Co-management across service lines has become increasingly common in hospital medicine. While debate continues over clinical outcomes, some co-management arrangements have led to enhanced provider satisfaction, which may have implications for burnout.
We have established successful co-management services with orthopedics, urology (GU), otorhinolaryngology (ENT), trauma and neurosurgery (NS). We are a large urban/suburban academic division with over 80 hospitalists at 2 tertiary care facilities. We have been able to create a viable model for increasing hospitalist productivity and specialization while simultaneously improving job satisfaction.
Purpose:
To demonstrate how to create multiple co-management services in a large academic institution while enhancing job satisfaction among hospitalists and potentially drawing new hires.
Description:
In 2015, a core group of 4 hospitalists (OHOS) started medically co-managing post-operative orthopedic patients. The agreement included a single contact number, 24-hour availability, enhanced communication and order writing privileges. Annually, each core hospitalist spends 25% of their time on OHOS. Initial success of this service model led to expansion to GU, trauma, ENT, and NS. Each new model created a hospitalist leadership opportunity. Through our co-management arrangements, we have demonstrated improved patient experience and performance metrics. High surgeon satisfaction led us to investigate hospitalist satisfaction.
Hospitalists (n =22) were surveyed on their experience rotating through co-management services. Respondents noted improved expertise (81.8%), increased sense of value (68.2%), neutral or improved work schedule flexibility (95.5%) and a positive contribution to overall job satisfaction (68.2%). Most felt that workload was not increased (86.4%).
Based on these encouraging results, a separate survey of newly hired hospitalists (n = 16) was conducted to investigate the impact of our co-management model on recruitment. While only 31.3% of respondents agreed that co-management was specifically a factor, an overwhelming majority agreed that the schedule structure (93.8%) and leadership opportunities (75.0%) were factors. As such, we believe co-management opportunities were a new hire draw.
Conclusions:
Over the last 2 years, our large division has seen a rapid expansion as we have established multiple co-management services. Our data reveal that co-management has contributed to improved sense of clinical expertise, value, flexibility, and overall job satisfaction and, through its impact on hospitalist schedules and leadership opportunities, may potentially aid recruitment. Next steps include reviewing this year’s SHM Engagement Survey results to see if these improvements in job satisfaction have led to decreased risk of burnout.