Good or bad thing? Hospitalists work more if base salary is lower

by Anne Zieger on October 6, 2010

Doctor with moneyThe following study, which lays out how adult hospitalists perform when their base salary is higher or lower, may seem pretty straightforward. But to this editor, it raises some questions that are worth considering, too.  I’ll explain.

In this story, Healthcare Finance News lists the conclusions of a study looking at how many “work RVUs” adult hospitalists perform relative to amount of their base salary.  The data was gathered from 443 hospital medical groups and 4,211 hospitalists.

The conclusion of the study, which was conducted by the Medical Group Management Association, seems to be that as base salary slides from 50 percent to 100 percent of compensation, the number of work RVUs performed by hospitalists drops.

When hospitalists are paid only 50 percent of compensation as fixed salary, they performed the highest level of work RVUs (wRVUs) per year, or 5,407.

On the other hand, hospitalists who were paid 51 percent to 70 percent of their compensation as salary performed 4,591 wRVUs, while those who got 71 percent to 90 percent of compensation performed wRVUs  performed 3,859 wRVUs.  And those who got 91 percent to 100 percent of their compensation as base salary performed  3,571 wRVUs, the MGMA reports.

For the record, internal medicine hospitalists reported median compensation of $215,000, while family practice hospitalists received $218,066, the study notes.

The easy way to analyze this study is to conclude, flat out, that it’s great to compensate hospitalists such that much of their salary is based on incentives or measurable work outputs.  And one can see why this might sound good;  after all, generally speaking, productive team members are a good thing.

My question is this.  While it makes some sense to measure productivity, is it necessarily a good thing to set up structures that encourage high productivity *just* to be productive?   I don’t see anything here that measures the quality of care for those performing more vs. less RVUs, after all.  Isn’t that a question that should be addressed?

As for me, I’d rather be treated by a hospitalist who wasn’t in a hurry to tote that barge and haul another RVU.

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