It’s not easy to be a hospitalist. Whether it’s the administrative burden of documentation, the stress of a heavy workload, or following new guidelines required by insurance companies, it’s causing significant dissatisfaction amongst hospitalists.
In fact, more than half of the 600 hospitalists surveyed for the 2023 Today’s Hospitalist Compensation & Career Survey said that burnout is the number one reason for dissatisfaction in their careers, followed by administrative burdens such as documentation and coding compliance, followed by bad patient behavior and scheduling. Another study, from the American Medical Association, found that of the top six most burned-out specialties, hospital medicine was number two (number one was emergency medicine). As well as feeling burnout, hospitalists also don’t feel valued by their organization, the study found.
More and more hospitalists are also expected to dedicate their working hours to non-clinical work, such as administrative tasks, while meeting the demands for excellent patient care. But some hospitalists don’t want to – or can’t do it anymore.
What’s Keeping Hospital Medicine Leaders Up at Night
I recently spoke to a few hospitalists across the country and also analyzed our own customers to determine the biggest challenges for hospitalists today. What came up, time and time again, was the administrative burdens, the non-clinical work they’re required to do, the documentation and insurance requirements that eat up their time and take away time from patient care.
One of the administrative tasks mentioned was making the patient assignment and distribution list – and making sure it’s fair so hospitalists don’t complain that some got “harder” patients than others.
“The typical hospitalist uses the skills and knowledge they gained in medical training for only about 90 minutes every 12-hour shift. The rest of that shift is spent on social issues, paperwork, things that are connected to clinical practice but not the core of doctoring,” said Dr. John Nelson, one of the early hospitalists in the country who also co-founded the Society of Hospital Medicine (SHM). “At least, not what most of us imagined it to be.”
“A lot of people are reconsidering their choices in life as the medical profession becomes more challenging, more demanding. We’re expected to do documentation as part of the job, and the expectation is to maintain a certain volume to be productive. It contributes to burnout,” said Dr. Kraydman. “We need to recognize that trend and provide the best baseline conditions for physicians to be more productive with the clinical piece and less involved in non-clinical work.”
Another hospitalist I spoke to described the arduous process of making the patient distribution list and assigning patients to providers every morning that is another common administrative task that hospitalists get tasked with.
“At one hospitalist program we rotated who made the list – whoever came in first did it. People started coming in later and later to avoid having to do it,” said Dr. Ryan Secan, a hospitalist working at a small community hospital on Nantucket, and medaptus’ Chief Medical Officer.
Here are some of the other top challenges that we discussed:
Staffing Challenges
“The biggest problem we’re experiencing in the Northeast is having difficulty staffing nurses,” said Dr. Joseph Nicholas, Associate Chief of Medicine, Highland Hospital in Rochester, NY. “I never appreciated as a hospitalist how much of the care I can deliver to patients and my efficiency was mitigated by nurses.”
More Documentation, More Problems
“Clinical documentation is always a huge burden, and it seems to be growing. The physical act of caring for a patient has gotten more detail-oriented and complicated with electronic health records. We’re constantly typing and reviewing data and all that becomes difficult and makes it hard to always identify the most important issues for a patient,” said Dr. Nicholas.
“When we get feedback on our doctors’ performance, a lot has to do with how well they’re documenting or billing. It’s hard to keep up with requirements – the best codes to use, the best words to use in your note to support certain billing requirements.”
“We’re hopefully piloting some AI tools that will write notes for us,” he said.
Getting New Technology to Work for Your Unique Needs
Doctors who have been successfully practicing one way for decades may find the transition to so many new technologies difficult. “Overall, we are in the process of changing from a paper and pen environment to a fully computerized environment which makes things way more efficient and organized. But you need to become comfortable with that,” said Dr. Val Kraydman, Medical Director Hospitalist Program at Good Samaritan University Hospital in Long Island, New York.
“As this is relatively new, it still has a lot of people not comfortable or adapted to devices or computers as the main way of doing things. The biggest issue is software for medical use like EHRs, all of them have their deficits. To write ideal software is almost impossible. You have to customize it towards the site and adjust it to the place where it will be used but usually this is not happening. As a result, you have physicians and nurses that have to learn new processes and adjust and that creates a lot of frustration and redundancy and extra administrative tasks.”
Making Patient Assignments Fair
When it comes to the patient assignment and distribution process, hospitalists often complain about why they were assigned a certain patient.
“That’s where Assign helped us – we used to have to manually distribute patients based on looking at our Epic census and then put it on a paper and divide it based on our internal rules of which patient goes where,” said Dr. Kraydman. “With the Assign software, we are way more efficient but still have to enter scheduling manually – it comes from an Excel spreadsheet. We’re working on getting that automated (currently they have no scheduling software).”
“Otherwise, changing to now automatic assignments is great. Before Assign, we had a nocturnist doing it and it created an opportunity for doctors to say, oh he favors this or that person and that’s why am I getting this complicated patient and not someone else. Right now, it’s still the nocturnist (who uses Assign and finalizes the assignment), but it’s fully automated so they can’t say it’s his choice – it’s the software.”
How do we solve these issues?
“The most hopeful things on the horizon are technology,” said Dr. Nelson. “Some places are already implementing things like AI-generated clinical notes. This can save significant time. Hospitals are also trying to navigate increasingly common social issues for patients. My hope it will help move hospitalists directly more towards clinical work.”
One of the areas we specialize in at Medaptus is removing the manual work and burden of creating the daily patient rounding lists and instead using an automated software to assign patients to providers, based on the factors that are most important to your organization, for example: maintaining geography, continuity of care, etc. It takes away one of the important non-clinical tasks that hospitalists are often faced with.
Want to learn more? Get a preview of how hospitalists are using Assign to get time back in your day – because no one went to medical school to do administrative tasks.
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