The American Lawyer: Health Law Jobs on the Rise

Over the course of the current recession, Health Care jobs have been an almost singular bright spot amidst almost continuous reports of employment loss. As we posted back in January of this year in “Health Care Jobs Up & Expected to Stay that Way,”  The Wall Street Journal then reported that

“Health care saw a net gain of 419,000 jobs in 2008 and its growth outlook continues to be strong through 2016, according to the Bureau of Labor Statistics.”

The Bureau of Labor Statistics’ most recent report again shows Health Care jobs to be one of the few bright spots in an otherwise bleak employment picture (to see the current health care employment numbers, click here, look at the column furthest to the right, and then scroll down towards the bottom and stop when you no longer see continuous minus signs).

What might one expect to be the effect of this relatively sanguine state of affairs for Health Care employment on Health Law practitioners?

In the well written and informative words of Professor Jennifer Bard, J.D., M.P.H (I highly recommend the article,  “I’m Interested in Health Law– Now Where Can I Get a Job?” to anyone who may be considering a career in Health Law),

Health care is a trillion-dollar industry[1]that has grown exponentially over the past 10 years with very little sign of slowing. The demand for legal services has tracked the growth of the industry,[2] and, as a result, attorneys calling themselves “health lawyers” have grown from a small core of specialists to a large and diverse group of individuals who are as likely to specialize in bond issuance and tax planning as in torts or food and drug law. Moreover, the increasing regulation of health care has created substantial need for lawyers specializing in compliance with a vast array of federal, state and local regulations. Where 15 years ago most health law was done by small, specialized law firms, today many of the nation’s biggest law firms have thriving health law practices.

Significantly, although officially published in the Winter of 2009 (14 New York State Bar Association Health Law Journal 73 (2009)), Professor Bard first published those words to SSRN in February of 2008–prior to the onset of the Obama Administration and the rising priority of Health Care Reform and regulatory enforcement. Because of these rising priorities, her words are no less true than when they were written, and have arguably gained an even greater currency since.

In an article this month in The American Lawyer, “Drug Supplement.  New federal regs demand more health care lawyers,” Rachel Breitman points out the following:

Ever since President Barack Obama gave health care reform a prime spot on his agenda, hospital, pharmaceutical, medical device, and insurance interest groups have been digging in, with the expectation of a battle to come–the kind that requires lawyers.

Changes have already begun. New federal regulations like a genetic discrimination shield law and new digital privacy security standards have been enacted. The U.S. Department of Justice and Health and Human Services launched a healthcare task force in May. “There’s going to be more oversight about how companies spend government grant funds for research and clinical trials,” says Frederick Robinson, the head of Fullbright & Jaworski’s Washington, D.C., health law practice, which advises clients like Zimmer, Inc., and Walgreen Company. “Also, as health care providers apply for stimulus funds, there will be new compliance challenges to get the money.”

As a result, law firms have a new appetite for health care lawyers.

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[1] See U.S. Dept. of Health & Human Services, http://www.cms.hhs.gov/NationalHealthExpendData/02_NationalHealthAccountsHistorical.asp#TopOfPage (last visited Dec. 1, 2007). The United States Department of Health and Human Services’ Centers for Medicare and Medicaid Services estimate that in 2005 the U.S. spent $2.0 trillion on health care. This equals $6,697 per person.

[2] aareahttp://law.case.edu/student_life/journals/health_matrix/141/rothstein.pdf. (last visited Dec. 1, 2007). (In reflecting on the growth of health law over the past 50 years, Professor Mark Rothstein writes that

in the last fifty years, law has become an integral (if not universally welcomed) part of medicine. Physician practices are now concerned with privacy notices, informed consent documents, and advanced directives. At most hospitals, expanded in-house legal departments have been joined by related departments of risk management, regulatory compliance, and health information privacy and security. 213.

Physician Shortage in Relation to Compensation

The New York Times has run an article regarding physician shortages and physician compensation that is well worth a read. The Times reports that Obama administration officials

said they were particularly concerned about shortages of primary care providers who are the main source of health care for most Americans.

