How compensation amount differs by employment model
by Leslie Flores
Those of you who are familiar with Medical Group Management Association’s reports know that MGMA uses medical group “ownership” categories that are similar to, but slightly different from, the employment model categories historically utilized by SHM. This year, we added the question: “Is your practice part of a multistate hospitalist group or management company?” to the SHM-MGMA Hospital Medicine Supplement. This question enables us to crosswalk from MGMA’s ownership categories to SHM’s traditional employment categories:
The blue columns in the chart below show median annual direct compensation (light blue) and retirement benefits (dark blue) for all adult hospitalists by employment model, including the data for academic internal medicine hospitalists from the separate SHM-MGMA academic survey conducted in the fall of 2010.1 The median ratio of compensation to work RVUs for each employment type is represented by red squares.
Academic hospitalists report the lowest compensation but the highest compensation per unit of clinical work, even when production data is standardized to 100% billable clinical time.
“For most academic hospitalists, teaching and supervising residents is an integral part of our clinical work; this probably impedes our clinical efficiency relative to non-academicians,” explains Grace Huang, MD, a member of SHM’s Practice Analysis Committee (PAC). “On weekends, when only half the residents are present and I don’t spend as much time teaching, I can see two to three times more patients.”
Independent hospitalist-only groups saw both the highest direct compensation and the highest compensation per unit of work, while hospitalists employed by multistate groups and management companies had the second-lowest overall direct compensation and the lowest compensation per wRVU.
When including the value of employer retirement plan contributions, however, hospitalists employed by management companies received a combined total remuneration that was higher than for hospitalists employed by hospitals or “other” employers.
“If I’m a hospitalist working for a multistate group, I want to know I’m getting something good that I might not get working for a hospital,” says PAC member Troy Ahlstrom, MD, SFHM. “A better retirement contribution is an obvious example; a hospital can’t afford to give a high-powered retirement plan to all 5,000-plus employees, while a physician company with all ‘highly compensated’ employees can. It’s a perk of working for an independent company.”
Multispecialty/primary-care medical groups and independent hospitalist-only groups provided the highest direct compensation and total remuneration (including retirement contributions). “Keep in mind, though, that they have different responsibilities that come with the money,” Dr. Ahlstrom says. “Hospitalists in local groups have more management responsibilities and more ownership risk, so they should make more for the extra work of running a business. Hospitalists in multispecialty groups have the benefit of an investment in their salaries by their colleagues, but they also have to answer directly to their colleagues for the privilege.”
Leslie Flores, SHM senior advisor, practice management
The Hospitalist newsmagazine reports on issues and trends in hospital medicine. The Hospitalist reaches more than 25,000 hospitalists, physician assistants, nurse practitioners, residents, and medical administrators interested in the practice and business of hospital medicine.