I can remember a time not so long ago when it was rare for me to encounter a dedicated nonphysician practice manager when visiting a hospital medicine group (HMG). Most groups had no nonphysician management support at all, or maybe just a part-time clerical person to help sort mail and post charges. In some cases, a single person supported the hospitalists and also worked with several other physician groups; this person spent only a small portion of their time with the hospitalist practice.
We all can acknowledge that most HMGs have grown much larger and more complex in recent years. SHM’s 2012 State of Hospital Medicine report suggests that one outcome of this growth is the increasing presence of nonphysician practice administrators: Fully 75% of all respondent HMGs serving adults only reported having a nonphysician administrator.
Interestingly, group size appears to have little impact on HMG administration. HMGs with four or fewer FTEs were just as likely to have an administrator as groups with 30 or more FTEs. The prevalence of administrators was highest in the South region (87%) and lowest in the West (48%). And it was highest among multistate hospitalist companies (84%) and lowest among private multispecialty or primary-care medical groups (45%).
The median time allocation for practice administrators was 1.0 FTE (the mean was 0.79 FTE). Again, very small groups are just as likely to have a full-time administrator as very large groups.
In my experience, extremely wide variation exists in nonphysician practice administrators’ roles, backgrounds, and qualifications. The survey attempted to categorize administrator roles in a meaningful way that might correlate with level of responsibility and compensation by asking about the incumbent’s management level:
- Senior management (e.g. CEO, president, executive director);
- Middle management (e.g. director, administrator, manager); or
- First-line management (e.g. supervisor or coordinator).
The majority of practice administrators were classified as middle management, as shown in Figure 1.
The survey collected information about compensation for practice administrators by management level. Senior management positions earned a median of $225,000 annually per FTE (though the sample size, n=10, was very small). Middle managers earned a median of $77,000, and first-line managers earned a median of $47,000.
SHM has worked diligently to reach out to nonphysician practice administrators and support them with a wide variety of tools and resources. SHM currently counts about 450 administrators as members and offers membership discounts for nonphysicians.
SHM’s Administrators’ Committee offers a series of quarterly roundtables via webinar; last year, it developed the white paper Core Competencies for a Hospitalist Practice Administrator, which can be downloaded at www.hospitalmedicine.org/Graphics/Administrators_White_Paper.pdf. And this year, for the first time, administrators became eligible for induction as Fellows in Hospital Medicine.
If you are a nonphysician practice administrator working for an HMG, or if you have one in your practice, I encourage you to get involved. Take advantage of the resources available to administrators through SHM. And please be sure that information about your administrator job gets included in the next State of Hospital Medicine survey, which will be conducted in early 2014.
Leslie Flores is a partner in Nelson Flores Hospital Medicine Consultants and a member of SHM's Practice Analysis Committee.