Attendees at Hospital Medicine 2008 were the first to hear the results of the latest SHM survey of hospitalists, learning that hospitalist pay is up, roughly one-third of hospitalist leaders don’t know their groups’ expenses or fee revenues, and that financial support has grown substantially.
The society’s biannual survey of U.S. hospital medicine groups went to 1,700 of an estimated 2,200 groups in 2007. SHM Senior Vice President Joseph Miller and Burke Kealey, MD, chair of SHM’s Benchmarks Committee (which designed the survey) presented the findings from the “Society of Hospital Medicine 2007-08 Survey: The Authoritative Source on the State of the Hospitalist Movement.”
“Our purpose is to provide a snapshot of hospital medicine at a moment in time for hospitalists and hospital medicine groups,” Miller said. “I think this is the best SHM survey ever conducted.”
The survey drew a 24% response rate, gleaning information from 440 hospital medicine groups representing 3,242 individual hospitalists, as well as summary data from a separate survey sent to the nation’s largest hospital medicine groups. “We think it adds to the richness of the data,” explained Miller.
All data were collected between September and December 2007 and reflects information for the previous 12 months. Miller was careful to note that RVU values changed midway through that period.
Hospital medicine still is a young specialty, but, Miller said, “I think we’re seeing a growing experience base.” The median age of hospitalists is 37, with 3.7 years of mean experience. For leaders, the median age is 41, with 6.7 years of experience.
The State of HMGs
Today’s hospital medicine groups are growing, and so is the financial support they receive from hospitals.
“There has been significant growth in the number of [full-time employees] in hospital medicine groups,” Miller said. Since the previous survey two years ago, there is a 31% mean growth in groups. “We’re seeing fewer new groups, with more growth coming from the established groups” More groups are using nurse practitioners and/or physician assistants, up from 29% to 38%.
As for the leadership of the hospital medicine groups, the survey revealed some serious knowledge gaps. “Thirty-five to 37% of leaders did not know the finances of their groups,” Miller pointed out. This percentage—up somewhat from two years ago—could not answer survey questions on their group’s expenses or fee revenue.
The numbers of those who know where their money comes from show that hospitals (or partner institutions) are supplying more financial support now. A whopping 91% of responding programs receive money, with the total mean amount exceeding $97,000 per full-time physician. “This has increased substantially since the last survey,” Miller said.
Productivity and Pay
To ensure clarity of data, the survey breaks down compensation and productivity information for hospitalists into four separate groups: those who treat adult patients; those who treat pediatric patients; those who treat both; and nurse practitioners and physician assistants. In the session, Dr. Kealey covered only the first group.
He pointed out the strong correlation between the number of hours worked and higher productivity, and between higher productivity and higher compensation.
“Encounters have remained relatively flat,” he said. (They are down just 4% from the previous survey.) “But total compensation has increased by 13%.” In other words, hospitalists are working about the same amount they were two years ago, but are making more money—on average, $193,000.
Of the survey respondents, 25.3% are paid by straight salary; 6.1% are paid based on productivity, and the remainder earn a mix of salary and bonus.
Productivity figures show hospitalist experience pays off: Experienced hospitalists have more encounters in the same number of hours than their less-experienced counterparts. They also have higher compensation.
Another disturbing trend among hospitalist leaders is that they put in about as many clinical hours as nonleaders. “This indicates that they may not have enough time to lead,” Dr. Kealey said.
The survey included information on 106 respondents who are nocturnists. These night workers have significantly fewer encounters, and work slightly fewer hours for slightly less money. Dr. Kealey noted that “when you cover nights, your productivity drops. This is good to know if you’re thinking about adding night coverage in your practice.”
The complete survey results should be available sometime in May, and information will be posted on the SHM Web site at www.hospitalmedicine.org.