“If you want to tie that with why there’s $136,000 going per hospitalist, [it’s] because they want us there for that rapid-response team, and rapid-response teams don’t generate a lot of RVUs necessarily.”
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Hawley, the consultant, agrees the percentage increase in financial support is somewhat shocking, but she isn’t surprised by the median figure. She knows hospitals are asking more of HM groups, and all of those value-added, non-billable tasks and responsibilities come with a cost.
“It’s not totally surprising, but it’s a big leap,” she says. “I would say at least some of that has to be driven by the fact that we have hospitals and integrated delivery systems employing more and more of these physicians that responded to this survey, as well as physicians’ practices are perhaps becoming more educated as to what their finances are. There’s a better understanding of allocation of overhead, of billing fees, all of those things that go into a practice where … that may not have been as clear to folks when HM was a bit younger.”
Downward Trend: Hospitalist Turnover
In what some are calling a positive sign for the specialty, hospitalist turnover dropped to 8% in 2011, compared with a 14% turnover rate among hospitalist groups serving adults in 2010 (see Figure 1). Rates declined for both hospital-owned and non-hospital-owned groups, according to the report. Hawley, the consultant, says the decline in physician movement is “consistent” with what she sees in daily interactions with HM groups. Moreover, she considers that trend to be just as important as the overall decline in hospitalist turnover.
“[The survey indicates] more physicians are employed by a hospital or an integrated hospital system. With that, what we’re seeing on the consulting side is there are certain benefits with being employed by a hospital or healthcare system, in terms of retirement plans, things that [hospitalists] may not find as rich in a private practice or with a multispecialty group,” she says. When a hospitalist becomes employed with a hospital system, she hears them say, ‘This is where I want to live and raise my family.’ People choose this type of employment for a reason.”
That has been the experience of PAC member Tierza Stephan, MD, FACP, SFHM, who supervises more than 135 hospitalists as hospitalist district medical director for Minneapolis-based Allina Medical Clinic. Dr. Stephan currently has 15 openings at six of the eight HM groups she directs. Even so, she admits that her programs have been “blessed with low turnover.” The upshot: “We use that when we talk to the C-suite,” she says. “It’s way more costly to have one physician come in, train them, and then have them leave. The low turnover rate gets factored into the cost of what they’re paying.”
Dr. Frost says HM is becoming “less and less a stopover specialty,” as more physicians adopt HM as their career. Dr. Landis says that, although just two consecutive years of data are available, the decline in turnover rate is a good sign for the specialty.
“I think many of us suspect that as the hospitalist movement matures that there hopefully will be a stabilization of the turnover rate,” he says. “Hospitalists tend to be very portable, and when there’s a lot of open jobs and only a few hospitalists, there can be even more and more [turnover]. Typically, someone gets themselves into a situation, they feel that they’re overworked, underpaid, underappreciated, they’re going to look for another job, and those jobs are out there. As the market stabilizes, there will probably be less and less moving around.”