Hospital Medicine burnout vs growing pains?

[honeyyygirl]

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Calling other hospitalists-

I am just a year out of residency and have been a hospitalist for the last year. I have heard that the first year out is "hard" given the steep learning curve and responsibility of having the buck stop with you. I chose hospital medicine because believe it or not I really enjoyed being on the wards as a medicine resident. I also did a fair share of electives and there was no fellowship that I loved more that made me want to train for X amount of years more. Fast forward a year out of residency. Hospital medicine is definitely different from the perspective of being medicine resident on the ward in that the administrative pressure comes through strong and the business of how the hospital works becomes more visible and is constantly talked about- LOS, discharge rate, readmission rate etc etc, these are things I didn't think twice about as a resident that I am constantly reminded of each day.

COVID aside, this year has been challenging in that in addition to the quality metrics, the "job role" continues to change at the whim of administration to add on more responsibility to make the hospital money $$

1. ED Hospitalist duties
2. doing rotations with lower censes that are 100% attending only (10max)
3. taking on tasks midlevels do (consults, notes)
4. somehow ended up working 12-14 day stretches (this next year this will not be the case)

I used to sleep through anything during residency. Could even squeeze in naps when I was on call in the ICU. Now I find myself waking up at 3am each night like clockwork and the only thing that changed was my job. Have other people had trouble sleeping their first year as a hospitalist? does it get better or should I start looking for another position. My family is concerned given the sleep factor and wants me to look elsewhere but I am determined to make it work, become more comfortable and work through this so that it works for me. But I also realize that the business of healthcare is deeply intertwined with hospital medicine and the system is not going to change and the MO will always be to stretch us as far as possible to save money.

Since this is my first job out of residency, I don't know if the grass is greener elsewhere. I truly felt like I hit a goldmine when I got the job offer (no nights, competitive salary for my location, prestigious academic center, teaching service opportunities.) I work on service 26 weeks of year, some of its is with the house staff and most with midlevels. At this point I'm absolutely not interested in lowering clinical time for more administrative responsibilities or leadership. When I'm off I want to be off.

 

[InvestingDoc]

Welcome to hospital medicine as an attending. The admin beat down is real and the lack of sleep is most likely related to anxiety about things at work + COVID times.

Meditate, work out, eat healthy and give it some time.

If you're not getting paid more for admin stuff on top of your regular duties without scaling back on those or overseeing midlevels, you are getting screwed.

There is a reason why hospital medicine has a rep for high burn out rates. It's an awesome job, just admin or hospital politics can quickly turn it into a ****ty job.

 

[Meridian32]

I just finished a two year hospitalist stint prior to starting fellowship and had a very different experience - there was almost no administrative pressure, and while I was vaguely aware that metrics like LOS were being tracked somewhere, I never felt pressured to discharge prematurely or anything like that and always felt empowered to keep patients "one more night" if anything about the discharge seemed iffy. Our leadership also seemed very responsive to hospitalist concerns/needs. Like you, I was at a well known academic center and had all days/no nights, but unlike you, my compensation was relatively low - I think on the lower end for hospitals in my area (major coastal city) and certainly lower than almost anything I've seen posted here. I wasn't complaining, though, as compensation was still much better than residency and my stress levels were the lowest they've been in many years. So, n = 1, but I think it may be worth looking around.

 

[medstudent2IM]

I just finished a two year hospitalist stint prior to starting fellowship and had a very different experience - there was almost no administrative pressure, and while I was vaguely aware that metrics like LOS were being tracked somewhere, I never felt pressured to discharge prematurely or anything like that and always felt empowered to keep patients "one more night" if anything about the discharge seemed iffy. Our leadership also seemed very responsive to hospitalist concerns/needs. Like you, I was at a well known academic center and had all days/no nights, but unlike you, my compensation was relatively low - I think on the lower end for hospitals in my area (major coastal city) and certainly lower than almost anything I've seen posted here. I wasn't complaining, though, as compensation was still much better than residency and my stress levels were the lowest they've been in many years. So, n = 1, but I think it may be worth looking around.

I would echo this sentiment. I am now entering year 2 of hospital medicine and have literally never gotten personal pressure from administration to discharge earlier. I am not in academic medicine so its a bit different. The most annoying "admin" component of my job is getting 2-3 messages per block of shifts to clarify/addend a note for coding purposes. It's tolerable. I was told by a former hospitalist lead that the most important part of that particular job is to learn to say "no" to administration for new tasks that they want to place onto hospitalists. I think hospital medicine is something that is so dependent on the specific job/health system.

 

[jurassicpark]

I am entering almost a decade of hospitalist work (omg I am freakin old) so let me weight in on this.

The first year absolutely there is a learning curve. Depending on the place you work this can be made easier or harder. Great case managers and colleagues to help guide you were fairly important. Even a rigorous residency doesn't fully prepare you, you haven't seen everything and most people don't realize coming out of residency the business of being a hospitalist. By business I don't mean the actual hiring and management of hospitalists, but that you play an integral role in the economics of your hospital and healthcare in general, and the moment you start you are being graded by a wide range of metrics and you have no idea how much the government is REALLY watching you.

It is normal to lose sleep when you're anxious about the new responsibilities you have, the things you have to keep track of, but don't forget to examine yourself, make sure you're not missing signs of depression, etc.

I interact with administration of 2-4 different hospital systems on average, as well as insurance companies. It is part of the game we play. If you're working for a large group or depending on the mechanics of where you work, some people are very well guarded from this and are just expected to do their work.

