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Rising compensation for hospitalists

Is it a blip or a trend?

July 2022
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THIS YEAR’S Today’s Hospitalist Compensation & Career survey results are out, the first survey we’ve done since 2019. The big takeaway for full-time, non-academic hospitalists who treat adults: From 2018 through 2021, the years covered by our two latest surveys, hospitalist compensation jumped 17%. Median compensation in this year’s survey was $319,000; the mean was $339,463.

Over the past 20 years, the specialty has seen some big jumps in pay. But our last survey in 2019 (asking about 2018 compensation) found that hospitalist pay was possibly cooling off. From 2017 to 2018, compensation actually dropped 1.6%.

Unfortunately, our survey team didn’t get the chance to follow up the next year and see if those numbers were a blip or the beginnings of a real trend. Covid struck shortly after we reported those data, and our surveys went on hold.

“I saw more turnover last year than in the previous 10.”

Hardik-Vora, MD

Hardik Vora, MD
Riverside Regional Health System

Three years later, we’re seeing a significant bump in compensation, but the data raise a lot of questions. Is that healthy increase in pay, for instance, due to some unhealthy work trends? Almost half (46%) of respondents in this year’s survey said they worked more hours than usual because of the pandemic. How sustainable are compensation gains that come at the high price of having to work more hours and shifts?

At the same time, some groups we’ve talked to received nothing in 2021 in the way of raises, and they seem to be OK with that. They appreciate that their hospitals didn’t lay anyone off when their patient census bottomed out during the pandemic, so they didn’t push very hard for raises—and they still don’t plan to.

With so much conflicting data, it’s unclear whether rising compensation is a real and sustainable trend, or if 2021 was just an anomaly. (See “Top indicators of hospitalist compensation.“)

Hardik Vora, MD, hospital medicine medical director at Riverside Regional Health System in Newport News, Va., put it succinctly: “It was a very odd year.”

Needing to “recruit fast”
In early 2021, Dr. Vora believed that he and his colleagues would get a small raise last fall. But he also expected more of their compensation to be put at risk, pegged to meeting performance targets. After all, hospitalist subsidies were close to $200,000 per physician, and their census was flat. Dr. Vora thought administrators would insist on better performance.

But that’s not what happened. Instead, covid erupted, wave after wave, and patient volumes surged. By the end of 2021, many group members wanted to step back, with some retiring early or opting to work less.

“I saw more turnover last year than in the previous 10,” says Dr. Vora. “The supply-demand equation shifted to physicians’ favor.” Instead of needing to recruit only a few doctors, like he does every year, he realized he needed 11 additional doctors (including three nocturnists!) and one nurse practitioner.

“Our physicians would rather have sustainable workloads as opposed to increased pay.”

Kevin-Sowti-DO

Kevin Sowti, MD
Penn Medicine Chester County Hospital

“It was unheard of to have that many openings,” he says. “We needed to recruit fast, so we made the strategic decision to go big.” By “big,” he means boosting physicians’ base salary by 8% (with none of that raise tied to performance metrics), not just for new recruits but across the board. That strategy worked and, according to Dr. Vora, the last of those 12 new hires is being onboarded this summer.

OK with cost-of-living increase
At Penn Medicine Chester County Hospital in West Chester, Pa., some hospitalists saw their compensation go up, but not because of raises. Kevin Sowti, MD, hospitalist group medical director, says that last year, a number of his colleagues earned more by working between 5% and 10% more shifts than usual.

“They were covering new units or more patients,” Dr. Sowti says, “or the significant number of our own workforce out because of covid exposure or infection.”

That productivity has come at a price, and many doctors now—as in Dr. Vora’s group—want to pull back and work less. “It hasn’t been ‘the big resignation,’ and no one has left to go to another system in the region,” Dr. Sowti says. “But it’s definitely been a trend.”

At the same time, Penn Medicine—along with most other health systems in the Philadelphia region—didn’t significantly increase hospitalist salaries last year. While Dr. Sowti plans to introduce incentives to attract doctors to certain shifts, including nights and early-morning admissions, group members this year (particularly those working days) don’t expect much besides a cost-of-living increase.

According to Dr. Sowti, he and his colleagues, at least for now, are OK with that because of their culture. “Our system was very supportive, and it didn’t lay anyone off during the entire pandemic or cut anyone’s pay,” he points out. “Our physicians would rather have sustainable workloads and better quality of life as opposed to increased pay.”

Shared experience
Martin Buser, MPH, founding partner of the hospitalist consulting firm Hospitalist Management Resources LLC, sees that attitude in many of the hospitalist groups that bring him in to review the comp proposals they’re submitting to their administrations.

