Hospitalist Career Insights

James Ratliff M.D.Ochsner Medical Center – Baton RougeChief of MedicineMedical Director – Hospital Medicine

Anne BrewerResidency Relations SpecialistTeamHealth Hospital Medicine

Objectives

Hospitalist Definition Hospitalist History Discuss Hospitalist Workforce Facts Discuss Physician Workforce Facts Discuss the Hospitalist Recruiting

Considerations Discuss the Hospitalist Recruiting Challenges Factors Influencing Physician Career Decisions Factors Influencing Physician Recruitment Hospitalist Role What We Like / What We Hate TeamHEALTH Residency Stipend Program Things To Think About

What is a Hospitalist - SHM Hospitalists are physicians whose

primary professional focus is the general medical care of hospitalized patients. Their activities include patient care, teaching, research, and leadership related to Hospital Medicine.

A Little Hospitalist History The term was first used in 1996,

when there were only a few hundred doctors in this field.

“Hospital Medicine” is the fastest growing medical specialty.

More than 30,000 hospitalists practice in U.S. hospitals.

Hospitalist Workforce Facts

Growth of Hospitalists

¨ 1997 23¨ 1999 800¨ 2000 1400¨ 2001 1750¨ 2002 3508¨ 2003 4076¨ 2005 12,000+¨ 2010 30,000+

Hospitalist Workforce Facts

Hospitalist Workforce Facts

Hospitalist Workforce Facts

Hospitalist Workforce Facts

RegionNorth/Midwest – 27%South – 26%East – 24%West – 22%Surrounding areaLg. urban (over 1 mill.) – 49%Sm. urban – 33%Rural – 18%Employment modelHospital – 34%Acad. institution – 20%Mgt. Co. - 19% Local hospitalist only – 12%

Hospitalist Workforce Facts

AgePhysician leader – 41 years oldNon leader – 37 years oldGenderPhys.leader-80% male, 20% femaleNon leader-62% Male, female 38%

Median years as a hospitalistLeader – 5.1 yearsNon leader – 3 years

Hospitalist Workforce Facts

Control/Hospital governance of affiliated hospitalNot for profit – 86%For profit – 10%Government – 3%

Teaching status of affiliated hospitalNon-teaching – 48%Major teaching– 28%Other teaching – 25%

Hospitalist Workforce Facts

Characteristics of Hospitalist Management Groups

Education (Percent graduates of U.S. medical school)Physician leaders – 85%/ Non leaders – 72%

Specialty trainingGen. Int. Med. – 75%Pediatrics – 11%Int. Med. Sub. – 4%FP – 3%

Physician Workforce Facts

According to the AMA:

67% of physicians are over the age of 42 (Boomers) 18% are 61 years of age or older 49% are between 42 and 60 years of age 88% are male

33% of physicians are between 27 and 41 years (GenX) 58% are male/ 42% female

54% of new medical school graduates are female (Millennials)

Physician Workforce Facts

While the number of physicians will increase from 781,200 FTE’s in 2000 to 971,800 in 2020 (a 24% increase), after 2015 the rate of the population growth will exceed the rate of physician growth

The US census bureau estimates between 2005-2020:

The projected population less than 65 years old will grow 9%

The projected population 65 and older will grow 50%

Keep in mind the elderly use much more services representing a significant increase in demand for physician services….

Physician Workforce Facts

What about physicians exiting medicine?

The AAMC ‘s Third Annual Physician Workforce Conference findings indicate that:

  One out of three doctors over 50 would retire today if they could afford to do so Older physicians cite increased regulation of medicine as the key factor

influencing retirement plans

Two out of three, or 66 percent of doctors under 50, are not interested in working longer hours for more money

Seventy-one percent of young doctors identify having family and personal time as an important factor in a desirable practice.

Physician Workforce Facts

What about physicians entering medicine?

A review of physician and recruiting initiatives by Merritt, Hawkins and Associates indicated:

The top five specialties by growth 73% - Hospitalists 54% - Pediatrics 43% - OB-GYN 31% - Hem/Onc 18% - Family Practice

 

Physician Workforce Facts

Reasons physicians voluntarily leave a practice: (Source: 2006 Retention Survey from the American Medical

Group Association (AMGA) and Cejka Search)

51% - Poor cultural fit Relocated to find a better community fit was mentioned 20% of the

time 42% - Family considerations To be closer to own or spouse’s family and spouse’s job required

relocation was mentioned 22% of the time

32% - Leaving to seek higher compensation Incompatible work schedule and excessive call schedule each

mentioned 17% of the time.

Hospitalist Role Considerations

Salary Practice model Work hours/Call schedule Daily workload Expectations/Demands from hospital Medical staff support

Specialty providers Referral network

Hospital administrative support Program staffing/Program stability Empowerment and career path Community and practice culture Hospital culture and systems

Hospitalist Roles

Where are hospitalists located?

