Background: Hospital medicine programs typically include a range of clinical shift types – direct care, teaching, consultative, triage, and admitting shifts – reflecting the diverse nature of hospitalist work. While workload has been identified as a significant determinant of hospitalist performance and well-being, less attention has been given to other factors influencing hospitalists’ preferences among different shift types. Understanding these factors may inform both compensation system design and efforts to support hospitalist career sustainability. This study aimed to identify factors, other than compensation, that influence hospitalists’ shift choices.
Methods: We conducted a single-center qualitative study in an academic hospital medicine group comprising ~175 faculty. Participants were recruited via email and divisional announcements to participate in one of five 45-minute, semi-structured focus groups held in September 2025. Focus groups were led by hospitalists with experience in hospital medicine service leadership and explored hospitalist perspectives on clinical workload, attitudes towards shift selection, and relative compensation by shift. Sessions were audio recorded, transcribed, and coded inductively, with iterative team input to refine and consolidate themes.
Results: Thirty-nine hospitalists participated in focus groups. Hospitalists emphasized the value of customizing their clinical schedules (Table 1). Within this broader context of valuing choice, the following themes emerged (Table 2): 1) shift desirability is highly person-specific, shaped by clinical interest, academic focus, and work-life considerations (e.g. commute time, caregiving responsibilities); and 2) perceived shift workload is multifactorial, encompassing quantifiable factors (e.g. shift length, patient census, being first call), as well as experiential factors (e.g. emotional intensity, patient complexity, shift predictability).
Conclusions: Hospitalists reported a wide variety of factors beyond compensation that influenced the types of shifts they preferred to work. Shift desirability is influenced by individual preferences and not uniformly shared across a large workforce. Despite volume of encounters remaining the standard for assessing workload, we identified additional factors such as emotional and cognitive load that impact perceived shift workload. Designing systems that incorporate variable shift features and allow for individual choice may enhance satisfaction and sustainability in hospitalist practice. Future research should examine how workload- and desirability-related factors, as well as the degree of individual scheduling autonomy, influence hospitalist well-being, burnout, and long-term career sustainability.
.png)
.png)