Hospitalist Recruiting and Staffing

By  |  March 3, 2009 | 

John Nelson writes…

At the 2008 SHM Annual Meeting in San Diego I got some ribbing for raising the issue of whether the supply of hospitalists might catch up with or exceed demand within the next 5 or 10 years.  I posed the question while moderating a panel discussion, and all three panelists were convinced that there would be a shortage of hospitalists for the rest of our careers.  One panelist, Ron Greeno, even teased that I just worry too much to even think of asking such a question.

So I asked the nearly 2,000 people attending the panel discussion whether they were part of a hospitalist group that was currently recruiting new doctors. Nearly every hand went up.  Only about 3 people raised their hand to indicate their group had no immediate plans to add hospitalists.  So relying on the Wisdom of Crowds, I decided that maybe the supply of hospitalists would continue to fall short of demand for many years to come.

While it can be really stressful to work in a practice with a staffing shortage, there are some benefits for current hospitalists.  For one thing, the shortage is a force that can lead to increases in salary and better working conditions, and it makes layoffs, even in distressed economic times like these, very unlikely.

But in just the last month or so I have had several lead hospitalists from practices across the country say that they are fully staffed for the time being and don’t plan to increase staffing in the current calendar year.  Some anticipate the need to replace departing doctors, but not to expand the total number of doctors in the practice.  Of course, I’ve heard this from only a handful of practices.  I doubt it reflects a significant national trend – yet.  But each one of these leaders said that even as recently as a year ago they thought they would continue expanding for years to come and are very surprised at how quickly their rate of growth has leveled off; even if it is only temporary.

I plan to post about the supply and demands for hospitalists again in the coming months and will let you know if it seems to me that supply is starting to catch up, or whether the practices that don’t plan to grow this year are just a blip in the overall hospitalist workforce.  Each bi-annual SHM survey of the hospitalist movement (’08 survey here, next survey will be published in the spring of 2010) provides a comprehensive picture of hospitalist recruiting needs.  And the number of recruitment ads in medical publications and on the Web is another good barometer.  So far, it doesn’t seem to me that these have decreased at all.


  1. Robert Zipper MD, MMM March 11, 2009 at 11:25 am - Reply

    Dr. Nelson,

    I think you are spot on with your questions. Our 12 FTE program in Central Oregon has gone from start up and a dire recruiting situation to being fully staffed with one extra physician signed up “in the on-deck circle” for the next available position. This has occurred within a short span of just under 3 years. We have had virtually no turnover. We now have several additional physicians in the community wanting shifts, and we have none to give. This has been a radical shift in a very short amount of time.

    I read somewhere that greater than 50% of hospitals are currently losing money. As hospitals tighten their belts due to economic pressures, and take increasingly hard looks at the value brought by their programs, many will consider freezing program growth, as our has. Some might even consider laying hospitalists off, as raised by SHM president Dr. Cawley in a recent issue of The Hospitalist.

    While opportunities will continue to be plentiful nationwide, I believe that we will see an increasing number of programs in desirable locations reach their capacity sooner rather than later. If you ask the same question in Chicago this year, I bet the numbers have changed. No hospitalist will soon be without a potential job somewhere, but it will become increasingly difficult for hospitalists to find work in some communities. Turnover will decrease nationally, as we see fewer programmatic implosions because of better management and the many lessons learned over the last 10 years. Consolidation will continue. As hospitalists have fewer opportunities, this could further reduce turnover, as there will be fewer scenarios in which the grass is truly greener.

    I believe that you are absolutely correct in bringing up questions about staffing challenges and a shift in the marketplace now. While we are only seeing the beginning of this trend, I expect it will, in fact, continue. things will look very different in 5 years, just as they did 5 years ago, when we were just beginning to take up our role as physician champions of quality in our various organizations.

  2. James O'Callaghan, M.D., F.A.A.P. March 12, 2009 at 3:40 am - Reply

    The largest employer nationwide of pediatric hospitalists is likely to be Pediatrix. Each month in Pediatrics (the journal), there are multiple ads across the country for pediatric hospitalist opportunities within Pediatrix. In the most recent issue of Pediatrics, there is not one ad from Pediatrix for pediatric hospitalists. Coincidence?

  3. Jairy Hunter, MD, MBA, FHM April 8, 2009 at 11:30 am - Reply

    When I first read this article a month ago, I have to admit my reaction was somewhat mixed. Initially I thought, “Well, I sure haven’t seen the job market drying up….” In fact, I am routinely updated by my hospitalists about the surrounding opportunities (often under the guise of “just lettin’ you know”–but a more cynical view would be to say that they are somehow trying to gain leverage…).