One proposal - to increase Medicare payments to general practitioners, at the expense of high-paid specialists - has touched off a lobbying fight.

But as the Times article does not give particulars as to physician compensation, it may be of some help to actually look at the numbers.  To do so, I’ve re-posted this blog from a few months back. If, after you’ve looked at the numbers, you would like some explanation as to why they are the way they are, Professor Frank Pasquale’s post, Will Specialist Pay Be a Target of Health Care Reform?, will also serve you well. For an even further look at physician compensation, click here, and for a look at physician shortage matters click here.

Physician Compensation II

Yesterday’s post displayed recent Bureau of Labor Statistic figures concerning physician compensation, and offered a link to recent median physician compensation data approved for use by Centers for Medicare and Medicaid Services (CMS) for calculations regarding direct graduate medical education under 42 CFR 413.78(f). The producer of this data, AMGA, also offers an interactive physician compensation survey which shows “average” and “starting” compensation for various specialties. A click on the arrow underneath “average” will sort from lowest to highest.

Here below is a list of a few of the CMS approved median physician compensation figures for a number of different specialties. The numbers are taken from the 2008 report.

The median compensation for a practitioner:

• Pediatric & Adolescent, Internal 161,444
• Pediatric & Adolescent, Infect. Disease 174,154
• Family Medicine, w/out Obstetrics 176,280
• Family Med., w/out Obst., Branch* 190,182
• Geriatrics 179,344
• Podiatry: 180,080
• Transplant Surgery, Kidney 368,750
• Dermatology, Branch* 301,111
• Dermatology, Mohs 423,848
• Not neural, Non-Interventionist, Radiology 420,858
• Mammography 540,028
• Orthopedic Surgery, Spine 611,670

*Branch is defined by AMGA as: These specialties have the same basic definition as the main specialty. These physicians located in small satellite or branch offices at least five miles from the main campus. The branch office practices primarily as its own separate entity, and often has different compensation and/or performance expectations than its main campus colleagues, there would be no teaching responsibilities at these locations.

With these numbers, over the course of ten career years, if calculated at a constant rate without regard to future increases in compensation, the median paid “Family Doctor, Branch” will have earned $1,900,182. During those same static ten years, a “Mammographer” will have earned $5,400,280. If the Family Doctor were to consult with the Mammographer at the end of those ten years, she would be doing so with someone who had made $3,500,098 more than she-nearly 3 times as much. If that same Family Doctor were to then consult with someone from the lowest paid of the three categories of Radiologist, Not neural, Non-Interventionist, she would be doing so with someone who had made $4,208,580 during that time-which would be $2,308,398 more than she-or more than twice as much.

Perhaps by way of consolation for the PCP, the Geriatrics specialist and the Pediatric Infectious Disease specialist would have fared worse, and even the Kidney transplant specialist who consults with the radiologist would be speaking with someone who had made a half of a million dollars more than he did.

But perhaps it is not consolation enough; the AMA has reported that the nation faces a shortage of 35,000 to 40,000 Primary Care Physicians.

Health Care Jobs Up & Expected to Stay That Way

The sickness of one is the work of the other. The Wall Street Journal reports that “Health care saw a net gain of 419,000 jobs in 2008 and its growth outlook continues to be strong through 2016, according to the Bureau of Labor Statistics.”

According to WSJ, Dennis Damp, “the Pittsburgh, Pa.-based author of ‘Healthcare Job Explosion’ and editor of Healthcarejobs.org, a free recruiting Web site,” said that “about half of the BLS’ 30 fastest-growing occupations through 2016 are health-related.”

An examination of the latest BLS report (p. 25) shows that employment numbers were up in every category of health care jobs tracked. WSJ reports that “among specific occupations, the number of registered nurses grew the most, adding 168,000 jobs through November as hospitals and agencies tried to address a nationwide nursing shortage.”

The Journal also reports that “The number of home care aides grew by 64,000 in 2008, the BLS said. Office and administrative support workers such as medical-records clerks accounted for 14% of the overall increase in health-care jobs year over year.” That 14% increase would be equivalent to approximately 59,000 jobs.

