Hospitalists Highlight Lack of Respect in 45% Burnout Rate

Marcia Frellick

May 13, 2019

Only about one in five hospitalists say they are happy or very happy at work in the Medscape Hospitalist Lifestyle, Happiness & Burnout Report 2019 . Twenty-one percent of hospitalists reported they were happy at work, which matched the percentage of internists and emergency medicine doctors who answered that way, according to the report.

Hospitalists' job satisfaction was slightly lower than that of the 24% of nonhospitalists (meaning nonhospitalist primary care physicians and pediatricians) who reported happiness at work this year.

Alok S. Patel, MD, a pediatric hospitalist at New York-Presbyterian's Morgan Stanley Children's Hospital in New York City, told Medscape that the varied pace of the workflow and wide variety of patients make the job exciting but also stressful.

"Critically ill patients or deaths are obviously the emotionally taxing part of the job, but other occurrences, such as unexpected changes in patient status, miscommunication among teams, medical errors, hospital systems problems that impede workflow, delays in discharge, administrative duties, coordinating procedures, and so much more, also add to stress," he said.

The survey found that outside work, however, hospitalists were happier than nonhospitalists (57% said they were happy vs 52% for nonhospitalists).

Almost Half Report Burnout

Hospitalists and nonhospitalists reported about the same levels of burnout (45% and 46%, respectively).

Major reasons for burnout among hospitalists included too many administrative tasks (mentioned by 55% of hospitalists and 67% of nonhospitalists) and lack of respect from administrators, employers, colleagues, or staff.

Lack of respect as reason for burnout was cited nearly twice as much by hospitalists as by nonhospitalists (45% vs 23%).

Liz Harry, MD, assistant medical director of the Brigham and Women's Physician Organization in Boston, Massachusetts, noted that something similar to lack of respect, "lack of perception of appreciation, is one of the major drivers of burnout. I do think hospitalists are vulnerable to feeling like they are less respected than other specialties by virtue of the nature of co-management relationships."

She told Medscape Medical News, "Hospitals need to be very careful about delineating the rules around co-management or consulting relationships, and be mindful that this is a risk factor for hospitalists to not feel respected."

Dependent on Their Hospital's Efficiency

Harry said that hospitalists "are uniquely dependent on the efficiency of the hospitals people work in, and they are very dependent on that efficiency. They end up taking the brunt of it, if the systems don't work well."

However, the schedule also can allow more easily for part-time work or personal time on the off weeks (working 7 days on and 7 days off).

"In most models you have half the year off," she said. "I think there's a recovery piece that a lot of specialties don't have."

Hospitalists were much less likely to cite electronic health records and the computerization of their practice as a driver of burnout (20% vs 35% for nonhospitalists).

Eleven percent said they had had thoughts of suicide, but had not attempted it; 4% said they had attempted it; 81% said they had not had thoughts of suicide, and 4% preferred not to answer.

The Medscape report on national physician burnout published in January showed that among all physicians 14% said they had thoughts of suicide but only 1% had attempted it.

Most hospitalists do not seek help for burnout or depression, the report indicates. Only 12% said they would or are seeking help. Two thirds (66%) said they would not be likely to seek professional help for burnout or depression and had not done so in the past.

Reasons cited, according to the report, are that they think it's a normal part of the physician experience or they don't think their problems are severe enough to seek professional help.

Asked about self-esteem, more than half (55%) of hospitalists said it was high or very high; 35% said it was average, while only 10% said it was low or very low.

A Medscape comparison of high self-esteem among specialties shows that hospitalists' rate of high/very high self-esteem was much lower than that of specialties including plastic surgeons (73%) and urologists (68%) but higher than that of specialties such as infectious disease specialists (47%), oncologists (48%), and internists (50%).

Most Are Married

Similar to physicians overall, a large percentage of hospitalists are married (69%) or living with a partner (8%). The great majority (84%) described their marriages as good or very good.

More hospitalists are single (17%) than in the general physician population (7%), but that may be because of the high numbers of young hospitalists, according to the report.

"Hospitalists by nature are relatively young," Patel said. "In 10 years or so, when you (ask for responses again), you'll likely see plenty more career hospitalists."

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