Jane Jerrard

SHM recently presented its 2007 Awards of Excellence to four hospitalists whose work and research have contributed significantly to hospital medicine and to the betterment of patient care and quality improvement. The award winners were recognized at “Hospital Medicine 2007” held in Dallas in May:

• Award for Clinical Excellence: Adrienne Green, MD, hospitalist at the University of California, San Francisco (UCSF) Medical Center, associate chief medial officer, associate professor of medicine, and physician lead for the Department of Care Coordination at UCSF.
• Award for Excellence in Research: Vineet Arora, MD, MA, assistant professor for the University of Chicago’s Department of Medicine, associate program director for the Internal Medicine Residency Program and assistant dean for curricular innovation for the Pritzker School of Medicine.
• Award for Excellence in Teaching: Jeffrey Glasheen, MD, assistant professor of medicine, director of the hospital medicine unit and inpatient clinical services, associate program director of the Internal Medicine Residency Training Program and program director for the Hospitalist Training Program at the University of Colorado at Denver Health Sciences Center.
• Award for Outstanding Service in Hospital Medicine: Daniel Rauch, MD, director of the pediatric hospitalist program and assistant residency director of pediatrics for the New York University School of Medicine.

Award for Clinical Excellence Adrienne Green, MD

Dr. Green has been a clinically active hospitalist at UCSF Medical Center since 1998. She is engaged in improving systems at USCF, especially in the areas of patient safety, utilization management, compliance, and throughput.

She also enjoys the challenge of working to fix broken systems within the hospital and strives to engage providers across disciplines to work collaboratively to improve the care of hospitalized patients. For this work, she received the UCSF Exceptional Physician Award in 2005.

A graduate of Wesleyan University, Dr. Green received her bachelor’s in molecular biology and chemistry. She earned her medical degree from Hahnemann University School of Medicine and completed her residency at Stanford University (Calif.) in internal medicine.

Award for Excellence in Research Vineet Arora, MD, MA

Dr. Arora’s academic research work on medical education topics such as the effects of sleep deprivation on resident fatigue and patient care, as well as resident interaction with industry, and communication during the handoff process, earned her this year’s Award of Excellence in Research. Her research focuses on measuring and improving quality of care of hospitalized elderly patients. She is the recipient of the Hartford Geriatrics Health Outcomes Research Scholars Award and has also served as a content expert for the development of hospital care quality indicators as part of the ACOVE-3 (Assessing Care for the Vulnerable Elder) Project.

As an active member of SHM, Dr. Arora is the co-founder of the Young Physicians Committee, a member of the SHM Annual Meeting Planning Committee, chair of the Handoff Standards Task Force, and a reviewer for the Research Abstract Committee. She received her bachelor’s from Johns Hopkins University, completed her graduate studies at the University of Chicago Irving B. Harris School of Public Policy, and received her medical degree from Washington University. She completed her residency training in internal medicine and her fellowship in general medicine research at the University of Chicago.

Award for Excellence in Teaching Jeffrey Glasheen, MD

Dr. Glasheen has received many awards recognizing his dedication to hospital medicine and teaching. He is a two-time winner of the Outstanding Clinical Teacher Award given by the students at the University of Colorado School of Medicine, as well as winner of the 7th Annual Elaine Cleary Faculty Teaching Award as the most outstanding educator in the University of Colorado’s Division of General Internal Medicine. As an active member of SHM, Dr. Glasheen participates in the Research, Annual Meeting, and Hospital Medicine Certification committees. He also serves as an SHM delegate to the American Board of Internal Medicine (ABIM) Task Force for Hospitalist Credentialing. Dr. Glasheen also has served as the assistant editor for the Journal of Hospital Medicine since its inception. Most recently, he has been named physician editor for The Hospitalist.

A graduate of Drake University in Des Moines, Iowa, Dr. Glasheen earned his bachelor’s in biology and earned his medical degree from the University of Wisconsin School of Medicine, where he also completed his residency training.

Award for Outstanding Service in Hospital Medicine Daniel Rauch, MD

Dr. Rauch is a nationally recognized leader in pediatric hospital medicine. He has done extensive work with the SHRQ Pediatric Quality Indicators Project, resulting in an invitation to serve on the National Quality Forum Pediatric Technical Advisory Panel, as part of the National Voluntary Consensus Standards for Hospital Care: Additional Priorities, 2006-2007. He is an active member of SHM, serving on the Pediatrics and Benchmarks Committees. Additionally, he sits on the executive committee of the hospital medicine section and is a member of the National Committee on Residential Scholarships for the American Academy of Pediatrics.

Dr. Rauch is a graduate of Wesleyan University, where he received his bachelor’s in biology. He earned his medical degree from Wesleyan’s Albert Einstein College of Medicine, where he also completed his residency in pediatrics.

For additional information call (800) 843-3360 or visit www.hospitalmedicine.org. All Award of Excellence recipients receive an all expense-paid trip and complimentary registration to “Hospital Medicine 2008” in San Diego from April 3-5. TH

SHM recently presented its 2007 Awards of Excellence to four hospitalists whose work and research have contributed significantly to hospital medicine and to the betterment of patient care and quality improvement. The award winners were recognized at “Hospital Medicine 2007” held in Dallas in May:

• Award for Clinical Excellence: Adrienne Green, MD, hospitalist at the University of California, San Francisco (UCSF) Medical Center, associate chief medial officer, associate professor of medicine, and physician lead for the Department of Care Coordination at UCSF.
• Award for Excellence in Research: Vineet Arora, MD, MA, assistant professor for the University of Chicago’s Department of Medicine, associate program director for the Internal Medicine Residency Program and assistant dean for curricular innovation for the Pritzker School of Medicine.
• Award for Excellence in Teaching: Jeffrey Glasheen, MD, assistant professor of medicine, director of the hospital medicine unit and inpatient clinical services, associate program director of the Internal Medicine Residency Training Program and program director for the Hospitalist Training Program at the University of Colorado at Denver Health Sciences Center.
• Award for Outstanding Service in Hospital Medicine: Daniel Rauch, MD, director of the pediatric hospitalist program and assistant residency director of pediatrics for the New York University School of Medicine.

Award for Clinical Excellence Adrienne Green, MD

Dr. Green has been a clinically active hospitalist at UCSF Medical Center since 1998. She is engaged in improving systems at USCF, especially in the areas of patient safety, utilization management, compliance, and throughput.

She also enjoys the challenge of working to fix broken systems within the hospital and strives to engage providers across disciplines to work collaboratively to improve the care of hospitalized patients. For this work, she received the UCSF Exceptional Physician Award in 2005.

A graduate of Wesleyan University, Dr. Green received her bachelor’s in molecular biology and chemistry. She earned her medical degree from Hahnemann University School of Medicine and completed her residency at Stanford University (Calif.) in internal medicine.

Award for Excellence in Research Vineet Arora, MD, MA

Dr. Arora’s academic research work on medical education topics such as the effects of sleep deprivation on resident fatigue and patient care, as well as resident interaction with industry, and communication during the handoff process, earned her this year’s Award of Excellence in Research. Her research focuses on measuring and improving quality of care of hospitalized elderly patients. She is the recipient of the Hartford Geriatrics Health Outcomes Research Scholars Award and has also served as a content expert for the development of hospital care quality indicators as part of the ACOVE-3 (Assessing Care for the Vulnerable Elder) Project.

As an active member of SHM, Dr. Arora is the co-founder of the Young Physicians Committee, a member of the SHM Annual Meeting Planning Committee, chair of the Handoff Standards Task Force, and a reviewer for the Research Abstract Committee. She received her bachelor’s from Johns Hopkins University, completed her graduate studies at the University of Chicago Irving B. Harris School of Public Policy, and received her medical degree from Washington University. She completed her residency training in internal medicine and her fellowship in general medicine research at the University of Chicago.

Award for Excellence in Teaching Jeffrey Glasheen, MD

Dr. Glasheen has received many awards recognizing his dedication to hospital medicine and teaching. He is a two-time winner of the Outstanding Clinical Teacher Award given by the students at the University of Colorado School of Medicine, as well as winner of the 7th Annual Elaine Cleary Faculty Teaching Award as the most outstanding educator in the University of Colorado’s Division of General Internal Medicine. As an active member of SHM, Dr. Glasheen participates in the Research, Annual Meeting, and Hospital Medicine Certification committees. He also serves as an SHM delegate to the American Board of Internal Medicine (ABIM) Task Force for Hospitalist Credentialing. Dr. Glasheen also has served as the assistant editor for the Journal of Hospital Medicine since its inception. Most recently, he has been named physician editor for The Hospitalist.

A graduate of Drake University in Des Moines, Iowa, Dr. Glasheen earned his bachelor’s in biology and earned his medical degree from the University of Wisconsin School of Medicine, where he also completed his residency training.

Award for Outstanding Service in Hospital Medicine Daniel Rauch, MD

Dr. Rauch is a nationally recognized leader in pediatric hospital medicine. He has done extensive work with the SHRQ Pediatric Quality Indicators Project, resulting in an invitation to serve on the National Quality Forum Pediatric Technical Advisory Panel, as part of the National Voluntary Consensus Standards for Hospital Care: Additional Priorities, 2006-2007. He is an active member of SHM, serving on the Pediatrics and Benchmarks Committees. Additionally, he sits on the executive committee of the hospital medicine section and is a member of the National Committee on Residential Scholarships for the American Academy of Pediatrics.

Dr. Rauch is a graduate of Wesleyan University, where he received his bachelor’s in biology. He earned his medical degree from Wesleyan’s Albert Einstein College of Medicine, where he also completed his residency in pediatrics.

For additional information call (800) 843-3360 or visit www.hospitalmedicine.org. All Award of Excellence recipients receive an all expense-paid trip and complimentary registration to “Hospital Medicine 2008” in San Diego from April 3-5. TH

SHM recently presented its 2007 Awards of Excellence to four hospitalists whose work and research have contributed significantly to hospital medicine and to the betterment of patient care and quality improvement. The award winners were recognized at “Hospital Medicine 2007” held in Dallas in May:

• Award for Clinical Excellence: Adrienne Green, MD, hospitalist at the University of California, San Francisco (UCSF) Medical Center, associate chief medial officer, associate professor of medicine, and physician lead for the Department of Care Coordination at UCSF.
• Award for Excellence in Research: Vineet Arora, MD, MA, assistant professor for the University of Chicago’s Department of Medicine, associate program director for the Internal Medicine Residency Program and assistant dean for curricular innovation for the Pritzker School of Medicine.
• Award for Excellence in Teaching: Jeffrey Glasheen, MD, assistant professor of medicine, director of the hospital medicine unit and inpatient clinical services, associate program director of the Internal Medicine Residency Training Program and program director for the Hospitalist Training Program at the University of Colorado at Denver Health Sciences Center.
• Award for Outstanding Service in Hospital Medicine: Daniel Rauch, MD, director of the pediatric hospitalist program and assistant residency director of pediatrics for the New York University School of Medicine.

Award for Clinical Excellence Adrienne Green, MD

Dr. Green has been a clinically active hospitalist at UCSF Medical Center since 1998. She is engaged in improving systems at USCF, especially in the areas of patient safety, utilization management, compliance, and throughput.

She also enjoys the challenge of working to fix broken systems within the hospital and strives to engage providers across disciplines to work collaboratively to improve the care of hospitalized patients. For this work, she received the UCSF Exceptional Physician Award in 2005.

A graduate of Wesleyan University, Dr. Green received her bachelor’s in molecular biology and chemistry. She earned her medical degree from Hahnemann University School of Medicine and completed her residency at Stanford University (Calif.) in internal medicine.

Award for Excellence in Research Vineet Arora, MD, MA

Dr. Arora’s academic research work on medical education topics such as the effects of sleep deprivation on resident fatigue and patient care, as well as resident interaction with industry, and communication during the handoff process, earned her this year’s Award of Excellence in Research. Her research focuses on measuring and improving quality of care of hospitalized elderly patients. She is the recipient of the Hartford Geriatrics Health Outcomes Research Scholars Award and has also served as a content expert for the development of hospital care quality indicators as part of the ACOVE-3 (Assessing Care for the Vulnerable Elder) Project.

As an active member of SHM, Dr. Arora is the co-founder of the Young Physicians Committee, a member of the SHM Annual Meeting Planning Committee, chair of the Handoff Standards Task Force, and a reviewer for the Research Abstract Committee. She received her bachelor’s from Johns Hopkins University, completed her graduate studies at the University of Chicago Irving B. Harris School of Public Policy, and received her medical degree from Washington University. She completed her residency training in internal medicine and her fellowship in general medicine research at the University of Chicago.

Award for Excellence in Teaching Jeffrey Glasheen, MD

Dr. Glasheen has received many awards recognizing his dedication to hospital medicine and teaching. He is a two-time winner of the Outstanding Clinical Teacher Award given by the students at the University of Colorado School of Medicine, as well as winner of the 7th Annual Elaine Cleary Faculty Teaching Award as the most outstanding educator in the University of Colorado’s Division of General Internal Medicine. As an active member of SHM, Dr. Glasheen participates in the Research, Annual Meeting, and Hospital Medicine Certification committees. He also serves as an SHM delegate to the American Board of Internal Medicine (ABIM) Task Force for Hospitalist Credentialing. Dr. Glasheen also has served as the assistant editor for the Journal of Hospital Medicine since its inception. Most recently, he has been named physician editor for The Hospitalist.

A graduate of Drake University in Des Moines, Iowa, Dr. Glasheen earned his bachelor’s in biology and earned his medical degree from the University of Wisconsin School of Medicine, where he also completed his residency training.

Award for Outstanding Service in Hospital Medicine Daniel Rauch, MD

Dr. Rauch is a nationally recognized leader in pediatric hospital medicine. He has done extensive work with the SHRQ Pediatric Quality Indicators Project, resulting in an invitation to serve on the National Quality Forum Pediatric Technical Advisory Panel, as part of the National Voluntary Consensus Standards for Hospital Care: Additional Priorities, 2006-2007. He is an active member of SHM, serving on the Pediatrics and Benchmarks Committees. Additionally, he sits on the executive committee of the hospital medicine section and is a member of the National Committee on Residential Scholarships for the American Academy of Pediatrics.

Dr. Rauch is a graduate of Wesleyan University, where he received his bachelor’s in biology. He earned his medical degree from Wesleyan’s Albert Einstein College of Medicine, where he also completed his residency in pediatrics.

For additional information call (800) 843-3360 or visit www.hospitalmedicine.org. All Award of Excellence recipients receive an all expense-paid trip and complimentary registration to “Hospital Medicine 2008” in San Diego from April 3-5. TH

This is the third in a series of articles on the four pillars of career satisfaction in hospital medicine.

How much does your satisfaction with your job rely on your compensation level? What about your sense of being appreciated for what you do each day?

Many hospitalists would say the latter could be a key factor in their happiness with their career. This is confirmed in a new white paper from SHM, “A Challenge for a New Specialty: A White Paper on Hospitalist Career Satisfaction” (available online at www.hospitalmedicine.org). This document, created by SHM’s Career Satisfaction Task Force (CSTF), can be used by hospitalists and hospital medicine practices as a toolkit for improving or ensuring job satisfaction. It outlines the four pillars of career satisfaction, the third of which is reward/recognition.

