A Challenge for a New SpecialtyHospitalist Career Satisfaction

The Stresses Facing Hospitalists The nature of the work

The nature of the work environment

External influences

Career/organizational issues

Personal issues

The Risks of Stress Unplanned turnover Absenteeism Judgment and action errors

Accidents; litigation

Conflicts with colleagues Physical illness Mental fatigue; substance abuse

A Framework for Hospitalist Career Satisfaction

HospitalistCareer Satisfaction

RewardRecognition

WorkloadSchedule

CommunityEnvironment

What hospitalist leaders can do: Address the 4 Pillars of Career Satisfaction

AutonomyControl

What individual hospitalists can do:Assess how their values/goals FIT with those of the hospitalist program

Reward/Recognition“Lack of reward is closely associated with feelings of inefficacy.”

(Maslach) Financial rewards/recognition involve compensation (including salary,

bonuses, and benefits)

Social rewards/recognition involve appreciation by other hospitalists (both inside and outside the group), members of the medical staff, non-physician providers (including nurses, case managers, pharmacists, etc.), hospital leadership, patients, and family members

Intrinsic rewards/recognition involve getting satisfaction from healing and educating patients, practicing quality care, effectively teaching house staff and medical students, being efficient and productive, and continuing to learn and grow professionally

Workload/Schedule“Generally, workload is most directly related to the exhaustion

aspect of burnout.” (Maslach) Type of work: patient care, teaching, administrative activities, etc.

Volume of work: e.g., for patient care, this involves the number of patients

Intensity of work: for patient care this may be defined by the acuity of patients and/or the work of doing admissions/discharges as compared to rounding

Time pressure: the need to get the work done within a specified timeframe

Variability of work: some days have less volume, intensity, and time pressure than others (peaks and valleys); work on nights/weekends is different than weekday, daytime work

Interruptions: patient care work can be intermittent (e.g., you never know when your beeper might go off)

Autonomy/Control“It is distressing for people to feel responsible for producing

results to which they are deeply committed while lacking the capacity to deliver on that mandate.” (Maslach)

Task Control: control over when, how, and how quickly a task is done

Decision/Organizational Control: control over task assignment and policies

Physical Environment Control: control over the location, layout, and climate of where work is done

Resource Control: control over the availability of support staff, supplies, and materials

Community/Environment“A mismatch occurs when people lose a sense of positive

connection with others in the workplace.” (Maslach)

Hospital community: This includes hospital administration, referring physicians, non-referring physicians, the emergency department, house staff, medical students and other healthcare staff (nurses, NPs/PAs, pharmacists, laboratory techs, etc.).

Hospitalist community: This consists of the hospitalists in their own group, as well as relationships with other hospitalists and hospitalist groups.

Patient community: This includes not only patients and their families, but also the broader public community served by the group and hospital.

Home community: This is an external, but vital component of the hospitalist environment consisting of family/friends.

Action Steps – The Basics Recognize each hospitalist as an individual Assure adequate environmental resources are in place Assure adequate professional development support Make informed decisions Build a cohesive team Build positive relationships Create an ownership mentality Operate the practice in a business-like manner

Action Steps Get the Facts - Suggestions on information that can be researched,

analyses that can be conducted, and/or surveys that might be administered

Organizational/Structural Strategies - Suggestions on formal steps that can be taken with regard to the structure of the hospitalist group, how it is staffed/organized, and/or how hospitalists are compensated

Systems Strategies - Suggestions on changes that can be made to the operation (processes) of the hospitalist group

Professional Development Strategies - Suggestions on actions that can be taken directed at individual hospitalists

Marketing/Relationship Strategies - Suggestions on how hospitalists can re-define how they relate to other key stakeholders in their work environment

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Work/Life Balance – Building a successful

career in hospital medicine

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What is Balance?• Integrating those components of your life that

are truly important to you.

