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Physicians are drawn to hospital medicine for a number of reasons. The care is action-packed and involves a wide breadth of skill sets. The shifts are often followed by a number of days off, and once you leave the hospital, the workday is done. But as hospitalists age in the profession, these long days filled with acute care can be more difficult.

Hospital systems are trying different ways of retaining aging hospitalists who have an abundance of knowledge that isn’t easy to replace. Not to mention that onboarding new hospitalists and getting them used to the work takes time and resources.

The Trials of Aging as a Hospitalist

Hospital medicine is a young specialty. The term hospitalist only came about in 1996, so we’re just now starting to see physicians who started hospital medicine as their career aging into their sixties.

The burnout rate in hospital medicine is significant due to schedule structure and patient acuity, said Jennifer Caputo-Seidler, MD, an assistant professor of medicine in the Division of Hospital Medicine at the University of South Florida in Tampa, Florida. “It can get pretty grueling when you’re multiple decades into your career,” Caputo-Seidler said.

The most common hospitalist schedule is 7 days on and 7 days off, which can initially be appealing when you’re young but can get more difficult with age. When each shift is 12 hours, that amounts to an 84-hour workweek, which can be extremely challenging even when you’re fresh out of training, and the older you get, the more it wears on you.

It’s also a 24/7 specialty because the hospital, unlike the clinic, isn’t closed during nights and weekends. “The night shift is a big part of the job, and transitioning from working nights can be physically harder as you get older,” said Caputo-Seidler.

The shortage of physicians in general is growing. One study published in the Journal of Graduate Medical Education found that workforce models predict a shortage of physicians in the next decade of between 13 ,500 and 86 ,000.

Hospital work is a particularly vulnerable profession because of the hours. A study published in the Journal of General Internal Medicine found that among millennial hospitalists, “one quarter plan to leave their current job within 1 year, and two thirds intend to do so in the next 5 years.”

In addition to aging in the field, hospital medicine can also be trying when physicians are in the busiest parts of their lives, in the thick of raising children in middle age, said Jensa C. Morris, MD, a hospitalist at Yale New Haven Hospital in New Haven, Connecticut.

“The most challenging time to be a hospitalist over the arc of one’s career is probably when you’re in the middle years of raising a family, when you’re racing against the clock to kid pickups and school drop-offs,” said Morris.

Now that her kids are mostly launched with only one left in the house before college, Morris said she tries to help out colleagues in ways that she couldn’t before, staying late to cover shifts or to do one last procedure so that another colleague who might need to run out for school pickup can do what she once had to do.

Retaining Hospitalists as They Age

No matter whether it’s in middle age when you’re busiest or as you get older and can’t physically do the longest shifts, 1-week-on, 1-week-off schedules can be trying. To combat this, some hospital systems instead require hospitalists to work a certain number of nights and weekends each month, said Sonia P. Dalal, MD, director of hospital medicine education and subinternship director at Johns Hopkins University School of Medicine in Baltimore.

In academic hospital systems like Johns Hopkins, faculty “owe” a certain number of nights and weekends where they’re scheduled based on other scholarly, academic, or family obligations. Additionally, said Dalal, younger faculty can do more shifts, whereas older hospitalists can ease into fewer of them.

“Our younger faculty come in right out of residency and do more time on service, and as you get older, you may find different roles that inspire you or you’re motivated to do, for example, less shift time and more research or education work,” said Dalal.

Additionally, as a hospitalist ages, they may do a combination of hospital shifts, while also rising in the ranks of hospital administration. This is helpful for those hospitalists who entered the field because they wanted to be on the front lines of improving hospital medicine, said Caputo-Seidler. This can be in a leadership role, such as a division chief, quality improvement officer, educational role, or a faculty development role.

Physician assistants and nurses can also be helpful in spreading out some of the items on a hospitalist’s task list. The extent to which advanced medicine practitioners are incorporated into healthcare groups is mixed, but this is an important option to help offset some of the workload as well as help with productivity, especially in hospitals with a large patient volume. It also comes at a lower cost to the hospital than onboarding another physician, said Dalal.

Hospital Medicine as a Career Extender

In some types of hospital medicine, for example, ob/gyn, hospital work can lengthen one’s career because it doesn’t involve the same administrative, clinic, and other obligations that can extend the day, said Lisa Bukovac, DO, who runs the OB Hospitalist Group in Greenville, South Carolina.

“Each shift is a finite period of time, and when the shift is over, the work is done,” said Bukovac. “You’re not having to go home and deal with administrative work, seeing patients in the office, or scheduling patients in the OR [operating room], which makes it a career extender for many physicians.”

Her group employs around 2000 physicians, half of whom are older than 50 years. Many of them spent two decades in private practice doing “all the things” and were approaching burnout, so they made the decision to transition to OB hospitalist work, said Bukovac.

Still, for most hospitalists, there’s no doubt that the shifts and pace can create difficulty with age. At the same time, retaining the breadth of knowledge of these senior physicians is more important than ever.

“It’s about recognizing the value that these seasoned physicians bring and utilizing their expertise for the benefit of the hospital without all their time being directed toward patient care,” said Caputo-Seidler.

Morris reported receiving honoraria from the American Board of Internal Medicine. No other disclosures were reported.