Navigating Hospitalist Work Schedules

Sidney Christiansen, MD

Hospitalists have become a critical provider of care of hospitalized patients. The creation of the Hospitalist position came from the need for physicians dedicated to hospitalized patients who were experiencing increasingly complex health issues. This type of care has resulted in shift-type work schedules and added the challenge of communication and continuity that is critical to positive outcomes.

To support this type of coverage, Hospitalists typically work long shifts ranging from 10 to 16 hours, with some shifts even topping out at 24 hours. Schedules often come in varying blocks, from the typical seven days on/seven days off to a more recent designation of only evenings and nights - Nocturnists.

Changes to Come?

The traditional seven on/seven off schedule has come under fire from Hospitalists and administrators alike. At the Society of Hospital Medicine’s Annual Meeting, Dr. Robert Wachter – professor of medicine at the University of California, San Francisco, and academic leader of the Hospitalist movement – confirmed what Hospitalists have said all along; the time has come to do away with the 12-hours-a-day, “7-on, 7-off.”

Adding to the conversation was Dr. John Nelson, the cofounder of the Society of Hospitalist Medicine, who fully agrees with Dr. Wachter. Neither are sure of a solution, but Dr. Nelson said, “Pursuit of the maximum number of days off is backfiring, failing to see the big picture.” One proposal is for Hospitalists to work more days, but with fewer hours per shift. With the continuing discussion about work/life balance, continuity of care and the highest quality of care of hospitalized patients, Hospitalists have the opportunity to gain input and control over their schedules.

Gaining Flexibility

Individual physicians have little influence in creating an empowering work environment, but many Hospitalists are utilizing physician contract attorneys who are knowledgeable in this work to create desirable work schedules and optimize patient care. Hospitalist groups are gaining additional influence with administrators because of the data they are accumulating and the working conditions that best suit their employed physicians. Burnout is very high in this specialty and the groups are listening to their doctors and taking steps to create a happy and fulfilling workplace. Flexibility is empowering for physicians and increases a sense of control over their lives, thus decreasing stress and improving quality of life.

But, What About Patient Care?

Hospitalists face challenges in relations to their schedules. A hallmark of Hospitalist care is being able to see the same patient throughout their hospital stay. This dynamic may be somewhat altered when Hospitalists switch shifts on a daily basis or decrease consecutive work periods. This is a tough balance to strike between what is an effective form of care for the patient and what meets the needs of the individual physician. One way that Hospitalist groups are addressing this issue is determining how referrals are managed. One preferred method is to frontload the newest referrals into a Hospitalist’s schedule so that the end of their work block coincides closely with the discharge of the patient. This helps with continuity of care for each patient and allows for a potentially lighter schedule as the Hospitalist’s block of shifts comes to an end.

So what is the solution? There is no perfect solution but communication between the Hospitalist, the Hospitalist group and the institution are critical in balancing the needs of patient care with healthy, satisfied physicians. With the majority of hospitalists employed physicians, an experienced physician contract attorney will often be an important advocate for the doctor in these negotiations.