1. Hospitalist Career Insights
James Ratliff M.D.
Ochsner Medical Center – Baton Rouge
Chief of Medicine
Medical Director – Hospital Medicine
Anne Brewer
Residency Relations Specialist
TeamHealth Hospital Medicine

2. Objectives
 Hospitalist Definition
 Hospitalist History
 Discuss Hospitalist Workforce Facts
 Discuss Physician Workforce Facts
 Discuss the Hospitalist Recruiting Considerations
 Discuss the Hospitalist Recruiting Challenges
 Factors Influencing Physician Career Decisions
 Factors Influencing Physician Recruitment
 Hospitalist Role What We Like / What We Hate
 TeamHEALTH Residency Stipend Program
 Things To Think About

3. What is a Hospitalist - SHM
 Hospitalists are physicians whose
primary professional focus is the
general medical care of hospitalized
patients. Their activities include
patient care, teaching, research,
and leadership related to Hospital
Medicine.

4. A Little Hospitalist History
 The term was first used in
1996, when there were only a few
hundred doctors in this field.
 “Hospital Medicine” is the fastest
growing medical specialty.
 More than 30,000 hospitalists
practice in U.S. hospitals.

5. Hospitalist Workforce Facts
Growth of Hospitalists
1997 23
1999 800
2000 1400
2001 1750
2002 3508
2003 4076
2005 12,000+
2010 30,000+

6. Hospitalist Workforce Facts

7. Hospitalist Workforce Facts

8. Hospitalist Workforce Facts

9. Hospitalist Workforce Facts
Region
North/Midwest – 27%
South – 26%
East – 24%
West – 22%
Surrounding area
Lg. urban (over 1 mill.) – 49%
Sm. urban – 33%
Rural – 18%
Employment model
Hospital – 34%
Acad. institution – 20%
Mgt. Co. - 19%
Local hospitalist only – 12%

10. Hospitalist Workforce Facts
Age
Physician leader – 41 years old
Non leader – 37 years old
Gender
Phys.leader-80% male, 20% female
Non leader-62% Male, female 38%
Median years as a hospitalist
Leader – 5.1 years
Non leader – 3 years

11. Hospitalist Workforce Facts
Control/Hospital governance of affiliated hospital
Not for profit – 86%
For profit – 10%
Government – 3%
Teaching status of affiliated hospital
Non-teaching – 48%
Major teaching– 28%
Other teaching – 25%

12. Hospitalist Workforce Facts
Characteristics of Hospitalist Management Groups
Education (Percent graduates of U.S. medical school)
Physician leaders – 85%/ Non leaders – 72%
Specialty training
Gen. Int. Med. – 75%
Pediatrics – 11%
Int. Med. Sub. – 4%
FP – 3%

13. Physician Workforce Facts
According to the AMA:
 67% of physicians are over the age of 42 (Boomers)
 18% are 61 years of age or older
 49% are between 42 and 60 years of age
 88% are male
 33% of physicians are between 27 and 41 years (GenX)
 58% are male/ 42% female
 54% of new medical school graduates are female (Millennials)

14. Physician Workforce Facts
 While the number of physicians will increase from 781,200
FTE’s in 2000 to 971,800 in 2020 (a 24% increase), after 2015
the rate of the population growth will exceed the rate of
physician growth
The US census bureau estimates between 2005-2020:
 The projected population less than 65 years old will grow 9%
 The projected population 65 and older will grow 50%
Keep in mind the elderly use much more services representing
a significant increase in demand for physician services….

15. Physician Workforce Facts
What about physicians exiting medicine?
The AAMC ‘s Third Annual Physician Workforce Conference findings indicate that:
 One out of three doctors over 50 would retire today if they could afford to do so
 Older physicians cite increased regulation of medicine as the key factor influencing
retirement plans
 Two out of three, or 66 percent of doctors under 50, are not interested in working longer
hours for more money
 Seventy-one percent of young doctors identify having family and personal time as an
important factor in a desirable practice.

