Chair

This has been an extraordinary year for CHEST, particularly in the core area of clinical education. In the past fiscal year, we exceeded our educational goals. We set out to reach 10,000 learners through educational programming including live courses and conferences, and online activities; in the end, we served 15,547.

Other goals accomplished include demonstrating a significant increase in average learner knowledge acquisition and procedural skills improvement; identifying top priorities for online offerings and delivering five stand-alone online modules that can serve as a point of entry to wider audiences; recording professional attendance at CHEST 2015 of 5,149 people; offering online training for guideline development and the panelists engaged in CHEST guidelines; achieving an attendance at CHEST World Congress in Shanghai of 2,089; and working with leading Chinese medical societies to see the China-CHEST Pulmonary and Critical Care Medicine Fellowship Program formally adopted by the government in China as one of the four first-ever subspecialty training programs to be implemented nationwide.

This is a lot!

These accomplishments depend on intense work and collaboration between our incredibly talented faculty and volunteers from among CHEST membership and CHEST’s amazing professional staff of 105 employees, of which 28 are dedicated full time to the development and delivery of education and best practices. Through this partnership, we continue to meet CHEST’s mission: To champion the prevention, diagnosis, and treatment of chest diseases through education, communication, and research.

Without these dedicated women and men, CHEST would be utterly unable to complete its mission. Our faculty work in a vast array of opportunities, including writing questions for SEEK, serving as a content expert for guidelines, proposing and delivering sessions at CHEST, running Board Review courses, recording videos, facilitating hands-on simulation sessions, and more. While intrinsically gratifying, there are many difficult elements to such work, requiring commitment that begins long before the delivery of an event or the launch of a new activity. Reviewing existing literature and knowledge on a topic to determine whether an activity will meet the needs of our membership; coming up with valid learning objectives; generating just the right multiple choice questions and other assessments to measure our success at helping learners reach those objectives; peer reviewing content to ensure we’re teaching to the latest science and established best practices; and then measuring learner outcomes – these elements put the “state of the art” into CHEST’s internationally recognized state-of-the-art educational program.

To achieve our mission, we have been asking CHEST’s valiant and dedicated volunteers to do more than ever before, and some of what we have asked them to do has been frustrating, tedious, and less than rewarding. The reasons for this are many, including the imperfect technology platforms we’ve asked our volunteers to use; the disconnect between the educational goals we have set and the implementation of the clear processes, communication, and on-boarding of staff required to support them; and the lag of recognition proportionate to the nature of these new asks.

So, how do we show our member-faculty that they are our most important resource? Recently, we have had internal discussions about how to acknowledge the priceless contributions made by our faculty volunteers. To that end, CHEST staff and volunteer leadership have developed a Faculty & Volunteer Treatment Action Plan, recently approved by the CHEST Board of Regents. This is part of our comprehensive “six F’s” plan:

Formal recognition and rewards. Recognition and rewards are different – but both important. Recognition is expressing gratitude for an expected job that was well done and includes a formal thank-you. Rewards are additional, tangible benefits for exceptional services. We now have enhanced guidelines for travel, honoraria, and amenities for our volunteer faculty. Also of note, two new awards will be bestowed annually beginning at CHEST 2017 Los Angeles – the Early Career Clinician Educator Award and the Master Clinician Educator Award. These are some additional ways we will more appropriately highlight the people who have helped make us CHEST, the leader in clinical education in chest medicine.

Feedback. In addition to learner satisfaction data, CHEST provides an unprecedented level of learner outcomes data to our faculty. We are even introducing a new peer-review of teaching (PRT) program so faculty can get even more feedback from expert colleagues.

Faculty Development. As an education-focused organization, training and development plays a foundational role. We are working to develop a comprehensive clinician educator program that will grow our bench of faculty. A newly launched database will more proactively track and match interested members with teaching opportunities within the organization.

Face Time. Easy access to leadership and staff is important. We are implementing staff training that will better position all CHEST employees to more effectively facilitate and support the work we ask of our faculty. On another front, we are engaged in identifying new, user-friendly systems for session submission, conflict of interest disclosure, and review, as well as developing content.

Food. It is a simple but well-established fact that having a stocked lounge area for busy faculty on the run between teaching sessions enhances efficiency, communication, camaraderie, and overall morale.

Fun. The fun of discovering better ways to take care of our patients, be it from the teacher or learner perspective, in an engaging, effective learning environment is and always has been at the center of what we do.

CHEST’s volunteer leaders, in service to their peers, the field, and the organization, have risen to many challenges over and over again. We realize we need to do a better job of rewarding and recognizing their irreplaceable contributions. The above initiatives, and others, we hope, will help demonstrate to our most precious resource, our member-faculty, that we truly value and appreciate their invaluable contributions on behalf of CHEST. Stay tuned and stay with us.

This has been an extraordinary year for CHEST, particularly in the core area of clinical education. In the past fiscal year, we exceeded our educational goals. We set out to reach 10,000 learners through educational programming including live courses and conferences, and online activities; in the end, we served 15,547.

Other goals accomplished include demonstrating a significant increase in average learner knowledge acquisition and procedural skills improvement; identifying top priorities for online offerings and delivering five stand-alone online modules that can serve as a point of entry to wider audiences; recording professional attendance at CHEST 2015 of 5,149 people; offering online training for guideline development and the panelists engaged in CHEST guidelines; achieving an attendance at CHEST World Congress in Shanghai of 2,089; and working with leading Chinese medical societies to see the China-CHEST Pulmonary and Critical Care Medicine Fellowship Program formally adopted by the government in China as one of the four first-ever subspecialty training programs to be implemented nationwide.

This is a lot!

These accomplishments depend on intense work and collaboration between our incredibly talented faculty and volunteers from among CHEST membership and CHEST’s amazing professional staff of 105 employees, of which 28 are dedicated full time to the development and delivery of education and best practices. Through this partnership, we continue to meet CHEST’s mission: To champion the prevention, diagnosis, and treatment of chest diseases through education, communication, and research.

Without these dedicated women and men, CHEST would be utterly unable to complete its mission. Our faculty work in a vast array of opportunities, including writing questions for SEEK, serving as a content expert for guidelines, proposing and delivering sessions at CHEST, running Board Review courses, recording videos, facilitating hands-on simulation sessions, and more. While intrinsically gratifying, there are many difficult elements to such work, requiring commitment that begins long before the delivery of an event or the launch of a new activity. Reviewing existing literature and knowledge on a topic to determine whether an activity will meet the needs of our membership; coming up with valid learning objectives; generating just the right multiple choice questions and other assessments to measure our success at helping learners reach those objectives; peer reviewing content to ensure we’re teaching to the latest science and established best practices; and then measuring learner outcomes – these elements put the “state of the art” into CHEST’s internationally recognized state-of-the-art educational program.

To achieve our mission, we have been asking CHEST’s valiant and dedicated volunteers to do more than ever before, and some of what we have asked them to do has been frustrating, tedious, and less than rewarding. The reasons for this are many, including the imperfect technology platforms we’ve asked our volunteers to use; the disconnect between the educational goals we have set and the implementation of the clear processes, communication, and on-boarding of staff required to support them; and the lag of recognition proportionate to the nature of these new asks.

So, how do we show our member-faculty that they are our most important resource? Recently, we have had internal discussions about how to acknowledge the priceless contributions made by our faculty volunteers. To that end, CHEST staff and volunteer leadership have developed a Faculty & Volunteer Treatment Action Plan, recently approved by the CHEST Board of Regents. This is part of our comprehensive “six F’s” plan:

Formal recognition and rewards. Recognition and rewards are different – but both important. Recognition is expressing gratitude for an expected job that was well done and includes a formal thank-you. Rewards are additional, tangible benefits for exceptional services. We now have enhanced guidelines for travel, honoraria, and amenities for our volunteer faculty. Also of note, two new awards will be bestowed annually beginning at CHEST 2017 Los Angeles – the Early Career Clinician Educator Award and the Master Clinician Educator Award. These are some additional ways we will more appropriately highlight the people who have helped make us CHEST, the leader in clinical education in chest medicine.

Feedback. In addition to learner satisfaction data, CHEST provides an unprecedented level of learner outcomes data to our faculty. We are even introducing a new peer-review of teaching (PRT) program so faculty can get even more feedback from expert colleagues.

Faculty Development. As an education-focused organization, training and development plays a foundational role. We are working to develop a comprehensive clinician educator program that will grow our bench of faculty. A newly launched database will more proactively track and match interested members with teaching opportunities within the organization.

Face Time. Easy access to leadership and staff is important. We are implementing staff training that will better position all CHEST employees to more effectively facilitate and support the work we ask of our faculty. On another front, we are engaged in identifying new, user-friendly systems for session submission, conflict of interest disclosure, and review, as well as developing content.

Food. It is a simple but well-established fact that having a stocked lounge area for busy faculty on the run between teaching sessions enhances efficiency, communication, camaraderie, and overall morale.

Fun. The fun of discovering better ways to take care of our patients, be it from the teacher or learner perspective, in an engaging, effective learning environment is and always has been at the center of what we do.

CHEST’s volunteer leaders, in service to their peers, the field, and the organization, have risen to many challenges over and over again. We realize we need to do a better job of rewarding and recognizing their irreplaceable contributions. The above initiatives, and others, we hope, will help demonstrate to our most precious resource, our member-faculty, that we truly value and appreciate their invaluable contributions on behalf of CHEST. Stay tuned and stay with us.

This has been an extraordinary year for CHEST, particularly in the core area of clinical education. In the past fiscal year, we exceeded our educational goals. We set out to reach 10,000 learners through educational programming including live courses and conferences, and online activities; in the end, we served 15,547.

Other goals accomplished include demonstrating a significant increase in average learner knowledge acquisition and procedural skills improvement; identifying top priorities for online offerings and delivering five stand-alone online modules that can serve as a point of entry to wider audiences; recording professional attendance at CHEST 2015 of 5,149 people; offering online training for guideline development and the panelists engaged in CHEST guidelines; achieving an attendance at CHEST World Congress in Shanghai of 2,089; and working with leading Chinese medical societies to see the China-CHEST Pulmonary and Critical Care Medicine Fellowship Program formally adopted by the government in China as one of the four first-ever subspecialty training programs to be implemented nationwide.