The Third Pillar

The reward/recognition pillar includes not just financial rewards but also social rewards (appreciation by your colleagues, leaders, patients, and family) and intrinsic rewards (healing patients or working efficiently and productively).

Achieving on-the-job recognition requires practicing high-quality medicine, communicating this to all the groups above, and participating in professional development and leadership. It also entails building relationships with peers and allied health professionals, hospital executives, patients, and the community.

“Reward and recognition ties in a lot with the other pillars—especially community,” says CSTF member Adrienne Bennett, MD, PhD, Ohio State University Medical Center, Columbus. “Part of what makes or breaks any hospitalist job is the group you work with and how you get along. This has to do with how you’re viewed and how you’re rewarded and supported.”

The classic dichotomy of values in hospital medicine is salary versus quality of life. Some groups offer higher salaries with heavy workloads and/or many shifts, and others value time over money. But there are additional values that affect reward and recognition. For example, let’s say you want to build a career or reputation in patient safety and quality of care but you work for a hospital medicine group focused mainly on high-volume patient care that is not engaged in quality improvement work. Your group may not value or reward your efforts. This can lead to job dissatisfaction.

“Make sure the group you join has a culture that shares or at least respects and supports your other career interests,” advises Dr. Bennett. “Working with a group where you’re a good fit and that supports your career aspirations is the most important aspect of career satisfaction.”

An Example of Reward Issues

To illustrate how reward/recognition works, here’s a fictional example of a hospitalist faced with a decision regarding her career:

“I’m ready to find my first job in hospital medicine, and my husband just accepted a pulmonary fellowship at a Midwestern university hospital. There are five hospital medicine groups in the area to choose from. I have to decide which I’d prefer to work for. My main priority is that I want to be ‘a name’ in hospital medicine—I want a chance to build a good reputation nationally.”

According to the white paper, a hospitalist in this position should take several steps to ensure career satisfaction:

Step 1: Assess your choices. Use the series of questions provided in the white paper to compare programs, including compensation and benefits.

“This hospitalist seems to want something more out of her work than just the rewards that come from taking excellent care of her patients,” observes Dr. Bennett. “When she’s interviewing, she needs to ask very carefully about opportunities for leadership development and for building her local reputation, which is the first step toward larger recognition. She needs to find out if the group supports and values work on hospital and/or medical association committees. Many community-based groups do support this.”

Step 2: Once you’re hired, set short- and long-term performance goals. Understand what you want to be recognized for, and outline what you want to accomplish—whether it’s a research project, a leadership role on a committee, or simply a standard of patient care you set for yourself.

Step 3: Participate in SHM chapter meetings. Network with physicians from other hospital medicine groups, get involved, and make a name for yourself.

How Your Rewards Stack up

Whether you’re questioning the compensation package at your long-term hospitalist position or weighing a decision on taking a new job, you’ll turn to available benchmark data on hospital medicine.

“There are a lot ways that benchmarks help and hurt,” warns Dr. Bennett. “Some of it isn’t very good because it’s based on very small numbers. If you’re dealing with an employer that relies on data [for compensation levels], it’s important to know what data they’re using. A reliable employer should share that information. Even the SHM benchmark data—which is probably the best we have, since it’s based on several thousand practicing hospitalists in a variety of settings—can’t always tell you how your job compares.”

Many variations within groups and individual jobs make it hard to compare positions side by side. Differentiating factors include salary and other compensation factors, patient load, shifts and schedule (including nights and weekends), and job responsibilities.

“Sometimes you can use the number of work [relative value units] RVUs to compare workloads,” Dr. Bennett suggests.

As with all the pillars of career satisfaction, the rewards and recognitions that come with your job must be measured against what other hospitalist positions offer—but more importantly against your values and priorities. TH

Jane Jerrard has written for The Hospitalist since 2005.

This is the third in a series of articles on the four pillars of career satisfaction in hospital medicine.

How much does your satisfaction with your job rely on your compensation level? What about your sense of being appreciated for what you do each day?

Many hospitalists would say the latter could be a key factor in their happiness with their career. This is confirmed in a new white paper from SHM, “A Challenge for a New Specialty: A White Paper on Hospitalist Career Satisfaction” (available online at www.hospitalmedicine.org). This document, created by SHM’s Career Satisfaction Task Force (CSTF), can be used by hospitalists and hospital medicine practices as a toolkit for improving or ensuring job satisfaction. It outlines the four pillars of career satisfaction, the third of which is reward/recognition.

The Third Pillar

The reward/recognition pillar includes not just financial rewards but also social rewards (appreciation by your colleagues, leaders, patients, and family) and intrinsic rewards (healing patients or working efficiently and productively).

Achieving on-the-job recognition requires practicing high-quality medicine, communicating this to all the groups above, and participating in professional development and leadership. It also entails building relationships with peers and allied health professionals, hospital executives, patients, and the community.

“Reward and recognition ties in a lot with the other pillars—especially community,” says CSTF member Adrienne Bennett, MD, PhD, Ohio State University Medical Center, Columbus. “Part of what makes or breaks any hospitalist job is the group you work with and how you get along. This has to do with how you’re viewed and how you’re rewarded and supported.”

The classic dichotomy of values in hospital medicine is salary versus quality of life. Some groups offer higher salaries with heavy workloads and/or many shifts, and others value time over money. But there are additional values that affect reward and recognition. For example, let’s say you want to build a career or reputation in patient safety and quality of care but you work for a hospital medicine group focused mainly on high-volume patient care that is not engaged in quality improvement work. Your group may not value or reward your efforts. This can lead to job dissatisfaction.

“Make sure the group you join has a culture that shares or at least respects and supports your other career interests,” advises Dr. Bennett. “Working with a group where you’re a good fit and that supports your career aspirations is the most important aspect of career satisfaction.”

An Example of Reward Issues

To illustrate how reward/recognition works, here’s a fictional example of a hospitalist faced with a decision regarding her career:

“I’m ready to find my first job in hospital medicine, and my husband just accepted a pulmonary fellowship at a Midwestern university hospital. There are five hospital medicine groups in the area to choose from. I have to decide which I’d prefer to work for. My main priority is that I want to be ‘a name’ in hospital medicine—I want a chance to build a good reputation nationally.”

According to the white paper, a hospitalist in this position should take several steps to ensure career satisfaction:

Step 1: Assess your choices. Use the series of questions provided in the white paper to compare programs, including compensation and benefits.

“This hospitalist seems to want something more out of her work than just the rewards that come from taking excellent care of her patients,” observes Dr. Bennett. “When she’s interviewing, she needs to ask very carefully about opportunities for leadership development and for building her local reputation, which is the first step toward larger recognition. She needs to find out if the group supports and values work on hospital and/or medical association committees. Many community-based groups do support this.”

Step 2: Once you’re hired, set short- and long-term performance goals. Understand what you want to be recognized for, and outline what you want to accomplish—whether it’s a research project, a leadership role on a committee, or simply a standard of patient care you set for yourself.

Step 3: Participate in SHM chapter meetings. Network with physicians from other hospital medicine groups, get involved, and make a name for yourself.

How Your Rewards Stack up

Whether you’re questioning the compensation package at your long-term hospitalist position or weighing a decision on taking a new job, you’ll turn to available benchmark data on hospital medicine.

“There are a lot ways that benchmarks help and hurt,” warns Dr. Bennett. “Some of it isn’t very good because it’s based on very small numbers. If you’re dealing with an employer that relies on data [for compensation levels], it’s important to know what data they’re using. A reliable employer should share that information. Even the SHM benchmark data—which is probably the best we have, since it’s based on several thousand practicing hospitalists in a variety of settings—can’t always tell you how your job compares.”

Many variations within groups and individual jobs make it hard to compare positions side by side. Differentiating factors include salary and other compensation factors, patient load, shifts and schedule (including nights and weekends), and job responsibilities.

“Sometimes you can use the number of work [relative value units] RVUs to compare workloads,” Dr. Bennett suggests.

As with all the pillars of career satisfaction, the rewards and recognitions that come with your job must be measured against what other hospitalist positions offer—but more importantly against your values and priorities. TH

Jane Jerrard has written for The Hospitalist since 2005.

This is the third in a series of articles on the four pillars of career satisfaction in hospital medicine.

How much does your satisfaction with your job rely on your compensation level? What about your sense of being appreciated for what you do each day?

Many hospitalists would say the latter could be a key factor in their happiness with their career. This is confirmed in a new white paper from SHM, “A Challenge for a New Specialty: A White Paper on Hospitalist Career Satisfaction” (available online at www.hospitalmedicine.org). This document, created by SHM’s Career Satisfaction Task Force (CSTF), can be used by hospitalists and hospital medicine practices as a toolkit for improving or ensuring job satisfaction. It outlines the four pillars of career satisfaction, the third of which is reward/recognition.

The Third Pillar

The reward/recognition pillar includes not just financial rewards but also social rewards (appreciation by your colleagues, leaders, patients, and family) and intrinsic rewards (healing patients or working efficiently and productively).

Achieving on-the-job recognition requires practicing high-quality medicine, communicating this to all the groups above, and participating in professional development and leadership. It also entails building relationships with peers and allied health professionals, hospital executives, patients, and the community.

“Reward and recognition ties in a lot with the other pillars—especially community,” says CSTF member Adrienne Bennett, MD, PhD, Ohio State University Medical Center, Columbus. “Part of what makes or breaks any hospitalist job is the group you work with and how you get along. This has to do with how you’re viewed and how you’re rewarded and supported.”

The classic dichotomy of values in hospital medicine is salary versus quality of life. Some groups offer higher salaries with heavy workloads and/or many shifts, and others value time over money. But there are additional values that affect reward and recognition. For example, let’s say you want to build a career or reputation in patient safety and quality of care but you work for a hospital medicine group focused mainly on high-volume patient care that is not engaged in quality improvement work. Your group may not value or reward your efforts. This can lead to job dissatisfaction.

“Make sure the group you join has a culture that shares or at least respects and supports your other career interests,” advises Dr. Bennett. “Working with a group where you’re a good fit and that supports your career aspirations is the most important aspect of career satisfaction.”

An Example of Reward Issues

To illustrate how reward/recognition works, here’s a fictional example of a hospitalist faced with a decision regarding her career:

“I’m ready to find my first job in hospital medicine, and my husband just accepted a pulmonary fellowship at a Midwestern university hospital. There are five hospital medicine groups in the area to choose from. I have to decide which I’d prefer to work for. My main priority is that I want to be ‘a name’ in hospital medicine—I want a chance to build a good reputation nationally.”

According to the white paper, a hospitalist in this position should take several steps to ensure career satisfaction:

Step 1: Assess your choices. Use the series of questions provided in the white paper to compare programs, including compensation and benefits.

“This hospitalist seems to want something more out of her work than just the rewards that come from taking excellent care of her patients,” observes Dr. Bennett. “When she’s interviewing, she needs to ask very carefully about opportunities for leadership development and for building her local reputation, which is the first step toward larger recognition. She needs to find out if the group supports and values work on hospital and/or medical association committees. Many community-based groups do support this.”

Step 2: Once you’re hired, set short- and long-term performance goals. Understand what you want to be recognized for, and outline what you want to accomplish—whether it’s a research project, a leadership role on a committee, or simply a standard of patient care you set for yourself.

Step 3: Participate in SHM chapter meetings. Network with physicians from other hospital medicine groups, get involved, and make a name for yourself.

How Your Rewards Stack up

Whether you’re questioning the compensation package at your long-term hospitalist position or weighing a decision on taking a new job, you’ll turn to available benchmark data on hospital medicine.

“There are a lot ways that benchmarks help and hurt,” warns Dr. Bennett. “Some of it isn’t very good because it’s based on very small numbers. If you’re dealing with an employer that relies on data [for compensation levels], it’s important to know what data they’re using. A reliable employer should share that information. Even the SHM benchmark data—which is probably the best we have, since it’s based on several thousand practicing hospitalists in a variety of settings—can’t always tell you how your job compares.”

Many variations within groups and individual jobs make it hard to compare positions side by side. Differentiating factors include salary and other compensation factors, patient load, shifts and schedule (including nights and weekends), and job responsibilities.

“Sometimes you can use the number of work [relative value units] RVUs to compare workloads,” Dr. Bennett suggests.

As with all the pillars of career satisfaction, the rewards and recognitions that come with your job must be measured against what other hospitalist positions offer—but more importantly against your values and priorities. TH

Jane Jerrard has written for The Hospitalist since 2005.

The federal government is moving toward offering monetary rewards for reporting on specific performance indicators. When hospitals begin to seek those rewards, hospitalists will be integrally involved.

The Centers for Medicare and Medicaid Services (CMS) has been tasked with developing an approach to value-based purchasing (VBP) for Medicare hospital services beginning in fiscal year 2009. Once the proposal is complete and approved by Congress, hospitals will receive differential payments tied to their performance.

VBP is similar to pay for performance (P4P) in that it links a bonus payment to reporting on performance of specific procedures. But the payment in this case is awarded to a hospital rather than a physician. The goals for the CMS proposal include:

• Improve clinical quality;
• Address underuse, overuse, and misuse of services;
• Encourage patient-centered care;
• Reduce adverse events and improve patient safety;
• Avoid unnecessary costs;
• Stimulate investments in structural components and the re-engineering of care processes;
• Make performance results transparent to and usable by consumers; and
• Avoid creating additional disparities in healthcare and work to reduce existing disparities.

CMS has hosted two listening sessions on the VBP program, during which healthcare providers were able to directly offer suggestions and opinions. The latest information, including an options paper based on the first listening session, is available online at www.cms.hhs.gov/center/hospital.asp.

“I was impressed with their responsiveness to the feedback they received at two listening sessions,” says Gregory B. Seymann, MD, associate clinical professor, University of California, San Diego School of Medicine, Division of Hospital Medicine, and a member of SHM’s Public Policy Committee. “I can see that the second options paper incorporates a lot of the comments from the first session.”

Aligning Measures

SHM has expressed support for CMS’ VBP proposal in a letter to the agency that also urged CMS to select candidate measures for hospitals that align with those for individual physicians under the Physician Quality Reporting Initiative (PQRI), which started July 1.

“These are very similar programs; one rewards hospitals for performing certain processes of care, and one rewards physicians for performing certain processes,” Dr. Seymann explains. “We’re simply asking CMS to make sure the measures [in VBP] match up with what physicians are asked to do. Many people voiced the same comment in the listening session.”

Although there are just 17 candidate measures proposed for the first year of the VBP program, the expectation is to add a considerable number as the program continues. Many candidate measures are similar or identical to those in the PQRI, such as giving aspirin on arrival and giving aspirin, beta-blockers, and ACE inhibitors on discharge for patients with acute myocardial infarction.

Additionally, the proposed measures are identical to those in the current P4P program most hospitals already participate in, known as Reporting Hospital Quality Data for Annual Payment Update (RHQDAPU). The difference will be that instead of getting credit just for reporting the data as they do now, starting in 2009 hospitals must report publicly and perform at a certain level to get a payment update.

