Thriving and surviving in a new medical career: the case of hospitalist physicians.

Managed care is cultivating a variety of new work careers within the medical profession, and it is worth asking whether they will function as long- or shorter-term career options for the individuals who participate in them. This paper uses the specific case of hospitalist physicians to explore how the surrounding social and economic work contexts contribute to two individual-level outcomes that inform the issue of career longevity: the concepts of burnout and intent to stay in the career. The findings of a national survey of hospitalists reveal that job burnout and intent to remain in the career are more meaningfully associated with favorable social relations involving colleagues, co-workers, and patients than with negative experiences related to the economically induced pressures of the job, such as reduced autonomy and the use of financial incentives. In addition, career longevity is enhanced by the extent to which individual physicians pursue intrinsic and extrinsic rewards through their choices to become hospitalists. These findings demonstrate that sociologists should pay greater attention to the career trajectories of contemporary doctors in order to understand larger scale professional stratification within medicine. They also offer empirical support for redirecting our focus towards the relational dynamics that shape these trajectories.