TAKE A LOOK AT hospitalist compensation trends revealed in the 2024 Today’s Hospitalist Compensation & Career Survey, and you will see that —not surprisingly—physician pay last year continued its steady climb. But not all hospitalists saw an increase from 2023 to 2024, which raises questions about how—and when—hospital medicine groups give their physicians pay hikes.
First, a look at the numbers: Nonacademic hospitalists who treat adults reported a mean 2023 income (including extra shifts) of $355,307. That’s a 4% increase over what they said they received the previous year ($341,471).
Some segments of the hospitalist market report significantly higher mean compensation including physicians who work for local hospitalist groups ($380,431) or multispecialty/primary care groups ($380,088). The Midwest was the regional winner, at least in terms of top comp, with hospitalists there saying they earn a mean of $383, 995.
While compensation trends included the fact that pay for all hospitalists as a group went up, nearly two-thirds of hospitalists (62%) said they didn’t see a raise in their pay in the previous year. That’s a number we’ve seen fairly consistently in Today’s Hospitalist survey data.
As for how—and when—hospitalists get pay increases, many groups rewarded physicians after the pandemic with double-digit hikes. But our sources say that those kinds of big pay increases now aren’t likely in the cards.
Plus, many of the hospitalist groups we talked to for this article revisit their comp plan every second or third year. Several groups said that they’re currently in an off cycle but planning on giving raises out in the next year or two.
Changing compensation every two years
James Leyhane, MD, hospitalist medical director at Crouse Hospital in Syracuse, N.Y., points out that while he and his group may adjust some compensation or incentive elements every year, they revisit the design of their compensation plan only every two years—and 2024 is their off cycle. That said, his hospital has already given out two separate 2% raises this year to all non-union employees, which includes the hospitalists.
“We are among the highest paid in our area.”
James Leyhane, MD
Crouse Hospital
Dr. Leyhane also notes that even with those raises, he and his colleagues earn about 10% less than the mean reported in this year’s Today’s Hospitalist survey. That’s because they work only 10-hour shifts, not 12 hours, and have done so since the group was first founded.
While some group members have hinted that they’d like to earn more, none has opted to start working 12-hour shifts. The main reason: While hospitalist pay in their area is less than the mean reported in the Today’s Hospitalist survey, “we are among the highest paid in our area.”
In addition to working 8 a.m.-6 p.m., the day hospitalists at Crouse also have no mandatory swing shift, another big satisfier. The two swing shift positions—6 p.m.-midnight and 6 p.m.-3 a.m., doing only admissions—are staffed on a per-diem basis by a rotating set of local chief residents and fellows, group members during their weeks off, and a handful of local physicians who are independent contractors.
Dedicated nocturnists likewise work 10 hours: 10 p.m.-8 a.m. The group pays nocturnists about 10% more than the doctors who work only days.
As for how he and his group are tweaking compensation this year, Dr. Leyhane says his group continues to lower the time threshold for when new hires can earn a higher base salary (see our article on asking How long is long enough for an experience differential?) and are thinking of ways to reward admission productivity for their swing shift (see “Hospitalist pay incentives: a look at bonuses and risk?”). Another change this year: increasing the per-diem rate the doctors who work swing shifts make.
“We just actually had to bring that rate up,” says Dr. Leyhane. “Otherwise, if you worked out the rate out per hour, those physicians would actually be taking a pay cut.”
Pay differential for working in a rural hospital
At Kettering Health in Kettering, Ohio, Ashlee Ames, MD, medical director of the hospitalist group that covers three network hospitals, explains that group members who work in the two larger hospitals have a standard day and a standard night contract.
“The last raise we got was in 2022 and it was pretty hefty.”
Ashlee Ames, MD
Kettering Health
“But at the third hospital, which is more rural, we have what we call a procedural hospitalist model,” Dr. Ames explains. Unlike their colleagues in the other two hospitals, those physicians are in charge of rapid response codes, intubations and minor procedures, and they run a four-bed ICU.
The procedural hospitalists earn a base salary above what the doctors at the other two campuses earn. Meanwhile, physicians working nights in the group also make more than their day-time colleagues. All of the doctors work seven-on/seven-off for a total of 182 shifts a year.
As an interim comp adjustment, Dr. Ames intends to raise the group’s moonlighting/per diem rate before the end of this year. “We can do so without changing our base compensation or our contract,” she says.
As for their overall comp plan, she and her colleagues typically renegotiate that every two or three years. But she doesn’t plan to revisit comp until next fall
“This next adjustment will actually be a four-year gap, and then we’ll move to a standardized two-year cycle of contract negotiation,” Dr. Ames says. “The last raise we got was in 2022 and it was pretty hefty.” She doesn’t expect the group’s next raise to be as large.
“I do not expect the same 8% increase we’ve been experiencing in the past. That curve might be flattening a bit.”
Hardik Vora, MD
Riverside Regional Health System
In Newport News, Va., Hardik Vora, MD, hospital medicine medical director at Riverside Regional Health System, is already on a schedule that revisits hospitalist compensation every other year.
He and his group members received a significant raise in 2021. That’s when everyone’s base compensation was boosted 8% to make recruiting go more easily.
The group’s most recent adjustment was in January 2024 when they received a similar total raise—but the amount was split between base salary and performance-based bonuses.
At the same time, says Dr. Vora, he doesn’t believe his group’s next raise will be that large. “I do not expect the same 8% increase we’ve been experiencing in the past,” he says. “I think that curve might be flattening a bit.”
Pay adjustments
Hospitalist Kimberly Bell, MD, MMM, regional medical director of TeamHealth West Group, points out that TeamHealth does not have regularly scheduled compensation adjustments. However, Dr. Bell manages three hospitalist programs—one in Hawaii, the other two in Washington state—and two of those three programs had their comp adjusted in the past year. She is now in the process of adjusting comp upwards at the third hospital, which is more rural.
“We’re looking at comp there this year,” says Dr. Bell. “We need to make sure it is competitive so it won’t have an impact on our ability to recruit.”
But as Dr. Bell points out, her group members aren’t pressuring her around compensation.
“Compensation is increasing, but provider satisfaction and engagement are not necessarily going up at the same rate.”
Kimberly Bell, MD, MMM
TeamHealth West Group
“Compensation is increasing, but provider satisfaction and engagement are not necessarily going up at the same rate,” she says. “It turns out that compensation is not the No. 1 factor but the work environment, clinicians’ feelings of recognition and appreciation, as well as support in terms of wellbeing.”
To address those needs, says Dr. Bell, TeamHealth provides a host of services: a wellbeing panel, free therapy sessions for providers and their family members, and legal services. “We’re really doubling down.”
Dr. Bell also notes how rapidly physicians’ work environment is changing. Hospital reimbursement continues to be constrained, and “our provider workforce is aging,” she points out. While hospital medicine remains one of the youngest specialties, “we are right at the point where we’re seeing hospitalists retire.” At the same time, many practices are expanding their scope of practice and changing the skills of their workforce mix.
“We are seeing a lot of NPs and PAs coming into hospital medicine, and that helps with the overall costs,” says Dr. Bell. “It also improves our manpower because we simply don’t have enough docs for all the places that need them—and compensation alone won’t fix that.”
Related articles:
Hospitalist pay incentives: a look at bonuses and risk
Paying hospitalists for experience: a look at retention bonuses
Hoping for a big pay raise? This may not be the year
Phyllis Maguire has been Executive Editor of Today’s Hospitalist since 2006. Based in Bucks County, Pa., her health care interests are hospital medicine and long-term care options. She also likes zydeco, hiking, and reading memoirs and romances.
