Background and Objective: Attending physicians’ career satisfaction is associated with higher patient satisfaction, better patient care, and even medical student career choice. Previous studies indicate that adequate mentorship improves job satisfaction, but finding mentors may be challenging for some hospitalists. Little is known about pediatric hospitalist career satisfaction or the role of mentorship. The goal of this study was to assess career satisfaction among pediatric hospitalists, determine which interventions may improve satisfaction, and investigate the role of mentorship in satisfaction.
Methods: This study included the use of an anonymous electronic cross-sectional survey sent to the American Academy of Pediatrics’ Section on Hospital Medicine Listserv between November 2009 and January 2010.
Results: A total of 222 pediatric hospitalists responded; 92% agreed with the statement, “Overall, I am pleased with my work.” Of the 23 satisfaction statements, “I have adequate mentorship in my career” was rated lowest (P ≤ .001); only 44% agreed. Adequate mentorship was significantly correlated with overall career satisfaction, having sufficient opportunity for promotion, feeling valued by one’s administration, and wishing to remain at one’s current hospital. Adequate mentorship was negatively correlated with planning to change specialty or leave clinical medicine. Mentorship satisfaction did not differ by age, years as a hospitalist, gender, or practice setting. Of the 15 potential interventions, creating a formal mentorship program ranked in the top 5. Only increasing base salary received a significantly higher score.
Conclusions: Although surveyed hospitalists have substantial overall career satisfaction, lack of mentorship is a significant problem that spans the demographic spectrum. Establishing a mentorship program may be an effective way for hospitalist groups to improve satisfaction.
Pediatric hospital medicine is a relatively new specialty that faces some unique challenges. In 2004, the American Academy of Pediatrics’ Section on Hospital Medicine (AAP SOHM) had 225 members. In 2010, it had 850 members, an increase of 380% in just 6 years. Self-reported data indicate that pediatric hospitalists now practice in at least 43 states and the District of Columbia.1 Exponential growth brings exciting changes but often leads to growing pains. Successful hospitalists must meet the evolving clinical needs of their institutions while facing limited resources. They must balance their often nontraditional work hours with educational and administrative responsibilities.
An experienced mentor could help hospitalists navigate these demands. Previous studies have shown a link between the availability of mentoring and physicians’ career satisfaction.2Unfortunately, lack of mentorship has been recognized as a significant problem for hospitalists.3 Without adequate support, competing pressures could potentially lead to burnout and high turnover rates.4,5
Freed et al6 surveyed hospital medicine leaders and found an average duration of employment of <3 years. Some hospitalists may leave the profession due to burnout. Others may leave because they perceive hospital medicine to be a temporary job rather than a career. How do we establish ourselves as a legitimate career choice, recruit trainees, and retain talented individuals? A strong base of committed physicians is critical if hospital medicine is to evolve into a successful and reputable specialty.
In December 2006,the Society of Hospital Medicine (SHM) acknowledged these challenges, issuing a White Paper on hospitalist careersatisfaction.4 They suggested action steps for hospitalist leaders and identified 4 pillars of career satisfaction: reward/recognition, workload/schedule, autonomy/control, and community/environment. To our knowledge, no published studies have specifically investigated pediatric hospitalist career satisfaction. The objectives of the current study were threefold: to assess the degree of career satisfaction among pediatric hospitalists, to determine which interventions may improve satisfaction, and investigate the role of mentorship in satisfaction.
An anonymous electronic cross-sectional survey of pediatric hospitalists was conducted from November 2009 to January 2010. The AAP SOHM Listserv served as a convenience sample. The Listserv is open to members of the AAP SOHM, as well as practitioners spending ≥50% of their time as pediatric hospitalists, trainees considering a career in hospital medicine, and providers interested in practicing pediatric hospital medicine within the next year.7
An e-mail announcing the survey was sent to the ∼1100 members of the Listserv along with an invitation link to the SurveyMonkey Web site. SurveyMonkey is an Internet-based company that facilitates the creation and distribution of electronic surveys. No identifying data were collected or stored. Three reminder e-mails were sent to all Listserv members during the study period encouraging participation.
The survey was sent in conjunction with a complex care survey to avoid overburdening Listserv participants with multiple e-mail requests. There was a lottery for a $250 incentive sponsored by the AAP SOHM Subcommittee on Complex Care. After completion of the survey, participants were invited to send a separate e-mail to the investigators if they wished to be eligible for the drawing. In this way, responses were kept completely separate from identifying contact information. The study was approved by the Children’s National Medical Center Institutional Review Board.
