A study has found that hospitalists' working hours have increased, and their working conditions have deteriorated since the government-doctor conflict began 10 months ago. Some 34 percent of hospitalists said they would resign if the conflict continued for long.
Based on these surveys, experts called for increasing the number of auxiliary personnel to support hospitalists who exclusively take care of inpatients and improve the system, including financial rewards.
A team of researchers from the medical colleges of Soon Chun Hyang University, Yonsei University, Seoul National University, and Inha University has published a study, “[**Changes in the Work Patterns of Hospitalists in South Korea Following Medical School Expansion**](https://ekjm.org/journal/view.php?doi=10.3904/kjm.2024.99.6.315),” in the Korean Journal of Medicine.
A new survey shows that 34 percent of inpatient specialists are willing to resign if the government-doctor conflict continues for long. (Credit: Getty Images)
The researchers noted that since February 2024, specialists have been continuously recruited as trainee doctors continue to leave. This is the first time that inpatient specialists have been put into the field to replace them. The team looked at how hospitalists' workloads have changed in the current situation compared to before the conflict’s outbreak.
The researchers conducted an online survey of 63 members of the Korean Society of Hospital Medicine and the Korean Society of Surgery Hospital Medicine Study Group from April 2 to 30. Fifty-eight were internal medicine hospitalists, and five were surgical hospitalists. Of these, 77.8 percent worked in tertiary care hospitals, and 22.2 percent worked in general hospitals.
The survey results showed that hospitalists' working environment has changed since the exit of trainee doctors, including an increase in working hours.
Among them, the number of type 3 hospitalists working 24/7 increased from 14 (22.2 percent) to 25 (49.7 percent) before the conflict. In contrast, the number of type 1 hospitalists working daytime hours, five days a week, decreased from 38 (60.3 percent) to 33 (52.4 percent). Type 2 placements working seven days a week decreased from 10 (15.9 percent) to four (6.3 percent).
The median working hour before the residency exodus was 40, and it has since increased to 45.
The number of patients treated per person has also changed. Before the conflict, the number of hospitalists seeing fewer than 10 patients increased from six (9.5 percent) to 13 (20.6 percent), and those seeing 26 or more patients increased from two (3.2 percent) to five (7.9 percent). In contrast, the number of physicians seeing 11 to 15 patients decreased from 32 (50.8 percent) to 24 (38.1 percent).
Despite the changes in the working environment for hospitalists, some reported worsening working conditions, such as not having enough staff to support them or not being paid for extra work.
Thirty-four respondents, or 54.8 percent, said they had no additional supporting staff. Besides, 58.6 percent (37) said they were not paid overtime.
Asked what duties had increased, 83.9 percent (52 respondents) reported an increase in basic skills, 45.2 percent (28 respondents) reported an increase in the number of nights they worked, and 45.2 percent (28 respondents) reported an increase in the number of nights they worked.
They also reported being dispatched to the ER (9.7 percent) or seeing ICU patients (9.7 percent), while 16.1 percent reported increasing Rapid Response Team duties. Nineteen hospitalists, or 30.2 percent, worked in wards other than the one they were assigned to, as the ward system was relaxed in response to the emergency.
When asked about the change in the number of hospitalists after the conflict, 78.7 percent (48 respondents) said there was no change. However, 14.8 percent (nine respondents) reported a decrease, and 6.6 percent (four respondents) reported an increase.
Of the respondents, 33.9 percent (21) said they would resign if the conflict continued. 27.4 percent (17) said they would stay on, and 38.7 percent (24) said they didn't know.
“In the 2022 National Survey of Hospitalists, 81 percent said they would continue their careers as hospitalists. However, in this survey, 33 percent said they would resign if the crisis prolongs,” the researchers said. “We can speculate that overwork and burnout among hospitalists may be one of the reasons.”
With the departure of trainee doctors in the wake of the medical school expansion, hospitalists are exposed to increased workload and burnout. However, systems to support their work, such as staffing and compensation, are not being implemented quickly enough, and it is predicted that the inpatient care system in training hospitals may collapse as hospitalists resign in response to the prolonged crisis, they added.