“Physicians, especially hospitalists, will need to watch this closely, as it is expected that the PQRI program, which is similar to RHQDAPU on the hospital level, will ultimately transition to a pay-for-performance program such as VBP,” says Dr. Seymann. “We can learn from the bumps in the road in the hospitals’ experience, and hopefully SHM can be active in ensuring that similar problems are anticipated prior to a physician-level pay-for-performance rollout. Furthermore, measures that will apply to hospitalists will likely mirror the hospital VBP measures.”

Rewards Program

Hospitals participating in the proposed VBP program can earn rewards based on two different criteria.

“This aspect is far and away the most important part of this program coming from CMS,” says Dr. Seymann. “They’ve learned from experience with the Premier [Hospital Quality Incentive Demonstration] project on hospital value-based purchasing that the hospitals that started out doing the best got the lion’s share of the reward because they were already doing well. Unfortunately, those that started at the bottom showed greater overall improvement but didn’t reach the top performance threshold, so they saw no financial recognition.”

So in the proposed VBP program, hospitals can demonstrate quality through overall performance on specific measures or through improvement over time in specific measures.

“Hospitals that reach the benchmark—the median of the top decile of performance—get the maximum number of points toward achieving the reward,” explains Dr. Seymann. “But hospitals can gain some points as long as they fall within the attainment range [between the 50th percentile and the mean of the top decile], proportional to how well they do. You get points for both the amount of improvement and the absolute attainment, and whichever score is higher comprises your score on that measure.”

Dr. Seymann calls this adjustment in the incentive structure “the most positive piece of this program,” explaining, “All hospitals have the opportunity to participate and to earn rewards.”

What It Means for Hospitalists

When VBP becomes a reality, how will that affect hospitalists?

“A lot of what hospitalists do for hospitals is improve quality,” says Dr. Seymann. “They’re likely to be asked to partner with their hospitals to put protocols in place for value-based purchasing. … Hospitals can’t make this work without physician participation, and a lot of hospital medicine groups are aligned with their hospitals on quality-improvement measures.”

It seems inevitable PQRI will morph into a CMS P4P or value-based purchasing program—or both. Whatever happens with these demonstration projects, hospitalists will be reporting on measures, and SHM wants to ensure those measures are appropriate.

“There are only 17 measures now; that’s a narrow sample to define quality at a hospital,” Dr. Seymann points out regarding VBP. “SHM will want to be involved in identifying gaps in care and recommending more measures in the future—like care coordination.” TH

Jane Jerrard also writes “Career Development” for The Hospitalist.

The federal government is moving toward offering monetary rewards for reporting on specific performance indicators. When hospitals begin to seek those rewards, hospitalists will be integrally involved.

The Centers for Medicare and Medicaid Services (CMS) has been tasked with developing an approach to value-based purchasing (VBP) for Medicare hospital services beginning in fiscal year 2009. Once the proposal is complete and approved by Congress, hospitals will receive differential payments tied to their performance.

VBP is similar to pay for performance (P4P) in that it links a bonus payment to reporting on performance of specific procedures. But the payment in this case is awarded to a hospital rather than a physician. The goals for the CMS proposal include:

• Improve clinical quality;
• Address underuse, overuse, and misuse of services;
• Encourage patient-centered care;
• Reduce adverse events and improve patient safety;
• Avoid unnecessary costs;
• Stimulate investments in structural components and the re-engineering of care processes;
• Make performance results transparent to and usable by consumers; and
• Avoid creating additional disparities in healthcare and work to reduce existing disparities.

CMS has hosted two listening sessions on the VBP program, during which healthcare providers were able to directly offer suggestions and opinions. The latest information, including an options paper based on the first listening session, is available online at www.cms.hhs.gov/center/hospital.asp.

“I was impressed with their responsiveness to the feedback they received at two listening sessions,” says Gregory B. Seymann, MD, associate clinical professor, University of California, San Diego School of Medicine, Division of Hospital Medicine, and a member of SHM’s Public Policy Committee. “I can see that the second options paper incorporates a lot of the comments from the first session.”

Aligning Measures

SHM has expressed support for CMS’ VBP proposal in a letter to the agency that also urged CMS to select candidate measures for hospitals that align with those for individual physicians under the Physician Quality Reporting Initiative (PQRI), which started July 1.

“These are very similar programs; one rewards hospitals for performing certain processes of care, and one rewards physicians for performing certain processes,” Dr. Seymann explains. “We’re simply asking CMS to make sure the measures [in VBP] match up with what physicians are asked to do. Many people voiced the same comment in the listening session.”

Although there are just 17 candidate measures proposed for the first year of the VBP program, the expectation is to add a considerable number as the program continues. Many candidate measures are similar or identical to those in the PQRI, such as giving aspirin on arrival and giving aspirin, beta-blockers, and ACE inhibitors on discharge for patients with acute myocardial infarction.

Additionally, the proposed measures are identical to those in the current P4P program most hospitals already participate in, known as Reporting Hospital Quality Data for Annual Payment Update (RHQDAPU). The difference will be that instead of getting credit just for reporting the data as they do now, starting in 2009 hospitals must report publicly and perform at a certain level to get a payment update.

“Physicians, especially hospitalists, will need to watch this closely, as it is expected that the PQRI program, which is similar to RHQDAPU on the hospital level, will ultimately transition to a pay-for-performance program such as VBP,” says Dr. Seymann. “We can learn from the bumps in the road in the hospitals’ experience, and hopefully SHM can be active in ensuring that similar problems are anticipated prior to a physician-level pay-for-performance rollout. Furthermore, measures that will apply to hospitalists will likely mirror the hospital VBP measures.”

Rewards Program

Hospitals participating in the proposed VBP program can earn rewards based on two different criteria.

“This aspect is far and away the most important part of this program coming from CMS,” says Dr. Seymann. “They’ve learned from experience with the Premier [Hospital Quality Incentive Demonstration] project on hospital value-based purchasing that the hospitals that started out doing the best got the lion’s share of the reward because they were already doing well. Unfortunately, those that started at the bottom showed greater overall improvement but didn’t reach the top performance threshold, so they saw no financial recognition.”

So in the proposed VBP program, hospitals can demonstrate quality through overall performance on specific measures or through improvement over time in specific measures.

“Hospitals that reach the benchmark—the median of the top decile of performance—get the maximum number of points toward achieving the reward,” explains Dr. Seymann. “But hospitals can gain some points as long as they fall within the attainment range [between the 50th percentile and the mean of the top decile], proportional to how well they do. You get points for both the amount of improvement and the absolute attainment, and whichever score is higher comprises your score on that measure.”

Dr. Seymann calls this adjustment in the incentive structure “the most positive piece of this program,” explaining, “All hospitals have the opportunity to participate and to earn rewards.”

What It Means for Hospitalists

When VBP becomes a reality, how will that affect hospitalists?

“A lot of what hospitalists do for hospitals is improve quality,” says Dr. Seymann. “They’re likely to be asked to partner with their hospitals to put protocols in place for value-based purchasing. … Hospitals can’t make this work without physician participation, and a lot of hospital medicine groups are aligned with their hospitals on quality-improvement measures.”

It seems inevitable PQRI will morph into a CMS P4P or value-based purchasing program—or both. Whatever happens with these demonstration projects, hospitalists will be reporting on measures, and SHM wants to ensure those measures are appropriate.

“There are only 17 measures now; that’s a narrow sample to define quality at a hospital,” Dr. Seymann points out regarding VBP. “SHM will want to be involved in identifying gaps in care and recommending more measures in the future—like care coordination.” TH

Jane Jerrard also writes “Career Development” for The Hospitalist.

The federal government is moving toward offering monetary rewards for reporting on specific performance indicators. When hospitals begin to seek those rewards, hospitalists will be integrally involved.

The Centers for Medicare and Medicaid Services (CMS) has been tasked with developing an approach to value-based purchasing (VBP) for Medicare hospital services beginning in fiscal year 2009. Once the proposal is complete and approved by Congress, hospitals will receive differential payments tied to their performance.

VBP is similar to pay for performance (P4P) in that it links a bonus payment to reporting on performance of specific procedures. But the payment in this case is awarded to a hospital rather than a physician. The goals for the CMS proposal include:

• Improve clinical quality;
• Address underuse, overuse, and misuse of services;
• Encourage patient-centered care;
• Reduce adverse events and improve patient safety;
• Avoid unnecessary costs;
• Stimulate investments in structural components and the re-engineering of care processes;
• Make performance results transparent to and usable by consumers; and
• Avoid creating additional disparities in healthcare and work to reduce existing disparities.

CMS has hosted two listening sessions on the VBP program, during which healthcare providers were able to directly offer suggestions and opinions. The latest information, including an options paper based on the first listening session, is available online at www.cms.hhs.gov/center/hospital.asp.

“I was impressed with their responsiveness to the feedback they received at two listening sessions,” says Gregory B. Seymann, MD, associate clinical professor, University of California, San Diego School of Medicine, Division of Hospital Medicine, and a member of SHM’s Public Policy Committee. “I can see that the second options paper incorporates a lot of the comments from the first session.”

Aligning Measures

SHM has expressed support for CMS’ VBP proposal in a letter to the agency that also urged CMS to select candidate measures for hospitals that align with those for individual physicians under the Physician Quality Reporting Initiative (PQRI), which started July 1.

“These are very similar programs; one rewards hospitals for performing certain processes of care, and one rewards physicians for performing certain processes,” Dr. Seymann explains. “We’re simply asking CMS to make sure the measures [in VBP] match up with what physicians are asked to do. Many people voiced the same comment in the listening session.”

Although there are just 17 candidate measures proposed for the first year of the VBP program, the expectation is to add a considerable number as the program continues. Many candidate measures are similar or identical to those in the PQRI, such as giving aspirin on arrival and giving aspirin, beta-blockers, and ACE inhibitors on discharge for patients with acute myocardial infarction.

Additionally, the proposed measures are identical to those in the current P4P program most hospitals already participate in, known as Reporting Hospital Quality Data for Annual Payment Update (RHQDAPU). The difference will be that instead of getting credit just for reporting the data as they do now, starting in 2009 hospitals must report publicly and perform at a certain level to get a payment update.

“Physicians, especially hospitalists, will need to watch this closely, as it is expected that the PQRI program, which is similar to RHQDAPU on the hospital level, will ultimately transition to a pay-for-performance program such as VBP,” says Dr. Seymann. “We can learn from the bumps in the road in the hospitals’ experience, and hopefully SHM can be active in ensuring that similar problems are anticipated prior to a physician-level pay-for-performance rollout. Furthermore, measures that will apply to hospitalists will likely mirror the hospital VBP measures.”

Rewards Program

Hospitals participating in the proposed VBP program can earn rewards based on two different criteria.

“This aspect is far and away the most important part of this program coming from CMS,” says Dr. Seymann. “They’ve learned from experience with the Premier [Hospital Quality Incentive Demonstration] project on hospital value-based purchasing that the hospitals that started out doing the best got the lion’s share of the reward because they were already doing well. Unfortunately, those that started at the bottom showed greater overall improvement but didn’t reach the top performance threshold, so they saw no financial recognition.”

So in the proposed VBP program, hospitals can demonstrate quality through overall performance on specific measures or through improvement over time in specific measures.

“Hospitals that reach the benchmark—the median of the top decile of performance—get the maximum number of points toward achieving the reward,” explains Dr. Seymann. “But hospitals can gain some points as long as they fall within the attainment range [between the 50th percentile and the mean of the top decile], proportional to how well they do. You get points for both the amount of improvement and the absolute attainment, and whichever score is higher comprises your score on that measure.”

Dr. Seymann calls this adjustment in the incentive structure “the most positive piece of this program,” explaining, “All hospitals have the opportunity to participate and to earn rewards.”

What It Means for Hospitalists

When VBP becomes a reality, how will that affect hospitalists?

“A lot of what hospitalists do for hospitals is improve quality,” says Dr. Seymann. “They’re likely to be asked to partner with their hospitals to put protocols in place for value-based purchasing. … Hospitals can’t make this work without physician participation, and a lot of hospital medicine groups are aligned with their hospitals on quality-improvement measures.”

It seems inevitable PQRI will morph into a CMS P4P or value-based purchasing program—or both. Whatever happens with these demonstration projects, hospitalists will be reporting on measures, and SHM wants to ensure those measures are appropriate.

“There are only 17 measures now; that’s a narrow sample to define quality at a hospital,” Dr. Seymann points out regarding VBP. “SHM will want to be involved in identifying gaps in care and recommending more measures in the future—like care coordination.” TH

Jane Jerrard also writes “Career Development” for The Hospitalist.

On the last day of SHM’s Annual Meeting in May, attendees started their morning with an overview of three exciting projects in hospital medicine, with “Best of Research, Innovations and Clinical Vignettes in 2007.”

Boosting Hospitalists’ Research Efforts

Although hospital medicine programs in academic medical centers are growing rapidly, the role of hospitalist-researchers remains underdeveloped, said Scott A. Flanders, MD, clinical assistant professor, University of Michigan Health Systems, Ann Arbor, by way of introducing “Jumpstarting Hospitalist Clinical Research: The Specialist-Hospitalist Allied Research Program (SHARP).”

“The problem is that our clinical roles dominate over research,” he said. “Also, many hospitalists lack formal research training.” Hospitalists may also lack expertise in clinical areas and are less likely than specialists to become involved in the diagnosis, treatment, and follow-up of complex hospitalized patients. Specialists are also more likely to have access to extramural funding for disease-based clinical research.

For these reasons, Dr. Flanders and his colleagues implemented SHARP. Their purpose was to jumpstart inpatient-based clinical and translational research in academic medical centers by pairing specialists with hospitalists.

SHARP is designed to facilitate pilot projects and preliminary data collection, which can lead to funding. Ultimately, they hope to disseminate research activities to other institutions.

The SHARP infrastructure partners an academic hospitalist as principle investigator (PI) with an academic cardiologist serving as co-PI. The team also includes a hospitalist investigator, a research associate, a clinical epidemiologist, and other personnel as needed.

SHARP is overseen by the PI and co-PI along with an executive from the University of Michigan Health System, vice chair of the Department of Medicine, and the associate dean for Clinical and Translational Research. This oversight group meets semi-annually and facilitates project selection and program development. It also monitors all program metrics.

“Every SHARP project developed is expected to apply for extramural support,” explained Dr. Flanders. SHARP projects and personnel are funded through these sources for pilot data and utilize revenue from the hospital medicine program.

To date, SHARP has resulted in a number of Internal Review Board-approved projects; a number of grants have been submitted, and some have been funded. In addition, peer-reviewed manuscripts have been submitted and accepted.

“Clinical research is underdeveloped at most academic hospitalist programs,” pronounced Dr. Flanders. “Partnering hospitalists with specialists can facilitate collaborative research and, in turn, identify the best way to care for inpatients. I encourage everyone to borrow this idea for their own institution.”

How Do Hospitalists Stack up?

In the short time hospitalists have been around, research has consistently shown that their addition has a positive or neutral effect on factors including length and cost of stay, patient mortality, and readmission rates. However, studies have been limited in scope—something Peter K. Lindenauer, MD, MSc, and his colleagues at Baystate Medical Center, Tufts University School of Medicine, Springfield, Mass., sought to correct in their own study, “Outcomes of Patients Treated by Hospitalists, General Internists and Family Physicians.”