John Challenger, chief executive of outplacement consulting firm Challenger, Gray & Christmas in Chicago is reported by WSJ to have said that in health care, “Long-term forces are outweighing the short-term recessionary forces.” Mr. Challenger cited “the aging of the baby boomers, rapid product development in biotechnology and increased momentum for comprehensive national health-care reform” as being “likely to drive job growth this year.”

Mr. Challenger also noted that “There’s strong demand for geriatricians, physical therapists and nurses of all kinds….noting support work is hot as well, especially as the incoming Obama administration takes up health reform. ‘A commitment to a new kind of more universal health-care system is going to create a new structure and consequently new jobs.”

Read the full WSJ article here.

Unemployment, Uninsured and Medicaid Rolls Up

The New York Times reports that
“The nation lost 524,000 jobs in December…. The unemployment rate, meanwhile, jumped to a 16-year-high of 7.2 percent, the Bureau of Labor Statistics reported on Friday.”

This is up from 6.7% in November, 2008; up from 4.7% in November 2007.

Last week, in a post about prognostications for health care in 2009 (”Ringing in a New Year in Health Care, For Whom the Bell Tolls?“), we quoted the following from Jane Sarosahn Kahn in The Health Care Blog:

Keep in mind the Kaiser Family Foundation’s metric on unemployment: an increase of 1% unemployment leads to 1.1 million uninsured, and 1 million more people added to Medicaid. This was the math that worked in 2007-8. The metric will probably change in 2009 as Governors struggle to balance budgets while providing medical services, education, and safe streets to citizens. The National Governors Association, and the individual state heads, have all warned that Governors will inevitably cut services in 2009 and into 2010 if tax receipts continue to decline.
In response, we stated:

According the U.S. Bureau of Labor Statistics, in November of 2007 the unemployment rate was 4.7%. For November of 2008 it was 6.7%. Regardless of the metric, the consequent health insurance math is less than reassuring.

Regardless of its lack of reassurance, perhaps the math should be done.

Using the Kaiser metric, understated as it may be for 2008-9, the half per cent increase in unemployment in December (7.2% from 6.7% in November) is equal to:

• 550,000 more people without health insurance
• 500,000 more people on Medicaid

This is in addition to a two per cent raise in unemployment from November 2007 (4.7%) to November 2008 (6.7%).
That 2% equals:

• 2,200,000 more people without health insurance
• 2,000,000 more people on Medicaid

Total from November 2007 (4.7% unemployment) to December 2008 (7.2% unemployment) equals:

• 2,750,000 more people without health insurance
• 2,500,000 more people on Medicaid

Physician Compensation II

Yesterday’s post displayed recent Bureau of Labor Statistic figures concerning physician compensation, and offered a link to recent median physician compensation data approved for use by Centers for Medicare and Medicaid Services (CMS) for calculations regarding direct graduate medical education under 42 CFR 413.78(f). The producer of this data, AMGA, also offers an interactive physician compensation survey which shows “average” and “starting” compensation for various specialties. A click on the arrow underneath “average” will sort from lowest to highest.

Here below is a list of a few of the CMS approved median physician compensation figures for a number of different specialties. The numbers are taken from the 2008 report.

The median compensation for a practitioner:

• Pediatric & Adolescent, Internal 161,444
• Pediatric & Adolescent, Infect. Disease 174,154
• Family Medicine, w/out Obstetrics 176,280
• Family Med., w/out Obst., Branch* 190,182
• Geriatrics 179,344
• Podiatry: 180,080
• Transplant Surgery, Kidney 368,750
• Dermatology, Branch* 301,111
• Dermatology, Mohs 423,848
• Not neural, Non-Interventionist, Radiology 420,858
• Mammography 540,028
• Orthopedic Surgery, Spine 611,670

*Branch is defined by AMGA as: These specialties have the same basic definition as the main specialty. These physicians located in small satellite or branch offices at least five miles from the main campus. The branch office practices primarily as its own separate entity, and often has different compensation and/or performance expectations than its main campus colleagues, there would be no teaching responsibilities at these locations.

