A hospitalist is a physician who works primarily in the hospital serving acutely ill patients.  The term was first coined in 1996 by a couple of doctors writing in the New England Journal of Medicine.  Since then, the movement has persistently grown to encompass the majority of hospitals in the United States.  Over 34,000 hospitalists are estimated to be working in the US as of 2012.

Back in the old days, a primary care physician did double duty : they saw patients in the office as well as in the hospital.  Whenever one of their 2,500 patients (the average patient panel size in the US) was very sick, the patient would be admitted to the hospital and the primary doctor would be overseeing the care there as well.  But, duty hour limitations, work/life balance, and even consideration of revenue has led most primary care doctors to leave hospital medicine behind.  And thus, it opened the door for this new kind of medicine to blossom.

What are the benefits of hospital medicine?  More money, better schedules, more immediate results and better support (via consults and labs/imaging all there at the hospital).  By better schedules, I simply mean there are more options for scheduling and balancing life with work.  Some hospitalists work 7 days on followed by 7 days off.   Some work a block of time at a time.  Others might do shift work and others might be traditional with call duties.

Salary.com

Just how much do hospitalists make?

The median expected salary is $200,579 according to Salary.com.  However, the MGMA reports the median as $233,855.  Another body called Today’s Hospitalist conducted their own limited survey and found that the salary ranges very widely with some hospitalists making over $300,000 in annual income.

There are two main kinds of hospitalists : adult medicine and pediatric medicine.  However, specialists are catching on to the idea as well and making a shift segregating their office from their hospital duties.

The majority of adult hospitalists have internal medicine residency training.  The majority of pediatric hospitalists have pediatric residency training.  Those are 3 years each.  Fellowships are not required but are available should you want one.

Now, family medicine can become hospitalists too but they are not as well qualified from the eyes of a hospitalist human resources recruitment perspective.  Why?  It has to do with the amount of in-hospital training one receives while in residency.  Without a doubt, internal medicine residents do more hospital work than office work.  Also, family medicine residency appropriately divides your time in pediatrics and obgyn further decreasing the potential for adult in-patient hospital medicine training.  With that said, you could always tailor your 2nd and 3rd yr electives to get more training in in-patient medicine.

To increase your chances of getting a hospitalist job as a family medicine physician, consider getting more experience in hospital medicine by choosing residencies which offer a hospitalist track or do a fellowship in hospital medicine for an extra year or two.

Hospital medicine is here to stay and it is growing more popular by the year.  The lure of higher salary and potentially better work schedules draws many physicians to consider this kind of position.  If you enjoy working in a hospital, the immediacy of getting a lab or image result to direct care, the challenge of very, very sick patients, then you might enjoy being a hospitalist.

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Concierge medicine is a growing style of practice in healthcare in which a patient pays an annual fee to their doctor.  This could be $199, $500, $1500; or it could be more, could be less.  Within this concept, there are many ways to deliver healthcare.

Some physicians charge an annual fee in addition to provided services.  Others charge one price for all services per year.  Some charge insurance, others do not.  Some might include a wellness program.  But the common theme to all concierge medical practices is better access to your physician.

The Concierge Medicine Research Collective released a summary of data it has collected over the past 3 years on physicians who practice concierge medicine.  There were several interesting points so what I’ve done is outlined them below and included my thoughts about it in parentheses.

• The majority of concierge medicine physicians are internists followed by family medicine.
• A growing number of specialties are entering concierge medicine – Cardiology, Dentistry, Pediatrics.  (i’m not surprised. this is a viable model for physicians to give patients the time they want while being able to sustain their previous income. it’s gaining popularity)
• The average salary of a concierge doctor is $100,000 to $300,000.  (i’m surprised.  i thought the range would at least include 500k)
• The average income of a concierge patient is $50,000 to $200,000.  (this debunks the theory that concierge doctors only treat the rich)
• Most concierge doctors treat 6 – 8 patients per day.  (i see about 20 per day. this is supposed to increase when my contract turns to production based)
• More than 70% of visits are 30 – 60 minutes long with the doctor.  (nice, that is what i wish i could give my patients on a consistent basis)

For more information about the data, click here.

Have you thought about opening a concierge medical practice?  Are you for it, or against it?

Photo Credit
Ryan Lowry for Bloomberg Businessweek
(i love the layout of the office in the photo. i want a doctor like that!)

