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Jon McKenna | August 2, 2023 | Contributor Information
Physicians who work full-time in hospitals received encouraging news on the pay front in 2022; their average compensation increased much faster than it did for US doctors in general. Still, half of hospitalists said that they felt underpaid, and female hospitalists continued to face a gender gap with earnings, albeit a narrowing one. This report explores trends in compensation and net worth for hospitalists as well as in their working conditions like hospital staff-tightening, work weeks, and time demanded by paperwork and administration tasks.
In this report, gender is based on how physicians self-identified in our survey.
Some totals in this presentation do not equal 100% because of rounding.
Jon McKenna | August 2, 2023 | Contributor Information
Average compensation for a hospitalist jumped nearly 12% over our 2022 report, outpacing the average pay gain of about 4% for physicians generally.
Thanks to that faster growth rate, primary care physicians (PCPs) who exclusively practice within a hospital setting, on average, earned more than nonhospitalist PCPs did (about $263,000). In last year's report, that wasn't the case. However, specialists who were assigned full-time to hospital positions still faced an earnings gap (about $376,000 on average for a nonhospitalist specialist).
A general physician shortage around the country after the COVID-19 pandemic is helping drive up compensation for hospitalists and other doctors, says Mike Belkin, JD, divisional vice president at the Merritt Hawkins physician recruitment firm.
"We see more physicians burned out, retiring, reducing their hours, or looking for shift work or virtual care, which further reduces the physician workforce," Belkin says.
Jon McKenna | August 2, 2023 | Contributor Information
As overall compensation rose on average for hospitalists, the performance bonus for those who qualified for one climbed about 23% from last year's report. It represented about 12% of the total compensation on average for a hospitalist who could get a bonus.
Bonuses can vary on the basis of patient and hospital types, patient volumes, areas of the country, and other factors.
"I don't think anything dramatic has happened recently with bonuses," says John Nelson, MD, MHM, the founding partner of the Nelson/Flores hospital management consulting firm in Bellevue, Washington.
"One hypothesis is that with hospitals in terrible financial circumstances right now, they might enlarge the dollars available for bonuses but at higher [performance] targets, while keeping base pay the same."
Jon McKenna | August 2, 2023 | Contributor Information
The nearly 12% compensation bump is an average that didn't apply to every hospitalist. In fact, 20% of hospitalists reported earning less in 2022.
In last year's report, 62% of hospitalists blamed the pandemic and 49% pointed to other factors. This was expected as the nation returned to normalcy, capped by the federal government ending the public health emergency declaration in May 2023.
Jon McKenna | August 2, 2023 | Contributor Information
These percentages closely resembled what hospitalists told us in last year's report. Though the economy had rocky moments in 2022, sharp COVID-driven cutbacks by hospitals affecting their physicians and staffs seemingly are in the past.
Jon McKenna | August 2, 2023 | Contributor Information
A gender gap in doctor pay is a recurring problem in hospitals and in most other medical work environments. In 2022, that gap in average compensation was about 22% in favor of male hospitalists. In 2017 (when our survey used a somewhat different definition of hospitalist), it was around 21% for men.
On a positive note, the average compensation for a female physician working full-time at a hospital rose faster last year than it did for men (approximately 17% vs 10%). And the gender gap narrowed (an advantage of about 22% for male hospitalists vs roughly 30% in our prior two reports).
Jon McKenna | August 2, 2023 | Contributor Information
Contrast this cross-section of medical specialties with our findings for all physicians across 29 different specialties; in the latter data, the representation of all female doctors last year ranged from a high of 62% in ob/gyn to a low of 10% in orthopedics.
Jon McKenna | August 2, 2023 | Contributor Information
In 2022, 53% of hospitalists answered yes to this question. Sixty-one percent of them did in 2021 and 60% in 2018 (when our survey used a different definition of hospitalist).
"Time spent with patients and their multitude of problems, and addressing them, is not adequately paid for," one internist shared.
"I am reasonably happy with my earnings, although I think our administration is overpaid. I have to get good outcomes; the administration has not met any of their goals," a neurosurgeon said.
Another internist added: "Although it is good money, it should have hazard pay. I got COVID twice from my work."
