Productivity and compensation benchmarks can be useful when negotiating with hospital administrators for increased reimbursements and support resources, when recruiting hospitalists, and when conducting self-evaluations. For many of these processes, hospitalists—and, indeed, hospital administrators—turn to the information contained in the voluminous SHM 2005-2006 Survey, “The Authoritative Source on the State of the Hospital Medicine Movement.” (See “For More Information,” p. 32.)
With a response rate of 26%, the survey represents some 2,550 hospitalists across the nation, and its variables present a more comprehensive aerial view of hospital medicine than did previous surveys. But on the ground and in the trenches, hospital medicine groups must be careful to look at the survey’s metrics with a discerning eye.
When applying the survey metrics to one’s own practice, there can be benefits as well as pitfalls, cautions Joe Miller, SHM senior vice president and principal analyst of the survey data. He emphasizes the great variation among hospital medicine groups and warns against looking at survey medians as representing a “typical” hospital medicine practice.
“When you’ve seen one hospital medicine group, you’ve seen one hospital medicine group,” he quips. In several recent conversations, hospital medicine group leaders and SHM leaders involved in compiling the survey discussed the survey’s strengths and limitations as a benchmarking tool.
Healthy to Negotiate
According to the survey 97% of hospitalist programs receive some type of financial support. “Virtually every program in the country is challenged to defend the amount of money [they receive] or to negotiate for support dollars,” says Miller, who believes that negotiation can be a healthy dynamic. “There is a sense of equality of both sides of the table, a mutual respect between hospitalists and the hospital.” In the process of such negotiations, it will be important not to pin one’s position entirely to the survey metrics.
John Nelson, MD, medical director of the hospitalist practice at Overlake Hospital in Bellevue, Wash., a consultant for hospitalist practices with Nelson/Flores Associates, a columnist for The Hospitalist (“Practice Management”), and a co-founder and past president of SHM, believes that some hospitalists mistakenly view the survey as SHM’s position on what a hospitalist should make. “The survey is the best information we have about what hospitalists do make—there is no better source—but it’s still a survey.”
Using compensation medians as yardsticks for actual salaries and compensation packages is analogous to “learning the average weight of an American and deciding that’s what we all should weigh—and that’s a big mistake,” he says. “If you hold up the survey as the governing document, then each party will use it to their advantage.”
Because the survey is regarded as the most authoritative existing source on hospitalists’ compensation and productivity, it nevertheless ends up being used as a benchmark, says Robin L. Dauterive, assistant director of the clinical hospitalist service at Massachusetts General Hospital in Boston.
“Whenever I’m preparing billings reports or dashboard measures—anything that shows my group’s workload—sooner or later, I always have to include something in there that states, ‘This is what other people are doing,’ ” says Dauterive. “It’s something that you can’t get away from, unfortunately, in medicine.”
She realizes that the survey does not purport to set any national standards, and yet, “all administrations want comparisons.” Dr. Nelson has also noted this phenomenon with the survey. In the absence of additional guidance, hospital executives and hospitalists often find that they’re just arguing about the survey. “And that’s unfortunate,” he says. “It means they’ve lost sight of the unique attributes of a given practice that might support higher or lower incomes and higher or lower workloads.”