Mark V. Williams, MD, FACP, director of Emory Healthcare’s Hospital Medicine Unit in Atlanta and editor of The Journal of Hospital Medicine, will become chief of the new Division of Hospital Medicine at Northwestern Memorial Hospital in Chicago later this year. He recommends scoping out how a potential employer’s hospital medicine group is perceived and treated within the institution.
“People coming out of residency should look at the amount of support provided by the department of medicine for the hospital medicine group,” he says. “Are the hospitalists active members of the department, with key faculty in leadership positions such as residency or associate residency program director, or are they being hired just to deliver clinical care? Ask if there is funded support for hospital medicine research faculty. If not, the job may be just like working in a community setting, only community settings historically pay better.”
Signs that an institution has a strong commitment to the field include the presence of a division of hospital medicine, and possibly even a hospital medicine fellowship.
Questions to Ask
Even if you’ve got your eye on a specific hospital medicine group, go though the interview process at several institutions so that you can see what the market offers. Important factors to consider include:
Who would I work for? Who owns the hospital medicine practice? “There are differences in who’s sponsoring the group,” says Dr. Harris. “It may be independent, employed by the hospital, or a national group that contracts with the hospital. The answer will give you insights into the job. You may not get the entire picture, but you’ll get a clue.” Consider whether the practice can offer opportunities for advancement—possibly even partnership—and the type of clinical or administrative work you prefer.
What type of schedule would I work? How is the schedule arranged? Consider the number of hours you’d spend on call, and the number of nights and weekends you’d be expected to cover.
“Residents don’t have a sustainable schedule, so anything that’s not ridiculous sounds good,” warns Dr. Harris. “But a seven-on, seven-off shift is very tiring and can lead to burnout over time. So consider whether a given schedule is realistic for the long-term.” Find out how many vacation days are included—or if there are none.
What is the workload? During the interviewing process, ask about the average number of encounters per day. Definitely ask those “nitty-gritty” questions about patient load, admissions, and so on, advises Dr. Harris.
Pay special attention to the number of encounters. “Seeing 18 to 20 patients a day is a lot; those are the turn-and-burn organizations that aren’t necessarily sustainable,” says Dr. Panwala. “The money offered for this may be appealing to younger hospitalists. But remember, if you’re getting paid more, nothing is free.”
Dr. Harris adds, “Ask if that includes admissions and—if there’s critical care work—ask how many of those encounters are in critical care, because those patients will take more time.”
Michael-Anthony Williams, MD, regional CMO of Sound Inpatient Physicians in Denver, advises job seekers to look at “what they have to do” for the salary offered. “Look at … the number of days worked, the length of those days, and the number of encounters per day. You have to ask questions about these things, because the information isn’t necessarily going to be laid out in front of you.”
What about compensation and benefits? Your first consideration of salary, benefits, and other compensation should be to ensure the figures are in line with what the market offers. You can find general information on what hospitalists make from SHM’s “Bi-Annual Survey on the State of the Hospital Medicine Movement,” available at www.hospitalmedicine.org. The Medical Group Management Association (MGMA) and the Association of American Medical Colleges (AAMC) provide salary scales, and salaries for positions at public institutions like university hospitals are public information.