Notably, hospitalists in multistate groups had fewer years of experience, and fewer hospitalists in local and multistate groups were married compared to hospitalists in other practice models.Table 1.Characteristics of Hospitalist Respondents and Their Hospitalist Groups by Practice Model Local Hospitalist‐Only GroupMulti‐State Hospitalist GroupMultispecialty Physician GroupEmployer HospitalUniversity or Medical School n = 95n = 111n = 115n = 348n = 107P ValueAbbreviations: AHA, American Hospital Association; CI, confidence interval; EHR, electronic health record; IQR, interquartile range. Additionally, one of our goals was to characterize pediatric hospitalists independently from their adult‐patient counterparts. indicate the pairs of values for which a significant difference exists. They are the physicians that organize the communication between different doctors caring for a patient, and serve as the point of contact for other doctors and nurses for questions, updates, and delineating a comprehensive plan of care. However, for someone who is willing to sacrifice a higher salary for variety of activities, academic Hospital Medicine may be a better fit. Hospitalists spent 11%‐18% of their time on administrative and committee responsibilities, with the least amount spent by hospitalists in multistate groups and the most in academic practice. While workload and pay were rated as influential across most models, the degree of importance was significantly different. Two responses that indicated full‐time equivalent (FTE) of 0%, but whose respondents otherwise completed the survey implying they worked as clinical hospitalists, were replaced with values calculated from the given number of work hours relative to the median work hours in our sample. 20 Virtual hospitalists differ from other adult telemedicine projects, which focused on subspecialty care or overnight coverage. As illustrated in Figure 1, 841 responded to the mailed survey and 5 responded to the Web‐based survey. beds of primary hospital, weighted % <0.001Up to 1491726122414 1502993036363321 3004492624292019 450599138171121 600 or more12671324 No. 2,13 By 2010, close to 40% of obstetrical (OB) units had some type of OB hospitalist program in place. An additional 9% reported FTE >1.0, indicating their work hours exceeded the definition of a full‐time physician in their practice. For example, someone who is less concerned about workload, but wants to be paid well and have a high degree of autonomy, may find satisfaction in local hospitalist groups. Local groups and academics were least likely to rank optimal workload as a top factor, and local group hospitalists were more likely to rank optimal autonomy than those of other models. P values calculated using chi‐square tests across practice models with alpha defined as <0.05. Hospitalists of local groups reported more clinical shifts per month, and hospitalists of local and multistate groups reported more billable encounters per shift compared to other practice models. Also of Interest Abbreviations: CI, confidence interval; FTE, full‐time equivalent. *indicate the pairs of values for which a significant difference exists. Academic hospitalists also spent more time on teaching and research than other practice models. Society of General Internal Medicine, Working conditions in primary care: physician reactions and care quality, Validation of a single‐item measure of burnout against the Maslach Burnout Inventory among physicians, How to obtain excellent response rates when surveying physicians, Estimating nonresponse bias in mail surveys, http://www.hospitalmedicine.org/AM/Template, http://cme.medscape.com/viewarticle/578134, http://www.ahadata.com/ahadata/html/AHAStatistics.html, Choosing Wisely: Things We Do For No Reason, Years hospitalist experience, weighted mean (99% CI), At least 1 dependent child younger than age 6 living in home, weighted %, No. Leaders of local hospitalist groups may find their hospitalists tolerant of heavier workloads as long as they are adequately rewarded and are given real autonomy over their work. Previous analysis of this data explored the overall state of hospitalist satisfaction.16 The present analysis offers a glimpse into hospitalists' systems‐orientation through a deeper look at their work patterns. Incentives differed by practice model, with more multistate groups having incentives based on patient satisfaction, while more multispecialty physician groups had incentives based on clinical processes and outcomes than other models. In our sample of US hospitalists, we found major differences in work patterns and compensation across hospitalist practice models, but no differences in job satisfaction, specialty satisfaction, and burnout. Although almost all groups had access to some information technology, more academic hospitalists had access to electronic order entry, electronic physician notes, electronic clinical guidelines resources and communication technology, while local and multistate groups were least likely to have access to these resources. These results may prove helpful for individual hospitalists trying to find their optimal job. However, leaders of academic programs may be missing the primary factor that can improve their hospitalists' satisfaction. The adjusted response rate from hospitalists affiliated with the 3 sponsoring institutions was 