Monday, February 28, 2022

Study: Starting pay differences reduce earning potential for women in academic medicine

Nearly all women in academic medicine start out at lower salaries than their male counterparts. But that early disparity also leads to significant gender-based differences in income and net worth for at least a decade, according to a new study.


For the study, researchers examined compensation data for about 25,000 female and 30,000 male academic physicians across 45 subspecialties from 2019 to 2020. They found that women’s estimated starting salaries were lower than men’s in 42 of them, with a median difference of $26,800, or 10%. After 10 years women had lower salaries in 43 of the subspecialities, with the median difference being $22,890, or 9%.

In addition, women had lower earning potential, as measured in 10-year net present value, in 43 of the subspecialties. The only exceptions were in pediatric nephrology and pediatric rheumatology.

The study found a slightly more positive picture for women in terms of mean annual salary growth rates, where theirs were higher rates in 23 of the 45 subspecialties.Differences ranged from 1.2% higher for women to 3.1% higher for men.



The authors add that while their study focused on gender-based pay disparities within subspecialties, other studies have shown significant differences between subspecialties, with those that are female-predominant experiencing a relative decline in compensation compared to those in which men predominate.

The authors recommend equalizing starting salaries, rather than annual salary growth rates, as the most effective method for addressing gender-based disparities in early career earning potential. That’s especially the case since new faculty members, in theory, should have little besides their gender to differentiate them.

They also suggest that schools institute “periodic compensation evaluations and adjustments” as a way of preventing gender-based disparities in career earnings, and correcting existing gender-based salary inequities for women already well into their careers.

Finally, they say, medical schools and postgraduate training programs can help women improve their career finances by teaching negotiation skills and financial literacy, They add, however, that “the onus for ensuring salary equity should not fall on the individual candidate alone; rather, departmental and hospital leadership should take responsibility to ensure uniform starting salaries and prevent gender-based inequalities.”

The study, “Addressing Gender-Based Disparities in Earning Potential in Academic Medicine” was published February 18 in JAMA Network Open.


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Saturday, February 26, 2022

Do merchant cash advances benefit physicians? February 21, 2022

Numerous types of small business funding exist for doctors and medical professionals, including Small Business Administration (SBA) loans, bank loans, and funding from alternative lenders.

SBA and bank loans have the largest loan amounts, longest terms, and lowest rates, but they also have the strictest approval timelines and it can take weeks or months to get a decision. Alternative lenders, on the other hand, specialize in fast funding for smaller amounts and shorter terms.

Merchant cash advances are one of the most common alternative funding products. In this post, we’ll explain what merchant cash advances are, how they work, and how doctors and medical practices can use them to fuel their growth.

What is a merchant cash advance?


A merchant cash advance is not actually a loan—it’s a non-loan form of financing known as an “asset purchase”.

When you receive an MCA, you’ll receive a cash advance up front in exchange for a portion of your practice’s future revenue. Your lender will receive a portion of your daily or weekly debit and credit card sales until the advance has been repaid (along with any fees).

Merchant cash advances are available up to $500,000 depending on the lender. The amount is based on your projected future sales, along with factors like your credit score and financial history.

How do merchant cash advances work?


Merchant cash advances are available from direct online lenders like Greenbox Capital®.

To apply for a merchant cash advance, you’ll typically submit a short form online and a representative from the lender will contact you to continue your application. Depending on how quickly you are able to supply the requested information, your merchant cash advance could be deposited in as little as 24 hours. This makes merchant cash advances ideal for medical practices that need working capital fast or don’t have time to navigate the complicated application process of the SBA or a bank.

Do your research and vet your lending partner carefully to make sure your MCA has the best terms for your business. Don’t apply for or accept an advance from a lender that engages in “loan stacking”—a term used to describe when an advance is granted to repay another advance.

Qualification requirements


Merchant cash advance qualification requirements are much less restrictive than other forms of funding. No collateral is required, but your medical practice must accept debit and credit card payments to qualify. Approval is based on the future potential of your business, rather than just your credit score and financial history. Your credit score and financial history may affect your loan amount and factor rate, but a low credit score is not an automatic cause for denial.

Merchant cash advance rates


Because terms are shorter and qualification requirements are more flexible, MCAs may have higher rates than other forms of funding. However, it’s a common misconception that merchant cash advance rates are always higher than other forms of funding. Ultimately, your rates will be based on your practice’s risk assessment and how quickly you are able to repay the advance.

Merchant cash advances use a factor rate, not a traditional interest rate. Instead of a percentage rate that compounds as you repay the loan, a factor rate is a simple decimal figure that shows how much “extra” you’ll owe on the loan. For example, a factor rate of 1.3 on an advance of $10,000 means you’ll owe $13,000.

