"I don't know anybody personally who can just do shifts month after month after month and never feel burnout," says another veteran hospitalist Mary Frances Barthel, MD, who is medical director with the Cogent Healthcare hospitalist program at Blessing Hospital in Quincy, Ill.
In the wake of new duty-hour rules protecting residents' time during training, Dr. Barthel
expected to see newly-trained doctors burning out fast once they started to practice.
But that hasn't been the case.
"The new people have tons of energy and no issues at all seeing a high volume of patients," says Dr. Barthel
"But I can't say the same for people I know who have been doing this for several years."
Here's a look at the lessons that both Drs.
Kendall and Barthel
have learned on how to mitigate burnout.
For Dr. Barthel
, the seven-on/seven-off block of 12-hour shifts she
colleagues currently work is the biggest burnout factor they face.
sees it as a major reason why veteran hospitalists face a greater risk of burning out than doctors just out of residency.
"The 12-hour shifts get to be really draining," she
As the parent of school-age children, she's
leading the charge in her
program to renegotiate her
group's contract to go to an hourly wage.
That will allow some group members each day to choose to work an eight-hour shift while another hospitalist holds down a traditional 12-hour one. (A nurse practitioner will provide coverage for the other four hours each day when a hospitalist won't be on.)
"Instead of 15 shifts per month, those of us working eight-hour shifts would have to do 22," Dr. Barthel
agrees that being able to draw on reserve physicians helps protect group members already on board.
She points to the advantage of working for a national management group, with Cogent sending what it calls a "traveling physician" to her group at Blessing, starting next month.
"We're losing one physician, partly because he
wants to teach but also because he's
tired of working seven-on/seven-off," Dr. Barthel
"The traveling physician could be here six months until we fill that slot."
A line in the sand
says that the one downside to working as a traveling physician or a locum is that "little bit of skepticism when physicians first arrive.
There's some hesitancy to really accept them.
Overall, however, Dr. Barthel
says that she
colleagues are very well received within the medical staff.
That's important, Dr. Kendall notes, because he
sees not being treated well on the job as a major factor in hospitalist burnout.
That's why, as another condition for heading up the program, he
negotiated having the freedom to choose whom the group admits for.
says that her
passion is quality improvement, and she
looks forward to negotiating more time to pursue it.
Right now, her
job is about one-quarter administrative vs.
75% clinical, but she'd like a 50-50 split.
"I enjoy patient care," she
says, "but there's rarely a day when I can come in, see patients, get my administrative issues taken care of, and be able to go home and be in a good mood with my family."
The problem, Dr. Barthel
adds, "is these hectic, busy days when you're on for 12 hours and you're running the whole time.