2011 Hospitalist Salaries and Food For Thought

We have additional 2011 hospitalist salary data out for consideration.  The title of the linked piece, “Has hospitalist pay finally peaked?,” asks the right question.  Today’s Hospitalist culled the data from 1000 hospitalists from various regions and venues.

Have a look:

You will note the subtle variation.  However, one year a trend doth not make, and given the changes afoot in the economy and hospitals, I sense a more than neutral swing.

Ask a professional group if they provide value to the health care system, any group, and I guarantee the answer: bet the affirmative.  We anchor to our salary (and worth), and if we esteem our work, any decrease translates to resentment.  No do-overs.  No give backs.  Ever.

Such denunciations distance us from others in the system and makes change more grueling.  We must prepare however, and separate the above sentiment from reality.  Despite the genuine or imagined value we provide, physicians will apprehend the impact of budgetary math, mostly subtraction, required to ensure U.S. economic viability.  Medicare will take a haircut, and commercial payers will soon clampdown on rate increases.

The two illustrations below convey my point.  I will explain after the jump:

The top graph displays a notable finding (hint: pink).  In 2008, the great recession begins.  What sector not only avoids contraction, but grows in stark contrast to all others?  Healthcare.

The nature of funding–a guaranteed stream of government income–along with a private sector beholden to the same masters, in the form of regulatory capture, aka “crony capitalism,” translates to unchecked market enlargement.  A wrecked economy does not obstruct the largesse.  Granted, the growth ebbs and flows, but our system moves with a continuous upward trajectory; no end in site.

The bottommost graph (1990-2010) displays sector growth according to productivity AND the labor inputs required to attain it.  Again, healthcare’s unique dynamic produces expansion–but instead of increased output secondary to efficiency, we are achieving results with bodies.  In 2010, for a given outcome, we use more individuals, in greater quantities, for smaller incremental returns.    Lots of squeeze, but not much juice—known as flat of the curve medicine, and an all too familiar calling card for our US health system.

We may not like the circumstances, but even with better hospital medicine performance, salaries will attenuate.  In better times, raises would be in order.  Not now though, as macroeconomic forces preclude winners from getting deserved rewards.  Don’t take the transformation personally.  The medical-industrial complex had to come down to earth, and if you read the papers or watch the news, you are witnessing the adjustment now.

I do mean to enlighten, not depress you.   These facts will make you more astute in any give and take.  Do not undervalue the data; they will make you more formidable and improve your competence, regardless of setting.