This is a lot!

These accomplishments depend on intense work and collaboration between our incredibly talented faculty and volunteers from among CHEST membership and CHEST’s amazing professional staff of 105 employees, of which 28 are dedicated full time to the development and delivery of education and best practices. Through this partnership, we continue to meet CHEST’s mission: To champion the prevention, diagnosis, and treatment of chest diseases through education, communication, and research.

Without these dedicated women and men, CHEST would be utterly unable to complete its mission. Our faculty work in a vast array of opportunities, including writing questions for SEEK, serving as a content expert for guidelines, proposing and delivering sessions at CHEST, running Board Review courses, recording videos, facilitating hands-on simulation sessions, and more. While intrinsically gratifying, there are many difficult elements to such work, requiring commitment that begins long before the delivery of an event or the launch of a new activity. Reviewing existing literature and knowledge on a topic to determine whether an activity will meet the needs of our membership; coming up with valid learning objectives; generating just the right multiple choice questions and other assessments to measure our success at helping learners reach those objectives; peer reviewing content to ensure we’re teaching to the latest science and established best practices; and then measuring learner outcomes – these elements put the “state of the art” into CHEST’s internationally recognized state-of-the-art educational program.

To achieve our mission, we have been asking CHEST’s valiant and dedicated volunteers to do more than ever before, and some of what we have asked them to do has been frustrating, tedious, and less than rewarding. The reasons for this are many, including the imperfect technology platforms we’ve asked our volunteers to use; the disconnect between the educational goals we have set and the implementation of the clear processes, communication, and on-boarding of staff required to support them; and the lag of recognition proportionate to the nature of these new asks.

So, how do we show our member-faculty that they are our most important resource? Recently, we have had internal discussions about how to acknowledge the priceless contributions made by our faculty volunteers. To that end, CHEST staff and volunteer leadership have developed a Faculty & Volunteer Treatment Action Plan, recently approved by the CHEST Board of Regents. This is part of our comprehensive “six F’s” plan:

Formal recognition and rewards. Recognition and rewards are different – but both important. Recognition is expressing gratitude for an expected job that was well done and includes a formal thank-you. Rewards are additional, tangible benefits for exceptional services. We now have enhanced guidelines for travel, honoraria, and amenities for our volunteer faculty. Also of note, two new awards will be bestowed annually beginning at CHEST 2017 Los Angeles – the Early Career Clinician Educator Award and the Master Clinician Educator Award. These are some additional ways we will more appropriately highlight the people who have helped make us CHEST, the leader in clinical education in chest medicine.

Feedback. In addition to learner satisfaction data, CHEST provides an unprecedented level of learner outcomes data to our faculty. We are even introducing a new peer-review of teaching (PRT) program so faculty can get even more feedback from expert colleagues.

Faculty Development. As an education-focused organization, training and development plays a foundational role. We are working to develop a comprehensive clinician educator program that will grow our bench of faculty. A newly launched database will more proactively track and match interested members with teaching opportunities within the organization.

Face Time. Easy access to leadership and staff is important. We are implementing staff training that will better position all CHEST employees to more effectively facilitate and support the work we ask of our faculty. On another front, we are engaged in identifying new, user-friendly systems for session submission, conflict of interest disclosure, and review, as well as developing content.

Food. It is a simple but well-established fact that having a stocked lounge area for busy faculty on the run between teaching sessions enhances efficiency, communication, camaraderie, and overall morale.

Fun. The fun of discovering better ways to take care of our patients, be it from the teacher or learner perspective, in an engaging, effective learning environment is and always has been at the center of what we do.

CHEST’s volunteer leaders, in service to their peers, the field, and the organization, have risen to many challenges over and over again. We realize we need to do a better job of rewarding and recognizing their irreplaceable contributions. The above initiatives, and others, we hope, will help demonstrate to our most precious resource, our member-faculty, that we truly value and appreciate their invaluable contributions on behalf of CHEST. Stay tuned and stay with us.

Always searching for new ways to enhance the value of SHM membership, the SHM Membership Committee has created several task forces to work on special projects.

Designed to build upon the success of the Annual Meeting’s Mentorship Breakfast (a one-time opportunity for SHM members to meet with experienced hospitalist clinicians and leaders), the Mentorship Task Force was convened to study opportunities to expand the use of mentoring programs for SHM members. The task force has suggested mechanisms on how to assist SHM local chapter leaders, suggestions that have resulted in the creation of recurrent conference calls between members of the Midwest Region Council and local chapter leaders in the Midwest. The Task Force has also studied creating a yearlong longitudinal mentoring program on leadership skills and continues to work on this project.

The Industry Support of Local Chapters Task Force is critically looking at the role of industry sponsorship of local chapter activities. This task force (comprising participants from the SHM Ethics and Membership Committees, Regional Councils, and local chapters) is studying two issues:

1. How to assist local leaders in finding and securing sponsorship for chapter functions, and
2. How to create a process to review industry sponsored grants to support local chapter meetings.

Preliminary recommendations from this task force include additions and revisions to the SHM Local Chapter Handbook about strategies and techniques to employ when negotiating with industry representatives.

Finally, the Family Practice Task Force was recently convened to study how family practice hospitalists differ from their internal-medicine-trained colleagues. Initial efforts will focus on gathering data about family-practice-trained hospitalists, defining the unique skill set that family practice has to offer hospital medicine, and reviewing the post-graduate medical training needs of family practitioner hospital medicine physicians.

In addition to these task forces, the Membership Committee will launch a new research initiative. During 2006 SHM members will be invited to share their opinions on a variety of topics via electronic surveys. Data from each survey will be regularly shared with SHM leadership for review and use in future planning.

Your support of SHM has played a vital role in helping the society to assume the leadership position that it currently holds in the hospital medicine community. Your continued support will enable us to continue to grow and provide each member with the tools they need to best serve their patients and grow their practices in the process.

Ethics Policies Revised

Real and potential conflicts addressed in revisions

By Tom Baudendistel, MD, FACP, chair, SHM Ethics Committee

Conflicts of interest have been the major theme of the SHM Ethics Committee this past year. As SHM has grown into a major force shaping healthcare policy, the need for transparency in all of the organization’s endeavors has never been greater. Rather than being reactive to individual issues that arise, the ethics committee has adopted a proactive stance in identifying potential areas of tension. Building on the general guidelines of the 2003 SHM “Principles for Organizational Relationships,” this year’s ethics committee has refined SHM policies to address the latest real and potential conflicts of interest in several areas: the Annual Meeting Abstract competitions, the Journal of Hospital Medicine, and the SHM Board.

Prior to the 2005 Annual Meeting, chairs of the Research, Innovations, and Vignettes (RIV) Committees augmented previous disclosure policy in requiring more transparent and detailed statements of disclosure from authors submitting abstracts to the national meeting. Anjala Tess, MD, and Sunil Kripilani, MD, took the lead in this initiative, preserving the integrity of the academic process while shielding the SHM RIV competition from potential misuse by third parties.

Later in 2005, in preparation for publication of the Journal of Hospital Medicine, the ethics committee worked with the editors to develop a policy regarding potential conflicts of interest between the journal’s editors, editorial board, reviewers, and authors. Ethical dilemmas within academic journals generally arise in two main areas: academic or financial. An example of the former would include an editor or a reviewer who might benefit from affiliation with the authors or from the publication of material contained in a manuscript. Financial conflicts might arise when, for instance, an editor or author receives monetary support from an industry source and selectively publishes only manuscripts that cast the sponsoring company in a favorable light.

The SHM Ethics committee contacted editors from major journals, including Annals of Internal Medicine, Journal of the American Medical Association, The New England Journal of Medicine, and The American Journal of Medicine, and consulted the International Committee of Medical Journal Editors before crafting a policy for the Journal of Hospital Medicine’s Editorial Board. This policy directs JHM to obtain annual disclosure of potential academic and financial conflicts from its editors and editorial board members, and requests similar information from its authors and reviewers on an article-by-article basis. Thanks to Brian Harte, MD, and Don Krause, MD, for their leadership in this process.

More recently, the SHM Ethics Committee was asked to join the SHM Task Force to identify areas of potential conflict for the SHM Board. As leaders of a major organization in U.S. medical care, members of the board are obvious targets of outside interests including healthcare or pharmaceutical industry, legal associations, and other organizations to represent those outside parties’ viewpoints—either implicitly or explicitly. Should the leaders of SHM participate in malpractice litigation involving hospitalists? What restrictions should SHM place on its board members pertaining to relationships with outside academic and industry organizations? Should SHM accept funding from industry to support regional and national meetings? Should the SHM board endorse pay-for-performance initiatives? How should hospitalist scope of practice be defined?

The answers to these and similar questions will guide SHM policy in the coming years, and the SHM Ethics Committee will be there every step of the way.

The SHM Ethics Committee is now 15 members strong and continues to convene regularly via conference calls and as a group at the Annual Meeting. Check out the recent article by Erin Egan, MD, in The Hospitalist discussing the safe and ethical care of disaster victims (Jan. 2006, p. 10), or attend the “Ethical Dilemmas in the ICU” talk at the upcoming critical care precourse at the Annual Meeting on May 3 at 9 a.m. to catch other glimpses of the committee’s work. With the continued support and membership from SHM members, the committee aims to chart a clear and ethically acceptable course for SHM for years to come.

Quality of Work-Life Tools

An interim report from the SHM Career Satisfaction Task Force

By Sylvia McKean, MD, Tosha Wetterneck, MD, and Win Whitcomb, MD

A variety of career satisfaction issues threaten the evolution of hospital medicine as a specialty. These issues are analogous to the experience of other, well-established specialties essential to the smooth functioning of a hospital, including critical care and emergency medicine.

