Organizers and Facilitators: Kirsten Kangelaris, Margaret Shyu, Sara Westergaard, Shradha Kulkarni, Michelle Knees, Angela Keniston, Marisha Burden, and Luci Leykum

Background: Hospitalist clinicians face persistent challenges related to burnout, turnover, and the sustainability of clinical roles. This summary highlights some of our discussion around the primary factors driving burnout, the impacts and costs of turnover, and how hospitalists think about diversifying work with non-clinical roles.

Factors Driving Burnout Among Hospitalists

Hospitalists experience significant burnout due to a disconnect between care expectations and system constraints, compounded by workloads and what at times can feel like a lack of support from high level leadership to make necessary change. Several concepts were brought up.

Systemic Issues: Excessive administrative tasks were felt to detract from patient care, and slow progress on health equity added to the frustration. Participants felt that they were always working uphill, struggling against numerous obstacles to get their patients what they needed. It isn't the medicine itself; it is the context of care filled with impossible predicaments.

Work Environment and Workload Stress: Persistent high patient loads and patient acuity, exacerbated by COVID-19, have not subsided. This relentless strain leaves no room for recovery. Ancillary support was felt to be critical to mitigating some of the challenges experienced in day-to-day care.

Leadership Disconnect: There was felt to be at times a lack of understanding from upper management about frontline challenges, with a continued focus on profit making. Additionally, there is a misunderstanding of the hospitalist model.

Team Dynamics: Strong teams were felt to help alleviate stress, but inequities in treatment by other specialties contribute to it. Hospitalists are often viewed as the workforce expected to pick up the types of work that other specialties prefer not to do.

"The corporate culture is very different than academic culture and so much is driven by money and the profit margins, it is ethically sometimes unsettling to have to work within the confines of that business mindset of our leaders."

Impacts and Costs of Turnover

Turnover, defined as both departures and reductions in clinical effort, carries significant financial, cultural, and operational costs, impacting team morale and patient safety. Participants identified a variety of areas of impact as well as thoughts of how to measure.

Financial and Efficiency Costs: Recruitment, onboarding, and loss of institutional knowledge are expensive and time-consuming.

Cultural and Safety Impacts: High turnover disrupts team cohesion, increases workload for remaining team members, and affects care quality. Turnover impacts moral and institutional knowledge.

Measurement: Quantifying impacts through HR metrics, burnout surveys, and exit interviews is essential for understanding turnover's full cost.

"The answer to this is kind of evident, right? When people leave, it hurts morale. Then you are catching up on staffing, you never quite catch up. People feel that they're overworked, and they get a sense they'll always be overworked."

Diversifying Work

Incorporating non-clinical duties or bought-out time was felt to help prevent burnout and provide a more balanced career path, helping clinicians remain engaged and fulfilled. Similarly, diversifying clinical work was felt to also help with professional fulfillment. Ideas on how to ensure sustainability of work was also discussed as it was also felt that this is critical to keeping clinicians engaged in the clinical work. Critical barriers were the high workloads, lack of predictability, and challenges getting patients what they need. Institutional cultures and messages impact sustainability as well.

Value of Bought-Out Time: Reducing clinical duties through administrative roles was felt to allow for skill diversification and reduce burnout. The challenge with this is finding this type of work, as it also costs resources.

Focus on Non-Traditional Clinical Roles: Exploring alternative roles, like telehealth, was felt to be critical to diversifying clinical work crucial for sustainable careers.

Sustainability Efforts: Offering remote work options, reducing patient loads, and focusing on meaningful metrics enhance job satisfaction. There could be creative ways to improve communication strategies and interruptions (e.g., secure chats).

Conclusion

Burnout among hospitalists is driven by systemic barriers, unsustainable workloads, and perceived disconnect between the corporatization of healthcare and the goals of patient care.

Addressing these challenges will require systemic changes, better workload management, and a focus on career development opportunities to ensure a sustainable and fulfilling work environment.

Our next meeting will be on December 13, 2024.