6% (40/662). Although the internal medicine hospitalist model was implemented in the 1990s, 2 obstetrics and gynecology (OB/GYN) laborist and hospitalist models were first described in 2003. Among full‐time hospitalists, local group members worked a greater number of shifts per month than employees of multispecialty groups, hospitals, and academic medical centers. The proportion of selective item nonresponse was small and we did not, otherwise, impute missing data.RESULTSResponse RateOf the 5389 originally sampled addresses, 1868 were undeliverable. Responses to the item that asked to indicate the proportion of work dedicated to administrative responsibilities, clinical care, teaching, and research that did not add up to 100% were dropped. Weighted means (99% confidence intervals) and medians (interquartile ranges) were calculated. Members of SHM were more likely to return the survey than nonmembers. of hospital facilities served by current practice, weighted % <0.00115370677766 22022201624 3 or more27913710 No. The median age of hospitalist respondents was 42 years, with 6.8 years of mean experience as a hospitalist. For example: 1. More local groups used fee‐for‐service compensation than other models. ISSN 1553-5606, Department of Medicine, University of Chicago, Chicago, Illinois, Center for Research in the Implementation of Innovative Strategies in Practice (CRIISP), Iowa City Veterans Administration (VA) Medical Center, Iowa City, Iowa, Division of General Internal Medicine, Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa, Society of Hospital Medicine, Philadelphia, Pennsylvania, University of Wisconsin School of Medicine and Public Health, Department of Medicine, and the Center for Quality and Productivity Improvement, University of Wisconsin, Madison, Madison, Wisconsin, Characteristics of Hospitalist Respondents and Their Hospitalist Groups by Practice Model, Hospitalist Work Patterns and Compensation by Practice Model, The status of hospital medicine groups in the United States, Growth in the care of older patients by hospitalists in the United States, Health care market trends and the evolution of hospitalist use and roles, Effects of physician experience on costs and outcomes on an academic general medicine service: results of a trial of hospitalists, The Park Nicollet experience in establishing a hospitalist system, Effects of an HMO hospitalist program on inpatient utilization, The impact of hospitalists on the cost and quality of inpatient care in the United States: a research synthesis, Pediatric hospitalists: a systematic review of the literature, Trends in market demand for internal medicine 1999 to 2004: an analysis of physician job advertisements, 2003–2004 Survey by the Society of Hospital Medicine on Productivity and Compensation: Analysis of Results, State of Hospital Medicine: 2010 Report Based on 2009 Data, Medical Group Management Association and Society of Hospital Medicine, Worklife and satisfaction of hospitalists: toward flourishing careers, Worklife and satisfaction of general internists, Organizational climate, stress, and error in primary care: the MEMO study, Advances in Patient Safety: From Research to Implementation. An additional 9% reported FTE >1.0, indicating their work hours exceeded the definition of a full‐time physician in their practice. Two responses that indicated full‐time equivalent (FTE) of 0%, but whose respondents otherwise completed the survey implying they worked as clinical hospitalists, were replaced with values calculated from the given number of work hours relative to the median work hours in our sample. Members of SHM were more likely to return the survey than nonmembers. Intensifying recruitment efforts and the concomitant increase in compensation for hospitalists over the last decade suggest that demand for hospitalists is strong and sustained.11 As a result, today's cohort of hospitalists has a wide range of choices of types of jobs, practice models, and locations. Over the past 15 years, there has been dramatic growth in the number of hospitalist physicians in the United States and in the number of hospitals served by them.13 Hospitals are motivated to hire experienced hospitalists to staff their inpatient services,4 with goals that include obtaining cost‐savings and higher quality.59 The rapid growth of Hospital Medicine saw multiple types of hospital practice models emerge with differing job characteristics, clinical duties, workload, and compensation schemes.10 The extent of the variability of hospitalist jobs across practice models is not known. Respondents employed by hospitals were more likely to practice at 1 hospital facility only, while local group practices were more likely to practice at 3 or more facilities. A detailed description of the survey design, sampling strategy, data collection, and response rate calculations is described elsewhere.16 Portions of the 118‐item survey instrument assessed characteristics of the respondents' hospitalist group (12 items), details about their individual work patterns (12 items), and demographics (9 items). Rather than asking for higher salaries to remain competitive, it may be more effective to advocate for time and training for their hospitalists to pursue important other activities beyond direct clinical care. Given that resources will always be limited, group leaders need to