Hospitalists weigh in on how high workloads affect patient care

Posted on: June 12th, 2013
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written by

Ben Amirault

High workloads do more than breed physician burnout. A study appearing in the March 11, 2013 issue of JAMA Internal Medicine found that some hospitalist blame high workloads for delayed admissions and discharges, unnecessary testing and treatment, as well as the inability to fully answer patient treatment questions. According to the survey of more than 500 hospitalists, hospital based physicians typically handle workloads that they feel are unsafe. In fact, 40% of respondents reported exceeding safe workload at least once a month, while 36% said it happens more than once a week. The survey also asked the hospitalists to identify any adverse effects that come with high workloads.

  • 22% said high workloads cause admissions and discharges to be delayed until the next shift.
  • 25% said high workloads demand too much time making it hard to fully discuss treatment options or answer questions from patients and their families.
  • 22% said they order more unnecessary tests and procedures because they do not have enough time to complete an adequate assessment of the patient.
  • 19% said high workloads actually worsen patient satisfaction.

The Affordable Care Act contains several quality care initiatives aimed at controlling costs, reducing unnecessary admissions, and improving discharges. Going forward, it is going to be critical for hospitals and healthcare organizations to maintaining adequate staffing levels in order to meet their quality goals. In a the latest issue of Today’s Hospitalist, Phyllis Maguire asked Henry J. Michtalik, MD, MPH, a hospitalist at Baltimore’s Johns Hopkins Hospital and associate faculty for the Armstrong Institute for Patient Safety and Quality at Johns Hopkins, why physician workload has not been studied as extensively as nurse workload.

“I think one factor is physician autonomy. While there are regulations in place for nursing and resident work hours, physicians function as independent practitioners once they complete training. Then there’s the issue of availability. Particularly in rural communities, there often aren’t enough physicians to provide continuous coverage if specific workhour regulations were applied to attending physicians.”

Indeed, rural hospitals and healthcare organizations struggle with maintaining adequate staffing levels. And with the physician shortage expected to intensify in the coming years, it’s a problem that is only getting worse. Many rural facilities rely on locum tenens hospitalists to meet their needs. Here at Barton, a significant percentage of our client base is located in rural areas. Many of our locum tenens providers find working in rural communities rewarding and a great way to gain valuable experience. However, if the patient population continues to outpace the physician workforce, facilities in all communities will be turning to locum tenens to help with their staffing needs.

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About Ben Amirault

Ben Amirault was formerly the marketing manager at Barton Associates' Peabody, MA headquarters. He received a B.A. in English, specializing in journalism, from the University of New Hampshire.

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