With these numbers, over the course of ten career years, if calculated at a constant rate without regard to future increases in compensation, the median paid “Family Doctor, Branch” will have earned $1,900,182. During those same static ten years, a “Mammographer” will have earned $5,400,280. If the Family Doctor were to consult with the Mammographer at the end of those ten years, she would be doing so with someone who had made $3,500,098 more than she–nearly 3 times as much. If that same Family Doctor were to then consult with someone from the lowest paid of the three categories of Radiologist, Not neural, Non-Interventionist, she would be doing so with someone who had made $4,208,580 during that time-which would be $2,308,398 more than she–or more than twice as much.

Perhaps by way of consolation for the PCP, the Geriatrics specialist and the Pediatric Infectious Disease specialist would have fared worse, and even the Kidney transplant specialist who consults with the radiologist would be speaking with someone who had made a half of a million dollars more than he did.

But perhaps it is not consolation enough; the AMA has reported that the nation faces a shortage of 35,000 to 40,000 Primary Care Physicians.

Physician Compensation

The Bureau of Labor Statistics, U.S Department of Labor, Occupational Outlook Handbook, 2008-09 Edition, publishes the data shown immediately below regarding physician compensation. The BLS report lists Primary Care Physicians under “Family practice.” The Handbook states:

.
Total compensation for physicians reflects the amount reported as direct compensation for tax purposes, plus all voluntary salary reductions. Salary, bonus and incentive payments, research stipends, honoraria, and distribution of profits were included in total compensation.

Specialty	Less than two years in specialty	Over one year in specialty
Anesthesiology	$259,948	$321,686
Surgery: General	228,839	282,504
Obstetrics/gynecology: General	203,270	247,348
Psychiatry: General	173,922	180,000
Internal medicine: General	141,912	166,420
Pediatrics: General	132,953	161,331
Family practice (without obstetrics)	137,119	156,010
Footnotes: (NOTE) Source: Medical Group Management Association, Physician Compensation and Production Report, 2005.

Footnotes:
(NOTE) Source: Medical Group Management Association, Physician Compensation and Production Report, 2005.
Self-employed physicians-those who own or are part owners of their medical practice-generally have higher median incomes than salaried physicians. Earnings vary according to number of years in practice, geographic region, hours worked, skill, personality, and professional reputation. Self-employed physicians and surgeons must provide for their own health insurance and retirement.

The American Medical Group Association (AMGA) offers a 2008 Physician Compensation Survey which is more comprehensive than the BLS data and has been approved for use in conjunction with the Centers for Medicare and Medicaid (CMS) regulations at 42 CFR 413.78(f) pertaining to calculations of physician pay (median) in reference to Graduate Medical Education. It features a wide range of specialist compensation data.

Health Benefit Costs Over Time

The U.S Bureau of Labor Statistics (BLS) offers a report: “Program Perspectives, On Health Benefits, recent data on employers’ costs and employees’ access.” The report (which also appears in the “Resources” section of this weblog) is user friendly and well worth the moment or two it would take to peruse it. It offers some interesting information on both relative cost and access. Of particular note, however, is “Chart 1,” which is a graphic representation of the “Employment Cost Index, private industry, 12 month percent change, health benefits and total benefits, 1982-2008.” Although BLS offers a caveat on the numbers, it cuts both ways.

BLS characterizes the data thus: “Over the last 25 years, health benefit costs for employers has moved in fits and starts.” The chart shows rapid accelerations in cost accompanied by periods of deceleration. In March1983 the cost of health benefits spiked 23.5% over the year prior; a similar (but not as large) rise may be seen from mid-1987 to mid-1988, and a protracted ascent may be seen from 1996 to 2002. BLS juxtaposes the health benefit costs with the costs of “total benefits;” in comparison, the movement of “health benefit costs” is precipitous.

BLS does not offer an explanation. It would be interesting to see charts which juxtaposed the cost of health benefits during this time period with the Inflation Rate, Interest Rates, Avg. ROI in the Stock and Bond Markets–and of course, the reported profit of the major commercial Health Insurance providers.