Study Concludes, Hospitalists are Overworked and Overtasked

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Cheryl Clark at HealthLeaders Media reports a recent Johns Hopkins University survey published in Jama Internal Medicine concluded that a large percentage of hospitalists are overworked and overtasked. Researchers found that 40 percent of 506 hospitalist respondents said “their workloads exceeded safe levels at least once a month,” while 36 percent “reported excessive workload assignments exceeding safe levels at least once per week.”

The researchers said they “weren’t surprised that there is an issue with workload, and that providers believed it fluctuated to points that exceeded safe levels. But we were surprised at the frequency with which we were seeing this across all different kinds of institutions and practice settings, and with different providers.”

Clark writes that increasing patient flow and decreasing length of stay is having an adverse effect on the hospitalist’s ability to thoroughly discuss treatment options with the patient, is delaying patient admissions and discharges, is worsening patient-experience scores, and is possibly leading to unnecessary test procedures and consultations. This, in turn, is contributing “to patient transfers, morbidity, or even mortality.” Furthermore, hospitalists are starting to experience burn-out.

“…What this would suggest is that while we’re being penny wise in increasing flow and decreasing stay, we might be pound foolish by paradoxically increasing costs,” Henry J. Michtalik, MD, one of the study’s authors said.

Co-founder and former president of the Society of Hospital Medicine John Nelson, MD, said the survey results are “important,” but feels another factor may be playing into its conclusions. Certified hospitalists, he said, “continue to be in short supply throughout much of the country.” The impact of this shortage cannot be diminished, he contested.

Furthermore, while the overworked aspect of this study may be true, don’t forget that hospitalists make their own schedules, Nelson said, so the heavy workload may involve some personal responsibility.

“While some organizations (that employ or contract with hospitalists for their services) may have unreasonable expectations of what they can do, and that may lead to performance suffering, hospitalists may be complaining about some conditions they bring on themselves,” he explained.

The Society for Hospital Medicine has found, “Hospitals that use hospitalists to manage care for admitting community physicians has been a dramatically expanding trend, with more than 34,000 hospitalists now practicing in more than 3,300 hospitals.”

In 2013, it is estimated that the number of hospitalists could increase to 40,000. Additionally, 80 percent “of acute-care facilities with more than 200 beds…employ or contract with hospitalists.”

If your organization has a hospitalist program, have you noticed that the hospitalists tend to be stretched too thin? Is their patient load too heavy? What have you done to address this? How do you plan on addressing it should it become a problem?

-by Pete Fernbaugh

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