But I am constantly in meetings regarding metrics and how best we need to work on them. Why? Because it keeps the hospital administration happy with our work and ensures our continual employment. Our LOS is constantly measured and the case managers have us all on speed dial and we are talking to them several times a day to move patients. I tell my students that medicine is the easy part.

As you get your groove it becomes easier. When I did my first night floats, I was always keyed up. Now, I sleep until called. Probably just like anything new, takes getting use to and finding the rhythm. Remember though : the grass is ALWAYS greener on the other side.

 

[shiftingmirage]

I'm approaching the 3 year mark as a hospitalist. I work for a private group on a non teaching service. We have mid-levels on the night service, but during the day, I fly (or sometimes sink) solo. Generally we start with 14-16 patients, and get 2-3 admits/ICU transfers a day. First year, I put in longer days than I did as a resident. Now I'm generally finished at the end of my shift. Like anything, the more you do it, the better you get at doing it.

Regarding administration - I try to please them when I can, and if I can't, I can't. If a patient had a cath and PCI yesterday, I don't see a reason why they can't be discharged before noon today. If they are bacteremic and I am waiting on surveillance blood cultures that wont be reported out until 2 PM, then it's going to be an afternoon discharge. I'm sure administration would agree that an afternoon discharge is better than an unsafe discharge, or a discharge tomorrow. Sometimes my morning is derailed by a rapid or impromptu family meeting, but that is usually the exception, and not the rule. Regarding LOS - don't know about you guys, but in just the three years I have been with my group, our patients have gotten sicker. The hospital is aware of this. Doesn't mean they don't bug us. One hospital we cover is generally full. There are days when we have 20+ patients holding in ED for a bed. We will get transfer requests from outlying hospitals and sometimes we don't have a bed for 24-28 hours. For this hospital, it's not only about dollars and cents, it's about throughput. We can't serve our community if we can't accommodate these patients.

 

[tantacles]

I'm approaching the 3 year mark as a hospitalist. I work for a private group on a non teaching service. We have mid-levels on the night service, but during the day, I fly (or sometimes sink) solo. Generally we start with 14-16 patients, and get 2-3 admits/ICU transfers a day. First year, I put in longer days than I did as a resident. Now I'm generally finished at the end of my shift. Like anything, the more you do it, the better you get at doing it.

Regarding administration - I try to please them when I can, and if I can't, I can't. If a patient had a cath and PCI yesterday, I don't see a reason why they can't be discharged before noon today. If they are bacteremic and I am waiting on surveillance blood cultures that wont be reported out until 2 PM, then it's going to be an afternoon discharge. I'm sure administration would agree that an afternoon discharge is better than an unsafe discharge, or a discharge tomorrow. Sometimes my morning is derailed by a rapid or impromptu family meeting, but that is usually the exception, and not the rule. Regarding LOS - don't know about you guys, but in just the three years I have been with my group, our patients have gotten sicker. The hospital is aware of this. Doesn't mean they don't bug us. One hospital we cover is generally full. There are days when we have 20+ patients holding in ED for a bed. We will get transfer requests from outlying hospitals and sometimes we don't have a bed for 24-28 hours. For this hospital, it's not only about dollars and cents, it's about throughput. We can't serve our community if we can't accommodate these patients.

haha, time to change your status in your profile, then!

 

[burkemil]

Glad you are reaching out to others. I've been a hospitalist for five years, I work as a locum doc (def. recommend) and have worked at 12 places so far. You won't escape administration. My recommendation is to stick to no more than 7 in a row and 14 a month, or maybe 10 in a row once a month. Stick to your guns about patient census. 16 is ideal, 18 should be max. I've seen after that, steep increase in dissatisfaction - AND its one of the few things we doctors can actually "control" about the workplace. Also, having a designated admitting physician has a huge impact on satisfaction of rounders. Remember, its about your patients. Having all the administration, billing, metrics, and uniquely attending issues is always a tough adjustment. Good Luck!

 

[deleted480308]

I'm approaching the 3 year mark as a hospitalist. I work for a private group on a non teaching service. We have mid-levels on the night service, but during the day, I fly (or sometimes sink) solo. Generally we start with 14-16 patients, and get 2-3 admits/ICU transfers a day. First year, I put in longer days than I did as a resident. Now I'm generally finished at the end of my shift. Like anything, the more you do it, the better you get at doing it.

Regarding administration - I try to please them when I can, and if I can't, I can't. If a patient had a cath and PCI yesterday, I don't see a reason why they can't be discharged before noon today. If they are bacteremic and I am waiting on surveillance blood cultures that wont be reported out until 2 PM, then it's going to be an afternoon discharge. I'm sure administration would agree that an afternoon discharge is better than an unsafe discharge, or a discharge tomorrow. Sometimes my morning is derailed by a rapid or impromptu family meeting, but that is usually the exception, and not the rule. Regarding LOS - don't know about you guys, but in just the three years I have been with my group, our patients have gotten sicker. The hospital is aware of this. Doesn't mean they don't bug us. One hospital we cover is generally full. There are days when we have 20+ patients holding in ED for a bed. We will get transfer requests from outlying hospitals and sometimes we don't have a bed for 24-28 hours. For this hospital, it's not only about dollars and cents, it's about throughput. We can't serve our community if we can't accommodate these patients.

“Accomodating” the patients isn’t the docs problem. The hospital needs more beds in that situation or the govt needs to life certificates of need, but it should never be the doc feeling pressure to make a bad discharge (I’m trying to back you up, not argue with you)