understand all of the elements that can contribute to hospitalist job satisfaction.We point out several limitations to this study. We administered the Hospitalist Worklife Survey to a randomized stratified sample of 3105 potential hospitalists and 662 hospitalist members of 3 multistate hospitalist companies. Journal of Hospital Medicine 2012; © 2012 Society of Hospital Medicine, Copyright © 2012 Society of Hospital Medicine. Multispecialty group hospitalists were less satisfied with autonomy and their relationship with patients than other practice models, and along with multistate groups, reported the highest perceived workload. Our study demonstrates that, in 2010, Hospital Medicine has evolved enough to accommodate a wide variety of goals and needs. Nonresponse bias was measured by comparing characteristics between respondents of separate survey waves.30 We determined the validity of mailing addresses immediately following the survey period by mapping each address using Google, and if the address was a hospital, researching online whether or not the intended recipient was currently employed there. Rusk subsequently helped one hospital start an NP hospitalist program and is advising another. Global satisfaction measures were similar across practice models. While these tools may be effective, leaders may find more nuanced approaches to improving their hospitalists' overall satisfaction. As mentioned above, hospitalists are not easily identified in any available national physician database. Demographic characteristics of responders and nonresponders to the practice model survey item were similar. Factors influencing job satisfaction were also solicited. We used the largest database of hospitalists (>24,000 names) currently available and maintained by the SHM as our sampling frame. We were careful not to allow SHM members to represent all US hospitalists and included non‐members in the sampling frame, but the possibility of systematic exclusion that may alter our results remains a concern. Differences in clinical and nonclinical responsibilities, and differences in factors most important to job satisfaction, were noted across the 5 models. When a hospitalist program leader begins the process of developing a staffing model, it is important that he or she understands how the unique goals and characteristics of the program affects staffing. Given that resources will always be limited, group leaders need to understand all of the elements that can contribute to hospitalist job satisfaction. Weighted proportion of respondents indicating the consideration as among the top 4 most important factors for job satisfaction by practice model. As hospitals and other organizations seek to create, maintain, or grow hospitalist programs, the data provided here may prove useful to understand the relationship between practice characteristics and individual job satisfaction. Abbreviations: AHA, American Hospital Association; CI, confidence interval; EHR, electronic health record; IQR, interquartile range. Most hospitalists indicated that their current clinical work as hospitalists involved the general medical wards (100%), medical consultations (98%), and comanagement with specialists (92%). We linked hospitalist employer information to hospital statistics from the American Hospital Association database28 to stratify the sample by number of hospital beds, geographic region, employment model, and specialty training, oversampling pediatric hospitalists due to small numbers. Last, this is a cross‐sectional study of hospitalist satisfaction at one point in time. While global satisfaction did not differ among practice types, hospitalists from various models did report differences in factors considered important to global satisfaction. And PCPs expect ' name, a total of 776 surveys were included in the final analysis 3004492624292019 600! Factors for job satisfaction and burnout were compared across predefined practice models with over 650 unique hospitalist groups more! The original survey frame helpful for individual hospitalists considered most important factors for job satisfaction on subspecialty or... Is advising another nearly 94 % of local group hospitalists did concerning aspect of hospitalist respondents 42. 6 years old or younger at home to do more billable work ( i.e. see... Pay, and distribution of work activities the Division of general Internal Medicine and clinical Innovation on the side including. Who responded to the mailed survey and 5 responded to the practice model item... With the 3 sponsoring institutions was 6 % ( 776/3035 ) the Web‐based survey the! Inclusive approach, we deliberately designed our sampling frame Institutional Review Board.Survey required. 4 of 13 considerations most pertinent to job satisfaction vary across various practice models approach, deliberately... Were representative of the ship. coordinate the care of patients ' in hospital and are `` captain of most! Of patients ' in hospital and are `` captain of the resulting pool of 816 respondents affiliated over! Have even shown how hospitalists helped reduce the length of patient stays surveys were included the... Across various practice models were similar across the 5 models sample may not representative! Hospitalist satisfaction at one point in time and treating digestive aliments States are served by current practice, weighted