Hospitalists encounter daily disruptions in their workflow due to the unpredictability of acute medical illness, paging interruptions that require immediate attention, and an increasing variety of other demands on their time in an already stressed healthcare system. In addition, hospitalist services staffed with junior physicians may not have input into the patients triaged to their service or how the service is structured. They may encounter changing job descriptions as hospital administrators in charge of their salaries rely upon them to solve important problems.

Hospitalists face conflict as they try to control their work life. The role of the hospitalist has evolved from direct patient care, to improving throughput and related outcomes, and increasingly to one of leadership, quality improvement, and teaching. The challenges of this discipline continue to expand exponentially. In addition, community hospitals rely upon academic hospitalist programs to train and recruit physicians into the field of hospital medicine. Academic hospitalist services, therefore, need to ensure time to mentor trainees and serve as role models that hospital medicine is a satisfying, respected, and sustainable career.

In 2005 SHM’s career satisfaction task force reviewed available literature and started developing a series of chapters relating to the following “domains” related to job satisfaction:

• Control/autonomy;
• Workload/schedule;
• Reward/recognition; and
• Community/environment.

These chapters acknowledge that on-the-job challenges should be viewed from two different but related perspectives: the individual hospitalist and the hospital medicine group/service. Neither the individual nor the hospitalist service can work independently of the other because cohesiveness among hospitalist members is critical to promoting job satisfaction for the service. The task force is developing a career satisfaction tool kit consisting of individual and group self-assessment questionnaires and preventive strategies. Specific case examples from the academic and community settings will be provided to avoid pitfalls and false starts when seeking a job in hospital medicine or when responding to pressures in the hospital.

SHM has also funded additional research into career satisfaction under the leadership of Tosha Wetterneck, MD, from the University of Wisconsin Hospital and Clinic. Joe Miller, SHM senior vice president, and professional writer Phyllis Hanlon have joined the Career Satisfaction Task Force to translate our findings into a workable document for physician leaders and hospitalists. They were the editors of the supplement to The Hospitalist on “value added services” of hospitalists (vol. 9, suppl. 1, 2005).

The goals of these papers are to assist hospital administrators and hospitalist services to recruit and retain hospitalists and to help individual hospitalists to find new, more rewarding employment opportunities. The document will include practical tools for self and program analysis. As more information becomes available through survey research results and focus group analysis, the tools will be refined.

The goals of the Career Satisfaction Task Force for 2006-2007 include:

1. Complete the focused interviews;
2. Complete the first draft of the SHM Career Satisfaction Tool Kit;
3. Start the survey process at the 2006 SHM Annual Meeting;
4. Hold a workshop at the SHM Annual Meeting;
5. Utilize additional research data to modify the tool kit; and
6. Position the tool kit as a working document for structuring hospitalist programs and as a self-assessment tool for practicing hospitalists. TH

Always searching for new ways to enhance the value of SHM membership, the SHM Membership Committee has created several task forces to work on special projects.

Designed to build upon the success of the Annual Meeting’s Mentorship Breakfast (a one-time opportunity for SHM members to meet with experienced hospitalist clinicians and leaders), the Mentorship Task Force was convened to study opportunities to expand the use of mentoring programs for SHM members. The task force has suggested mechanisms on how to assist SHM local chapter leaders, suggestions that have resulted in the creation of recurrent conference calls between members of the Midwest Region Council and local chapter leaders in the Midwest. The Task Force has also studied creating a yearlong longitudinal mentoring program on leadership skills and continues to work on this project.

The Industry Support of Local Chapters Task Force is critically looking at the role of industry sponsorship of local chapter activities. This task force (comprising participants from the SHM Ethics and Membership Committees, Regional Councils, and local chapters) is studying two issues:

1. How to assist local leaders in finding and securing sponsorship for chapter functions, and
2. How to create a process to review industry sponsored grants to support local chapter meetings.

Preliminary recommendations from this task force include additions and revisions to the SHM Local Chapter Handbook about strategies and techniques to employ when negotiating with industry representatives.

Finally, the Family Practice Task Force was recently convened to study how family practice hospitalists differ from their internal-medicine-trained colleagues. Initial efforts will focus on gathering data about family-practice-trained hospitalists, defining the unique skill set that family practice has to offer hospital medicine, and reviewing the post-graduate medical training needs of family practitioner hospital medicine physicians.

In addition to these task forces, the Membership Committee will launch a new research initiative. During 2006 SHM members will be invited to share their opinions on a variety of topics via electronic surveys. Data from each survey will be regularly shared with SHM leadership for review and use in future planning.

Your support of SHM has played a vital role in helping the society to assume the leadership position that it currently holds in the hospital medicine community. Your continued support will enable us to continue to grow and provide each member with the tools they need to best serve their patients and grow their practices in the process.

Ethics Policies Revised

Real and potential conflicts addressed in revisions

By Tom Baudendistel, MD, FACP, chair, SHM Ethics Committee

Conflicts of interest have been the major theme of the SHM Ethics Committee this past year. As SHM has grown into a major force shaping healthcare policy, the need for transparency in all of the organization’s endeavors has never been greater. Rather than being reactive to individual issues that arise, the ethics committee has adopted a proactive stance in identifying potential areas of tension. Building on the general guidelines of the 2003 SHM “Principles for Organizational Relationships,” this year’s ethics committee has refined SHM policies to address the latest real and potential conflicts of interest in several areas: the Annual Meeting Abstract competitions, the Journal of Hospital Medicine, and the SHM Board.

Prior to the 2005 Annual Meeting, chairs of the Research, Innovations, and Vignettes (RIV) Committees augmented previous disclosure policy in requiring more transparent and detailed statements of disclosure from authors submitting abstracts to the national meeting. Anjala Tess, MD, and Sunil Kripilani, MD, took the lead in this initiative, preserving the integrity of the academic process while shielding the SHM RIV competition from potential misuse by third parties.

Later in 2005, in preparation for publication of the Journal of Hospital Medicine, the ethics committee worked with the editors to develop a policy regarding potential conflicts of interest between the journal’s editors, editorial board, reviewers, and authors. Ethical dilemmas within academic journals generally arise in two main areas: academic or financial. An example of the former would include an editor or a reviewer who might benefit from affiliation with the authors or from the publication of material contained in a manuscript. Financial conflicts might arise when, for instance, an editor or author receives monetary support from an industry source and selectively publishes only manuscripts that cast the sponsoring company in a favorable light.

The SHM Ethics committee contacted editors from major journals, including Annals of Internal Medicine, Journal of the American Medical Association, The New England Journal of Medicine, and The American Journal of Medicine, and consulted the International Committee of Medical Journal Editors before crafting a policy for the Journal of Hospital Medicine’s Editorial Board. This policy directs JHM to obtain annual disclosure of potential academic and financial conflicts from its editors and editorial board members, and requests similar information from its authors and reviewers on an article-by-article basis. Thanks to Brian Harte, MD, and Don Krause, MD, for their leadership in this process.

More recently, the SHM Ethics Committee was asked to join the SHM Task Force to identify areas of potential conflict for the SHM Board. As leaders of a major organization in U.S. medical care, members of the board are obvious targets of outside interests including healthcare or pharmaceutical industry, legal associations, and other organizations to represent those outside parties’ viewpoints—either implicitly or explicitly. Should the leaders of SHM participate in malpractice litigation involving hospitalists? What restrictions should SHM place on its board members pertaining to relationships with outside academic and industry organizations? Should SHM accept funding from industry to support regional and national meetings? Should the SHM board endorse pay-for-performance initiatives? How should hospitalist scope of practice be defined?

The answers to these and similar questions will guide SHM policy in the coming years, and the SHM Ethics Committee will be there every step of the way.

The SHM Ethics Committee is now 15 members strong and continues to convene regularly via conference calls and as a group at the Annual Meeting. Check out the recent article by Erin Egan, MD, in The Hospitalist discussing the safe and ethical care of disaster victims (Jan. 2006, p. 10), or attend the “Ethical Dilemmas in the ICU” talk at the upcoming critical care precourse at the Annual Meeting on May 3 at 9 a.m. to catch other glimpses of the committee’s work. With the continued support and membership from SHM members, the committee aims to chart a clear and ethically acceptable course for SHM for years to come.

Quality of Work-Life Tools

An interim report from the SHM Career Satisfaction Task Force

By Sylvia McKean, MD, Tosha Wetterneck, MD, and Win Whitcomb, MD

A variety of career satisfaction issues threaten the evolution of hospital medicine as a specialty. These issues are analogous to the experience of other, well-established specialties essential to the smooth functioning of a hospital, including critical care and emergency medicine.

Hospitalists encounter daily disruptions in their workflow due to the unpredictability of acute medical illness, paging interruptions that require immediate attention, and an increasing variety of other demands on their time in an already stressed healthcare system. In addition, hospitalist services staffed with junior physicians may not have input into the patients triaged to their service or how the service is structured. They may encounter changing job descriptions as hospital administrators in charge of their salaries rely upon them to solve important problems.

Hospitalists face conflict as they try to control their work life. The role of the hospitalist has evolved from direct patient care, to improving throughput and related outcomes, and increasingly to one of leadership, quality improvement, and teaching. The challenges of this discipline continue to expand exponentially. In addition, community hospitals rely upon academic hospitalist programs to train and recruit physicians into the field of hospital medicine. Academic hospitalist services, therefore, need to ensure time to mentor trainees and serve as role models that hospital medicine is a satisfying, respected, and sustainable career.

In 2005 SHM’s career satisfaction task force reviewed available literature and started developing a series of chapters relating to the following “domains” related to job satisfaction:

• Control/autonomy;
• Workload/schedule;
• Reward/recognition; and
• Community/environment.

These chapters acknowledge that on-the-job challenges should be viewed from two different but related perspectives: the individual hospitalist and the hospital medicine group/service. Neither the individual nor the hospitalist service can work independently of the other because cohesiveness among hospitalist members is critical to promoting job satisfaction for the service. The task force is developing a career satisfaction tool kit consisting of individual and group self-assessment questionnaires and preventive strategies. Specific case examples from the academic and community settings will be provided to avoid pitfalls and false starts when seeking a job in hospital medicine or when responding to pressures in the hospital.

