State of Hospital Medicine: Nationwide Demand Continues for Hospitalists

Findings from SHM’s Bi-Annual Survey Report Show Increasing Roles of Family Medicine Physicians, Nurse Practitioners and Physician Assistants in Hospital Medicine

The demand for hospitalists continues to grow and many hospitals and hospital medicine groups are responding by hiring more physicians trained in family medicine, nurse practitioners and physician assistants and others to care for hospitalized patients, according to the new 2014 State of Hospital Medicine Report, published today by the Society of Hospital Medicine.

The use of nurse practitioners (NPs) and physician assistants (PAs) in hospitalist programs serving adults has risen by nearly 12 percentage points since the last State of Hospital Medicine Report in 2012. In 2012, 53.9 percent of hospital medicine groups reported employing NPs or PAs; this year, it rose to 65.5 percent.

In addition to the increase of NPs and PAs in the specialty, more work is being done by hospitalists trained in family medicine. Nearly 60 percent of hospital medicine groups serving adults had at least one physician trained in family medicine. The median physician wRVU (work relative value unit – a measure established by Medicare to represent work conducted by hospitalists) for family medicine hospitalists increased by 14.7 percent to 4,283 since 2012.

Nocturnists – hospitalists specializing in caring for patients during the night – have also emerged as a growth specialty within hospital medicine. Now, more than eight in ten adult hospital medicine groups now report using a nocturnist in their practice, compared to just over half in 2012.

“This year’s report reflects the continued growth and dynamism of the hospital medicine specialty,” said Tierza Stephan, MD, SFHM, chair of the SHM Practice Analysis Committee, which develops the report. “The demand for hospital-based clinicians to provide inpatient care has truly shaped the inclusive nature of hospital medicine. Hospitalists and executives working in hospital medicine should use these findings to improve and grow their practices and compete in a still-developing marketplace.”

Published biannually, the 223-page 2014 State of Hospital Medicine Report provides the most comprehensive data available on hospitalist productivity, compensation, scheduling and practice models – all examined through different lenses focusing on group types, locations and populations served. The data in the report are based on nearly 500 responses from hospital medicine groups representing more than 6,000 hospitalists.

The report is available in print and electronic formats for purchase at www.hospitalmedicine.org/survey. 

Other findings from the report include:

• Hospital medicine groups are growing. The median number of full-time physicians in an adult hospital medicine group was 10, up from 9.2 in the 2012 Survey. Pediatric hospital medicine groups grew to 6.4 full-time physicians, up from 5.0 in 2012.
• Hospitalists are doing more. The percentages of adult hospitalist groups doing other inpatient services include: medical co-management (89.1 percent), surgical co-management (87.0 percent), care of patients in an ICU (69.7 percent), nighttime admissions for other physicians (57.1 percent), responsibility for an observation/short stay unit (51.7 percent), responsibility for the rapid response team (45.3 percent) and responsibility for the code blue team (42.4 percent). Hospitalists are even expanding to responsibilities outside the inpatient environment with 25.4 percent of groups seeing patients in post-acute care facilities and 13.3 percent doing some outpatient care.
• Hospitalist compensation is increasing. Over the past two years, compensation for non-academic adult hospitalists increased from $233,855 to $252,996 (8.2 percent). For non-academic pediatric hospitalists it increased from $178,885 to $195,832 (9.5 percent).
• Physicians are staying with their practices. The median turnover of physicians in hospitalist group treating adults was 8.0 percent, with 38.1 percent indicating no physician turnover. For pediatric hospitalist groups, the median turnover was zero: 63.2 percent of the groups had no physician leaving the group.

Historically, hospital medicine group leaders and hospitalists have used the State of Hospital Medicine Report to compare their practices with others – especially those sharing geographic or categorical similarities – to best retain and recruit hospitalists and understand the factors affecting their practice models. Together, with the “Key Characteristics of an Effective Hospital Medicine Group,” an article published by SHM in the Journal of Hospital Medicine in February (www.hospitalmedicine.org/keychar), the 2014 State of Hospital Medicine provides a roadmap for optimal performance within the specialty.

“The 2014 State of Hospital Medicine Report is an important reference for assessing the vital signs of any hospital medicine group,” says SHM president, Burke Kealey, MD, SFHM. “As hospitalist leaders use this information to improve their groups, so does the specialty along with them, which translates to the best possible care to hospitalized patients.”