Private Practice Infectious Disease: Metro Infectious Disease Consultants

MIDC Overview

MIDC comprises 106 infectious disease physicians working in 26 offices, 110 hospitals, and 8 states. Physicians are stratified into four levels: employee, partner, senior partner, and founding partner. Of the 106 ID physicians, 63 are male and 43 are female. Ages range from 31 to 70, with a median age of 46.
Multiple schedules are available for employees, including full- or part-time, and 7 days of consecutive work followed by 7 days off (7/7). In addition, MIDC employs 190 physician extenders.

These professionals are primarily utilized in the inpatient setting to clinically support a larger or more challenging patient population. This results in a more organized workflow, limiting the inherent inefficiencies of hospital care. Physician extenders are also invaluable in the outpatient arena for infusion therapy administration and management. In addition, the supervising physician has the opportunity to provide educational support for the extender.

One hundred and eighty-three nurses provide support for in-office patient care, outpatient parenteral antibiotic therapy (OPAT) evaluation, and infusion administration. Sixteen pharmacists are utilized for antimicrobial stewardship, clinical research, continuing medical education (CME) support, and medication safety.

Having achieved Accreditation Council for Continuing Medical Education certification in 2017, MIDC awarded over 1500 h of category 1 infectious disease CME to their physicians in 2022 alone. With the onset of the pandemic, MIDC convened a weekly meeting available via teleconference. This expedited the transmission of rapidly changing information to the physician, extender, and pharmacy workforce. In addition, these educational events enhanced collegiality and solidified MIDCs efforts to manage these critically ill patients.

MIDC revenue generation is diverse, including inpatient and outpatient consultations, OPAT, biologic infusion supervision, and clinical research. MIDC also services numerous contracts for infection control, antibiotic stewardship, and medical leadership.

Methods

Results

Analysis

MIDC physicians are highly compensated compared to other ID physicians based on other available surveys [2–4]. A Medscape survey in 2022 listed the yearly average for all ID physicians as 260 thousand dollars. The IDSA 2017 survey showed private practice ID physicians earning an average of 316 thousand dollars yearly. In contrast, the employed physicians of MIDC receive a total remuneration almost identical to the average of all private practice ID physicians. MIDC partners receive an average remuneration that is 93% higher than the average listed for private practice ID physicians in the same IDSA survey [2]. It is unclear to what extent private practice IDs are represented in the Medscape and IDSA surveys. This may have negatively skewed the physician revenue figures.

In addition, 90% of MIDC physicians audited are satisfied or very satisfied. While the interpretation of this satisfaction may be complex, the listing of valuable MIDC aspects would suggest that financial stability is a key factor. ID conversations that deal with the value of infectious disease frequently discuss the ability to direct patient care, interface with multiple factions of a hospital and medical staff, and cost containment efforts. While these are noble and definitive skills, they are not well reimbursed or financially valued. MIDC optimizes reimbursement through a diversification of revenue, which includes, but is not limited to, patient consultation. This provides a safety net as federal payers continue to implement payment cuts over the next several years. These factors, in turn, lead to MIDCs salary numbers being dramatically higher for both employees and partners. The Medscape survey listed the average yearly salary for an ID physician as 260 thousand dollars. In contrast, MIDC employees averaged 18% higher and partners 235% higher than those published numbers.

The ability to incorporate flexible work schedules, such as 7/7 and part-time models, is attractive to a large segment of the ID workforce—both men and women. Utilizing these models to accommodate work–life balance has and should continue to assist in recruiting and retaining clinicians. MIDC-employed physicians highly value this flexibility, as it helps them accommodate to personal stresses while maintaining a professional career.

Clearly, MIDC values physician extenders and incorporates their skills widely. The utilization of extenders results in a clinicians ability to service more patients while spending less time documenting the encounters. Physicians have the opportunity to continue to educate the extender and generate close working relationships, resulting in enhanced efficiencies of care. This frequently translates to increased productivity and time for either professional development or personal endeavors.

As life-long learners, education is an anchor tenant for any ID practice, regardless of model, location, or size. In an environment where private practice ID physicians are not typically associated with progressive education, MIDC has invested significant time and money to refute this belief. MIDC utilizes ACCME certification to provide timely and pertinent infectious disease education to its physicians.

These data may not be generalizable to a large segment of the private practice ID groups. The basic tenets of group productivity and stability, however, should be similar. Revenue diversification (professional fees, OPAT, contracts) generates financial stability, which subsequently establishes a means to attain physician capacity or infrastructure growth. This, in turn, allows for a more comfortable and sustainable clinical practice.

In short, MIDC is organized to optimize patient care by providing a strong clinical workforce surrounded by a robust infrastructure and financial stability. This, combined with lifestyle flexibility, allows for a diverse and collegial atmosphere that is adaptable to the vast majority of infectious disease clinicians.