When it comes to hospital medicine groups, size matters. Some physicians, like Jeffrey Hay, MD, senior vice president for medical operations and chief medical officer at Lakeside Comprehensive Healthcare in Glendale, Calif., say larger groups (i.e., those with 20 or more physicians) have the advantages of financial stability, better advancement opportunities and more support for physicians.
But Dr. Hay also sings the praises of smaller groups. A small hospital medicine group (HMG) can be a niche for those who seek particular geographic ties and a long-term commitment, he says.
Then again, a big hospital in an affluent coastal area of California, for example, has had a long-term relationship with its hospitalist group for more than 10 years. “The [hospitalists] made a decision,” Dr. Hay says. “They want to be there, they want to work and retire there. This is it; and it works for everybody.”
Which size works for you? The Hospitalist asked physicians who have experience with both large and small groups to comment about salary, shift coverage, advancement and research opportunities, and social networking. Perhaps their answers can help you decide.
Working at a smaller institution doesn’t necessarily mean receiving lower compensation, says Joe D. Metcalf II, MD, director of the five-physician HMG at Faith Regional Health Services in Norfolk, Neb. “Because recruiting hospitalists to any location is competitive, most recruiters understand they must offer a competitive salary and benefit package to their applicants.”
Salary discrepancies could, however, stem from geographic location of the group, differing workload expectations, or level of market saturation, says Brian Bossard, MD, director of Inpatient Physician Associates in Lincoln, Neb. “Salaries are increasing rapidly because of a rapid increase in the number of groups around the country,” he says.
In its annual survey of programs around the country, the Society of Hospital Medicine documents the normal salaries for different hospital medicine practices. The latest survey suggests the large-chain, independent groups have the highest average salaries. One factor affecting salary is the location: the farther away from an urban area a practice group is, sometimes the greater the salary because of added recruiting difficulties.
As a hospitalist moves from a small group to a large one, interest in the characteristics of an individual physician may be diminished. “The ability to negotiate a better salary by being a ‘good Joe’ is less important in a large group than in a small one,” Dr. Bossard says. In addition, fringe benefits of a small group might not be available in a larger group; in Dr. Bossard’s group of 20 hospitalists, an extra bonus is awarded as an end-of-the-year thanks for hard work. “That’s not part of contract, there’s no qualification for that except being a good member of the group. I doubt that would not happen in a large group,” he says.
If you are considering joining a large HMG, Dr. Hay suggests asking what role you will play in the direction of the organization and whether the possibility exists for eventual partnership or equity in the company.