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John Nelson: Recognition, Promotion, Development Critical to Group Success


Well-designed forms of non-monetary compensation can have a greater impact on a hospitalist than providing a reward in dollars. This is true for any employee in any enterprise. It can have a greater impact than dollars in making a doctor feel appreciated and committed to the work of the organization. For example, a $100 gift certificate at a nice local restaurant can have a lot more impact and value than adding an extra $100 to the next paycheck.

A hospitalist’s salary and typical benefits (e.g. health insurance and retirement plan) must be attractive and competitive in the marketplace (obviously), but they are typically seen as entitlements, so they aren’t very effective at improving retention or motivating a doctor to perform well. Various forms of non-monetary compensation can be an effective way to achieve these things.

I should say that as I’m using the term here, non-monetary compensation includes things provided in some form other than dollars. But many forms—such as a restaurant gift certificate or tickets to a baseball game—likely will cost the practice something to provide. They also could be taxable to the doctor (i.e. should be reported on a W-2 statement), and Stark laws apply.

When discussing a citizenship bonus in my November 2011 column (see “Good Citizenship,” p. 53), I mentioned Daniel Pink’s book Drive: The Surprising Truth About What Motivates Us. In it, he argues that “Carrots and sticks are so last-century. We need to upgrade to autonomy, mastery, and purpose.” I’ll discuss forms of non-monetary compensation that fall into a modified version of Pink’s three upgrade categories.


When is the last time a hospitalist leader or hospital executive sent a handwritten note of thanks and recognition to a hospitalist? It costs nothing, and it can be brief. Variations on this theme include awarding a plaque or trophy at a group meeting, or having an annual social event, such as a holiday party, that includes expressions of praise and gratitude for accomplishments in front of all the hospitalists and their significant others.

SHM past president Joseph Ming Wah Li, MD, SFHM, presides over his group’s annual “Hospy Awards,” a name inspired by ESPN’s ESPY Awards. Nurses, case managers, and residents vote for different awards and are asked to provide written comments about the doctor they’re voting for. Joe reads comments about both the winners and other hospitalists. The group has several additional social events each year, and photos from these are posted on the Internet.

Some hospital CEOs or other leaders periodically invite hospitalists to their homes for a dinner as a way of recognizing their work, as well as to build relationships and connectedness.

I was co-presenter in a session at HM12 in San Diego. Attendees had several terrific suggestions, including:

  • Sending a note to the hospitalist’s significant other, rather than the hospitalist herself, expressing thanks for sharing her with us. Doing so is a way of acknowledging the good work of the hospitalist and the potential sacrifice of his or her family behind it. A short note of thanks with a restaurant gift certificate, so that hospitalist and a significant other can have dinner out paid for by the practice, seems like a great idea.
  • Another idea that on the surface seems pretty silly, but likely has real value, is to identify a “superhero hospitalist” at some or all monthly group meetings. The group leader who brought it up does this by superimposing a photo of the doctor’s head onto a picture of a superhero like Superman and projects it during the meeting while saying something about the good work done to earn it. While silly, it has created some interest within the group regarding who the next winner will be and which superhero the honoree will be.
A hospitalist’s salary and typical benefits (e.g. health insurance and retirement plan) must be attractive and competitive in the marketplace (obviously), but they are typically seen as entitlements, so they aren’t very effective at improving retention or motivating a doctor to perform well.


Promoting a doctor into a position with greater responsibility, and perhaps a little (OK, maybe very little) prestige can be a valuable form of non-monetary compensation. A promotion could be as small as electing a doctor to serve on the hospitalist group’s own advisory committee, or representing the group at the hospital’s medical executive committee or other leadership group. More significant promotions could be having the hospitalist serve as medical director for case management or a clinical activity, such as palliative care; these positions often include additional monetary compensation.

SHM offers recognition in the form of fellowship and the opportunity for promotion to Senior Fellow in Hospital Medicine and Master of Hospital Medicine status. This can be seen as a promotion.

Professional Development

I think it is pretty tough to work an entire career devoted solely to patient care in any field, not just hospitalist practice. In June 2011 (see “Good Advice, Bad Advice,” p. 46), I wrote about the value of every hospitalist having at least a few additional professional interests and activities. A practice can encourage development of new interests and career roles, and make some available as a reward and recognition for good performance. Examples include sending your superstar doctors to SHM’s Leadership Academy, or even enroll them in a course to expand their clinical skill set, such as a procedures course or one that teaches interpretation of carotid ultrasounds or echocardiograms. An institution might find it worthwhile to reward the right doctor by paying their tuition at an executive MHA or MBA program.

It is all too easy to think that salary and benefits are the only rewards—i.e., compensation—that matter. Yet, in addition to money, all of us seek rewards in recognition, promotion, and professional development, and every practice should think deliberately about whether there are valuable opportunities in these categories.

I’d love to hear from anyone who has put in place novel and effective non-monetary compensation.

Dr. Nelson has been a practicing hospitalist since 1988. He is co-founder and past president of SHM, and principal in Nelson Flores Hospital Medicine Consultants. He is co-director for SHM’s “Best Practices in Managing a Hospital Medicine Program” course.

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