First surfacing in nineteenth-century France, modern medicine's concept of a “specialist” physician is now well-established. Today, the American Association of Medical Colleges (AAMC) recognizes more than 160 specialties and medical specialties (www.aamc.org/cim/explore-options/specialty-profiles). As the list of specialties expands, appraisers must identify unique factors in determining fair market value (FMV) compensation for new types of physicians. For example, special considerations are advised when setting compensation and incentives for these three new types of specialists – nocturnists, clinical informatics specialists, and neurointensivists.
Nocturnists are hospital-based physicians typically trained in internal medicine, family medicine, or pediatrics. They perform the same essential functions as hospitalist physicians, except that nocturnists practice exclusively during nighttime hours, allowing them to report to duty alert and conditioned for overnight shifts. The benefits that nocturnists bring to a hospital are being realized nationwide. The Society of Hospital Medicine’s 2020 State of Hospital Medicine Report showed that in 2020, 71.9% of reporting hospitalist groups included a nocturnist, up from 46.1% in 2012.
Fair Market Value Considerations for Nocturnists
With any new specialty, the lack of published compensation and production benchmarks can present a problem when determining fair market value compensation. Since nocturnist data is less readily available than hospitalist data, it is reasonable to assume that hospitalist data may be used as a proxy. However, in terms of expectations surrounding compensation terms, there are marked differences between nocturnists and their daytime counterparts that need to be considered.
First, a premium is often paid for nocturnist work because fewer physicians want to work the night shift. Generally speaking, nocturnists commonly receive a 10% to 20% pay differential above daytime hospitalist rates. Secondly, nocturnists generally have lower productivity totals than daytime hospitalists. Overnight responsibilities vary widely by organization, but for the median producer, night work may generate only half as many RVUs as daytime work. There may be many contributing factors to this; one factor may be as straightforward as the nocturnist’s schedule having fewer shifts. However, many in the industry attribute lower work RVU productivity to billing limitations for physicians on nighttime schedules (e.g., a limit on the number of times an inpatient can be billed for an evaluation and management visit – and more billable visits occurring during daytime hours).
Differences in compensation and production between hospitalists and nocturnists make it essential to utilize nocturnist-specific benchmark data when setting compensation and incentives for these physicians. If hospitalist data must be used, it is well-advised to make considerations for these differences.
Clinical Informatics Specialists
Clinical informatics specialists are physicians who collaborate with other health care and information technology professionals to analyze, design, implement and evaluate information and communication systems that enhance individual and population health outcomes, improve patient care, and strengthen the clinician-patient relationship. The American Board of Medical Specialties (ABMS) has formally recognized clinical informatics as a certified subspecialty, with the first certifications awarded in 2013. All ABMS member boards have agreed to allow their diplomates to take the clinical informatics subspecialty examination if they are otherwise eligible. As a result, clinical informatics specialists may come from various clinical specialty backgrounds.
Fair Market Value Considerations for Clinical Informatics Specialists
Clinical informatics specialists often serve in leadership roles, such as Chief Medical Informatics Officer (CMIO), in health systems across the country. CMIOs are physician executives who partner with information technology (IT) and clinical operations professionals for digital innovation to advance the patient experience and ensure high-quality and safe patient care.
In many health systems, the CMIO role is held by a physician who also maintains a clinical practice. When setting compensation for a CMIO, it is important to ensure that fair market value is paid for each distinct role — clinical and administrative — with an understanding that the fair market values may differ. It is also important to consider that, since clinical informatics specialists can come from a wide range of clinical backgrounds, and fair market value can vary significantly among clinical specialties, there may be a sizable remunerable difference between the clinical and administrative functions. Therefore, having a firm grasp on the physician’s professional time allocation and using appropriate (i.e., different) benchmarks for the physician’s clinical work versus their administrative work will be critical components of the valuation process.
In 2018, the ABMS adopted a new subspecialty for critical care neurologists: neurointensivists. This subspecialty (also known as neurologic intensive care, critical care neurology, and neurocritical care) designates physicians who care for critically ill patients with neurological diseases/conditions. Neurointensivists can arrive at the subspecialty from various specialty backgrounds (including neurology, neurosurgery, anesthesiology, and emergency medicine). These physicians interface with many other specialties and may practice across multiple hospital departments.
Fair Market Value Considerations for Neurointensivists
When setting compensation terms for a neurointensivist, it is important to consider the inherent differences between the work performed within the subspecialty of neurocritical care versus that of the physician’s original specialty. Several well-known compensation surveys are now publishing neurointensivist-specific benchmarks, and early indications show that this specialty does not track with neurology, neurosurgery, anesthesiology, or emergency medicine from the standpoint of compensation, work RVU levels, or compensation to wRVU rates. This makes sense as the top procedure codes for neurointensivists are time-based critical care procedures involving the evaluation and management of critically ill patients. Also interesting is that, while neurointensivist compensation benchmarks are somewhat similar to those of intensivist physicians, there are still some noticeable differences on the production front (i.e., lower work RVUs and higher compensation-to-work RVU rates).
Setting compensation for a physician in a new or emerging specialty can be daunting. BFMV offers valuation consulting services for hospitals and physicians involved in compensation negotiations for physician services. Contact BFMV for assistance in determining fair market value compensation for all types of physician contracts.