Building a thriving academic hospitalist workforce: A rapid qualitative analysis identifying key areas of focus in the field

Abstract

Background: The hospitalist workforce has been at the forefront of the pandemic and has been stretched in both clinical and nonclinical domains. We aimed to understand current and future workforce concerns, as well as strategies to cultivate a thriving hospital medicine workforce.Design, Setting, and Participants: We conducted qualitative, semistructured focus groups with practicing hospitalists via video conferencing (Zoom). Utilizing components from the Brainwriting Premortem Approach, attendees were split into small focus groups and listed their thoughts about workforce issues that hospitalists may encounter in the next 3 years, identifying the highest priority workforce issues for the hospital medicine community. Each small group discussed the most pressing workforce issues. These ideas were then shared across the entire group and ranked.We used rapid qualitative analysis to guide a structured exploration of themes and subthemes.Results: Five focus groups were held with 18 participants from 13 academic institutions. We identified five key areas: (1) support for workforce wellness; (2) staffing and pipeline development to maintain an adequate workforce to match clinical growth; (3) scope of work, including how hospitalist work is defined and whether the clinical skillset should be expanded; (4) commitment to the academic mission in the setting of rapid and unpredictable clinical growth; and (5) alignment between the duties of hospitalists and resources of hospitals. Hospitalists voiced numerous concerns about the future of our workforce. Several domains were identified as high-priority areas of focus to address current and future challenges.

A methodological progress note: Introducing qualitative focus group research and the brainwriting premortem

“…The data produced during the session is immediately accessible and can be discussed within the group to consolidate ideas, identify the most valuable, and rank order them to support real-time decision making. 11 Two examples of virtual brainwriting sessions pertinent to hospital medicine include a study by Steenbruggen et al 11 that used virtual brainwriting to design a framework to enhance the quality of hospital-based physiotherapy in the Netherlands and a study by Kulkarni et al 5 that gathered insights from hospitalists regarding potential workforce challenges over the next 3 years. These teams adapted the brainwriting method to fit the needs of their projects by using multiple breakout rooms to keep the group size <5 people, recording the sessions, and having moderators collect field notes to support future qualitative analyses.…”

“…The authors reported that the brainwriting method effectively elicited novel insights 11 and facilitated input from all participants. 5 An advantage of the brainwriting method, compared to verbal brainstorming, is the rapid collection of written data and the creation of an environment where everyone feels safe to share, making brainwriting the ideal method for a project premortem.…”

“…In this issue of the Journal of Hospital Medicine , Kulkarni et al 5 used components from the brainwriting premortem method 2 with hospitalists to understand the current and future workforce challenges facing the hospitalist workforce. This methodological progress note was developed to introduce the hospital medicine community to focus group research, the brainwriting premortem, and the benefits and challenges of these methods.…”

Revisiting negotiation for hospitalist groups: Getting what you need when the game has changed

“…Hospitalist groups report burnout, excessive cognitive load, escalating social and clinical complexity of patients, and a perceived lack of respect for their contributions. 1 Meanwhile, hospitalist leaders face intense pressure from health systems to increase productivity, reduce costs, and justify their expenses, especially for nonclinical effort. Navigating these competing agendas can feel daunting, as it may seem that shared values and interests supporting past collaboration have disappeared.…”

“…However, a growing sense of misalignment exists between hospitalists and the institutions funding them. Hospitalist groups report burnout, excessive cognitive load, escalating social and clinical complexity of patients, and a perceived lack of respect for their contributions 1 . Meanwhile, hospitalist leaders face intense pressure from health systems to increase productivity, reduce costs, and justify their expenses, especially for nonclinical effort.…”