One key factor cited in physician burnout discussion is the rigid block scheduling that has become ubiquitous for Hospital Medicine. For years, nursing has allowed self-scheduling to improve work life balance and abate burnout with good success per the literature. Recent commentary by leaders in Hospital Medicine has piqued the interest in further evaluation of alternatives to the traditional work model for hospitalists.
To describe the scheduling model of a community hospitalist practice and the impact on physician quality of life.
Since 2006, the Department of Hospital Medicine at Huntington Hospital has allowed physicians to choose their own schedule. The Department adheres to the Northwell Hospital Medicine service line mandate of 2000 worked hours per year, which equates to 15.7 shifts per month, with the practice also requiring 2 weekends per month.
Each month, the individual hospitalist selects their desired weekdays and weekends to be worked, totaling 15-16 shifts monthly. They are free to cluster shifts for travel, or to work extra or fewer hours one month compared to the next. Even the number of shifts worked in a row is up to provider preference allowing individuals to choose what works for them. Schedule requests are handled by a chief scheduler or worked out between 2 hospitalists that are sharing a geographic unit for the month. The minimum goal is at least 4 consecutive shifts for continuity.
The traditional block scheduling model poses many challenges including exclusion from participation in both work related quality improvement projects along with personal obligations due to difficult switches between co-workers. The advantage to self-selection of days worked is that despite working longer hours, there is flexibility in adhering to other commitments by either choosing to work consecutive weekends or taking off a single day. Choosing the schedule also allows physicians the ability for self-inventory to decide whether blocks of 5, 7, or other numbers are feasible for their personality or season of life.
A recent survey of our current full time hospitalists in our 25 FTE practice reinforced the importance of being allowed to modify work responsibility to allow personal commitments to also be upheld. 76% of respondents reported that the flexible schedule is why they choose to practice medicine at our site over others in the market. 100% of respondents felt that the flexible schedule allowed them to maintain a healthy work life balance. Our hospitalist group reported being happy at work with 28% stating they are happy every day and 72% reporting being happy most days. No hospitalist reported being unhappy to any degree.
By allowing hospitalists to have autonomy in selecting which days they want to work, the program has been successful in engaging physicians and improving work life balance. Feedback from the group resoundingly shows that flexible scheduling is a key component to health and happiness both at work and during time off.