Are You in Control?
Autonomy and control over your work and work life remain key factors in career satisfaction. This includes having input not only when it comes to the schedule but also, and more importantly, with regard to the processes. Can you participate in design for your group or at the hospital? If you find that all your suggestions fall on deaf ears, then either the work environment needs some adjusting or you are always wrong! Small things can be important here. Just having the flexibility to participate in quality processes or to give input on a protocol creates a feeling of control over your work. Hospitalists who have decisions imposed on them experience a great deal of tension and may, ultimately, resign.
Is there an opportunity for promotion or further learning? An individual who feels boxed in and unable to make career improvements is often dissatisfied. This ties in to the need for challenge and the importance of the nature of the work.
We all have personal challenges that we would like the flexibility to address. You may have childcare or elder care issues. Perhaps you want to train for the next Ironman race. If you are unable to address these personal aspirations and goals, you may feel that you have no control over your life, much less your work life.
Are You Happy at Work?
Work environment—who knew how important this could be? Let’s say you are employed at a large organization, perhaps General Electric. GE controls the environment for all of its employees. The company makes sure that the lighting is adequate. It tries to protect its employees from hostility based on gender, race, or disability. GE controls work assignments, and there is a chain of command for any issue that needs to be addressed.
The hospitalist, as a member of the medical staff, may be in a much different setting. Often, hospitalists work in someone else’s environment. The nurses and physicians with whom they work are generally hired by others. The atmosphere in which they work can be hostile, devoid of respect. There is often no clear chain of command set up to resolve work environment issues. Some facilities are frustrating and challenging to work in, with insufficient translators or inadequate lab or X-ray support. Fellow medical staff members or administrators may not understand how hospitalists differ from other specialists, making the job of the hospitalist more difficult
An individual’s inability to affect the work environment due to the structure of the facility can be detrimental to morale. Are the committees structured so that hospitalists can participate in them and influence the decisions they make? Even seemingly small issues can have a big impact on a hospitalist’s feelings of control and autonomy.
What Do You Earn?
Finally, compensation. Everyone wants a fair wage for a reasonable work effort. It seems simple, but obviously there are tensions here. All things being equal, a person’s income should be competitive and fair. The definition of “fair” is often determined by the marketplace. In the field of hospitalist medicine, there is a great deal of competition for labor, so there are many opportunities to evaluate. But finding the work that is most satisfying involves attaining a combination of the abovementioned characteristics as well as evaluating location.
SHM’s Task Force Examines the Issue
So, what to do? As an organization, SHM has appointed a Career Satisfaction Task Force to study work satisfaction and to design processes that will address this issue specifically for the hospitalist workforce. As I mentioned above, this topic has been studied extensively in various employee environments for many years. Retention of valuable employees is a key component of an organization’s success. This applies to nonmedical as well as to medical fields. The emergency medicine field, for example, has done some work on the challenges specific to their physicians and has some interesting insights. We expect to share the work product of our own task force in the future.