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ONLINE EXCLUSIVE: Shifting Strategies Can Make Physician Workloads Manageable

by Bryn Nelson, PhD

As hospitalists have learned, sometimes a workload problem is related to how that work is apportioned. The trick is to devise a solution that’s good for patients, doctors, and the hospital.

Adam Singer, MD, CEO of North Hollywood, Calif.-based IPC: The Hospitalist Company, has long advocated changing from a shift-based model to a more full-time model that expands the number of days worked per month. Although the concept has faced resistance from many rank-and-file hospitalists, Dr. Singer argues that the latter model means that more staff will be available to care for patients on any given day, leading to a lower and more manageable average census. Dr. Singer concedes that switching to a full-time model can be a “painful process,” but it’s one that has led to improved patient outcomes, higher revenues, and more sustainable workloads.

John Nelson, MD, MHM, FACP, medical director of the hospitalist practice at Overlake Hospital Medical Center in Bellevue, Wash., agrees that titrating the same annual workload over more shifts is desirable. “If you work a small number of days in a year, then every day you work, you’re going to get smacked,” says Dr. Nelson, co-founder of SHM and longtime practice management columnist for The Hospitalist. “It’s going to be hard. And that’s just not smart. It’s not a good idea.”

Dr. Nelson worries that a straightforward, Monday-to-Friday model with periodic weekend responsibilities, though, can be disruptive to doctor-patient continuity. Another strategy, he says, is to take each doctor’s workload preferences into account when devising a practice’s schedule, with compensation distributed accordingly. At one practice in the Pacific Northwest, for example, the hospitalists all decided they wanted to work about half as much as they were. Their pay dropped accordingly, Dr. Nelson says, providing the necessary funds for hiring new doctors to pick up the slack.

Bryn Nelson is a freelance medical journalist in Seattle.