#427 - 🏖️ [COOL TOPICS] - Are Neonatologists Being Fairly Compensated for the Work They Do? (ft. Dr. Robin Steinhorn)

Dr. Robin Steinhorn, Professor and Vice Dean for Children’s Clinical Services at UC San Diego and President of Children’s Specialists of San Diego, tackles one of neonatology’s most uncomfortable conversations: compensation. She breaks down how to identify reliable benchmark data, explains why neonatologists are generating more RVUs than ever while pay has not kept pace with workload complexity, addresses gender discrepancy trends in the literature, and offers practical strategies for individuals and division chiefs to use rigorous national data when advocating for fair compensation at the institutional level.

Transcript

Ben Courchia MD (00:00.45) Hello everybody. Welcome back to the Incubator Podcast, live at Cool Topics in Neonatology in San Diego, California. We have the pleasure of being joined in the booth this morning by Dr. Robin Steinhorn. Robin, welcome back to the show.

Dr. Robin Steinhorn (00:11.426) Thanks so much for having me — and for being in my hometown, San Diego. I hope you're enjoying it.

Daphna Yasova Barbeau MD (00:17.174) We're having a lovely time.

Ben Courchia MD (00:18.766) It is such a beautiful city and the weather is just wonderful. It reminds me a lot of the south of France — I get that little feeling of —

Daphna Yasova Barbeau MD (00:29.506) — home. And we've had such a warm reception. The people are very friendly — you know that, you live and work here. And as we said earlier, anybody can come to Cool Topics. It's not just for California.

Dr. Robin Steinhorn (00:45.102) We welcome everyone.

Daphna Yasova Barbeau MD (00:50.392) People could really learn a lot — and take advantage of the great weather and the wonderful people while they're at it. Speaking of great content — you have a very important session later today. There's a panel that we get the honor of moderating, but you did all the hard work: economics and compensation in neonatology. That's a big topic.

Dr. Robin Steinhorn (00:57.89) So much to learn.

Daphna Yasova Barbeau MD (01:18.943) Your portion specifically focuses on benchmarking — how your compensation compares. How does one even know what their compensation should be?

Dr. Robin Steinhorn (01:30.638) I got really interested in this topic more than a decade ago. We're here hearing all these great talks on the advances in neonatal intensive care and the hard work that people are doing — and that reflects a population of sicker babies. And yet, when you look at how a neonatal intensivist is paid relative to a pediatric intensivist or a cardiac intensivist, there's a real gap. There's a gap in the number of hours credited and the work effort credit a neonatal intensivist receives. That's what drew me into figuring out how we get to a source of truth. And for me, the source of truth is always data. The data we're talking about today are survey data — what we refer to as benchmarks.

Ben Courchia MD (02:31.118) Because if someone today feels they're not being compensated fairly, they might go online and find something like a Doximity survey, look at average salaries — but that doesn't really reflect reality, unfortunately.

Dr. Robin Steinhorn (02:46.19) That's exactly right. And that's one of the things I'm going to address today — you have to know your source, which is true with all data. The best sources are large surveys that collect information from a broad population — ideally from people in academic, community hospital, and non-academic environments — and that are very rigorous in their methodology. There are maybe three or four surveys that I think tick all of those boxes. Doximity is not really on that list, although they do seem to be making an effort to get there. As an individual, accessing these major surveys is very difficult. You're going to have to trust that your leadership is acquiring them — which happens through a two-step process: you contribute your own institutional data rigorously, and you pay for the survey. They do not allow individuals to purchase these surveys directly.

Ben Courchia MD (04:04.267) They're behind an institutional paywall.

Dr. Robin Steinhorn (04:08.75) Yes — believe me, I tried for years when I was a division chief. But now I understand how this works at the institutional level.

Daphna Yasova Barbeau MD (04:25.346) So if we were able to access those surveys, what would we see? What are the compensation trends looking like? What can we expect over the next five to ten years?

Dr. Robin Steinhorn (04:36.078) Great question. Across all specialties — and these surveys cover not just neonatal intensivists but all intensivists, all pediatric specialties, and most adult specialties as well — we've seen a pretty solid rise in compensation for all intensivists over the last three or four years. None of us know what the future will bring, but that's what the recent trend looks like. We also see that work effort is fairly stable for cardiac intensivists and pediatric intensivists. In neonatology, we see a lot of variability — and I find it especially striking that on average, neonatal intensivists report working more hours and, as a result, generate more RVUs.

