In this nationally representative sample, US hospitalists reported a relatively high degree of satisfaction overall with their job and with the hospital medicine specialty. They were most satisfied with the quality of care they were able to provide and with relationships with patients, staff, and colleagues, but had a low degree of satisfaction with personal time, autonomy, organizational climate, organizational fairness, and compensation. Across the subspecialties, pediatric-trained hospitalists had higher levels of hospitalist specialty satisfaction compared to those with internal and family medicine training. Organizational climate, care quality, fairness, personal time, relationship with leader, compensation, and relationship with patients all predicted job satisfaction. Satisfaction with personal time, relationship with patients and staff, and compensation predicted specialty satisfaction. Satisfaction with compensation had the weakest impact on specialty satisfaction of all of the significant predictors. Job burnout symptoms were reported by about 30 percent of hospitalists, a greater proportion of whom were more likely to reduce work efforts and leave their job or the profession than their colleagues without burnout symptoms.
While the high levels of hospitalist job and specialty satisfaction are positive signs for the longevity of the profession, there are several concerning risks to the sustainability of hospitalist work. First and foremost is the high rate of hospitalists reporting burnout symptoms and its strong relationship with the intent to decrease effort and to abandon clinical medicine. Unfortunately, we cannot directly compare burnout rates between this study and the 1999 hospitalist worklife study as different measures were used. However, the prior study found that only 13% of hospitalists were burned out and 25% were at risk of burnout.10
A 2002 and 2003 study of academic hospitalists using the same single-item burnout measure found burnout rates of 13% and 21% in respective years.21
Thus, the number of burned-out hospitalists may have increased over time.
As a career, hospital medicine is known for better compensation than similarly trained outpatient practicing physicians, and better lifestyle with flexibility in the number of hours worked and scheduling.10
Our study shows that hospitalists with higher satisfaction with personal time and compensation also had higher job and specialty satisfaction, yet most hospitalists in our study reported relatively low levels of satisfaction in these two domains. This indicates that current hospitalist work models may be less flexible in work hours than desired and that compensation has a relatively weak influence over global satisfaction.
Hospitalists also have unique relationships with their organizations given that they are site-based specialists. Our findings suggest that sufficient hospital resources are allowing hospitalists to deliver the highest quality care possible, but also indicate the need for hospitalist employers and organizations to address climate and fairness issues in hospitalist programs to improve satisfaction and retention. Recently, SHM worked with the American Medical Association, the American Hospital Association, and the Joint Commission to draft a set of principles for a sustainable and successful hospitalist program.35
These principles, which focus on organizational structure, communications, operations, and management, address the areas of deficiency elucidated in this study and may be a useful place for hospitalist programs to start.
There are notable differences in the current hospitalist workforce and in satisfaction compared to the last time hospitalist satisfaction was measured in 1999.10
The proportion of women in hospital medicine has risen from 26% to 33.5%, while the mean age has risen from 40.2 to 44.3 years (p
0.001). In 1999, only 15.1% had been hospitalists for greater than 5 years, but half of practicing hospitalists today have made hospital medicine their careers for at least 6 years. This shows that many physicians are staying in the profession. Whether burnout and attrition are affecting hospitalists earlier or later in their careers remains an important question to be answered.
Although variations in survey scale preclude direct comparisons, hospitalists rated satisfaction comparably or higher than office-based physicians surveyed in the Physician Worklife Survey.13
These include satisfaction with the relationship with patients (mean, hospitalists 4.18 vs PWS 3.59–3.80), personal time (3.16 vs 2.66–2.92), job (3.96 vs 3.52–3.77), and specialty (4.18 vs 3.59–3.80). Autonomy alone appears lower in hospitalists (3.14 vs 3.27–3.50), possibly because of their often subordinate role with consultants. Hospitalist burnout rates were comparable to those of emergency medicine physicians and internist intensivists8,9
, but lower than those for surgeons.36
This study has several limitations. First, the response rate of 25.6% is low for survey research in general, but is not unusual of physician surveys, which have seen declining participation over the years.36,37
Traditionally utilized sources of physician lists such as the AMA physician masterfile do not yet designate hospitalists. To further complicate the matter, hospital medicine is a transitional career for some physicians, and job turnover even among career hospitalists is believed to be high. Although SHM has made major efforts to assure the accuracy and currentness of the database, a simple post hoc analysis of data quality found many outdated addresses. We believe an unknown but significant proportion of nonresponse is due to surveys being sent to recipients that would be excluded from the survey population (invalid addresses and non-hospitalists) and that the true response rate may be higher than reported. Our assessment of nonresponse bias suggests that nonmembers compared to members of SHM were less likely to complete the survey. While this could have lead to a systematic oversampling of hospitalists engaged with the specialty, the known distributions of demographic characteristics were matched between our respondents and other surveys of hospitalists. Additionally, despite our efforts to capture a representative sample of all hospitalists, there may be categories of practicing hospitalists who were excluded from our sampling frame. Whether or not these hospitalists share attitudes and experiences of our respondents remains a valid question.
Hospital medicine jobs and careers are only continuing to grow in the US, making this specialty the fastest growing specialty in medicine. Of vital importance is creating hospitalist jobs and careers that are sustainable and successful. Although hospitalists have relatively high levels of overall job and specialty satisfaction, there are several areas of immediate concern that could impact hospitalist satisfaction and longevity in the profession, including high levels of burnout and organizational climate and fairness issues. Further studies are warranted to evaluate the job and workplace factors that are associated with low satisfaction and burnout, and can be remediated through hospitalist program and job redesign.