The hospitalist-researchers wanted to compare outcomes for patients treated by three groups across a range of practice settings: hospitalists, non-hospitalist general internists, and family physicians.

The project they undertook was a retrospective cohort study that included patients admitted to 45 U.S. hospitals between September 2002 and July 2005. Patients were all at least 18 years old and had any of seven diagnoses: pneumonia, heart failure, chest pain, ischemic stroke, urinary tract infection, acute exacerbation of COPD, or acute myocardial infarction.

The total number of patients in the study was 76,926. Of these, 284 were cared for by a hospitalist, 993 by a general internist, and 971 by a family physician.

Dr. Lindenauer and his colleagues found that patients in all groups had similar patterns of comorbidities, although hospitalists were more likely to have patients who were covered by managed-care plans and not covered by traditional Medicare.

As for length of stay (LOS), patients cared for by hospitalists had an LOS 0.6 days shorter than internists and 0.4 days shorter than family physicians. Similarly, hospitalists’ patients had an adjusted cost per case approximately $404 less than that of general internists and on a par with family physicians.

The researchers found no significant differences in mortality or readmission rates among patients in the three physician groups.

Dr. Lindenauer wondered if the higher volume of patients seen by hospitalists would explain the differences in patient outcomes. However, when the researchers compared data for hospitalists with similar high-volume general internists and family physicians, they found similar differences in LOS and costs as they had found previously—suggesting other factors may be responsible for hospitalist effect.

Glycemic Control Issues

“Can we have our sugar-free cake and eat it too?” asked Greg Maynard, MD, MS, chief of the Division of Hospital Medicine, University of California, San Diego, when he presented his team’s project on inpatient glycemic control, “Effect of a Standardized Subcutaneous Insulin Order Set and an Insulin Management Protocol.”

“Inpatient diabetes and hyperglycemia is very common,” Dr. Maynard pointed out, “and poor control is associated with poor outcomes.” Although a standardized subcutaneous insulin order set (SQIO) is recommended, its impact is not yet proven.

Therefore, Dr. Maynard’s team set out to test the effectiveness of a standardized order set on adult inpatients in non-critical care wards with point-of-care glucose testing, in academic medical centers with more than 400 beds. Between November 2002 and October 2003, the group put together a baseline for insulin use patterns, glycemic control, and hypoglycemia. They then implemented a standardized SQIO set, which lasted for a year and a half, followed by a second intervention to monitor the incremental effect of an insulin management protocol.

In the first intervention, the researchers introduced basal, nutritional, and correction dose terminology to clinicians. They made a multiple correction dose scale available (based on total insulin dose required), discouraged sliding-scale-only regimens, instituted check-box simplicity, provided guidance for dosing, and incorporated hypoglycemia protocol. Order sets were produced in print first, then as computerized physician order entries.

The second stage, insulin management protocol, included a one-page algorithm, a glycemic target, a prompt for A1C, guidance on dosing including adjustments, and suggested regimens for patients who are eating, non-eating patients, and patients on enteral nutrition. This intervention was introduced with case-based teaching.

Within three months of implementing the SQIO, the use of sliding-scale-only regimens decreased as clinicians switched to regimens with some scheduled basal insulin.

The percentage of patients with a mean glucose lower than 180 mg a day was 62% at baseline and rose to 69% with the implementation of the SQIO. When the algorithm was used, it rose to 73%. The percentage of patient days with completely controlled glucose (between 60 and 180 mg/day) rose from 44% at baseline, to 48% with the SQIO, to 53% with the algorithm.

“But what about hypoglycemia?” asked Dr. Maynard. “The percentage of patient days with hypoglycemia decreased by 30% and 31%, respectively.” The addition of a standardized SQIO with an insulin management protocol improved glycemic control, reduced hypoglycemia, and changed insulin use patterns. TH

On the last day of SHM’s Annual Meeting in May, attendees started their morning with an overview of three exciting projects in hospital medicine, with “Best of Research, Innovations and Clinical Vignettes in 2007.”

Boosting Hospitalists’ Research Efforts

Although hospital medicine programs in academic medical centers are growing rapidly, the role of hospitalist-researchers remains underdeveloped, said Scott A. Flanders, MD, clinical assistant professor, University of Michigan Health Systems, Ann Arbor, by way of introducing “Jumpstarting Hospitalist Clinical Research: The Specialist-Hospitalist Allied Research Program (SHARP).”

“The problem is that our clinical roles dominate over research,” he said. “Also, many hospitalists lack formal research training.” Hospitalists may also lack expertise in clinical areas and are less likely than specialists to become involved in the diagnosis, treatment, and follow-up of complex hospitalized patients. Specialists are also more likely to have access to extramural funding for disease-based clinical research.

For these reasons, Dr. Flanders and his colleagues implemented SHARP. Their purpose was to jumpstart inpatient-based clinical and translational research in academic medical centers by pairing specialists with hospitalists.

SHARP is designed to facilitate pilot projects and preliminary data collection, which can lead to funding. Ultimately, they hope to disseminate research activities to other institutions.

The SHARP infrastructure partners an academic hospitalist as principle investigator (PI) with an academic cardiologist serving as co-PI. The team also includes a hospitalist investigator, a research associate, a clinical epidemiologist, and other personnel as needed.

SHARP is overseen by the PI and co-PI along with an executive from the University of Michigan Health System, vice chair of the Department of Medicine, and the associate dean for Clinical and Translational Research. This oversight group meets semi-annually and facilitates project selection and program development. It also monitors all program metrics.

“Every SHARP project developed is expected to apply for extramural support,” explained Dr. Flanders. SHARP projects and personnel are funded through these sources for pilot data and utilize revenue from the hospital medicine program.

To date, SHARP has resulted in a number of Internal Review Board-approved projects; a number of grants have been submitted, and some have been funded. In addition, peer-reviewed manuscripts have been submitted and accepted.

“Clinical research is underdeveloped at most academic hospitalist programs,” pronounced Dr. Flanders. “Partnering hospitalists with specialists can facilitate collaborative research and, in turn, identify the best way to care for inpatients. I encourage everyone to borrow this idea for their own institution.”

How Do Hospitalists Stack up?

In the short time hospitalists have been around, research has consistently shown that their addition has a positive or neutral effect on factors including length and cost of stay, patient mortality, and readmission rates. However, studies have been limited in scope—something Peter K. Lindenauer, MD, MSc, and his colleagues at Baystate Medical Center, Tufts University School of Medicine, Springfield, Mass., sought to correct in their own study, “Outcomes of Patients Treated by Hospitalists, General Internists and Family Physicians.”

The hospitalist-researchers wanted to compare outcomes for patients treated by three groups across a range of practice settings: hospitalists, non-hospitalist general internists, and family physicians.

The project they undertook was a retrospective cohort study that included patients admitted to 45 U.S. hospitals between September 2002 and July 2005. Patients were all at least 18 years old and had any of seven diagnoses: pneumonia, heart failure, chest pain, ischemic stroke, urinary tract infection, acute exacerbation of COPD, or acute myocardial infarction.

The total number of patients in the study was 76,926. Of these, 284 were cared for by a hospitalist, 993 by a general internist, and 971 by a family physician.

Dr. Lindenauer and his colleagues found that patients in all groups had similar patterns of comorbidities, although hospitalists were more likely to have patients who were covered by managed-care plans and not covered by traditional Medicare.

As for length of stay (LOS), patients cared for by hospitalists had an LOS 0.6 days shorter than internists and 0.4 days shorter than family physicians. Similarly, hospitalists’ patients had an adjusted cost per case approximately $404 less than that of general internists and on a par with family physicians.

The researchers found no significant differences in mortality or readmission rates among patients in the three physician groups.

Dr. Lindenauer wondered if the higher volume of patients seen by hospitalists would explain the differences in patient outcomes. However, when the researchers compared data for hospitalists with similar high-volume general internists and family physicians, they found similar differences in LOS and costs as they had found previously—suggesting other factors may be responsible for hospitalist effect.

Glycemic Control Issues

“Can we have our sugar-free cake and eat it too?” asked Greg Maynard, MD, MS, chief of the Division of Hospital Medicine, University of California, San Diego, when he presented his team’s project on inpatient glycemic control, “Effect of a Standardized Subcutaneous Insulin Order Set and an Insulin Management Protocol.”

“Inpatient diabetes and hyperglycemia is very common,” Dr. Maynard pointed out, “and poor control is associated with poor outcomes.” Although a standardized subcutaneous insulin order set (SQIO) is recommended, its impact is not yet proven.

Therefore, Dr. Maynard’s team set out to test the effectiveness of a standardized order set on adult inpatients in non-critical care wards with point-of-care glucose testing, in academic medical centers with more than 400 beds. Between November 2002 and October 2003, the group put together a baseline for insulin use patterns, glycemic control, and hypoglycemia. They then implemented a standardized SQIO set, which lasted for a year and a half, followed by a second intervention to monitor the incremental effect of an insulin management protocol.

In the first intervention, the researchers introduced basal, nutritional, and correction dose terminology to clinicians. They made a multiple correction dose scale available (based on total insulin dose required), discouraged sliding-scale-only regimens, instituted check-box simplicity, provided guidance for dosing, and incorporated hypoglycemia protocol. Order sets were produced in print first, then as computerized physician order entries.

The second stage, insulin management protocol, included a one-page algorithm, a glycemic target, a prompt for A1C, guidance on dosing including adjustments, and suggested regimens for patients who are eating, non-eating patients, and patients on enteral nutrition. This intervention was introduced with case-based teaching.

Within three months of implementing the SQIO, the use of sliding-scale-only regimens decreased as clinicians switched to regimens with some scheduled basal insulin.

The percentage of patients with a mean glucose lower than 180 mg a day was 62% at baseline and rose to 69% with the implementation of the SQIO. When the algorithm was used, it rose to 73%. The percentage of patient days with completely controlled glucose (between 60 and 180 mg/day) rose from 44% at baseline, to 48% with the SQIO, to 53% with the algorithm.

“But what about hypoglycemia?” asked Dr. Maynard. “The percentage of patient days with hypoglycemia decreased by 30% and 31%, respectively.” The addition of a standardized SQIO with an insulin management protocol improved glycemic control, reduced hypoglycemia, and changed insulin use patterns. TH

On the last day of SHM’s Annual Meeting in May, attendees started their morning with an overview of three exciting projects in hospital medicine, with “Best of Research, Innovations and Clinical Vignettes in 2007.”

Boosting Hospitalists’ Research Efforts

Although hospital medicine programs in academic medical centers are growing rapidly, the role of hospitalist-researchers remains underdeveloped, said Scott A. Flanders, MD, clinical assistant professor, University of Michigan Health Systems, Ann Arbor, by way of introducing “Jumpstarting Hospitalist Clinical Research: The Specialist-Hospitalist Allied Research Program (SHARP).”

“The problem is that our clinical roles dominate over research,” he said. “Also, many hospitalists lack formal research training.” Hospitalists may also lack expertise in clinical areas and are less likely than specialists to become involved in the diagnosis, treatment, and follow-up of complex hospitalized patients. Specialists are also more likely to have access to extramural funding for disease-based clinical research.

For these reasons, Dr. Flanders and his colleagues implemented SHARP. Their purpose was to jumpstart inpatient-based clinical and translational research in academic medical centers by pairing specialists with hospitalists.

SHARP is designed to facilitate pilot projects and preliminary data collection, which can lead to funding. Ultimately, they hope to disseminate research activities to other institutions.

The SHARP infrastructure partners an academic hospitalist as principle investigator (PI) with an academic cardiologist serving as co-PI. The team also includes a hospitalist investigator, a research associate, a clinical epidemiologist, and other personnel as needed.

SHARP is overseen by the PI and co-PI along with an executive from the University of Michigan Health System, vice chair of the Department of Medicine, and the associate dean for Clinical and Translational Research. This oversight group meets semi-annually and facilitates project selection and program development. It also monitors all program metrics.

“Every SHARP project developed is expected to apply for extramural support,” explained Dr. Flanders. SHARP projects and personnel are funded through these sources for pilot data and utilize revenue from the hospital medicine program.

To date, SHARP has resulted in a number of Internal Review Board-approved projects; a number of grants have been submitted, and some have been funded. In addition, peer-reviewed manuscripts have been submitted and accepted.

“Clinical research is underdeveloped at most academic hospitalist programs,” pronounced Dr. Flanders. “Partnering hospitalists with specialists can facilitate collaborative research and, in turn, identify the best way to care for inpatients. I encourage everyone to borrow this idea for their own institution.”

How Do Hospitalists Stack up?

In the short time hospitalists have been around, research has consistently shown that their addition has a positive or neutral effect on factors including length and cost of stay, patient mortality, and readmission rates. However, studies have been limited in scope—something Peter K. Lindenauer, MD, MSc, and his colleagues at Baystate Medical Center, Tufts University School of Medicine, Springfield, Mass., sought to correct in their own study, “Outcomes of Patients Treated by Hospitalists, General Internists and Family Physicians.”

The hospitalist-researchers wanted to compare outcomes for patients treated by three groups across a range of practice settings: hospitalists, non-hospitalist general internists, and family physicians.

The project they undertook was a retrospective cohort study that included patients admitted to 45 U.S. hospitals between September 2002 and July 2005. Patients were all at least 18 years old and had any of seven diagnoses: pneumonia, heart failure, chest pain, ischemic stroke, urinary tract infection, acute exacerbation of COPD, or acute myocardial infarction.

The total number of patients in the study was 76,926. Of these, 284 were cared for by a hospitalist, 993 by a general internist, and 971 by a family physician.

Dr. Lindenauer and his colleagues found that patients in all groups had similar patterns of comorbidities, although hospitalists were more likely to have patients who were covered by managed-care plans and not covered by traditional Medicare.

As for length of stay (LOS), patients cared for by hospitalists had an LOS 0.6 days shorter than internists and 0.4 days shorter than family physicians. Similarly, hospitalists’ patients had an adjusted cost per case approximately $404 less than that of general internists and on a par with family physicians.

The researchers found no significant differences in mortality or readmission rates among patients in the three physician groups.

Dr. Lindenauer wondered if the higher volume of patients seen by hospitalists would explain the differences in patient outcomes. However, when the researchers compared data for hospitalists with similar high-volume general internists and family physicians, they found similar differences in LOS and costs as they had found previously—suggesting other factors may be responsible for hospitalist effect.

Glycemic Control Issues

“Can we have our sugar-free cake and eat it too?” asked Greg Maynard, MD, MS, chief of the Division of Hospital Medicine, University of California, San Diego, when he presented his team’s project on inpatient glycemic control, “Effect of a Standardized Subcutaneous Insulin Order Set and an Insulin Management Protocol.”

“Inpatient diabetes and hyperglycemia is very common,” Dr. Maynard pointed out, “and poor control is associated with poor outcomes.” Although a standardized subcutaneous insulin order set (SQIO) is recommended, its impact is not yet proven.

