Home Analysis Trouble in academia

Trouble in academia

August 2011

Published in the August 2011 issue of Today’s Hospitalist

HOW SATISFIED are academic hospitalists in their jobs?

That was the question a group of researchers wanted to answer through an e-mail survey of hospitalists at 20
academic centers across the country. The survey was designed to find out not only how successful hospitalists felt in their careers, but to assess their stress level, job satisfaction and self-reported risk of burnout.

"We were trying to get at whether or not academic hospitalists are getting the support they need to be successful," says Jeffrey Glasheen, MD, associate professor of medicine and director of the hospital medicine program at the University of Colorado Denver. Dr. Glasheen was lead author of the study, which appeared in the April 25 Archives of Internal Medicine. "We wanted to know how academic the job looks and what the consequences of low satisfaction related to academic efforts may be."

What Dr. Glasheen and his colleagues discovered was pretty grim. While 75% of the more than 260 hospitalists who responded said they were satisfied with their job, two-thirds (67%) reported high stress levels. Even more alarming, almost one in four were experiencing some level of burnout, in large part because of time pressures and what researchers referred to as poor career fit.

"Academic hospitalists are not having a lot of success," says Dr. Glasheen. "They come to academics to be academic and in many cases, their academic needs are not being met, resulting in a lack of academic output and high levels of stress and burnout."

Career dissatisfiers
A 2001 study that looked at hospitalists in both academic and community settings found that 12.9% of physicians reported feeling burned out. But compared to the rate that Dr. Glasheen and his colleagues uncovered by surveying only academic hospitalists (23%), that earlier finding looks good.

Some of the factors he and his team found associated with low job satisfaction included dissatisfaction with the amount of personal or family time physicians receive, too little control over work schedule and too little support from a division chief. Burnout predictors among survey responders were likewise too little personal or family time and too little control over schedules.

But an even gloomier picture emerged from responses related to academic success. Less than half (42%) of those responding to Dr. Glasheen’s survey had a mentor, and only one in four had given grand rounds at his or her own or another institution.

More than half admitted that they had yet to score a first authorship on any academic publication. And while 57% reported having only 20% or less of their time protected for "scholarly activities," 20% said they spent more than 80% of their time on nonteaching services.

"They end up doing a lot of clinical work," Dr. Glasheen points out. That’s a huge dilemma for physicians who accept lower paying jobs in academia precisely because they want to pursue teaching, research or authorship.
It seems, says Dr. Glasheen, that the academic hospitalist jobs being developed aren’t really academic in scope. Given the bad career fit that survey responses revealed, he adds, he is surprised that the self-reported burnout rate is not higher.

Wake-up call
According to Dr. Glasheen, having one in four physicians feeling burned out and less than satisfied with his or her job does not bode well for the future of academic hospital medicine. Those results, he points out, should serve as a wake-up call to push academic leaders to create more sustainable, fulfilling careers. He adds that he’s talked to many residents who are planning an academic hospitalist career “but who don’t see themselves staying in that position for more than 10 years.

Part of the problem is the lack of senior-level academic hospitalists and mentors, which stems from the fact that most academic hospitalists are about the same age. "That’s a problem when programs are all between five and 15 years old," says Dr. Glasheen. "It means there is a systemic lack of leadership and mentorship."

What are some solutions? In his own program, Dr. Glasheen points out, he and his colleagues make sure they keep at least 20% of their time protected for scholarship and academic pursuits.

The group also limits shift lengths to 10 hours, although "many of our docs are out in eight," Dr. Glasheen says. He also works to assign weekend shifts as seldom as possible and help physicians customize their schedules.

Protecting the pipeline of recruits
In addition to protecting more time for scholarly activities, academic centers need to bolster their research infrastructure via grants, fellowship training, and departmental support for early career funding and faculty development. They also need to make it possible for doctors to focus more on teaching and less on clinical work without learners.

That’s particularly critical now that revised workhour rules could result in many academic hospitalists needing to see even more patients.

"Either create more opportunities for scholarship, or consider a move to hire completely nonacademic physicians," Dr. Glasheen says. But he cautions that starting a nonteaching hospitalist service "comes at a huge financial cost, as those physicians are paid more."

Still, he adds, more academic centers seem to be taking that route. "Some centers are trying to shore up academic resources and make the jobs more academic," he notes, "but it’s tough to keep up with the rapid growth. My sense is that most are moving toward hiring folks with less of an academic focus and more of a focus on being clinicians."

As for academic services, Dr. Glasheen says, "Most of us are really struggling with how to double or treble the size of our groups without more teaching opportunities, research infrastructure, mentorship and training."

The implications of that struggle, he adds, are huge. "Our future hospitalists “current students and residents “see burned out and stressed hospitalists who aren’t achieving academic success," he says. "This is not a great recruitment tool to the field and may push many away."

Instead, says Dr. Glasheen, "the success of academics will go a long way toward keeping the pipeline of the best and brightest coming into hospital medicine, academic and community."

Tracy Granzyk Wetzel is a freelance health care writer based in Chicago.