Medicolegal Issues

Hard Work Pays Off


This is the second in a series on the four pillars of career satisfaction. Part 1 appeared on p. 14 in the June issue of The Hospitalist.

How can hospitalists work long days often packed from beginning to end and still remain happy with their jobs? One answer can be found in “A Challenge for a New Specialty: A White Paper on Hospitalist Career Satisfaction” (available online at, a comprehensive document by SHM’s Career Satisfaction Task Force (CSTF). This white paper can be used by hospitalists and hospital medicine practices as a toolkit for improving job satisfaction. It outlines the four pillars of career satisfaction.

The Second Pillar: Workload/Schedule

The workload/schedule pillar refers to the type, volume, and intensity of a hospitalist’s work as well as time pressures, variability of work, and number of interruptions. A hospitalist schedule must take all these factors into consideration.

CSTF Co-Chairperson Winthrop Whitcomb, MD, Mercy Medical Center, Springfield, Mass., maintains that this pillar is supported by the other three—autonomy/control, reward/recognition, and community/environment—but most closely with reward/recognition.

“There needs to be a reward system in place no matter what the workload,” says Dr. Whitcomb. “You can’t really talk about workload without addressing rewards. It’s human nature that in order to work hard, you need to be rewarded in some meaningful way.”

But many people—not just physicians but workers from all fields—may have separate concerns about heavy workload and just rewards.

An Example of Workload Issues

You probably know from your own experience as a hospitalist how workload can affect career satisfaction. Here is a fictional example of a hospitalist struggling with an increased patient load:

The director of my community-based hospital medicine program has mandated that each hospitalist see 15 to 20 patients each weekday, and 20 to 30 patients a day over weekends. I know this workload is too heavy to allow good quality of care. Under the pressure of seeing my quota of patients, I’m afraid I might make a mistake or miss something.

“There are physicians out there who can and do handle this type of workload, and they do it happily and well,” Dr. Whitcomb points out. “But this is only true if there is an appropriate reward system in place, and there clearly needs to be a good support system in order to provide quality of care” under this example.

CSTF says this individual should take the following steps:

Step 1: Go on a fact-finding mission. Find out whether hospitalist workload, responsibilities, and schedule at this facility are the norm. “[The hospitalist] should get an idea of what’s happening at other hospital medicine groups; he should understand the national picture,” says Dr. Whitcomb. “He might then realize that hospitalists in his group are only working 187 days a year, and that over a course of a year they’re not really working any harder than others who work more days,” says Dr. Whitcomb. “This might get him thinking a little bit differently about the workload.”

Step 2: Undertake organizational strategies. A hospitalist can find out how he or she has a voice in workload issues.“Figure out how hospitalists are represented in the structure of the group,” advises Dr. Whitcomb. “If a director is mandating how much [hospitalists] work, there has to be some mechanism for the physicians to be able to provide feedback. This often takes the shape of a compensation committee; this group is not just about compensation but about budget and sustainability for both the hospital and the hospitalists.” Physician representation—having a say in workload and schedule—is important to maintain a good balance within a hospital medicine program.

Step 3: Consider recommendations to ease workload. “You can try to change the workload through justifying adding staff or through putting systems in place that allow you to see more patients,” says Dr. Whitcomb. But what if the hospitalist considers or takes these steps and still finds his patient load to be unsustainable long term? “In terms of feeling like you’re not able to provide safe care,” says Dr. Whitcomb, “once you’ve suggested changes to the leadership and no changes are made, this may become a deal-breaker.”

Workload Leans on Other Pillars

The interesting thing about the workload/schedule pillar of job satisfaction is that, if you are unhappy with your workload, the other three pillars can sustain you and make you generally satisfied.

Dr. Whitcomb points to a 2002 article published in the Journal of Health and Social Behavior.1 The study examined a national survey of hospitalists and found that job burnout and intent to remain in the career are more meaningfully associated with favorable “community” relations than with negative experiences such as reduced autonomy.

“Workload is not a predictor of burnout as long as the other three pillars are intact,” summarizes Dr. Whitcomb.

Jane Jerrard has written for The Hospitalist since 2005.


  1. Hoff T, Whitcomb WF, Nelson JR. Thriving and surviving in a new medical career: the case of hospitalist physicians. J Health Social Behav. 2002 Mar;43(1):72-91

Career Nuggets

Advice, Resources for Physician-Moms: The Web site Mom MD offers a list of resources for physicians who are mothers, with recommendations from how to hire a nanny to how to breast-feed while working or on call. Visit

The Stress of Being Sued: When facing a malpractice suit or other litigation, take these steps to cope with emotional stress:

  • Keep your hours under control: Sued physicians often work harder, but adequate rest and relaxation are essential during this time.
  • Ask for second opinions and consultations: By consulting with others, you can help prevent clinical errors that might lead to other lawsuits. And when your colleagues confirm that your decisions are correct, this positive feedback can restore your self-confidence.
  • Emphasize people skills: Don’t let the suit have a negative effect on your relationships with patients.
  • Work on personal relationships: Share your experience with significant others in your life.
  • Use your time wisely: Maintain balance in work, rest, recreation, and, if you choose, worship.
  • Stay healthy: Monitor consumption of controlled and uncontrolled substances.

Source: American Medical News, published by permission of the author, Flora Johnson Skelly.

Watch Your Contract: Some hospitalist contracts make the (often unintentional) mistake of setting unrealistically high thresholds, says John Nelson, MD, a past president of SHM and columnist for “Practice Management” in The Hospitalist. For example, they may offer quality- or productivity-related compensation to the physician for exceeding a predetermined threshold. If you’re considering such a contract, be sure you know how difficult it is to achieve the target. For example, how regularly do existing hospitalists exceed the threshold. If the threshold seems unreasonably high, you might negotiate to lower it and accept a lower “bonus” when it is achieved. —JJ

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