Background: Hospitalist comanagement of surgical patients has become the standard of care for conditions such as hip fractures and has expanded widely to involve numerous surgical disciplines. While hospitalist comanagement has demonstrated improved patient outcomes, its impact on hospitalist satisfaction is unknown. The objective of this study was to evaluate the hospitalist experience and satisfaction with surgical comanagement.
Methods: An anonymous survey study evaluating the hospitalist experience and satisfaction with surgical comanagement was conducted across 8 hospitals within a large integrated health system in the New York metropolitan area. Hospitalists who round on a surgical comanagement service were sent an anonymous survey link via email. Survey questions utilized a 5-point Likert scale that ranged from “strongly disagree” (1) to “strongly agree” (5). Positive responses were defined as “agree” and “strongly agree” statements.
Results: Of the 77 hospitalist comanagers, 32 completed the survey (43% response rate). Among hospitalists who completed the survey, 65% (N=21) were between the ages of 31-40, 56% (N=18) were male, and 38% (N=12) were white. Over half (53%, N=17) had < 5 years experience on comanagement; 47% (N=15) primarily worked a Monday through Friday and another 47% ( N=15) worked variable shifts; and 53% (N=17) reported working on the co-management for less than 25% of the academic year. The most frequently reported surgical comanagement services were orthopedics (50%, N=16), vascular surgery (41%, N=13), and neurosurgery (38%, N=12). The majority (83%, N=26) reported they were asked to join, rather than requesting to join the comanagement service. All (100%, N=32) of hospitalists were happy being members of surgical comanagement. Most hospitalists perceived that their workdays were more flexible on comanagement, when compared to working with housestaff (84%, N=27) or an attending directed service (78%, N=25). The majority of hospitalists thought that they worked more efficiently on comanagement, when compared to working with housestaff (69%, N=22) and attending directed service (56%, N=18). Only 6% (N=2) thought their workload increased on comanagement. Most hospitalists (84%, N=27) felt more confident optimizing patients for surgery and over half reported that comanagement provided them with a sense of fulfillment (56%, N=18) and professional expertise (65%, N=21). Very few (9%, N=3) hospitalists felt as though they were working outside their comfort zone or overwhelmed by the complexity of the patients they were caring for on the comanagement service (6%, N=2).While working with the surgical teams, 53% (N=17) reported that working on the comanagement service changed their perception of the surgical services in a positive way, 59% (N=19) felt appreciated by the surgical teams, and many (63%, N=20) felt their recommendations were followed. Nearly three-quarters (72%, N=23) of hospitalists believed comanagement improved communication between hospitalists and surgeons. Most hospitalists felt that the patients perceived them as a vital member of the surgical team 63% (N=12) and understood their role 68% (N=20).
Conclusions: This study highlights that hospitalists greatly enjoy working on comanagement. Incorporating comanagement rotations into hospitalist work schedules has the potential to improve hospitalist satisfaction and professional fulfillment, which is essential in the face of increasing moral distress and burnout among hospitalists.