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Top Challenges Hospital Medicine Leaders

1. Work hours/work life balance 42%2. Recruitment 35%3. Daily work load 29%4. Expectations/demand from hospital 23%5. Reimbursement and collections 17%6. Professional respect and job satisfaction 17%7. Career sustainability 15%8. Retention 15%9. Quality of care/quality indicators 13%

SHM’s 2005 bi-annual survey

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Ranking Exercise• Workload• Salary • Schedule• Hospital culture• Colleagues• Group leadership• Professional opportunities

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Career SatisfactionProfessional Opportunities

GroupLeadershipHospital

CultureColleagues

Schedule Salary

Workload

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Hospitalist StressorsThe nature of the work• High acuity/complexity of illness/lack of predictability• Life and death implications of clinical decisions• Provider interdependency and communication• Limited patient information• Administrative and documentation requirements• Medical legal risk• Potential hostility from patient’s family________________________________________________________

The nature of the work environment• Volume of work• Time pressure• Night and weekend coverage responsibilities• High census conditions• Intermittent demand (beeper always going off)• Workplace conflicts and interruptions• Workplace discrimination• Lack of understanding of the hospitalist role by administrators• Hospitalists working on a temporary basis while waitingto pursue other career plans• Medical staff conflicts• Ergonomics (poorly designed work space and/or equipment)• Limited workspace

Personal issues•Professional advancement•Financial pressures •Pressures from spouse/family•Unrealistic job expectations•Inability to say “no”

Career/organizational issues• Reimbursement based on office model• No established track for promotion• Little control over key issues (workload, schedule, case types)• Conflict between service mission and other equally important responsibilities• Limited professional recognition and funding for scholarly activities• Leadership structure within the hospital (not “at the table”)

SHM Whitepaper 2006

External influences• Impact of ACGME work rules on patient care/teaching• Legal and regulatory concerns• Financial pressures from payers

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We are different• 24/7 coverage• Majority of FTE is related to clinical work• Collaboration is a necessity• Lack of fellowship training• Each program is unique• Unpredictable days• Jobs are evolving

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Clinical Work• Workload/Acuity• Schedule• Variability• Teamwork/Autonomy• Supervision of trainees• Scope of Care• Evolving Roles

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Evolving Clinical Roles• Increasing Census

– ACGME work hours– Increased housestaff supervision

• Surgical Co-management• Subspecialty Co-management• Consultations• Your input in the Evolution

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Professional Growth• Clinical Work• Education• Quality & Safety• Research• Technology• Hospital Administration

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Professional Activities• Diversity of Opportunities• Required/Optional/Not Available• Protected Time• Mentoring• Support Staff• Measurable Outcomes

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Where is your job going?• 12 month plan

– SMART goals• 3-5 year plan

– What is changing at your institution?– What are you planning to do to get to your goal?

• 10 year plan– Imagine doing the exact same job in 10 yrs

• Does it exist? In your institution?• Do you still want to do it?

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Where is your group going?• Needs of the hospital

– Respect each others priorities• Group leadership• Balancing individual needs with group goals

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Strategies to prevent Burnout

• Right number of nights• Right director• Good age mix• Collegiality & Colleague recognition• Everyone on the same page• Decent benefits• Room to grow

Are You Happy? Hospitalists weighin on career satisfaction

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Successful Program• Shared values• Support individual pursuits/understand

individual needs• Identify and own the problems• Input is sought and valued• Successes are shared• Plan for the future

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What is important to you?• Family• Friends• Health• Work• Money• Personal growth• Spirituality• Physical surroundings• Recreation

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Life Balance

Family

Friends

Health

WorkMoney

Personal Growth

Spirit-uality

Recreation

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Shift work/Overnight workBenefits

•Blocks of time off•Less days on calendar•Flexible scheduling

Challenges•Upset circadian rhythms•Building academic career•Health issues•Shift work disorder•Patient continuity•Isolation at night

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Optimizing shiftwork • Optimize circadian-friendly schedules• Employ proper sleep hygiene• Eat healthy • Promote a healthy life and work style • Avoid pharmaceuticals

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Mary Ann’s Work Plan• Define “having it all” for yourself• Decide how/when work & life can overlap• Accept that perfect jobs don’t exist• Create your niche• Consider part-time status• Get organized

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Mary Ann’s Life Plan• Accept that some days/wks/months won’t have

balance• Get organized• Be flexible• Pursue outside interests• Pay for good help/Build networks of friends• Find humor• Be grateful that your life has so much going on

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