10 Current Healthcare Employment and Compensation Trends

Here are 10 trends affecting employment and compensation in healthcare, according to various surveys, studies and news reports.

1. Nursing enrollment is rising. Enrollment in nursing programs from baccalaureate level to advance practice is growing, and more men are entering the field, according to a survey by the American Association of Colleges of Nursing. The survey, which covered nursing enrollments in 2010, also found that more students are enrolling in entry-level nursing baccalaureate programs and PhD nursing programs. In addition, accelerated nursing programs are growing; there are currently 13,605 students enrolled in the nation's 233 accelerated baccalaureate programs, up from 11,960 in 2009. The survey also found that 2010 introduced more clinical nurse leader programs with a 24.7 percent increase in enrollment and more baccalaureate-to-doctoral programs. With the rise in these programs comes a rise in rejected applicants; the survey found that 67,563 applicants were rejected last year, due primarily to a shortage of faculty and resource constraints.

2. Female physicians earn less. The gender gap in starting salaries for female physicians is widening, rising from a difference of $3,600 in 1999 to $16,819 in 2008, according to a study published in Health Affairs. The study mentioned in the report is based on survey data from more than 8,000 physicians exiting training programs in New York, which is home to more residency programs and resident physicians than any other state in the country. The study also found female heart surgeons were paid $27,103 less on average than males; female otolaryngologists made $32,207 less than males; and women specializing in pulmonary disease made $44,320 less than men. The differences in pay remain even when specialty, practice type, hours worked and other factors were taken into account.

3. More medical students choose primary care. The number of seniors and U.S. medical students entering primary care rose again in the 2011 residency match, according to the National Resident Matching Program. Positions filled by U.S. seniors rose by 11 percent in family medicine, 8 percent in internal medicine and 3 percent in pediatrics over the last year, and family medicine matches were higher for the second consecutive year. Emergency medicine, anesthesiology and neurology also saw increases in matches. The specialty fields that showed little growth can often blame a high level of competition; at least 90 percent of the available positions in dermatology, orthopedic surgery, otolaryngology, plastic surgery, radiation oncology, thoracic surgery and vascular surgery were filled by U.S. seniors. The 2011 Match also placed 2,178 osteopathic applicants and 3,769 applicants from international medical schools in U.S. residency programs.

4. Physician compensation in academic settings increased in 2010.
Academic faculty physicians in primary and specialty care reported slight increases in compensation between 2009 and 2010, according to a survey published by MGMA. The survey reports median compensation for primary care faculty physicians was $163,704 in 2010. The 2010 salary represents an increase of 3.47 percent over 2009. The median compensation for specialty care faculty was $241,959, an increase of 2.70 percent since 2009. The survey reported that rank plays an important role in increasing compensation. Department chairs and chiefs received the highest compensation, at $292,243 for primary care faculty and $482,293 for specialty care faculty. Primary care professors received $190,815 in compensation and specialty care professors received $268,786.

5. Staffing levels affect mortality rates. Patient mortality was linked to hospital shifts with low nurse staffing levels and high patient turnover in a study published in the New England Journal of Medicine. Researchers at University of California-Los Angeles estimated the risk of death increased by 2 percent for each shift below a selected staffing target and 4 percent for each shift with high patient turnover. Patient turnover is thought to divert nurses' time and attention from other matters. The study, using data from 2003-2006 at an unnamed academic medical center, identified shifts with staffing that was eight hours or more below an adjusted target.

6. On-call pay has increased in half of hospitals. Over half of respondents reported that their on-call pay expenditures increased over the last year, according to Sullivan, Cotter and Associates' 2010 Physician On-call Pay Survey Report. The survey looked at data from 148 healthcare organizations nationwide. From 2007-2010, the median on-call expenditures reported by trauma centers more than doubled, from $1.2 million in 2007 to $2.4 million in 2010. For non-trauma centers, expenditures in 2007 were $433,849, compared to $798,000 in 2010. The majority of survey participants reported providing on-call pay to at least some of their non-employed physicians with admitting privileges. Nearly 65 percent reported providing on-call pay to at least some of their employed physicians, and 27 percent indicated that on-call pay was factored into employed physicians' salaries (with no additional pay provided).

7. Critical care employees report lowest job satisfaction. Hospital senior management reported the highest overall job satisfaction of all hospital employees, while critical intensive care workers reported the lowest overall satisfaction, according to a study conducted by HR Solutions. The study identified hospital employees who exhibit the highest and lowest overall job satisfaction. Senior management employees differed from critical intensive care workers by almost 26 percentage points. The departments experiencing the highest overall job satisfaction based on percent favorable norm were senior management (87 percent), hospice (84 percent) and human resources (81 percent). Those experiencing the lowest overall job satisfaction were critical intensive care (62 percent), medical-surgical and critical care (64 percent) and neonatal intensive care (65 percent).

8. Employed physician salaries are expected to increase. Physicians employed by hospitals and health systems could experience a 2.3 percent increase in base salary in 2011, according to a survey by management consulting firm Hay Group. Hay Group predicts a 2.6 percent pay increase for all healthcare employees in 2011, up from 2.3 percent in 2010. Salaries for employed physicians will increase slightly less than nurse salaries, which could be in for a 2.7 percent boost. "Healthcare providers have felt the pinch, but salary budgets are beginning to move upward, mirroring the slow ascent in the broader economy," said Ron Seifert, vice president and executive compensation practice leader for Hay Group's healthcare practice, in a news release.

9. Nurse provider shortage decreases. A recent report by the Washington Post suggests that the recession alleviated a nursing provider shortage, at least for hospitals in the Washington, D.C., metro area. The recession seems to have pushed a significant number of retired nurses back into the field as well as delayed the retirement dates of older nurses. Additionally, part-time nurses are seeking full-time positions. At Howard County General Hospital in Columbia, Md., for example, the percent of full-time nurses has increased from 60 percent to 73 percent since the recession. These forces have lowered nursing vacancy rates in the region. The vacancy rate for RNs in Maryland hospitals dropped from 10 percent in 2005 to 5.3 percent in 2009, and the vacancy rate for LPNs dropped from 6.2 percent to 1.7 percent, according to the Maryland Hospital Association.

10. Feb. 2011 saw higher employment than Jan. 2011 and Feb. 2010. Hospital employment in the United States increased more than 0.5 percent from 4.708 million in Jan. 2011 to 4.711 in Feb. 2011, on a seasonally adjusted basis, according to a news release from the Bureau of Labor Statistics. Compared to Feb. 2010, hospital employment rose nearly 0.8 percent, on a seasonally adjusted basis. Seasonal adjustment removes the effect of fluctuations due to seasonal events.

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