Wednesday, December 31, 2008

Top 10 issues in hospital medicine for 2008, issue 1: state of the hospitalist movement

Here’s my very biased take on where things stand at the close of 2008:

The never ending debate over the value of the hospitalist model is moot. Research on hospitaists’ impact on outcomes and efficiency has been inconclusive and is likely to remain so, given that large comparison groups against which to study the model are shrinking fast and will soon be nonexistent.

The security of our niche is based not on any measurable value, but on the mass exodus of traditional practitioners from the hospital. The resulting expansion in hospitalist jobs has outpaced growth in the work force. The trend shows no sign of abating. The current economic crisis will only serve to accelerate this exodus. The inflation of salaries may moderate, but hospitalists’ jobs should remain secure.

Larger threats to the hospitalist movement are turnover and burnout. Although we lack hard data on the magnitude of the problem it is widely apparent. This creates challenges for leaders in hospital medicine who are poised to define the ultimate direction of the movement. Hospitalists are increasingly being asked to go beyond the limits of their training by caring for all hospitalized patients regardless of illness. Moreover, their role as expert clinicians is increasingly threatened by pressure to become business and administrative solutions.

This emerging jack-of-all-trades model for hospitalists is a departure from the original notion of doctors devoting all their professional time caring for inpatients in the realm of their specialty (usually internal medicine) who, because they ascended a steep learning curve, developed unique expertise in hospital medicine. The old model attracted me to the field almost a decade ago because of its promise of professional satisfaction. The new model will be palatable for many of the short timers and moonlighters who increasingly make up the work force of hospital medicine but may not attract the career hospitalists needed to sustain and grow hospital medicine as a specialty.


Anonymous said...

do you think hospitalists are burning out faster than other docs? if so, why?
is it perhaps the notion that they should be doing a certain amount that creates a self fulfilling prophecy of exhaustion? i'm a specialist in a small town and on call every day if i'm in town. i admit my own patients, and field their phone calls. i'm paged approximately 15 times per week between 10 pm and 6am (which absolutely sucks btw and is the thing most likely to drive me to early retirement).
it always amuses me to hear how overworked my local hospitalists feel with their 26 weeks off a year. (i'm not saying they have it easy, just that they seem to spend a lot of time explaining to everyone how overworked they are and convincing themselves that shm says they should only see 20 patients a day and shm says they should only do so many shifts a month.) just curious on your thoughts

R. W. Donnell said...

Anonymous 7:54:

No. There are a lot of other docs who have it worse than hospitalists. Nevertheless, for what ever reason, hospitalists turn over fast and recriting is hard.

I was trying to weigh in on what I see as a developing in house debate among hospitalist leaders about how to define the specialty and direct the movement in such a way as to ensure professional satisfaction and make hospital medicine an attractive career choice.

DrHertzLikeaRentaCarORaBigPain said...

When you state that we hospitalists have 26 weeks off a year, you need to quantify the statement. We work 26 or more weeks a year at 7-8 days straight minimum of 13 hours a day often 15 a day.. so lets calculate 13 x 7 = 91 hours in ONE WEEK. So in one weeks we are working more than most Outpatient docs and we do not have 3-4 nurses organizing our day. Ok now lets multiply 91 x 26 = 2366 hours a year - and we don't get paid vacation like most other physicians OR CME time either. Anonymous states that he takes call at night if he is in town. How convienient. Who takes his call when "He is not in town?" The hospitalist. We are in the hospital 24 hours a day and take those calls from the specialists that don't want to come in if there are problems in the hospital. So lets see how many hours you work at 50 hours a week x 46 with 4 weeks vacation and 2 weeks CME = 2300 .. OK Oh that's right our patients in the hospital have a much higher acuity as well. Thank you for letting me relay the reality of the comments made by Anonymous. If you are interested I have a blog about helping to make the hospitalist job a sustainable one that we can live with. Take care, Huggs,