Practice Management

Hospitalist scheduling: A search for balance


Scheduling methodologies

7-on-7-off scheduling preferred by 56% of adult HMGs
For HMGs serving adults only, 7 on/7 off remains the preferred scheduling method (56% of groups). This is higher than in the 2016 survey (38%), but it is probably related to year-over-year differences in the mix of survey respondents as opposed to a significant change in how groups are scheduling.

For pediatric practices, the fixed rotating block scheduling has decreased over the two survey periods (16.7% versus 6.7%).

Even though the 7-on/7-off schedule remains quite popular among adult-only HMGs, many seasoned hospitalists wonder whether this is sustainable through all seasons of life. Some hospitalists have said a 7-on/7-off schedule is like turning on and off your personal life and that it takes a day or 2 to recover from 7 consecutive 12-hour days.

fixed block rotating scheduling down among ped HMGs

On the other hand, a fixed schedule is the easiest to explain, and many new hospitalists are requesting a fixed schedule. Even so, a fixed schedule may not allow for enough flexibility to adapt the schedule to the demands of patient care.

Nonetheless, a fixed schedule remains a very popular scheduling pattern. Does this scheduling model lead to burnout? Does this scheduling model increase or decrease elasticity? The debate of flexible versus fixed schedules continues!

Results by shift type

Very simply, the length of individual shifts has not changed much in prior years. For adult-only practices, most all day and night shifts are 12 hours in length. For pediatric-only HMGs, most day shifts are about 10 hours, and most night shifts are about 13 hours.

Most evening or swing shifts for adult-only practices are about 10 hours, which is a slight decrease from 2016. Pediatric-only practices’ evening shifts are about 8 hours in length.

A new question this year is about daytime admitters. For adult hospitalist groups, over half of groups have daytime admitters. For pediatric groups, nearly three out of four groups have daytime dedicated admitters. Also, the larger the group size, the more likely it is to have a dedicated daytime admitter.

Nocturnists remain in demand! Over 80% of adult hospitalist groups have on-site hospitalists at night. About a quarter of pediatric-only practices have nocturnists.

Scheduled workload distribution

One way of scheduling patient assignments is the phenomenon of unit-based assignments, or geographic rounding. As this has become more prevalent, the SHM Practice Analysis Committee recommended adding a question about unit-based assignments to the 2018 SoHM report.

The adoption of unit-based assignments is higher in academic groups (54.3%), as well as among hospitalists employed at a “hospital, health system or integrated delivery system” (47.4%), than in other group practice models.

Just as with the presence of daytime admitters, the larger the group the more likely it has some form of unit-based assignments. Further study would be needed to determine whether there is a link between the presence of daytime admitters and successful unit-based assignments for daytime rounders.

What’s the verdict?

Hospitalist scheduling will continue to evolve. It’s a never-ending balance of what’s best for patients and what’s best for hospitalists (and likely many other key stakeholders).

Scheduling is personal. Scheduling is an art form. The biggest question in this topic area is: Has anyone figured out the ‘secret sauce’ to hospitalist scheduling? Go online to SHM’s HMX to start the discussion!

Ms. Trask is national vice president of the Hospital Medicine Service Line at Catholic Health Initiatives in Englewood, Colo. She is also a member of The Hospitalist’s editorial advisory board.

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