If you were designing the perfect hospitalist job description, what would be the optimal workload to achieve high productivity? This was the crux of the discussion during September’s JHMChat. The conversation featured Drs. Marisha Burden, Moksha Patel, Mark Kissler, and Elizabeth Harry as well as researcher Angela Keniston, coauthors of “Measuring and driving hospitalist value: Expanding beyond wRVUs,” published in the Journal of Hospital Medicine.
Multiple themes emerged in this hour-long conversation, using their article as the springboard. (Check out this visual abstract by JHM Digital Media Fellow Dr. Gian Toledanes summarizing the article!) The discussion dove into the differences between what clinicians value vs what hospitals may be valuing, which do not always overlap.
JHM Digital Media Fellow, Dr. Jen Readlynn, moderated the chat and kicked off the discussion by asking, “How should hospital leadership support an optimal workload?” Many respondents stated that while hospitalists’ workload is much more than what is captured by wRVUs (workload Relative Value Units), it can be difficult to measure or capture. While medicine hasn’t quite figured this out, it was pointed out that NASA may have a solution with their Task Load Index – which measures workload across multiple domains including mental demand and even frustration!
A4. Leadership should evaluate the entire picture.
In the Short Term Costs may ?? to hire more Hospitalists.
But in the long run the payoff will come with ?? less burnout, ?? provider satisfaction ?? better patient care.
The ? is to provide great patient care! #JHMChat— Anika Kumar, MD (she/her) (@freckledpedidoc) September 13, 2022
Another theme that emerged is the idea of “right-sized” staffing (i.e., having just the right amount of hospitalists…but not too many). While this approach may be a priority from a financial risk standpoint, focusing on “leaning” the system can have adverse effects, as lean systems often fail to account for medical, parental, and unexpected leaves. Thus, leaving groups high and dry when a colleague has to step away from clinical work. Many agreed that having a staffing “buffer” is essential for clinician well-being and patient safety.
Been a Hospitalist for nearly 20 years and I don’t recall ever being ‘over staffed!’ #JHMChat
We’re probably measuring the wrong outcomes to determine staffing— Areeba Kara (@areeba_kara) September 13, 2022
Another key feature in the conversation was the importance of leaders who set productivity targets truly understanding which value-added factors contribute to both patient and clinician well-being. Simply put, what factors of the job drive physician wellness and which ones drive burnout?
Totally agree! Observing clinical work is an absolute MUST for non-clinical types like myself! #DataEmpathy for the win! #JHMChat https://t.co/TagWeX9csp pic.twitter.com/I7tm9v6Z1o
— Angela Keniston (@KenistonAngela) September 13, 2022
One unexpected factor impacting wellness and satisfaction was communication tools and the system design around them.
A3: Hmmm. I’d say the EMR. When I started we were on the old school paper charts. And, at first, the EMR was the best. But then it got intrusive. And now the secure chat on EPIC is like everyone having our cell phone at all times. I find it cognitively exhausting. #JHMChat
— Kimberly D. Manning, MD (@gradydoctor) September 13, 2022
This is a hot topic at Jefferson lately too. But the interruptions are it for me. Can’t think/focus = can’t do my job. But just shifting that burden to another team member isn’t the answer. False dichotomy. Need smarter system design. #jhmchat
— Rebecca Jaffe, MD (@RJmdphilly) September 13, 2022
Finally, several participants pointed out the importance of good communication. Communication skills and coordinating multidisciplinary teams is the crux of hospitalist work. Unfortunately, this skill is never measured or captured when we use traditional approaches to capturing clinical productivity.
I would say viewing communication tasks as my “procedural skill” & the time it takes to accomplish them in that lens has made the amount of time spent #worthit — for example “helping Ms. A understand her goals are aligned with home hospice”#jhmchat A3
— Sharon OJ, MD (@sostfeldjohns) September 13, 2022
For hospitalist leaders looking for crowdsourced wisdom around defining hospitalist value, the September 2022 #JHMChat is a great resource. While a perfect solution to capturing one’s productivity and contributions may not exist, it’s safe to say that expanding what counts beyond wRVU is something that we should be talking more about in hospital medicine.
We can’t wait to see you at October’s #JHMChat! Make sure to follow @JHospMedicine and @SocietyHospMed for the latest updates.
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