Physicians in academic hospital medicine are usually motivated not just by their interest in clinical care, but by a love of intellectual progress, academic citizenship, mentorship, and teaching. For those attracted to these aspects as well as to direct patient care, a career as an academic hospitalist can bring a balanced sense of fulfillment, as one contributes to both immediate patient well-being and the broader missions of academic medicine.
Yet the multifaceted nature of these responsibilities can make it challenging to build a compensation structure that is truly fair. In some cases, clinical productivity metrics may unfairly weigh specific clinical achievements, while leaving other important contributions relatively unrecognized and invisible.
Dr. Kurian
“Traditional models of hospitalist compensation were mostly focused just on clinical productivity,” said Linda M. Kurian, MD, executive vice chair of the department of medicine at Northwell Health, and professor of medicine at the Zucker School of Medicine at Hofstra/Northwell, both in New York. “In hospital medicine, and in academic medicine in general, there’s been a lot of resurgence of trying to think about how we can also compensate for the non-clinical work that physicians are doing.” Such work might include not just research and teaching, but other important aspects, such as committee work or quality improvement projects.
Institutions have developed different approaches and metrics to financially compensate academic hospitalists for these different responsibilities, but all have their drawbacks. Delving into such questions brings up broader tensions: What is the difference between “academic” and “nonacademic” hospitalists, fundamentally? Can all important contributions be measured, and should we even try? What motivates people to do good work, and to what extent should compensation reflect that? Will some kinds of work necessarily be reflected in relatively poorer compensation?
The Hospitalist talked with Dr. Kurian and several other hospitalists about these interrelated and hard-to-answer questions.
Compensation Models
Currently, most hospitalists are paid a base yearly salary, requiring a certain number of clinical hours. This salary often comes with the potential for bonuses or incentives, which might constitute a relatively small or quite large proportion of the base salary, depending on the institution and the individual; these can be specified in various ways.
wRVU
These extra bonuses are sometimes quantified in terms of work relative value units (wRVUs). These units originally derive from the Centers for Medicare and Medicaid Services, which specifies the base physician fee schedule they will pay for specific physician services. Thus, they reflect income for the health center via Medicare and other insurance payors.
Community and private hospitals often use this measure. As part of a salary bonus, physicians may earn a certain base rate per wRV,U which reflects their clinical output and the revenue they have generated; a minority of hospitalists are paid entirely based on their wRVUs.
Dr. Percelay
Many have criticized the wRVU system, arguing that it prioritizes revenue concerns over patient health, makes volume more important than quality of care, and negatively impacts physician well-being. Jack Percelay, MD, a clinical professor of pediatrics in the division of hospital medicine at Stanford Medicine in Pleasanton, Calif., noted that the allocated wRVU doesn’t always match the care that is needed. For example, a hospitalist often needs more time to perform patient education during discharge than the corresponding wRVU will cover.
Whatever its flaws, however, the wRVU system at least has the advantage of attempting to capture the primary mission of these settings: providing clinical care.
FTE Models and Academic Medicine Settings
Applying wRVU is more complicated in academic settings. Kevin J. O’Leary, MD, MS, chief of the division of hospital medicine and the John T. Clarke Professor of Medicine at Northwestern University Feinberg School of Medicine in Chicago, shared, “In academic hospital medicine, patient care is the most important mission, but the mission is also in teaching and doing innovative research to discover new knowledge.”
Dr. O’Leary
Thus, many academic medical centers use a different salary model, the full time equivalent (FTE) model. Here, physicians are paid a salary based on their time commitment, e.g., requiring a certain number of shifts.
Because of the intensity of time on the wards, such physicians primarily pursue non-clinical tasks when they aren’t on service. In such a model, interested physicians might apply for certain opportunities, e.g., in teaching or research, that buy out part of their time. For example, an administrative, research, or teaching position at .2 FTE might allow for a consequent 20% reduction in expected clinical time. This gives physicians additional time to pursue these non-clinical interests.
Partly due to increasing budgetary pressures, some academic hospitals have begun incorporating wRVUs in contracts to potentially increase clinical revenue. This has important implications for academic hospitalists who want to pursue non-clinical avenues as part of their career, as wRVUs do not capture this other important work.
Dr. Sankey
For example, Christopher Sankey, MD, FACP, SFHM, is director of the program in hospital medicine and associate professor of internal medicine at Yale School of Medicine in New Haven, Conn. His institution moved from an FTE model to one based on clinical productivity, under which faculty are expected to generate a certain threshold of wRVUs per year. He has a combination of teaching and administrative roles that bought out 60% of his time, so his expected annual wRVU expectation was reduced by 60%.
However, it’s difficult to match this up exactly, in either a wRVU or FTE system; many nonclinical roles realistically take up more time than the percent allotment, which can impinge on other job tasks or personal time.
