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Hospitalists: still in demand

Plus, sick physicians just won't stay home

August 2015
Equal pay for hospitalists

Published in the August 2015 issue of Today’s Hospitalist

Hospitalists still make the top 5

STAFFING COMPANY MERRITT HAWKINS last month released its latest recruitment and compensation report on the most heavily recruited physician specialties. The report was based on more than 3,100 search assignments in 2015.

For the ninth straight year, family medicine was the No. 1 most frequent search, followed by internal medicine. Coming in at No. 3 (the slot hospital medicine filled in Merritt Hawkins’ 2014 report) was psychiatry, followed by hospital medicine at No. 4 and nurse practitioners at No. 5.

For hospitalist searches, the average income offered was $232,000, with a low-high range of $170,000-$300,000. Among searches across all specialties, 84% included a relocation allowance (of more than $10,000) and 73% offered a signing bonus. The average signing bonus offered to physicians was more than $26,000; the average for NPs/PAs was nearly $9,000.

Among searches that included loan forgiveness, 79% were for three-year terms. For the few searches that included income guarantees, most positions (56%) were for a term of one year. The average CME allowance offered to physicians was more than $3,600, with a low-high CME range of $500-$35,000.

Gender gap alive and well 
in hospital medicine

A NEW OBSERVATIONAL STUDY finds that women hospitalists make nearly $15,000 less per year than their male colleagues, even after data are adjusted for part-time status, specialty differences and types of practice.

But the study authors concluded that at least some of that pay gap may be due to men and women having different career priorities. Working from 2009-10 data, researchers found that women hospitalists were more likely than men to be pediatricians and to work in a university. Women hospitalists were also younger (42 vs. 45), more likely to work part-time (18% vs. 12%) and less likely to serve in leadership roles (24% vs. 34%). Results were posted online in June by the Journal of Hospital Medicine.

When asked to rank the most important factors contributing to their job satisfaction, male hospitalists put substantial pay as No. 2, just behind optimal workload. For women hospitalists, on the other hand, substantial pay was item No. 4 behind optimal workload, collegiality with other physicians and control over personal time.

A treatment blockbuster
 for heart failure

THE FDA LAST MONTH gave fast-track approval to a new heart failure drug that holds out the promise of reducing cardiovascular deaths and the number of hospitalizations related to heart failure.

The drug, Entresto (sacubitril/valsartan), is an angiotensin receptor’neprilysin inhibitor manufactured by Novartis. FDA approval was based on results of the PARADIGM-HF trial, which were published in the Sept. 11, 2014, issue of the New England Journal of Medicine. That study tested Entresto against enalapril, an ACE inhibitor. The trial was stopped early after data found a 2.8% absolute risk reduction of death from any cause.

According to an FDA announcement, Entresto should not be combined with any ACE inhibitor, which could increase the risk of angioedema, and patients should wait 36 hours when switching between Entresto and an ACE inhibitor. (African-Americans and patients with a prior history of angioedema are at higher risk of angioedema.) The FDA also warned that Entresto should not be taken by patients who are pregnant.

Education (and money) 
drive down telemetry rates

AN EDUCATIONAL INITIATIVE coupled with financial incentives helped reduce hospitalists’ use of telemetry, along with length of stay and total costs.

Hospitalists at Stanford University launched several interventions to reduce telemetry rates. They used an educational module to teach trainees about telemetry use. They also discussed the need for telemetry on teaching rounds and received quarterly data on telemetry utilization. In addition, hospitalists were offered a $2,000 bonus if the group reduced the use of telemetry beds.

The interventions led to lower length of stay for telemetry beds (2.13 days vs. 2.75 pre-intervention) and a 22.5% drop in telemetry bed costs. The use of telemetry beds by nonhospitalists, meanwhile, remained the same.

“Our study also revealed,” the authors wrote, “that nearly half of participants were not aware of the criteria for appropriate utilization of telemetry before our intervention.” Study results were posted online last month by the Journal of Hospital Medicine.

Surgeons get two new scorecards

TWO NEW SEARCHABLE SCORECARDS are providing a very public view of surgeons and their complication rates. The first, created by investigative journalism group ProPublica, provides data on 2009-13 complication rates for close to 17,000 surgeons across 3,600 U.S. hospitals.

ProPublica’s effort encompasses eight elective surgery categories (including knee/hip replacement) with results on all surgeons who performed 20 or more surgeries in each category. The database is searchable by name, hospital, city and state.

Average complication rates were between 2% and 4%, although 11% of surgeons were behind 25% of all complications. “Hundreds of surgeons across the country,” according to a ProPublica article written about the online tool, “had rates double and triple the national average.”

The second scorecard can be found at SurgeonRatings.org, produced by the ratings service Checkbook.org. This system looks at 15 types of surgeries for Medicare patients that were performed from 2009-12. But this database lists only those surgeons whose rates of readmissions, 90-day mortality and same-stay complications are significantly above average.

Sick doctors just won’t stay home

DESPITE KNOWING THE RISK they posed to patients, a hefty majority (83%) of clinicians surveyed at Children’s Hospital of Philadelphia reported working sick at least once in the previous year. That included clinicians who came to work with acute onset of significant respiratory symptoms (56%) and fever (16%).

Nearly 300 attendings and more than 250 advanced practice clinicians (APCs) were surveyed in the winter of 2014. Survey results were posted online last month by JAMA Pediatrics.

Researchers found that doctors were more guilty of coming to work sick than APCs. Reasons given for not calling out included not wanting to let colleagues down, concerns about staffing, fear of being ostracized and concerns about continuity of care. Free-text comments from respondents also noted problems finding coverage as well as “a strong cultural norm to come to work unless remarkably ill.”

Clinicians surveyed also noted that they were unclear how sick is too sick to come to work.