Sep - 5 - 2016

How Hospitalist Shifts Are Influenced by Patient Volume

The new doctor looking at hospitalist jobs has a lot to think about in terms of expectations and needs. Among the considerations are the varying kinds of shift models hospitals use to fill their schedules. Suffice it to say that there is no single shift model that works for every facility. In fact, much of what goes into planning shifts is primarily based on patient volume.

There are a few common models that apply to the vast majority of hospitalist jobs in America:

  • Seven On/Seven Off – For the longest time, nearly every hospital in the country who used permanent or locum hospitalists utilized the seven days on/seven days off model. Doctors worked seven days straight, at 12 hours per day, followed by seven full days off.
  • 24 Hours On – Another popular model that has been around for decades is the 24-hour model that has the hospitalist working around the clock for a full day. This model affords a room where doctors can get some rest during down times, as well as access to other doctors who will be on call when the workload gets heavy.
  • Private Practice Shifts – A third model that is gaining popularity is one that mimics private practice shifts. In other words, hospitalists work a routine 9-to-5 and then share on-call responsibilities during the evenings and on weekends.

Hospital administrators of all stripes tend to prefer one model over the others for their facilities. But as mentioned earlier, there is no single model that works equally well for every hospital. Administrators have to look at patient volume, available hospitalist resources, and other concerns.

Offering 24-Hour Coverage

Twenty years ago, it was possible for even the largest hospitals to get away without providing 24-hour hospitalist coverage. Staff doctors could work regular shifts while emergency coverage, when necessary, was provided by locums pulling extra shifts to earn a little spending cash. That is no longer the case. Patient volumes have increased to the point where large and mid-sized hospitals alike are increasingly forced to provide 24-hour coverage.

The need for around-the-clock hospitalist coverage is forcing a lot of facilities to rethink the way they schedule shifts. For example, consider the major metropolitan hospital that needs to keep a full staff of hospitalists in the facility at all times. That hospital will undoubtedly experience fluctuations in workload throughout the day. Their scheduling must account for that.

One way to do this is to use staggered shifts. In a staggered shift scenario, both locums and employee hospitalists work straight 8- or 12-hour days on a regular schedule. Administrators make up for fluctuations in patient volume by staggering shifts accordingly. This accomplishes two things: it prevents having too many doctors in the hospital when the workload is likely to be low (during the early and mid afternoon hours, for example) and it ensures there are enough doctors on staff during likely times of high patient volume (evening and late weekend hours).

The one thing that remains crystal clear to today’s administrators is that the old shift models are not necessarily applicable anymore. Hospitals are increasingly under the gun to provide more robust and flexible hospitalist staffs better able to respond to the evolving healthcare environment.

Locums will play a more important role in hospitalist staffing as we move into the future. So it is up to administrators to find the right shift scheduling model that works best for their facilities. Otherwise, all of the locum hospitalists in the world will not be enough to make up for staffing shortages and persistent coverage gaps.

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