From the Society

The state of hospital medicine in 2018

Productivity, pay, and roles remain center stage


In a national health care environment undergoing unprecedented transformation, the specialty of hospital medicine appears to be an island of relative stability, a conclusion that is supported by the principal findings from SHM’s 2018 State of Hospital Medicine (SoHM) report.

Leslie Flores, MHA, SFHM, partner, Nelson Flores Hospital Medicine Consultants

Leslie Flores

The report of hospitalist group practice characteristics, as well as other key data defining the field’s current status, that the Society of Hospital Medicine puts out every 2 years reveals that overall salaries for hospitalist physicians are up by 3.8% since 2016. Although productivity, as measured by work relative value units (RVUs), remained largely flat over the same period, financial support per full-time equivalent (FTE) physician position to hospitalist groups from their hospitals and health systems is up significantly.

Total support per FTE averaged $176,657 in 2018, 12% higher than in 2016, noted Leslie Flores, MHA, SFHM, of Nelson Flores Hospital Medicine Consultants, and a member of SHM’s Practice Analysis Committee, which oversees the biennial survey. Compensation and productivity data were collected by the Medical Group Management Association and licensed by SHM for inclusion in its report.

Figure 1. Compensation and productivity

These findings – particularly the flat productivity – raise questions about long-term sustainability, Ms. Flores said. “What is going on? Do hospital administrators still recognize the value hospitalists bring to the operations and the quality of their hospitals? Or is paying the subsidy just a cost of doing business – a necessity for most hospitals in a setting where demand for hospitalist positions remains high?”

Andrew White, MD, FACP, SFHM, chair of SHM’s Practice Analysis Committee and director of the hospital medicine service at the University of Washington Medical Center, Seattle, said basic market forces dictate that it is “pretty much inconceivable” to run a modern hospital of any size without hospitalists.

Dr. Andrew White, University of Washington, Seattle

Dr. Andrew White

“Clearly, demand outstrips supply, which drives up salaries and support, whether CEOs feel that the hospitalist group is earning that support or not,” Dr. White said. “The unfilled hospitalist positions we identified speak to ongoing projected greater demand than supply. That said, hospitalists and group leaders can’t be complacent and must collaborate effectively with hospitals to provide highly valuable services.” Turnover of hospitalist positions was up slightly, he noted, at 7.4% in 2018, from 6.9% in 2016, reversing a trend of previous years.

Figure 2. Unfilled hospitalist positions

But will these trends continue at a time when hospitals face continued pressure to cut costs, as the hospital medicine subsidy may represent one of their largest cost centers? Because the size of hospitalist groups continues to grow, hospitals’ total subsidy for hospital medicine is going up faster than the percentage increase in support per FTE.

How do hospitalists use the SoHM report?

Dr. White called the 2018 SoHM report the “most representative and balanced sample to date” of hospitalist group practices, with some of the highest quality data, thanks to more robust participation in the survey by pediatric groups and improved distribution among hospitalist management companies and academic programs.


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