The survey was created by using applicable questions from the Physician Work Life Study (PWLS).8 Conducted in the late 1990s, the PWLS was a large, rigorously validated survey of adult and pediatric primary care and nonsurgical specialists that measured physician job satisfaction.9 Additional questions were designed to address the 4 pillars of career satisfaction identified by using the 2006 SHM White Paper (reward/recognition, workload/schedule, autonomy/control, and community/environment) and to determine which recommended interventions from that report are endorsed by pediatric hospitalists.4 All satisfaction questions were rated on a 5-point Likert scale, where 5 equaled strongly agree, 4 was agree, 3 equaled no opinion, 2 was disagree, and 1 equaled strongly disagree. All potential intervention questions were rated on a 5-point Likert scale, where 5 equaled extremely helpful, 4 was very helpful, 3 equaled helpful, 2 was somewhat helpful, and 1 equaled not at all helpful. Demographic and clinical practice characteristics were collected by self-report. The survey was pilot tested in small groups and revised for content and readability based on the feedback received.
To create an organizational framework for the large amount of data obtained, a separate group of 6 hospitalists retrospectively placed each satisfaction statement into 1 of 6 domains. The first 4 domains consisted of the 4 pillars from the 2006 SHM White Paper.4 The other 2 domains, global job satisfaction and global specialty satisfaction, were taken from the PWLS.9 Although some statements overlapped between domains, the group was surveyed and domains discussed until consensus was reached.
De-identified data were retrieved from the SurveyMonkey Web site in Microsoft Excel format and imported into PASW (SPSS) version 17.0 (SPSS Inc, Chicago, IL) for nonparametric analysis. The degree of career satisfaction was first assessed by analyzing Likert scores for the marker question (“Overall, I am pleased with my work”). In addition, a total career satisfaction score was calculated for each respondent by summing across all 23 questions. Respondents were considered “satisfied” if their mean per-question score was a Likert score of ≥4. The frequency and distribution of Likert scores were calculated for all satisfaction statements, and the statistically highest and lowest rated were determined by using the Wilcoxon signed rank test. Potential interventions were similarly assessed. Because Likert scales are ordinal and nonparametric, median and interquartile ranges (IQRs) were calculated in place of means and SDs. Correlates of the statement “I have adequate mentorship in my career” were determined by using Spearman’s rank test. The Mann–Whitney U test was used to assess satisfaction differences across demographic groups.
A total of 222 of ∼1100 Listserv members completed the survey. Seventy percent were female, and 65% completed residency >5 years ago (mean: 9.6 years; median: 7 years); 63% had been hospitalists for ≤5 years (mean: 5.7 years; median: 4 years). A total of 13% had completed a fellowship, the majority in infectious disease or hospital medicine; 76% held academic appointments, and 90% were involved in medical education; 34% practiced at a freestanding academic children’s hospital, 29% at an academic children’s hospital or ward within an adult hospital, and 34% at a community hospital (Table 1).
Overall, 92% of respondents either strongly agreed or agreed with the statement, “Overall, I am pleased with my work” (Likert score median: 4 [IQR:4–5]). However, when summing across all 23 questions, 53% of respondents were satisfied, with a mean per-question Likert score of ≥4.
Of the 23 satisfaction statements, “I have adequate mentorship in my career” was significantly rated lowest (P ≤ .001). Just 44% of respondents strongly agreed or agreed (Likert score median: 3 [IQR: 3–4]).
Also rated poorly were the statements “I have too much administrative work to do,” “My office space is not sufficient for my needs,” and “The volume of work is overwhelming”(median: 3 [IQR: 2–4]; median:4 [IQR: 2–4]; and median: 4 [IQR:3–4], respectively). Because these questions were negatively phrased, Likert scores were inverted (eg, a median score of “2/disagree” that one’s office space is not sufficient was changed to a median score of “4/agree”that one’s office space is sufficient).In addition, “My total compensation package is fair” (median: 4 [IQR: 3–4])and “My prospects for future financial security are bright” (median: 4 [IQR:3–4]) received lower scores. The 2 significantly highest rated statements (P = .03) were “I get along well with my nonphysician colleagues” (median:5 [IQR: 4–5]) and “I am able to refer patients to consultants when necessary”(median: 5 [IQR: 4–5]) (Table 2).
Of the 15 potential interventions, creating a formal mentorship program ranked in the top 5 (Likert score median: 3 [IQR: 2–4], P = .018). Only increasing base salary received a significantly higher score (median: 4 [IQR:3–5]; P ≤ .001). Mentorship programs received the second highest score, but this was not significantly different than the others in the top 5. The top 5 interventions also included limiting long stretches of consecutive days worked (median: 3 [IQR: 2–4]), hiring additional physician providers (median: 3[IQR: 2–4]), and scheduling shifts for circadian rhythms (median: 3 [IQR:2–4]) (Table 3).
