Effectiveness of a Nephrohospitalist Program at Two Large Tertiary Care Teaching Hospitals: Faculty Perspective Survey

Background: Growing demand for inpatient nephrology services between 2021 and 2023 prompted the creation of a non-teaching inpatient nephrology attending-only (nephrohospitalist) service at our two large teaching hospitals in 2024. Each newly hired nephrohospitalist, on weekdays, managed ~15-20 patients, previously covered by teaching services. We assessed the impact of our newly created nephrohospitalist service on our inpatient teaching faculty members. Methods: An anonymous survey was created on-line and distributed to all inpatient teaching faculty members, 10 months after the implementation of our nephrohospitalist program. Results: The survey had a 100% completion rate. Before the creation of the nephrohospitalist program, teaching faculty members indicated substantial challenges: 90% reported a diminished ability to teach, 20% a negative impact on patient care quality and/or safety, and 50% reported difficulties communicating with referring and consulting physicians. Following program implementation, all surveyed faculty reported improvements. Specifically, 100% reported having more time for teaching, improved patient care quality and safety, and better communication with other physicians. Regarding service size reduction, 30% of the respondents saw a decrease of over 30%, 60% of the respondents saw a decrease between 15-30%, and 10% of the respondents saw a decrease of less than 15%. The additional time afforded by the program was utilized in various ways: 80% experienced improved work-life balance, 20% increased office patient volume, 40% engaged in more scholarly activities, and 70% found it easier to attend divisional academic conferences. Conclusion: The implementation of a nephrohospitalist service, with its associated reduction in hospital service sizes, yielded positive effects on our teaching faculty. Faculty members reported improvements in learning opportunities, quality of care delivered, communication, work-life balance, personal well-being, and time for scholarly pursuits. Our experience highlights some potential benefits of a dedicated nephrohospitalist service in large teaching hospitals.