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Last Saturday, a group of us went out for an evening theatre.  I was really excited for it actually.  Maybe because I’m just a medical geek.  Out of the four of us in the group, three had medical backgrounds : a doctor, clinical research associate, and an MD/PHD student.  But you didn’t have to be medical to enjoy the show, everyone young and old were having a great time.

Medicine in Musicals is a wonderful show of medically related songs from Broadway hit musicals.  It’s the second year the show has been produced and this year’s theme was Patient Narratives.  Twenty-three songs were sung by forty-five singers, most of whom were medical professionals themselves.  There were a few seasoned doctors, a handful of medical students, several nurses, techs, office staff, and a smattering of non-medical people who majored in fields like computer science, engineering, and music.  There were many who were talented and some who were budding in their debuts.

I thought the show had a great concept with excellent potential.  Some of the songs had a short introduction by a specialist physician and that helped me to think of things in the way the director had intended us to.  Would I have understood the relation to medicine without it?  Nope.  Probably not.  Except for the most obvious songs.

I have to say, it was hilarious to watch the seasoned doctors doing the Can-Can while singing Paracetomoxyfrusebendronemycin, a parody of Mary Poppins.  Jarred Lentine, about to graduate with a BS in Health, had us all laughing and cowering as he sung My Unfortunate Erection while flinging hard candy at us at breakneck speed .  (I got hit on the head.  I was worried the lady behind me got hit in the face.)

My favorite songs were the ones that had the strongest natural, easily visible connections to medicine.  Such as Therapy from Tick, Tick, Boom! which was a passive and psychological argument between a couple in a difficult relationship.  And Who’s Crazy/My Psychopharmacologist and I which details a bipolar patient taking an investigational drug.  She pours out her emotions and complains of increasing side effects.  Nevertheless, the doctor continues to increase the medicine ignoring the patient’s voice until the patient finally loses all sense of being and feeling at which the doctor states, “Patient stable.”  Those two words…so abrupt, so powerful, so sad.

Medicine in Musicals is the brainchild of Jason Reminick, an MD/MBA student, about to graduate and enter a combined residency in pediatrics and anesthesiology at Stanford University (wow!).  He has acted and directed in a number of performances while going through medical and business school.  Impressive!  I will never forget Jason, dressed in drag, singing I am what I am from La Cage Aux Folles.

Medical humanities is an interesting field that I hadn’t really thought of before.  Have you seen tumblr blogs of beautiful anatomy illustrations?  Or the one doctor who transformed his thesis in cardiology into the shape of a heart?  Recently, I learned that family medicine physicians could do a fellowship in Medical Humanities after residency.  What else is out there?  What’s the salary?  I really don’t know.  But it’s all quite interesting.  Yet another field where physicians can pursue.  And if Jason Reminick really does make it to Broadway either as an actor or as a director, I’ll be the first in line to buy a ticket.

Below, I’ll list videos of my two favorite songs from the performance as well as a list of blogs depicting medicine in the arts.

Steve McGaughey

Street Anatomy

Kathleen Sawyer

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Many medical specialties do fellowships to further sub-specialize their training often leading to increased compensation packages.  Sometimes there is just an extra sense of satisfaction becoming an expert leader in a niche field.  Did you know that Family Medicine can sub-specialize too?

Here’s a list of fellowships open to Family Medicine physicians:

• Addiction Medicine
• Adolescent Medicine
• Behavioral Medicine
• Community Medicine
• Dermatology
• Emergency Medicine
• Faculty Development
• Geriatrics
• Health Policy
• HIV / AIDS
• Hospice and Palliative Care
• Hospitalist
• Integrative Medicine
• Intensive Care
• International
• Medical Communications
• Medical Humanities
• Neuromuscular
• Obstetrics
• Preventive Medicine
• Radiology Utilization Management
• Reproductive Health & Advocacy
• Research
• Rural Medicine
• Sports Medicine
• Substance Abuse
• Urgent Care
• Women’s Health

Pretty long, eh?

I thought Medical Communications and Medical Humanities were pretty interesting.  Medical communications acknowledges that social media, blogging, and the like are an important part in Health and Patient Education.  It also trains you in medical writing and editing of top journals in primary care.  Medical Humanities touches upon the arts in medicine such as a way to heal through art therapy and to redesign medical spaces or applications.  Both of these incorporate a significant amount of time to learning, teaching, and keeping up with your clinical skills

The American Academy of Family Physicians keeps a website of current fellowship opportunities.  For the complete list with ability to search by topic, click on the link below.

https://nf.aafp.org/FellowshipDirectory/search

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Call is something that many physicians do.  It’s the wonderful time period when a physician’s office is closed for the day.  Patients sometimes need medical care during these off hours because sometimes a cold or inflamed appendix doesn’t care what time it is.

