After over 13 years of hospital medicine practice in various community and academic facilities, this year I joined the hospital medicine team at my local veterans hospital in a part-time capacity. Beyond the shock to my system inflicted by the bureaucracy inherent to the VA, it is such an honor to care for these selfless service men and women. From the veterans of the Vietnam War who willingly detail their various tours of duty, to the young injured soldiers of our current or recent conflicts, they all have a tale that begs us to pause. Recently, I cared for a 38 year-old veteran who did two tours in Afghanistan and after having a rather challenging time reacclimating to everyday life he reenlisted for another tour. Unfortunately, his story is one dripping with tragedy since on this third tour he was the sole survivor of an IED blast that killed his fellow soldiers and left him with traumatic brain injury. He is now bed bound, unable to verbally communicate, obtaining all his nutrients via feeding tube, dependent on caregivers at the VA nursing home. I highlight this story as a reminder to all of us that everyday our veterans make such…

Over the past decade, the number of non-physician providers (NPPs) practicing within hospitals has increased dramatically, especially in hospitalist programs. This is largely due to the increased demand for streamlined inpatient medical care and an inadequate supply of physicians. Additionally, the fact that the cost of hiring NPPs is just a fraction of the cost of hiring physicians certainly adds incentive for programs nationwide to embrace the practice. The lack of consensus regarding the proper use of NPPs, however, is widespread and concerning.  Hospitals—and hospitalist programs in particular— must strive toward a more structured collaboration between physicians and NPPs. While each hospital is unique and therefore requires specific staffing and scheduling solutions, there are some common characteristics of programs that have successfully integrated NPPs. Here are the “Top 10 Keys to Success”: 1.    Avoid assigning NPPs to clerical tasks that absolutely do not match their skill sets 2.    Focus on great patient care and involve the NPPs as partners in the process3.    Insist on CME maintenance and participation in didactics4.    Recognize the NPP as a provider and, as such, insist on a mutually respectful work environment 5.    Provide a thorough orientation process to build strong relationships and trust among all…

On June 28th, the US Supreme Court voted to uphold the Patient Protection and Affordable Care Act (PPACA). The 5-4 decision likely satisfied a few eager constituents, but many people (including physicians) are still unaware of the actual provisions in this law. The ruling created more points for discussion since it was based on Congress’ authority to impose a tax penalty on some people who choose not to purchase health insurance. All this controversy notwithstanding, the ACA was ruled constitutional. Healthcare providers need to therefore make every effort to understand its implications as we strive to be better patient advocates. The expansion of Medicaid was also a noteworthy point in the Supreme Court ruling. The court affirmed the constitutionality of this ACA provision for people with incomes up to 133 percent of the federal poverty level – with a caveat that limits the federal governments ability to terminate existing Medicaid funding to states that choose to opt out. Since most of us providers have difficulty simply keeping up with our journal reading, I doubt our schedules will permit a page-by-page review of the PPACA law – it is over 900 pages. Fortunately, the Henry J. Kaiser Family Foundation released a…

Many surveys indicate that hospitalists whose compensation is mostly based on productivity have a higher total compensation and, for that matter, higher productivity. Hospitalists, especially those who are employed, are unwilling to accept compensation that is mostly based on productivity, in spite of survey evidence indicating their potential for greater financial rewards. Try to strike a happy medium that satisfies physicians' need for a base salary while allowing some compensation to remain at risk. That will help to drive desired behaviors, such as increased productivity, increased patient satisfaction survey scores and improved performance on other various hospital initiatives. One place to start would be setting the base salary between 75% and 80% of the total estimated compensation. The remainder should be based on incentives that are aligned with organizational goals. For information on how Medicus Consulting Services can help you design a competitive compensation package for your market, please fill out this short form to Request a Call from one of our consulting physicians.  

Over the past decade, organizations such as SHM, MGMA and Today’s Hospitalist Magazine have conducted surveys that give both prospective employers and hospitalists a glimpse of the national hospitalist marketplace. These reports indicate national and regional data including hospitalist activity, work type, workload and productivity. The data is very important for establishing general trends and ranges, but the question remains: What can an employer do to attract and retain qualified hospitalists? One very important and impactful element is the compensation package, but the decision-makers in hospitalist programs should do their due diligence in seeking out comparables. Each program has so many unique aspects that even after a careful review of the local market and regional data, programs must exercise caution when interpreting those figures. How to compare? First, what is the key clinical and non-clinical hospitalist duties required in a new (or reorganized) service? What will each hospitalist's job look like in year 1, 2, 5 and beyond? Next, review the available surveys that give details of hospitalist activities, and try to pinpoint the most pertinent categories and survey results that apply to your institution. Then, make every attempt to investigate the local market. This is easier said than done…