Determinants of Career Satisfaction Among Pediatric Hospitalists: A Qualitative Exploration

Abstract

Objectives To characterize determinants of career satisfaction among pediatric hospitalists working in diverse practice settings, and to develop a framework to conceptualize factors influencing career satisfaction. Methods Semi-structured interviews were conducted with community and tertiary care hospitalists, using purposeful sampling to attain maximum response diversity. We employed close- and open-ended questions to assess levels of career satisfaction and its determinants. Interviews were conducted by telephone, recorded, and transcribed verbatim. Emergent themes were identified and analyzed using an inductive approach to qualitative analysis. Results A total of 30 interviews were conducted with community and tertiary care hospitalists, representing 20 hospital medicine programs and 7 Northeastern states. Qualitative analysis yielded 657 excerpts which were coded and categorized into four domains and associated determinants of career satisfaction: (i) professional responsibilities; (ii) hospital medicine program administration; (iii) hospital and healthcare systems; and (iv) career development. While community and tertiary care hospitalists reported similar levels of career satisfaction, they expressed variation in perspectives across these four domains. While the role of hospital medicine program administration was consistently emphasized by all hospitalists, community hospitalists prioritized resource availability, work schedule and clinical responsibilities while tertiary care hospitalists prioritized diversity in non-clinical responsibilities and career development. Conclusions We illustrate how hospitalists in different organizational settings prioritize both consistent and unique determinants of career satisfaction. Given associations between physician satisfaction and healthcare quality, efforts to optimize modifiable factors within this framework, at both community and tertiary care hospitals, may have broad impacts.

Career Motivators for Community Pediatric Hospitalists

“…Perhaps more interestingly, unlike previous studies, 6,10 the most frequently cited motivator for community pediatric hospitalists in our study was professional impact, a theme that consists exclusively of nonclinical subthemes. We found that there are ample opportunities for career growth at community sites, including in the areas of scholarship and leadership.…”

“…6 In a different study, researchers found that community PHM physicians prioritized resource availability, work schedules, and clinical responsibilities over nonclinical responsibilities and career development. 10 Although the physicians in our study were also motivated by work-life integration and various clinical responsibilities as seen in the themes of personal and professional satisfaction and scope of practice, income was not mentioned as a motivating factor.…”

Epidemiology of pediatric hospitalizations at general hospitals and freestanding children's hospitals in the United States

“…At GHs, research and QI efforts focused on common conditions are needed to increase our knowledge of contextually relevant barriers to and facilitators of high‐quality pediatric care. This, however, can be made more difficult by small sample sizes, limited resources, and infrastructure, and competing priorities in adult‐focused GH settings . Multihospital learning collaboratives and partnerships between FCHs and GHs can begin to address these challenges, but their success is contingent upon national advocacy and funding to support pediatric research and quality measures at GHs.…”

Graduating Pediatric Residents Entering the Hospital Medicine Workforce, 2006–2015

“…Hospitalists working at community hospitals may experience several unique opportunities and challenges, including limited pediatric-specific equipment and skills among non-hospitalist colleagues, increased needs to advocate to administration for child health, and needs to address pediatric safety and quality improvement in adult-oriented settings. 15,17,18 PHM fellowship training can provide valuable skills for addressing these opportunities, provided that there is flexibility in the fellowship curricula to support training across the structurally diverse hospitals where children receive hospital care. 19 Relative to residents entering subspecialty fellowships, we found that residents' family situation, geographic location preferences, and level of educational debt were strongly associated with decisions to enter PHM.…”