Hospitalist Burnout Humor: You Win Some You Lose Some!

If you've been in the hospitalist business for a few years, you've probably heard of hospitalist burnout.  Presumably, doctors working in the unpredictable stress of in-patient medicine are more likely to quit being hospitalists and move on to other subspecialties of care. 

Fortunately, I believe hospitalist burnout is a function of individual physicians in addition to local practice environments and not the specialty of hospitalist  medicine.  Every specialty will have physicians who burn out. In addition, malignant hospitalist programs will always exists.    I don't think there is anything specific about hospitalist medicine that puts doctors at additional risk for work fatigue.

Not all hospitalist programs are created equal.  Hospitalists provide different levels of care in different hospital systems.  For some hospitals, hospitalists will  admit all patients. For other hospitals, hospitalists may  act only as consultants.  Some hospital systems close their ICU to only intensivists while others welcome hospitalist care.  Some hospitalists perform procedures while others do not. Some hospitalists may provide post discharge continuity and some may not. 

Hospitalist responsibilities will also vary in expectations of clinical, academic and administrative duties.  Some programs expect their hospitalists to make their own  E/M coding decisions.  Other hospitals will look to hospitalists to  lead quality initiatives in patient satisfaction or assist in   maximizing DRG collections and EHR implementation. 

The sky is the limit.   Can hospitalists burn out?  Of course.  There are only so many hours in a day.  There are only so many patients a doctor can see before feeling exhausted.  That threshold is different for every doctor.  More efficient doctors may be able to handle 30 encounters a day while slower doctors may only be able to handle 10 before feeling exhausted and out of time.  Under salaried models of hospitalist compensation, the variation in productivity may create animosity among hospitalist partners if some doctors feel they are providing a greater portion of work RVUs without additional compensation.

This is where hospitalist benchmarks for productivity can establish expectations.  Research suggests compensation expectations vary widely when comparing  salary vs productivity models as well.  Hospitalist groups should strongly consider the consequences of both when making decisions for their local group.  Some doctors may feel too much time pressure to provide the kind of productivity that other members of the group find acceptable.  If these lone members have difficulty "keeping up" they may feel isolated on their road to burnout.   These folks will gravitate to other fields or programs with lower expectations.  If a hospitalist program is malignant, most members will eventually leave and these programs will have difficulty recruiting members for long term retention.  Malignant programs are easy to spot.   They are the ones that can't recruit and can't retain.  If you are a resident, I believe the most important question to ask when joining a hospitalist program is how long each member has been in the group.  That will tell you how happy their hospitalists are.  Stability is a sign of excellence and a program that respects their hospitalists.

Unpredictable Hospitalist Medicine Census
If hospitalists want to reduce burnout potential in their program, I believe they should staff appropriately based on a majority of their members expectations while  accepting predictably unpredictable high and low patient census as variable of chance.   In addition, hospitalists should focus their energies on implementing processes to minimize minute-to-minute or hour-to-hour interruptions in their work flow.  Hospitalists cannot be the doctor of convenience for  nurses, doctors, patients or families as a 24 hour all you can eat buffet of physician access and not suffer the consequences of burnout.

With that said, I just so happened to have an example of how unpredictable the hospitalist medicine census can be.  As hospitalists, we must accept these periods of atypical stress with a grain of salt and work through them with excellence in mind.  I work in a hospital system with two free standing hospitals housing two free standing emergency rooms.  That means we may be in contact on a daily basis with our partners across town.  Some days we're busy.  Some days we're slow.   In this example above, I was texting my partner across town on a very slow day of sitting around doing nothing.  On the other hand, my partner was getting bombarded with new patients.   Some days you win.  Some days you lose. That's hospitalist medicine.



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Some of this post is for entertainment purposes only and likely contains humor only understood by those in a health care profession. Read at your own risk.

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