Therefore, Dr. Maynard’s team set out to test the effectiveness of a standardized order set on adult inpatients in non-critical care wards with point-of-care glucose testing, in academic medical centers with more than 400 beds. Between November 2002 and October 2003, the group put together a baseline for insulin use patterns, glycemic control, and hypoglycemia. They then implemented a standardized SQIO set, which lasted for a year and a half, followed by a second intervention to monitor the incremental effect of an insulin management protocol.

In the first intervention, the researchers introduced basal, nutritional, and correction dose terminology to clinicians. They made a multiple correction dose scale available (based on total insulin dose required), discouraged sliding-scale-only regimens, instituted check-box simplicity, provided guidance for dosing, and incorporated hypoglycemia protocol. Order sets were produced in print first, then as computerized physician order entries.

The second stage, insulin management protocol, included a one-page algorithm, a glycemic target, a prompt for A1C, guidance on dosing including adjustments, and suggested regimens for patients who are eating, non-eating patients, and patients on enteral nutrition. This intervention was introduced with case-based teaching.

Within three months of implementing the SQIO, the use of sliding-scale-only regimens decreased as clinicians switched to regimens with some scheduled basal insulin.

The percentage of patients with a mean glucose lower than 180 mg a day was 62% at baseline and rose to 69% with the implementation of the SQIO. When the algorithm was used, it rose to 73%. The percentage of patient days with completely controlled glucose (between 60 and 180 mg/day) rose from 44% at baseline, to 48% with the SQIO, to 53% with the algorithm.

“But what about hypoglycemia?” asked Dr. Maynard. “The percentage of patient days with hypoglycemia decreased by 30% and 31%, respectively.” The addition of a standardized SQIO with an insulin management protocol improved glycemic control, reduced hypoglycemia, and changed insulin use patterns. TH

This is the second in a series on the four pillars of career satisfaction. Part 1 appeared on p. 14 in the June issue of The Hospitalist.

How can hospitalists work long days often packed from beginning to end and still remain happy with their jobs? One answer can be found in “A Challenge for a New Specialty: A White Paper on Hospitalist Career Satisfaction” (available online at www.hospitalmedicine.org), a comprehensive document by SHM’s Career Satisfaction Task Force (CSTF). This white paper can be used by hospitalists and hospital medicine practices as a toolkit for improving job satisfaction. It outlines the four pillars of career satisfaction.

The Second Pillar: Workload/Schedule

The workload/schedule pillar refers to the type, volume, and intensity of a hospitalist’s work as well as time pressures, variability of work, and number of interruptions. A hospitalist schedule must take all these factors into consideration.

CSTF Co-Chairperson Winthrop Whitcomb, MD, Mercy Medical Center, Springfield, Mass., maintains that this pillar is supported by the other three—autonomy/control, reward/recognition, and community/environment—but most closely with reward/recognition.

“There needs to be a reward system in place no matter what the workload,” says Dr. Whitcomb. “You can’t really talk about workload without addressing rewards. It’s human nature that in order to work hard, you need to be rewarded in some meaningful way.”

But many people—not just physicians but workers from all fields—may have separate concerns about heavy workload and just rewards.

An Example of Workload Issues

You probably know from your own experience as a hospitalist how workload can affect career satisfaction. Here is a fictional example of a hospitalist struggling with an increased patient load:

The director of my community-based hospital medicine program has mandated that each hospitalist see 15 to 20 patients each weekday, and 20 to 30 patients a day over weekends. I know this workload is too heavy to allow good quality of care. Under the pressure of seeing my quota of patients, I’m afraid I might make a mistake or miss something.

“There are physicians out there who can and do handle this type of workload, and they do it happily and well,” Dr. Whitcomb points out. “But this is only true if there is an appropriate reward system in place, and there clearly needs to be a good support system in order to provide quality of care” under this example.

CSTF says this individual should take the following steps:

Step 1: Go on a fact-finding mission. Find out whether hospitalist workload, responsibilities, and schedule at this facility are the norm. “[The hospitalist] should get an idea of what’s happening at other hospital medicine groups; he should understand the national picture,” says Dr. Whitcomb. “He might then realize that hospitalists in his group are only working 187 days a year, and that over a course of a year they’re not really working any harder than others who work more days,” says Dr. Whitcomb. “This might get him thinking a little bit differently about the workload.”

Step 2: Undertake organizational strategies. A hospitalist can find out how he or she has a voice in workload issues.“Figure out how hospitalists are represented in the structure of the group,” advises Dr. Whitcomb. “If a director is mandating how much [hospitalists] work, there has to be some mechanism for the physicians to be able to provide feedback. This often takes the shape of a compensation committee; this group is not just about compensation but about budget and sustainability for both the hospital and the hospitalists.” Physician representation—having a say in workload and schedule—is important to maintain a good balance within a hospital medicine program.

Step 3: Consider recommendations to ease workload. “You can try to change the workload through justifying adding staff or through putting systems in place that allow you to see more patients,” says Dr. Whitcomb. But what if the hospitalist considers or takes these steps and still finds his patient load to be unsustainable long term? “In terms of feeling like you’re not able to provide safe care,” says Dr. Whitcomb, “once you’ve suggested changes to the leadership and no changes are made, this may become a deal-breaker.”

Workload Leans on Other Pillars

The interesting thing about the workload/schedule pillar of job satisfaction is that, if you are unhappy with your workload, the other three pillars can sustain you and make you generally satisfied.

Dr. Whitcomb points to a 2002 article published in the Journal of Health and Social Behavior.1 The study examined a national survey of hospitalists and found that job burnout and intent to remain in the career are more meaningfully associated with favorable “community” relations than with negative experiences such as reduced autonomy.

“Workload is not a predictor of burnout as long as the other three pillars are intact,” summarizes Dr. Whitcomb.

Jane Jerrard has written for The Hospitalist since 2005.

Reference

1. Hoff T, Whitcomb WF, Nelson JR. Thriving and surviving in a new medical career: the case of hospitalist physicians. J Health Social Behav. 2002 Mar;43(1):72-91

This is the second in a series on the four pillars of career satisfaction. Part 1 appeared on p. 14 in the June issue of The Hospitalist.

How can hospitalists work long days often packed from beginning to end and still remain happy with their jobs? One answer can be found in “A Challenge for a New Specialty: A White Paper on Hospitalist Career Satisfaction” (available online at www.hospitalmedicine.org), a comprehensive document by SHM’s Career Satisfaction Task Force (CSTF). This white paper can be used by hospitalists and hospital medicine practices as a toolkit for improving job satisfaction. It outlines the four pillars of career satisfaction.

The Second Pillar: Workload/Schedule

The workload/schedule pillar refers to the type, volume, and intensity of a hospitalist’s work as well as time pressures, variability of work, and number of interruptions. A hospitalist schedule must take all these factors into consideration.

CSTF Co-Chairperson Winthrop Whitcomb, MD, Mercy Medical Center, Springfield, Mass., maintains that this pillar is supported by the other three—autonomy/control, reward/recognition, and community/environment—but most closely with reward/recognition.

“There needs to be a reward system in place no matter what the workload,” says Dr. Whitcomb. “You can’t really talk about workload without addressing rewards. It’s human nature that in order to work hard, you need to be rewarded in some meaningful way.”

But many people—not just physicians but workers from all fields—may have separate concerns about heavy workload and just rewards.

An Example of Workload Issues

You probably know from your own experience as a hospitalist how workload can affect career satisfaction. Here is a fictional example of a hospitalist struggling with an increased patient load:

The director of my community-based hospital medicine program has mandated that each hospitalist see 15 to 20 patients each weekday, and 20 to 30 patients a day over weekends. I know this workload is too heavy to allow good quality of care. Under the pressure of seeing my quota of patients, I’m afraid I might make a mistake or miss something.

“There are physicians out there who can and do handle this type of workload, and they do it happily and well,” Dr. Whitcomb points out. “But this is only true if there is an appropriate reward system in place, and there clearly needs to be a good support system in order to provide quality of care” under this example.

CSTF says this individual should take the following steps:

Step 1: Go on a fact-finding mission. Find out whether hospitalist workload, responsibilities, and schedule at this facility are the norm. “[The hospitalist] should get an idea of what’s happening at other hospital medicine groups; he should understand the national picture,” says Dr. Whitcomb. “He might then realize that hospitalists in his group are only working 187 days a year, and that over a course of a year they’re not really working any harder than others who work more days,” says Dr. Whitcomb. “This might get him thinking a little bit differently about the workload.”

Step 2: Undertake organizational strategies. A hospitalist can find out how he or she has a voice in workload issues.“Figure out how hospitalists are represented in the structure of the group,” advises Dr. Whitcomb. “If a director is mandating how much [hospitalists] work, there has to be some mechanism for the physicians to be able to provide feedback. This often takes the shape of a compensation committee; this group is not just about compensation but about budget and sustainability for both the hospital and the hospitalists.” Physician representation—having a say in workload and schedule—is important to maintain a good balance within a hospital medicine program.

Step 3: Consider recommendations to ease workload. “You can try to change the workload through justifying adding staff or through putting systems in place that allow you to see more patients,” says Dr. Whitcomb. But what if the hospitalist considers or takes these steps and still finds his patient load to be unsustainable long term? “In terms of feeling like you’re not able to provide safe care,” says Dr. Whitcomb, “once you’ve suggested changes to the leadership and no changes are made, this may become a deal-breaker.”

Workload Leans on Other Pillars

The interesting thing about the workload/schedule pillar of job satisfaction is that, if you are unhappy with your workload, the other three pillars can sustain you and make you generally satisfied.

Dr. Whitcomb points to a 2002 article published in the Journal of Health and Social Behavior.1 The study examined a national survey of hospitalists and found that job burnout and intent to remain in the career are more meaningfully associated with favorable “community” relations than with negative experiences such as reduced autonomy.

“Workload is not a predictor of burnout as long as the other three pillars are intact,” summarizes Dr. Whitcomb.

Jane Jerrard has written for The Hospitalist since 2005.

Reference

1. Hoff T, Whitcomb WF, Nelson JR. Thriving and surviving in a new medical career: the case of hospitalist physicians. J Health Social Behav. 2002 Mar;43(1):72-91

This is the second in a series on the four pillars of career satisfaction. Part 1 appeared on p. 14 in the June issue of The Hospitalist.

How can hospitalists work long days often packed from beginning to end and still remain happy with their jobs? One answer can be found in “A Challenge for a New Specialty: A White Paper on Hospitalist Career Satisfaction” (available online at www.hospitalmedicine.org), a comprehensive document by SHM’s Career Satisfaction Task Force (CSTF). This white paper can be used by hospitalists and hospital medicine practices as a toolkit for improving job satisfaction. It outlines the four pillars of career satisfaction.

The Second Pillar: Workload/Schedule

The workload/schedule pillar refers to the type, volume, and intensity of a hospitalist’s work as well as time pressures, variability of work, and number of interruptions. A hospitalist schedule must take all these factors into consideration.

CSTF Co-Chairperson Winthrop Whitcomb, MD, Mercy Medical Center, Springfield, Mass., maintains that this pillar is supported by the other three—autonomy/control, reward/recognition, and community/environment—but most closely with reward/recognition.

“There needs to be a reward system in place no matter what the workload,” says Dr. Whitcomb. “You can’t really talk about workload without addressing rewards. It’s human nature that in order to work hard, you need to be rewarded in some meaningful way.”

But many people—not just physicians but workers from all fields—may have separate concerns about heavy workload and just rewards.

An Example of Workload Issues

You probably know from your own experience as a hospitalist how workload can affect career satisfaction. Here is a fictional example of a hospitalist struggling with an increased patient load:

The director of my community-based hospital medicine program has mandated that each hospitalist see 15 to 20 patients each weekday, and 20 to 30 patients a day over weekends. I know this workload is too heavy to allow good quality of care. Under the pressure of seeing my quota of patients, I’m afraid I might make a mistake or miss something.

“There are physicians out there who can and do handle this type of workload, and they do it happily and well,” Dr. Whitcomb points out. “But this is only true if there is an appropriate reward system in place, and there clearly needs to be a good support system in order to provide quality of care” under this example.

CSTF says this individual should take the following steps:

Step 1: Go on a fact-finding mission. Find out whether hospitalist workload, responsibilities, and schedule at this facility are the norm. “[The hospitalist] should get an idea of what’s happening at other hospital medicine groups; he should understand the national picture,” says Dr. Whitcomb. “He might then realize that hospitalists in his group are only working 187 days a year, and that over a course of a year they’re not really working any harder than others who work more days,” says Dr. Whitcomb. “This might get him thinking a little bit differently about the workload.”

Step 2: Undertake organizational strategies. A hospitalist can find out how he or she has a voice in workload issues.“Figure out how hospitalists are represented in the structure of the group,” advises Dr. Whitcomb. “If a director is mandating how much [hospitalists] work, there has to be some mechanism for the physicians to be able to provide feedback. This often takes the shape of a compensation committee; this group is not just about compensation but about budget and sustainability for both the hospital and the hospitalists.” Physician representation—having a say in workload and schedule—is important to maintain a good balance within a hospital medicine program.

Step 3: Consider recommendations to ease workload. “You can try to change the workload through justifying adding staff or through putting systems in place that allow you to see more patients,” says Dr. Whitcomb. But what if the hospitalist considers or takes these steps and still finds his patient load to be unsustainable long term? “In terms of feeling like you’re not able to provide safe care,” says Dr. Whitcomb, “once you’ve suggested changes to the leadership and no changes are made, this may become a deal-breaker.”

Workload Leans on Other Pillars

The interesting thing about the workload/schedule pillar of job satisfaction is that, if you are unhappy with your workload, the other three pillars can sustain you and make you generally satisfied.

Dr. Whitcomb points to a 2002 article published in the Journal of Health and Social Behavior.1 The study examined a national survey of hospitalists and found that job burnout and intent to remain in the career are more meaningfully associated with favorable “community” relations than with negative experiences such as reduced autonomy.

“Workload is not a predictor of burnout as long as the other three pillars are intact,” summarizes Dr. Whitcomb.

Jane Jerrard has written for The Hospitalist since 2005.

Reference

1. Hoff T, Whitcomb WF, Nelson JR. Thriving and surviving in a new medical career: the case of hospitalist physicians. J Health Social Behav. 2002 Mar;43(1):72-91

This is the first in a series of articles on the four pillars of career satisfaction in hospital medicine.

How do you feel about the hours, compensation, responsibilities, and stresses of your present position? Do you think your job is sustainable—that is, would you be happy to continue your current work for years to come?

Many of today’s hospitalists might not answer the last question with a resounding “yes” because of one or more common factors that lead to chronic dissatisfaction with their careers.

In 2005, SHM formed the Career Satisfaction Task Force (CSTF) to combat this dissatisfaction, charging it with a three-pronged mission: to identify working conditions in hospital medicine that promote success and wellness; to provide resources to enhance career satisfaction; and to promote research into hospitalist career satisfaction and burnout.

“Originally, we were concerned with burnout in hospital medicine,” says CSTF co-chair Sylvia C. W. McKean, MD, FACP, medical director at Brigham and Women's Hospital/Faulkner Hospitalist Service and associate professor of medicine, Harvard Medical School, Boston. “The task force was charged to examine the factors that lead to a long, satisfactory career in hospital medicine.”

