The conversation came as a surprise to Len Scarpinato, DO, MS, SFHM. The chief medical officer of clinical development for Brentwood, Tenn.-based Cogent-HMG had sensed something was bothering one of the community hospitalists at Aurora St. Luke’s Medical Center in Milwaukee. When Dr. Scarpinato approached him, the hospitalist told Dr. Scarpinato that he wanted to work as an academic hospitalist.
Dr. Scarpinato encouraged the clinician to try his hand at an academic center on his “off weeks.” The once-discouraged hospitalist stayed with Cogent-HMG, received leadership training, and now is an associate program medical director.
Whether group leaders across the country know it or not, there are hospitalists who are unfulfilled in their careers or dissatisfied with their work. Sometimes a group leader sees the problem coming; sometimes it manifests out of thin air.
A lack of fulfillment in a job can affect patient care. Experts say unhappy hospitalists are less likely to have good rapport with patients, less likely to communicate with the care team, and less likely to follow up on post-discharge lab results. It also hampers the efficacy of a company that frequently has to fill jobs vacated by dissatisfied physicians.
Job fulfillment is a feeling of satisfaction that is related to, but distinct from, burnout (the feeling of being overworked). And while burnout is a topic of widespread concern throughout HM, a lack of job fulfillment is equally important.
The Hospital Medicine Physician Worklife Survey administered in 2009 and 2010 found that 62.6% of the hospitalists who responded reported high satisfaction in their jobs.1 But according to the survey, there was lower satisfaction in terms of organization climate, autonomy, compensation, and availability of personal time.
HM groups should make it a priority to keep their clinicians involved in activities that keep them interested, says John Nelson, MD, MHM, FACP, medical director of the hospitalist practice at Overlake Hospital Medical Center, Bellevue, Wash., hospitalist practice management consultant, and columnist for The Hospitalist.
“You’ve got to do something besides taking care of patients,” Dr. Nelson says.
The Hospitalist asked group leaders and consultants how to spot signs of low job satisfaction, how they can keep their hospitalists fulfilled, and tips for other HM group leaders on how to handle this sensitive topic. Their suggestions offer an array of mechanisms hospitalists can use to battle fulfillment issues in their groups.
Learn to spot the signs of dissatisfaction.
Hospitalist group leaders say there are classic indicators that a hospitalist is not feeling fulfilled on the job.
“Usually, job performance falls off,” Dr. Scarpinato says. “People will have an attitude and you’ll say, ‘Where’d that come from?’ You’ll be surprised that they’re not pitching in to help with the team or they’re developing a cynical attitude or something like that. Those are the clues for me, as a leader.”
Martin Austin, MD, medical director of the 23-physician inpatient medical group at Gwinnett Medical Center in Lawrenceville, Ga., says he sometimes notices a recurring theme. “There are some people where it’s really a pattern,” he says. “Either they consistently complain about something, or other people in the hospital start complaining about them.”
—David Bowman, MD, executive director, Tucson, Ariz., region, IPC: The Hospitalist Company
David Bowman, MD, executive director of the Tucson, Ariz., region for IPC: The Hospitalist Company, says that if a physician isn’t fulfilled by the varied, interesting cases offered by working in a hospital, it just may not be the right fit.
“The cases that you’re admitting are the best of the best compared to outpatient medicine, where things are stable and it’s a chronic disease process,” he says. “You’re dealing with the most exciting clinical stuff that goes on in the hospital.
“You know, it’s a challenge for most physicians, and they’re glad they’re involved in that,” he adds. “If they’re not, if they’re fearful of that, they probably are not in hospital medicine very long.”
Be honest in your assessment of situations involving unfulfilled hospitalists.
Whether it stems from an annual evaluation or just a conversation with a hospitalist, when considering a case of dissatisfaction, decide whether it is really a situation that can be fixed. Sometimes, it’s not.
