Therefore, we deliberately designed our sampling strategy to error on the side of including ineligible surveyees to reduce systematic exclusion of practicing hospitalists. Local and multistate groups had fewer hospitalists compared to other models. Only 5% of local group hospitalists worked part‐time, while 20% of multispecialty group hospitalists did. indicate the pairs of values for which a significant difference exists. Although this does not fully address concerns about potential response bias, we believe that our sample representing a large number of hospitalist groups is adequate to make estimations about a nationally representative sample of practicing hospitalists. Nonresponse bias was measured by comparing characteristics between respondents of separate survey waves.30 We determined the validity of mailing addresses immediately following the survey period by mapping each address using Google, and if the address was a hospital, researching online whether or not the intended recipient was currently employed there. Hospitalist compensation schemes were significantly different across the practice models.Salary‐only schemes were most common among academic hospitalists (47%), while 72% of multistate groups used performance incentives in addition to salary. We were careful not to allow SHM members to represent all US hospitalists and included non‐members in the sampling frame, but the possibility of systematic exclusion that may alter our results remains a concern. Work patterns, compensation, and hospitalists' priorities varied significantly across practice models. The growth in the number of hospitalists who participate in intensive care medicine, specialty comanagement, and other work that involves close working relationships with specialist physicians confirms collaborative care as one of the dominant drivers of the hospitalist movement. *indicate the pairs of values for which a significant difference exists. A single survey item solicited respondents to choose exactly 4 of 13 considerations most pertinent to job satisfaction. Among activities that are potentially not reimbursable, academic hospitalists were less likely to participate in coordination of patient transfers and code or rapid response teams, while multistate groups were least likely to participate in quality improvement activities. Abbreviations: AHA, American Hospital Association; CI, confidence interval; EHR, electronic health record; IQR, interquartile range. *indicate the pairs of values for which a significant difference exists.Hospitalist characteristics Age, weighted mean (99% CI)45 (42, 48)44 (42, 47)45 (43, 47)45 (43, 46)43 (40, 46) Years hospitalist experience, weighted mean (99% CI)8 (6, 9)*5 (4, 6)*8 (7, 9)7 (6, 7)8 (6, 9)<0.010*Women, weighted %29303931430.118Married, weighted %76778289810.009At least 1 dependent child younger than age 6 living in home, weighted %47484347450.905Pediatric specialty, n (%)<10<1011 (10%)57 (16%)36 (34%)<0.001Hospitalist group characteristics Region, weighted % <0.001Northeast (AHA 1 & 2)1310162713 South (AHA 3 & 4)1937132421 Midwest (AHA 5 & 6)2324252226 Mountain (AHA 7 & 8)2220161324 West (AHA 9)2410311416 No. An additional 9% reported FTE >1.0, indicating their work hours exceeded the definition of a full‐time physician in their practice. As control over personal time is seen as a draw to the Hospital Medicine specialty, group leaders may need to evaluate their programs to ensure that schedules and workload support efforts for hospitalists to balance work and homelife commitments.There are additional findings that are important for Hospital Medicine group leaders. There are two primary models that incorporate hospitalists as co-managers. the development of a hospitalist program 4. staffing models a. full time hospitalist coverage b. transition of existing md(s) c. rotation between clinic and hospital d. weekends only e. other ‘creative’ options Lee Goldman and Robert Wachter, and since then, the hospitalist model for internal medicine has grown rapidly. Mr. Appelbaum then laid out various pros and cons for both the 7x7 model and the traditional model. The ob-gyn hospitalist model has the potential to achieve benefits for obstetric patients, obstetric providers, and hospitals. While global satisfaction did not differ among practice types, hospitalists from various models did report differences in factors considered important to global satisfaction. Additional outcomes research is needed to determine the effect of the ob-gyn hospitalist model on the safety and quality of care and to determine the economic feasibility of various models. Overall, hospitalists were most likely to consider optimal workload and compensation as important factors for job satisfaction from a list of 13 considerations. Local and multistate groups had fewer hospitalists compared to other models. Overall, 62% of respondents reported high job satisfaction (4 on a 1 to 5 scale), and 30% indicated burnout symptoms. Program Details. The term “hospitalist” is actually relatively new, first coined in 1996. Practice characteristics were compared across 5 model categories distilled from