New White Paper Available

After reviewing the literature on physician burnout and general career satisfaction, the CSTF created a comprehensive document, “A Challenge for a New Specialty: A White Paper on Hospitalist Career Satisfaction” (available at www.hospitalmedicine.org), which can be used by hospitalists and hospital medicine practices as a toolkit for improving or ensuring job satisfaction.

The white paper outlines the four pillars of career satisfaction: autonomy/control, workload/schedule, reward/recognition, and community/environment. It includes a Job Fit self-evaluation questionnaire and other tools and advice that can be used to gather information and take steps to improve problems identified by the survey.

While the information in the white paper can best be used to improve an entire hospital medicine program, individual hospitalists can also benefit from it. The paper clearly states that an individual hospitalist has the power to influence change within his or her job, perhaps by majority rule. They can find a niche of expertise within their practice; pursue continuing medical education opportunities to promote their areas of expertise; nurture networks with peers; and find a mentor and regularly seek advice.

The First Pillar: Autonomy/Control

Control, or autonomy, refers to the need to be able to affect the key factors that influence job performance. For example, do you have control over when, how, and how quickly you perform a specific task? Do you have some say in task assignment and policies? What about the availability of support staff, supplies, and materials?

“Doctors expect to have control in their jobs, control over the tasks they do, how and when they do those tasks,” says CSTF member Tosha Wetterneck, MD, University of Wisconsin Hospital/Clinics in Madison. “This control helps them cope with stress; take that control away, and they can’t cope as well.”

Autonomy is a problem in hospital medicine because the field is still new and not widely understood. Consequently, hospitalists may end up responsible for additional duties and hours—especially on weekends—that other physicians dump on them.

“In some hospitals, the only doctors who can’t cap [their workloads] are the hospitalists,” reports Dr. McKean.

The best way to ensure you’re comfortable with the autonomy offered by your position is to be aware of what you want—and what you get—when you take your job.

“An individual hospitalist always has a choice of taking a job with the clear understanding of what they’ll have control over,” says Dr. Wetterneck. “However, you have to understand what you as a person need to have control over. You don’t want to get yourself into a position where you don’t have control over the specific areas that matter the most to you.”

An Example of Autonomy

To help clarify how lack of autonomy can make career satisfaction plummet, here is a fictional example of a hospitalist who suddenly lost control in her job:

“I love working in hospital medicine and take my job very seriously. However, two months ago my hospital medicine group assumed responsibility for care of neurosurgical patients, and all hospitalists are now required to provide care to these patients. I find this upsetting—I feel like this is one more step in relegating my colleagues and I to the status of ‘super-residents’ who are responsible for everything that other physicians don’t want to do. I want to have control over which type of patients I see.”

According to the CSTF research, this individual should take the following steps:

Step 1: Assess the situation in the manner outlined in the white paper. The hospitalist should:

• Use the Job Fit questionnaire to profile the control elements of the hospitalist practice;
• Become familiar with the hospital’s leadership and committee structure;
• Understand key payer issues that might affect inpatient care; and
• Review her job description.

After reviewing the role personal autonomy plays within her practice, the hospitalist must consider whether she’s in a position to request a change of duties, or whether her new responsibilities are non-negotiable.

“There are different facets of control,” says Dr. Wetterneck. “Some could make the argument that a hospitalist doesn’t have the skills to take care of neurosurgical patients, that this is out of the realm of reasonable expectations for the job. Others might say that there is reasonable expectation, as long as the hospitalists would get extra learning and extra support from other [subspecialists] that they’d be available for consult.”

Regardless of where you stand on the argument of reasonable expectation of a hospitalist’s responsibilities, what if a new job task simply rubs you the wrong way—to the point where you no longer enjoy your work?

“If it’s truly an issue of ‘I don’t want to do this,’ then it becomes an issue of your fit with your group,” Dr. Wetterneck continues. “If everyone in the group is doing it and you don’t want to, then you need to understand how important this control is for you. Is it important enough to change jobs?”

Step 2: If the answer to that last question is “Yes,” this hospitalist should keep autonomy in mind as she begins a job search. The white paper includes questions to ask herself and her potential employers to ensure she has control in her next position. The diversity of hospitalist responsibilities works in her favor—assuming she’s willing to move to another part of the country.

“You can list all the things that make you happy in a job, and you can probably find every single thing on your list in a hospitalist job somewhere in the U.S.,” speculates Dr. Wetterneck.

Next Month

A discussion of the workload/schedule pillar, which refers to the type, volume, and intensity of a hospitalist's work.

The Only Constant

Working in hospital medicine practically guarantees your job will continually change. Whether it’s a change in responsibilities like the example above, the steady growth of your practice, or even a change in leadership or ownership, hospitalists must go with the flow.

“I definitely think that the job requires a certain amount of flexibility,” says Dr. Wetterneck. “Hospitalists have to understand that their job role will continue to change over time. Therefore, people have to really understand what’s important to them.”

The cost of lack of autonomy—or other job stressors—can be severe.

“If a change [in your job] throws you out of control, this can lead to stress,” Dr. Wetterneck points out. “We know from recent studies that stress has an impact on your health, specifically on cardiovascular disease and mortality.” TH

Jane Jerrard has written for The Hospitalist since 2005.

This is the first in a series of articles on the four pillars of career satisfaction in hospital medicine.

How do you feel about the hours, compensation, responsibilities, and stresses of your present position? Do you think your job is sustainable—that is, would you be happy to continue your current work for years to come?

Many of today’s hospitalists might not answer the last question with a resounding “yes” because of one or more common factors that lead to chronic dissatisfaction with their careers.

In 2005, SHM formed the Career Satisfaction Task Force (CSTF) to combat this dissatisfaction, charging it with a three-pronged mission: to identify working conditions in hospital medicine that promote success and wellness; to provide resources to enhance career satisfaction; and to promote research into hospitalist career satisfaction and burnout.

“Originally, we were concerned with burnout in hospital medicine,” says CSTF co-chair Sylvia C. W. McKean, MD, FACP, medical director at Brigham and Women's Hospital/Faulkner Hospitalist Service and associate professor of medicine, Harvard Medical School, Boston. “The task force was charged to examine the factors that lead to a long, satisfactory career in hospital medicine.”

New White Paper Available

After reviewing the literature on physician burnout and general career satisfaction, the CSTF created a comprehensive document, “A Challenge for a New Specialty: A White Paper on Hospitalist Career Satisfaction” (available at www.hospitalmedicine.org), which can be used by hospitalists and hospital medicine practices as a toolkit for improving or ensuring job satisfaction.

The white paper outlines the four pillars of career satisfaction: autonomy/control, workload/schedule, reward/recognition, and community/environment. It includes a Job Fit self-evaluation questionnaire and other tools and advice that can be used to gather information and take steps to improve problems identified by the survey.

While the information in the white paper can best be used to improve an entire hospital medicine program, individual hospitalists can also benefit from it. The paper clearly states that an individual hospitalist has the power to influence change within his or her job, perhaps by majority rule. They can find a niche of expertise within their practice; pursue continuing medical education opportunities to promote their areas of expertise; nurture networks with peers; and find a mentor and regularly seek advice.

The First Pillar: Autonomy/Control

Control, or autonomy, refers to the need to be able to affect the key factors that influence job performance. For example, do you have control over when, how, and how quickly you perform a specific task? Do you have some say in task assignment and policies? What about the availability of support staff, supplies, and materials?

“Doctors expect to have control in their jobs, control over the tasks they do, how and when they do those tasks,” says CSTF member Tosha Wetterneck, MD, University of Wisconsin Hospital/Clinics in Madison. “This control helps them cope with stress; take that control away, and they can’t cope as well.”

Autonomy is a problem in hospital medicine because the field is still new and not widely understood. Consequently, hospitalists may end up responsible for additional duties and hours—especially on weekends—that other physicians dump on them.

“In some hospitals, the only doctors who can’t cap [their workloads] are the hospitalists,” reports Dr. McKean.

The best way to ensure you’re comfortable with the autonomy offered by your position is to be aware of what you want—and what you get—when you take your job.

“An individual hospitalist always has a choice of taking a job with the clear understanding of what they’ll have control over,” says Dr. Wetterneck. “However, you have to understand what you as a person need to have control over. You don’t want to get yourself into a position where you don’t have control over the specific areas that matter the most to you.”

An Example of Autonomy

To help clarify how lack of autonomy can make career satisfaction plummet, here is a fictional example of a hospitalist who suddenly lost control in her job:

“I love working in hospital medicine and take my job very seriously. However, two months ago my hospital medicine group assumed responsibility for care of neurosurgical patients, and all hospitalists are now required to provide care to these patients. I find this upsetting—I feel like this is one more step in relegating my colleagues and I to the status of ‘super-residents’ who are responsible for everything that other physicians don’t want to do. I want to have control over which type of patients I see.”

According to the CSTF research, this individual should take the following steps:

Step 1: Assess the situation in the manner outlined in the white paper. The hospitalist should:

• Use the Job Fit questionnaire to profile the control elements of the hospitalist practice;
• Become familiar with the hospital’s leadership and committee structure;
• Understand key payer issues that might affect inpatient care; and
• Review her job description.

After reviewing the role personal autonomy plays within her practice, the hospitalist must consider whether she’s in a position to request a change of duties, or whether her new responsibilities are non-negotiable.

“There are different facets of control,” says Dr. Wetterneck. “Some could make the argument that a hospitalist doesn’t have the skills to take care of neurosurgical patients, that this is out of the realm of reasonable expectations for the job. Others might say that there is reasonable expectation, as long as the hospitalists would get extra learning and extra support from other [subspecialists] that they’d be available for consult.”

Regardless of where you stand on the argument of reasonable expectation of a hospitalist’s responsibilities, what if a new job task simply rubs you the wrong way—to the point where you no longer enjoy your work?

“If it’s truly an issue of ‘I don’t want to do this,’ then it becomes an issue of your fit with your group,” Dr. Wetterneck continues. “If everyone in the group is doing it and you don’t want to, then you need to understand how important this control is for you. Is it important enough to change jobs?”

Step 2: If the answer to that last question is “Yes,” this hospitalist should keep autonomy in mind as she begins a job search. The white paper includes questions to ask herself and her potential employers to ensure she has control in her next position. The diversity of hospitalist responsibilities works in her favor—assuming she’s willing to move to another part of the country.

“You can list all the things that make you happy in a job, and you can probably find every single thing on your list in a hospitalist job somewhere in the U.S.,” speculates Dr. Wetterneck.

Next Month

A discussion of the workload/schedule pillar, which refers to the type, volume, and intensity of a hospitalist's work.

The Only Constant

Working in hospital medicine practically guarantees your job will continually change. Whether it’s a change in responsibilities like the example above, the steady growth of your practice, or even a change in leadership or ownership, hospitalists must go with the flow.

“I definitely think that the job requires a certain amount of flexibility,” says Dr. Wetterneck. “Hospitalists have to understand that their job role will continue to change over time. Therefore, people have to really understand what’s important to them.”

The cost of lack of autonomy—or other job stressors—can be severe.

“If a change [in your job] throws you out of control, this can lead to stress,” Dr. Wetterneck points out. “We know from recent studies that stress has an impact on your health, specifically on cardiovascular disease and mortality.” TH

Jane Jerrard has written for The Hospitalist since 2005.

This is the first in a series of articles on the four pillars of career satisfaction in hospital medicine.

How do you feel about the hours, compensation, responsibilities, and stresses of your present position? Do you think your job is sustainable—that is, would you be happy to continue your current work for years to come?

Many of today’s hospitalists might not answer the last question with a resounding “yes” because of one or more common factors that lead to chronic dissatisfaction with their careers.

In 2005, SHM formed the Career Satisfaction Task Force (CSTF) to combat this dissatisfaction, charging it with a three-pronged mission: to identify working conditions in hospital medicine that promote success and wellness; to provide resources to enhance career satisfaction; and to promote research into hospitalist career satisfaction and burnout.

“Originally, we were concerned with burnout in hospital medicine,” says CSTF co-chair Sylvia C. W. McKean, MD, FACP, medical director at Brigham and Women's Hospital/Faulkner Hospitalist Service and associate professor of medicine, Harvard Medical School, Boston. “The task force was charged to examine the factors that lead to a long, satisfactory career in hospital medicine.”

New White Paper Available

After reviewing the literature on physician burnout and general career satisfaction, the CSTF created a comprehensive document, “A Challenge for a New Specialty: A White Paper on Hospitalist Career Satisfaction” (available at www.hospitalmedicine.org), which can be used by hospitalists and hospital medicine practices as a toolkit for improving or ensuring job satisfaction.

The white paper outlines the four pillars of career satisfaction: autonomy/control, workload/schedule, reward/recognition, and community/environment. It includes a Job Fit self-evaluation questionnaire and other tools and advice that can be used to gather information and take steps to improve problems identified by the survey.

While the information in the white paper can best be used to improve an entire hospital medicine program, individual hospitalists can also benefit from it. The paper clearly states that an individual hospitalist has the power to influence change within his or her job, perhaps by majority rule. They can find a niche of expertise within their practice; pursue continuing medical education opportunities to promote their areas of expertise; nurture networks with peers; and find a mentor and regularly seek advice.

The First Pillar: Autonomy/Control

Control, or autonomy, refers to the need to be able to affect the key factors that influence job performance. For example, do you have control over when, how, and how quickly you perform a specific task? Do you have some say in task assignment and policies? What about the availability of support staff, supplies, and materials?

“Doctors expect to have control in their jobs, control over the tasks they do, how and when they do those tasks,” says CSTF member Tosha Wetterneck, MD, University of Wisconsin Hospital/Clinics in Madison. “This control helps them cope with stress; take that control away, and they can’t cope as well.”

Autonomy is a problem in hospital medicine because the field is still new and not widely understood. Consequently, hospitalists may end up responsible for additional duties and hours—especially on weekends—that other physicians dump on them.

“In some hospitals, the only doctors who can’t cap [their workloads] are the hospitalists,” reports Dr. McKean.

The best way to ensure you’re comfortable with the autonomy offered by your position is to be aware of what you want—and what you get—when you take your job.

“An individual hospitalist always has a choice of taking a job with the clear understanding of what they’ll have control over,” says Dr. Wetterneck. “However, you have to understand what you as a person need to have control over. You don’t want to get yourself into a position where you don’t have control over the specific areas that matter the most to you.”

An Example of Autonomy

To help clarify how lack of autonomy can make career satisfaction plummet, here is a fictional example of a hospitalist who suddenly lost control in her job:

“I love working in hospital medicine and take my job very seriously. However, two months ago my hospital medicine group assumed responsibility for care of neurosurgical patients, and all hospitalists are now required to provide care to these patients. I find this upsetting—I feel like this is one more step in relegating my colleagues and I to the status of ‘super-residents’ who are responsible for everything that other physicians don’t want to do. I want to have control over which type of patients I see.”