SHM has also funded additional research into career satisfaction under the leadership of Tosha Wetterneck, MD, from the University of Wisconsin Hospital and Clinic. Joe Miller, SHM senior vice president, and professional writer Phyllis Hanlon have joined the Career Satisfaction Task Force to translate our findings into a workable document for physician leaders and hospitalists. They were the editors of the supplement to The Hospitalist on “value added services” of hospitalists (vol. 9, suppl. 1, 2005).

The goals of these papers are to assist hospital administrators and hospitalist services to recruit and retain hospitalists and to help individual hospitalists to find new, more rewarding employment opportunities. The document will include practical tools for self and program analysis. As more information becomes available through survey research results and focus group analysis, the tools will be refined.

The goals of the Career Satisfaction Task Force for 2006-2007 include:

1. Complete the focused interviews;
2. Complete the first draft of the SHM Career Satisfaction Tool Kit;
3. Start the survey process at the 2006 SHM Annual Meeting;
4. Hold a workshop at the SHM Annual Meeting;
5. Utilize additional research data to modify the tool kit; and
6. Position the tool kit as a working document for structuring hospitalist programs and as a self-assessment tool for practicing hospitalists. TH

Always searching for new ways to enhance the value of SHM membership, the SHM Membership Committee has created several task forces to work on special projects.

Designed to build upon the success of the Annual Meeting’s Mentorship Breakfast (a one-time opportunity for SHM members to meet with experienced hospitalist clinicians and leaders), the Mentorship Task Force was convened to study opportunities to expand the use of mentoring programs for SHM members. The task force has suggested mechanisms on how to assist SHM local chapter leaders, suggestions that have resulted in the creation of recurrent conference calls between members of the Midwest Region Council and local chapter leaders in the Midwest. The Task Force has also studied creating a yearlong longitudinal mentoring program on leadership skills and continues to work on this project.

The Industry Support of Local Chapters Task Force is critically looking at the role of industry sponsorship of local chapter activities. This task force (comprising participants from the SHM Ethics and Membership Committees, Regional Councils, and local chapters) is studying two issues:

1. How to assist local leaders in finding and securing sponsorship for chapter functions, and
2. How to create a process to review industry sponsored grants to support local chapter meetings.

Preliminary recommendations from this task force include additions and revisions to the SHM Local Chapter Handbook about strategies and techniques to employ when negotiating with industry representatives.

Finally, the Family Practice Task Force was recently convened to study how family practice hospitalists differ from their internal-medicine-trained colleagues. Initial efforts will focus on gathering data about family-practice-trained hospitalists, defining the unique skill set that family practice has to offer hospital medicine, and reviewing the post-graduate medical training needs of family practitioner hospital medicine physicians.

In addition to these task forces, the Membership Committee will launch a new research initiative. During 2006 SHM members will be invited to share their opinions on a variety of topics via electronic surveys. Data from each survey will be regularly shared with SHM leadership for review and use in future planning.

Your support of SHM has played a vital role in helping the society to assume the leadership position that it currently holds in the hospital medicine community. Your continued support will enable us to continue to grow and provide each member with the tools they need to best serve their patients and grow their practices in the process.

Ethics Policies Revised

Real and potential conflicts addressed in revisions

By Tom Baudendistel, MD, FACP, chair, SHM Ethics Committee

Conflicts of interest have been the major theme of the SHM Ethics Committee this past year. As SHM has grown into a major force shaping healthcare policy, the need for transparency in all of the organization’s endeavors has never been greater. Rather than being reactive to individual issues that arise, the ethics committee has adopted a proactive stance in identifying potential areas of tension. Building on the general guidelines of the 2003 SHM “Principles for Organizational Relationships,” this year’s ethics committee has refined SHM policies to address the latest real and potential conflicts of interest in several areas: the Annual Meeting Abstract competitions, the Journal of Hospital Medicine, and the SHM Board.

Prior to the 2005 Annual Meeting, chairs of the Research, Innovations, and Vignettes (RIV) Committees augmented previous disclosure policy in requiring more transparent and detailed statements of disclosure from authors submitting abstracts to the national meeting. Anjala Tess, MD, and Sunil Kripilani, MD, took the lead in this initiative, preserving the integrity of the academic process while shielding the SHM RIV competition from potential misuse by third parties.

Later in 2005, in preparation for publication of the Journal of Hospital Medicine, the ethics committee worked with the editors to develop a policy regarding potential conflicts of interest between the journal’s editors, editorial board, reviewers, and authors. Ethical dilemmas within academic journals generally arise in two main areas: academic or financial. An example of the former would include an editor or a reviewer who might benefit from affiliation with the authors or from the publication of material contained in a manuscript. Financial conflicts might arise when, for instance, an editor or author receives monetary support from an industry source and selectively publishes only manuscripts that cast the sponsoring company in a favorable light.

The SHM Ethics committee contacted editors from major journals, including Annals of Internal Medicine, Journal of the American Medical Association, The New England Journal of Medicine, and The American Journal of Medicine, and consulted the International Committee of Medical Journal Editors before crafting a policy for the Journal of Hospital Medicine’s Editorial Board. This policy directs JHM to obtain annual disclosure of potential academic and financial conflicts from its editors and editorial board members, and requests similar information from its authors and reviewers on an article-by-article basis. Thanks to Brian Harte, MD, and Don Krause, MD, for their leadership in this process.

More recently, the SHM Ethics Committee was asked to join the SHM Task Force to identify areas of potential conflict for the SHM Board. As leaders of a major organization in U.S. medical care, members of the board are obvious targets of outside interests including healthcare or pharmaceutical industry, legal associations, and other organizations to represent those outside parties’ viewpoints—either implicitly or explicitly. Should the leaders of SHM participate in malpractice litigation involving hospitalists? What restrictions should SHM place on its board members pertaining to relationships with outside academic and industry organizations? Should SHM accept funding from industry to support regional and national meetings? Should the SHM board endorse pay-for-performance initiatives? How should hospitalist scope of practice be defined?

The answers to these and similar questions will guide SHM policy in the coming years, and the SHM Ethics Committee will be there every step of the way.

The SHM Ethics Committee is now 15 members strong and continues to convene regularly via conference calls and as a group at the Annual Meeting. Check out the recent article by Erin Egan, MD, in The Hospitalist discussing the safe and ethical care of disaster victims (Jan. 2006, p. 10), or attend the “Ethical Dilemmas in the ICU” talk at the upcoming critical care precourse at the Annual Meeting on May 3 at 9 a.m. to catch other glimpses of the committee’s work. With the continued support and membership from SHM members, the committee aims to chart a clear and ethically acceptable course for SHM for years to come.

Quality of Work-Life Tools

An interim report from the SHM Career Satisfaction Task Force

By Sylvia McKean, MD, Tosha Wetterneck, MD, and Win Whitcomb, MD

A variety of career satisfaction issues threaten the evolution of hospital medicine as a specialty. These issues are analogous to the experience of other, well-established specialties essential to the smooth functioning of a hospital, including critical care and emergency medicine.

Hospitalists encounter daily disruptions in their workflow due to the unpredictability of acute medical illness, paging interruptions that require immediate attention, and an increasing variety of other demands on their time in an already stressed healthcare system. In addition, hospitalist services staffed with junior physicians may not have input into the patients triaged to their service or how the service is structured. They may encounter changing job descriptions as hospital administrators in charge of their salaries rely upon them to solve important problems.

Hospitalists face conflict as they try to control their work life. The role of the hospitalist has evolved from direct patient care, to improving throughput and related outcomes, and increasingly to one of leadership, quality improvement, and teaching. The challenges of this discipline continue to expand exponentially. In addition, community hospitals rely upon academic hospitalist programs to train and recruit physicians into the field of hospital medicine. Academic hospitalist services, therefore, need to ensure time to mentor trainees and serve as role models that hospital medicine is a satisfying, respected, and sustainable career.

In 2005 SHM’s career satisfaction task force reviewed available literature and started developing a series of chapters relating to the following “domains” related to job satisfaction:

• Control/autonomy;
• Workload/schedule;
• Reward/recognition; and
• Community/environment.

These chapters acknowledge that on-the-job challenges should be viewed from two different but related perspectives: the individual hospitalist and the hospital medicine group/service. Neither the individual nor the hospitalist service can work independently of the other because cohesiveness among hospitalist members is critical to promoting job satisfaction for the service. The task force is developing a career satisfaction tool kit consisting of individual and group self-assessment questionnaires and preventive strategies. Specific case examples from the academic and community settings will be provided to avoid pitfalls and false starts when seeking a job in hospital medicine or when responding to pressures in the hospital.

SHM has also funded additional research into career satisfaction under the leadership of Tosha Wetterneck, MD, from the University of Wisconsin Hospital and Clinic. Joe Miller, SHM senior vice president, and professional writer Phyllis Hanlon have joined the Career Satisfaction Task Force to translate our findings into a workable document for physician leaders and hospitalists. They were the editors of the supplement to The Hospitalist on “value added services” of hospitalists (vol. 9, suppl. 1, 2005).

The goals of these papers are to assist hospital administrators and hospitalist services to recruit and retain hospitalists and to help individual hospitalists to find new, more rewarding employment opportunities. The document will include practical tools for self and program analysis. As more information becomes available through survey research results and focus group analysis, the tools will be refined.

The goals of the Career Satisfaction Task Force for 2006-2007 include:

1. Complete the focused interviews;
2. Complete the first draft of the SHM Career Satisfaction Tool Kit;
3. Start the survey process at the 2006 SHM Annual Meeting;
4. Hold a workshop at the SHM Annual Meeting;
5. Utilize additional research data to modify the tool kit; and
6. Position the tool kit as a working document for structuring hospitalist programs and as a self-assessment tool for practicing hospitalists. TH

The Benchmarks Committee has completed the data accumulation portion of the SHM 2005-2006 Productivity and Compensation Survey. As you might recall, we set a goal of 400 group respondents. With a final push for responses in early December, we exceeded our target. The responses were invaluable in making this survey a worthwhile effort and a credible reflection of the national hospitalist movement.

