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Scheduling surgical hospitalists

Hospitalist Leadership Connection, September 21, 2010

Scheduling a night shift surgeon who has no responsibility the day before or after the night shift should reduce surgeon burnout and fatigue-related errors. This may be prohibitively expensive in small practices, but it becomes more financial viable for larger practices. Hospitals with Level I and II trauma designation must have a trauma surgeon in-house around the clock, and in many cases, the surgical hospitalist will fulfill this role. In most practices that cover one hospital and have a dedicated night shift, the night shift doctor is expected to be in the hospital for the entire shift. If the surgical hospitalists cover more than one hospital at night, they are usually on call for each hospital, with the expectation that they will be working most of each night and not trying to sleep at home.

In smaller practices, the surgical hospitalist usually manages night call by pager from outside the hospital. Many of these practices have the surgical hospitalist(s) alternate night call with other local surgeons in traditional practice, since a one- or two-person surgical hospitalist practice may not be able to manage all of the night call without additional help. If there are no other local surgeons available to participate in a shared night coverage arrangement with the surgical hospitalists, there are several options to consider:

• Surgical resident or fellows
• In-hospital medical hospitalists who serve as first responders but call the surgical hospitalist when needed
• Increase the volume of night work to support increased surgical hospitalist staffing at night
• Nonphysician providers such as nurse practitioners or physician assistants

The above excerpt is adapted from The Surgical Hospitalist Program Management Guide: Tools and Strategies for Executives and Physicians, by John Nelson, MD, FACP; John Maa, MD, FACS; and foreword by Robert M. Wachter, MD, published by HCPro, Inc. Download a free sample chapter online at www.HCMarketplace.com.
 

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