According to the CSTF research, this individual should take the following steps:

Step 1: Assess the situation in the manner outlined in the white paper. The hospitalist should:

• Use the Job Fit questionnaire to profile the control elements of the hospitalist practice;
• Become familiar with the hospital’s leadership and committee structure;
• Understand key payer issues that might affect inpatient care; and
• Review her job description.

After reviewing the role personal autonomy plays within her practice, the hospitalist must consider whether she’s in a position to request a change of duties, or whether her new responsibilities are non-negotiable.

“There are different facets of control,” says Dr. Wetterneck. “Some could make the argument that a hospitalist doesn’t have the skills to take care of neurosurgical patients, that this is out of the realm of reasonable expectations for the job. Others might say that there is reasonable expectation, as long as the hospitalists would get extra learning and extra support from other [subspecialists] that they’d be available for consult.”

Regardless of where you stand on the argument of reasonable expectation of a hospitalist’s responsibilities, what if a new job task simply rubs you the wrong way—to the point where you no longer enjoy your work?

“If it’s truly an issue of ‘I don’t want to do this,’ then it becomes an issue of your fit with your group,” Dr. Wetterneck continues. “If everyone in the group is doing it and you don’t want to, then you need to understand how important this control is for you. Is it important enough to change jobs?”

Step 2: If the answer to that last question is “Yes,” this hospitalist should keep autonomy in mind as she begins a job search. The white paper includes questions to ask herself and her potential employers to ensure she has control in her next position. The diversity of hospitalist responsibilities works in her favor—assuming she’s willing to move to another part of the country.

“You can list all the things that make you happy in a job, and you can probably find every single thing on your list in a hospitalist job somewhere in the U.S.,” speculates Dr. Wetterneck.

Next Month

A discussion of the workload/schedule pillar, which refers to the type, volume, and intensity of a hospitalist's work.

The Only Constant

Working in hospital medicine practically guarantees your job will continually change. Whether it’s a change in responsibilities like the example above, the steady growth of your practice, or even a change in leadership or ownership, hospitalists must go with the flow.

“I definitely think that the job requires a certain amount of flexibility,” says Dr. Wetterneck. “Hospitalists have to understand that their job role will continue to change over time. Therefore, people have to really understand what’s important to them.”

The cost of lack of autonomy—or other job stressors—can be severe.

“If a change [in your job] throws you out of control, this can lead to stress,” Dr. Wetterneck points out. “We know from recent studies that stress has an impact on your health, specifically on cardiovascular disease and mortality.” TH

Jane Jerrard has written for The Hospitalist since 2005.

Nine members of SHM’s Public Policy Committee (PPC), accompanied by several SHM staff members, paid a visit to Capitol Hill early this year.

The group spent Feb. 28 calling on senators, representatives, and congressional staff, as they participated in meetings similar to those included in SHM’s Legislative Advocacy Day, held during the 2006 Annual Meeting. In fact, many of the PPC members had second meetings with legislative staff they had met last May.

“We had already broken some ground with Legislative Day, so some people were familiar with us,” says Ron Angus, MD, Department of Medicine, Presbyterian Hospital of Dallas. “We had a little more time to talk about the issues.”

During their meetings, “We emphasized the different roles that SHM can play, and we tried to get a feel for what it means to have a Democrat-led Congress,” says Jack Percelay, MD, MPH, FAAP, Virtua Health, Ridgewood, N.J.

SHM’s senior adviser for advocacy and government affairs, Laura Allendorf, pronounces it “a very productive day.”

Building on a Foundation

The PPC visits were successful partly because this was the second time SHM had visited representatives, allowing the hospitalists to build on their introductory meetings and spend more time discussing issues and offering help. The committee hopes to continue this trend.

“In the long term, we want to see if we can meet with the same people more frequently,” explains Dr. Angus. Allendorf agrees, saying, “The more often we’re up there, the better.”

There may be many more visits or communications. “I think we’re building something long-term, and it’s going to take a while to do that,” says Dr. Angus. “As we get more comfortable talking to these folks, we’ll work on getting them to contact us when issues first come up. Our goal is to be there at the beginning of the process, rather than the end, when it’s too late to have much impact.”

Another reason the February visits were deemed a success involves whom the PPC met with.

“These meetings were more productive because we were meeting with key staff, people on key committees,” recounts Allendorf. “And [participants] had more visits during the day—each had between five and eight. We made a point to meet with committee staff, staff for key committees, including the House Ways and Means Health Subcommittee, the Senate Finance Committee, the Senate Committee on Appropriations, and the Senate Committee on Health, Education, Labor, and Pensions. We met with committee aides hired to handle special issues like Medicare Part B.”

Targeting these influential offices—particularly the powerful Ways and Means Committee—should have greater impact on healthcare legislation and funding.

Making Inroads with Ways and Means

The entire group ended the day in a meeting with Rep. Shelley Berkley, D-Nev., and her health legislative aide Jeff Davis. Berkley serves on the House Ways and Means Committee and is perceived as “physician-friendly.” Her husband is a nephrologist, and Allendorf describes the lawmaker as “very knowledgeable about the issues” in healthcare. “She’s now in a position to do something; she’ll be a major player,” predicts Allendorf.

“We met with Berkley for five or 10 minutes, then had a roundtable with Jeff Davis from her office,” says Dr. Angus. “We talked about increased funding for AHRQ [Agency for Healthcare Research and Quality] and coordinating quality initiatives being brought to bear in hospitals. We tried to emphasize that when you talk about quality in hospitals, you’re talking about hospitalists.”

With her majority role on a key committee, Berkley is one example of the newly empowered Democrats in office—Democrats who may make a difference in pushing through SHM-sponsored legislation.

Democratic Differences?

Did the PPC members notice a difference since May, with the change of majority party in Congress?

“I could feel it,” says Dr. Angus. “There’s been a huge sea change. Those who felt unempowered last year now feel that there’s a clean slate.”

Dr. Percelay saw a difference in priorities among healthcare issues. “In general, the access issue is much more prominent,” he says. “There’s a sense that we need to do something about healthcare expenses and access for everyone. There’s a recognition of big-picture issues—by both Democrats and Republicans—that we aren’t providing coverage for everyone, and we’re spending too much on it.”

Future Advocacy

The PPC counts its Capitol Hill visit a success. Members want to broaden the influence of SHM and hospitalists by enlisting the help of others.

“We want to identify members who are interested in public policy who live in key areas—areas served by legislators on key committees,” explains Dr. Percelay, “so that they can lobby from a local perspective.” Dr. Angus adds, “Ideally, they’ll interact with their national officials when they’re in their local offices. Also, we’d like members to keep an eye on state and local issues.”

Allendorf points out that these members can be identified and reached though SHM’s online Legislative Action Center at capwiz.com/hospitalmedicine/home. If you receive an e-mail asking you to contact one of your representatives regarding a specific issue, you can take part in the advocacy efforts.

In other plans, says Dr. Angus, “We hope to construct some body of resources that hospitalists who go to D.C. on their own can use to go up to the Hill with information in hand and talk to their Congress people.”

PPC members understand they have their work cut out for them when it comes to increasing awareness of SHM and hospitalists on Capitol Hill.

“This is a long-term investment process,” Dr. Percelay says. “We’re learning as an organization how to conduct our public policy efforts. We’re at the beginning stages of meeting with these people and letting them know what hospitalists can do.” TH

Jane Jerrard writes “Public Policy” for The Hospitalist.

Nine members of SHM’s Public Policy Committee (PPC), accompanied by several SHM staff members, paid a visit to Capitol Hill early this year.

The group spent Feb. 28 calling on senators, representatives, and congressional staff, as they participated in meetings similar to those included in SHM’s Legislative Advocacy Day, held during the 2006 Annual Meeting. In fact, many of the PPC members had second meetings with legislative staff they had met last May.

“We had already broken some ground with Legislative Day, so some people were familiar with us,” says Ron Angus, MD, Department of Medicine, Presbyterian Hospital of Dallas. “We had a little more time to talk about the issues.”

During their meetings, “We emphasized the different roles that SHM can play, and we tried to get a feel for what it means to have a Democrat-led Congress,” says Jack Percelay, MD, MPH, FAAP, Virtua Health, Ridgewood, N.J.

SHM’s senior adviser for advocacy and government affairs, Laura Allendorf, pronounces it “a very productive day.”

Building on a Foundation

The PPC visits were successful partly because this was the second time SHM had visited representatives, allowing the hospitalists to build on their introductory meetings and spend more time discussing issues and offering help. The committee hopes to continue this trend.

“In the long term, we want to see if we can meet with the same people more frequently,” explains Dr. Angus. Allendorf agrees, saying, “The more often we’re up there, the better.”

There may be many more visits or communications. “I think we’re building something long-term, and it’s going to take a while to do that,” says Dr. Angus. “As we get more comfortable talking to these folks, we’ll work on getting them to contact us when issues first come up. Our goal is to be there at the beginning of the process, rather than the end, when it’s too late to have much impact.”

Another reason the February visits were deemed a success involves whom the PPC met with.

“These meetings were more productive because we were meeting with key staff, people on key committees,” recounts Allendorf. “And [participants] had more visits during the day—each had between five and eight. We made a point to meet with committee staff, staff for key committees, including the House Ways and Means Health Subcommittee, the Senate Finance Committee, the Senate Committee on Appropriations, and the Senate Committee on Health, Education, Labor, and Pensions. We met with committee aides hired to handle special issues like Medicare Part B.”

Targeting these influential offices—particularly the powerful Ways and Means Committee—should have greater impact on healthcare legislation and funding.

Making Inroads with Ways and Means

The entire group ended the day in a meeting with Rep. Shelley Berkley, D-Nev., and her health legislative aide Jeff Davis. Berkley serves on the House Ways and Means Committee and is perceived as “physician-friendly.” Her husband is a nephrologist, and Allendorf describes the lawmaker as “very knowledgeable about the issues” in healthcare. “She’s now in a position to do something; she’ll be a major player,” predicts Allendorf.

“We met with Berkley for five or 10 minutes, then had a roundtable with Jeff Davis from her office,” says Dr. Angus. “We talked about increased funding for AHRQ [Agency for Healthcare Research and Quality] and coordinating quality initiatives being brought to bear in hospitals. We tried to emphasize that when you talk about quality in hospitals, you’re talking about hospitalists.”

With her majority role on a key committee, Berkley is one example of the newly empowered Democrats in office—Democrats who may make a difference in pushing through SHM-sponsored legislation.

Democratic Differences?

Did the PPC members notice a difference since May, with the change of majority party in Congress?

“I could feel it,” says Dr. Angus. “There’s been a huge sea change. Those who felt unempowered last year now feel that there’s a clean slate.”

Dr. Percelay saw a difference in priorities among healthcare issues. “In general, the access issue is much more prominent,” he says. “There’s a sense that we need to do something about healthcare expenses and access for everyone. There’s a recognition of big-picture issues—by both Democrats and Republicans—that we aren’t providing coverage for everyone, and we’re spending too much on it.”

Future Advocacy

The PPC counts its Capitol Hill visit a success. Members want to broaden the influence of SHM and hospitalists by enlisting the help of others.

“We want to identify members who are interested in public policy who live in key areas—areas served by legislators on key committees,” explains Dr. Percelay, “so that they can lobby from a local perspective.” Dr. Angus adds, “Ideally, they’ll interact with their national officials when they’re in their local offices. Also, we’d like members to keep an eye on state and local issues.”

Allendorf points out that these members can be identified and reached though SHM’s online Legislative Action Center at capwiz.com/hospitalmedicine/home. If you receive an e-mail asking you to contact one of your representatives regarding a specific issue, you can take part in the advocacy efforts.

In other plans, says Dr. Angus, “We hope to construct some body of resources that hospitalists who go to D.C. on their own can use to go up to the Hill with information in hand and talk to their Congress people.”

PPC members understand they have their work cut out for them when it comes to increasing awareness of SHM and hospitalists on Capitol Hill.

“This is a long-term investment process,” Dr. Percelay says. “We’re learning as an organization how to conduct our public policy efforts. We’re at the beginning stages of meeting with these people and letting them know what hospitalists can do.” TH

Jane Jerrard writes “Public Policy” for The Hospitalist.

Nine members of SHM’s Public Policy Committee (PPC), accompanied by several SHM staff members, paid a visit to Capitol Hill early this year.

The group spent Feb. 28 calling on senators, representatives, and congressional staff, as they participated in meetings similar to those included in SHM’s Legislative Advocacy Day, held during the 2006 Annual Meeting. In fact, many of the PPC members had second meetings with legislative staff they had met last May.

“We had already broken some ground with Legislative Day, so some people were familiar with us,” says Ron Angus, MD, Department of Medicine, Presbyterian Hospital of Dallas. “We had a little more time to talk about the issues.”

During their meetings, “We emphasized the different roles that SHM can play, and we tried to get a feel for what it means to have a Democrat-led Congress,” says Jack Percelay, MD, MPH, FAAP, Virtua Health, Ridgewood, N.J.

SHM’s senior adviser for advocacy and government affairs, Laura Allendorf, pronounces it “a very productive day.”

Building on a Foundation

The PPC visits were successful partly because this was the second time SHM had visited representatives, allowing the hospitalists to build on their introductory meetings and spend more time discussing issues and offering help. The committee hopes to continue this trend.

“In the long term, we want to see if we can meet with the same people more frequently,” explains Dr. Angus. Allendorf agrees, saying, “The more often we’re up there, the better.”

There may be many more visits or communications. “I think we’re building something long-term, and it’s going to take a while to do that,” says Dr. Angus. “As we get more comfortable talking to these folks, we’ll work on getting them to contact us when issues first come up. Our goal is to be there at the beginning of the process, rather than the end, when it’s too late to have much impact.”

Another reason the February visits were deemed a success involves whom the PPC met with.

“These meetings were more productive because we were meeting with key staff, people on key committees,” recounts Allendorf. “And [participants] had more visits during the day—each had between five and eight. We made a point to meet with committee staff, staff for key committees, including the House Ways and Means Health Subcommittee, the Senate Finance Committee, the Senate Committee on Appropriations, and the Senate Committee on Health, Education, Labor, and Pensions. We met with committee aides hired to handle special issues like Medicare Part B.”

Targeting these influential offices—particularly the powerful Ways and Means Committee—should have greater impact on healthcare legislation and funding.

Making Inroads with Ways and Means

The entire group ended the day in a meeting with Rep. Shelley Berkley, D-Nev., and her health legislative aide Jeff Davis. Berkley serves on the House Ways and Means Committee and is perceived as “physician-friendly.” Her husband is a nephrologist, and Allendorf describes the lawmaker as “very knowledgeable about the issues” in healthcare. “She’s now in a position to do something; she’ll be a major player,” predicts Allendorf.

“We met with Berkley for five or 10 minutes, then had a roundtable with Jeff Davis from her office,” says Dr. Angus. “We talked about increased funding for AHRQ [Agency for Healthcare Research and Quality] and coordinating quality initiatives being brought to bear in hospitals. We tried to emphasize that when you talk about quality in hospitals, you’re talking about hospitalists.”

With her majority role on a key committee, Berkley is one example of the newly empowered Democrats in office—Democrats who may make a difference in pushing through SHM-sponsored legislation.

Democratic Differences?

