View in Context
Hospitalists reading the survey for the first time might first seek to analyze the metrics regarding billings and collections. Here it is especially important not to view the reported numbers in isolation, says Dr. Nelson. For instance, to learn how a hospitalist’s annual gross charges (billings) compare with others across the country (question 12 of the Individual Hospitalist questionnaire—p. 87, Appendix 2), details on pages 251 and 252 supply pertinent variables. For instance, in comparing the four regions of the country, Table 056-A shows that the median annual gross charges for physicians in the south are highest, at $354,000. Hospitalists compensated by a 100% incentive method report higher charges per year ($392,000) than those who are on a 100% salary or a mix of the two methods of payment. Turning to Table 056-B, on page 252 of the published survey, hospitalists can find annual gross charges according to practitioner type, specialty, and employment model. Hospitalists should not stop their reading there, however, as a comparison of others’ annual gross collections might give a more complete picture.
Still, the SHM Survey does not reference all possible explanatory variables. Collections can be influenced by location and payer mix. Hospitalists practicing in a large urban hospital are likely to see more indigent patients for whom the hospital is not reimbursed. A careful reading of the survey should include the questionnaire and the tables supporting chapter conclusions, and the reader must recognize the survey’s limitations.
Apples to Oranges
IPC–The Hospitalist Company participates in the SHM survey and also uses it as a recruitment tool, reports IPC Vice President of Physician Staffing Timothy Lary. “We look at the income averages, and we’re able to demonstrate how our averages are, for the most part, higher than the averages,” he explains. “We also look at the survey from an internal viewpoint, but oftentimes you are comparing apples to oranges.”
Like individual hospitalists, hospital medicine group leaders seek comparisons when they read the survey. For her part, Dr. Dauterive has found the data on starting salaries for new hospitalists useful. For example, page 259, detailed table 060-A on hospitalists’ compensation by category and total, breaks out median yearly income by years as a hospitalist, from less than a year to six or more years. (Many of the detailed “A” tables in Chapter 8 on compensation include the “years as a hospitalist” category.) Dr. Dauterive praises the wealth of data in the survey, pointing to examples of the many variables she was surprised to learn. One of those factors was that 48% of surveyed hospitalist programs were at non-teaching hospitals. (See page 7 of the survey, Executive Summary, “Teaching status of affiliated hospital.”)
Those interviewed for this article agree that productivity data are probably more telling about the day-to-day clinical realities for hospitalists. Productivity metrics figure prominently in Dr. Dauterive’s uses for the survey. Accordingly, the annual number of billable patient encounters seen by the hospitalist (Table 58-B, page 256) and the annual number of work relative value units (RVUs) worked by the hospitalist (Table 59-B, page 258) caught her interest.
Still, Dr. Dauterive found herself wanting more data to shed light on those numbers. In negotiations for resources with hospital administrators, Dr. Dauterive would like to be able to pinpoint the reasons behind reported numbers of clinical encounters seen by the hospitalist. If the median number of billable patient encounters seen by the hospitalist in a teaching service was 1,668 (based on 107 responses; page 256, Detailed Table 058-B), what were some of the influences on this number? What was the acuity level of patients? Did the hospitalist have group resources, such as physician extenders, to help with patient admissions and rounds?