The Economic Impact of Rural Family Physicians Practicing Obstetrics

Article Figures & Data

Table 1. Annual Rural Economic Impact Per Family Physician by Different Sources

Sources (n)	Revenue	Total Impact
Partners for Rural Health in Alabama (5)	Clinic and hospital	$1,000,000
Eilrich, Doeksen, and St. Clair (2)	Clinic and hospital	$1,532,730
American Academy of Family Physicians (6)	Clinic only	$776,585
Kentucky Rural Health Works Program (4)	Clinic and hospital	$1,677,872
Economic Impact of Noble County, OK (7)	Clinic and hospital	$1,915,912
Doeksen, St. Clair, and Eilrich (8)	Clinic and hospital	$1,800,000
Robert Graham Center (21)	Clinic only	$904,696

Table 2. Median Salaries and Compensation of Family Physicians versus Family Physicians Practicing Obstetrics in 2011 from Several Sources

Source (n)	Family Physicians	Family Physicians Practicing Obstetrics	Increase
MGMA HHS region 4 median salary (15)	$195,974	$227,447	$31,473
MGMA HHS region 4 median compensation (15)	$172,497	$205,517	$33,020
MGMA southern US compensation (15)	$185,945	$238,307	$52,362
Merritt Hawkins average salaries (16)	$178,000	$197,000	$19,000

Table 3. Output Multipliers of Selected Rural Hospitals and Physician Clinics

Source (n)	Hospital	Clinic
Rural primary care physicians (2)	1.32	1.37
Rural general surgery (12)	1.33	1.33
Sumter County, Alabama (20)	1.28	1.15
Oklahoma rural counties (3)	1.99	1.47
Measuring economic importance (32)	1.43	1.31
Smith County, Kansas (22)	1.18	1.12
Rural critical care hospitals (23)	1.24	—
Humboldt County, Nevada (24)	1.24	1.22
Big Sandy Area (25)	1.29	—
Rural Nebraska (31)	1.58	1.44
Health care sector in Kansas (27)	1.48	1.40
Atoka, Oklahoma (28)	1.47	1.34
Douglas County, Nevada (29)	1.25	1.22
Hamilton County, Illinois (30)	1.31	1.24
Range	1.18–1.99	1.12–1.47

Table 4. Common Procedures Performed by Family Physicians Practicing Obstetrics

CPT Code	Description	Physician Charge	Medicaid Reimbursement
54900	Delivery	$2760	$1390
59510–80	Assist at cesarean delivery	$911	$0
58120	Dilatation & curettage	$549	$170
57522	LEEP	$693	$176
57520	Cervical conization	$723	$211
57511	Cryotherapy cervix	$172	$99
57454	Colposcopy/biopsies	$225	$108
58100	Endometrial biopsy	$139	$76
J7307	Implanon/Nexplanon placement	$874	$659
J7302	Mirena placement	$899	$703
J7300	Paragard placement	$750	$598
58605	Postpartum tubal ligation	$931	$432
56420	I&D Bartholin gland abscess	$160	$94.50
54161	Newborn circumcision	$254	$172
—	Ultrasound^*	$150	$100

↵* $100 for providing ultrasounds regardless of how many are performed.
CPT, current procedural terminology; I&D, incision and drainage; LEEP, loop electrosurgical excision procedure.

Table 5. Table of Physician Procedures^*

↵* Physicians are in no particular order.
BTL, bilateral tubal ligation; I&D BGA, incision and drainage Bartholin gland abscess; LEEP, loop electrosurgical excision procedure.

