are for ratings of 1 and 2. Performance. When valuing staff, performance is top on the list. Over one half (52%) of physicians gave performance ratings of 1 or 2 out of 5. When considering reasons for firing or cutting particular staff members, 42% of physicians ranked bad performance in the first or second slots. Job important to practice. More than one third (35%) gave job importance the first and second rating for keeping a staff member, although only about one half gave it any ranking at all. About one third (36%) put a 1 or 2 rating on nonessential jobs as a reason to cut staff. Hard work. Hard work was the second most important reason for keeping staff members, with a third rating it 1 or 2. It was the third reason for cutting staff, with 28% believing that not working hard ranked 1 or 2 for letting someone go. Positive attitude. About one quarter of physicians ranked a positive attitude first or second in keeping a staff member (27%) and as a reason to cut an employee (25%). Being accurate. Less than one quarter (21%) thought that being careful and accurate was in the top two spots for keeping a staff member, although over 60% thought it was important enough to rank at all. Reliability. Being reliable was not high on the list for deciding who to keep or let go (17% and 18% rated this 1 or 2, respectively). Likeable to patients. Although over one half (57%) of physicians thought being liked by patients was a reason for keeping a staff member, only 14% put this as first and second in importance. Just 11% gave these high ranking as a reason to let a staff member go. Other factors. Unique skills, low salary, and willingness to work extra hours are the least important factors among respondents considering staff cuts, with low percentages citing these assets as alternative choices. Physicians' Relationships With Staff The vast majority (76%) of respondents believe that they have good relationships with members of their staffs. An additional 23% of respondents say they have good relationships with staff members on the whole, with one or two exceptions. A mere 1% of respondents say they don't pay much attention to these relationships. Nevertheless, some surveys of health professionals suggest that disruptive behavior by physicians is a problem. In one such survey, 42% of respondents said that in their organization, a nurse or other staff requested a reassignment or transfer because of such behavior. Source