Jon McKenna | August 2, 2023 | Contributor Information
As hospitalists work to build their family wealth, 52% of them reported a net worth of $1 million or more in 2022. In comparison, 59% of all physicians said that their net worth was at least $1 million.
Jon McKenna | August 2, 2023 | Contributor Information
The top-seven categories of debts and expenses selected remained unchanged from last year's report, and the associated percentages were similar. For several years running, about two thirds of hospitalists have reported that they are still paying off a mortgage on their primary residence.
However, comparing 2022 with 2017 (when our survey used a different definition of hospitalist), smaller percentages of hospitalists carried debt for car loans (49% in 2017), their own undergrad or medical school loans (42%), and credit cards (30%).
Jon McKenna | August 2, 2023 | Contributor Information
Physicians are aware that accepting full-time positions at a hospital translates to longer work weeks. Thus, the additional hours at work compared with an average physician in a different setting is not surprising.
However, the average hospitalist work week ticked up slightly from 52.6 hours in last year's report, despite the easing of time demands due to COVID-19.
Jon McKenna | August 2, 2023 | Contributor Information
If you are a physician practicing full-time in a hospital, you will spend more face-to-face hours with patients than will many peers in medical offices who can utilize telehealth.
Case in point: 20% of hospitalists told us that they see patients for more than 50 hours in an average week vs 12% of physicians generally. (Many hospitalists follow schedules with concentrated work hours over 7 consecutive days then taking off the next 7 days.)
Jon McKenna | August 2, 2023 | Contributor Information
The unfortunate reality is that spending more time with patients drives up the number of hours hospitalists must devote to EHR documentation, managerial oversight, clinical readings, and other such tasks.
Doctors across 23 specialties told us that they dedicate an average of 14.7 hours per week to paperwork and administrative tasks. Fifty-nine percent of hospitalists reported their time commitment is bigger than that.
"Over the last 30 years of my career, the amount of administrative time needed for each patient has gone up," Nelson says. "We'd all like it to go down, it can be a barrier to being clinically productive, but we're stuck with this" circumstance.
For some hospitalists, "more than three quarters of your time is not spent on clinical work."
Jon McKenna | August 2, 2023 | Contributor Information
Hospitalists' attitudes about the rewards of their work have been stable across our past three reports. Pride in their professional skills consistently tops the list, followed by knowing how much they help their communities.
Jon McKenna | August 2, 2023 | Contributor Information
Once again, in this year's report, hospitalists identified rules and regulations, challenging patients, and the job's time demands as their primary headaches — and all at fairly equal pain points.
Jon McKenna | August 2, 2023 | Contributor Information
Despite the demands of routine 12-hour-plus days and the need to recharge and refresh, 49% of hospitalists said that they took on extra work to supplement their income. Last year, 47% of hospitalists reported medical moonlighting or other outside work.
Jon McKenna | August 2, 2023 | Contributor Information
In our 2022 report, 71% of hospitalists answered yes to this question (down from 77% in the 2021 report), as their profession emerged from the stresses of pandemic work life. This suggests that attitudes toward full-time practice in hospitals could be trending in a positive direction.
Jon McKenna | August 2, 2023 | Contributor Information
In both of our prior two reports, about 3 in 4 hospitalists who would go back into medicine again if they had a do-over also said that they would pick the same specialty. That trend was consistent across a sample of several specialties in this year's report except for internists, who were less positive in comparison.
In our 2018 report (which used a different definition of hospitalist), 77% of hospitalists said that they would choose the same specialty.
Jon McKenna | August 2, 2023 | Contributor Information
Fewer than 4 in 10 hospitalists (41% of women, 37% of men) said that a promotion at their current workplace is a goal. Interestingly, hospital-based physicians working full-time were likelier to pursue a promotion than were their counterparts in different medical settings, like offices or outpatient clinics.
Jon McKenna | August 2, 2023 | Contributor Information
Despite the high-stress environments and demanding work schedules that hospitalists experience, half of them said that those conditions have not undermined the professional drive with which they launched a medical career.
Medscape Physician Compensation Report 2023: Your Income vs Your Peers'
Which specialties earn the most, and which physicians work the longest hours? Our 2023 Physician Compensation Report tells what's happening with doctors' income.Medscape Features Slideshows, Apr 2023
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Jon McKenna
Senior Editor, Reports, Medscape Business of Medicine
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