Table 6. Sample Computation of One Physician

	Number	Physician Reimbursement	Physician Total	Hospital Reimbursement	Hospital Total
Procedure
Deliveries	200	$1,390	$278,000	$3,100	$620,000
Assist cesarean delivery	—	—	—	—	—
Dilatation and curettage	20	$170	$3,400	$274	$5,480
LEEP	—	—	—	—	—
Cervical Cone	—	—	—	—	—
Cryotherapy	15	$94	$1,410	—	—
Endometrial Biopsy	10	$76	$76	—	—
Colposcopy	34	$108	$3,682	—	—
Nexplanon	5	$659	$3,295	—	—
Mirena	20	$703	$14,060	—	—
Paragard	2	$598	$1,196	—	—
Postpartum BTL	30	$432	$12,960	$0	$0
Laparoscopic BTL	—	—	—	—	—
I&D BGA	10	$94	$940	$61	$610
Circumcision	100	$172	$17,200	$303	$30,300
Ultrasound	600	$100	$20,000	—
Subtotal			$356,903		$656,390
Physician multiplier of 1.15 × $356,903 =			$410,438
Hospital multiplier of 1.28 × $656,390 =			$840,172
Total for physician and hospital =			$1,250,617

BTL, bilateral tubal ligation; I&D BGA, incision and drainage Bartholin gland abscess; LEEP, loop electrosurgical excision procedure.

Table 7. Total Economic Impact of Physician's Clinic and Hospital Revenue with Multipliers

Physician^*	Clinic	Multiplier	Physician Total	Hospital	Multiplier	Hospital Total	Total Impact
1	$310,762	1.15	$357,376	$396,560	1.28	$507,597	$864,973
2	$202,110	1.15	$232,427	$376,016	1.28	$481,300	$714,685
3	$356,903	1.15	$410,438	$656,390	1.28	$840,179	$1,250,617
4	$182,206	1.15	$209,537	$325,015	1.28	$416,019	$625,556
5	$171,655	1.15	$197,403	$314,008	1.28	$401,930	$599,333
6	$175,406	1.15	$201717	$192,730	1.28	$253,094	$454,411
7	$197,076	1.15	$226,375	$393,042	1.28	$503,094	$729,731
8	$122,540	1.15	$140,921	$197,885	1.28	$253,293	$394,214
9	$196,848	1.15	$226,375	$393,042	1.28	$503,094	$729,469
10	$169,832	1.15	$195,307	$260,396	1.28	$333,307	$528,613
						Total:	$6,885,602
						Mean:	$688,560

Table 8. Computation of the Average Economic Impact from Rural Family Physicians Practicing Obstetrics

Annual economic impact of practicing family medicine	$1,000,000
20% FTE reduction in family medicine for practicing obstetrics	−$200,000
Annual economic impact of practicing family medicine at 80%	$800,000
Annual economic impact for practicing obstetrics	+$688,560
Annual economic impact of practicing family medicine and obstetrics	$1,488,560^*

Table 9. Total Economic Impact of Practicing Rural Family Medicine and Obstetrics^*

Physician	Years in Family Medicine^{^†}	×$1,000,000	Years in Obstetrics^{^‡}	×$488,560	Physician Total
1	10	$10,000,000	10	$4,885,600	$14,885,600
2	21	$21,000,000	16	$7,816,960	$28,816,960
3	2	$2,000,000	1	$488,560	$2,488,560
4	15	$15,000,000	14	$6,839,884	$21,398,840
5	9	$9,000,000	8	$3,908,480	$12,908,480
6	3	$3,000,000	2	$977,120	$3,977,120
7	30	$30,000,000	22	$10,748,320	$40,748,320
8	22	$22,000,000	5	$2,442,800	$24,442,320
9	8	$8,000,000	7	$3,419,920	$11,419,920
10	11	$11,000,000	10	$4,885,600	$15,885,600
11^{^§}	18	$18,000,000	4	$1,954,240	$19,542,240
12^{^‖}	20	$20,000,000	19	$9,282,640	$29,282,640
13^{^‖}	15	$15,000,000	9	$4,397,040	$19,397,040
Total	184	$184,000,000	127	$62,047,120	$246,047,120

↵* Physicians in no particular order.
↵† Years of practice of family medicine.
↵‡ Years of practice of obstetrics.
↵§ Reported after completion of study.
↵‖ Did not respond but numbers of years of practice obtained from departmental records.