Background: Hospital medicine has expanded significantly over the last two decades but faces a higher physician turnover rate compared to other specialties1 and a critical shortage of providers. A survey conducted in 2019 and again in 2022 showed a reduction in the number of hospitalists identified as being “very satisfied” with their career (from 55% to 20%) and a 10% increase in dissatisfaction2. Hospitalists reported high stress levels (67%) and burnout (12.9%), with another 25% at-risk for burnout.3 Key predictors of burnout included low satisfaction with personal time and control over work schedules.3 Hospital medicine requires long, high-stress days with some nights and weekends. Creative strategies to address schedule flexibility, variety in practice scope, and reduction in on-call demands may improve hospitalist career longevity.
Purpose: To address these issues, we developed a hybrid work model in which physicians alternate working one month in the hospital with one month in primary care.
Description: The “hybrid” general internist practice model allows physicians to alternate monthly between inpatient and outpatient roles, partnering to split responsibilities. Created in 2016, there are currently 16 hybrid general internists at our institution. During clinic months, the focus is on their primary care role, while during inpatient months they work scheduled hospital shifts with minimal clinic duties. This model reduces on-call demands and minimizes simultaneous inpatient and outpatient duties, making it appealing for those seeking work balance without the monotony or burden of traditional roles (Table 1).Interviews with hybrid physicians indicated they enjoyed building long-term relationships with patients and the continuity of care in primary care, along with the novelty and challenge of acute patient care in the hospital. The breadth of experience kept their skills sharp and was perceived to facilitate effective outpatient management of certain conditions and smoother hospital discharge and transitions of care. The variety increased perceived job interest and satisfaction and decreased perceived burnout. Some also incorporated other passions or roles (e.g., teaching, administration) into their job. Hybrid physicians enjoyed the predictability of a month-to-month work structure, which afforded some control of their time and facilitated coordinating schedules and personal activities (e.g., vacations, family needs) in pursuit of greater work-life balance.We are reviewing our institution’s most recent internal well-being survey results for career satisfaction and to compare burnout rates between outpatient-only physicians, hybrids, and hospitalists.
Conclusions: A hybrid general internist career is appealing for physicians wanting to practice full-spectrum general internal medicine. It blends the dynamic nature of inpatient care with the preventive focus and longitudinal patient relationships of primary care, with a schedule that reduces work on nights and weekends. This flexibility helps prevent burnout and enhances job satisfaction; its simplicity allows it to be implemented in various settings. Hybrids are also well-suited for meeting the evolving needs in hospital medicine including transitions of care, utilization of telehealth, and hospital capacity challenges. The hybrid model may fortify career longevity and reduce unexpected turnover, resulting in a more stable workforce in both hospital medicine and primary care.
