American College of Physicians: Internal Medicine — Doctors for Adults ®

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From the February 1998 ACP Observer, copyright © 1998 by the American College of Physicians.

ABIM registration due April 1

Internists planning to earn certification in a subspecialty this year have until April 1 to register with the American Board of Internal Medicine (ABIM). Late fee registrations will be accepted until July 1.

The following certification examinations are scheduled for Nov. 4: clinical cardiac electrophysiology; critical care medicine, endocrinology and diabetes; gastroenterology; geriatric medicine; hematology; infectious disease; medical oncology; nephrology; pulmonary disease; and rheumatology. Certification testing for cardiovascular disease is scheduled for Nov. 4-5. All ABIM subspecialty certification examinations are now offered annually.

Registration for recertification in internal medicine and its subspecialties and added qualifications is ongoing for the Nov. 4. test. To be eligible, candidates must return all required at-home Self-Evaluation Process Modules to ABIM by Aug. 1.

Information: 800-441-2246.

Hospitals' physician CEOs strike it rich

While managed care is driving physician income down, salaries for physician CEOs are booming.

According to a survey by the Physicians Executive Management Center in Tampa, Fla., physician CEOs at large hospitals earn about $319,000 in base salary plus incentives. The survey also found that the vice president of medical affairs and senior physician executives in hospitals make a mean salary of $193,751 and $205,233, respectively.

The tradeoff: physician executives usually give up practicing medicine. Fewer than 10% of senior medical managers surveyed were able to continue practicing clinical medicine.

The typical physician who makes the move into hospital administration is male, 53 years old, board certified in a primary care specialty and has been in his current position for five years, according to survey data.

More than half of doctors paid by capitation

More than half of U.S. doctors now report that their practices receive capitation for at least some of their patients, according to a survey published by the Center for Studying Health System Change.

The report found that 71% of primary care physicians were in practices that received capitation, compared to 43% of specialists. Doctors on the West Coast were more likely to be in practices receiving capitation than those elsewhere in the country. For example, more than 70% of doctors in Orange County, Calif., and Seattle, Wash., reported they are paid on a capitated basis. In Syracuse, N.Y., Greenville, S.C., and Little Rock. Ark., just more than 40% of the doctors reported accepting capitation.

The study also found that most doctors thought that being paid on a capitated basis did not compromise their ability to provide adequate care to their patients. More than 70% said they somewhat or strongly agreed with the statement, "I can make clinical decisions in the best interests of my patients without the possibility of reducing my income."

Less medically needed drugs covered less often

Drug benefit plans decreased coverage in 1996 for drugs they considered not medically necessary and placed restrictions on many of those they do cover.

According to the data collected by the Pharmacy Benefit Management Institute from 264 large employers, the surveyed plans covered just 2% of cosmetic drug prescriptions such as Rogaine in 1996, down substantially from 22% in 1995. Smoking cessation drug coverage dropped from 48% to 40%, and fertility medication coverage dropped from 50% to 39%.

The survey also found that many of the plans that cover smoking cessation drugs placed a cap on the number of allowed treatments and plans that pay for fertility treatments frequently limited the dollar amount paid for fertility medications.

The survey showed that when employers chose not to cover less medically necessary drugs, it was typically to save money. When they did cover them, it was to attract employees to the company.

Drug price increases slowing

The average price increases for all prescription drugs in the third quarter of 1997 was lower than it was for the same period in any of the last five years. The average price increase was 2.2%, compared to 2.3% in 1996 and 3.6% in 1996, according to a survey by First DataBank.

Brand-name drugs from the top 25 pharmaceutical companies, however, increased in price more—3.9%. Price increases chalked up by generic products was 1.8%.

Where to turn after a needlestick

A new toll-free hot line offers information, counseling and treatment recommendations for individuals who have been exposed to a blood-borne disease or infection such as hepatitis and HIV.

The National Clinicians' Post-Exposure Prophylaxis Hotline (PEPline) can be reached 24 hours a day at 888-448-4911. The PEPline is a joint project of HHS' Health Resources and Services Administration and the CDC, in collaboration with the San Francisco Department of Public Health and the University of California, San Francisco.

The CDC estimates that at least 5,000 HIV needle exposures occur annually.

Compiled by Deborah Gesensway and Jennifer Fisher Wilson

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