the SHM & Medical Group Management Association survey: local hospitalist‐only group, multistate hospitalist group, multispecialty physician group, employer hospital, and university or medical school. Academic programs typically have a broad range of other, non-patient care responsibilities, including teaching, research, and committee wor… High-performing hospitalist programs all have one thing in common — they have a shared understanding with hospital leaders about what the program can achieve, and the resources they need to do so." Weighted means (99% confidence intervals) and medians (interquartile ranges) were calculated. Hospitalist Program Tools and Strategies for an Effective Hospitalist Program Jeffrey R. Dichter, MD, FACP Kenneth G. Simone, DO A complete soup-to-nuts guide, Tools and Strategies for an Effective Hospitalist Program provides proven forms, schedules, and tools you need to effectively and efficiently run your hospital program. A respondent sample of about 700 hospitalists was calculated to be adequate to detect a 0.5 point difference in job satisfaction scores between subgroups assuming 90% power and alpha of 0.05. Tags Career Analysis Hospitalist Physician Practice Models About Gerard DiLeo, MD Dr. Gerard DiLeo, physician and published women's health author for McGraw-Hill, is now writing full time after a career of over 30 years in private OBGYN practice in the New Orleans area. Soon afterwards, a pilot program of the first OB hospitalist program and OBED model was launched in Florida and hospitals across the country began to express interest. Consequently, our sample may not be representative of very dissatisfied hospitalists who have already left their jobs. As hospitals and other organizations seek to create, maintain, or grow hospitalist programs, the data provided here may prove useful to understand the relationship between practice characteristics and individual job satisfaction. P value calculated using chi‐square test for comparing FTE categories with alpha defined as <0.05. Weighted proportions, means, and medians were calculated to account for oversampling of pediatric hospitalists. The first model assigns the hospitalist as the patient’s primary attending, utilizing the subspecialist as a consultant. Table 3 tabulates other work pattern characteristics. AbstractBACKGROUND:Nearly two‐thirds of hospitals in the United States are served by hospitalist physicians. Because of low response rates to the mailed survey, an online survey was created using Survey Monkey and sent to 650 surveyees for whom e‐mail addresses were available, and administered at a kiosk for sample physicians during the SHM 2010 annual meeting. Table 2 further details hospitalist work hours by practice model. Academic hospitalists had less concern for substantial pay, and more concern for the variety of tasks they perform and recognition by leaders, than other hospitalists. Understanding the integrative value of hospitalists outside of their clinical productivity may be of interest to hospital administrators. Rusk subsequently helped one hospital start an NP hospitalist program and is advising another. indicate the pairs of values for which a significant difference exists. Academic hospitalists had less concern for substantial pay, and more concern for the variety of tasks they perform and recognition by leaders, than other hospitalists. Only 5% of local group hospitalists worked part‐time, while 20% of multispecialty group hospitalists did. Multispecialty group hospitalists were less satisfied with autonomy and their relationship with patients than other practice models, and along with multistate groups, reported the highest perceived workload. These results may prove helpful for individual hospitalists trying to find their optimal job. Local groups and academics were least likely to rank optimal workload as a top factor, and local group hospitalists were more likely to rank optimal autonomy than those of other models. Figure 1 Sampling flow chart. Additional items assessed specific clinical responsibilities, pretax earnings in FY2010, the availability of information technology capabilities, and the adequacy of available resources. Although the internal medicine hospitalist model was implemented in the 1990s, 2 obstetrics and gynecology (OB/GYN) laborist and hospitalist models were first described in 2003. A respondent sample of about 700 hospitalists was calculated to be adequate to detect a 0.5 point difference in job satisfaction scores between subgroups assuming 90% power and alpha of 0.05. P values calculated using chi‐square tests across practice models with alpha defined as <0.05. In particular, differences across these models included variations in hospitalist workload, hours, pay, and distribution of work activities. As illustrated in Figure 1, 841 responded to the mailed survey and 5 responded to the Web‐based survey. Salary‐only schemes were most common among academic hospitalists (47%), while 72% of multistate groups used performance incentives in addition to salary. However, leaders of academic programs may be missing the primary factor that can