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Featured: The rise of the hospitalist

by Lisa Chamoff, Contributing Reporter | April 28, 2014
From the April 2014 issue of HealthCare Business News magazine

Scheduling and support
Hospitalist programs are also working out how to provide continuity of care in the hospital and also avoid physician burnout. It’s a tough balancing act. Greenwich Hospital’s physicians work a challenging seven-day schedule, which Archer says some hospitalists find appealing, since they know when they’re working and they enjoy having every other week to themselves. For some doctors, the more predictable block scheduling provides work/life balance, but balance is a relative term in hospital medicine.

Healey says a seven on/seven off schedule is the predominant model these days, with more than 70 percent of practices employing that kind of schedule.

“A lot of that has to do with the desire of continuity for patients,” Healey says. “The average hospital stay is three to three-and-ahalf days. A doctor who’s on for seven days straight is going to be the primary physician for that patient.”

The challenge comes in balancing the intensity of 10- to 12-hour workdays and coverage on the weekends. In systems where weekends are covered by other people, doctors have observed that care doesn’t progress
as fast, Healey says. “There are many, many models out there on how to structure the work,” Healey says.

At UCSF, each service has a different schedule. When hospitalists are working with residents, for instance, they work 15 days in a row, with the residents doing most of the work, Wachter says. Other services have a five-day workweek.

Wachter doesn’t think the seven-day block schedule is feasible for doctors in the long term, especially when patient volume is high.

“I think it burns people out,” Wachter says. “I think the field is going to mature and ask hard questions about that schedule.”

Hospitals are finding other ways to improve hospitalist satisfaction to in turn help boost patient satisfaction — giving the physicians support staff and assigning them social workers, among other things.

“All the support really helps them facilitate successful practices,” Healey says.

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