Hospitalist Practice Characteristics: The Vha Experience

1University of Iowa, Iowa City, IA
2Iowa City VA Healthcare System, Iowa City, IA
3VA Boston Healthcare System, Boston, MA

Meeting: Hospital Medicine 2012, April 1-4, San Diego, Calif.

Abstract number: 97678

Background:

As in the private sector, the Veterans Health Affairs (VHA) has seen a steady increase in the number of hospitalist programs. Currently, nearly 90% of VHA hospitals have hospitalists admit at least a portion of their medicine patients. This study examines the professional and practice characteristics of a sampling of VHA hospitalists.

Methods:

A web–based, cross–sectional survey of staff physicians at 36 VHA hospitals, representing a stratified sample based on geographic region, facility size, open vs. closed intensive care unit (ICU) status, and presence of a hospitalist program.

Results:

The overall response rate was 474 out of 795 (60%), of which 115 (24%) identified as a hospitalist. Hospitalists reported an average of 7.3 years as a practicing hospitalist (SD = 7.4, Range 1 – 39), 97% were board certified in internal medicine, and 30% reported a sub–specialty board. For 53%, all of their professional VHA time was dedicated to inpatient care or administrative duties. Only 27 (24%) reported any time spent on research with just 10 (9%) reporting > 10% effort dedicated to research. Average workload was reported as 15 – 24 admissions per week and an average census of 10 – 14 patients. There was high job satisfaction with 95 (83%) reporting they were somewhat or very satisfied with their job, and only 13 (11%) reporting they agree or strongly agree that they would leave their current job because they are dissatisfied. Additionally, only 18 (16%) reported mild to severe symptoms of burnout, a rate that mirrored responses across all respondents. In a subset of 28 hospitals with both hospitalist and non–hospitalists, measures of care coordination and interdisciplinary team function were similar between the two physician groups. However, hospitalists were more likely than non–hospitalists to agree or strongly agree that nursing staff were available to physicians when needed and that nurses and physicians work well together on quality improvement teams. Further, hospitalists were more likely to report often or constant communication with staff nurses. Frequency did not translate into quality as hospitalists and non–hospitalists both provided equally poor ratings about the timeliness and accuracy of conversations with staff nurses. Lastly, hospitalists were more likely to report developing or promoting 23 out of 24 quality improvement activities, the one exception being similar rates for chronic disease registries.

Conclusions:

The growth of hospitalist programs in VA has been achieved with high levels of job satisfaction and limited development of physician burnout. These physicians support the facility by caring for patients and developing and promoting QI activities. However, there is still a need to improve the quality of communication between hospitalists and nurses.

To cite this abstract:

Kartha A, Restuccia J, Glasgow J, Meterko M, McIntosh N, Kaboli P, Johnson S. Hospitalist Practice Characteristics: The Vha Experience. Abstract published at Hospital Medicine 2012, April 1-4, San Diego, Calif. Abstract 97678. Journal of Hospital Medicine. 2012; 7 (suppl 2). https://www.shmabstracts.com/abstract/hospitalist-practice-characteristics-the-vha-experience/. Accessed May 26, 2019.

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