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For hospitalists, hard work doesn't mean higher pay

New survey data show disconnect between salary, productivity

From the July ACP Hospitalist, copyright © 2011 by the American College of Physicians

By Jessica Berthold

Hospitalists who work in the South have higher salaries than those in other U.S. regions, but they also make less per unit of work, according to new data from the Society of Hospital Medicine and Medical Group Management Association, presented at Hospital Medicine 2011.

The average nonacademic, nonpediatric hospitalist in the southern U.S. can expect to make $246,000 per year including bonuses, and get paid $52 per work relative value unit, or wRVU. A wRVU refers to the relative level of time, skill, training and intensity of a particular service. Those figures compare to $224,000 and $56/wRVU in the Midwest; $213,000 and $55/wRVU in the West; and $212,000 and $54/wRVU in the Northeast.

Robert Bessler, MD, and Joseph Li, FACP. Photo cou...

Robert Bessler, MD, and Joseph Li, FACP. Photo courtesy of the Society of Hospital Medicine.



“So think about this. Do you want to work yourself silly and get paid more, but make less per wRVU?” said John Nelson, FACP, during the opening session of the conference. “Remember the tax man takes a lot.”

Session panelist Robert Bessler, MD, president and CEO of Sound Inpatient Physicians in Tacoma, Wash, agreed that working too hard typically doesn't benefit the individual hospitalist.

“You don't have to work much to be paid a good salary. If you go from $59/wRVU down to $40/wRVU, the monetary difference goes to someone, but not the doctor,” Dr. Bessler said. “In high productivity practices, the organization makes more of it.”

The fiscal year 2010 data in the survey came from 414 hospital medicine practices. It showed salaries were up about 3% from the previous year, likely due to three factors, Dr. Nelson said: cost of living inflation, a historical trend of rising productivity (though flat over the last year), and the relative shortage of hospitalists.

Hospitalist salaries are “micromarket specific,” Dr. Bessler said. “If you recruit to downtown Houston or rural California, you need to know the hospitals in that area,” and the salaries they are paying, he said.

While a few cities like Seattle and Boston are filling up with hospitalists, in most places they are still in high demand—especially the experienced ones, he said. Also, thanks to the housing crisis, there are fewer experienced hospitalists willing to relocate and take a hit on the sale of their home. “A couple of years ago, 70% of the people hired as hospitalists were experienced, and 30% were new grads. Now it has gone to 50/50,” Dr. Bessler said.

Academic practices, which were surveyed separately, reported a national median hospitalist compensation of $173,113.

Productivity

Productivity numbers didn't change much from the previous year's survey, Dr. Nelson noted. “I guess that is a desirable thing, as far as our take-home pay, since salaries did increase,” he said. Measured by the average number of patient encounters and wRVUs per hospitalist, the productivity per region was:

  • Northeast: 2,297 encounters and 4,092 wRVUs;
  • Midwest: 1,928 encounters and 3,858 wRVUs;
  • South: 2,747 encounters and 4,931 wRVUs; and
  • West: 1,745 encounters and 3,892 wRVUs.

Such figures should be taken with a grain of salt, however, as patient encounters aren't the ideal way to measure productivity, said co-panelist and SHM President Joseph Li, FACP, director of the hospitalist program at Beth Israel Deaconess Medical Center in Boston.

“Some patients are simple, others are extremely ill or socially complex and require a significant amount of time,” Dr. Li said. “I think it's naïve to say that on the West Coast they see sicker patients or are better coders. These numbers don't tell us what kind of encounters these are—are they on the ICU, the floor, etc.”

Dr. Bessler had a somewhat different opinion. “There is clear data we have captured across many states that, if you have the average blend of patients, then a busy, full day of 15 to 17 patient visits per day is the target,” Dr. Bessler said. “Obviously, there are all the caveats to this about ICU volume, etc.”

Since academicians typically see fewer patients than community hospitalists, SHM and MGMA adjusted the data for academic hospitalists to reflect what their productivity would be if they saw patients full-time. The result was a median of 2,057 annual patient encounters, and 3,365 median wRVUs.

Academics may code visits lower or be less active in ICUs, Dr. Nelson said. It's also possible that residents haven't learned to write notes appropriate to coding, so billing doesn't reflect the actual amount of work done, he said. Dr. Li countered that, in his experience, residents are more fastidious about coding, however.

“The business of medicine is not a high priority in academic medicine—that is our experience,” Dr. Bessler said. “Length of stay is longer, which drives down the average RVU.”

One of the biggest changes in the latest survey data was in the financial contribution hospitals made to hospitalist practices per full-time equivalent (FTE). In 2001, this contribution was approximately $65,000 per FTE hospitalist per year; in 2007-2009, it increased to $98,000 per FTE hospitalist. In the current survey, the figure jumped to $132,000 per FTE hospitalist.

“That's about one million dollars annually for your practice, if you are in an average practice,” Dr. Nelson said. The lackluster economy may have led to hospitals contributing more, as they may have had to cover more patients who were unable to pay for care, he said.

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