Author Affiliations: Section of Hospital Medicine, Division of General Internal Medicine, University of Colorado Denver, Aurora (Drs Glasheen and Misky); Division of Hospital Medicine, Denver Health Medical Center, Denver, Colorado (Dr Reid); Division of Hospital Medicine, Department of Medicine, Oregon Health & Science University, Portland (Dr Harrison); and Division of Hospital Medicine, University of California, San Francisco (Drs Sharpe and Auerbach).
The number of hospitalists in academic medical centers has grown rapidly, producing a field with few senior members, potentially impeding the academic success and career sustainability of academic hospitalists, not to mention contributing to burnout.1 However, little is known about career promotion, job satisfaction, stress, and rates of burnout in academic hospital medicine or how these factors affect scholarly success and productivity.
We performed a cross-sectional 61-question e-mail survey of hospitalists at 20 academic medical centers in the United States. Hospital medicine faculty at each site were identified via their group leader; members of each group then received an e-mail survey up to 5 times.
Burnout was assessed using the previously validated question:
Using your own definition of “burnout,” select one of the following: 1 = “I have no symptoms of burnout,” 2 = “I don't always have as much energy as I once did, but I don't feel burned out,” 3 = “I am definitely burning out and have one or more symptoms of burnout, such as physical and emotional exhaustion,” 4 = “The symptoms of burnout that I am experiencing won't go away,” 5 = “I feel completely burned out and wonder if I can go on.”
A score of 3 or higher was consistent with burnout.2
Levels of stress and satisfaction were assessed using a 5-point Likert scale with responses of 4 (“somewhat”) and 5 (“high”) interpreted as high stress and satisfaction. Working relationships were assessed using a similar Likert scale with 4 (“very good”) and 5 (“excellent”) interpreted as good relationships. Academic output was assessed using self-report of teaching, publications, and presentations.
Of 420 hospitalists, 266 (63%) completed the survey (Table 1). Of the respondents, 57% reported having 20% or less protected time for scholarly activity, while 1 in 5 spent more than 80% of their time on nonteaching services. Most (86%) were at the instructor or assistant professor rank. Most respondents had no first-author peer-reviewed publications or presentations at a grand rounds or national meeting.
Although most were satisfied with their job (75%), their division chief support (63%), and their ability to control their schedule (54%), the majority reported high levels of stress (67%). Approximately 1 in 4 (23%) reported some degree of burnout (Table 2).
Predictors of low overall job satisfaction (Table 3) included the following: training in a medical subspecialty; practicing at a nonuniversity hospital; and low satisfaction with the amount of personal/family time, amount of control over work schedule, and level of support from their division chief. Predictors of burnout (Table 3) included low satisfaction with the amount of personal/family time and low satisfaction with control over their work schedule.
Low job satisfaction was associated with nonstatistically significant trends toward fewer peer-reviewed first-author publications, lower teaching skills confidence, and lack of institutional grand rounds presentation. Burnout was associated with a nonstatistically significant trend toward lack of institutional grand rounds presentation (Table 4).
Although academic hospitalists are generally satisfied with their career choice, rates of low career satisfaction, stress, and burnout appear higher than those that have been reported elsewhere.3,4 The only prior evaluation of hospitalist burnout, surveying both community and academic hospitalists, reported that 12.9% of hospitalists were burned out, while an additional 25% were at risk for burnout.4
Our data confirm known causes of burnout (eg, lack of control over work schedule) but suggest additional potential associations, such as lack of division chief support. While we observed that low satisfaction and burnout were associated with lower academic productivity, we cannot discern the causal link between these factors. However, we are able to develop a picture of an “at risk academic hospitalist,” as one who has fewer peer-reviewed publications, lower confidence in their teaching skills, and a lower likelihood of having presented institutional grand rounds.
Previous research suggests that “career fit” appears to be a driver of physician burnout,5 providing another potential way to interpret our results. Hospitalists in our study likely chose to work in an academic environment to partake in scholarly activity. While most described their roles as ones generally considered “academic” (eg, clinician educators), many had large nonteaching clinical roles. This discordance between self-identified job goals and actual work reported represents a clear lack of career fit, and one that may also partially explain the high rate of burnout we observed.
Academic leaders should develop faculty plans to ensure academic career fit. This should include mentorship, faculty development, and balance between academic activities and rising clinical needs. Since hospitalist groups are generally funded by hospitals, we were surprised that perceptions of hospital support were not associated with risks for burnout and low satisfaction. This suggests that even though relationships with their hospital are critical for financial and strategic success,1 direct support from divisions appears to be more critical for hospitalists' career satisfaction and burnout. Nearly 90% of respondents reported to a general internal medicine chief, which suggests a need for general internal medicine division chief support to balance work demands, schedules, and protected time in a manner consistent with academic success.
Our study had several important limitations. First, we studied only a subset of hospitalists from primarily larger academic institutions known to the study authors. It is likely that scholarly infrastructure, support, and expectations are different in these institutions than other types of teaching hospitals, reducing the generalizability of our data. Next, our study design was prone to response bias and we did not assess the actual vs reported academic productivity of respondents. Finally, low satisfaction, stress, and burnout were assessed through subjective assessment tools.
In conclusion, few academic hospitalists have succeeded in achieving senior levels of promotion. This is likely owing, in part, to the youth of the field and inadequate amounts of protected scholarly time fueled by high demands for nonteaching clinical work. However, the resultant high levels of stress and burnout and low satisfaction may also present a real threat to the vitality of a budding field. Targeted efforts and interventions are needed to stem this tide in order to create fulfilling, sustainable, and scholarly, robust academic hospitalist careers.
Correspondence: Dr Glasheen, Section of Hospital Medicine, Division of General Internal Medicine, University of Colorado Denver, Mail Stop F782, 12401 E 17th Ave, Ninth Floor, Aurora, CO 80045 (email@example.com).
Author Contributions:Study concept and design: Glasheen, Misky, Reid, Harrison, Sharpe, and Auerbach. Acquisition of data: Glasheen, Misky, Reid, Sharpe, and Auerbach. Analysis and interpretation of data: Glasheen, Misky, Sharpe, and Auerbach. Drafting of the manuscript: Glasheen, Misky, Harrison, Sharpe, and Auerbach. Critical revision of the manuscript for important intellectual content: Glasheen, Misky, Reid, Harrison, Sharpe, and Auerbach. Statistical analysis: Misky and Auerbach. Administrative, technical, and material support: Misky and Auerbach. Study supervision: Glasheen, Misky, and Reid.
Financial Disclosure: None reported.
Funding/Support: Dr Auerbach was supported by a Mid-Career Research Development Award (K24HL09837) from the National Heart, Blood, Lung Institute during the period of this study.
Previous Presentation: This information was presented as a research poster at the Society of Hospital Medicine Annual Meeting; May 15, 2009; Chicago, Illinois.
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