16. Physician Workforce Facts
What about physicians entering medicine?
A review of physician and recruiting initiatives by Merritt, Hawkins
and Associates indicated:
The top five specialties by growth
 73% - Hospitalists
 54% - Pediatrics
 43% - OB-GYN
 31% - Hem/Onc
 18% - Family Practice

17. Physician Workforce Facts
Reasons physicians voluntarily leave a practice:
(Source: 2006 Retention Survey from the American Medical Group
Association (AMGA) and Cejka Search)
 51% - Poor cultural fit
Relocated to find a better community fit was mentioned 20% of the time
 42% - Family considerations
To be closer to own or spouse’s family and spouse’s job required relocation was
mentioned 22% of the time
 32% - Leaving to seek higher compensation
Incompatible work schedule and excessive call schedule each mentioned 17% of
the time.

18. Hospitalist Role Considerations
 Salary
 Practice model
 Work hours/Call schedule
 Daily workload
 Expectations/Demands from hospital
 Medical staff support
 Specialty providers
 Referral network
 Hospital administrative support
 Program staffing/Program stability
 Empowerment and career path
 Community and practice culture
 Hospital culture and systems

19. Hospitalist Roles
Where are hospitalists located?
 Critical access hospitals
 Community hospitals
 Major medical centers
 Teaching programs
 Involved in basic and clinical research
 Administrative leadership positions (CEO, Medical Director, VPMA)
 Medical staff leadership (Chief of staff, Department chair, QA Director)
 Involved in medical policy making and patient advocacy (quality and safety
initiatives)
 Creating evidence-based clinical guidelines and protocols
 Developing surgical co-management programs
 Developing palliative care programs

20. Hospitalist Pool
Where do we come from?
 New graduates
 Internal medicine, IM/Peds, Family medicine, Pediatrics
 Hospitalist fellowship programs/Hospitalist tracks
 Sub-specialty training programs (e.g. Intensivists, pulmonary, cardiology)
 International medical graduates (IMG’s)
 Established hospitalists in other programs
 Established physicians in non-hospitalist practices (e.g. private
or hospital practice)
 Emergency Department physicians
 Locum Tenems

21. Physician Workforce Facts
Turnover ratios
(Source: 2006 Retention Survey from the American Medical Group
Association (AMGA) and Cejka Search)
 6.7% - Total average turnover (6.4% in 2005)
 By sex
 Males: 6.85% (5.9% in 2005)
 Females: 6.6% (7.5% in 2005)
 The first three years in practice hold the greatest likelihood for turnover
 12% - First year
 46% - In the first three years
 23% - Greater than ten years

22. Factors Influencing Physician
Career Decisions
 Changing culture
 Limited resident work hours
 Growing ratio of women entering the medical profession
 Increasing male participation in the household
 Graduate debt burden
 Generational (X, Millennial) expectations
The new generation of doctors may view the medical profession
as a job and not a calling….

23. Factors Influencing Physician
Satisfaction and Retention
 Health Care Reform
 Changing focus of the specialist
 Consultant role
 Procedurist orientation and training
 Aging physician workforce
 Practice scope
 Medico-legal concerns
 Employment model

24. Hospitalist vs Specialist vs PCP
Whats The Right Choice

25. Hospitalist Role- What We Like
 Block Schedule
 No Call
 Excellent Salary
 RVU Based Bonus
 Corporate Protections
 Limited Staff Issues
 Limited Business Issues

26. Hospitalist Role – What We Hate
 Working for Somebody Else
 When on Shift – Long Hours
 Highest Acuity Patients
 People Die
 Surgeons
 Orthopedic Docs
 Heme Onc Docs
 ED Docs ………You get the point

27. TeamHEALTH
Residency Stipend Program
 PGY3 Internal Medicine Residents are eligible to
participate
 Requires a TeamHealth agreement to work after
completing an IM residency
 A 2 year post-graduate commitment
 $1,000 /MONTH stipend PAID DURING RESIDENCY
 This program is location / practice specific

