And with a little brainstorming and schedule-wrenching, the new nocturnist was born at Lehigh Valley. We are a group of 17. By taking the three willing participants out of the pool of 17 hospitalists and asking them to exclusively work nights, rotating in a one-week-on, two-weeks-off rotation, we were able to still leave 14 doctors to run the day shifts. The daytime hospitalists would no longer have to work nights, drastically improving their quality of work life.
This was a huge step forward for our group. It was a morale boost for the daytime doctors and actually allowed the group to save money. We were looking for doctors 18 and 19, and instead found internal solutions to our night problems. The schedule fit together like a patchwork quilt.
In exchange for two weeks off, the three nocturnists agreed to no additional vacation time. Our salaries stayed the same, too. So from a budgetary standpoint, nothing changed. From a quality-of-life standpoint, everyone was happy. My nocturnist colleagues and I were happy to exchange working nights every third week for the same salary in exchange for more days off.
The new schedule even allowed the group to eliminate the middle shift, creating an additional hospitalist available for daytime rounding. And having three nocturnists creates a pool of night doctors who are readily available to cover each other’s sick or personal time.
In all fairness, this new model was not an easy sell to administration. But as the group became more stable and morale increased, we, as members of the group, relied on this stability. We also noticed an increase in recruitment. Veterans and rookies wanted to start in a practice that had its nights covered. Ultimately, increasing our daytime capacity increased our inpatient encounters, and by increasing recruitment and retaining our current staff, our administration saw the benefits.
Employing a team of nocturnists maintains group stability, is cost-effective, helps with retention, boosts morale, and is attractive new recruits. Hospitalist programs that are struggling with staffing should consider a similar approach—and remember that they might be able to change everyday life without changing the ever-important bottom line.
Dr. Verdetti-Healy is a nocturnist at Lehigh Valley Hospital in Allentown, Pa.
Daniel Bitetto, MD, SFHM, chief of the section of hospital medicine at Lehigh Valley Hospital in Allentown, Pa., contributed to this report.