Public Policy

Group Growth

This is the last article in a series on the four pillars of career satisfaction in hospital medicine.

What kind of support do you get from your hospital medicine group? From your hospital? How cohesive is your group? Do these things really matter?

The answers can be found in the SHM white paper “A Challenge for a New Specialty: A White Paper on Hospitalist Career Satisfaction” (available online at www.hospitalmedicine.org). SHM’s Career Satisfaction Task Force (CSTF) drafted the document to be used by hospitalists and hospital medicine practices as a toolkit for ensuring or improving job satisfaction. It outlines the four pillars of career satisfaction: autonomy/control (see the June edition of The Hospitalist, p. 14), workload/ schedule (July edition, p. 10), reward/ recognition (August edition, p. 10), and community/environment. This article looks at the last of these.

CAREER NUGGETS

Does Pay Influence Performance?

The Physician Compensation Research Project, conducted by investigators at the University of Washington School of Public Health and Community Medicine, Seattle, examined how different methods used by managed care organizations to compensate primary care physicians affected the utilization and cost of healthcare services, as well as physician productivity.

Contrary to their expectations, the investigators found that the method of compensation for physicians, whether fee-for-service or salary, had a negligible effect on treatment decisions for patients. Their research also showed that physician compensation methods tied to productivity increase individual productivity.

An Inside Opinion on Burnout

“Hospitalist Careers: A Field of Growing Opportunity” by Niraj L. Sehgal, MD, MPH, assistant professor of medicine at the University of California, San Francisco, and Robert M. Wachter, MD, professor and associate chairman of medicine at UCSF, states: “One of the factors that could contribute to hospitalist burnout is a mismatch between optimal staffing and patient volumes. A hospitalist caring for too many patients may generate more clinical revenue, but at the cost of prolonged patient hospitalization, since the hospitalist cannot take the steps to facilitate a timely discharge under such circumstances. Another potential contributor to hospitalist burnout is the ever-increasing expectations of employers, hospitals, consultants, primary care physicians, and payers. … These expectations, though validating the need for hospitalists, also increase risk for burnout if not managed carefully and proactively.”

The article appeared in the January 2007 issue of Resident and Staff Physician.—JJ

The Fourth Pillar

Hospitalists belong, in some sense, to four communities and must address the expectations of each group: administration, referring and nonreferring physicians, house staff and other healthcare staff, and medical students.

The hospitalist’s community includes his/her practice as well as hospitalists from other groups. The patient community is not just patients and their family members, but the broader public community served by the hospital medicine group and the hospital. The home community, consisting of the hospitalist’s family and friends, is also a vital part of the individual’s environment.

Each of these communities contributes to job satisfaction. A sense of shared values and connection with others, as well as social and work support, can ensure satisfaction; a sense of isolation, lack of support, and unresolved conflict can lead to unhappiness with a job.

Working within a strong community “makes everything else easier,” says CSTF member Noah Harris, MD, a hospitalist at Presbyterian Hospital, Albuquerque, N.M.

“Twenty years ago, there was a medical community in hospitals where physicians came together,” recalls Dr. Harris. “With managed care, physicians have become much less invested in the hospital and you see fewer [primary care] physicians there. Hospitalists have filled that gap. The question is how to restructure the hospital medical community.”

A hospitalist might struggle with the issue this way:

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