As we approach the holiday season, we wanted to take a moment to extend our warmest wishes to each of you. 

This time of year offers a wonderful opportunity to reflect on the achievements and progress we have made together as a community of Academic Hospitalist Researchers.

Your dedication to advancing the field of hospital medicine, improving patient care, and fostering a collaborative spirit within our academic community has been truly inspiring. Each collaboration and contact within HOMERuN leads to the betterment of healthcare and the enrichment of our collective knowledge. We are grateful for your hard work, passion, and resilience throughout the year.

May this holiday season bring you and your loved ones joy, peace, and a well-deserved break. We hope you find time to relax, recharge, and celebrate the festive season with happiness and good health.

Introducing HOMERuN Scholars!

The goal of the Scholars program is to develop early-career hospitalists' academic footprint and skills.

Aveena Kochar, Assistant Professor at the Icahn School of Medicine at Mount Sinai Hospital

"I find inspiration in the work being done at other institutions and am excited to help build a larger, collaborative network of academic hospitalists."

I was born and raised in Virginia and completed my undergraduate education at the College of William and Mary. I, then, went on to attend medical school at the Medical University of Lublin in Lublin, Poland. I completed my Internal Medicine residency training at New York Presbyterian Brooklyn Methodist Hospital and subsequently joined the Mount Sinai Division of Hospital Medicine in 2015. 

Through my hospitalist career, I have focused on quality improvement and wellness. I have been faculty for the student High Value Care projects and Co-Course director for the Patient Safety and Quality Improvement course for the 3rd year Medical Students. Currently, I am the Medical Director for an inpatient medicine floor, Chair of the Department of Medicine Quality Improvement Peer Review Committee, which reviews patient safety events and mortalities for areas of system improvement, and Wellbeing Champion for the Internal Medicine Residency Program. Over the last few years, I have become more involved with HOMERuN as co-site lead for Mount Sinai in the ADEPT study and involved with HOMERuN Workforce Workgroup. I hope to continue to explore Quality Improvement with a focus on diagnostic excellence while also supporting providers' wellbeing.

Lucy Shi, Assistant Clinical Professor at UC Davis School of Medicine

"I would love to explore how hospitalists can develop a deeper understanding of patient experiences, values, and the cultural context of their decisions to provide better care. I look forward to collaborating and learning from hospitalists across the nation as a HOMERuN scholar."

I was born and raised in Michigan where I completed my undergraduate degree at the University of Michigan before I moved to Ohio for my medical degree at Wright State University Boonshoft School of Medicine. I then completed my Internal Medicine residency at Oregon Health and Science University in Portland, OR and moved to Sacramento with my husband, where I joined the Division of Hospital Medicine at UC Davis in 2017. We have a full house with two young daughters, one dog, and two cats.

In recent years, I have focused on medical student education, overseeing part of the clinical skills curriculum and developing structure for the student-run clinics. Student-run clinics affiliated with UC Davis use limited resources and funding to provide basic medical services and culturally concordant care for distinct groups of underserved communities. When there are provider and patient discordances in language, culture, or even lived experiences, this can impact a provider's ability to fully understand their patient and there are still gaps in our understanding of both the extent of the discrepancies as well as how to best address these issues.

New Publications!

• Andy Auerbach and Jeff Schnipper published an Invited Commentary in JAMA Internal Medicine: Creating Diagnostic Tests for Diagnostic Errors.
• Farah Kaiksow's UPSIDE sub-study was published in the Journal of Hospital Medicine: Measuring the Association Between Diagnostic Errors and Neighborhood Disadvantage.
• Gopi Astik, Michelle Fletcher, Katie Welter, and Andrew Olson recently published "Utilizing Care Transitions for Diagnostic Error Detection in Hospital Medicine Patients" in Annals of Internal Medicine.
• Anuj Dalal, Daniel Motta-Calderon, Abhishek Goyal, and Jeff Schnipper recently published "Adverse Diagnostic Events in Hospitalized Patients: A Single Center Retrospective Cohort Study" in BMJ Quality and Safety.

Organizers and Facilitators: Samantha Murray-Bainer, Gopi Astik, Khoosh Dayton, Joy Engblade, Mark Williams, Shira Winter, Anna Maw, Kasey Bowden

Background

With such a rapidly growing workforce of predominately young hospitalists, the question becomes how do we ensure this workforce remain hospitalists until retirement? The average age for physicians to retire nationally is between 60-69. Turnover, whether due to FTE reduction or attrition, is costly, and with experience comes wisdom, so retention is very valuable. Are there examples of fields with similar work hours in which we can formulate recommendations to promote retention? We argue that our profession is similar to Anesthesia and Emergency Medicine in its 24/7/365 requirement.

