Background: Hospital medicine groups are rapidly expanding with an increasing presence across academic medical centers yet little data exist to identify which models yield the best outcomes for patients, hospitalists and the health system. Poorly designed staffing models can contribute to hospitalist burnout and turnover. We sought to explore hospitalist clinicians’ perceptions of care delivery models within their hospital medicine groups and to gain insight into how staffing decisions are made.
Methods: We conducted an exploratory mixed method study utilizing an embedded survey and virtual focus groups with hospitalist clinicians participating in the Hospital Medicine ReEngineering Network (HOMERuN) collaborative. Seven 30-minute focus groups were held during a monthly HOMERuN collaborative meeting. A 12-question survey was also completed during this session. Rapid qualitative methods were used including templated summaries and matrix analysis to identify major themes.
Results: Seven semi-structured focus groups were held on June 14, 2024, with 31 individuals from all five geographic regions in the US. Twenty-seven individuals completed the survey (87% response rate). Of those completing the survey, 23 (85%) identified as physicians, one (4%) as an APP, and nine (33%) reported a leadership role. Mean years in practice was 13 with a standard deviation (SD) of 7. Mean percent clinical effort was 43% (SD 24). All but one (96%) practiced in an academic setting. We identified three main themes (Table). (1) Expanding roles and increasing service complexity. Hospitalists’ roles are becoming more complex, encompassing a wide range of services and care models (Figure). (2) Work design and competing priorities. While hospitalists generally appreciate opportunities to opt into some specialized services and the variety in their work, excessive task switching can lead to cognitive overload. Specialized roles offer benefits such as improved continuity and efficiency but pose challenges like scheduling complexities and the need for sophisticated jeopardy coverage systems. (3) Hospitalists as ‘fixers’ in a reactive system. Changes to hospitalist models are primarily driven by external factors, including rising patient volume and complexity, capacity challenges and financial considerations. Some groups perceived these demands as one-sided while others found their expanding presence in the hospital strengthened their influence with leadership and improved their negotiating power.
Conclusions: Hospitalists’ perspectives on their rapidly evolving field highlight the complexities groups face due to rapid expansion and external demands. Identifying optimal work models is crucial for designing sustainable careers for hospitalists.