“I wouldn’t feel right asking for raises when our census was so low.”

Anandi-Subbian-MD

Anandi Subbian, MD
Blessing Hospital

“Nine times out of 10, those proposals are less aggressive than I would have been,” Mr. Buser says. He chalks that up to hospitalists realizing that their hospitals and administrations have, like them, gone through some very tough times. “They don’t push the envelope,” he says. “It’s almost like, ‘Hey, we’re in this together, and we just want to try and stay even.’ ”

That’s the approach being taken by Anandi Subbian, MD, hospitalist medical director at Blessing Hospital in Quincy, Ill. Dr. Subbian says hospital administration preserved hospitalists’ hours and pay during the pandemic, even when their census fell dramatically for long stretches of time.

While the employed group saw plenty of covid patients, members were never overwhelmed. As electives were cut back and patients stayed home, a typical daily census of as many as 70 patients for the nine-physician group sometimes dipped into the 40s.

That has since changed, and each hospitalist now has between 16 and 20 encounters a day. Dr. Subbian expects their census to continue to grow due to increasing numbers of unassigned patients.

As for compensation, she and two other doctors who were hired in 2018 have yet to see any raise, let alone the rest of the group, all of whom were hired after her.

“I plan to have a conversation about raises because several of us haven’t had one in almost five years,” says Dr. Subbian. She also plans to begin negotiating compensation every three years. But she’s putting those conversations with administration about raises off until 2023.

“I wouldn’t feel right asking for raises when our census was so low,” she says. She also points out that members of her group are pleased with their quality of life and workload. So far, they aren’t clamoring for more money. “Our whole team is satisfied,” Dr. Subbian adds. “We want good quality of life, and they treat us well.”

Competitive compensation
That attitude isn’t embraced by all hospitalists. Kimberly Bell, MD, MMM, regional medical director, TeamHealth West Group, says that some of her physicians saw others earning increased pay from shift bonuses and higher hourly rates due to surge staffing during covid. Those doctors now say they too want to earn the higher amounts.

“If you don’t have enough providers, that changes the balance of power.”

Kimberly-Bell-MD-MMM

Kimberly Bell, MD, MMM
TeamHealth West Group

At the same time, TeamHealth is converting independent contractors to W2 employees. Along with rising inflation, that has some hospitalists complaining that their compensation isn’t competitive. Making matters even more complicated, Dr. Bell regularly receives e-mails from physicians who want to cut back their clinical time.

“The fewer people we have available,” she says, “the more we have to lean on locums or on shift bonuses to encourage our current team to pick up shifts. That costs more, and it becomes a vicious cycle where even more people burn out and want to cut back.”

It also gives doctors lobbying for more pay additional leverage. “If you don’t have enough providers,” she says, “that changes the balance of power.”

How is TeamHealth responding? Dr. Bell says that while some of the nine sites she oversees got salary increases last year, others are receiving raises this year, but some haven’t seen a raise at all in a couple of years. Some of the physicians asking for more pay are looking for substantial increases of between 15% and 20%.

That amount is “probably not doable,” says Dr. Bell. But TeamHealth is starting discussions around compensation with some hospital clients in her region.

“At the end of the day, hospitals and management companies will do what’s required to stabilize the workforce and get compensation close to where it should be,” Dr. Bell says. But given financial pressures from rising subsidies and decreasing reimbursements, “there could be unforeseen consequences, such as the need for higher productivity.”

Additional benefits
Mr. Buser points out that hospitalists now may succeed asking for more pay. He points out that because many of the clients he works with received government subsidies during covid, “many hospitals’ bottom lines aren’t as bad as you’d think.”

When he’s hired by hospital administrators to work on hospitalist pay, Mr. Buser regularly sees those administrations offering what he calls “generous” raises of between 3% and 5%. In return, programs are asking hospitalists to produce 18 encounters per day instead of 15 or 16.

“This is not the time to be cheap.”

Martin-Buser, MPH

Martin Buser, MPH
Hospitalist Management Resources LLC

But not everyone is putting pay at the top of their wish list. As in every other industry, Mr. Buser says the pandemic is causing hospitalists to rethink their personal and professional lives. For some, that may mean moving closer to extended family. Others may want to stop commuting to a downtown hospital and work at a smaller one closer to home instead.

Right now, “the dust is starting to settle a bit, and I expect a lot of turnover and recruiting to start later this year and into 2023,” he says. That has hospitals thinking long and hard about how to retain their physicians. While compensation is part of that, Mr. Buser is seeing hospitals, often for the first time, extending paid time off as well as a minimum number of sick days.

