Is Greater Physician Workload Worth the Cost?

Summary and Comment |
July 14, 2014

Is Greater Physician Workload Worth the Cost?

  1. Raymund B. Dantes, MD, MPH and
  2. Daniel D. Dressler, MD, MSc, SFHM, FACP

Higher hospitalist inpatient census is associated with longer hospital stays and higher costs.

  1. Raymund B. Dantes, MD, MPH and
  2. Daniel D. Dressler, MD, MSc, SFHM, FACP

What is the relation among physician workload, quality of care, and efficiency? To answer this question, researchers in Delaware conducted a retrospective cohort study of 20,241 inpatient admissions to their (primarily nonteaching) hospitalist services at two hospitals (1 tertiary care, 1 community; 1071 total beds). Outcomes were adjusted for multiple factors, including severity of illness, provider continuity, hospital occupancy, and test turnaround time.

On average, hospitalists managed 15 patients and accrued 29 Relative Value Units (RVUs) billed daily. As census and RVUs increased, both hospital length of stay (LOS) and cost of hospitalization increased. Cost per hospitalization and LOS increased for each additional patient managed, although the rate of increase depended on total hospital occupancy. Average patient LOS was 2 days longer and average cost was more than US$5000 higher for a hospitalist with 22 patients daily versus a hospitalist with 11 patients daily. Increasing hospitalist census did not significantly affect patient satisfaction or care quality measures (in-hospital mortality, 30-day readmission rates, or number of rapid response team activations).


As hospitalist employers and hospital administrators address the efficiency and costs of their systems and networks, they will need to incorporate the effect of inpatient physician workload. This study quantifies the widely held presumption that a higher physician inpatient census leads to less-efficient care, and the results should have implications on staffing practices and number of patients cared for by individual clinicians.

Dr. Dantes is an Assistant Professor of Medicine at Emory University School of Medicine in Atlanta, Georgia.

Editor Disclosures at Time of Publication

  • Disclosures for Daniel D. Dressler, MD, MSc, SFHM, FACP at time of publication Editorial boards Hospital Medicine Reviews; Journal of Hospital Medicine


Reader Comments (3)

Melinda Allen,DO Physician, Hospital Medicine, Oklahoma

No surprise. When my census goes up the hospital census also goes up, the nurse to patient ratio goes up, the physical therapist to patient ratio goes up. With high inpatient census quality of care goes down. Often the delay in discharge is not due to my care but due to the lack of care the patient received over their stay. But yes, when I have had 6 admissions and 6 discharges and rounded on 6 CCU patients that day, one more discharge is often a task that can be put off until tomorrow.


When doctors give up their centuries old independence for
"convenience" and to "have someone else take care of the
hassles" guess what happens? Yep, you become a cow
being milked for all you have. The greed will never stop nor
improve as greed begets greed.

Thomas F, Kline, MD PhD
38 years and still independent

JAMES CORSONES Physician, Internal Medicine, Health Alliance of the Hudson Valley, Kingston, NY

After three years as a hospitalist following 28 years in private practice, your numbers definitely seem realistic and consistent with our hospital's experience. The problem is reimbursement in an ever demanding environment where administrators are trying to squeeze out more productivity with fewer staff. However, on those rare days when the census per provider is close to 20, it is impossible to see patients in a timely enough manner to efficiently deliver quality care and keep LOS down.

Your Comment

(will not be published)

Filtered HTML

  • Allowed HTML tags: <a> <em> <strong> <cite> <blockquote> <code> <ul> <ol> <li> <dl> <dt> <dd>
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.

Plain text

  • No HTML tags allowed.
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.
Do you have any conflict of interest to disclose?
This question is for testing whether you are a human visitor and to prevent automated spam submissions.

Vertical Tabs

* Required

Reader comments are intended to encourage lively discussion of clinical topics with your peers in the medical community. We ask that you keep your remarks to a reasonable length, and we reserve the right to withhold publication of remarks that do not meet this standard.

PRIVACY: We will not use your email address, submitted for a comment, for any other purpose nor sell, rent, or share your e-mail address with any third parties. Please see our Privacy Policy.