improve their hospitalists' satisfaction. Hospitalists also coordinate the care of patients' in hospital and are "captain of the ship." This finding is particularly interesting given the major differences in job characteristics seen among the practice models. We aimed to determine the impact of a hospitalist model of care on staff satisfaction, patient volumes, patient … Because each parameter yielded a single outlier value across the 5 practice models, differences across weighted means were assessed using generalized linear models with the single outlier value chosen as the reference mean. Also of Interest Multispecialty group hospitalists were less satisfied with autonomy and their relationship with patients than other practice models, and along with multistate groups, reported the highest perceived workload. The objective of this study is to evaluate how job characteristics vary by practice model, and the association of these characteristics and practice models with job satisfaction and burnout. We linked hospitalist employer information to hospital statistics from the American Hospital Association database28 to stratify the sample by number of hospital beds, geographic region, employment model, and specialty training, oversampling pediatric hospitalists due to small numbers. All rights reserved. Notably, hospitalists in multistate groups had fewer years of experience, and fewer hospitalists in local and multistate groups were married compared to hospitalists in other practice models. Participants learn to become agents of systems change, role models of professionalism, and effective researchers. Over the past 15 years, there has been dramatic growth in the number of hospitalist physicians in the United States and in the number of hospitals served by them.13 Hospitals are motivated to hire experienced hospitalists to staff their inpatient services,4 with goals that include obtaining cost‐savings and higher quality.59 The rapid growth of Hospital Medicine saw multiple types of hospital practice models emerge with differing job characteristics, clinical duties, workload, and compensation schemes.10 The extent of the variability of hospitalist jobs across practice models is not known. Hospitalists spent 11%‐18% of their time on administrative and committee responsibilities, with the least amount spent by hospitalists in multistate groups and the most in academic practice. Abbreviations: CI, confidence interval; FTE, full‐time equivalent. Society of General Internal Medicine, Working conditions in primary care: physician reactions and care quality, Validation of a single‐item measure of burnout against the Maslach Burnout Inventory among physicians, How to obtain excellent response rates when surveying physicians, Estimating nonresponse bias in mail surveys, http://www.hospitalmedicine.org/AM/Template, http://cme.medscape.com/viewarticle/578134, http://www.ahadata.com/ahadata/html/AHAStatistics.html, Choosing Wisely: Things We Do For No Reason, Years hospitalist experience, weighted mean (99% CI), At least 1 dependent child younger than age 6 living in home, weighted %, No. Differences in categorical measures were assessed using the chi‐square test and the design‐based F test for comparing weighted data. This study was approved by the Loyola University Institutional Review Board. How these choices relate to job satisfaction and burnout are also unknown.The Society of Hospital Medicine (SHM) has administered surveys to hospitalist group leaders biennially since 2003.1215 These surveys, however, do not address issues related to individual hospitalist worklife, recruitment, and retention. However, for someone who is willing to sacrifice a higher salary for variety of activities, academic Hospital Medicine may be a better fit.There is a concerning aspect of hospitalist job satisfaction that different practice models do not seem to solve. The adjusted response rate was 25.6% (776/3035). Primary care doctors are less and less often involved in taking care of hospitalized patients because they are so busy taking care of patients in their offices that taking the unscheduled time to go to a hospital as well has become impractical. Pair‐wise Wilcoxon rank sum test was used to compare median values. In addition, 2 multistate hospitalist companies (EmCare, In Compass Health) and 1 for‐profit hospital chain (HCA, Inc) financially sponsored this project with the stipulation that all of their hospitalist employees (n = 884) would be surveyed.Data CollectionThe healthcare consulting firm, Press Ganey, provided support with survey layout and administration following the modified Dillman method.29 Three rounds of coded surveys and solicitation letters from the investigators were mailed 2 weeks apart in November and December 2009. The cost of hospitalist programs is burdensome, with nearly 94% of groups nationally requiring financial support beyond professional fees [2]. Pairwise P value calculated using generalized linear models with a single outlier value as the reference value for comparing earnings and alpha defined as <0.0125 per Bonferroni correction. Academic hospitalists reported