The Benchmarks Committee would like to specially thank those who attempted to complete the survey online and gave us feedback on this process. We had a few glitches with the online survey, and thanks to these folks and their communication we learned a few valuable lessons regarding this electronic process. We were able to intervene immediately and re-direct folks to the written survey. We’ll apply these lessons to the electronic component of future surveys as well.

Over the next few months we will be analyzing the data in preparation for presentation of the results to be offered up initially at the SHM Annual Meeting in Washington, D.C., the first week in May. (Visit www.hospitalmedicine.org under “Upcoming Events” to register.) Additionally, results will be available to survey participants online later in the year following the national presentation.

On a different note, the committee continues to work on the Hospitalist Dashboard Project. We are creating a dashboard that deals with metrics in the categories of resource utilization, clinical quality, productivity, and satisfaction.

Subsequently, we have worked through a Delphi process to whittle a long list of possible metrics down to 10 key metrics. These have been divided among the committee members, who will use an agreed-upon outline to write a brief description of the metric, how it is measured, and how it can be utilized to manage a hospitalist practice. The final product will be a white paper made available to the SHM membership.

How to Develop a Hospital-Based Palliative Care Program

Why your hospital needs such a program and how to create it

By Eva H. Chittenden, MD, and the SHM Palliative Care Task Force

Palliative care consists of medical care focused on the relief of suffering for patients living with chronic, advanced illness and it also helps their families. It is offered at any stage of disease, concurrently with all other appropriate medical treatment.

Palliative care providers treat the many physical symptoms that patients experience, including pain, dyspnea, nausea, and delirium. In addition, providers assist patients and families with complex medical decision-making, and attend to patients’ and families’ spiritual and psychosocial needs. Physicians work closely with an interdisciplinary team of nurses, chaplains, social workers, and pharmacists. Care continues beyond the point of death, with phone calls and consolation letters, as well as bereavement services.

Arguments for inpatient Palliative Care

The clinical imperative: We need better quality of care for people with serious and complex illness. The multicenter SUPPORT study, published in JAMA in 1995, looked at more than 9,000 hospitalized patients with life-threatening illness and demonstrated significant problems with pain and symptom control and with patient-doctor communication.1 Of the patients who died, more than 50% had moderate to severe pain more than half the time during the last three days of their lives. Of patients preferring do-not-resuscitate status, less than 50% of their physicians were aware of their wishes.

In another study, Nelson, et al. documented that more than half of cancer patients receiving intensive care had moderate to severe pain, anxiety, thirst, and hunger, and that 75% had moderate to severe discomfort of some kind.2 These studies have been a wake-up call to clinicians and hospitals across the country.

Patient and Family Preferences

Family members—especially women—shoulder most of the care of patients with serious illness. A minority of caregivers are over age 65 themselves and in ill health. When asked what they want from the medical system, family caregivers ask for help with transportation and personal care of their loved one at home, and for better home nursing support. They want 24/7 access to providers, better communication with their doctors, and to be remembered and contacted after the death of their family member.3-5 Caregiving itself has been shown to increase likelihood of premature mortality and lead to financial crisis.6

In the SUPPORT study, one-third of families lost most of their savings due to illness.7 Patients want pain and symptom control, avoidance of inappropriate prolongation of the dying process, and relief of burdens on family.8 Palliative care programs, both inpatient and ambulatory, can help provide families with needed services and improve communication at all levels.

The Demographic Argument

Hospitals need palliative care to effectively treat the growing numbers of people with serious, advanced, and complex illness. By 2030, the number of people over age 85 will double to almost 10 million.9 Many of these patients will have multiple chronic conditions, making their care complicated and expensive. And for many chronic conditions, including heart and lung disease, diabetes, and hypertension, death is not predictable.

Therefore, people need better care throughout the multiyear course of advanced illness. And while the Medicare Hospice Benefit is helpful for care of the dying (defined as people with six months or less to live) we need additional approaches for the much larger number of patients with chronic, progressive illness, years to live, continued benefit from disease-modifying therapy, and obvious palliative care needs.

The Educational Imperative

Hospitals are the site of training for most clinicians. Researchers have documented significant deficits in palliative care knowledge, skills, and attitudes among medical students, residents, and practicing physicians. Medical school and residency curricula, although improving, offer relatively little teaching in palliative care principles and practice.10,11

In 2000 the Liaison Committee on Medical Education mandated that medical school curricula include “important aspects of … end-of-life-care.” That same year the Accreditation Council for Graduate Medical Education encouraged internal medicine training programs to provide instruction in the principles of palliative care. Inpatient palliative care programs could provide much of this teaching through medical student and resident rotations, informal teaching during the consultation process, and through workshops and grand rounds.

The Financial Argument

Medical costs are rising exponentially due to multiple factors, including effective yet expensive new technologies and an expanding elderly population with more chronic conditions. Under the current Diagnosis Related Group (DRG) system, long, high-intensity hospital stays are causing a fiscal crisis for hospitals. The hospital and insurer of the future will have to work together to learn how to treat serious and complex illness efficiently and in the most cost-effective manner possible. Palliative care programs have the potential to ease this looming crisis through decreasing length of stay, both in the ICU and on the floors, and decreasing direct costs, including radiology, pharmacy, and laboratory costs. Researchers are beginning to document the positive fiscal impacts in rigorous studies.

Palliative Care: The Bottom Line

Palliative care teams have demonstrated improvement in pain and other symptom scores, in patient and family satisfaction with care, and in patient-provider communication. In addition, they have improved compliance with Joint Commission on Accreditation of Healthcare Organizations (JCAHO) quality measures. They have had these positive effects while simultaneously showing decreases in length of stay and costs. As a result, many programs have gained significant financial and administrative support from their hospitals.

Hospitalists and Palliative Care

Many hospitalist groups have found that building and staffing a palliative care consultation team is an important addition to their portfolio of services, further solidifying their value in the eyes of their hospital administration. The professional fee revenues are one more funding source, and palliative care is a critical service the group can provide the institution to improve the quality of care, improve patient satisfaction, and decrease costs.

The work involved in starting a program, including needs assessment, internal marketing, building a financial case, and developing a staffing model, is similar to that done when starting a hospitalist program. Hospitalists are ideally positioned to start palliative care services because they have already built relationships with key administrators and opinion leaders, and they understand the institution’s method for evaluating financial data, and how to access outcome and satisfaction data.

What Hospitalists Gain

By leading and staffing palliative care programs, hospitalists gain visibility and respect from colleagues, and improve their patients’ quality of care and their hospital’s financial bottom line. Clinically palliative care adds variety and depth to the work life of hospitalists and allows them to work with a rich interdisciplinary team. Although hospitalists should obtain additional training, they already possess the building blocks to provide excellent palliative care, such as skillfully leading family conferences and treating complex symptoms. When wearing the palliative care “hat,” providers have the luxury of spending more time at a patient’s bedside discussing what is truly important to the patient and his or her loved ones. The work is meaningful and rewarding.

Obtaining the Tools to Start a Program

The Center to Advance Palliative Care (CAPC), funded by the Robert Wood Johnson Foundation, is dedicated to advancing inpatient palliative care programs through their Web site (www.capc.org) and through their manual, “A Guide to Building a Hospital-Based Palliative Care Program,” available for purchase on its Web site.

In addition, CAPC sponsors the six national Palliative Care Leadership Centers (PCLCs) that each hold two-day, hands-on workshops on the nuts and bolts of starting inpatient palliative care programs, followed by a year of personalized mentoring by phone. The University of California, San Francisco’s PCLC, which is tailored specifically to hospitalists, will hold its last workshop in April 2006. For more information, visit www.capc.org/palliative-care-leadership-initiative.

At the upcoming SHM Annual Meeting in May, the Palliative Care Taskforce will present a workshop, “The Basic Why and How to Develop a Hospital-Based Palliative Care Program.”

Obtaining the Clinical Expertise

There are numerous opportunities for hospitalists to gain clinical expertise in palliative care, including Web-based and written materials and CME courses. Highlights include the Education in Palliative and End of Life Care programs; courses and study guides through the American Association of Hospice and Palliative Medicine, as well as Fast Facts (one-page synopses of relevant palliative care concepts that can be made into handouts or downloaded to one’s PDA). For more information on these resources and others, visit www.capc.org/palliative-care-professional-development/Education_Material_for _Professionals.

In addition, on Thursday, May 4, at 1:20, there will be a breakout session on pain management at the SHM Annual Meeting.

Hospitalists and other physicians can get certified in Hospice and Palliative Medicine by documenting relevant clinical experience and sitting for a qualifying exam. The American Board of Hospice and Palliative Medicine will administer its last exam in November 2006 (final application deadline is May 31, 2006). In September 2006 the field of Hospice and Palliative Medicine is expected to win American Board of Medical Specialties’ (ABMS) recognition as a subspecialty. After that the ABMS will take over administration of the exams. There will likely be a grandfathering period with the ABMS in which relevant clinical experience can substitute for completion of an ACGME-approved palliative care fellowship. For more information, visit the AAHPM Web site at www.abhpm.org/gfxc_100.aspx.

Summary/Conclusions

Inpatient palliative care programs benefit patients, hospitalists, and hospitals alike. Hospitalists are in the perfect position to lead the next generation of inpatient palliative care programs. Currently, about 20% of hospitals in the United States have programs. With the help of hospitalists, the percentage can increase significantly.

Special thanks to Diane Meier, MD, whose work inspired and informed this article.