Adequate mentorship was modestly but significantly correlated with the statement, “Overall, I am satisfied with my work” (P ≤ .001, Spearman’s ρ = 0.213).Adequate mentorship was also significantly correlated with having sufficient opportunity to advance in one’s career (P ≤ .001, ρ = 0.493), feeling valued by one’s administration (P ≤ .001, ρ = 0.374),and wishing to remain at one’s current hospital (P ≤ .001, ρ = 0.335). Adequate mentorship was negatively correlated with planning to leave clinical medicine (P = .002, ρ = −0.211) or change specialty (P ≤ .001, ρ = −0.301) (Table 4).
Mentorship satisfaction did not statistically differ according to gender (P = .93), years since residency graduation (P = .08), years as a hospitalist (P = .07), or practice setting (P = .29).Fellowship graduates reported significantly better mentorship (P = .004).Fellowship graduates (n = 26) were more likely to be male, with more time since residency graduation and longer careers as hospitalists. Their responses did not significantly differ from nonfellowship graduates on any of the other 22 satisfaction questions.
This survey represents the first formal inquiry into pediatric hospitalist career satisfaction. Surveyed hospitalists were fundamentally satisfied with their careers. In response to the statement, “Overall, I am pleased with my work,” 92% either agreed or strongly agreed. Hospitalists were most satisfied with factors relating to patient care and professional relationships. These core aspects of hospital medicine were almost universally seen as rewarding. When evaluated across all 23 satisfaction statements, however, just 53% of respondents were considered satisfied, defined as a mean per-question Likert score of ≥4. Although some central aspects of hospital medicine are satisfying, other areas left significant room for improvement. Pediatric hospitalists were less satisfied with hospital and administration factors, opportunities for advancement, work–life balance, compensation, and mentorship.
Over the years, studies have repeatedly demonstrated the importance of physician satisfaction.10 Physicians who rate themselves as highly satisfied with their careers receive superior patient satisfaction scores.11 Job satisfaction is correlated with better patient adherence and overall quality of care.12,13 Dissatisfied physicians are more likely to report health problems or file for disability.14 They are also more likely to leave their current positions.15 The resulting turnover has significant financial and psychological costs for any organization. Job satisfaction of attending physicians even seems to influence the career decisions of trainees, potentially limiting future growth of the profession.16,17 For an expanding field such as pediatric hospital medicine, issues of quality patient care, sustainability, retention, and recruitment are of the utmost importance.
Our study found that pediatric hospitalists have similar or higher levels of satisfaction compared with other physicians; 92% of pediatric hospitalists in our survey were pleased with their work, while a longitudinal survey of emergency physicians found an 88% overall satisfaction rate.5 Glasheen et al18 found that 75% of adult hospitalists were satisfied with their current jobs. As with pediatric hospitalists, they were more likely to be satisfied with aspects relating to interpersonal relationships. Similar to our study, they were less satisfied with hospital/administration factors and work–life balance.
Our survey found that pediatric hospitalists frequently lack sufficient office space. Given the relative newness of the field, many hospitals were not designed with hospitalist needs in mind. Not surprisingly, we found that 86% of pediatric hospitalists would like to improve their physical environment by increasing their office space and the availability of computers. As hospitalist programs expand across the country, it will be important to voice these concerns to administrators when renovations and new facilities are planned.
Pediatric hospitalists were also concerned with the volume of work and the number of administrative tasks required. To some degree, these problems are inherent to the field. Still, certain changes are possible. Hospitalists in our survey preferred scheduling shifts with awareness of circadian rhythms and limiting long stretches of consecutive days worked. They preferred to hire additional physicians and administrative support staff over hiring nurse practitioners or physician assistants.
Just 64% of pediatric hospitalists in our survey felt their compensation packages were fair. In recent years, the SHM and the Medical Group Management Association have performed rigorous, comprehensive salary surveys of adult and pediatric hospitalists. Their extensive data reports are available for purchase through the SHM. Today’s Hospitalist also performs a yearly salary survey of its readers, with results easily accessible on their Web site. Their 2011 data revealed that lower compensation was correlated with burnout.19 Hospitalist group leaders, as well as individual hospitalists, should be aware of salary benchmarks and advocate for fair compensation.
