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Seasonal staffing

Learning how to manage low-census days

May 2024

AFTER EXPERIMENTING with different flexible shift options, the hospitalists with Williamson Health’s Williamson Medical Center in Franklin, Tenn., have turned to seasonal staffing to help right-size the number of physicians onsite.

Their experimentation with flexible scheduling began in 2019. That’s when group members could choose to do eight-hour rounding shifts if they wanted to, in addition to the 12-hour, seven-on/seven-off schedule the group had maintained for years.

The idea was to give colleagues what hospitalist director Bradley Bullock, MD, calls “a real life, even during weeks when they’re working,” including dinner with family. Those who opted for that schedule took a corresponding pay cut—or they worked seven days on with only four days off to boost their earnings.

“We can hire for it. We’re selling this schedule as a feature.”

Bradley Bullock, MD
Williamson Medical Center

But the group killed that eight-hour rounding option after only a year. “The morning folks didn’t have time to finish discharges before they had to leave—and sometimes, sicker patients weren’t rounded on until later in the day,” Dr. Bullock says. “We decided we just couldn’t do that.”

Instead, the group now flexes up or down in staffing depending on the season. For four months (November-February), the hospitalists staff six rounding teams. (Dedicated admitters work 1:30 p.m. to midnight.) But during the other eight months, the number of teams drops to five, allowing those hospitalists who want to work only one week a month (instead of every other week) to do so.

That works out well for people who have children home during the summer or who want to take extended vacations. Not surprisingly, many of the group’s 35 physicians work less than a full-time equivalent. Fortunately, full benefits are available for those working a 0.6 FTE or more.

Low census days
Dr. Bullock also says that Williamson still has some variability in its daily census. Instead of the hospital being at capacity all the time, what the hospitalist group calls “low census days” still crop up, even in winter months.

“That’s triggered by the number of patients that we have at 7 a.m.,” he explains. “If each rounding team doesn’t have 13 patients or more, three teams in the winter, two teams in the other months, can go home early.” On such days, one team will leave after eight hours while the others can leave after 10 hours. The hospitalists leaving early get their pay docked for the hours they don’t work.

But low-census days are cancelled if, during the day, it’s clear that the ED is getting slammed with patients and waiting admissions. “We pivot and we make that decision at 2 p.m., which is when the first person would be eligible to leave,” Dr. Bullock points out. “Sometimes, the people we planned on leaving early end up going to the ED in the afternoon to see patients instead.”

Many group members stick with their full-time seven-on/seven-off schedule year round. But the ones who opt to work fewer weeks in the slower months love the flexibility. “Now that we’ve got this established,” Dr. Bullock says, “we can hire for it. We’re selling this schedule as a feature.”