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Ask the expert: How will we decide how many hospitalists we need?

Hospitalist Leadership Connection, February 8, 2011

It is important for a practice to develop its staffing plan based on a projection of the workload. Most candidates will want to know how many hospitalists there are on staff, as well as how many patients they will be expected to see each day.

Begin with some projection of the number of total expected daily patient encounters.

Many hospitals conduct a survey of their medical staffs to get a baseline of how many patients their doctors will refer to the hospitalist service. After conducting the survey, the hospital can gather the historical admitting patterns of each doctor who indicated that he or she would refer all or a portion of his or her patients to the hospitalist service. The hospital can then reasonably estimate the gross number of patients that might be referred to the hospitalist service.

The hospitalist program should research how many unassigned patients are admitted through the emergency department. Many hospitalists programs are responsible for all the unassigned patient care. In other institutions, however, newly recruited primary care physicians depend on this pool of unassigned patients to build their practices. In these situations, the hospitalists participate in a call rotation to receive emergency department patient admissions. The practice should then attempt to estimate the number of consults and comanaged surgical cases the hospitalists might be asked to perform. Finally, any other work duties defined as hospitalist work should be quantified and added to the total estimation of the workload. Once this projection is complete, the program must decide how the work will be divided amongst the hospitalists.

Consider the following tips for staffing and workload:
•    Design a plan that estimates the total patients encounters per day
•    Conduct a survey of the estimated number of referrals to the hospitalist service
•    Estimate the number of assigned emergency patient consults
•    Estimate other miscellaneous work

The above excerpt is adapted from Practical Guide to Hospitalist Recruitment and Retention, by Kirk Mathews, MBA, and John Nelson, MD, FACP, FHM, published by HCPro, Inc.

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