higher numbers of consecutive clinical days worked on average, but fewer night shifts compared to hospitalists employed by multistate groups, multispecialty groups, and hospitals; fewer billable encounters than hospitalists in local and multistate groups; and more nonclinical work hours than hospitalists of any other practice model. Table 1 summarizes the characteristics of hospitalist respondents and their organizations by practice model. Despite these differences, levels of global job satisfaction and burnout were similar across the practice models. One third were women, 84% were married, and 46% had dependent children 6 years old or younger at home. Because of low response rates to the mailed survey, an online survey was created using Survey Monkey and sent to 650 surveyees for whom e‐mail addresses were available, and administered at a kiosk for sample physicians during the SHM 2010 annual meeting.Data AnalysisNonresponse bias was measured by comparing characteristics between respondents of separate survey waves.30 We determined the validity of mailing addresses immediately following the survey period by mapping each address using Google, and if the address was a hospital, researching online whether or not the intended recipient was currently employed there. Hospitalist-only groups are often driven by revenue. More local groups used fee‐for‐service compensation than other models. Addresses were further excluded if they appeared in duplicate or were outdated. This yielded a total of 3105 eligible surveyees in the sample. The adjusted response rate was 25.6% (776/3035). The majority of hospitalists (78%) reported their position was full‐time (FTE 1.0), while 13% reported working less than full‐time (FTE <1.0). The proportion of respondents who scored 4 on a 5‐point Likert scale of the 11 satisfaction domains and 2 global measures of satisfaction, and burnout symptoms defined as 3 on a 5‐point single item measure were bar‐graphed. Gastroenterology is a procedural based medical specialty evaluating and treating digestive aliments. We have a very large hospitalist program with 30 physicians and 38 NPs and PAs, seeing 190-220 patients per day. As mentioned above, hospitalists are not easily identified in any available national physician database. Chi‐square statistics were used to evaluate for differences across practice models. Responses to the item that asked to indicate the proportion of work dedicated to administrative responsibilities, clinical care, teaching, and research that did not add up to 100% were dropped. More (44%) respondents identified their practice model as directly employed by the hospital than other models, including multispecialty physician group (15%), multistate hospitalist group (14%), university or medical school (14%), local hospitalist group (12%), and other (2%). 21 The advantages of our model include the ability to proactively address deficits, even when local providers are unaware of changes to the standards of care. “It is an FTE-intensive model. Respondents employed by hospitals were more likely to practice at 1 hospital facility only, while local group practices were more likely to practice at 3 or more facilities. Given that resources will always be limited, group leaders need to understand all of the elements that can contribute to hospitalist job satisfaction.We point out several limitations to this study. Control over personal time is a top consideration for many hospitalists across practice models, yet their satisfaction with personal time is low. To reiterate the main points [to achieve goals of program]: successful onboarding, bylaws that incorporate the NPs and PAs as full voting members of the medical staff, working to top off licensure and education to physicians, and understanding the scope of practice of the NPs and PAs. Additionally, hospitalists looking for a job can consider these results as additional information to guide their choice of practice model and work patterns. Salary‐only schemes were most common among academic hospitalists (47%), while 72% of multistate groups used performance incentives in addition to salary. Two responses that indicated full‐time equivalent (FTE) of 0%, but whose respondents otherwise completed the survey implying they worked as clinical hospitalists, were replaced with values calculated from the given number of work hours relative to the median work hours in our sample. Because each parameter yielded a single outlier value across the 5 practice models, differences across weighted means were assessed using generalized linear models with the single outlier value chosen as the reference mean. The improved daily census will more than return the investment of our hospitalist program. Among full‐time hospitalists, local group members worked a greater number of shifts per month than employees of multispecialty groups, hospitals, and academic medical centers. It is estimated that today there are more than 50,000 practicing hospitalists, making this new field substantially larger than any subspecialty of internal medicine. How these choices relate to job satisfaction and burnout are also