COMMITTEE REPORT

How to Build a Sustainable Career in Hospital Medicine

An interim report from the SHM Career Satisfaction Task Force

By Sylvia McKean, MD, Tosha Wetterneck, MD, and Win Whitcomb, MD

In 2005 SHM recognized the importance of establishing work standards for hospitalists by charging a task force to articulate key work conditions that promote success and wellness for a career in hospital medicine. As a professional society SHM is committed to developing resources for hospitalists that facilitate long and satisfying careers in hospital medicine in diverse work settings.

Since the first SHM survey of hospitalists in 1999, the role of the hospitalist has evolved to address the needs of multiple stakeholders. Reports of stress and dissatisfaction have subsequently generated dialogue on the SHM list serve. In March a recent SHM member commented: “These messages obviously concern me, and I hope the individuals can find a reasonable solution. However, I was wondering: Are management problems like these the exception or the rule?”

As a new specialty, ill-defined and evolving job descriptions can promote burnout along with other factors. Traditional residency programs in internal medicine and pediatrics don’t adequately train physicians to become hospitalists. Lack of clarity about the hospitalist role may create a mismatch between expectations of hospital leaders and junior physicians who have not yet assumed leadership roles. Hospitalists at academic medical centers are faced with additional burdens brought on by Accreditation Council for Graduate Medical Education resident workload restrictions. The absence of career promotion tracks in medical schools may limit advancement and recognition. These issues are not unique to hospital medicine and have surfaced as problems for critical care and emergency medicine.

According to the 1999 survey, burnout in general is correlated with a lower level of perceived autonomy to perform work as one sees fit and to control the professional experience.1 Less recognition by patients, families, and other professionals for a job well done and poor integration with nonphysician team members is associated with burnout. Lacking occupational solidarity as part of a team of professionals, sharing the joys and frustrations with peers, negatively affects job satisfaction.

Although the 1999 SHM study found that burnout was not independently correlated with workload, clearly there is a ceiling beyond which physicians should not work. Consistent with what the literature says about emergency medicine, professions with high demands are more likely to experience burnout. The American College of Emergency Physicians has its own wellness section that includes consensus statements about specific work parameters.

SHM has raised awareness that the hospitalist model cannot be equivalent to office practice. It’s not feasible for hospitalists to work a volume of annual hours equivalent to those worked by primary care physicians and medical specialists How Hospitalists Add Value (a special supplement to The Hospitalist published in April 2005) reinforces the need to structure reimbursement accordingly. At the SHM 2005 Annual Meeting, Tosha Wetterneck, MD, a member of the SHM Career Satisfaction Task Force and an expert on physician burnout, led a workshop on “Burnout and Hospitalists” with Michael Williams.

Progress Report to Date

The work of the task force intersects activities of other SHM committees and task forces. Practice support, education, leadership, benchmarks, and research are fundamental to providing hospitalists with the necessary skill set to succeed. Modifiable factors in the practice (or work environment) of local hospitals will be identified in the near future to optimally support hospitalists. In addition, the SHM 2005 Education Summit identified ongoing education as critical for the development of skills required for academic and administrative advancement.