References

1. A controlled trial to improve care for seriously ill hospitalized patients. The study to understand prognoses and preferences for outcomes and risks of treatment. The SUPPORT Principal Investigators. JAMA. 1995;274:1591-1598.
2. Nelson JE, Meier DE, Oei EJ, et al. Self-reported
3. symptom experience of critically ill cancer patients receiving intensive care. Crit Care Med. 2001;29 (2):277-282.
4. Emanuel EJ, Fairclough DL, Slutsman J, et al. Assistance from family members, friends, paid care givers, and volunteers in the care of terminally ill patients. N Engl J Med. 1999;341 (13):956-963.
5. Emanuel EJ, Fairclough DL, Slutsman J, et al. Understanding economic and other burdens of terminal Illness: the experience of patients and their caregivers. Ann Intern Med. 2000;132(6):451-459.
6. Tolle et al. The Oregon report card: Improving care of the dying. 1999. Available at www.ohsu.edu/ethics/barriers2.pdf. Last accessed Feb. 3, 2006.
7. Schulz R, Beach SR. Caregiving as a risk factor for mortality: the caregiver health effects study. JAMA. 1999;282 (23):2215-2219.
8. Covinsky KE, Goldman L, Cook EF, et al. The impact of serious illness on patients’ families. SUPPORT Investigators. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment. JAMA. 1994;272:1839-1844.
9. Singer PA, Martin DK, Kelner M. Quality end-of-life care: patients’ perspectives. JAMA. 1999;281(2):163-168.
10. U.S. Interim Projections by Age, Sex, Race, and Hispanic Origin. Table 2a. US Census Bureau/CDC. 2002. Available at www.census.gov/ipc/www/usinterimproj/. Last accessed Feb. 3, 2006.
11. Meier DE, Morrison RS, Cassel CK. Improving palliative care. Ann Intern Med. 1997;127:225-230.
12. Billings JA, Block S. Palliative care in undergraduate medical education. Status report and future directions. JAMA. 1997;278:733-738.

Update:

New Hospitalist Productivity & Compensation Data

Survey results to be presented at 2006 SHM Annual Meeting

By the end of the data collection period in December 2005 approximately 400 hospital medicine programs had submitted responses for SHM’s 2005-2006 Hospitalist Productivity and Compensation Survey—a 35% increase from 2003. In addition to salary and production trends, this year’s survey should provide new insights into hospitalist responsibilities, the concerns of hospitalist program leaders, night coverage arrangements, and the use of nurse practitioners and physician assistants.

SHM thanks the program leaders who completed the comprehensive survey questionnaire. The following participants were randomly selected to receive awards:

• Danny Moore, MD, of Gilmore Memorial Hospital (Amory, Miss.) received a complimentary registration at the SHM Leadership Academy; and
• Four hospitalists received complimentary registration to the SHM Annual Meeting: Adrienne L. Bennett, MD, PhD, Ohio State University College of Medicine (Columbus, Ohio); Jasvinder S. Dhillon, St. Mary’s Hospital PICU Pediatric Hospitalist Program (Richmond, Va.); Howard Dubin, MD, Inpatient Medical Services of Bristol Hospital (Cheshire, Conn.); and Sujith Sundararaj MD, Signature Healthcare Solutions (Chicago).

The results of the 2005-2006 Hospitalist Productivity and Compensation Survey will be presented for the first time on Thursday, May 4 at 8:10 a.m. at the SHM Annual Meeting. A panel representing different perspectives within hospital medicine will react to the data. The panelists—SHM co-founder John Nelson, MD, President-Elect Mary Jo Gorman, MD, and Past-President Bob Wachter, MD—will represent hospital-employed practices, private groups, and academic programs, respectively. A report of the survey results will be available to survey participants for free. SHM members will be able to purchase the report at a discounted price. TH

The Benchmarks Committee has completed the data accumulation portion of the SHM 2005-2006 Productivity and Compensation Survey. As you might recall, we set a goal of 400 group respondents. With a final push for responses in early December, we exceeded our target. The responses were invaluable in making this survey a worthwhile effort and a credible reflection of the national hospitalist movement.

The Benchmarks Committee would like to specially thank those who attempted to complete the survey online and gave us feedback on this process. We had a few glitches with the online survey, and thanks to these folks and their communication we learned a few valuable lessons regarding this electronic process. We were able to intervene immediately and re-direct folks to the written survey. We’ll apply these lessons to the electronic component of future surveys as well.

Over the next few months we will be analyzing the data in preparation for presentation of the results to be offered up initially at the SHM Annual Meeting in Washington, D.C., the first week in May. (Visit www.hospitalmedicine.org under “Upcoming Events” to register.) Additionally, results will be available to survey participants online later in the year following the national presentation.

On a different note, the committee continues to work on the Hospitalist Dashboard Project. We are creating a dashboard that deals with metrics in the categories of resource utilization, clinical quality, productivity, and satisfaction.

Subsequently, we have worked through a Delphi process to whittle a long list of possible metrics down to 10 key metrics. These have been divided among the committee members, who will use an agreed-upon outline to write a brief description of the metric, how it is measured, and how it can be utilized to manage a hospitalist practice. The final product will be a white paper made available to the SHM membership.

How to Develop a Hospital-Based Palliative Care Program

Why your hospital needs such a program and how to create it

By Eva H. Chittenden, MD, and the SHM Palliative Care Task Force

Palliative care consists of medical care focused on the relief of suffering for patients living with chronic, advanced illness and it also helps their families. It is offered at any stage of disease, concurrently with all other appropriate medical treatment.

Palliative care providers treat the many physical symptoms that patients experience, including pain, dyspnea, nausea, and delirium. In addition, providers assist patients and families with complex medical decision-making, and attend to patients’ and families’ spiritual and psychosocial needs. Physicians work closely with an interdisciplinary team of nurses, chaplains, social workers, and pharmacists. Care continues beyond the point of death, with phone calls and consolation letters, as well as bereavement services.

Arguments for inpatient Palliative Care

The clinical imperative: We need better quality of care for people with serious and complex illness. The multicenter SUPPORT study, published in JAMA in 1995, looked at more than 9,000 hospitalized patients with life-threatening illness and demonstrated significant problems with pain and symptom control and with patient-doctor communication.1 Of the patients who died, more than 50% had moderate to severe pain more than half the time during the last three days of their lives. Of patients preferring do-not-resuscitate status, less than 50% of their physicians were aware of their wishes.

In another study, Nelson, et al. documented that more than half of cancer patients receiving intensive care had moderate to severe pain, anxiety, thirst, and hunger, and that 75% had moderate to severe discomfort of some kind.2 These studies have been a wake-up call to clinicians and hospitals across the country.

Patient and Family Preferences

Family members—especially women—shoulder most of the care of patients with serious illness. A minority of caregivers are over age 65 themselves and in ill health. When asked what they want from the medical system, family caregivers ask for help with transportation and personal care of their loved one at home, and for better home nursing support. They want 24/7 access to providers, better communication with their doctors, and to be remembered and contacted after the death of their family member.3-5 Caregiving itself has been shown to increase likelihood of premature mortality and lead to financial crisis.6

In the SUPPORT study, one-third of families lost most of their savings due to illness.7 Patients want pain and symptom control, avoidance of inappropriate prolongation of the dying process, and relief of burdens on family.8 Palliative care programs, both inpatient and ambulatory, can help provide families with needed services and improve communication at all levels.

The Demographic Argument

Hospitals need palliative care to effectively treat the growing numbers of people with serious, advanced, and complex illness. By 2030, the number of people over age 85 will double to almost 10 million.9 Many of these patients will have multiple chronic conditions, making their care complicated and expensive. And for many chronic conditions, including heart and lung disease, diabetes, and hypertension, death is not predictable.

Therefore, people need better care throughout the multiyear course of advanced illness. And while the Medicare Hospice Benefit is helpful for care of the dying (defined as people with six months or less to live) we need additional approaches for the much larger number of patients with chronic, progressive illness, years to live, continued benefit from disease-modifying therapy, and obvious palliative care needs.

The Educational Imperative

Hospitals are the site of training for most clinicians. Researchers have documented significant deficits in palliative care knowledge, skills, and attitudes among medical students, residents, and practicing physicians. Medical school and residency curricula, although improving, offer relatively little teaching in palliative care principles and practice.10,11

In 2000 the Liaison Committee on Medical Education mandated that medical school curricula include “important aspects of … end-of-life-care.” That same year the Accreditation Council for Graduate Medical Education encouraged internal medicine training programs to provide instruction in the principles of palliative care. Inpatient palliative care programs could provide much of this teaching through medical student and resident rotations, informal teaching during the consultation process, and through workshops and grand rounds.

The Financial Argument

Medical costs are rising exponentially due to multiple factors, including effective yet expensive new technologies and an expanding elderly population with more chronic conditions. Under the current Diagnosis Related Group (DRG) system, long, high-intensity hospital stays are causing a fiscal crisis for hospitals. The hospital and insurer of the future will have to work together to learn how to treat serious and complex illness efficiently and in the most cost-effective manner possible. Palliative care programs have the potential to ease this looming crisis through decreasing length of stay, both in the ICU and on the floors, and decreasing direct costs, including radiology, pharmacy, and laboratory costs. Researchers are beginning to document the positive fiscal impacts in rigorous studies.

Palliative Care: The Bottom Line

Palliative care teams have demonstrated improvement in pain and other symptom scores, in patient and family satisfaction with care, and in patient-provider communication. In addition, they have improved compliance with Joint Commission on Accreditation of Healthcare Organizations (JCAHO) quality measures. They have had these positive effects while simultaneously showing decreases in length of stay and costs. As a result, many programs have gained significant financial and administrative support from their hospitals.

Hospitalists and Palliative Care

Many hospitalist groups have found that building and staffing a palliative care consultation team is an important addition to their portfolio of services, further solidifying their value in the eyes of their hospital administration. The professional fee revenues are one more funding source, and palliative care is a critical service the group can provide the institution to improve the quality of care, improve patient satisfaction, and decrease costs.

The work involved in starting a program, including needs assessment, internal marketing, building a financial case, and developing a staffing model, is similar to that done when starting a hospitalist program. Hospitalists are ideally positioned to start palliative care services because they have already built relationships with key administrators and opinion leaders, and they understand the institution’s method for evaluating financial data, and how to access outcome and satisfaction data.

