Reimagining Hospital Medicine for Long-Term Sustainability

Abstract Background High rates of burnout and turnover exist in the field of hospital medicine. Factors that make the career less sustainable and impact hospitalists as they age are not well understood. Objective To identify factors that promote or impede hospitalist career longevity and understand job- and age-related challenges faced by older hospitalists. Design Mixed-methods study of semi-structured qualitative focus groups within a national hospitalist consortium followed by a brief participant survey. Focus group discussions were recorded, summarized, and analyzed using matrix analyses to identify themes and subthemes. Participants Thirty-seven attendees of the HOMERuN collaborative session in November 2024 participated in the focus groups, and 24 completed the survey. Main Measures Information sought in the survey included demographics, years practicing as a hospitalist, full- or part-time workload, their estimated age of retirement, and their opinions about whether they would still be working in hospital medicine and at what capacity. The focus groups sought to understand how aging impacts hospitalists’ ability to perform their work, and what work structure or group factors support retention as a hospitalist. Key Results Most survey participants were hospitalists for 10–14 years. Nearly two-thirds (63%) anticipated they would have a lower clinical load as they approached retirement. Three major themes emerged in the qualitative data: (1) aging affects the work in both positive and negative ways; (2) stage of parenting and generation appear to matter more than age; (3) career sustainability increases with influence over one’s schedule, reduction in clinical load, and reduction or elimination of nighttime work. Conclusions As a field, hospital medicine needs better structure to achieve career sustainability. Retention until traditional retirement age is thought to be more likely when hospitalists have flexible schedules, diversification of roles, reduction in clinical workloads, reduction or elimination of night shifts, and benefits with rising seniority.