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Hospital Medicine's successful growth in the United States concurrently poses challenges to its sustainability. Its growth has occurred in response to the demand of managed care for dedicated inpatient generalists to serve in various roles, including boundary spanners, communicators, quality enhancers, and care givers. The combination of roles and the often shifting work requirements demand flexibility from hospitalists who are also collectively working harder each year according to the biannual productivity surveys administered by the Society of Hospital Medicine. Moreover, many of the ranks are being filled by young physicians at the beginning of their medical careers. The characteristic stressors related to the work environment and demographics of the hospitalist workforce create conditions under which job burnout has emerged as a valid concern.

The scope of burnout among hospitalists was exposed in 1999 when a nationwide survey of the National Association of Inpatient Physicians (NAIP) identified 12.9% of respondents feeling “burned out” and an additional 24.9% “at risk of burnout.” In 2005, a survey of hospitalist leaders ranking the top challenges to their groups identified 7 areas directly related to burnout situated at the top of the list (Table 30-1). Other site-based medical specialties like critical care and Emergency Medicine have seen burnout rates as high as 40% to 60% and have taken proactive steps in trying to reduce burnout rates through job design and focus on the individuals. Not in spite of, but because of its rapid growth leaders in the field have deliberated over the sustainability of hospitalist practice models. To retain the best physicians capable of delivering the highest quality of care, understanding burnout and ways to address it remains an essential task for the discipline.

Table 30-1 Top Challenges Facing Hospital Medicine Groups


Burnout is a psychological syndrome leading to a worker's erosion of engagement with their job due to long-term exposure to emotionally demanding work. It is a condition observed predominantly, though not exclusively, among those in the helping professions, like health and social services, where direct, frequent, and intense interactions with people are common and where the outcomes of work are not totally dependent on the actions of the worker. The most frequently cited conceptualization of burnout comes from Christina Maslach and colleagues who describe three constitutive dimensions. The first, emotional exhaustion, is a literal depletion of the worker's energy due to the work demands. It may manifest ...

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