Medicolegal Issues

Get Control


This is the first in a series of articles on the four pillars of career satisfaction in hospital medicine.

How do you feel about the hours, compensation, responsibilities, and stresses of your present position? Do you think your job is sustainable—that is, would you be happy to continue your current work for years to come?

Many of today’s hospitalists might not answer the last question with a resounding “yes” because of one or more common factors that lead to chronic dissatisfaction with their careers.

In 2005, SHM formed the Career Satisfaction Task Force (CSTF) to combat this dissatisfaction, charging it with a three-pronged mission: to identify working conditions in hospital medicine that promote success and wellness; to provide resources to enhance career satisfaction; and to promote research into hospitalist career satisfaction and burnout.

“Originally, we were concerned with burnout in hospital medicine,” says CSTF co-chair Sylvia C. W. McKean, MD, FACP, medical director at Brigham and Women's Hospital/Faulkner Hospitalist Service and associate professor of medicine, Harvard Medical School, Boston. “The task force was charged to examine the factors that lead to a long, satisfactory career in hospital medicine.”

New White Paper Available

After reviewing the literature on physician burnout and general career satisfaction, the CSTF created a comprehensive document, “A Challenge for a New Specialty: A White Paper on Hospitalist Career Satisfaction” (available at, which can be used by hospitalists and hospital medicine practices as a toolkit for improving or ensuring job satisfaction.

The white paper outlines the four pillars of career satisfaction: autonomy/control, workload/schedule, reward/recognition, and community/environment. It includes a Job Fit self-evaluation questionnaire and other tools and advice that can be used to gather information and take steps to improve problems identified by the survey.

While the information in the white paper can best be used to improve an entire hospital medicine program, individual hospitalists can also benefit from it. The paper clearly states that an individual hospitalist has the power to influence change within his or her job, perhaps by majority rule. They can find a niche of expertise within their practice; pursue continuing medical education opportunities to promote their areas of expertise; nurture networks with peers; and find a mentor and regularly seek advice.

The First Pillar: Autonomy/Control

Control, or autonomy, refers to the need to be able to affect the key factors that influence job performance. For example, do you have control over when, how, and how quickly you perform a specific task? Do you have some say in task assignment and policies? What about the availability of support staff, supplies, and materials?

“Doctors expect to have control in their jobs, control over the tasks they do, how and when they do those tasks,” says CSTF member Tosha Wetterneck, MD, University of Wisconsin Hospital/Clinics in Madison. “This control helps them cope with stress; take that control away, and they can’t cope as well.”

Autonomy is a problem in hospital medicine because the field is still new and not widely understood. Consequently, hospitalists may end up responsible for additional duties and hours—especially on weekends—that other physicians dump on them.

“In some hospitals, the only doctors who can’t cap [their workloads] are the hospitalists,” reports Dr. McKean.

The best way to ensure you’re comfortable with the autonomy offered by your position is to be aware of what you want—and what you get—when you take your job.

“An individual hospitalist always has a choice of taking a job with the clear understanding of what they’ll have control over,” says Dr. Wetterneck. “However, you have to understand what you as a person need to have control over. You don’t want to get yourself into a position where you don’t have control over the specific areas that matter the most to you.”

An Example of Autonomy

To help clarify how lack of autonomy can make career satisfaction plummet, here is a fictional example of a hospitalist who suddenly lost control in her job:

“I love working in hospital medicine and take my job very seriously. However, two months ago my hospital medicine group assumed responsibility for care of neurosurgical patients, and all hospitalists are now required to provide care to these patients. I find this upsetting—I feel like this is one more step in relegating my colleagues and I to the status of ‘super-residents’ who are responsible for everything that other physicians don’t want to do. I want to have control over which type of patients I see.”

According to the CSTF research, this individual should take the following steps:

Step 1: Assess the situation in the manner outlined in the white paper. The hospitalist should:

  • Use the Job Fit questionnaire to profile the control elements of the hospitalist practice;
  • Become familiar with the hospital’s leadership and committee structure;
  • Understand key payer issues that might affect inpatient care; and
  • Review her job description.

After reviewing the role personal autonomy plays within her practice, the hospitalist must consider whether she’s in a position to request a change of duties, or whether her new responsibilities are non-negotiable.

“There are different facets of control,” says Dr. Wetterneck. “Some could make the argument that a hospitalist doesn’t have the skills to take care of neurosurgical patients, that this is out of the realm of reasonable expectations for the job. Others might say that there is reasonable expectation, as long as the hospitalists would get extra learning and extra support from other [subspecialists] that they’d be available for consult.”

Regardless of where you stand on the argument of reasonable expectation of a hospitalist’s responsibilities, what if a new job task simply rubs you the wrong way—to the point where you no longer enjoy your work?

“If it’s truly an issue of ‘I don’t want to do this,’ then it becomes an issue of your fit with your group,” Dr. Wetterneck continues. “If everyone in the group is doing it and you don’t want to, then you need to understand how important this control is for you. Is it important enough to change jobs?”

Step 2: If the answer to that last question is “Yes,” this hospitalist should keep autonomy in mind as she begins a job search. The white paper includes questions to ask herself and her potential employers to ensure she has control in her next position. The diversity of hospitalist responsibilities works in her favor—assuming she’s willing to move to another part of the country.

“You can list all the things that make you happy in a job, and you can probably find every single thing on your list in a hospitalist job somewhere in the U.S.,” speculates Dr. Wetterneck.

Next Month

A discussion of the workload/schedule pillar, which refers to the type, volume, and intensity of a hospitalist's work.

The Only Constant

Working in hospital medicine practically guarantees your job will continually change. Whether it’s a change in responsibilities like the example above, the steady growth of your practice, or even a change in leadership or ownership, hospitalists must go with the flow.

“I definitely think that the job requires a certain amount of flexibility,” says Dr. Wetterneck. “Hospitalists have to understand that their job role will continue to change over time. Therefore, people have to really understand what’s important to them.”

The cost of lack of autonomy—or other job stressors—can be severe.

“If a change [in your job] throws you out of control, this can lead to stress,” Dr. Wetterneck points out. “We know from recent studies that stress has an impact on your health, specifically on cardiovascular disease and mortality.” TH

Jane Jerrard has written for The Hospitalist since 2005.

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