28. Things to Think About
Your Job Satisfaction will be affected by many variables:
 Geography
 Economics
 Workforce supply
 Population demographics
 Generational expectations
 Practice and workplace culture
 Presence of a hospitalist program
 Communication
 Collegial support
 Medico-legal landscape
 Community fit, family integration and satisfaction
 Potential for professional growth
 Practice flexibility and call
 Life style requirements

29. More Things to Consider
Your Opportunities are affected by many variables including:
 Number of medical school graduates
 Number of residency programs and seats
 Number of international medical graduates
 Government policy
 Health of the U.S. economy
 Insurance
 Specialty choice
 Physician productivity
 Work schedules
 Number of FTE’s
 New medical technologies
 Aging physician population/retirement patterns
 Growing and aging patient population
 Utilization of mid-level providers

30. Concluding thoughts….
 Your Path is Unique – One size Doesn’t fit All
 Money Only Matters When You Don’t Have Any
 Find a Place to Work that Feels Like Family
 Call Me if I can Help

31. Contact information
James Ratliff MD – Chief of Medicine
Ochsner Medical Center – Baton Rouge
Email address: jratliff@ochsner.org
Phone: 225-209-5932
Anne Brewer
Residency Relations Specialist
TeamHealth Hospital Medicine
Email address: Anne_Brewer@teamhealth.com
Phone: 865-985-7177

32. References
1. SHM 2005 - 2006 Survey.
2. Physician Supply and Demand: Projections to 2020. U.S. Department of Health and Human
Services. Health Resources and Services Administration. Bureau of Health Professions.
October 2006.
3. Physician Workforce Policy Guidelines for the United States, 2000 – 2020: Sixteenth Report.
U.S. Council on Graduate Medical Education. U.S. Department of Health and Human
Services – HRSA. January 2005.
4. Coile, Jr., Russell C. “10 Factors Affecting the Physician Shortage of the Future - Next!”
Physician Executive, Sept-Oct, 2003.
5. Full, James M. “Physician Recruitment Strategies for a Rural Hospital.”, ache.org,,
6. Westfall, Carol. “Strong Physician Recruitment and Retention”, Physicians News
Digest, January 2004.
7. 2006 Retention Survey from the American Medical Group Association (AMGA) and Cejka
Search.
8. Third Annual AAMC Physician Workforce Research Conference, May, 2007.<http:AAMC
Physician Workforce Research Conference.htm.
9. Cohen, Jordan J. “Physician Workforce Trends and Expectation.” Association Of American
Medical Colleges. December 21, 2006.

33. References
10. Strategies for Recruiting and Retaining Top Hospitalists. Hospitalist Management Advisor.
May, 2007.
11. Pratt, Mary K. “On the wards: Hospitalists Steadily Bolster Their Ranks”, Boston Business
Journal - March 24, 2006.
12. Lurie, J.D., Miller, D.P., Lindenauer, P.K., Wachter, R.M., Sox, H.C. “The Potential Size of
the Hospitalist Workforce in the United States”, The American Journal of Medicine® 106
(4) (1999) pp. 441-445.
13. Holton, Lisa. “Put More Than Money on the Table When Recruiting Hospitalists”, ACP
Hospitalist. February, 2007.
14. 2007 Physician and Recruiting Initiatives Survey by Merritt, Hawkins and Associates.
15. Dichter, Jeffrey R., Simone, Kenneth G., Tools and Strategies for an Effective Hospitalist
Program (HCPro: MA., 2006).
16. Cooper, Richard A., Stoflet, Sandra J., Wartman, Steven A. “Perceptions of Medical School
Deans and State Medical Society Executives About Physician
Supply”, JAMA. 2003;290:2992-2995.
17. Cooper, Richard A., Getzen, Thomas E., McKee, Heather J., Laud, Prakash. “Economic And
Demographic Trends Signal An Impending Physician Shortage”, Health Affairs. Vol.
21, Number 1. Project Hope, 2002. 140 – 154.

34. Physician
Recruitment and Retention
TeamHEALTH South East