Background: Scholarly productivity is critical for academic fulfilment and promotion in hospital medicine (HM), but many hospitalists struggle to achieve scholarly success. Protected time (PT) (i.e., non-clinical time that can be dedicated to scholarly activities) is a key facilitator of academic productivity in HM. However, little is known about how PT for scholarship is managed in HM groups. Understanding current practices regarding how PT for scholarship is managed in academic HM is a necessary step in a program of study to determine effective models for PT. The objective of this project is to describe the processes surrounding PT for scholarship-related FD in academic HM.
Methods: As academic hospitalists, we sought to explore PT for scholarship through a constructivist paradigm. We developed and pilot tested an interview guide focusing on the following aspects of PT; how it is funded, allocated, progress monitored, and productivity measured. Then, we conducted semi-structured interviews with division leaders of academic HM groups. Interview recordings were converted to transcripts and these were analyzed using a qualitative, inductive thematic approach. A codebook was developed and iteratively refined. Interviews were continued until the author group determined that thematic sufficiency was reached.
Results: We reached thematic sufficiency after 10 interviews. Data was categorized into four overarching themes about PT: Sources, Allocation, Implementation, and Evaluation. Within the Sources theme, a key subtheme that developed was the expectation that academic hospitalists would self-fund their scholarly time, either through working during days off from clinical responsibilities or by reducing their work hours. Within the Allocation theme, respondents described three subthemes: starting packages or “seed time”, submission-based competitive proposals or providing a small amount of time for all members. The key subtheme to emerge from Implementation was the difficulty that leaders in HM had in navigating the zero-sum game of providing time while covering clinical shifts. Several groups made use of matching time between the individual and the division to reduce the cost to the division and as a motivational technique to foster productivity. HM leaders are concerned that lack of skills for conducting research and paucity of research mentors in HM are constraints on productive use of PT by hospitalists. Evaluation of the use of PT was nearly universally informal and qualitative through “check-ins”, works-in-progress sessions, or mentor meetings. The principal formal metric used was for HM researchers on a track for external grant support. In those cases, achieving a grant award was the key measure of success.
Conclusions: Academic HM groups experience several barriers to providing PT for scholarship. First, funding for PT is often reliant on self-funding or small one-time allotments of division resources, with limited institutional, grant, or benefactor-based financial support. Second, division leaders are constrained by clinical practice needs and concerns about the efficient use of PT. Lastly, HM groups lack robust mechanisms for measuring the academic outcomes of PT.