The survey also underscores hospitalists’ roles as change leaders in their institutions. In the “non-clinical activities” section of Chapter 3, “The Work of Hospital Medicine Groups,” results reveal high participation in hospital committees (92%), in quality improvement initiatives (86%); and other activities, such as generating practice guidelines, teaching, planning, and research.
John A. Bolinger, DO, FACP, medical director of the hospitalist program at Terre Haute (Ind.) Regional Hospital, serves on multiple committees at his hospital: critical care, pharmacy therapeutics, patient safety, credentials (as chair), and the executive committee. He and his hospital’s clinical pharmacist have developed standardized order sets, a new IV insulin protocol, and a new DVT prophylaxis protocol.
“I think participation in non-clinical activities is a plus for the hospitalist profession,” he says. In addition, “every hospital with a hospitalist involved in practice sees a tremendous benefit from that very thing.”
The Devil’s in the Details
John Nelson, MD, medical director of the Hospitalist Practice at Overlake Hospital in Bellevue, Wash., a consultant for hospitalist practices with Nelson/Flores Associates, and cofounder and past president of SHM, was one of three panelists at the recent annual meeting where survey results were presented. Dr. Nelson believes that the statistics “can be a kind of starting point for thinking about whether your workload and compensation are typical. However,” he cautions, “the mistake I see so often is that people tend to think the average compensation, the average workload, are right for a given practice. Well, there are very few practices that are average. The variation is dramatic, and there’s no reason you should be average.”
Dr. Nelson advises hospitalists and group leaders not to interpret the compensation medians in the survey as a “final authority” for what hospitalists should be earning. Rather, he says, “what you could do is look at the big picture of an average practice—in terms of compensation, productivity, and other factors, such as location, whether your practice is primary adult or pediatric—and then compare your practice to see how you differ.
“Do you work harder and make less? In that case, you might want to fix it. If you work less and make more, you might want to be quiet!” he quips.
Brian Bossard, MD, medical director of Inpatient Physician Associates, a group of 15 hospitalists and two nurse coordinators that contracts with Bryan LGH hospital in Lincoln, Neb., to provide hospitalist services, agrees with Dr. Nelson’s characterization of the survey results as “a starting point.” While Dr. Bossard declined to state specifics about his group’s compensation figures, he did say that the median total compensation for non-leader physician hospitalists ($168,000 per year) was “about what I would expect it to be if you combine all hospitalists.”
He says that the numbers listed for HMG leaders was more reliable because leader roles are not quite as variable as non-leader roles. The survey shows that HMG leaders typically make $12,000 more annually than non-leader hospitalists, and that they tend to do less clinical work.
“It is also important to caution everyone in this area, too: This survey has not established the correct salary for a group leader—it varies tremendously,” reiterates Dr. Nelson.
In his role as HMG director, Dr. Bossard finds the survey’s work hours and work productivity data more valuable than compensation medians. “The number of hours per shift [median, 10.8] is very useful as a guide, I think, for someone who is starting a program or for someone like me, who knows what my numbers are,” he explains. “That—the median of 187 shifts per year; 10.8 hours per shift—provides an excellent target for new or established groups.”