Published in the October 2008 issue of Today’s Hospitalist
What gives you the greatest amount of satisfaction in your job: that big sign-on bonus? The 10 hours a week of dedicated time for research? Having seven days off every other week or the chance to pilot different glycemic control protocols?
Hospitalist Chad Whelan, MD, says that hospitalists should expect different factors to contribute to their sense of satisfaction over the course of their careers. The whopping compensation package that so appealed to you straight out of residency probably won’t be your biggest priority four years later.
While hospitalists experience many of the same satisfiers (and career killers) as other physicians and professionals, Dr. Whelan points out that the field has some unique characteristics. Dr. Whelan, an associate professor of medicine at the University of Chicago, co-presented a session on career satisfaction at last month’s Midwestern hospital medicine conference in Chicago.
He spoke with Today’s Hospitalist.
You’ve been a hospitalist for eight years. What brings you satisfaction in your career?
Clinically, I very much enjoy the inpatient setting. I also like the ability to do different things outside of clinical care that all relate back to inpatient medicine: medical education, quality and systems improvement, research, administration and mentorship.
I particularly like dealing with the complex social issues that patients have here. We are an academic center in the middle of an underserved medical community where many people don’t have insurance or have only limited access to health care. Patients are balancing chronic health problems with having to care for family members or work two jobs.
One of the reasons I went into medicine was to try to effect change for individuals at some level. So when you have a success story with patients who have complex social needs, that is incredibly satisfying.
What are some key components of career satisfaction in hospital medicine?
General concepts probably run throughout medicine and even beyond. For physicians, issues of autonomy and control are increasingly a source of tension. Historically, physicians have been incredibly autonomous, but as people are paying more attention to quality and dollars and efficiency, that autonomy is being challenged.
I think physicians now are also concerned about their potential earnings. It’s not that physicians don’t make good money, but that potential is different than a generation ago.
What factors in career satisfaction are unique to hospitalists?
Issues of autonomy come up a lot because many of us are hospital employees or at least have specific financial relationships with a facility. Our relationship with the medical center is fundamentally different than most other physicians’.
Workload and scheduling can be particularly challenging, especially when you move to 24/7 coverage. There are some shifts that are inherently undesirable. And hospitalists have to balance continuity of care with lifestyle sustainability. Unlike emergency physicians, we can’t just pick any 18 shifts a month to work.
Hospitalists also face challenges because we’re working in such a new field. The vast majority of hospitalists are young and junior, and other more senior people in the hospital setting may not have a good understanding of exactly what a hospitalist is. So the voice of a hospitalist or even of a hospitalist program, because we tend to be junior, may not have the weight of a cardiology program.
What kind of evolution can doctors expect in what satisfies them over the course of a career?
Big money is attractive early on, but big money doesn’t make people impassioned about their career for very long.
Both as individuals and a field, we’re still sorting out the right workload balance. But increasingly, hospitalists are going to find satisfaction not just in direct patient care, but in improving the medical center itself. Hospitalists will increasingly gravitate toward quality improvement or patient safety.
How satisfying those will be depends on how systems figure out how to reward people “financially, or with time or titles “over time.
To take advantage of those types of opportunities, do hospitalists have to invest in themselves?
I don’t think hospitalists can anticipate that if they hang up a shingle and say, “I am a hospitalist,’ ” people are going to suddenly say, “Well, you should be our leader of quality.” Everyone who builds a career has to identify where he or she wants to build it to and then figure out how to get there.
You have to demonstrate that you are passionate about something, that you are effective and successful, before people are going to invest money or time in that component of your career. It’s definitely a two-way street.
Do you think there is such a thing as a five-year itch, where hospitalists feel they need to explore other avenues, like hospital administration?
I think that is very individualized. A lot of people work as practicing physicians for their entire career and are happy with that.
But there is certainly a percentage of hospitalists who do need something else eventually “and hospitalists are moving into hospital administration at a remarkably young age, actually. But that “something else” will be different for different people.
We talk a lot about “job fit.” There is not a single hospitalist job that is right for everybody, so you have to fit the individual to the position.
That’s true of schedules as well. Many hospitalists find that the seven-on/seven-off schedule, for instance, is an incredible opportunity because there is so much time off. But for others, it’s a terrible fit. If you’re a single parent, that would be a really complex schedule to manage daycare around.
Some hospitalists job-hop frequently, every year or two. For a physician who isn’t satisfied in a position, what’s your advice about changing jobs?
Clearly, there can be catastrophic job mismatches. But generally speaking, if you leave before two years, you’re at risk for thinking that the problems with your satisfaction have to do with the job fit, rather than with a learning curve.
Say you want to get involved in quality improvement. In your first year in a new position, even if you have been successful somewhere else, it’s going to take a lot of effort, bumping into walls and getting to know the people who are the key stakeholders before you have a chance of being successful. If you take those early failures as a marker of, “Well, this isn’t a good fit for me,” you’re selling the opportunity short.
You mentioned catastrophic mismatches. What are some you’ve run across?
A colleague of mine who thought he’d love academics took a job with research training. He realized that every minute he wasn’t seeing patients he was really unhappy, so this was someone who was self-aware enough to know that this fundamentally wasn’t what he wanted.
A far more common mismatch is when hospitalists are being asked to see more patients than is truly safe. If you’re in a situation where systematically the expectation is to do something that just is not safe for clinical care, I think that is a reason to exit early. This is less about poor job fit than it is about poor job design.
Phyllis Maguire is Executive Editor of Today’s Hospitalist.