Additionally, many academic hospitalists have other responsibilities and expectations that don’t fall under specifically funded “protected” time. For example, Dr. Sankey participates in a longstanding student preceptor program that requires significant time, but without any additional time allotment or alteration in wRVU expectations. It’s often culturally expected that academic hospitalists take on this sort of additional work, although it may not technically be required. Academic faculty often hope this work be viewed favorably in academic promotions considerations, but this is also becoming less the case, noted Dr. Sankey.
Thus, academic hospitalists may be expected and pressured to assume certain responsibilities, responsibilities that are relatively invisible at the institutional oversight level, in contrast to wRVU. These pressures can lead to underprioritizing important non-clinical work that is part of the academic hospital mission; moreover, such invisible work can contribute to poor job satisfaction and physician burnout.
Dr. Lagu
Tara Lagu, MD, MPH, recently moved from a full-time role in academic medicine with Northwestern University to adjunct status there and a position with Alliant Insurance Services, with additional work as a per diem hospitalist at Maine Health. The relentlessness of these extra responsibilities was a big part of the reason she made this choice, although she loved the world of academic medicine.
Dr. Lagu shared, “At some points in my academic career, I was doing so much of that extra work like mentoring, giving lectures, and serving on committees that I wasn’t having time to do my own research. I was working every weekend and night to get it all done.”
Academic Hospitalist Compensation and Motivation
For complicated reasons, academic hospitalists have a lower median annual salary compared to non-academic hospitalists of the same level. This may be partly based on differences between medical schools and private hospitals, the relevant payers, and the kind of communities served. Also, clinicians in a community setting have more of an opportunity to significantly increase their income via additional clinical wRVUs.
“In the community setting, there’s often a larger percentage of the compensation that is dependent on clinical productivity versus an academic setting,” Dr. O’Leary said.
Dr. O’Leary pointed out that academic medical centers have additional responsibilities that impact their net income, which can impact potential salaries downstream. “Funding through research grants and funding for medical education is just not as lucrative as the clinical payment rate,” he said.
Yet most people pursuing academic medicine do so out of intrinsic motivation and their desire to contribute. “Pediatric hospital medicine educators and researchers didn’t go into this for the money,” Dr. Percelay said.
Whether or not these compensation differences should matter is a sticky question. Academic hospitalists are still well paid, if not quite as well as some of their colleagues. Shouldn’t that be enough? Or, if they truly value education, research, and other essential non-clinical work, shouldn’t institutions make every effort to reflect that in financial compensation?
Dr. Sankey explained that salary differences between academic and clinically focused faculty don’t necessarily bother him, as long as they truly reflect payment for a different type of work: Taking a pay cut for a job with more non-clinical protected time and opportunities for other academic work, or vice versa, might appeal to different faculty members.
However, Dr. Sankey pointed out that the work of “academic hospitalists” and “non-academic hospitalists” has been converging in recent years, such that the field would benefit from more clearly defining the roles, skills, and goals of academic faculty. For example, some hospitalists at academic medical centers pursue only clinical responsibilities. Are they also academic hospitalists?
Present-day academic hospitalists in general have less protected time and greater clinical expectations than in the past, with wRVU-based models now creeping into compensation. Conversely, more community and clinical hospitalists are likely doing more academic work. As hospitalist jobs converge, salary differences may be less defensible in the absence of a clearer delineation of the roles and expectations of academic faculty.
Dr. Sankey is also concerned that viewing faculty strictly through the lens of wRVUs may ultimately lead to the extinction of the classic academic hospitalist role. From a purely fiduciary standpoint, if an academic hospitalist generates fewer wRVUs than their more clinically focused colleagues, do they become less valuable to the institution? This perspective risks overlooking the many important, often invisible, contributions that academic hospitalists make to academic medical centers beyond the generation of clinical revenue as measured by wRVUs.
“If academic hospitalists are going to continue to exist, we need to figure out a clear, convincing, and authentic way to show that we offer ‘different value’ and not lesser value,” Dr. Sankey said.
Hybrid Models, Academic RVU, and Other Tracking
To balance the advantages and disadvantages of pure salary or pure wRVU methods, many health systems are moving towards some sort of hybrid compensation model. These might include compensation for wRVU but also for specific academic achievements, for teaching, or for other non-academic contributions. At an academic center, these bonuses are often a relatively small percentage of the overall salary, perhaps not an amount sufficient to truly change behavior.
Dr. Percelay explained, “These are used to demonstrate respect and recognition, to give people confidence, but it’s not dollar for dollar the same as the clinical compensation. But that works for the people in the field who are primarily motivated to be educators and researchers.” This is deliberately a relatively small percentage at Northwestern, explained Dr. O’Leary, because they are primarily hoping to tap into physicians’ intrinsic motivation for such work.
Some centers have also developed explicitly non-clinical RVU systems to help better compensate physicians for their non-clinical work, including teaching, research, administrative work, quality improvement projects, committee work, curriculum development, mentorship, and more.
