If today’s learners interact with grumpy, overworked, unsatisfied, marginalized intern-extenders, they will quickly up-regulate the gastroenterology gene, and the best and brightest will start to flow out of our pipeline.
Are hospitalists happy? Are we satisfied, stressed, burned out? How is this impacting our field? What can we do about it? The Hospitalist this month takes a hard look at the often overlooked issue of career satisfaction and its cousins burnout, stress, and turnover.
After a decade of taking a fly-by-the-seat-of-our-pants approach to building, managing, and remediating HM programs, we finally have some concrete data to help guide us in building our programs. In fact, no fewer than three research papers studying these issues have been published recently—two of them from my institution.1,2,3 As such, I’ve been thinking about this a lot and what this means to the field in general and, more specifically, academic hospitalists.
Now I recognize that academic hospitalists make up but a fraction of the hospitalist work force; nonetheless, I believe it is an important fraction, even for community hospitalists. As I’ve written before, HM’s pipeline is dependent upon future hospitalists (commonly referred to as residents and students) engaging with fulfilled, satisfied, and successful academic hospitalists—the kind of specialists that look and feel like other specialists. If today’s learners interact with grumpy, overworked, unsatisfied, marginalized intern-extenders, they will quickly up-regulate the gastroenterology gene, and the best and brightest will start to flow out of our pipeline.
So what do these studies show? How do we assimilate these data into our programs, and how can we use it to produce more sustainable, effective, and productive academic HM groups? Here’s my take: a seven-step prescription of sorts for what ails academic HM.
Step 1: Honor Thy Mission
I was having dinner recently with a higher-level executive with a national hospitalist management company that primarily staffs community hospitals. An uncomfortable pause, followed by gasping sounds, ensued after I told him our starting academic salary. After collecting himself, he asked how on Earth I could recruit hospitalists at such a low salary—I think hoping to discover the fount to lower personnel costs. Simply put, some people are willing to sacrifice salary for the academic mission and all its trappings.
In fact, the only differential advantage academic programs have over their community brethren is the ability to be, well, academic—that is, to teach, develop, innovate, disseminate, and create the knowledge base that fuels our specialty. The academic mission is not for everyone. But there is a pool of individuals who are willing to forego financial compensation for compensation of a different sort. Take away the academic mission, and the two jobs start to look similar, salaries equilibrate, and people with academic leanings become unsatisfied.
And burned out. I’d argue that career-fit mismatch is a main cause of academic hospitalist burnout—I come to academics to be academic but find in turn a community job in a teaching hospital. This is supported by data showing that 75% of academic hospitalists described their primary role as either teacher or investigator, yet most (52%) spent 40% or less of their time with learners, and 57% had 20% or less of their time protected for scholarly pursuits.1 This epitomizes career-fit mismatch, and likely explains why nearly a quarter of academic hospitalists are burned out.