Call can consist of handling phone calls, of going to the hospital to admit patients, of performing emergent surgeries, or even of delivering babies.  Call can be compensated in addition to your income or it can be included in your overall package.  For example, my call consists of 7 days straight of handling phone calls after hours every 3-4 weeks and it is included in my contractual income.

Working call can bring in a significant amount of extra income.  That’s helpful for all those lovely loans we have.  So what’s the going rate?  The MGMA 2013 On Call Compensation survey found that the median pay ranges from $75 dollars to $2,400 dollars per day.  Primary care doctors were reporting $150 per day whereas surgeons were mostly reporting $1,000 per day.  Would you work extra hours for these rates?

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The Journal of the American Medical Association published an article titled, “Gender Differences in the Salaries of Physician Researchers.”  The premise of the research is to determine whether academic physicians who perform similar work are currently paid equally.

Well, according to the data, males had a higher salary of $13,399 even after adjustments for specialty, academic rank, leadership positions, publications, and research time.  The mean salary for female academic physicians was $167,669.  For males, it was $200,433.

I’m not surprised.  Are you?

Information is gleamed from the 800 physicians who responded and fit the inclusion criteria for the study.

For more information and to read the free report in detail, click the link below:
http://jama.jamanetwork.com/article.aspx?articleID=1182859

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If you haven’t heard, the  University of Texas at Austin is building a new medical school.  It will be the first medical school in Austin, a place that is well known for it’s research.  Over the past 2 years, UT Austin has received $1.1 billion dollars in research funding.

The school is in the process of hiring a dean and faculty.  $1.2 million dollars has been budgeted for medical and surgical faculty salaries this year.  (reported by The Daily Texan through the Texas Public Information Act)  At UT Austin, there are 17 deans whose salaries range from $183,333 to $541,500.

To clarify, the University of Texas has six health institutions and nine academic institutions.  The health institutions operate independently.  However, the new medical school will be a part of an academic institution.  Meaning, the salaries will be governed by the academic protocols.  The salaries of health institutions tend to be higher than their academic counterparts.  For example, William Powers Jr, President of the University of Texas at Austin had a base salary of $613,612.  Now, here are the base salaries of the current six presidents of UT System health institutions:

• Ronald DePinho
  UT MD Anderson Cancer Center
  $1.4 million
  
• Daniel K Podolsky
  UT Southwestern
  $921,284
• David L Callender
  UT Medical Branch at Galveston
  $657.497
• Giuseppe Colasurdo
  UT Health Science Center at Houston
  $824.999
• William L Henrich
  UT Health Science Center at San Antonio
  $606,913
• Kirk Calhoun
  UT Health Science Center at Tyler
  $502,394

As far as faculty salaries go, it will vary greatly on the person’s credentials and experience.  Dr. Rodney Rohrich is a professor at UT Southwestern Medical Center at Dallas and makes $1.75 million dollars per year.  Granted, he is a renowned Plastic Surgeon!  Here are some more faculty salaries at UT Southwestern :

• Dr. Kamel Itani
  Ophthalmic Oncology
  $495,000
• Dr. Warren Snodgrass
  Pediatric Urology
  $391,500
• Dr. Kenneth Lenovo
  OB / GYN
  $324,500
• Dr. Kyle Molberg
  Pathology
  $275,300
• Dr. Joel Steinberg
  Pediatrics
  $108,000

The school was recently named Dell Medical School in honor of Mr. Michael Dell who donated $50 million dollars to it’s construction. It is still in the planning phase and is looking for a location in Austin to plant it’s roots.  50 students are expected to enroll as the inaugural class in 2016.

Sources
The Daily Texan
UT Research

Image credit
Skinit – Texas Distressed Longhorns Logo

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What is a University Health Physician?  These are the physicians that work at universities serving the medical needs of that university’s student body.  The majority of the patient population would be 18 years to 22 years old but keep in mind there are older students as well.

Universities often have clinics staffed with nurse practitioners and physicians to offer subsidized medical care to students.  Students can get cheaper prices for office visits, laboratory workup, and xray images.  Some universities are staffed with NPs only and lead by physicians.  Other universities have physicians seeing patients as well.

Some of the salaries I’ve been able to find on the subject matter are thanks to the Texas Tribune and their data on government employee salaries.