Daphna Yasova Barbeau MD (05:45.42) We've spoken about this and read a great deal of what you and Dr. Satyan have written. So why is this especially challenging for neonatology? We're generating more RVUs, seeing more patients, and pay is going up — but is it commensurate with the amount of work?

Dr. Robin Steinhorn (06:06.03) I think we got anchored decades ago, in the early phases of neonatal medicine, when life was just really different. A 23-week gestation baby rarely survived to be admitted to the NICU. Most neonatal units were academic units with large numbers of residents, and a single neonatologist could see 30 patients in a day. As a result, when the RVU system came on the scene, we generated an enormous number of RVUs — and that seemed fine at the time.

But we have evolved into a world where the work we do is every bit as complex, intensive, and time-consuming as what other intensivists do. We just haven't adapted the payment model to reflect that. In addition, departments draw income from across multiple specialties, and the disproportionate share coming from neonatology has become more of a problem as other specialties — ambulatory specialties like endocrinology and pediatric nephrology — struggle for compensation in the outpatient setting. Their rates aren't rising much, and trying to find the right balance has really brought things to a crisis point.

Ben Courchia MD (08:07.087) What have you found in terms of gender discrepancy in the data you've been able to review?

Dr. Robin Steinhorn (08:12.206) It's a great question. We do see a gender discrepancy in many of the reports in the literature — Catanacchio has done very good work in that area. However, when you adjust for many of the other contributing factors, we don't see a systematic gender discrepancy — at least not in neonatology, and not in pediatrics more broadly. I think that's because more groups are becoming very systematic in their approach to compensation. It used to be that your starting salary was largely based on how well you negotiated for yourself. The more that department chairs and hospitals adopt a rigorous, systematic approach to compensation, the less you're going to see those gender discrepancies.

Daphna Yasova Barbeau MD (09:21.528) And that brings us to the next question — what are some of the solutions? What can we do at the individual level? What can we do at the division level, if we have any influence at our institution? You're touching on transparency — how people are paid, what increments look like. What is our responsibility in shaping the culture for the future of neonatology?

Dr. Robin Steinhorn (09:50.414) First and foremost: know the data. That's really the central point I want to make today. The data are out there. And it's important to understand how your own compensation is structured. People often say, "I haven't gotten a raise in five years" — what they usually mean is their base salary hasn't increased. But their total compensation may have. So understanding compensation means understanding both your base salary and any incentives you receive — for call coverage, for extra RVUs generated. Being aware of your total compensation package — including benefits like a robust retirement plan — makes a significant difference. And then, once you understand your own structure, understanding where your group sits relative to the benchmark data — are we working around average and earning around average, or are we working harder and earning more? — gives you the tools to have informed conversations about how your practice should be run.

Daphna Yasova Barbeau MD (11:17.292) What are some tips for approaching C-suites and people outside your division to make change?

Dr. Robin Steinhorn (11:28.62) What tends to be most persuasive to C-suites is rigorous national data. When someone says, "I looked it up on Doximity and neonatologists are making more than I am," that seldom moves the needle. But being able to present benchmark survey data and say, "We can see that we are more productive than other academic groups of our size — so why isn't our compensation keeping pace? Why are we generating more RVUs for less compensation?" — that's a very different conversation. Many of the companies that publish these surveys also offer advisory services — you can engage them to help ensure your compensation structure is fair and competitive. And one last point: hospitals want excellent physicians and they want to keep them. Retention matters. It's expensive to go out and recruit a new neonatal intensivist. Appealing to that institutional self-interest is a legitimate and effective strategy.

Daphna Yasova Barbeau MD (12:56.174) I have one last question — it's more philosophical. People say, "I'm a pediatrician, I'm a neonatologist, I get a lot of fulfillment from what I do. I'm a kind person, I don't want to fight with anyone." But why does it matter that we're all invested in this — to protect the future of neonatology?

Dr. Robin Steinhorn (13:21.934) I don't think there will be a strong future if we aren't shoulder to shoulder advocating for fair compensation. We do reasonably well at attracting people to neonatal intensive care right now, but increasingly in pediatrics we see fewer people choosing to become pediatricians — and one of the biggest reasons is lower compensation. We need to attract top talent into neonatal critical care. Compensation isn't the only way we'll do that, but it is one of them.

Ben Courchia MD (13:58.904) Dr. Steinhorn, thank you so much for dropping by — and we'll see you at the panel later today.

Dr. Robin Steinhorn (14:03.832) Thank you.

Daphna Yasova Barbeau MD (14:04.302) See you later. Likewise.