IN HOSPITAL MEDICINE, it’s generally been true that the more patient encounters hospitalists have, the more money they earn. While that still generally holds true in our 2023 survey results, this year’s data show some interesting wrinkles in the relationship between patient volume and hospitalist pay.
To start, the biggest group in our survey, which is hospitalists who see 15-17 patient encounters per shift, reported earning $340,740. That’s an increase of nearly 4%, or $12,734, over last year’s mean compensation. It’s impressive when you consider that pay for all adult hospitalists rose only 0.6%, or about $2,000, in our 2023 survey.
Hospitalists with the highest patient volume—those having 21 or more patient encounters per shift—reported the highest income, with an average of $346,625. That confirms a trend we’ve seen in 15-plus years of tracking hospitalist compensation.
There’s a new wrinkle in this year’s data, however: Hospitalists with 21 or more patient encounters a shift aren’t being paid as much extra as in previous years.
Between our 2022 survey to our 2023 survey, for example, that group of hospitalists saw their pay drop 12%, or almost $47,000, from the $393,538 they reported in 2022. The bottom line: While hospitalists having the most patient encounters still earn more than everyone else, the pay gap shrank this year.
The impact of new regulations?
Why? It’s always possible that the compensation figures we’re reporting this year are a blip and will reverse themselves in next year’s survey. But our data offer some clues that may explain why high-volume hospitalists saw their pay shrink.
For one, hospitalists who work for national hospitalist management companies are the most likely to have 21-plus patient encounters per shift. While adult hospitalists reported having an average of 16.4 patient encounters per shift, their colleagues at national companies like Envision and TeamHealth say they have an average of 18.9 patient encounters per shift. That’s a 15% difference.
We also know from this year’s survey that hospitalists working for national hospitalist management companies reported lower compensation this year. Pay for these hospitalists dropped $4,790, or 1.4%, in our 2023 survey to a mean of $334,828. (For more details on how hospitalist pay varies by type of group, see our analysis on the Today’s Hospitalist website.)
National hospitalist management companies have been having high-profile problems lately, in part because of changes in the laws regulating surprise billing. It’s possible that the drop in pay among hospitalists working at national management companies is connected to a drop in mean compensation for those physicians, a cohort that happens to have the highest number of patient encounters per shift among different employment types.
Compensation changes by geography may also explain flagging pay for high-volume hospitalists.
In the Southwest, hospitalists reported an average of 17.7 patient encounters per shift, which is 8% higher than the mean reported by all adult hospitalists.
But hospitalists in the Southwest reported a drop in income from our 2022 results of 7.7%, or $27,395. That may be another indication that high-volume hospitalists aren’t seeing their pay increases keep pace with their additional patient encounters.
Look at more data on hospitalist pay at our 2023 Today’s Hospitalist Compensation & Career Survey coverage.
The effect is worse when you add in the fact that taxes are progressive.