How will the economy affect hospitalist salaries?

It’s been said that hospitalists are the fastest growing specialist field in the history of medicine.

Hospitals are constantly recruiting, and the increasing demand is continually pushing salaries up. But, in the midst of the current recession, what does the future hold?

Writing in Today’s Hospitalist (via Dr. RW), Erik DeLue predicts that salaries are likely to plateau, or even fall. Most hospitals run these programs at a loss, and there is a danger that as margins continue to be squeezed, some hospitals may conclude that it’s not worth the financial burden.

It will be interesting to see what will happen if hospitals decide to disband their hospitalist programs. Will outpatient doctors now be required to take care of their inpatients?

I assume there’s no other choice. However, under that scenario, consider that most of these doctors have been away from hospital medicine for years. Such an erosion of skills may endanger patients, lengthen patient stays, and reduce these physicians’ outpatient productivity.

I don’t think that hospitals are willing to take that chance. So, as long as it continues to be a buyer’s market, hospitals are going have to live with their skyrocketing salaries.

Comments

The Happy Hospitalist
With well run hospitalist programs, the savings alone in length of stay would be economic suicide to disband. Hospitalists are in a sweet spot. They are in demand because they impact every aspect of hospital dynamics from nursing satisfaction and recruitment to patient satisfaction to specialist satisfaction to primary care satisfaction to financial satisfaction to coding and billing satisfaction to quality initiative satisfaction.
In fact, without hospitalists in many hospitalis, the loss in payment due to quality coding initiatives alone would be financial suicide.
Hospitalists play the game. And they play it well. It’s darn near impossible to get rid of the engine that makes the wheels work.
Bad Medicine, Good Solutions
Don’t kid yourself. Outpatient docs are more than capable of stepping up to the plate. They are where they are because of the very system that’s growing hospitalists.
As more and more hospitals run into the red they will see their salaried employees as tasty opportunities for cost savings. They won’t subsidize their salaries forever. As for the contracted groups, they will be saddled with more bureaucracy and decreasing salary just like everyone else. The BS threshold will make new graduates ask themselves which is the better choice – outpatient/inpatient/traditional practice. It won’t always be a clear cut decision.
Outpatient medicine, or a traditional practice, still affords autonomy. It also allows cash only practices.
The hospitalist bubble is about to cap.
Anonymous
The budgets have to be met. If it came to cutting CEO pay or hospitalist subsidy, I will bet which one will go first. They can always hire midlevels to be hospitalists (administrator’s opinion, not mine). In fact, from an administration standpoint, the midlevel will likely be less willing to challenge authority and would certainly be willing to make less. One could even argue that they get along better with the nursing staff.
I’m not sure that we have quantified the $ from correct coding initiatives. In fact, as far as I know, there is no consensus that the data support the hypothesis that hospitalists save money. I’m happy to be proven wrong though.
Anonymous
I am a fan of Happy, his blog is excellent.
However, his model of hospitalist medicine sure does promise a lot of satisfaction to many different people.
In my neck of the woods, I must be the family practice equivalent of Mick Jagger; as far as hospitalists go, I can’t get no satisfaction. In fact, they stink.
There is no substitute to the patient’s primary care doctor providing care to them while they are at their sickest. Any alleged cost savings or quality improvements are pure hyperbole.
Show me the data. Good data. Not cooked data.
The truth is that the hospitalist model is a bad solution to a big problem, that being the strain on primary care by the current reimbursement model. Let’s not settle for a bad solution; lets look for a good solution.
A family practitioner
The Happy Hospitalist
Anon. Remember, I said a well run hospitalist program. Bad programs are expendable because they bring no intrinsic or intangible value. I work in a well run hospitalist program. The day my value runs out is the day I move on.
Anonymous
Happy:
In my neck of the woods, the phrase “well-run hospitalist program” is an oxymoron.
Family practitioner
Slightly Disgruntled Hospitalist (but becoming less so)
