A Challenge for a New Specialty Hospitalist Career Satisfaction

1. A Challenge for a New SpecialtyHospitalist Career Satisfaction

2. The Stresses Facing Hospitalists • The nature of the work • The nature of the work environment • External influences • Career/organizational issues • Personal issues

3. The Risks of Stress • Unplanned turnover • Absenteeism • Judgment and action errors • Accidents; litigation • Conflicts with colleagues • Physical illness • Mental fatigue; substance abuse

4. Hospitalist Career Satisfaction Reward Recognition Workload Schedule Autonomy Control Community Environment What hospitalist leaders can do: Address the 4 Pillars of Career Satisfaction A Framework for Hospitalist Career Satisfaction What individual hospitalists can do: Assess how their values/goals FIT with those of the hospitalist program

5. 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/recognitioninvolve 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

6. 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)

7. 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

8. 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.

9. 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

10. 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

11. Work/Life Balance – Building a successful career in hospital medicine

12. What is Balance? • Integrating those components of your life that are truly important to you.

13. 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

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

16. Career Satisfaction

17. Hospitalist Stressors External influences • Impact of ACGME work rules on patient care/teaching • Legal and regulatory concerns • Financial pressures from payers SHM Whitepaper 2006

18. 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

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

20. Evolving Clinical Roles • Increasing Census • ACGME work hours • Increased housestaff supervision • Surgical Co-management • Subspecialty Co-management • Consultations • Your input in the Evolution

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

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

23. 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?

24. Where is your group going? • Needs of the hospital • Respect each others priorities • Group leadership • Balancing individual needs with group goals

25. 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 weigh in on career satisfaction

26. 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

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

28. Life Balance

29. Shift work/Overnight work

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

31. 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

32. 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