“Those are starting to creep into the equation,” he says. “Those are easy for administrators to sneak into the financials because they’re not as dramatic as a salary increase. And my advice to hospital administrators is that this is not the time to be cheap. If doctors are going to leave, you don’t want them to leave over compensation.”

How to boost retention
TeamHealth’s Dr. Bell notes that some of her colleagues are also asking for more non-comp benefits. But she adds that paid time off, which is often mentioned, is a non-starter. “That’s highly unlikely, given our schedule,” Dr. Bell says. Other asks including 401(k) matches and more CME may be possible. And retention bonuses “have probably been implemented more over the last year or so, given the instability and concerns around compensation.”

In Virginia, members of Dr. Vora’s group have for years been paid a retention bonus, based on the years they’ve been employed. After working three years—all of which are covered by their sign-on bonus—doctors each year receive “north of $5,000 a year,” Dr. Vora says. That amount keeps getting bigger, based on how long physicians stay.

“I have several doctors who have been here 20-plus years,” Dr. Vora points out. “They have a fairly high retention bonus on top of their compensation.”


Read how one hospitalist group was able to weather the pandemic with little impact on hospitalist turnover or compensation: “Health systems leverage size, technology.


Toward better work-life balance
Last year, Dr. Vora also started sitting down with providers to ask about their nonclinical interests.

“Quality, leadership, utilization management, teaching, health informatics—there’s so much a hospitalist can do to develop skills,” he points out. “I try to hook them up with the right people in the organization to make that happen.”

In Philadelphia, Penn Medicine’s Dr. Sowti says that hospital margins are so tight that it’s hard to get the OK to recruit new providers. That could be a problem if there’s another covid surge—or if more area hospitals close, causing the volume in all the others to rise.

That makes retention even more important. “We’re working harder at making work-life balance better,” he says. While he may introduce retention bonuses, he really wants to give group members “a percentage of their time to do something they love.”

“The hook is not the money or the extra shifts,” says Dr. Sowti. “It’s allowing people to spend a portion of their time on quality or research or teaching, whatever it is they really want to do. We need to figure out how to do that and develop leaders.”

Phyllis Maguire is Executive Editor of Today’s Hospitalist.

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Health systems leverage size, technology

LIKE IN MANY HEALTH SYSTEMS, the last two years have been hard on the hospitalists at Atrium Health, which has about 500 hospitalists working at 30 acute care facilities in North Carolina and Georgia. But unlike many other hospitalist groups, Atrium Health has weathered the pandemic with little impact on hospitalist turnover or compensation.

Inpatient volumes didn’t really fall, for instance, nor did hospitalist RVUs take a significant hit. According to Brian Schroeder, MHA, vice president, enterprise hospital medicine, hospitalist turnover has held steady at about 5%, which is where it lands every year, and hospitalist compensation has remained on track. While hospitalists—at least in the Charlotte market—didn’t receive a raise in 2020-21, they did in 2021-22.

“Hospital at home and virtual hospital medicine have been game-changers.”

Chi-Cheng-Huang-MD

Chi-Cheng Huang, MD
Atrium Health

So how has Atrium Health retained its providers and avoided compensation upheavals while other groups have struggled? Chi-Cheng Huang, MD, enterprise specialty medical director, hospital medicine, explains that covid became an agent of “disruptive innovation.” Long before its 2020 integration with Wake Forest Baptist Health, Atrium Health had a thriving telemedicine arm, which “got much bigger during the pandemic,” Dr. Huang explains. That made it possible to provide virtual hospitalist services at outlying hospitals.

During the pandemic, Atrium Health also launched a hospital at home program that saw demand explode. Over the past two years, Dr. Huang says, the health system in the greater Charlotte region alone provided 3,000 hospital at home visits. And the Atrium virtual hospital program launched at the end of December 2021 has already completed between 500 and 600 visits.

“Both hospital at home and virtual hospital medicine have been game-changers,” Dr. Huang adds, in terms of group flexibility and stability. “Some providers want to do a little bit of everything because it keeps things fresh. Others do virtual hospital and hospital at home full time, while others want to see patients in the hospital.”

The health system’s telemedicine and hospital at home capabilities also leverage the number of physicians and advanced practice providers. When he’s working the virtual hospital program, Dr. Huang says, he’s able to work at his office. “It allows me to help out at three different hospitals vs. having to hire three locums or moonlighters. From the vantage point of being a physician or an advanced practitioner, that’s working smarter.”

Mr. Schroeder agrees: “The telemedicine component in hospital medicine gives us the flexibility to use our providers efficiently, across geographies. Being able to share staff across markets has been a huge benefit.” And because of the group’s size, “we can offer providers a variety of work.”

Published in the July/August 2022 issue of Today’s Hospitalist.

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