to the family practitioner who has only bad experiences with hospitalists: If you admit your own patients, you shouldn’t have to deal with hospitalists at all. Just admit your own and the occasional un-doctored and you never have to speak to us. Where I work, some of the community docs do just that. Many do not. And the number that don’t admit is increasing all the time. If all of a sudden, they decided to reapply for priveleges, I would be out of a job. But that doesn’t seem to be happening anytime soon.
But, as you have said before – communication is key. Do you have an EMR that works with the hospitals? Can the hospitalist get information from you on nights and weekends? That is my biggest frustration in admitting some doctors’ patients – I can’t get any info. Almost all of the PCPs I call though are happy to hear from me and say the hospitalists never call them. That is sad…
Anonymous
In my neck of the woods, I never see a family practitioner actually admit their own patients.
Anonymous
I do admit my own patients. My experience with hospitalists includes the following:
1) when my patients are admitted to a neighboring hospital. I NEVER hear from the hospitalists when this happens, neither upon admission nor discharge.
2) in my own hospital, I receive, and resist, pressure from administration to utilize the hospitalists.
3) I have to endure the false mantra that hospitalists decrease costs and improve quality. As I requested in another response, please show me the data. I know that some studies may have shown this, but many others have not.
In summary, just as we regret the day that the first doctor agreed to accept payment from the first HMO, therefore opening the pandora’s box of third party payment, we will rue the day that primary care doctors gave up caring for their sick patients, under the illusion that it was neither profitable nor “quality.” The less we do, the more easily replaced we are.
A family practitioner
Sharon
Why do people keep holding on to the idea that hospitalists are cost-effective despite a large study that does not support this conclusion? If you look at the confidence intervals in this study, you find that the evidence is simply not there.
http://www.ahrq.gov/research/may08/0508RA17.htm
The Happy Hospitalist
Sharon. My Hospitalist program blows those numbers out of the water. Perhaps there are few well run hospitalist programs, at the least ones being researched.
jb
Good. Fast. Cheap.
Pick any two.
That’s been true in medicine forever.
Hospitalists can be worth their salaries because good and fast can equal cheap, if they don’t cost too much to keep on staff.
If their salaries go up further, they won’t be cheap (i.e., cost effective), no matter how good they are, or how much time they save. In my experience, there are some good and fast ones, and Happy very likely is one of them (to hear him say it, in any event), but many are good but not fast, or fast but not good. A few are neither, but they don’t get rehired.
It will also get realized at some point that the cost of an extra day in the hospital is not as high as the UR people and administrators seem to think. When an extra day is tacked on to a stay, the cost is meals and meds and 1/6 of a nurse. It’s not a trivial cost, but hiring a crew of hospitalists at $250K can add up in a hurry also.
Anonymous
JB,
You forget that the cost of the extra day is the opportunity cost of the admit that got turned away. That’s the important value an efficient inpatient (primary care or hospitalist) physician brings to the hospital’s budget.
It’s becoming a moot point whether hospitalists are more efficient. As primary care slowly dies , our inpatient skils are being abandoned in hopes of keeping the office solvent a little longer. Many primary care docs couldn’t return to the hospital at this point. It sucks but the alternative for many of us is to go bankrupt.
Sharon
Happy, with all respect to your program, I think it’s far from the majority. I think it’s great that you can show that your own hospitalist program has results in your particular community setting, but when we look overall, we really don’t find the evidence to be there. Meanwhile hospitals are hiring hospitalists left and right, on the assumption (based on some smaller studies) that they will save money. Another thing that I do not think these studies look at enough is patient satisfaction, doing tests again that may have been done before, (one might argue that cost of stay is a proxy indicator of this, but given the way hospital stays are reimbursed I don’t think it’s an appropriate measure), exposing patients to radiation, etc. Obviously all of this would be very hard to tease apart, but I think the hospitalist movement does not have the ammunition to back up its claims that it leads to cost savings.
That being said, I would be very interested to know more about the data you’ve collected at your institution, because in the end I’m in favor of the most efficient, safe, and affordable ways to take care of patients.

How will the economy affect hospitalist salaries?

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