As we move away from the traditional internist and continue to separate the inpatient realm from the outpatient, hospitalist scheduling remains controversial. Through my own job searches, I have seen many scheduling models. Seven on, seven off remains common, but many groups are moving away from this in favor of more lifestyle-friendly schedules. Working seven consecutive days can be exhausting and may lead to early burnout. It also leaves little time for family, exercise, or hobbies outside of work during the week. Taking an extended vacation may require coordination with colleagues and a grueling 14-day work stretch.
Unlike other shift work based-specialties, such as anesthesiology or emergency medicine, hospital medicine requires day-to-day patient continuity. This leads to the challenge of minimizing patient hand-offs while balancing the physician lifestyle. I believe the best hospitalist scheduling models have the following features:
- Flexible Scheduling: The ability to work shorter stretches of 3, 4, or 5 consecutive days still allows for ample patient continuity while minimizing physician fatigue. This model also allows for easier coordination of extended time off.
- Round and Go Model: This refers to the ability of the daytime physician to leave the hospital after the work is done. Most groups on this model require the hospitalist to take admissions until early afternoon, after which they can go home. Patients that come in later will be admitted by a swing shift hospitalist or held by the emergency department until the night hospitalist arrives. This may require coordination with emergency physicians to help with codes and rapid responses.
- Good and Bad Weekends/Holidays: Everybody wants weekends and holidays off, but somebody has to cover. An excellent way to manage this is to allow most hospitalists to go home very early while one stays late and handles all of the admissions. This may lead to a brutal day when you stay late. However, depending on group size, this may not be very often.
- Night Shift Differential: This entails higher nighttime pay incentivizes picking up shifts. It may also help a group attract a full-time nocturnist. Another strategy is to reduce shift requirements for full-time physicians; for example, many groups advertise a five on, ten off model for nights. This leads to a better work-life balance and less nocturnist turnover.
The ability to utilize these strategies is heavily dependent on the particular group and hospital size. Above all, the key is to minimize long work stretches and allow hospitalists to go home when the work is done. These strategies lead to a more sustainable career and a happier physician, which, in a specialty known for high burnout rates, is a constant balancing act.
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