    In the past month, I have witnessed firsthand, two scenarios which lead me to believe what Drs. Nelson and Zipper have highlighted are coming to fruition.

    I found out that our hospitalist group very narrowly dodged layoffs about a year ago, and I am aware of a number of situations where hospitalists are being asked to renegotiate terms of contracts midstream, partly because of global economic factors, but also partly due to management issues and practices Dr. Zipper referenced above. While some of the concessions on the part of the hospitalists may seem small in the proverbial “Grand Scheme,” they could signal a change in the leverage position of hospital administrations IF good, comparable jobs are truly drying up, and runaway salaries are being reigned in. A casual perusal of the various doctor job sites shows wide disparities in proposed salaries and compensation models…investigation of some of the eye-poppers reveals, more often than not, less desirable situations, or vague descriptions of startups. At this stage in Hospital Medicine, most anyone who has been around has seen or been through programs which have gone through (sometimes) painful evolutions. Many of us can spot future problems for “start-ups” or “rebuilding projects” a mile away.

    The other thing that kind of makes me a little indignant is the notion of at least some new residency grads, that they have the upper hand in pretty much every negotiating situation (“they need me more than I need them”)…sometimes overestimating their supposed value. It appears that, based on some of the eye-poppers, that they believe they command much higher compensation than some of the hospitalists who have been in the program for some time. Granted I’m all for getting my physicians as much as they can get, so to speak, but some of the counters from candidates make it seem like they are getting bad advice or are just plain naîve to the state of Hospital Medicine and medical economics in general. It’s not a value judgment on the candidates necessarily. It is hard to sometimes convince them to compare “like” programs and offers, and I have seen some downright dirty tricks attempted to play groups against each other in contracting (and while I’m at it, the level of professionalism has gone out the window–candidates not showing up for interviews, declining offers by email, using false pretenses to obtain competitor contracts–but that’s another story).

    I guess my point is that I think the confluence of global and local economic factors, combined with hospital medicine’s move toward stability as a specialty is causing a shift to steady state more rapidly than we thought.

    I don’t mean to sound bitter or cynical (or like the Old Man Hospitalist), but it goes back to some of the talks I’ve heard Dr. Nelson give on the expectations of new residency grads as far as lifestyle, amount of work, and compensation (and I guess, work ethic).

    Then again, when I was just starting out in Hospital Medicine, we had to park 2 miles away, draw blood, spin urines, and bring bag lunches, with no PTO or CME….

  4. JOHN BEUERLEIN, M.D, MMM May 8, 2009 at 9:27 pm - Reply

    I must admit that the idea of a saturation point in hospital medicine seems somewhat distant at this time in many enviroments. All things are local. In the academic enviroments we are yet to see the effect of the IOM and ACGME mandates that go into effect in July. Like many I have too often heard from residents in the program here that they will not work as hard as my hospitalists do.

    I gave a lecture about 2 months ago only to be told by a young man, who is a second year IM resident, that he would not be graded with regard to quality. Also, I was interested when asked if I would be decreasing the number of patients seen by each of my hospitalists because residents would only be used to seeing 10 patients per day. I said, that this would mean that my staff would be expected to see more not less.

    Given the economic times and tight budgets, I find these views from our future hospitalists somewhat disheartening. But I have to remember that most of them have never had a real job. Hospital medicine is not being spared the tightening of the belt. One of my concerns in the downturn is that we as leaders still push to keep the right people on our buses and not retain staff simply because we have them in hand and can’t replace them with someone of higher quality. Saturation will help many of us to be more selective in the future. I am just not sure it will be in 5 years without a federal push and expansion of projects like the demostration projects in California linking reimbursement to one pot paid to the hospital which then determines what the physician is paid.

  5. Neil Louwrens June 10, 2009 at 12:47 am - Reply

    A factor not mentioned here are the effects of ‘burn out’ on the total pool of Hospitalists. I believe this pool will potentially lessen (as burnout increases) as secondary effects of the higher uninsured patient pool, and the inability of the Hospitals to financially justify adding more hospitalists to meet the need of higher admission numbers with sicker patients (defaulting on valuable primary care).

    Also, if congress is able to boost primary care incomes (Home Care Model), our supply pool for new hospitalists will decrease as the incentive to choose that track increases (and I will be the first to say for the sake of the nation that we need a stronger primary care basis- catastrophe awaits us as sure as the earth is round if we don’t fix this problem!).

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