The media often make complex issues sound simple—10 tips for this, the best eight ways to do that. Vexing problems are neatly addressed in a page or two, ending with bullet points lest the reader misunderstand the sage advice offered. While The Hospitalist would not presume that a task as fraught as hospitalist scheduling could be approached using tips similar to those suggested for soothing toddler temper tantrums, we lightly present some collective wisdom on scheduling.
Before sharing how several hospitalist medicine groups (HMGs) previously profiled in The Hospitalist attacked their toughest scheduling issues, we looked at the “2005-2006 SHM Survey: State of the Hospital Medicine Movement” of 2,550 hospitalists in 396 HMGs for insights about how hospitalists spend their time and how they struggle to balance work and personal lives. This background information provides a context for scheduling.
Here’s what the data say. For starters, the average hospitalist is not fresh out of residency. The SHM survey says the average HMG leader is 41, with 5.1 years of hospitalist experience. Non-leader hospitalists are, on average, 37 and have been hospitalists for an average of three years. Hospitalist physician staffing levels increased from 8.49 to 8.81 physicians, while non-physician staffing decreased from 3.10 to 1.09 FTEs.
Hospitalists spend 10% of their time in non-clinical activities, and that 10% is divided as follows: committee work, 92%; quality improvement, 86%; developing practice guidelines, 72%; and teaching medical students, 51%. New since the last survey is the fact that 52% of HMGs became involved in rapid response teams, while 19% of HMGs spend time on computerized physician order entry (CPOE) systems.
Scheduling’s impact on hospitalists’ lives remains a big issue. Forty-two percent of HMG leaders cited balancing work hours and personal life balance as problematic, 29% were concerned about their daily workloads, 23% said that expectations and demands on hospitalists were increasing, 15% worried about career sustainability and retaining hospitalists, while 11% cited scheduling per se as challenging.
Coverage arrangements changed significantly from the 2003-2004 survey. More HMGs now use hybrid (shift + call) coverage (35% in ’05-’06 versus 27% in ’03-’04) and fewer use call only (25% in ’05-’06 versus 36% in ’03-’04).
SHM’s survey shows that hospitalists working shift-only schedules average 187 shifts, 10.8 hours a day. Call-only hospitalists average 150 days on call, for 15.7-hour days. Hybrid schedules average 206 days, with each day spanning 8.9 hours; of those days, 82 are 12.8-hour on-call days.