What Hospitalists Gain

By leading and staffing palliative care programs, hospitalists gain visibility and respect from colleagues, and improve their patients’ quality of care and their hospital’s financial bottom line. Clinically palliative care adds variety and depth to the work life of hospitalists and allows them to work with a rich interdisciplinary team. Although hospitalists should obtain additional training, they already possess the building blocks to provide excellent palliative care, such as skillfully leading family conferences and treating complex symptoms. When wearing the palliative care “hat,” providers have the luxury of spending more time at a patient’s bedside discussing what is truly important to the patient and his or her loved ones. The work is meaningful and rewarding.

Obtaining the Tools to Start a Program

The Center to Advance Palliative Care (CAPC), funded by the Robert Wood Johnson Foundation, is dedicated to advancing inpatient palliative care programs through their Web site (www.capc.org) and through their manual, “A Guide to Building a Hospital-Based Palliative Care Program,” available for purchase on its Web site.

In addition, CAPC sponsors the six national Palliative Care Leadership Centers (PCLCs) that each hold two-day, hands-on workshops on the nuts and bolts of starting inpatient palliative care programs, followed by a year of personalized mentoring by phone. The University of California, San Francisco’s PCLC, which is tailored specifically to hospitalists, will hold its last workshop in April 2006. For more information, visit www.capc.org/palliative-care-leadership-initiative.

At the upcoming SHM Annual Meeting in May, the Palliative Care Taskforce will present a workshop, “The Basic Why and How to Develop a Hospital-Based Palliative Care Program.”

Obtaining the Clinical Expertise

There are numerous opportunities for hospitalists to gain clinical expertise in palliative care, including Web-based and written materials and CME courses. Highlights include the Education in Palliative and End of Life Care programs; courses and study guides through the American Association of Hospice and Palliative Medicine, as well as Fast Facts (one-page synopses of relevant palliative care concepts that can be made into handouts or downloaded to one’s PDA). For more information on these resources and others, visit www.capc.org/palliative-care-professional-development/Education_Material_for _Professionals.

In addition, on Thursday, May 4, at 1:20, there will be a breakout session on pain management at the SHM Annual Meeting.

Hospitalists and other physicians can get certified in Hospice and Palliative Medicine by documenting relevant clinical experience and sitting for a qualifying exam. The American Board of Hospice and Palliative Medicine will administer its last exam in November 2006 (final application deadline is May 31, 2006). In September 2006 the field of Hospice and Palliative Medicine is expected to win American Board of Medical Specialties’ (ABMS) recognition as a subspecialty. After that the ABMS will take over administration of the exams. There will likely be a grandfathering period with the ABMS in which relevant clinical experience can substitute for completion of an ACGME-approved palliative care fellowship. For more information, visit the AAHPM Web site at www.abhpm.org/gfxc_100.aspx.

Summary/Conclusions

Inpatient palliative care programs benefit patients, hospitalists, and hospitals alike. Hospitalists are in the perfect position to lead the next generation of inpatient palliative care programs. Currently, about 20% of hospitals in the United States have programs. With the help of hospitalists, the percentage can increase significantly.

Special thanks to Diane Meier, MD, whose work inspired and informed this article.

References

1. A controlled trial to improve care for seriously ill hospitalized patients. The study to understand prognoses and preferences for outcomes and risks of treatment. The SUPPORT Principal Investigators. JAMA. 1995;274:1591-1598.
2. Nelson JE, Meier DE, Oei EJ, et al. Self-reported
3. symptom experience of critically ill cancer patients receiving intensive care. Crit Care Med. 2001;29 (2):277-282.
4. Emanuel EJ, Fairclough DL, Slutsman J, et al. Assistance from family members, friends, paid care givers, and volunteers in the care of terminally ill patients. N Engl J Med. 1999;341 (13):956-963.
5. Emanuel EJ, Fairclough DL, Slutsman J, et al. Understanding economic and other burdens of terminal Illness: the experience of patients and their caregivers. Ann Intern Med. 2000;132(6):451-459.
6. Tolle et al. The Oregon report card: Improving care of the dying. 1999. Available at www.ohsu.edu/ethics/barriers2.pdf. Last accessed Feb. 3, 2006.
7. Schulz R, Beach SR. Caregiving as a risk factor for mortality: the caregiver health effects study. JAMA. 1999;282 (23):2215-2219.
8. Covinsky KE, Goldman L, Cook EF, et al. The impact of serious illness on patients’ families. SUPPORT Investigators. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment. JAMA. 1994;272:1839-1844.
9. Singer PA, Martin DK, Kelner M. Quality end-of-life care: patients’ perspectives. JAMA. 1999;281(2):163-168.
10. U.S. Interim Projections by Age, Sex, Race, and Hispanic Origin. Table 2a. US Census Bureau/CDC. 2002. Available at www.census.gov/ipc/www/usinterimproj/. Last accessed Feb. 3, 2006.
11. Meier DE, Morrison RS, Cassel CK. Improving palliative care. Ann Intern Med. 1997;127:225-230.
12. Billings JA, Block S. Palliative care in undergraduate medical education. Status report and future directions. JAMA. 1997;278:733-738.

Update:

New Hospitalist Productivity & Compensation Data

Survey results to be presented at 2006 SHM Annual Meeting

By the end of the data collection period in December 2005 approximately 400 hospital medicine programs had submitted responses for SHM’s 2005-2006 Hospitalist Productivity and Compensation Survey—a 35% increase from 2003. In addition to salary and production trends, this year’s survey should provide new insights into hospitalist responsibilities, the concerns of hospitalist program leaders, night coverage arrangements, and the use of nurse practitioners and physician assistants.

SHM thanks the program leaders who completed the comprehensive survey questionnaire. The following participants were randomly selected to receive awards:

• Danny Moore, MD, of Gilmore Memorial Hospital (Amory, Miss.) received a complimentary registration at the SHM Leadership Academy; and
• Four hospitalists received complimentary registration to the SHM Annual Meeting: Adrienne L. Bennett, MD, PhD, Ohio State University College of Medicine (Columbus, Ohio); Jasvinder S. Dhillon, St. Mary’s Hospital PICU Pediatric Hospitalist Program (Richmond, Va.); Howard Dubin, MD, Inpatient Medical Services of Bristol Hospital (Cheshire, Conn.); and Sujith Sundararaj MD, Signature Healthcare Solutions (Chicago).

The results of the 2005-2006 Hospitalist Productivity and Compensation Survey will be presented for the first time on Thursday, May 4 at 8:10 a.m. at the SHM Annual Meeting. A panel representing different perspectives within hospital medicine will react to the data. The panelists—SHM co-founder John Nelson, MD, President-Elect Mary Jo Gorman, MD, and Past-President Bob Wachter, MD—will represent hospital-employed practices, private groups, and academic programs, respectively. A report of the survey results will be available to survey participants for free. SHM members will be able to purchase the report at a discounted price. TH

The Benchmarks Committee has completed the data accumulation portion of the SHM 2005-2006 Productivity and Compensation Survey. As you might recall, we set a goal of 400 group respondents. With a final push for responses in early December, we exceeded our target. The responses were invaluable in making this survey a worthwhile effort and a credible reflection of the national hospitalist movement.

The Benchmarks Committee would like to specially thank those who attempted to complete the survey online and gave us feedback on this process. We had a few glitches with the online survey, and thanks to these folks and their communication we learned a few valuable lessons regarding this electronic process. We were able to intervene immediately and re-direct folks to the written survey. We’ll apply these lessons to the electronic component of future surveys as well.

Over the next few months we will be analyzing the data in preparation for presentation of the results to be offered up initially at the SHM Annual Meeting in Washington, D.C., the first week in May. (Visit www.hospitalmedicine.org under “Upcoming Events” to register.) Additionally, results will be available to survey participants online later in the year following the national presentation.

On a different note, the committee continues to work on the Hospitalist Dashboard Project. We are creating a dashboard that deals with metrics in the categories of resource utilization, clinical quality, productivity, and satisfaction.

Subsequently, we have worked through a Delphi process to whittle a long list of possible metrics down to 10 key metrics. These have been divided among the committee members, who will use an agreed-upon outline to write a brief description of the metric, how it is measured, and how it can be utilized to manage a hospitalist practice. The final product will be a white paper made available to the SHM membership.

How to Develop a Hospital-Based Palliative Care Program

Why your hospital needs such a program and how to create it

By Eva H. Chittenden, MD, and the SHM Palliative Care Task Force

Palliative care consists of medical care focused on the relief of suffering for patients living with chronic, advanced illness and it also helps their families. It is offered at any stage of disease, concurrently with all other appropriate medical treatment.

Palliative care providers treat the many physical symptoms that patients experience, including pain, dyspnea, nausea, and delirium. In addition, providers assist patients and families with complex medical decision-making, and attend to patients’ and families’ spiritual and psychosocial needs. Physicians work closely with an interdisciplinary team of nurses, chaplains, social workers, and pharmacists. Care continues beyond the point of death, with phone calls and consolation letters, as well as bereavement services.

Arguments for inpatient Palliative Care

The clinical imperative: We need better quality of care for people with serious and complex illness. The multicenter SUPPORT study, published in JAMA in 1995, looked at more than 9,000 hospitalized patients with life-threatening illness and demonstrated significant problems with pain and symptom control and with patient-doctor communication.1 Of the patients who died, more than 50% had moderate to severe pain more than half the time during the last three days of their lives. Of patients preferring do-not-resuscitate status, less than 50% of their physicians were aware of their wishes.

In another study, Nelson, et al. documented that more than half of cancer patients receiving intensive care had moderate to severe pain, anxiety, thirst, and hunger, and that 75% had moderate to severe discomfort of some kind.2 These studies have been a wake-up call to clinicians and hospitals across the country.

Patient and Family Preferences

Family members—especially women—shoulder most of the care of patients with serious illness. A minority of caregivers are over age 65 themselves and in ill health. When asked what they want from the medical system, family caregivers ask for help with transportation and personal care of their loved one at home, and for better home nursing support. They want 24/7 access to providers, better communication with their doctors, and to be remembered and contacted after the death of their family member.3-5 Caregiving itself has been shown to increase likelihood of premature mortality and lead to financial crisis.6

In the SUPPORT study, one-third of families lost most of their savings due to illness.7 Patients want pain and symptom control, avoidance of inappropriate prolongation of the dying process, and relief of burdens on family.8 Palliative care programs, both inpatient and ambulatory, can help provide families with needed services and improve communication at all levels.

