Finding a Hospitalist Schedule That Works for You
From set blocks of time on and time off, to complete flexibility, there are many variances in the schedules of today’s hospitalists. A hospitalist schedule will depend on a variety of factors, some of which are not under the physician’s control.
So, control what you can by securing a hospitalist job that can best meet the needs of your professional and personal life.
According to the 2016 State of Hospital Medicine Report by the Society of Hospital Medicine (SHM), over half of hospitalists surveyed work seven days on/seven days off schedule (7-on/7-off), and nearly two-thirds work 12- to 14-hour days.
Both provider factors and patient factors explain why over half of hospitalists work this type of schedule, according to Flora Kisuule, MD, MPH, SFHM, associate division director for hospital medicine at Johns Hopkins Bayview and assistant professor at Johns Hopkins University School of Medicine and School of Public Health in Baltimore.
Physicians often choose this type of hospitalist schedule because it is predictable and allows them to plan the rest of their lives, while these schedules also benefit patients by providing continuity of care.
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Predictability and continuity
“This [7-on/7-off] schedule is the most prevalent, and that might be because this is how groups have scheduled hospitalists from the inception of this specialty, and it is what is best known,” Kisuule explained. “The average patient will stay around 4-5 days, so a hospitalist will see a patient through the entire stay of the hospitalization.”
Kisuule has also noted trends in hospitalist schedule preferences that are dependent on tenure, time spent practicing, and personal factors.
“In our group, we have fresh graduates wanting stretches this long while the ‘veteran’ hospitalists want shorter stretches, for example, 4-5 days in a row. By the same token, the younger, fresh grads with no children want 12-14 hour days while the veterans who have kids want shorter days so that they can have dinner with their families.”
In addition to the 7-on/7-off schedule, other common schedules for hospitalist jobs include 14-on/14-off, and 4- to 5-on/4- to 5-off.
The flexibility factor
Hospitalist jobs will evolve over time, and it’s important for practitioners to keep this in mind when identifying their preferred hospitalist schedule, said Tiffani Panek, MA, SFHM, CLHM, hospital medicine division administrator for Johns Hopkins Bayview.
“Don’t be afraid to try things—no schedule type needs to be forever, so some trial and error can help guide you to the best solution,” she said. “Make sure you know what your group’s preferences really are; there’s no sense trying to figure out how to make all your shifts less than 10 hours…when it turns out the most important thing to your group is having to be in the hospital fewer days of the year.”
“What your group and your hospital patients need will change over time,” Panek explained, ”so be nimble and willing to embrace changes to your schedule, too. Take into account your facility/environment/patient population; schedules are not one-size-fits-all, and what works at the hospital across town might not work at all in yours…Look at lots of options, take what you need from each and toss the rest." Panek believes there can be too much of a good thing when it comes to schedule flexibility in hospital medicine.
“If you make a schedule that is too flexible/provider-centric, many things can suffer, including continuity, quality metrics affected by continuity such as length of stay, and the ability to even create a viable schedule where you can staff adequately while accounting for all provider requests.”
“Balance is crucial in determining what is enough flexibility to keep providers content, while still having a viable, sustainable, functional model,” Panek continued.
“For me, the key factor that keeps me at my institution is flexibility,” Kisuule said. “My husband travels out of the country a lot and I need a schedule that allows me the flexibility to plan around his travels so that I am available for our son when my husband is traveling.”
Designing a mutually beneficial hospitalist schedule
Employers (hospitals) are also trying to find hospitalist scheduling options that work for the practitioners—and improve retention—while maintaining high levels of patient care. So individuals need to work within these parameters.
“Years ago, provider satisfaction did not quite figure into the equation. Medicine was a ‘calling’ and since we ‘chose’ the field, we did what we had to do to take care of patients. If that meant working 18-36 hours straight, that is what we did. However, provider burnout is now a real issue, and joy in practice is a priority for employers,” Kissule said. Employers have learned that hospitalists’ satisfaction and patient outcomes are all affected if physicians reach the point of burnout, or have inadequate time for training.
“Providers have to be at the top of their game so as to provide patient-centered care that will lead to good patient experience scores. For all these reasons, it is important for employers to develop schedules that will cater to their providers. It does follow that when providers are happy they will give the best care.”
“As long as folks work all their required hours and there is a minimum number of shifts in a row that are required, this might allow for some flexibility while not compromising continuity of care,” Kisuule concluded. “Electronic schedules will continue to play a bigger role in allowing for this kind of scheduling.”
5 questions to help determine the best hospitalist schedule for you
Kisuule offered the following self-examination questions for choosing hospitalist jobs that will allow you to thrive—both personally and professionally:
1. Know your priorities, e.g., do you want to have dinner with your kids above all else? If so, you might want shorter days, unless your spouse is just as busy, in which case you might want longer shifts but fewer days worked.
2. Do you want predictability (like a 7/7 schedule) or do you want flexibility?
3. Are you a morning person or a night person (day rotator vs. nocturnist)?
4. Are you straight clinical (a more predictable schedule would work) versus academic/administrative/teaching (in which case flexibility is needed)?
5. Do you want to work alone (might need flexibility) versus with residents (usually 14 days-1 month stretches on service)?
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