Dr. Clark sees another important aspect of the hospitalist role: “ … participating on committees and QI initiatives and developing order sets, [which] can be additional and/or non-paid time. I think this needs to be recognized by hospitals in general, and physicians have to advocate for their value in this regard.”
The section on participation in non-clinical activities also drew praise from Dr. Bossard. “I don’t think this [percentage of time in non-clinical activities] would be necessary in terms of negotiating with the hospital, but it would be a very useful gauge for assessing where an individual program is relative to the rest of the programs, to see whether you are overdoing or under-representing yourself on committees.
“These surveys are just fabulous,” he says. “I’ve used the prior surveys to present information to the hospitals and identify how hard we’re working relative to our own region, and I present results to my hospitalist group in terms of pay and benefits. The survey is a wonderful tool.”
Academic Hospitalists Weigh In
Robert Wachter, MD, FACP, professor and associate chairman of the department of medicine at the University of California, San Francisco, and past president of SHM, also participated in the survey panel discussion and addresses issues specific to academic hospitalists. The growth in academic hospitalists shown in the current survey—while not surprising—confirms his impression that the field has grown in the last couple of years. The evidence of growth furnishes useful information for him as a hospitalist group leader in an academic institution.
“Unlike seven or eight years ago when I would be competing against only a handful of other academic programs for good people, I am now going to be competing against dozens and dozens of different groups,” he explains. “That changes the dynamic of my recruiting strategy.”
In addition, Dr. Wachter says he will make use of specific tables addressing concerns of academic hospitalists. “There are certain issues that are very different in an academic program, as compared to a community-based program,” he notes. “For instance, in my environment, burnout issues—or ‘dissatisfiers’—may relate to income or schedules or the abilities of support staff, but they may also relate to the teaching role or the research infrastructure—things that may be irrelevant to other people [in community programs] answering the surveys.”
Healthy Signs, Troubling Signs
Dr. Nelson summarizes his main points from the panel discussion about the survey: “It seems to show that incomes are rising faster than could be explained by inflation. There is also a rise in productivity, so incomes are up in part due to that.”
Another healthy trend, he says, is that in the last several surveys there has been a significant decline in hospitalists paid a fixed salary and an increase in those paid a combination of a base salary with a variable component, such as productivity. “I think getting away from fixed salaries is a good idea,” he notes.
Mary Jo Gorman, MD, MBA, SHM president and chief medical officer of IPC—The Hospitalist Company, was also a presenter during the survey’s debut in panel discussion. “Sustainability,” she says, is “very important for the field of hospital medicine. What this [survey] shows is that physicians are making a living, doing better than the average internist, and apparently getting career longevity out of this. Each year, the percentage of people who are staying in hospital medicine is increasing. New people are coming to the field, but other people are also staying. It’s not all about money and hours worked, but it’s some magical mixture of that.”