Hospitalist Employment Contract Considerations and Recommendations Reviewed

It's now been seven years.  Seven exciting years of continuous hospitalist employment with the same hospitalist program.  Hospitalist programs are a dime a dozen.  Every hospital on this earth is trying to incorporate the benefits of a hospitalist service into their long term business plan.  Why?  Because we are the present and the  future of hospital based medical care.  

Our value goes far beyond the direct economic impact of billing and coding in the madness of fee for service known as evaluation and management.  As the economic realities of today's bankrupt Medicare National Bank start to hit home, hospitalists will be looked to as leaders for quality and hospitalist efficiency in the push towards bundled care. 

With so many different hospitalist practice environments available,  those internists interested in pursuing inpatient medicine need to arm themselves with knowledge.   From the private practice eat what you kill community hospitalist employment model to the salaried lecture circuit  hospitalist at the Univeristy of Research Dollars, hospitalists have a wide variety of  employment opportunities  to choose from.  One recent reader asked me for my opinions on how to find the best hospitalist employment environment.  
I've been following your blog for about a year now. I'm an internal medicine resident in Illinois, winding down my second year of residency, and am trying to organize a sensible post-residency plan. I was hoping I could pick your brain on some issues. I'm an IMG and am looking to settle down somewhere in the Chicagoland area (Chicago and its suburbs). I'm set on becoming a hospitalist, and at this point in time am pretty sure that what I want to do for the rest of my career.

I'm concerned about getting into a hospitalist position in which I'd be unhappy. The hospital I currently work at is great and I like it here a lot, but the town is too small for my taste and I'm keen on moving to a larger metropolis. I haven't worked in other hospitals in the US, so I don't know to what extent the good things I find in this hospital are going to be replicated in others. I'm wondering if there's any advice you would give to residents looking to get into hospital medicine. What does one look for when seeking out positions? What should I try to avoid? I'm kind of sailing in uncharted waters and looking for any useful directives to guide my decision making.  Thanks!
Congratulations on making the jump into hospitalist employment as a career.  There are certain things you must keep in mind before signing the employment contract. Before you even begin to figure out what kind of hospitalist employment model you want to pursue, you have to know what is important to you.  Do you want the lifestyle of a salaried academic hospitalist  working bankers hours or do you want  the income potential of an eat what you kill model where patient volumes could get real high real quick. 

Here are the basic hospitalist employment model opportunities:
  • Community vs academic
  • Hospital employee vs local private practice vs national hospitalist corporation
  • Big city vs rural
  • The Coasts vs The South vs The Midwest
  • Salaried compensation vs productivity vs a hybrid of both
  • Nocturnist work
These are your basic hospitalist employment opportunities in a nutshell.  In general, community hospitalists will make more than academic hospitalists.  Productivity based compensation will make more than pure salaried hospitalists.  Rural hospitalists will make more than big city hospitalists because of supply and demand.  Nocturnists command premium pricing for their night shift differential.  The Midwest and the South will generally pay better than the coasts due to supply and demand and HMO infiltration on the coasts.    As far as compensation goes for the hospital employee vs the local private practice vs the national hospitalist corporation, that all depends on your hospital's administration and how much they are willing to subsidize your group for the right to have 24 hour in house physicians at their hospital.

I know of several major hospital systems that have struggled for years to get a hospitalist program up and running.  The administrators at these hospitals have failed to understand what it takes financially to support a viable program with a long term commitment in mind.  

What's your best guage as to how happy you're going to be with the hospitalist employment contract you sign?  You have to find a group where everyone else is happy.  And you do that by finding a group with many hospitalists that have many years of service within the organization.   You want to find a group that has a strong core of dedicated hospitalists who have been  around the block together.  Most of my group has been  together for many years.  Every year we lose folks who never intended to stay, and we gain folks who plan on staying forever and our retention gets stronger every year.  

To get there you have to have the full faith and backing of an administration that understands what you bring to the table.  It all starts with the administration of the hospital.  I can't stress that enough.  Without the support of adminstration, most hospitalist programs would flounder.  It's WIN-WIN when both sides understand the symbiotic relationship they provide for each other.  If your potential hospitalist employment opportunity is experiencing a high turnover rate (>10-15% per year) you need to understand why.  The market in hospitalist medicine is a dynamic one.  

To remain competitive, programs must understand what their competition is offering.  Programs experiencing mass exodus of their members have failed to live up to the expectations of the hospitalist free market enterprise system.   I can understand a hospitalist here or there leaving for a subspecialty fellowship.  But a programs that consistently fail to maintain adequate staffing with a core membership  of life long hospitalist physicians is a serious red flag institution in my book.  This usually indicates either the work load is unbearable or the compensation is inadequate for the work being provided. 

If you have the full faith and backing of a hospital's administration, you are bound to succeed in a WIN-WIN relationship. You can tell who's got the backing and who doesn't by how long the group's core members have been together.  

So let's say you've found a tight knit group  of hospitalists that have weathered the storm of rapid expansion by winning the recruitment war.  What do you want to make sure you get in your contract?  Just some of the standard offerings these days?

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