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Transplant hepatology:
finanacial program organization
Background
Pick the set of problems you want to deal with. Daniel Foster, MD, circa 1992
In hepatology, there are no great jobs; only good jobs. Thomas Boyer, MD, circa 1997
MD/institutional equinimity
institutional support
MD productivity
Overview
4) The most common reason for hepatologist discontentment is the perception of inadequate salary and support.
MD discontentment
institutional support
MD productivity
Institutional discontentment
MD productivity
institutional support
MD/institutional equinimity
5) Hepatology funding/support is one of the most important means of building and stabilizing a liver transplant program.
MD/institutional equinimity
institutional support
MD productivity
GENERAL HEPATOLOGY
POST-TRANSPLANT HEPATOLOGY
PRE-TRANSPLANT HEPATOLOGY
Program background
liver transplantation since 1984 approximately 4000 total liver transplants yearly activity 450 liver transplant evaluations 442 active listed patients 135 liver transplants co-manage 2500 liver recipients
Program background
hospital-based, 12-MD (11 FTE) practice two hospitals Dallas and Fort Worth IM, GI and transpl hep training programs HealthTexas 400+ MD, multi-specialty subsidiary of Baylor Health System employs transplant hepatologists/surgeons
Service distribution
11 hepatology MD FTE
19 clinical 24 admin
MD salary (49 %)
Hepatology - salary
starting salary $2X0,000 RVU > 3000/year + $42.65/RVU RVU 3000 4000 5000 6000 7000 salary $2X0,000 + $2X0,000 $2X0,000 + $42,650 $2X0,000 + $83,300 $2X0,000 + $127,950 $2X0,000 + $170,600
MD salary (49 %)
Revenue
$278k
Revenue - supplement
$6.1 million per year deficit 22,643 encounters per year
=
Revenue - supplement
Funding - revenue
$3.1 M revenue - $9.1 M cost = $6.0 M loss
Contribution margin
contribution margin = hospital revenue direct costs,
Contribution margin
contribution margin = hospital revenue direct costs,
MD/institutional equinimity
institutional support
MD productivity
Funding - revenue
total
44,725 RVUs
22,623 encounters RVU/encounter RVU/encounter range
per hepatologist 4066 2057 1.98 1.6 for non-procedural 2.0 procedural (poor