Most hospitalists asked to work more are resilient and adapt. But over time, Dr. Wetterneck says, they begin to lose the ability to balance the demands and rewards of the job, and burnout develops.
“The study that we’ve been conducting suggests that the rate of burnout among practicing hospitalists is about 30 percent, which is a significant proportion of us,” Dr. Hinami says. “[It appears] that the rate of burnout symptoms of practicing hospitalists has remained stable, or may have increased, since the last time the publication of a nationwide survey was done.”
The last time a large survey measuring satisfaction among hospitalists was published was in 2001.2 It found that about 13% of hospitalists were burned out and about 25% were at risk of burnout, says Winthrop Whitcomb, MD, MHM, medical director of healthcare quality at Baystate Medical Center in Springfield, Mass., and one of the authors of the 2001 study. Without question, burnout continues to be a major challenge for the entire field of HM, he says.
“Growth has always and will continue to fuel burnout,” says Dr. Whitcomb, cofounder and past president of SHM. “It’s a hard job, and as long as you’re growing, you’re not really getting your feet underneath you.”
The task force study found that hospitalists with burnout symptoms were much more likely to reduce work effort, leave their clinical situation, leave HM, and abandon direct patient care altogether than those without burnout symptoms.
Whereas the task force survey used a single-item question to ask hospitalists their level of burnout on a scale of 1 to 5, the 2001 study used a different scale and asked multiple questions to determine if respondents were burned out or at risk of burnout, Dr. Wetterneck explains.
“Even though it’s not a fair comparison, could it be that more hospitalists are burned out now than they were 10 years ago? I happen to think it probably is real … because of some of the satisfaction data we’re looking at,” she says.
Dr. Wetterneck’s group hasn’t analyzed if the reasons for burnout among hospitalists have changed over the years, but, anecdotally, Dr. Whelan has noticed a difference. Early hospitalists often burned out because they had to work day shifts and take night call. Today, far fewer hospitalists are always on. However, there are more hospitalists than ever before working in the hospital at off hours, which comes with different stressors, he says.
Greater Responsibility, Greater Dissatisfaction
As hospitalists’ roles expand, unpredictable interruptions are more frequent, says Sylvia McKean, MD, SFHM, FACP, a senior hospitalist at Brigham and Women’s Hospital in Boston, associate professor of medicine at Harvard Medical School, and former co-chair of the Career Satisfaction Task Force.
“For example, if you’re [scheduled] to admit patients to the hospital and you’re also on the rapid-response team and someone happens to need a rapid assessment, you can be interrupted,” she says. “If you’re a hospitalist taking care of someone who has had a subarachnoid hemorrhage and the neurosurgeon is going to come in the next morning but you’re uncertain about what to do or even to recognize a problem in that patient, those are the kinds of things that cause people to get anxious and feel more fatigued.”
As more subspecialists focus on consultations in the hospital, hospitalists are tending to see more specialty patients and, as a result, could feel overwhelmed, Dr. McKean says.