November 29, 2021

HOMERuN Collaborative: Provider Wellness Focus Group Discussions

The Hospital Medicine Reengineering Network (HOMERuN) is a national network of Hospital Medicine investigators at 12 academic medical centers (AMCs) and 50 affiliated sites.

Organizers and Facilitators: Krishna Chokshi, MD, Andrew Schram, MD, Angela Keniston, MSPH, Anne Linker, MD, Andrew Auerbach, MD, MPH Background: The HOMERuN Provider Wellness Workgroup was formed during the peak of the COVID-19 pandemic and has been studying the landscape of clinician wellness issues that have arisen during the pandemic and institutions’ responses to these needs.  During the earlier parts of the pandemic, the workgroup was most concerned with identifying urgent issues around well-being and institutional and divisional best practices to begin addressing these concerns. The workgroup survey involved sites in HOMERuN and conducted focus group interviews in January 2021. As the pandemic continues to unfold in different ways and we all have learned to live with COVID-19, we recognize that the pandemic has left indelible marks on medicine and the specialty of hospital medicine. The Provider Wellness Workgroup held focus groups on 10/8/2021 to understand the enduring effects of COVID-19 on hospitalist divisions and hospitalists’ roles in their institutions and their career aspirations and plans.

Provider Wellness Issues in Hospital Medicine Has the pandemic promoted the creation of new programs or positions to promote clinician wellness? Many common themes came up in focus groups around issues of mental health support, childcare, and community-building efforts to make staff feel more valued. More awareness and normalization around mental health support and increased resources to address this. While most institutions reported some sort of wellness committee either before or after the pandemic, several noted that these committees were new. Many programs that made staff feel valued during the peak of the pandemic were often not continued. For example, meals, coffee, and snacks have been missed! Individuals recognize the importance of support for things such as childcare, but these issues have not yet been addressed sufficiently. Has COVID-related staffing and workload management led to durable changes? Nearly all participants shared that their hospitals are busier and their census is higher than before the pandemic. The institutions that did increase staffing support during surges have not maintained the degree of staffing or ancillary support. The sustained increase in census seems to be a central driver of fatigue and burnout. Many divisions are trying to hire more midlevels to support the increased need, but most participants are seeing more patients or working more. There is increased utilization of moonlighters and locums.   Physicians are changing institutions, going part-time or leaving medicine altogether. Are you seeing this in your groups? Any insight as to why? Every group commented on how the pandemic has motivated people to think about their lives and priorities more carefully and to prioritize individual happiness and family. There are trends for hospitalists, especially women, to go part time to be with their children. Many have reconsidered leadership roles, as these may be too demanding. There is some decrease interest in academic involvements, as people reevaluate what matters most to them. Several groups noted that there have been increases in challenging patient interactions overall. There is more hostility toward the medical community and increased distrust. This manifests over issues related to the vaccine, but also beyond this. The concept of moral injury has come up in all groups. Clinicians have not had enough time or support to fully grapple with the psychological impact of the pandemic. Do you feel like your institution continues to make hospitalists better able to impact change at your institution? Some participants noted that hospitalists have the opportunity to be more involved in hospital operations. Others felt that the pandemic response was driven primarily by ID and critical care. Several participants noted that hospitalists were more involved during the peak of the pandemic by hospital leadership, but this has not led to sustained integration of hospitalists into key operational roles. Many participants remarked that there is increased respect and visibility for hospital medicine in their institutions.

"Focusing on well-being is essential to maintaining a sustainable hospital medicine group and creating a supportive and resilient team. SHM encourages groups to take a holistic approach to wellbeing, offering resources designed for hospital leaders who seek to build a culture that fosters a collaborative environment, promotes wellbeing, and ultimately engages hospitalists as valuable members of the team."

Our next meeting will be on December 10, 2021. We will hold focus group discussions on Hospital Medicine Jeopardy systems with the Workforce Planning Working Group.

Check out the HOMERuN COVID-19 Knowledge Base for more details. If you would like to join the HOMERuN Collaborative calls, please reach out to Tiffany.Lee@ucsf.edu.