Under such a system, certain activities might be defined in terms of their worth, e.g., a certain number of non-clinical RVU for giving grand rounds, serving as a clerkship director, or publishing a peer-reviewed paper. Depending on the context, these might also be termed “academic RVU,” “teaching RVU,” or “research RVU.” A certain number of non-clinical RVUs might be required as part of one’s contract, and/or such nonclinical RVU might be used to help calculate bonus compensation along with clinical wRVUs.
Many institutions have been excited about the potential of non-clinical RVU systems to help allocate resources more fairly allocate resources in an objective and transparent way. One major challenge, however, is that unlike wRVUs, no national standard exists for what constitutes a unit of non-clinical work. Thus, institutions have had to develop their own methodologies to calculate and track such non-clinical RVUs.
“Everyone believes in the value of academic RVUs, but the operationalization of that has been the biggest challenge,” Dr. Kurian said.
Dr. Kurian shared that Northwell’s division of hospital medicine began tracking non-clinical RVUs several years ago, with the aim of potentially moving to a compensation system that included it as an element. However, they found it extremely burdensome to track and oversee physician self-reporting, and it was difficult to develop a system that properly reflected different kinds of contributions. Other institutions have also experienced challenges developing non-clinical RVU systems that properly value non-clinical contributions without creating excessive documentation and administrative overhead.
Currently, Northwell is employing a more relaxed tracking method in which physicians yearly self-report on a number of academic and non-clinical contributions, information which can help guide departmental decisions. Even if not used directly as part of compensation measures, tracking can have benefits for academic departments, Dr. Kurian noted.
“I think we do need to show the value of the clinical and academic work physicians are doing as an academic department, because there’s immense value in that work, and it helps us to justify equitable compensation,” Dr. Kurian said.
Dr. Percelay advises physicians to try to track such work personally, even if not required by their institution. If non-clinical work is becoming burdensome, such data can be helpful in discussions with your division chief, for example. It can also help you recognize if work is encroaching on personal time; such knowledge may help you set limits and say no to extra unpaid professional responsibilities if overstretched.
Dr. Lagu also speculates on the potential value of evaluating processes and rethinking what institutions should ask of their academic physicians, eliminating or reorganizing components that aren’t adding real value. “We aren’t likely to be able to pay academics more, but what can we reduce to offset some of the additional workload we’re putting on them?” she asked.
Helping physicians feel valued in their non-clinical work isn’t just about compensation. Dr. O’Leary said, “There are so many ways to show people that we value their academic work.”
For example, support might mean providing the right mentorship, helping someone get access to data or statistical resources, or providing curricular expertise. Dr. O’Leary also underscores that not everyone has the same interests and goals in medicine, and he tries to maintain a healthy division by supporting everyone’s individual gifts.
Ultimately, many agree on the goal of getting better recognition for non-clinical work in academic medicine. Dr. Percelay sees these efforts as best originating from either the departmental level or across the entire school of medicine or academic center rather than specifically from a hospital medicine program or division. “Ultimately the goal is to get better recognition across the board for this non-clinical work. But it’s going to be incremental, and it’s going to be slow,” he said.
“As a profession, we need to keep working on how to apply these principles to academics in a way that’s fair and equitable,” Dr. Lagu said.
“Hospital medicine is so pivotal in the functioning of any academic medical center,” Dr. Kurian added. “It is incredibly important to try to capture and quantify the value of hospitalists’ academic efforts from research, quality, innovation, and then to appropriately compensate for that, because that does have an impact on the way we deliver care for our patients.
Ruth Jessen Hickman, MD
By the Numbers
SHM’s State of Hospital Medicine Report is packed with research and trends on hospital medicine group configuration and operation that can help hospitalists make decisions and improve groups. The following data, pulled from the report, relate to compensation and wRVUs:
According to the SoHM Report, in 2025, the median compensation for adult academic internal medicine hospitalist faculty was $278,258 per year, and the median number of wRVUs was 3,419. The median compensation for pediatric academic hospitalist faculty was $213,143 per year.
Physician compensation is comprised of three categories— base, production, and performance. For adult hospitalists, on average, that breaks down to 81.6% base, 11.2% production, and 7.2% performance. For nocturnists, on average, it breaks down to 87.5% base, 5.7% production, and 6.8% performance. For nurse practitioners or physician assistants, on average, it breaks down to 94.6% base, 1.5% production, and 4.0% performance.
The most commonly used performance measures for individuals were citizenship (attending meetings, working on committees, etc.), 58.3%; accuracy and/ or timeliness of documentation, coding, or billing, 38.6%; clinical process measures, 23.8%; and academic productivity, 22.9%. The most common performance measures for groups were patient satisfaction, 51.1%; readmission rates, 50.2%; inpatient flow or throughput measures, 49.3%; and discharge time, 38.6%