The Demographic Argument

Hospitals need palliative care to effectively treat the growing numbers of people with serious, advanced, and complex illness. By 2030, the number of people over age 85 will double to almost 10 million.9 Many of these patients will have multiple chronic conditions, making their care complicated and expensive. And for many chronic conditions, including heart and lung disease, diabetes, and hypertension, death is not predictable.

Therefore, people need better care throughout the multiyear course of advanced illness. And while the Medicare Hospice Benefit is helpful for care of the dying (defined as people with six months or less to live) we need additional approaches for the much larger number of patients with chronic, progressive illness, years to live, continued benefit from disease-modifying therapy, and obvious palliative care needs.

The Educational Imperative

Hospitals are the site of training for most clinicians. Researchers have documented significant deficits in palliative care knowledge, skills, and attitudes among medical students, residents, and practicing physicians. Medical school and residency curricula, although improving, offer relatively little teaching in palliative care principles and practice.10,11

In 2000 the Liaison Committee on Medical Education mandated that medical school curricula include “important aspects of … end-of-life-care.” That same year the Accreditation Council for Graduate Medical Education encouraged internal medicine training programs to provide instruction in the principles of palliative care. Inpatient palliative care programs could provide much of this teaching through medical student and resident rotations, informal teaching during the consultation process, and through workshops and grand rounds.

The Financial Argument

Medical costs are rising exponentially due to multiple factors, including effective yet expensive new technologies and an expanding elderly population with more chronic conditions. Under the current Diagnosis Related Group (DRG) system, long, high-intensity hospital stays are causing a fiscal crisis for hospitals. The hospital and insurer of the future will have to work together to learn how to treat serious and complex illness efficiently and in the most cost-effective manner possible. Palliative care programs have the potential to ease this looming crisis through decreasing length of stay, both in the ICU and on the floors, and decreasing direct costs, including radiology, pharmacy, and laboratory costs. Researchers are beginning to document the positive fiscal impacts in rigorous studies.

Palliative Care: The Bottom Line

Palliative care teams have demonstrated improvement in pain and other symptom scores, in patient and family satisfaction with care, and in patient-provider communication. In addition, they have improved compliance with Joint Commission on Accreditation of Healthcare Organizations (JCAHO) quality measures. They have had these positive effects while simultaneously showing decreases in length of stay and costs. As a result, many programs have gained significant financial and administrative support from their hospitals.

Hospitalists and Palliative Care

Many hospitalist groups have found that building and staffing a palliative care consultation team is an important addition to their portfolio of services, further solidifying their value in the eyes of their hospital administration. The professional fee revenues are one more funding source, and palliative care is a critical service the group can provide the institution to improve the quality of care, improve patient satisfaction, and decrease costs.

The work involved in starting a program, including needs assessment, internal marketing, building a financial case, and developing a staffing model, is similar to that done when starting a hospitalist program. Hospitalists are ideally positioned to start palliative care services because they have already built relationships with key administrators and opinion leaders, and they understand the institution’s method for evaluating financial data, and how to access outcome and satisfaction data.

What Hospitalists Gain

By leading and staffing palliative care programs, hospitalists gain visibility and respect from colleagues, and improve their patients’ quality of care and their hospital’s financial bottom line. Clinically palliative care adds variety and depth to the work life of hospitalists and allows them to work with a rich interdisciplinary team. Although hospitalists should obtain additional training, they already possess the building blocks to provide excellent palliative care, such as skillfully leading family conferences and treating complex symptoms. When wearing the palliative care “hat,” providers have the luxury of spending more time at a patient’s bedside discussing what is truly important to the patient and his or her loved ones. The work is meaningful and rewarding.

Obtaining the Tools to Start a Program

The Center to Advance Palliative Care (CAPC), funded by the Robert Wood Johnson Foundation, is dedicated to advancing inpatient palliative care programs through their Web site (www.capc.org) and through their manual, “A Guide to Building a Hospital-Based Palliative Care Program,” available for purchase on its Web site.

In addition, CAPC sponsors the six national Palliative Care Leadership Centers (PCLCs) that each hold two-day, hands-on workshops on the nuts and bolts of starting inpatient palliative care programs, followed by a year of personalized mentoring by phone. The University of California, San Francisco’s PCLC, which is tailored specifically to hospitalists, will hold its last workshop in April 2006. For more information, visit www.capc.org/palliative-care-leadership-initiative.

At the upcoming SHM Annual Meeting in May, the Palliative Care Taskforce will present a workshop, “The Basic Why and How to Develop a Hospital-Based Palliative Care Program.”

Obtaining the Clinical Expertise

There are numerous opportunities for hospitalists to gain clinical expertise in palliative care, including Web-based and written materials and CME courses. Highlights include the Education in Palliative and End of Life Care programs; courses and study guides through the American Association of Hospice and Palliative Medicine, as well as Fast Facts (one-page synopses of relevant palliative care concepts that can be made into handouts or downloaded to one’s PDA). For more information on these resources and others, visit www.capc.org/palliative-care-professional-development/Education_Material_for _Professionals.

In addition, on Thursday, May 4, at 1:20, there will be a breakout session on pain management at the SHM Annual Meeting.

Hospitalists and other physicians can get certified in Hospice and Palliative Medicine by documenting relevant clinical experience and sitting for a qualifying exam. The American Board of Hospice and Palliative Medicine will administer its last exam in November 2006 (final application deadline is May 31, 2006). In September 2006 the field of Hospice and Palliative Medicine is expected to win American Board of Medical Specialties’ (ABMS) recognition as a subspecialty. After that the ABMS will take over administration of the exams. There will likely be a grandfathering period with the ABMS in which relevant clinical experience can substitute for completion of an ACGME-approved palliative care fellowship. For more information, visit the AAHPM Web site at www.abhpm.org/gfxc_100.aspx.

Summary/Conclusions

Inpatient palliative care programs benefit patients, hospitalists, and hospitals alike. Hospitalists are in the perfect position to lead the next generation of inpatient palliative care programs. Currently, about 20% of hospitals in the United States have programs. With the help of hospitalists, the percentage can increase significantly.

Special thanks to Diane Meier, MD, whose work inspired and informed this article.

References

1. A controlled trial to improve care for seriously ill hospitalized patients. The study to understand prognoses and preferences for outcomes and risks of treatment. The SUPPORT Principal Investigators. JAMA. 1995;274:1591-1598.
2. Nelson JE, Meier DE, Oei EJ, et al. Self-reported
3. symptom experience of critically ill cancer patients receiving intensive care. Crit Care Med. 2001;29 (2):277-282.
4. Emanuel EJ, Fairclough DL, Slutsman J, et al. Assistance from family members, friends, paid care givers, and volunteers in the care of terminally ill patients. N Engl J Med. 1999;341 (13):956-963.
5. Emanuel EJ, Fairclough DL, Slutsman J, et al. Understanding economic and other burdens of terminal Illness: the experience of patients and their caregivers. Ann Intern Med. 2000;132(6):451-459.
6. Tolle et al. The Oregon report card: Improving care of the dying. 1999. Available at www.ohsu.edu/ethics/barriers2.pdf. Last accessed Feb. 3, 2006.
7. Schulz R, Beach SR. Caregiving as a risk factor for mortality: the caregiver health effects study. JAMA. 1999;282 (23):2215-2219.
8. Covinsky KE, Goldman L, Cook EF, et al. The impact of serious illness on patients’ families. SUPPORT Investigators. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment. JAMA. 1994;272:1839-1844.
9. Singer PA, Martin DK, Kelner M. Quality end-of-life care: patients’ perspectives. JAMA. 1999;281(2):163-168.
10. U.S. Interim Projections by Age, Sex, Race, and Hispanic Origin. Table 2a. US Census Bureau/CDC. 2002. Available at www.census.gov/ipc/www/usinterimproj/. Last accessed Feb. 3, 2006.
11. Meier DE, Morrison RS, Cassel CK. Improving palliative care. Ann Intern Med. 1997;127:225-230.
12. Billings JA, Block S. Palliative care in undergraduate medical education. Status report and future directions. JAMA. 1997;278:733-738.

Update:

New Hospitalist Productivity & Compensation Data

Survey results to be presented at 2006 SHM Annual Meeting

By the end of the data collection period in December 2005 approximately 400 hospital medicine programs had submitted responses for SHM’s 2005-2006 Hospitalist Productivity and Compensation Survey—a 35% increase from 2003. In addition to salary and production trends, this year’s survey should provide new insights into hospitalist responsibilities, the concerns of hospitalist program leaders, night coverage arrangements, and the use of nurse practitioners and physician assistants.

SHM thanks the program leaders who completed the comprehensive survey questionnaire. The following participants were randomly selected to receive awards:

• Danny Moore, MD, of Gilmore Memorial Hospital (Amory, Miss.) received a complimentary registration at the SHM Leadership Academy; and
• Four hospitalists received complimentary registration to the SHM Annual Meeting: Adrienne L. Bennett, MD, PhD, Ohio State University College of Medicine (Columbus, Ohio); Jasvinder S. Dhillon, St. Mary’s Hospital PICU Pediatric Hospitalist Program (Richmond, Va.); Howard Dubin, MD, Inpatient Medical Services of Bristol Hospital (Cheshire, Conn.); and Sujith Sundararaj MD, Signature Healthcare Solutions (Chicago).

The results of the 2005-2006 Hospitalist Productivity and Compensation Survey will be presented for the first time on Thursday, May 4 at 8:10 a.m. at the SHM Annual Meeting. A panel representing different perspectives within hospital medicine will react to the data. The panelists—SHM co-founder John Nelson, MD, President-Elect Mary Jo Gorman, MD, and Past-President Bob Wachter, MD—will represent hospital-employed practices, private groups, and academic programs, respectively. A report of the survey results will be available to survey participants for free. SHM members will be able to purchase the report at a discounted price. TH