The employment market for hospitalist physicians remains competitive, despite the fact that 30,000 are already working in the United States healthcare industry.
According to one hospitalist firm, saturated regional markets such as Seattle and Chicago rank high on the desirability scale with many hospitalists, and those markets are getting tighter.
“There are tons and tons of middle-sized markets and even more smaller markets that are scrambling to fill hospitalist positions,” said Kirk Mathews, CEO of Inpatient Management, a St. Louis-based hospitalist firm. “It’s not just a shortage issue, but a mal-distribution issue.”
Programs such as medical school loan forgiveness and the use of foreign hospitalists are only a short-term fix for markets short on hospitalists, according to Mathews. Incentives included in the healthcare reform bill aren’t enough to persuade medical students to become hospitalists and practice in needy areas, he said.
Hospitalist physicians are either employed by hospitals, belong to hospitalist group practices or work for hospitalist management firms like Inpatient Management or Brentwood, Tenn.-based Cogent Healthcare.
Market demand is generally outpacing supply, Mathews said.
The predominant model is direct employment by hospitals, he said. Within the various employment categories, there are multiple types of compensation plans. Independent private practices tend to use a fee-for-service model and those who are hospital-employed are most likely to receive a base salary plus incentives.
"State of Hospital Medicine: 2010 Report Based on 2009 Data," released last week by the Medical Group Management Association and the Society of Hospital Medicine, showed that hospitalists receiving 50 percent or less of their compensation as fixed base salary reported the highest median work relative value units (wRVUs) at 5,407, compared to colleagues.
The survey also revealed that hospitalists who received 51 percent to 70 percent of their compensation as base salary performed 4,591 wRVUs, compared to 3,859 wRVUs for hospitalists who received 71 percent to 90 percent of their compensation as base salary.
“One of the concerns I have is that there could be a lot of hospitals thinking that they can shift more of hospitalist pay into incentive-based payments and lower base salary, but this still has the potential for unintended consequences,” said Mathews.
Initial savings can be generated by an increase in efficiency, he said. But if a physician is compensated on productivity, increased efficiency can reduce his or her own income while simultaneously putting more money in the pockets of the hospital.