Pros and Cons of Hospitalist Staffing Models

At the Becker's Hospital Review 4th Annual Meeting in Chicago on May 11, Glenn Appelbaum, senior vice president of operations for IPC The Hospitalist Company, discussed various hospitalist staffing models and how switching models can potentially cut costs for hospitals.

According to Mr. Appelbaum, three main components of hospitalist staffing models have emerged as the norm in most healthcare markets:

Traditional model. In this model, hospitalists work about 22 days each month, according to Mr. Appelbaum, and resembles how most traditional physicians schedule their work days – Monday through Friday and one weekend each month.
Seven on, seven off. As the name suggests, in this model, hospitalists work seven days in a row and then have seven days off, and they usually work 12-hour shifts. "The roots came from hospital scheduling," Mr. Appelbaum said, since nurses and emergency room physicians typically work in shifts.
Hybrid model. Hospitalists work anywhere from 16 to 21 days every month in this model.

Mr. Appelbaum then laid out various pros and cons for both the 7x7 model and the traditional model.

7x7 model

• This model can be used as a recruiting tool, as physicians like that they can have a full week off from work.
• There will be a hospitalist in the building for 12 solid hours.
• The hospital has the same staffing level every day, even on weekends.

• The sense of team is lost.
• Two physician leaders are necessary because of the shifts.
• This model can lead to burnout, as many physicians do other work during their seven days off.

Traditional model

• The core team is on-site every weekday.
• Only one physician leader is necessary.
• Fewer patient handoffs happen.

• This model can be difficult to recruit into because there is less time off than the 7x7 model.
• Hospitals will need some "moonlighter" support.

One big pro for the traditional staffing model, according to Mr. Appelbaum, is that it can save most hospitals money if they switch from the 7x7 model, because the further a hospital moves from the 7x7 shift model, less financial support is required from hospitals. Additionally, Mr. Appelbaum argued that using the traditional staffing model can save money because covering a volume of patients in the 7x7 model requires more FTEs than the traditional model.

Overall, both the 7x7 and traditional hospitalist staffing models have their advantages and disadvantages, but the traditional model could be less costly for most hospitals.

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