We found that the surveyed pediatric hospitalists were least satisfied with their mentorship. Mentorship has been defined as a formal social support that provides a range of benefits including emotional support, empathy, practical assistance, advice and information, feedback, and encouragement.20 Academic hospitalists without a mentor produce fewer peer-reviewed publications and are less likely to have given grand rounds or to have lectured at a national meeting.21 Adequate mentorship has been shown to improve career satisfaction, career development, and perceived institutional support.22 Research also indicates that mentoring programs can improve faculty retention.23 In a recent survey of adult hospitalists, only 42% could identify a mentor and just 53% felt prepared to take on a greater mentorship role for others.18
Perhaps these findings are not surprising for such a new field. In our survey, respondents had been practicing hospital medicine for a median of 4 years. With new programs developing nationwide, the demand for seasoned mentors rapidly outpaces the supply of experienced hospitalists. Many freestanding academic children’s hospitals have large and well-established hospitalist programs, yet still suffered from a lack of mentorship. There was a trend towards lightly better mentorship among older and more experienced hospitalists, but this result was small and not statistically significant. Regardless of practice setting or gender, hospitalists reported difficulty in finding mentors, and 91% felt that adding a mentorship program would be helpful.
Accessibility will be a key factor in the success of any mentorship program. Some hospitalist groups may have invaluable resources, but individual mentors may be overwhelmed by other duties. Because adequate mentorship is correlated with overall career satisfaction and desire to stay at one’s current hospital, department leaders and administrators should place a premium on mentoring activities among their faculty. Protected time and consideration for promotion may encourage experienced faculty to reach out to new hires.20
Harrison et al24 recently found that 77% of clinicians/educators relied on senior faculty within their group as the primary source of mentorship. Others seek experienced faculty mentors beyond their hospitalist divisions.25 These traditional dyadic relationships are most familiar, whereas peer mentorship may be overlooked. Some hospitalists may feel they have little to offer a new faculty member, being relatively new to the field themselves. Seasoned mentors offer perspective and networking opportunities, but less experienced hospitalists may be better able to provide practical and timely assistance.20 Hospitalist groups could maintain a Web site listing each faculty member’s previous projects, strengths, and skills to identify group resources. Many programs have had success with collaborative mentorship, in which a group of peers come together over a similar goal, often with the use of a facilitator.23
Other forms of mentorship may help supplement traditional and peer programs. For example, newer hospitalist programs might hire outside experts to consult during a group retreat. Attendance at regional and national meetings can widen the field of available mentors.25 Opportunities such as the Educational Scholars Program may help meet specific mentorship needs.26 Web-based mentorship via the professional societies represents a tremendous, and as yet underused, resource. The SOHM Listserv provides still another source of informal peer mentorship in the Internet age.7 Finally, many hospitalists are parents of young children and may need practical advice on balancing career and family. Our survey did not investigate which types of mentoring are most needed or desired. Further studies at the national or institutional level could help guide the design of mentorship programs.
There are several limitations to this study. Because it involved an anonymous survey, we do not know whether respondents were geographically diverse or if a few large programs were overrepresented. Our study population (ie, the Listserv members) represents a specific demographic that is likely to be more academic and perhaps more invested in hospital medicine as a career. The Listserv does not collect demographic data on its members, so it is difficult to assess the significance of this problem. Combining with the complex care survey may have further increased the number of academic respondents, leading to oversampling of the academic pediatric hospitalist community. Academic hospitalists may feel the most acute need for a mentor, as the non clinical expectations may be unfamiliar and not covered during residency training. Therefore, the survey may not be generalizable to hospitalists as a whole.
In addition, our study was hampered by a low response rate. It is difficult to estimate the true number of Listserv members due to duplicate and inactive accounts. Although there were ∼1100 e-mail addresses on the Listserv in 2009, just 380 “active” members posted to the Listserv that year.27 Other published studies of the Listserv have had similarly low response rates, possibly due in part to this discrepancy.
As a largely new survey instrument, our questions may not have fully captured the key elements of career satisfaction. In particular, many of the potential interventions received lower ratings than expected. Perhaps hospitalists have other suggestions that could have been captured in a free response format. Future surveys could collect additional demographic data such as percent effort in the clinical, educational, research, and administrative areas to further define the relationship between our roles as hospitalists and career satisfaction.
Pediatric hospitalists seem to be fundamentally satisfied with their careers but remain concerned with hospital and administration factors, opportunities for advancement, work–life balance, and compensation. Most concerning to hospitalists is a lack of mentorship, an understandable challenge for this relatively new specialty. In our study, pediatric hospitalists faced mentorship deficits regardless of gender, age, or practice setting. Facilitating formal and informal mentorship programs may be an effective way for hospitalist groups to improve career satisfaction.
FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose.
FUNDING: No external funding.
Preliminary results of this work were presented at the plenary platform session at the Pediatric Hospital Medicine meeting; July 22-25, 2010;Minneapolis, MN.
- American Academy of Pediatrics
- interquartile range
- Physician Work Life Study
- Society of Hospital Medicine
- Section on Hospital Medicine
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- Copyright © 2012 by the American Academy of Pediatrics