Within the field of Anesthesia, the average age of retirement is 62.7 years, with a strong trend of reducing clinical FTE as one gets older. The American Society of Anesthesiologists has recommendations on their website about how to address the needs of more senior anesthesiologists in regard to nights, shift hours, and other expectations. The field of Emergency Medicine has more concerning statistics — in a study collected prior to the COVID pandemic, female Emergency Medicine physicians left the workforce at an average age of 44 years, and male Emergency Medicine physicians left at an average age of 56.4 years.

Emergency Medicine also has recommendations through their national society (American College of Emergency Physicians) in which they recommend the following accommodations for their more senior colleagues: reducing or eliminating nights, reducing shift length, and supporting transitions to non-clinical roles.

We in Hospital Medicine do not currently have any such recommendations for our field.

To that end, we surveyed HOMERuN Collaborative participants to get a sense of what age they estimate they'll be at retirement and whether they will be at their same amount of work at that time. We also explored in the breakout sessions what parts of the job of Hospital Medicine are more difficult as you get older, and what are factors within a Hospital Medicine group or hospital that can be improved to promote your retention.

Impacts of Age on Hospitalist Ability to Perform Work

This discussion blossomed into discussing the work of the hospitalist at many different life stages and how our needs change depending on what stage we are at. 

Night work: 

• There was strong sentiment that nights are physically harder to recover from as one gets older. 
• Night work is sometimes less clinically complex, so that's not perceived as the issue. 
• Nights are also hard for hospitalists who have young children or school-age children — the schedule switching affects the whole family. 
• Nocturnists at multiple institutions tend to be younger hospitalists, sometimes fellowship bound, and they don't typically stay nocturnists for longer than 2-3 years. 
• Many groups have adopted an age-out policy for nights, or adopted a plan where seniority equates to less nights. 

Weekends:

• Weekends are actually perceived as easier for the older hospitalists who may have less child rearing responsibilities. 
• Weekends are harder on hospitalists who have young or school-age children, as their absence affects the whole family. 

Direct care services:

• There were some positives of being a more senior hospitalist — the wisdom gained allows you to deal with some of the logistical or behavioral issues more easily. 
• The institutions where more senior hospitalists are primarily in non-direct care clinical roles note that it's harder for those hospitalists to bounce back into direct care in times like surges or the pandemic. 

Schedule niches:

• There is a trend toward senior hospitalists gaining bought-out roles and their remaining clinical time is dedicated toward only a few clinical roles, rather than the entire service structure. It is hard to remain competent in every role your group performs if you are not 100% clinical. 
• The bought-out FTE time allows for more sustainable careers with less nights, less weekends, less 7-day stretches. 

Technology:

• The more senior hospitalists are sometimes less adept at adopting new technology than their younger peers. Multiple institutions made note of that regarding training in POCUS and advancements in AI. 

Factors That Would Promote Hospitalist Retention

Niche formation: Multiple participants have noted that when passions are cultivated beyond the direct clinical care, hospitalists are more satisfied. Bought-out roles in realms such as QI, systems management, medical education, POCUS, and others are beneficial to career sustainability. 

Schedule flexibility: Multiple institutions who have adopted practices that seek individual hospitalists' input into their own schedules have seen improved morale. The ability to work different shifts in your 30s when you have young children, vs in your 40s with school-aged children, vs in your 50s and nearing retirement is vital. Having different kinds of shifts (direct care, teaching service, admitter shifts, triage shifts, hospital at home shifts, etc.) also helps with sustainability. 

Leadership that listens: Having hospital medicine and hospital leadership that listens to your concerns, seeks your input, and makes changes based on that input makes you feel valued and more likely to stay in your job. 

Recognition: Being given roles with bought-out time and associated titles aids in retention. 

Key Takeaways:

1. There are many aspects of the typical hospitalist service structure that are perceived as more difficult when one gets older, including night shifts, working for 7 days in a row, and maintaining competency in many different roles.
2. The aspects of the hospitalist service structure that most negatively impact the younger hospitalists who have young or school-aged children are night shifts, working for 7 days in a row, and the weekend shifts. 
3. Factors that promote retention of career-long hospitalists include: consideration of policies around nights in which age or seniority can allow you to opt out; fostering niches with associated bought-out time that reduces the clinical load; seeking individual hospitalists' input into their schedules; and accommodating changing desires of hospitalists as they progress through different life stages. 

Our next meeting will be on January 10, 2024.