UPDATE 2012: On July 18th, 2012, The Hospitalist published details on the most up-to-date hospitalist salary compensation data currently available. This comprehensive SHM/MGMA report is now available for purchase from the Society of Hospital Medicine (SHM). In addition to the SHM/MGMA report, you can find free 2012 salary survey data at Today's Hospitalist website. You may need to sign up to get their publication. If you haven't already, I encourage you to do so. They provide an excellent free publication all hospitalists can appreciate and enjoy.
I have updated this blog post on a yearly basis in 2010, 2011 and 2012 to help hospitalists understand how their income and benefit package compares with national survey data. I started my hospitalist journey in 2003 at a large community hospitalist. Ten years later I continue to provided hospitalist services as a partner in my private practice hospitalist group.
Over the years I have watched hospitalist salary trends rise with strength and conviction. This is not a mistake. Our value is being rewarded by our unique position outside third party insurance models of care. The most recent report from the publication The Hospitalist is based on 2011 SHM/MGMA data. The median financial support for hospitalists by hospitals increased to $140,204 per full time hospitalist, per year, an increase of 6.6% from the $131,564 reported in the previous survey. Confirming this continued rise in hospitalist value, hospitalist salaries rose 6% year over year. Excluding academic hospitalists, the median hospitalist compensation in this survey was $233,855 per year. The median number of annual encounters declined by 6.4% while the collections per encounter increased by 13%. This resulted in a stagnant 0.17% decline in work RVU production year over year to 4,159 wRVU per hospitalist per year. This will certainly cause adjustments in RVU compensation benchmarks for hospitalists.
I have updated this blog post on a yearly basis in 2010, 2011 and 2012 to help hospitalists understand how their income and benefit package compares with national survey data. I started my hospitalist journey in 2003 at a large community hospitalist. Ten years later I continue to provided hospitalist services as a partner in my private practice hospitalist group.
Over the years I have watched hospitalist salary trends rise with strength and conviction. This is not a mistake. Our value is being rewarded by our unique position outside third party insurance models of care. The most recent report from the publication The Hospitalist is based on 2011 SHM/MGMA data. The median financial support for hospitalists by hospitals increased to $140,204 per full time hospitalist, per year, an increase of 6.6% from the $131,564 reported in the previous survey. Confirming this continued rise in hospitalist value, hospitalist salaries rose 6% year over year. Excluding academic hospitalists, the median hospitalist compensation in this survey was $233,855 per year. The median number of annual encounters declined by 6.4% while the collections per encounter increased by 13%. This resulted in a stagnant 0.17% decline in work RVU production year over year to 4,159 wRVU per hospitalist per year. This will certainly cause adjustments in RVU compensation benchmarks for hospitalists.
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| Today's Hospitalist 2012 total compensation excluding benefits |
Why is that? Why would hospitalist income continue to rise in 2012 in the face of declining RVU production? It's the market. The hospital market is speaking loudly and it's telling us that the value hospitalists provide on the back end is greater than any RVU production number hospitalists can generate on the front end. I've written about this extensively in the past. We are worth our weight in gold.
Hospitalist medicine has left the constraints of the failed Medicare National Bank experiment and has found a partner in hospitals willing to provide payments to hospitalist groups that promise returns on investment that would make Goldman Sachs traders' mouths water.
As witnessed by the 27% rise in average hospitalist salary over the last four years, our value will continue its current trajectory until the day it doesn't. What day is that? Nobody knows except the market. That day will happen when it happens. That is exactly how it should be. If we can't bring value on the backend of the failed E/M model, then we shouldn't be valued for our contribution. Fortunately for us, we are. There is no other medical specialty that is able to fill the much needed void in hospital care that hospitalist medicine can. As such, our value will continue to grow until the market says we are no longer valued for our contribution.
I have previously purchased the salary survey report from SHM. I found it eye opening. Understanding salary and productivity data is mandatory for any hospitalist who wants to be satisfied they are getting paid what the market says they are worth. With so many variables in hospitalist income, including geographic location, size of the group and the structure of the group, studying compensation data from SHM/MGMA and Today's Hospitalist is mandatory if you want to understand what it means to your specific situation. Have a great year and I'll update this post when I see the most up-to-date data come across the wire!
UPDATE 2011: The SHM/MGMA Hospitalist Salary Compensation Survey for 2011 (based on 2010 data) was initially reported on June 15th, 2011. The national median hospitalist salary for adult internal medicine hospitalists was $220,144, up from $215,000 the year before. This represented a 2.4% increase from 2010 (based on 2009 data) Data released at the 2011 HM conference indicates current hospitalist subsidies by hospitals have continued their relentless track north, now averaging $136,400 per hospitalist, per year. That can only mean hospitals continue to see a great return on their investment. In addition, make sure to review Today's Hospitalist 2011 hospitalist salary survey results to see how rapidly the salary scene is changing.
UPDATE 2010: There's only one direction for hospitalist salary compensation these days and that is up! The 2010 hospitalist salary survey is a bit different this year in that it represents a joint effort by The Society of Hospital Medicine and the Medical Group Management Association (MGMA). I had a chance to review the summarized version yesterday from the online and interactive September 2010 hospitalist survey report at The Hospitalist. This report is based on 2009 data.
