Hospitalist compensation plans and incentives

Hospitalist compensation plans and incentives

January 2009

Published in the January 2009 issue of Today’s Hospitalist

WHEN IT COMES TO PAYMENT INCENTIVES FOR HOSPITALISTS, there’s tremendous variation in who is receiving bonuses in addition to a salary, and what those bonuses are pegged to. Here’s a look at the most recent data on the topic from the Today’s Hospitalist Compensation & Career Survey,

How are you paid: via straight salary, pure productivity or a combination of the two?

100% salary: 33.9%
100% productivity: 6.31%
Combination: 59.76%

The use of productivity incentives for hospitalists shows some clear differences by specialty. While only 33% of internists receive a straight salary, that number jumps to 53% for general pediatricians working as hospitalists and 67% for pediatric subspecialists. While relatively few hospitalists who trained as family physicians said they’re paid a straight salary (15%), none reported being paid pure productivity. Most (85%) said they were paid a combination.

Slice the numbers by employer type, and you’ll find that straight salary is most common among hospitalists who work for hospitals/hospital corporations (56%). That number is about 30% for hospitalists working with local hospitalist groups, national management companies and primary care/ multispecialty groups. Pure productivity is most common “although not exactly prevalent “in local hospitalist groups, where 16% of physicians said they were paid on productivity alone.

Survey data reveal two other trends of note. One is that the fewer patients hospitalists see, the greater the odds that they’ll be paid straight salary. More than half (55%) of hospitalists who see fewer than 10 patients per day are paid a straight salary, compared to only 16% who see 21 or more patients.

And the more years hospitalists are out of residency, the less likely they are to be paid a straight salary. While 41% of hospitalists just out of residency reported getting paid a straight salary, that number dropped to 29% of hospitalists who have been out of residency six years or longer.

What types of payment bonuses or incentives do you receive?

Productivity as measured by patient volume or number of shifts worked is the measure that most hospitalists are rewarded for financially. A strong second was quality measures, which includes areas like satisfaction scores, documentation and adherence to guidelines.

While there are differences among specialties, most aren’t huge. Pediatric hospitalists who do receive a bonus are a little more likely to receive a bonus based on productivity than their counterparts in internal medicine (80% compared to 72%), but they’re slightly less likely to be paid based on quality measures (40% compared to 57%).

Incentives for quality measures are less common for hospitalists working with local and national groups (42% and 45%, respectively) than for hospitalists employed by hospitals (68%).

And payment incentives for committee work are relatively uncommon across all work settings, with a low at national hospitalist management companies (6%) and a high for physicians at primary care/ multispecialty groups (24%).

Popular payment incentives for hospitalists
Productivity (number of admissions, shifts worked, RVUs): 72.8%
Quality measures (satisfaction scores, guidelines, medical documentation): 55.4%
Committee work: 16.5%
Other: 15.1%

Are you paid for the time that you spend on committee work?

Yes: 13.5%
No: 86.5%

What committees do you serve on?

Only three answers garnered responses of more than 20%: quality improvement (46%), pharmacy and therapeutics (26%), and utilization review (23%).

Quality improvement: 46%
Pharmacy and therapeutics: 26%
Utilization review: 23%
Practice guidelines: 19%
CPOE: 16%
Ethics: 13%
End of life/palliative care: 12%
Credentialing: 11%
Disaster response planning: 7%
Formulary: 7%

Want more details? YOU’LL FIND MORE DETAILS “and more than 100 charts “from the latest Today’s Hospitalist Compensation & Career Survey online. Look for the link near the upper left side of the home page.