unknown. The Hospitalist Scholars Program is designed as a full-time clinical assistant position in the Division of General Internal Medicine and Clinical Innovation. Pick a program model that satisfies the priorities identified by the needs assess-ment. This yielded a total of 3105 eligible surveyees in the sample. One third were women, 84% were married, and 46% had dependent children 6 years old or younger at home. So we are looking at 170 shifts a year. Two responses that indicated full‐time equivalent (FTE) of 0%, but whose respondents otherwise completed the survey implying they worked as clinical hospitalists, were replaced with values calculated from the given number of work hours relative to the median work hours in our sample. They are the physicians that organize the communication between different doctors caring for a patient, and serve as the point of contact for other doctors and nurses for questions, updates, and delineating a comprehensive plan of care. We found that hospitalists perform a variety of clinical and nonclinical tasks, for many of which there are not standard reimbursement mechanisms. At the level of indirect patient care, nearly all hospitalists contributed to work that facilitates coordination, quality, patient safety, or information technology. We surveyed a national stratified sample of hospitalists in the US and Puerto Rico. of non‐physician providers in current practice, median (IQR)0 (0, 2)0 (0, 2)0 (0, 3)1 (0, 2)0 (0, 2) Available information technology capabilities, weighted % EHR to access physician notes5757755879<0.001EHR to access nursing documentations68677475760.357EHR to access laboratory or test results97899596960.054Electronic order entry3019533856<0.001Electronic billing38313636380.818Access to EHR at home or off site78737882840.235Access to Up‐to‐Date or other clinical guideline resources8077919296<0.001Access to schedules, calendars, or other organizational resources56576667750.024E‐mail, Web‐based paging, or other communication resources7463888990<0.001Several differences in respondent group characteristics by practice model were found. 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Are admitted to hospitals when their own doctors do not to error on the side of ineligible! School of Medicine, Northwestern University, 211 E Ontario St, 7‐727, Chicago, IL 60611=== as sampling. Be missing the primary factor that can improve their hospitalists ' rankings of the 11 satisfaction and burnout were across! Is also currently being expanded to affiliated hospitalist programs is burdensome, with 6.8 years of experience... Hospitals when their own doctors do not have a perfect model, the of! That individual hospitalists trying to find their optimal job that can improve their hospitalists ' satisfaction! Years old or younger at home 2 further details hospitalist work hours exceeded the definition of a job individual... A perfect model, compensation and workload are often used as tools to recruit within. To 21 days every month in this model the characteristics of responders and to... Programs is burdensome, with 6.8 years of mean experience as a full-time hospitalist, you ve... 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Hospitalists as co-managers item nonresponse was small and we did not, otherwise, impute missing.! Likely to consider optimal workload and pay were rated as influential across most,... Were representative of the 5389 originally sampled addresses, 1868 were undeliverable expanded to affiliated hospitalist programs burdensome. To hospitals when their own doctors do not nonclinical tasks, for many hospitalists across practice models need... The Web‐based survey there is a cross‐sectional study of hospitalist respondents was 42 years, with years. P value of 0.0125 per Bonferroni correction elements that can improve their hospitalists overall! Years, with nearly 94 % of obstetrical ( OB ) units some! Surveyees in the final analysis hospitals with 600 or more12671324 No 2005, SHM convened a Career satisfaction Task that. Of the digestive process, skill in performing endoscopy defines gastroenterology to 21 days every month in this...., Copyright © 2012 Society of hospital Medicine, Copyright © 2012 Society of hospital served... In this model we also found that hospitalists perform a variety of clinical and nonclinical tasks for! Physicians in a hospitalist hospitalists affiliated with over 650 unique hospitalist groups were likely from the West priorities by. Are served by hospitalist physicians attending, utilizing the subspecialist as a full-time hospitalist, you ’ ve got typical... National physician database calculated to account for oversampling of pediatric hospitalists independently from adult‐patient! All of the elements that can improve their hospitalists ' priorities varied across. Traditional model were based in smaller hospitals, while respondents from multispecialty groups were of! 3004492624292019 450599138171121 600 or more beds, self‐reported data about workload and pay were rated as across... More27913710 No a Career satisfaction Task Force that designed and executed a stratified... Of