Critical access hospitals Community hospitals Major medical centers Teaching programs Involved in basic and clinical research Administrative leadership positions (CEO, Medical Director, VPMA) Medical staff leadership (Chief of staff, Department chair, QA Director) Involved in medical policy making and patient advocacy (quality and

safety initiatives) Creating evidence-based clinical guidelines and protocols Developing surgical co-management programs Developing palliative care programs

Hospitalist Pool

Where do we come from? New graduates Internal medicine, IM/Peds, Family medicine, Pediatrics

Hospitalist fellowship programs/Hospitalist tracks Sub-specialty training programs (e.g. Intensivists, pulmonary,

cardiology) International medical graduates (IMG’s)

Established hospitalists in other programs Established physicians in non-hospitalist practices (e.g.

private or hospital practice) Emergency Department physicians Locum Tenems

Physician Workforce Facts

Turnover ratios

(Source: 2006 Retention Survey from the American Medical Group Association (AMGA) and Cejka Search)

6.7% - Total average turnover (6.4% in 2005)

By sex Males: 6.85% (5.9% in 2005) Females: 6.6% (7.5% in 2005)

The first three years in practice hold the greatest likelihood for turnover

12% - First year 46% - In the first three years 23% - Greater than ten years

Factors Influencing Physician Career Decisions

Changing culture Limited resident work hours Growing ratio of women entering the medical profession Increasing male participation in the household Graduate debt burden Generational (X, Millennial) expectations

The new generation of doctors may view the medical profession as a job and not a calling….

Factors Influencing Physician Satisfaction and Retention

Health Care Reform Changing focus of the specialist

Consultant role Procedurist orientation and training

Aging physician workforce

Practice scope Medico-legal concerns Employment model

Hospitalist vs Specialist vs PCP

Whats The Right Choice

Hospitalist Role- What We Like Block Schedule No Call Excellent Salary RVU Based Bonus Corporate Protections Limited Staff Issues Limited Business Issues

Hospitalist Role – What We Hate

Working for Somebody Else When on Shift – Long Hours Highest Acuity Patients People Die Surgeons Orthopedic Docs Heme Onc Docs ED Docs ………You get the point

TeamHEALTH Residency Stipend Program

PGY3 Internal Medicine Residents are eligible to participate

Requires a TeamHealth agreement to work after completing an IM residency

A 2 year post-graduate commitment $1,000 /MONTH stipend PAID DURING

RESIDENCY This program is location / practice specific

Things to Think About

Your Job Satisfaction will be affected by many variables: Geography Economics Workforce supply Population demographics Generational expectations Practice and workplace culture Presence of a hospitalist program Communication Collegial support Medico-legal landscape Community fit, family integration and satisfaction Potential for professional growth Practice flexibility and call Life style requirements

More Things to Consider

Your Opportunities are affected by many variables including:

Number of medical school graduates Number of residency programs and seats Number of international medical graduates Government policy Health of the U.S. economy Insurance Specialty choice Physician productivity Work schedules Number of FTE’s New medical technologies Aging physician population/retirement patterns Growing and aging patient population Utilization of mid-level providers

Concluding thoughts….

Your Path is Unique – One size Doesn’t fit All

Money Only Matters When You Don’t Have Any

Find a Place to Work that Feels Like Family

Call Me if I can Help

Contact information

James Ratliff MD – Chief of MedicineOchsner Medical Center – Baton RougeEmail address: jratliff@ochsner.orgPhone: 225-209-5932

Anne BrewerResidency Relations SpecialistTeamHealth Hospital MedicineEmail address: Anne_Brewer@teamhealth.comPhone: 865-985-7177

References

1. SHM 2005 - 2006 Survey.2. Physician Supply and Demand: Projections to 2020. U.S. Department of Health

and Human Services. Health Resources and Services Administration. Bureau of Health Professions. October 2006.

3. Physician Workforce Policy Guidelines for the United States, 2000 – 2020: Sixteenth Report. U.S. Council on Graduate Medical Education. U.S. Department of Health and Human Services – HRSA. January 2005.

4. Coile, Jr., Russell C. “10 Factors Affecting the Physician Shortage of the Future - Next!” Physician Executive, Sept-Oct, 2003.

5. Full, James M. “Physician Recruitment Strategies for a Rural Hospital.”, ache.org,, 6. Westfall, Carol. “Strong Physician Recruitment and Retention”, Physicians News

Digest, January 2004.7. 2006 Retention Survey from the American Medical Group Association (AMGA)

and Cejka Search.8. Third Annual AAMC Physician Workforce Research Conference, May,

2007.<http:\\AAMC Physician Workforce Research Conference.htm.9. Cohen, Jordan J. “Physician Workforce Trends and Expectation.” Association Of

American Medical Colleges. December 21, 2006.

References

10. Strategies for Recruiting and Retaining Top Hospitalists. Hospitalist Management Advisor. May, 2007.

11. Pratt, Mary K. “On the wards: Hospitalists Steadily Bolster Their Ranks”, Boston Business Journal - March 24, 2006.

12. Lurie, J.D., Miller, D.P., Lindenauer, P.K., Wachter, R.M., Sox, H.C. “The Potential Size of the Hospitalist Workforce in the United States”, The American Journal of Medicine® 106 (4) (1999) pp. 441-445.

13. Holton, Lisa. “Put More Than Money on the Table When Recruiting Hospitalists”, ACP Hospitalist. February, 2007.

14. 2007 Physician and Recruiting Initiatives Survey by Merritt, Hawkins and Associates.

15. Dichter, Jeffrey R., Simone, Kenneth G., Tools and Strategies for an Effective Hospitalist Program (HCPro: MA., 2006).

16. Cooper, Richard A., Stoflet, Sandra J., Wartman, Steven A. “Perceptions of Medical School Deans and State Medical Society Executives About Physician Supply”, JAMA. 2003;290:2992-2995.

17. Cooper, Richard A., Getzen, Thomas E., McKee, Heather J., Laud, Prakash. “Economic And Demographic Trends Signal An Impending Physician Shortage”, Health Affairs. Vol. 21, Number 1. Project Hope, 2002. 140 – 154.

Physician Recruitment and Retention

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