Hospitalist job

[FutureInternist]

Is that including rvu? Sounds like a fair gig. Do you moonlight?

I would never work in an RVU job.
Have enough trouble getting good notes and sign outs from salaried docs, no use trying to follow a doc who blazed through the first X pts so they can see the next one and take a higher % of its billing.
I just pick extra shifts at work.

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[wamcp]

Depends what RVU threshold is in the first place. Some places have ridiculously impossible RVUs, some places have pretty decent RVUs, some places don't have it at all actually.

One place I moonlight pays per patient but not by actual billing rvu. One time I took home $3000 for a single 12 hour admitting shift, I did 15 admits

 

[VA Hopeful Dr]

I would never work in an RVU job.
Have enough trouble getting good notes and sign outs from salaried docs, no use trying to follow a doc who blazed through the first X pts so they can see the next one and take a higher % of its billing.
I just pick extra shifts at work.

The potential problem there lies in your partners. Generally speaking, if you are on salary you're not likely to work as hard. I'm not saying this is universally true, but its common enough to be a problem lots of places.

My wife's last hospitalist job was salaried. Some of her partners would fight admissions from the ED, refuse admission in the last 90 minutes of their shifts (they split up admitting between the day people - the total shift was 6-6 so one person would admit 6-10, another 10-2, the last 2-6), refuse consults if the patient census wasn't exactly evenly distributed. Stuff like that. You can also look at threads in the EM forum where the EPs that work in hospitals that pay their hospitalists on production don't have nearly the push-back when it comes to admissions.

Now you do make a good point about some places going a bit too far for production. There's a hospital nearby where the average census per hospitalist is 30 patients and those guys make bank. But I've seen their discharge summaries, they're not doing good work which isn't surprising.

I think an ideal would be either salaried with a bonus based on production to a defined maximum, or production but have enough hospitalists so that you won't end up with an insane number of patients.

 

[bobow98]

The potential problem there lies in your partners. Generally speaking, if you are on salary you're not likely to work as hard. I'm not saying this is universally true, but its common enough to be a problem lots of places.

My wife's last hospitalist job was salaried. Some of her partners would fight admissions from the ED, refuse admission in the last 90 minutes of their shifts (they split up admitting between the day people - the total shift was 6-6 so one person would admit 6-10, another 10-2, the last 2-6), refuse consults if the patient census wasn't exactly evenly distributed. Stuff like that. You can also look at threads in the EM forum where the EPs that work in hospitals that pay their hospitalists on production don't have nearly the push-back when it comes to admissions.

Now you do make a good point about some places going a bit too far for production. There's a hospital nearby where the average census per hospitalist is 30 patients and those guys make bank. But I've seen their discharge summaries, they're not doing good work which isn't surprising.

I think an ideal would be either salaried with a bonus based on production to a defined maximum, or production but have enough hospitalists so that you won't end up with an insane number of patients.

I’m wondering how many wRVUs you guys are billing a year working 7 on 7 off? I’d say the best incentive structure would probably be taking mgma median RVU , subtract 10% of that as your baseline. Anything over 90% mgma median should be incentivized to a year end RVU bonus per RVU up to 150% of the RVUs to keep it reasonable. If you kill it 2 years in a row I’d probably change the individuals structure to have them have a higher ceiling based on annual review?

 

[FutureInternist]

The potential problem there lies in your partners. Generally speaking, if you are on salary you're not likely to work as hard. I'm not saying this is universally true, but its common enough to be a problem lots of places.

My wife's last hospitalist job was salaried. Some of her partners would fight admissions from the ED, refuse admission in the last 90 minutes of their shifts (they split up admitting between the day people - the total shift was 6-6 so one person would admit 6-10, another 10-2, the last 2-6), refuse consults if the patient census wasn't exactly evenly distributed. Stuff like that. You can also look at threads in the EM forum where the EPs that work in hospitals that pay their hospitalists on production don't have nearly the push-back when it comes to admissions.

Now you do make a good point about some places going a bit too far for production. There's a hospital nearby where the average census per hospitalist is 30 patients and those guys make bank. But I've seen their discharge summaries, they're not doing good work which isn't surprising.

I think an ideal would be either salaried with a bonus based on production to a defined maximum, or production but have enough hospitalists so that you won't end up with an insane number of patients.

My current job negates some of that by having a separate triage doc who fields all calls from ER and specialists for consults, so rounders don’t have a vested interest in refusing consults or admissions.

Rounders also have a max of 2 admits per day although since we have 7 different docs doing admits over a 24 hour period, we generally get 0-1 admit per rounding day, and even that is only until 1.5 hours before the end of your rounding shift (ie no admissions past 430pm).

 

[VA Hopeful Dr]

My current job negates some of that by having a separate triage doc who fields all calls from ER and specialists for consults, so rounders don’t have a vested interest in refusing consults or admissions.

Rounders also have a max of 2 admits per day although since we have 7 different docs doing admits over a 24 hour period, we generally get 0-1 admit per rounding day, and even that is only until 1.5 hours before the end of your rounding shift (ie no admissions past 430pm).

Yeah with a day like that paying for production probably isn't either needed or necessarily wise depending on what you're already making.

 

[pgy0246]

Never heard of anything above 18 patients' census... Do people think physicians are stupid?

I seen placed with the census of 20-21 daily; you basically have to pan-consult specialist (nephrology for hyponatremia) since you really have no time to work up the patient.