Hospital medicine groups are becoming an integral part of healthcare delivery in the US. Since the term hospitalist was coined in 1996 by Robert Wachter, the U.S. has witnessed an amazing growth and development of inpatient programs. Physicians going into inpatient medicine experience impressive fluctuations in patient volume when new programs begin and when existing programs expand their primary referral base or comanage patients with subspecialists and surgeons.
Ideal patient volume numbers vary from group to group but range, on average, from 15 to 18 patients per hospitalist. Layered on the management of patients in the hospital is a myriad of duties the hospitalist must perform to effectively care for patients. Depending on program layout, hospitalists will also be involved in committee work, end-of-life discussions, protocol development, and measurement of data that links improvement of care when hospitalists are involved in caring for patients.
A good reason to talk about inpatient time management is that without it physicians can become overstressed. Physician burnout, job dissatisfaction, and high turnover with hospital medicine groups are major concerns, due in part to the increased demands placed on hospitalists. Small programs, especially, can experience great fluctuations in volume as they define their patient referral base, and deficient physician time management skills can be the main reason a program does not gain momentum.
Early in my training, I wondered if there was a better way to see patients and not feel stressed when new patients were admitted to my service. But it wasn’t until I started work with a healthcare organization in Wisconsin that I noticed there was a way to gain control of my busy day. I was introduced to time management principles by physicians who exercised this important skill everyday. These physicians did not seem stressed when the day seemed to be getting “out of control.” Their time management skills allowed them to stay efficient. After a few busy days, it didn’t take long for me to seek out information on time management and begin my own journey of self-assessment. At its core, that’s what time management is: an honest assessment of yourself. After learning about time management, I created a plan to assist me in getting through my day. Now, time management is automatic, an integral part of my ability to function on a busy inpatient floor. Time management is important for anyone who wants to achieve more control of his or her day, improve on work efficiency, set personal and professional goals, and, in my opinion, extend himself or herself in ways that don’t seem possible.
Some important terms to review include “goal,” “objective,” and “priority.” Goals are long-range and provide overall direction for an individual or a group. A good goal for a hospital medicine group is to be the premiere group in their state or their region. A good goal for a hospitalist is to implement an inpatient time management strategy. An objective is a clear-cut description of how to achieve a goal, and priorities are the ranked items in a goal or objective list. Priorities must be assigned to time management objectives. An exact order will ensure nothing is missed when working on a given objective.
The best way to tackle inpatient time management is to see how the day is laid out by keeping a time log and by performing an internal review of how a typical day marches out. When I performed my internal review I realized I looked at my day chopped into sections that were spent rounding, teaching, and discharging. I never discharged a patient in the morning. I saved all my discharges until the afternoon. I knew discharges required more time, and I felt better seeing patients first and then going back and doing discharges. I wasn’t being efficient with this method, because I always felt tired in the afternoon.