ICACS Governor’s Poll 2002

James A. Madura, MD FACS

Governor at Large, Indiana

ICACS Governor’s PollThe Stimulus

Questions were raised at a past Clinical Congress as to the volunteer activities of the members of the ACS

In 2000 we had a good response to our last poll from the membership in Indiana concerning meeting attendance

ICACS Governor’s Poll 2001-2002

Purpose: To “take the pulse” of the membership and gather information about the attitudes and activities of the membership.

To determine what problems the members are seeing in their practices, and to see if the Chapter and the College were fulfilling perceived needs

ICACS Governor’s Poll 2002 > 400 questionnaires mailed out to

members of IC/ACS twice and also placed on Chapter Web Site

216 members responded and make up the basis for this report

Mean age = 49.5 ± 11.1 years Males: 200 (93%) Females: 16 (7%) General Surgery 214 Specialties 102

How long in practice (years)

Total respondents: 216 surgeons• 16.7 ± 10.9 years

GNS: 114 surgeons• 17.4 ± 11.6 years

Specialties: 102 surgeons• 16.1 ± 9.8 years

Respondents practice modes

Practice mode All GNS Specialties

Solo 26% 30% 21%

Surgical group 55% 55% 48%

Multispecialty group 4% 3% 5%

Clinic 3% 5% 0

University 12% 7% 18%

Practice Modes 216 respondents

0%

10%

20%

30%

40%

50%

60%

Solo Surg Group Multispecialty Clinic University

Pe

rce

nt

of

resp

on

da

nts

All GNS Specialty

Respondents City Size

City size All GNS Specialties

< 50,000 30% 44% 11%

50-100,000 16% 20% 12%

100-200,000 13% 13% 13%

> 200,000 37% 19% 55%

Where the Indiana surgeons practice

0

20

40

60

80

100

< 50,000 50-100,000 100-200,000 > 200,000

Community size

Percent of respondants

GNS Specialty

Make up of Surgical Respondents

Specialty # Specialty #

General Surgery 114 Ophthalmology 6

Cardiothoracic 19 Colorectal 5

ENT 13 Orthopaedics 5

Plastic Surgery 13 Neurosurgery 5

Urology 12 Pediatric Surgery 4

Peripheral vascular 11 Transplant 2

OB/GYN 7 Trauma 1

Responding Surgeons by Specialty

CV, 19ENT, 13

Plastic , 13

Urology, 12

Vasc ular, 11

OB/GYN, 7

Ophthalm, 6

ColoRec t, 5

Ortho, 5

Neurosurg, 5

Ped Surg, 4

Trauma, 1

GNS, 114

ICACS Members volunteer activities

Volunteer activity # members ICACS

Overseas missions 28

Local free clinics 20

US/Regional Clinic 7

Uninsured/indigent patient care 12

High school sport MD 7

Church related activity 3

Boy scouts/children’s camps 4

US Indian reservation 1

SWAT Team Member 1

Misc. 5

ICACS Members hospital activities

Administrative position # IC ACS Members

Service Chief/Chief of Staff 35

Member Board of Trustees of Hospital

16

Hospital Executive Committee 7

President of Medical Staff 5

Hospital Committees 7

Ethics 2

Peer review 1

Credentials 2

Bylaws 1

Participation in medical organizations & societies: 216 respondents

Group # ICACS Members

Group # ICACS Members

ACS 108 Midwest Surgical Soc 12

AMA 84 Am Soc General Surgery 8

ISMA 92 Am Soc General Surgery 8

County Med Soc. 73 SSAT 5

Soc Thoracic Surgery 14 Western Surgical Assn 6

SAGES 16 Central Surgical Assn 5

Am Soc Lap Surgeons 12 Christian Med/Dent Soc 5

Important issues to the members

1. Declining fees2. Quality of care3. Malpractice4. Managed care5. Surgical competency issues6. Insurance exclusion7. Patient privacy legislation8. Competition for cases

Importance of issues ( rank 1-8)GNS vs. Specialty Surgeons

Issue All Surgeons GNS Specialty

Declining fees 2.02 2.08 1.88

Quality of care 3.65 3.47 3.99

Malpractice 3.73 3.75 3.65

Managed care 3.73 3.99 3.46

Insurance exclusion 4.93 5.01 4.80

Surgical competency 5.11 5.09 5.15

Patient privacy legislation 5.85 5.80 5.90

Competition for cases 6.01 6.16 5.72

Importance of issues ( rank 1-8)Sorted by age

Issue All Surgeons Age < 50 Age > 51

Declining fees 2.02 2.82 2.25

Quality of care 3.65 4.71 3.53

Malpractice 3.73 4.68 3.33

Managed care 3.73 4.73 3.61

Insurance exclusion 4.93 5.90 4.89

Surgical competency 5.11 6.17 4.87

Patient privacy legislation 5.85 6.69 6.04

Competition for cases 6.01 6.90 5.92

Has practice changed?

Yes: 178/216 = 82.4%

• Age < 50 years 71.1%

• Age > 51 years 98.9%

• General surgeons 84.2%

• Specialty surgeons 73.5%

How has practice changed??Most frequent answers

Decreased reimbursement for more work Exciting new technology (the only positive) More paper work Managed care interfering with quality of care Difficulties dealing with 3rd party payors Less respect for general surgeons Loss of autonomy in practice More regulations in patient care (esp Medicare &

Medicaid) More time with business issues, less with patients

Retirement At what age do you plan on retiring?

• All comers: 62.2 ± 4.7 years

• GNS: 62.2 ± 5.0 years

• Specialties: 62.5 ± 4.8 years

• < 50 yrs.: 61.2 ± 4.3 years

• > 51 yrs.: 64.8 ± 4.5 years Will you stay in current community

• Yes 163/216 74.9%

• No 26/216 12.3%

• Undecided 27/216 13.2%

Do you have computer access to the Chapter Web site?

All comers: 184/216 85% GNS: 100/115 88% Specialties: 81/102 80%

Age < 50 113/120 88.3% Age > 51 71/88 80.7%

What can the IN Chapter ACS do for you?Most frequent answers

Communicate important present and future issues Lobby over reimbursement issues with State Govt.. More subspecialty emphasis Provide a forum for publication of interesting cases Be a stronger advocate for General Surgery with

AMA, HCFA, etc. Form a real union for collective bargaining Get younger surgeons & residents involved Seminars on contract negotiation

Conclusions In Indiana, more general surgeons than specialists

practice solo and in small communities Indiana surgeons are very involved with volunteer

activities, and other medical/surgical organizations Their major concerns are: declining fees,

malpractice, managed care and the quality of care they are able to give in the current environment

Most surgeons consider retirement at age 62 Most will remain in current communities Greater than 80% have computer access to our web

site

Where do we go from here?

Make ACS aware of Hoosier concerns Make broader appeal to specialists & small town

practitioners with ICACS educational programs Use the Web site more effectively

• Publish ways to act effectively for reform

• Educational forum

• Links to government, educational opportunities

• Interesting case forum??

• Surgical Grand Rounds on the Web

• Links to Surgery Education Sites. IUMC, ACS, etc.

Thanks to:

All 216 Hoosier surgeons who took the time to thoughtfully fill out the questionnaire

(Especially to those who filled them out multiple times!)

Thanks to Carolyn Downing who made sure I got all the forms sent to her

Larry Micon, the program director for this year’s meeting