Background: Millions of patients with cancer are hospitalized each year in the US for treatment or complications of their disease. Increasing numbers are cared for by hospitalists on services dedicated to patients with cancer. Little is known about the practice characteristics or working environment of this expanding pool of oncology hospitalists.
Methods: Using a modified Delphi method, we developed a survey with topics including general practice and group characteristics, physician training, workload and hours, schedule, financial support, patient mix, role of oncologists, goals of care conversations, and Likert questions on perceptions of autonomy, respect by oncologists, and acceptance by patients. The survey contained branching logic, and had a maximum of 74 questions. Using the snowball method, we distributed the survey via Survey Monkey between April and September 2016 to leaders of oncology hospitalist groups. We used descriptive statistics to summarize data.
Results: We found a total of 26 leaders of inpatient oncology hospitalist groups. 23 returned surveys for a response rate of 88%. Groups have been in existence for a median of 6 years (range 1-15). 17 (85%) groups exist at academic institutions, and 7 (33%) at hospitals with >100 oncology-dedicated beds. Groups have a median of 8 individual daytime hospitalists (range 1-22), with a median of 4 dedicated daytime FTEs (range 1-8). All hospitalists are board-certified in internal medicine, and 7 (33%) groups have hematology-oncology board-certified hospitalists. The median number of patients seen on non-teaching services is 11.5 (range 8-16) and on teaching services, 14 (range 8-18). The mean duration of dayshift is 11.3 hours (range 10-13), and the median number of shifts per year is 175 (range 146-264). The amount of financial operating support received by groups varies from 0 to >80%. The most common types of patients cared for are solid tumor (n=15, 71%) and palliative/hospice (n=12, 57%). The role of oncologists in patient care varies among groups. The most common model consists of oncologists acting as consultants focused on cancer-related treatment while hospitalists independently manage other aspects of patient care (n=11, 52%). Oncology hospitalists (n=20, 95%), patients’ own oncologists (n=19, 86%), and palliative physicians (n=17, 82%) all have goals of care conversations. 17 (77%) of leaders perceive hospitalists as having a large degree of autonomy caring for patients with cancer. Overall, leaders perceive oncology hospitalists to be well-respected by oncologists (n=16, 76%) and accepted by patients (n=15, 79%).
Conclusions: Knowing more about oncology hospitalists’ practice characteristics, working environment, and patient characteristics will enable the development of studies and guidelines for most effective care delivery, while improving outcomes of patients with cancer.