This 2010 hospitalist salary compensation survey contained the self reported results from 4,211 hospitalists in 443 hospitalist groups, a 30% increase from the bi annual SHM 2007-2008 hospital salary survey. In 2009, Today's Hospitalist gave us their 2009 hospitalist salary survey results, indicating a continued rise in hospitalist salary compensation during the depths of the greatest recession in 50 years.
And here we are in September, 2010. What is the state of hospitalist salary and compensation? It continues to make hyperbolic gains in all areas. We are doing more, billing more, billing higher fees, and making more money. A lot more money.
And here we are in September, 2010. What is the state of hospitalist salary and compensation? It continues to make hyperbolic gains in all areas. We are doing more, billing more, billing higher fees, and making more money. A lot more money.
The survey creators caution on making direct comparisons with years past. They say the survey this year is different because it contains responses from just under 1% of academic hospitalists while the SHM survey two years ago had about 25% academic hospitalist involvement. If anything, I would say that makes the 2010 survey all the more accurate for us community hospitalists. It strips out the skewed economics of academic based medicine, where physicians are often paid for providing other services as well.
Here are the key points for the 2010 SHM/MGMA salary compensation survey (based on 2009 data) for adult hospitalist medicine.
- The nationwide average for all cash compensation (not including benefits) was $215,000, a rise of 17% since the 2008 survey. By region the numbers broke down as follows
- Midwest $211,715
- Northeast $205,000
- Southeast $235,701
- West $213, 831
- Median workRVU (wRVU) per FTE hospitalist per year is 4,107, an increase of just over 10% from 2 years ago (but remember the skewed population comparison)
- wRVU per encounter was 1.86 an increase of just over 21% ( but again, we are excluding the less productive academic physicians in this survey)
- Using my own math, if you take 4,107 wRVUs/year and divide it by the 1.86 wRVU/encounter, you can see the average hospitalist saw, on average, 2,208 encounters/year.
- The collection per workRVU was $45.57 (compared with $44.97 in 2008, a 1.3% rise in two years). This number can be affected by payer mix, allowable charges, number of uninsured, aggressiveness of the billing company, and what the government defines as the value of an RVU. The current rate of payment for one RVU for a Medicare patient is about $35. Using my calculator, you can extrapolate the average work RVU collections per year per hospitalist comes out to 4,107 * $45.57, or $187,000 in unsubsidized revenue. This amount does not include RVU collections for the practice expense and malpractice expense components of the total RVU formula. If you add an additional 20% conservative estimate for collections from these components, you'll see that the hospitalist is collecting an additional $35,000-$40,000 a year, or about $220,000 in total RVU collections, per year.
- Hospital financial support (subsidy) per hospitalist per year by the sponsoring hospital rose to mean average of $111, 486. If you have 20 hospitalists in your group, your hospital, on average is providing over 2.2 million dollars in financial subsidy. What that says to me is that hospitals continue to see great value and return on their investment for implementing hospitalist groups aggressively. If you add this to the $220,000 a year in insurance and self pay collections, the average non academic hospitalist position is worth around $330,000 in total value. Subtract 10% for administrative expenses (or more if you implement the hiring of secretaries, business managers, legal and accounting expenses, RNs, PA's or APRNs to help make the practice run smoothly) and I would suggest the total compensation package of hospitalists should be around $300,000 a year.
I find these numbers encouraging. The average hospitalist position is now worth about $300,000 (if you add in collections plus hospital subsidy). This article did not describe the average number of hours worked. However, most hospitalist contracts call for an average of 40 hours of clinical duties per week. That means, if you are hospitalist looking for a second job doing hospitalist locum tenens work, you are worth about $150 an hour for your efforts, at a minimum. That's the going rate. If you aren't being paid at least $150 an hour, either the locums company is taking advantage of you, or the hospital is. You've got the data right here to prove it. It's time to start asking the appropriate questions.
With that said, I agree about not making significant comparisons between the 2008 survey and the 2010 survey. We have stripped out the skewed economics of academic medicine and now have a much more accurate evaluation of community based hospitalist economics.
UPDATE 2009: This data is a bit outdated but present it here for historical reference. I was unable to find a link to the actual survey data but was able to pull out an old blog post of mine. Here is an article from Today's Hospitalist that references the 2009 salary data.
UPDATE 2009: This data is a bit outdated but present it here for historical reference. I was unable to find a link to the actual survey data but was able to pull out an old blog post of mine. Here is an article from Today's Hospitalist that references the 2009 salary data.
- The highest total compensation occurred in the Texas, New Mexico and Arizona regions at just over $226,000 a year, a 14% increase.
- The lowest total compensation occurred in the Northeast at just over $195,000 a year, a 9% increase.
- Just over half of hospitalist salaries are a determined by a combination of salary and bonus incentives. Only 7% are 100% productivity based, or eat the eat what you kill mentality.
- The most common sign on bonus was $10,000 at 44% of respondents.
- The most common group size was 5-9 physicians at 20% of respondents
- 32% of groups used nocturnists, who's hospitalist salaries can be 10-20% or more.
- 50% of hospitalist salaries are support by the shift only model. The rest carry some call.
LINK TO E/M POCKET REFERENCE CARD POST
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