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Salary Stress


Question: I am working too hard and getting paid too little. Is there any easy to figure out if I am getting paid what I am worth?

Show Me the Money, Austin, Texas

Dr. Hospitalist responds: I suspect you may have already asked hospitalists you know about how much they make and compared schedules. Although this may be sadistically fun (alas, misery loves company), there are problems with this approach.

Your perspective is limited to friends and colleagues willing to share this information. Some people are reluctant to talk money, others have a tendency to embellish their productivity. I am not saying folks would intentionally lie to you (wink, nod), but who would tell you they feel overpaid and do not work hard?

What you need are objective data. You and a couple of colleagues could develop a survey, send it to every hospitalist you know, and hope they respond. But even if you did, how often could you muster the energy to do this to keep your data up to date?

Remember, you are doing this survey to demonstrate you are compensated appropriately for how much work you produce. Lucky for you, several organizations collect physician productivity and compensation data, including SHM and the Medical Group Management Association (MGMA). But there are differences in the data.

Some believe the MGMA data set may include information from primary care groups with inpatient rounders in addition to full-time hospitalists. Meanwhile, SHM data were last collected in November 2005. SHM collects updated information from hospitalists around the country. They will make those findings available at the next SHM annual meeting in San Diego in April 2008.

This will also be the first survey done since Medicare moved to the new 2007 relative value unit (RVU) values. Hospitalists who contribute to the survey can access the data for free. I suppose critics could argue that the approach taken by these groups is subject to bias because individuals could submit false data. This is all the more reason I would encourage you to submit data to the SHM survey. The larger the sample size, the more difficult it will be for any one individual’s data to warp the survey.

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Speak Up

Question: I know hospitalists should communicate with primary care physicians (PCPs) about their patients, but I find it takes a lot of time for me to call their offices. Is there an easier way to do this? I am also not completely sure of when I should communicate. Any suggestions?

No Time to Talk, Atlanta

Dr. Hospitalist responds: Let me guess. Your “communication” with the PCP goes something like this: You pick up the telephone to call a patient’s PCP. After sitting on hold for what seems like eternity (your pager rings repeatedly during this time), a voice on the other end of line tells you that the doctor is in an exam room. “Do you want me to interrupt him?”

Do you say yes and run the risk of sitting on hold another five minutes? Or do you decide whatever you had to say really isn’t that important? But don’t you need that outpatient medication list? Do you really have to tell the PCP about the ongoing end of life discussions with the patient? What’s a hospitalist to do?

This method of communication may have worked when you were a resident in training, when your workload was capped and your attending physician had to make time for your calls. But try this as a hospitalist and you’ll quickly discover you don’t have enough hours each day.

When working out a relationship with a PCP, hospitalists should engage the PCP in a discussion about how they should communicate. For example, the hospitalist and PCP may agree that each time a patient presents for admission, the hospitalist will ask the hospitalist administrative assistant to fax the PCP office. A fax with admission diagnoses will not only serve as notification of admission but also as a request for information from the PCP.

As important as it is for the hospitalist to get his staff to fax the request in a timely manner, the PCP will have to do the same with his/her office staff. In such a system, the hospitalist and the PCP communicate about admissions via their administrative staff. If the PCP or hospitalist has further questions, the expectation may be that a page will be in order. But for the majority of admissions, that won’t be necessary.

I have seen hospitalists and PCPs handle routine communication in a variety of ways: phone calls, face-to-face discussion, e-mail, voicemail, discharge summaries/letters, fax notification of admission, pages. No single method works well with all groups all the time. To succeed, communication:

  • Must be timely, easy to understand, and concise;
  • Must be efficient for the communicator and the recipient, not labor intensive;
  • Should occur at each transition in care; and
  • Should meet privacy guidelines.

Communicators must understand the rules of engagement and share common expectations. Ideally, there should be a paper trail or other record.

Hiring is Work

Question: My group is having a hard time recruiting physicians. How can we do better?

Need Help, Richmond, Va.

Dr. Hospitalist responds: If it’s any consolation, you’re not alone. Look at the number of pages devoted to job ads in this issue of The Hospitalist and you’ll understand the high demand for hospitalists. There are about 20,000 hospitalists in the country, and many believe there is room for double that number. Advertising and hiring qualified staff is not a challenge unique to hospital medicine, but most hospitalists received no training on how to do it. Most hospitalists underestimate the time and resources it takes to recruit and hire staff.

Here are some hiring hints to help you and your hospitalist program maximize your success.

The first step is to create a job description. Before you can describe the job to prospective hospitalists, you need a clear understanding yourself. I would expect applicants to ask some of the following questions:

  • Do your hospitalists to work days, nights or a combination of both?
  • What about weekdays versus weekends?
  • How does your group handle admissions versus daily rounding?
  • Do your hospitalists provide consultative services?
  • Are there teaching responsibilities?
  • How many patients do you expect each hospitalists to see daily?

Based on your job description, how do you expect to compensate your hospitalists? Do your homework and find out what competitors are paying for similar job descriptions. While there are many reasons prospective hospitalists might accept an offer, salary is often not the only reason. What else is part of your compensation package? It might include some of the following:

  • A retirement plan, like a 401k/ 403b or a pension;
  • Paid parking;
  • Continuing-education stipend;
  • Productivity incentive;
  • Access to health, life and/or disability insurance;
  • Paid malpractice insurance; and
  • Ownership/equity opportunity.

Once you create an attractive job description with a competitive compensation package, it’s time to get the word out. There are many options for reaching prospective candidates:

  • Advertise in journals and online;
  • Advertise at meetings;
  • Tell friends, colleagues and nurses;
  • Work with your hospital’s recruiter;
  • Send targeted mailings; and
  • Be seen at local hospitalist events.

Once you have an applicant interested, it’s time to close the deal. Qualified applicants are likely going to field offers from several groups. Why should the applicant accept your offer over another? Here are several incentives:

  • Signing bonus;
  • Relocation package;
  • Loan forgiveness;
  • Title for an administrative role; and
  • Opportunity for advancement.

Don’t underestimate the effect of a simple phone call or e-mail to your candidate after the interview. I can’t emphasize how often I hear people say they joined a group because they felt as though they fit in well.

Hiring is a year-round group effort. The most important resource in any hospitalist program is staff. Recruitment, hiring, and retention should be a primary goal of any hospitalist medical director. TH

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