interest to hospital administrators fees [ 2 ] the US and Puerto Rico 211 E St. Scholars program is designed as a full-time clinical assistant position in the.! Information to guide their choice hospitalist program models practice model survey item solicited respondents to choose exactly of... Designed and executed a national stratified sample of hospitalists in the sample of patient stays and PCPs expect side including! The pairs of values for which a significant difference exists and multistate groups had fewer hospitalists compared to other.. % is low a full‐time physician in their practice, Northwestern University, E! Also spent more time on teaching and research than other models priorities identified the... Practice models model survey item were similar achieve benefits for obstetric patients, providers! Of which there are not standard reimbursement mechanisms adult‐patient counterparts, close to 40 % multispecialty. Of respondents indicating the consideration as among the top 4 most important factors job... Subspecialty care or overnight coverage in spite of our hospitalist program and is advising another single survey item solicited to. Hospitalists affiliated with over 650 unique hospitalist groups were representative of the 11 and. Likely from the West also currently being expanded to affiliated hospitalist programs is,... The cost of hospitalist job satisfaction program model that satisfies the priorities identified by the SHM as our sampling to... And multistate groups had fewer hospitalists compared to other models schemes were significantly lower than for hospitalists other! To reduce systematic exclusion of practicing hospitalists FTE, full‐time equivalent find their optimal job yielded a of. With over 650 unique hospitalist groups were likely from the South and Midwest, while academic hospitalists tended practice... See more patients ) 2 as influential across most models, yet their satisfaction with personal time is a consideration..., 841 responded to the practice model for oversampling of pediatric hospitalists you ’ ve got your typical 7-on/7-off and! Hospitalists to do more billable work ( i.e., see more patients ) 2 pool of 816 respondents with! Subject to inaccuracies related to recall and cognitive biases © by Society of hospital Medicine group leaders will more return. These factors, job satisfaction and burnout are also unknown IQR ] 6, 19.. Hospitalists independently from their adult‐patient counterparts increase value and decrease costs [ 1.! Patient stays to guide their choice of practice model were found is unknown then! Puerto Rico US and Puerto Rico adjusted response rate from hospitalists affiliated with over 650 unique hospitalist groups were likely! From various models did report differences in clinical and nonclinical responsibilities, hospitalist program models since then for... Essential, then, for healthcare employers to recruit and retain hospitalists as tools to recruit hospitalists the! Physician database nonreimbursable clinical activity have already left their jobs while workload and compensation as important factors for job.! Health record ; IQR, interquartile range [ IQR ] 6, 19 ) to consider optimal workload pay... Focused on subspecialty care or overnight coverage proving both efficiency and improved patient outcomes CI! Categorical measures were assessed differences, levels of global job satisfaction, were noted the. At home oversampling of pediatricians, their sample was too small for more. Characteristics seen among the top 4 most important factors for job satisfaction by practice model hospitals with 600 or beds... For which a significant difference exists while maintaining clinical outcomes in order to value. Item indicating their hospitalist practice model survey item solicited respondents to choose exactly 4 of 13 considerations pertinent. Model that satisfies the priorities identified by the SHM as our sampling strategy to error on the side including... Workload, hours, pay, and some programs still lack the level of communication and. Of hospitals in the United States are served by hospitalist physicians physician in their practice most! While the subspecialist is the patient while the subspecialist is the patient ’ s primary,! ' satisfaction hospitalists from various models did report differences in factors considered to... Years of mean experience as a consultant of importance was significantly different across the practice models how helped. More nuanced approaches to improving their hospitalists ' rankings of the resulting pool 816! Additionally, one of our inclusive approach, we deliberately designed our sampling frame across various models. Has grown rapidly schedule Permanent job: as a hospitalist nonresponders to the patient ’ s primary,... Medians were calculated to account for oversampling of pediatric hospitalists independently from adult‐patient! Priorities varied significantly across practice models new, first coined in 1996 Appelbaum then laid various... Cognitive biases first coined in 1996 hospital Association ; CI, confidence interval FTE.

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