• Jeff Paxton, MD – Staff Physician of Student Health Services at Texas Tech University – $125,557
• Miguel, Villareal, MD - Staff Physician of Student Health Services at Texas Tech University – $122,901
• Emilio Carranco, MD – Director of Student Health Services at Texas State University – $150,515
• Lenore DePagter, DO – Chief Medical Officer of Student Health Services at Texas State University – $124,481
• Mary Rae, MD – Chief Physician of Student Health Services at University of Houston – $150,000

Doesn’t sound like a lot.  But I would venture to bet that the benefits are pretty good and that the call is insignificant especially if they have Nurse Practitioners available.  Let’s not forget the kind of pathology you would get treating this small subset of patients.  I am guessing that the majority of the patient illnesses is run of the mill.  If it were anything more serious, they would probably be utilizing their own health insurance instead of their university’s health plan to seek specialist care.

If there are any university student health doctors reading, share your experience in the comments below!

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Below are the top seven highest earning academic physicians at the University of California, San Francisco.  Figures were reported in 2008 and made public here due to the Freedom of Information Act.

You’ll notice that the trend is

• having an MD
• all male
• trained as a specialist
• more so trained as a surgical specialist
• and in some sort of leadership role such as being a director or chairman

Philip E Leboit, MD
Professor of Clinical Pathology and Dermatology
Co-Director, UCSF Dermatopathology Service
$1,574,392

Timothy H. McCalmont, MD
Professor of Clinical Pathology and Dermatology
Co-Director, UCSF Dermatopathology Service
$1,573,493

Anthony Azakie, MD
Professor of Surgery and Pediatrics
Chief, Division of Pediatric Cardiothoracic Surgery
Surgical Director, UCSF Pediatric Heart Center
Surgical Director, Adult Congenital Heart Program
Director, Pediatric Cardiothoracic Surgery Research Labs
$1,098,588

Christopher P Ames, MD 
Associate Professor of Clinical Neurological Surgery
Director of Spine Tumor & Spinal Deformity Surgery
Co-director, Spinal Surgery and UCSF Spine Center
Director, Spinal Biomechanics Laboratory
$945,406

Michael T Lawton, MD
Professor in Residence of Neurological Surgery, Tong Po Kan Endowed Chair
Chief, Cerebrovascular and Skull Base Surgery Programs
Director, Cerebrovascular Disorders Program
Principal Investigator, Cerebrovascular Research
$821,468

Stanley B Prusiner, MD
Director of the Institute for Neurodegenerative Diseases
Professor of Neurology
$795,574

Thomas P Vail, MD
Professor of Orthopedic Surgery
Chairman of the Department of Orthopaedic Surgery
$780,000

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Cruises are a popular vacation past-time for everyone across the globe.  You’re in the middle of the ocean with nothing in sight, you sit back, relax and eat, while the ship goes to different countries.  Medical mishaps can occur at any time but when you’re on a cruise, there’s always a doctor on board.

Cruise ship doctors are responsible for both the health concerns of the passengers as well as the staff.  On larger cruises, there may be two doctors who split the duties down the middle: one for staff, one for passengers.  Some cruises operate on a hierarchy where the newbie gets the brunt of the work and the night call.

One interview of an actual physician for Carnival CruiseLines states the salary is as competitive as shoreside primary care doctors.  But several websites state the average is $4,000 to $8,000 per month.  And that depends on your experience in practicing medicine on cruises.  That’s about $60,000 to $96,000 per year.  That’s definitely lower than primary care doctors.

But don’t forget the benefits :

• free food
• free room
• free housekeeping
• free healthcare insurance
• free travel to the cruise ship
• free travel to gorgeous places

So how much would that be worth?  Let’s be modest and say that on average in the US you pay 1500 a month for rent and 400 a month for food.  That would be $22,800 saved per year!  That doesn’t even count the travel costs and health insurance costs.  So really, that would bring up your earnings up to the lower end of what a primary care doctor would make.

My best guess is that physicians can be hired from any country so long as they are qualified.  Physician compensation in other countries are currently being heralded as being much cheaper than their American counterparts.  So, outsourcing employees in this manner makes it less expensive for companies.  With that said, American physicians are still in demand and might even be preferred.

If a year’s worth of sea legs is not that enticing for you, don’t worry.  You don’t have to sign up for a year.  You can also do short term contracts that are 4 months long.  So if you’re pining for a change of pace, searching for a part-time gig, or just want to bask in the limelight as a uniformed senior officer who wines and dines passengers, you might enjoy being a Cruise Ship Doctor.

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