Who should apply for a merchant cash advance?


Merchant cash advances are ideal for:
  • Medical practices that need fast funding to support their growth or take advantage of a short-lived opportunities to grow
  • Practices that process a lot of debit and credit card transactions
  • Practices that need smaller amounts of funding
  • Practices with lower credit scores
  • Medical practices that do not have collateral, such as real estate and other major assets

How to use a merchant cash advance


MCAs are a flexible form of funding, and often there are no restrictions on how the funds can be used. Typically, merchant cash advances are best used to support growth initiatives with strong ROI potential, such as:
  • Purchasing inventory
  • Purchasing or repairing equipment
  • Upgrading technology
  • Investing in real estate
  • Hiring staff
  • Boosting marketing
  • Improving patient services


Is a merchant cash advance right for you?


Merchant cash advances offer medical practices a number of advantages over financing options offered by traditional lending institutions, including:
  • Simplified applications with less paperwork and less rigorous approval requirements
  • Faster processing and approvals, with funding available in as little as one business day in some cases
  • More flexibility with no restrictions on how funds are used

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Friday, February 25, 2022

Five things to consider before starting a concierge medical practice

A new year brings new ideas and while some practices will remain the same this year, some may consider transitioning their practices to a “concierge” model, sometimes called a “subscription” or “retainer” practice. A concierge practice is a direct contract between a doctor and patient where the patient pays for an agreed menu of healthcare services; patients pay a fixed fee, whether the fee is monthly or annually, to receive medical services administered by a provider. The concierge medicine business model is expected to reach $10 billion by 2028 and is expected to continue to expand.

Some providers find concierge medicine appealing because they can spend more time with their patients listening and understanding their needs, offering better care to them. Additionally, in a concierge model, providers manage to earn more despite a smaller number of patients and establish a work-life balance. The idea of controlling work, avoiding provider burn-out, allocating more family time, pursuing personal & professional interests, offers an attractive choice for all providers. But despite this, there are still several legal and compliance hurdles associated with this practice model.

PITFALL (1) Patient Agreements


The provider will create and enter a patient agreement where the patient agrees to pay some fee and all fee schedule charges at the time of service for access to a specific menu of enhanced services.

Problem
Some patients cannot afford the services under the patient agreement.
Some patients will still try to pay with insurance instead of the patient agreement.
Understand and review the payor agreement to avoid breaching the contract; refrain from offering concierge services that may be covered by a third-party payor agreement.

PITFALL (2) Insurance Licensure



Spend time with your attorney reviewing your patient agreement to ensure it does not violate state law.

Problem
Some provider arrangements may appear less like patient-provider contracts and more like an insurance agreement. Insurance laws in most states have several requirements before any person can offer this to any patient. Thus, it’s important that your attorney reviews your state’s insurance licensure laws and provides you a summary of this review before drafting a provider-patient agreement.

PITFALL (3) kickbacks


Review the ways you are marketing and convincing patients to use your concierge services.

Problem
An issue that arises is that of illegal kickbacks and fee-splitting legal rules. When concierge practices offer “free” services, this raises concerns under the federal anti-kickback statute (AKS) if Medicare is involved, or state antikickback laws. Enforcement authorities can view the “free” service as an illegal inducement for clinical services.

PITFALL (4) Medicare


Understand how Medicare addresses concierge medicine.

Problem
As for governmental healthcare programs, Medicare providers may engage in concierge services if the provider complies with Medicare regulations and the terms of assignment agreements, most notably the requirement to not charge Medicare beneficiaries extra for services already covered by Medicare.
Medicare’s concerns about concierge medicine and assignment agreements are outlined in a 2004 Office of Inspector General Opinion alert titled, “OIG Alerts Physicians About Added Charges for Covered Services – Extra-Contractual Charges Beyond Medicare’s Deductible. Medicare providers should also review federal authorities for Civil Monetary Penalties.

PITFALL (5) Patient ABANDONMENT


Review the way in which you are separating from patients who do not join your concierge services.

Problem
When providers switch over to a concierge model, some patients will not follow your practice. Provide adequate notice to patients of your new business model and provide patients enough time to find another healthcare provider if they choose not to follow your new business model. Review state patient abandonment laws to ensure you remain in compliance with any state regulation.

In conclusion, a concierge practice can be a very lucrative way for a provider to achieve work-life balance by reducing the number of patients, increasing time with patients, and making great profits. But before you transition, speak with an attorney experienced in healthcare business law who can help you through the transition.


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