Ask the Experts: Your Top Questions Answered

Pediatric Shortage?Q:I read your article, “Disappearing Docs,” in which you indicate that “the physician shortage is real.” You didn’t mention pediatrics. Is this specialty at the bottom? How do you see the future of general pediatrics and subspecialties?

I read in another article in your magazine that our future looks “bleak.” I am going on my tenth year of practicing, and my instinct tells me that I may have to make some adjustments, maybe even changing specialty.

A: I don’t have any data specific to pediatrics. But my subjective opinion is that these large trends in demand should only be a single factor when it comes to the direction of your career. If you love doing general pediatrics and can find a way to make your practice work for you, great. There will always be children who need help. The fact that there is not as much demand right now for pediatricians as there is for internal medicine physicians doesn’t mean no one needs pediatricians any longer.

If you have other reasons for considering a subspecialty - like income or you just love surgery - then all those factors together might make a change worth it.

The American Association of Pediatrics did some work on shortage issues in the late 1990s. That’s out of date now and the association’s Web site doesn’t reveal anything more, but it might be worth contacting them to see what data they might have.

Self-Pay
Q:We are a new solo pediatric office that isn’t currently networked with any insurance carriers. I am looking for resources - for example, other self-pay pediatric offices, management companies, publications, or seminars - on how to grow this type of practice. We do not want to wait for the “any willing provider” legislation. Can you help?
A: You can contract with commercial payers or with your state Medicaid program without waiting for new willing provider laws unless you’ve already been refused contracts.

If you do want to go self-pay, you will need to focus on marketing and communicating to potential patients about why they should pay to see you rather than going to a pediatrician on their insurance list.

You will also want to be very clear about your fee schedule and whether or not you will help patients file with their insurance carriers after they have paid you.

Be sure to think through your collection policy. (Do your best to collect at the time of service or to at least put a payment plan in place.) Patients are notoriously slow to pay physicians if billed after the visit.

Starting UpQ:I am starting a solo pediatric practice and hoping to take commercial insurance. Do I need a license from the Department of Health and Human Services even though I am not seeing Medicare patients? Do I need a business license?
A: There are some overlapping issues in your question: business structure and contracting.

Most practices structure themselves as a formal entity, such as a limited liability corporation or professional corporation. The consequences of each vary by state, so you’ll want to work with an experienced accountant or other professional to get some help on that.

You must also apply for federal, state, and sometimes local tax ID numbers so everyone knows where to find you come tax time. And you must register your business with the state.

Any business would have to take those steps. As a medical practice, you also need to have your credentials ready, including a state medical license, DEA number, board certification, and an up-to-date CV. Then contact the payers in your area for applications and submit all the paper work for their credentialing processes - which can take nine months! Eventually, they’ll send you contracts that establish your fees. Meanwhile, you’ll probably also apply for hospital privileges.

Since you’re a pediatrician, you don’t need to worry about Medicare. You might, however, look into the state’s Medicaid program. Compare Medicaid’s rates with rates from other payers to get a sense of whether you want to participate in Medicaid - or if you are committed to that program for other reasons.

Pamela Moore, PhD, CPC, editorial director for Physicians Practice, is this month’s expert. Moore has been writing for physicians on practice management issues for 10 years and she is a recognized speaker on healthcare management. She can be reached at pmoore@physicianspractice.com.

This article originally appeared in the October 2008 issue of Your Best Practice.