What effect does increasing inpatient time have on outpatient-oriented internist satisfaction?
OBJECTIVE
Because career satisfaction among general internists is relatively low, we sought to understand the impact on satisfaction of general internists managing patients both in and outside of the hospital. Using data from a national survey, we asked, "Among outpatient-oriented general internists (i.e., internists who spend less than 50% of their clinical time caring for inpatients), what effect does time spent in the hospital have on physician satisfaction, stress, and burnout?"


METHODS
The Physician Worklife Study, in which 5,704 physicians in primary and specialty nonsurgical care selected from the American Medical Association's Masterfile were surveyed (adjusted response rate = 52%), was used. Our analyses focused on clinically active outpatient-oriented general internists (N = 339).


RESULTS
We constructed multivariate linear models to test for statistically significant associations between the amount of time spent seeing inpatients and physician satisfaction as measured by several satisfaction scales. Even after controlling for total hours worked and other possible confounding variables, we found that increased time working in the hospital was significantly associated with decreases in satisfaction with administration, specialty, autonomy, and personal time, and significantly associated with an increase in life stress. There was also a significant association between increased time spent in the hospital and burnout.


CONCLUSIONS
Our findings imply that there may be a tension between the practice of inpatient and outpatient medicine by general internists, and suggest that fewer hospital duties may increase career satisfaction for outpatient-oriented internists. Although additional studies are warranted in order to better understand why these relationships exist, our data suggest that the hospitalist model of inpatient care might be one approach to alleviate stress and improve satisfaction for many general internists.
Saint
Sanjay
S
Health Services Research and Development Field Program, Ann Arbor VA Center for Practice Management and Outcomes Research, Ann Arbor, MI, USA. saint@umich.edu
Zemencuk
Judith K
JK
Hayward
Rodney A
RA
Golin
Carol E
CE
Konrad
Thomas R
TR
Linzer
Mark
M
D000328:Adult; D000553:Ambulatory Care; D002055:Burnout, Professional / Q000209:etiology* / Q000517:prevention & control; D005260:Female; D020445:Hospitalists; D006760:Hospitalization; D006801:Humans; D007325:Institutional Practice; D007388:Internal Medicine / Q000458:organization & administration*; D007588:Job Satisfaction; D008297:Male; D008875:Middle Aged; D013997:Time Factors; D014481:United States