“You have to triage the person you’re talking to,” Dr. Austin says.
If the situation can be fixed, don’t judge the physician for their concerns; identify the problem and do whatever you can to fix it, Dr. Austin says.
“I think most people will warm up to you doing that—taking the emotion out of whatever the problem is—then trying to do something for them, if you can, and if it’s appropriate,” he explains.
Use annual evaluations to assess doctors’ ambitions beyond the clinic.
Just as important to assessment is the follow-up—checking back with hospitalists to see whether they’ve pursued new projects or committee work.
“When we sit down for our annual [performance evaluations] with the docs, we have those discussions,” says Christine Lum Lung, MD, SFHM, medical director of Northern Colorado Hospitalists, which was founded in 2004. “Where do you see yourself in five years? What can we do to help get you there?”
Many times, group leaders will discover that their hospitalists haven’t followed through on what they said they would do a year before. That affords group leaders a chance to motivate the hospitalist or steer them in another direction.
Flexible schedules are key to hospitalists pursuing a professional or academic ambition, as those interests take time. The annual evaluation is a good time to reassess a hospitalist’s schedule.
Develop a “committee rotation.”
Matching committee posts with physician experience levels helps promote professional involvement beyond routine patient care. If hospitalists receive assistance with a committee match, they are more likely to participate in committees and enjoy it when they do, says Dr. Lum Lung.
Committee participation and other activities help foster what she sees as a primary goal: a “culture of ownership within the group,” or the sense that each hospitalist has a role in guiding the organization and in the success of the whole team.
Dr. Bowman says that involvement in hospital affairs is critical to becoming a fulfilled hospitalist.
“Our mantra, if you will, is to be involved,” he says. “If you’re involved, you don’t have a chance to be bored.”
It’s important, Dr. Bowman adds, for doctors to see “the milieu that they’re involved with” in the hospital organization.
Foster a team atmosphere that offers flexibility and encourages doctors to fill in for one another when required.
Flexibility is a crucial part of keeping hospitalists happy, and many times is necessary for group retention, Dr. Lum Lung says.
“For some people, at this point, when their kids are getting to a certain age, it’s that they want to be able to have some time that is flexible where they can go to their kids’ soccer games and to softball games,” she says. “Providing them these opportunities will give them the longevity to do this job.”
Hospitalists are people, too, and they often deal with personal issues, such as a looming divorce or a seriously ill family member. Group leaders need to be tuned in to such situations so they can accommodate their colleagues as best as possible, Dr. Lum Lung says.
Be conscious of and willing to mitigate “mission creep.”
Sometimes, the growing list of responsibilities for hospitalists gets to be unwieldy. And, if necessary, group leaders should communicate to administration the need for changes that meet those demands.
A healthy working relationship between hospitalists and administration is crucial, says Steve Rubin, executive director at Gwinnett.
“I think it’s critical that administration recognizes value and works with your physicians—and hospitalists included—in a collaborative manner,” he says. “If people don’t feel valued or involved or engaged in decisions, then obviously they get disenfranchised.”
Hold frequent meetings and encourage free discourse.
A problem raised by one colleague could be solved by another colleague if brought up at a meeting. And group leaders can take the temperature of the group before issues become big problems.
At Gwinnett Medical Center, the hospitalist retention level is high, with just three physicians leaving the group since it was formed more than 12 years ago. The group holds mandatory monthly meetings that foster communication and allow potential problems to be aired before they become a big issue, says Dr. Austin. Such topics as relationships with subspecialists, acceptable consults, workloads, and staffing levels are discussed at these meetings.
“People have a good chance to really vent and hear how other people feel,” Dr. Austin says. “And you really take the pulse of the group.” He described the sessions as “a controlled period of time to gripe to each other and have everybody together to group problem-solve.”
At Gwinnett, gatherings outside the workplace—with families—also help build camaraderie.
Thomas R. Collins is a freelance writer in South Florida.