Heavy Workloads Burden Hospitalists, Raise Concerns about Patient Safety


A recent study in which 36% of hospitalists reported that their workload exceeds safe patient census levels at least once a week could spur serious discussions on productivity and quality of care, according to one of its authors.

Daniel Brotman, MD, FACP, FHM, director of the hospitalist program at Johns Hopkins Hospital in Baltimore and one of the study's authors, says the results highlight the delicate balance between pushing hospitalists to generate revenue and maintaining patient safety.

"It's certainly not in the best interest of our patients or our healthcare system to fix financial stress by expecting more clinical productivity of doctors year over year,” he says. "At some point, and it's self-evident—at least in my mind—quality starts to suffer when workload gets excessive."

The report, "Impact of Attending Physician Workload on Patient Care: A Survey of Hospitalists," details findings of the first study to assess perception of unsafe workloads by directly questioning physicians, according to its authors. They electronically queried 506 hospitalists enrolled in the physicians' online network and information site

As many as 40% of physicians reported their typical inpatient census exceeded safe levels at least once monthly, the report noted, and physicians pegged 15 as the optimal number of patients to see on a shift dedicated to clinical work.

John Nelson, MD, MHM, a principal in Nelson Flores Hospital Medicine Consultants in La Quinta, Calif., says staffing shortages are likely the most common cause of heavy workloads, and that the high number of physicians reporting overloaded censuses is evidence that hospitalists are concerned their job performance is adversely affected.

"I suspect that as belt-tightening continues to occur," Dr. Brotman adds, "we're going to see the importance of [research] like this increasing, because we're going to see more and more stressed-out, overextended doctors who are having trouble delivering the care that they know they can deliver if they had more time."

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