Bylaws and governance monthly: Balance the value of time and money when determining medical staff leadership pay

If the burden of medical staff leadership was shared equally by all medical staff members, each member would spend a reasonable amount of time on their leadership duties. As a result, medical staff members would be less likely to consider these duties an additional burden worthy of monetary compensation. But the reality is that a handful of the members do the bulk of the work while the remaining wouldn’t touch leadership responsibilities with a 10-foot pole.

In the past, medical staff members gave their time more freely and without the expectation of being paid. However, in today’s economic environment, physicians are watching their salaries dwindle, and they resist giving their time and expertise away for free.

This trend begs several questions:

Should we pay medical staff leaders?  More often than not, medical staffs are offering leaders some form of compensation. Some medical staffs are unable to get leaders on board unless they offer compensation in the form of a yearly salary, stipend, or hourly rate. So, if you’re not offering compensation but want to keep experienced leaders on board, consider it seriously.

Which medical staff leaders should we pay? The answer to this question varies widely from hospital to hospital. Some pay only the president of the medical staff, some pay the president and department chairs, and some pay everyone on the medical executive committee. I suggest that you analyze the amount of time these individuals spend on their leadership duties to determine which positions warrant compensation.

How much should medical staff leaders be paid? The answer to this question also varies from hospital to hospital, and we see huge differences based on the size of the institution. Unfortunately, we can offer no magic numbers. It depends on the need to pay leaders, how much time leaders spend performing their duties, and how much the organization can afford. Most medical staff leaders know that the compensation they receive will not reimburse them fully for the time they spend on their leadership responsibilities, so for most institutions, payment is best approached as a token of appreciation.

Who should pay medical staff leaders? Historically, the hospital has been responsible for paying medical staff leaders because they perform the duties designated to them by the board. But some medical staffs feel that if the full payment comes from the hospital, the hospital will have the leaders in its pocket. As a result, more medical staffs are sharing the cost of paying leaders with the hospital, usually dipping into the monies generated from medical staff dues. Some medical staffs across the country are so opposed to the hospital reimbursing medical staff leadership (and a potential conflict of interest) that they fully fund the cost themselves. 

In these economic times, we understand that it is difficult to find the monetary sources to fund these positions. Start thinking creatively – is there something else that the medical staff leader would value that could be used instead of a monetary award? How about reducing or eliminating unassigned call for certain medical staff? Medical staff leaders want to feel appreciated for the hard work that they do, so another reward might include public recognition of a leader’s efforts.  Money is nice, but other forms of recognition may work as well, and in some cases, better.

Mary Hoppa, MD, MBA, CMSL, is a senior consultant with The Greeley Company, a division of HCPro, Inc. in Marblehead, MA.