As clinicians and educators, academic hospitalists function within several arenas: They are role models and teachers in the inpatient arena, but they also feel pressure from hospital administration to meet throughput and capacity goals. In addition, hospitalist clinician-educators are expected to be leaders in quality improvement.
But are the rewards for academic hospitalists commensurate with the demands placed upon them? Even as hospitalists prove their worth to hospital administrators, many clinician-educators find themselves pulled between time spent on service and time for the academic pursuits necessary to improve resident education and merit faculty promotions.
“In my current situation, there is difficulty in fitting in the prep work time for teaching rounds,” says Elizabeth A. Schultz, MD, who practices with the Adult Hospitalist Team at Swedish Medical Center in Seattle and is also affiliated with the University of Washington School of Medicine. “There’s really no time for that, other than time on my own—and I’m actually in a really good situation right now where my boss has capped the number of patients I see in a day and afforded me the ability to go to conferences, do teaching rounds, and to really focus on resident and medical student education.”
Dr. Schultz is not alone in struggling to balance clinical and educational duties. Many hospital medicine leaders wrestle with these concerns, aware that growing clinical responsibilities impinge on teaching time and that the sustainability of hospital medicine as a career is at stake.
Confront the Dilemma
An October 2006 survey by the University HealthSystem Consortium confirmed that hospitalists have improved the educational process for residents and medical students, but it also identified impediments to the continuation and growth of hospitalist programs. (The Benchmarking Study, “Role of the Hospitalist,” is available online to University HealthSystem Consortium (UHC) members and registered website users at www.uhc.edu.) The most common barrier is the difficulty in attracting and retaining quality candidates, given the ratio of salary to workload, the potential for burnout, and undefined career paths.
“There is a significant amount of demand on one small group of physicians, and we haven’t necessarily found a way to compensate them for the different roles they play,” reflects Alpesh Amin, MD, MBA, FACP, associate program director for the Internal Medicine Residency Program and the medicine clerkship director at the University of California at Irvine (UCI), where he founded the UCI hospitalist program in 1998 and serves as its executive director. “These three arenas that hospitalists have to constantly keep moving in are not always complementary. How do you spend more time facilitating the teaching mission versus time facilitating the throughput mission or the expanding clinical mission?”