For the first time in several years, SHM included questions about employee benefits and paid time off in its 2012 State of Hospital Medicine survey. The median value of benefits per physician FTE reported by HM groups serving adults only was $26,000, according to the 2012 survey. But what a surprise it was when survey respondents in 2007 reported median benefits of $31,900.
I admit to being flummoxed by the decrease. The definition of “benefits” was identical in both surveys. The only difference is that in 2007, SHM collected actual benefit cost for each individual on the individual questionnaire; in 2012, we asked for the average benefits per FTE for the group. One possible explanation is that some respondents simply guessed about the average, because they didn’t have to report data for individual doctors. Of course, it’s also possible that groups are requiring physicians to pay a higher proportion of insurance premiums or are reducing retirement plan contributions due to the weak economy. But in the work I do with hospitalist groups around the country, I rarely see benefit costs below about $35,000.
Another interesting finding from the 2012 survey is that 37% of adult medicine groups reported offering paid time off (PTO), down from 54% in 2007. Even among groups using a seven-on/seven-off schedule, the PTO rate was only 44%. Does this represent a survey design or respondent input error, differences in respondent populations, or an actual shift in the prevalence of PTO benefits? I suspect it’s the latter, because the median amount of PTO time awarded has also declined. In 2007, adult HMGs reported a median of 25 PTO days annually. In 2012, the median for those groups offering PTO was 160 hours of PTO, which represents somewhere around 13 to 20 days, depending on shift length.
Why might PTO benefits be declining? I suppose it could be belt-tightening associated with the poor economy. But I think many HM groups simply have found PTO benefits difficult to administer and fraught with unintended consequences. Many groups are so thinly staffed that for someone to take a PTO day, someone else must work extra to cover. Then, when the covering doctor takes PTO, the first doctor must work extra—effectively offsetting the value of PTO. And if a hospitalist takes PTO and also works extra shifts in the same pay period, do these two offset each other? Or does the doctor get paid for both the PTO days and the extra shift days?
For clinicians such as hospitalists, whose work is defined in highly variable, shift-based schedules that include a lot of night and weekend work, it becomes very difficult to determine which of the days not worked were PTO days versus just days the doctor wasn’t scheduled.
Personally, I don’t think it makes much sense for most hospitalists to have PTO. Don’t get me wrong—I think hospitalists should be paid well and have generous amounts of time off in exchange for long, challenging workdays and a disproportionate amount of night and weekend work. But arbitrarily assigning some of the days not worked as PTO while others are just unscheduled days seems unnecessarily complex.
Time will tell if the specialty as a whole agrees with me or not.
Leslie Flores is a principal in Nelson Flores Hospital Medicine Consultants and a member of SHM’s Practice Analysis Committee.