Pediatric Hospitalist Workload and Sustainability in University-Based Programs: Results from a National Interview-Based Survey
Wide variability exists in the clinical workload of pediatric hospitalists without an accepted standard for benchmarking purposes. By using data obtained from interviews of pediatric hospital medicine (PHM) program leaders, we describe the clinical workload of university-based programs and report on the program sustainability perceived by PHM program leaders. The median clinical hours reported for a full-time pediatric hospitalist were 1,800 hours per year, with a median of 15 weekends worked per year. Furthermore, program leaders reported an ideal number of clinical hours as 1,700 hours per year. Half of the interviewed program leaders perceived their current models as unsustainable. Programs perceived as unsustainable were more likely than those perceived as sustainable to require a higher number of weekends worked per year or to be university employed. Further research should focus on establishing benchmarks for the workloads of pediatric hospitalists and on evaluating factors that can affect sustainability.
© 2018 Society of Hospital Medicine
Pediatric hospital medicine (PHM) has grown tremendously since Wachter first described the specialty in 1996.1 Evidence of this growth is seen most markedly at the annual Pediatric Hospitalist Meeting, which has experienced an increase in attendance from 700 in 2013 to over 1,200 in 20172. Although the exact number of pediatric hospitalists in the United States is unknown, the American Academy of Pediatrics Section on Hospital Medicine (AAP SOHM) estimates that approximately 3,000-5,000 pediatric hospitalists currently practice in the country (personal communication).
As PHM programs have grown, variability has been reported in the roles, responsibilities, and workload among practitioners. Gosdin et al.3 reported large ranges and standard deviations in workload among full-time equivalents (FTEs) in academic PHM programs. However, this study’s ability to account for important nuances in program description was limited given that its data were obtained from an online survey.
Program variability, particularly regarding clinical hours and overall clinical burden (eg, in-house hours, census caps, and weekend coverage), is concerning given the well-reported increase in physician burn-out.4,5 Benchmarking data regarding the overall workload of pediatric hospitalists can offer nationally recognized guidance to assist program leaders in building successful programs. With this goal in mind, we sought to obtain data on university-based PHM programs to describe the current average workload for a 1.0 clinical FTE pediatric hospitalist and to assess the perceptions of program directors regarding the sustainability of the current workload.
METHODS
Study Design and Population
To obtain data with sufficient detail to compare programs, the authors, all of whom are practicing pediatric hospitalists at university-based programs, conducted structured interviews of PHM leaders in the United States. Given the absence of a single database for all PHM programs in the United States, the clinical division/program leaders of university-based programs were invited to participate through a post (with 2 reminders) to the AAP SOHM Listserv for PHM Division Leaders in May of 2017. To encourage participation, respondents were promised a summary of aggregate data. The study was exempted by the IRB of the University of Chicago.
Interview Content and Administration
The authors designed an 18-question structured interview regarding the current state of staffing in university-based PHM programs, with a focus on current descriptions of FTE, patient volume, and workload. Utilizing prior surveys3 as a basis, the authors iteratively determined the questions essential to understanding the programs’ current staffing models and ideal models. Considering the diversity of program models, interviews allowed for the clarification of questions and answers. A question regarding employment models was included to determine whether hospitalists were university-employed, hospital-employed, or a hybrid of the 2 modes of employment. The interview was also designed to establish a common language for work metrics (hours per year) for comparative purposes and to assess the perceived sustainability of the workload. Questions were provided in advance to provide respondents with sufficient time to collect data, thus increasing the accuracy of estimates. Respondents were asked, “Do you or your hospitalists have concerns about the sustainability of the model?” Sustainability was intentionally undefined to prevent limiting respondent perspective. For clarification, however, a follow-up comment that included examples was provided: “Faculty departures, reduction in total effort, and/or significant burn out.” The authors piloted the interview protocol by interviewing the division leaders of their own programs, and revisions were made based on feedback on feasibility and clarity. Finally, the AAP SOHM Subcommittee on Division Leaders provided feedback, which was incorporated.