Did the PPC members notice a difference since May, with the change of majority party in Congress?

“I could feel it,” says Dr. Angus. “There’s been a huge sea change. Those who felt unempowered last year now feel that there’s a clean slate.”

Dr. Percelay saw a difference in priorities among healthcare issues. “In general, the access issue is much more prominent,” he says. “There’s a sense that we need to do something about healthcare expenses and access for everyone. There’s a recognition of big-picture issues—by both Democrats and Republicans—that we aren’t providing coverage for everyone, and we’re spending too much on it.”

Future Advocacy

The PPC counts its Capitol Hill visit a success. Members want to broaden the influence of SHM and hospitalists by enlisting the help of others.

“We want to identify members who are interested in public policy who live in key areas—areas served by legislators on key committees,” explains Dr. Percelay, “so that they can lobby from a local perspective.” Dr. Angus adds, “Ideally, they’ll interact with their national officials when they’re in their local offices. Also, we’d like members to keep an eye on state and local issues.”

Allendorf points out that these members can be identified and reached though SHM’s online Legislative Action Center at capwiz.com/hospitalmedicine/home. If you receive an e-mail asking you to contact one of your representatives regarding a specific issue, you can take part in the advocacy efforts.

In other plans, says Dr. Angus, “We hope to construct some body of resources that hospitalists who go to D.C. on their own can use to go up to the Hill with information in hand and talk to their Congress people.”

PPC members understand they have their work cut out for them when it comes to increasing awareness of SHM and hospitalists on Capitol Hill.

“This is a long-term investment process,” Dr. Percelay says. “We’re learning as an organization how to conduct our public policy efforts. We’re at the beginning stages of meeting with these people and letting them know what hospitalists can do.” TH

Jane Jerrard writes “Public Policy” for The Hospitalist.

The 10-year anniversary of SHM was an occasion not for looking back on the first decade of the organization, but for looking ahead.

In addition to seven tracks of educational sessions and ample opportunities for networking, SHM’s 10th Annual Meeting, held May 23-25 in Dallas, provided opportunities to get a big-picture glimpse into the future of hospital medicine, in the form of some eye-opening plenary sessions.

Coming Soon: Hospital Medicine Certification

Annual Meeting attendees heard from Robert M. Wachter, MD, and past-SHM President Mary Jo Gorman, MD, MBA, on “Certification in Hospital Medicine: What Does This Mean to Hospitalists? To Employers? To Patients?” The two outlined how the American Board of Internal Medicine (ABIM) is developing a Focused Recognition for Hospital Medicine through its Maintenance of Certification (MOC) system.

Dr. Wachter, who chairs the ABIM Committee on Hospital Medicine Focused Recognition, explained that the focused recognition would give hospitalists a formal credential that recognizes hospital medicine as a distinct field within internal medicine. This is the first time ABIM has offered focused recognition for any subset of internal medicine—and, if approved, the first time the umbrella organization, the American Board of Medical Specialties (ABMS), will offer a focused recognition for a subset of any specialty.

“This is a brand new idea,” stressed Dr. Wachter. “One of the exciting things—the challenging things—is that this is a first step toward the broader issue of how to certify based on experience rather than just training.”

A Look at Digital Medicine

Informally known as the “health technology czar,” David J. Brailer, MD, PhD, served as the first national coordinator for Health Information Technology, at the Department of Health and Human Services until he resigned in April 2006. He is vice chairman of the American Health Information Community, and based on his plenary session “Health Care’s Digital Era: Implications for Hospitalists,” he is obviously familiar with hospital medicine.

“Hospitalists and health IT are co-factors in the same equation of change in healthcare,” said Dr. Brailer. “I can’t see how one can exist without the other.”

He went on to explain that hospitals must lead the way for digital medicine, as they are the institutions with the most opportunity for cost reductions in healthcare, the most opportunity for error reduction (“I’m not saying hospitals have the most errors, but that the corporatized process allows them to reduce errors that occur there,” he clarified), and the best site for innovation to move to a virtual model such as e-ICUs and new tele-specialties.

“And who can we turn to who ‘gets it,’ who can make all this happen?” asked Dr. Brailer of the innovations. “It won’t be the cardiologists, or the emergency department doctors. The obvious answer is that it will be the hospitalists.”

He warned that in order for hospitalists to be change agents, they must first take on the role of leaders of other doctors in inpatient care. “Some [hospitalists] don’t want to take on this role; others are already doing it,” he said. “I think that doctors need this leadership and I can’t think of a better group to do it than hospitalists. They’re going to have to step up to the plate on this.”

Dr. Brailer listed big issues coming up for hospitals, predicting that they will become “the hub of chronic-care management, leaders in adopting state-of-the-art technology, and leaders in quality improvement. Hospitalists are attached to each of these.” He explained that in chronic-care management, patients with chronic illnesses are cared for in a continuum-based way. Currently, inpatient care is the anchor not just for treatment, but for monitoring weight or assessing daily function levels. With chronic-care management, doctors can monitor patients without having them come into the office or the hospital.

“Primary-care doctors won’t be able to perform this off-site monitoring; they don’t have the time or the infrastructure,” explained Dr. Brailer. “But this is exactly what hospitals already do. Electronic monitoring is a real opportunity for them—and for hospitalists—to expand their care offerings.”

In spite of this expansion, he warned that hospitals will be in danger if they don’t change with the times. “The world is moving away from hospital-based care and toward [patient]-centered care,” he stated. “This is apparent in the current push for portability of patient-care information, and in today’s healthcare transparency issues. These are not hospital-friendly measures; in fact, they threaten hospitals to some degree. I hope that these trends will challenge hospitals to question how changes apply to them.”

Dr. Brailer ended with an update on public policy regarding healthcare—not a pretty picture from his insider’s view.

“Not much will happen in the next two years,” he predicted. “The FDA will pass the Prescription Drug User Fee program, and SCHIP [State Children’s Health Insurance Program] will pass in Washington D.C. I don’t think anything else will make it through the thicket of everything else going on.”

He also warned that regardless of who the next president of the U.S. is, nothing much will happen with healthcare reform. “It’s a high-priority item, but not high enough to warrant significant attention,” he said. “In the long term, it will get major attention, but probably only as a result of a catastrophe.”

Factors That Will Shape Our Future

On Friday morning, attendees heard from Jonathan B. Perlin, MD, PhD, MSHA, former under secretary for health at the Veterans Affairs, and currently the chief medical officer and senior vice-president of quality for Hospital Corporation of America (HCA) in Nashville, Tenn.—the nation’s largest hospital group.

In presenting, “Healthcare 2015: Challenges and Opportunities in the Decade Ahead,” Dr. Perlin threaded together the factors that will drive healthcare to a new level in the next eight years: the health needs of the population, including aging and the complications of diabetes, the increased requirements for delivering value, the economic pressures, and the technological changes and decentralization of healthcare delivery. Dr. Perlin, a leader in healthcare transformation and health information technology who has been termed a “clinical futurist,” pointed out that the result of these factors will be a transformation from an industrial to an information age model of healthcare.

Dr. Perlin traced the path being shaped by these challenges and opportunities, explaining that the economics of healthcare are creating pressure on the environment and disrupting the status quo. “Costs are increasing rapidly,” he stated. “It’s pretty clear that we’ve already hit some statutory alarms in the Medicare trust fund. Estimates now indicate that the trust fund will be bankrupt by 2018; we can either limit what we do or we can find better value in delivery of care.”

Response to economic pressure by Medicare and private insurers, said Dr. Perlin, provides a construct for change.

“The private sector, the government, and employers are all saying that we’re not going to buy units of healthcare services any more, we’re going to buy outcomes,” stressed Dr. Perlin. “The result is that performance becomes a gate function for even doing business in the new world.”

Toying with modest incentives in current pay-for-performance models will soon be trumped. “Medicare is changing from an incentive for simply reporting [with the current “Reporting Hospital Quality Data for Annual Payment Update” program] to value-based purchasing,” Dr. Perlin pointed out. Similarly, private insurers are differentiating performance levels and using lower co-pays to direct patients to better performers and high co-pays to redirect patients away from lower performers.

To participate in this new world of value-based purchasing and what Dr. Perlin termed “tiering and steering,” the healthcare industry must reorganize ways that it has traditionally provided care. Pen and paper are replaced by electronic health records. A locus of care is replaced by an interoperable, coordinated cooperative information network.

“The patient is the point of care in the new system, whether supported by glucometers that feed data into a central system,” said Dr. Perlin, “or a heart failure patient is tracked after discharge with a digital scale … or whether it is a hospitalist who reaches into the traditional healthcare setting with remote monitoring to provide round-the-clock support to a critically ill patient.”

In addition to providing enhanced safety, quality, continuity, and efficiency, new systems like these will provide central information sources, powerful in providing real-time, clinical decision-support, as well as generating new knowledge about disease, treatment and service delivery. The tremendous data available will reveal previously unnoticed patterns and provide more support for evidence-based care.

“Medicare and private insurers are focusing more on evidence-based care and are increasingly ambivalent about decisions not supported by evidence,” observed Dr. Perlin.

His view of the near future of healthcare was followed later that day with another plenary session that mulled how hospital medicine might look a decade from now.

Now It’s Time to Say Goodbye …

Dr. Wachter traditionally closes each Annual Meeting with a review of how far the young field of hospital medicine has come.

But at the 10th Annual Meeting, Dr. Wachter chose not to look back but to peer into his crystal ball. His presentation, “The Hospitalist Movement Two Decades Later: A Letter from the Future,” took the form of a letter from his future self, written in 2017, to SHM CEO Larry Wellikson, MD, as each man settles into a long-term care facility.

Dr. Wachter outlined the major forces starting to affect hospital medicine and imagined where they would lead us. And he couldn’t resist one glimpse back in time: “Think about the change we’ve seen already,” he marveled. “There’s no field in modern medical history that’s grown this quickly. We’re both leading the way and riding the waves.”

Dr. Wachter admitted his initial estimates for phenomenal growth of the field are already surpassed. “We originally projected that there would be 20,000 or 30,000 hospitalists,” he said. “Well, we’re already over 20,000. Now I’m thinking the final number will be around 50,000 or 60,000.”

He attributed part of that growth to several changes, including the additional responsibility of hospitalists for caring for surgical patients—something he sees as eventually becoming the norm. Another factor is the role hospitalists play in replacing residents in teaching hospitals, an area that has seen unplanned growth.

And finally, Dr. Wachter speculated that the quality measures movement will also boost the ranks of hospitalists. “We’re already seeing tremendous pressure on hospitalists to help their hospitals achieve success in pay-for-performance programs and in publicly reported measures,” he said. “This type of responsibility was originally considered a nice add-on for using hospitalists, but now it’s getting to be a crucial part. There’s a building expectation that hospitalists will guarantee superb performance.”

Dr. Wachter also touched on how information technology might change hospital medicine. “IT will definitely have an impact, in some exciting ways, and in other ways that have not been thought through,” he warned. “For example, consultation may be very different.” For example, a hospitalist in 2017 may be able to use a video link at a patient’s bedside to consult with one of 100 cardiologists around the country or around the world.

Following Dr. Wachter’s view of the future, Sylvia C. McKean, MD, had the last word at the meeting. As the chair in charge of next year’s Annual Meeting in San Diego, she presented the wrap-up on Friday afternoon, covering “What Have We Learned.”

Looking back on the previous three days, Dr. Mc­Kean pronounced, “The future is now.” Pointing to the number of meeting sessions, abstracts and poster presentations that emphasized recent innovations in hospital medicine, she said, “The Annual Meeting helps us find our expertise as hospitalists.” The Annual Meeting, along with SHM’s published Core Competencies helps define the role that hospitalists play in patient-centered care and in patient safety.

Dr. McKean thanked Chad Whelan, chair of the Annual Meeting Committee, for all his work, and said she was looking forward to 2008.

SHM Elects New Members to Board of Directors

Two new members announced; one member re-elected

SHM is pleased to announce the election of Joseph Li, MD, and Mahalakshmi Halasyamani, MD, and the re-election of Patrick Cawley, MD, to its board of directors for terms that began at the SHM Annual Meeting May 23-25 in Dallas.

“One of the strengths that keeps SHM on the cutting edge is the infusion of new talent on the board. SHM is fortunate to have a continued source of hospitalist leaders who willingly share their time and talents to help SHM shape and grow the hospital medicine specialty,” says Larry Wellikson, MD, CEO of SHM.

Each of the newly elected SHM board members comes from distinguished programs and institutions.

Dr. Li

Dr. Li is the director of the hospital medicine program at Beth Israel Deaconess Medical Center in Boston and an assistant professor of medicine at the Harvard Medical School. He has been an active member of SHM, serving on the Education and Annual Meeting Committees, as well as the Procedures Task Force. Dr. Li earned his bachelor’s degree in pharmacy at the University of Oklahoma College of Pharmacy and his medical degree at the University of Oklahoma College of Medicine. He completed his residency at the Beth Israel Deaconess Medical Center.

Dr. Cawley

Dr. Cawley is executive medical director at the Medical University Hospital of South Carolina. Prior to this, he was chief of staff at Conway Medical Center, S.C. He has served on the SHM board of directors since 2004 and is its treasurer. As an active member of SHM, he serves on the Public Policy Committee, Leadership Task Force, and on the advisory board for the Practice Management and Coding Courses. Dr. Cawley earned his bachelor’s degree in biology and chemistry from the University of Scranton (Penn.) and his medical degree from Georgetown University School of Medicine in Wash., D.C. He completed his residency at the Duke University Medical Center in Durham, N.C.

Dr. Halasyamani

Dr. Halasyamani is the medical director of the heart failure program at Saint Joseph Mercy Hospital in Ann Arbor, Mich. Before that, she served as director of academic internal medicine inpatient services. She is also a clinical instructor of internal medicine at the University of Michigan and associate chair of the department of internal medicine at Saint Joseph Mercy Hospital. Dr. Halasyamani earned her bachelor’s degree in English and chemistry from Saint Louis University (Mo.) and her medical degree from Harvard Medical School, Boston. She completed her residency at Brigham and Women’s Hospital.

Congratulations to the newest members of the SHM Board of Directors.

The 10-year anniversary of SHM was an occasion not for looking back on the first decade of the organization, but for looking ahead.

In addition to seven tracks of educational sessions and ample opportunities for networking, SHM’s 10th Annual Meeting, held May 23-25 in Dallas, provided opportunities to get a big-picture glimpse into the future of hospital medicine, in the form of some eye-opening plenary sessions.

Coming Soon: Hospital Medicine Certification

Annual Meeting attendees heard from Robert M. Wachter, MD, and past-SHM President Mary Jo Gorman, MD, MBA, on “Certification in Hospital Medicine: What Does This Mean to Hospitalists? To Employers? To Patients?” The two outlined how the American Board of Internal Medicine (ABIM) is developing a Focused Recognition for Hospital Medicine through its Maintenance of Certification (MOC) system.

Dr. Wachter, who chairs the ABIM Committee on Hospital Medicine Focused Recognition, explained that the focused recognition would give hospitalists a formal credential that recognizes hospital medicine as a distinct field within internal medicine. This is the first time ABIM has offered focused recognition for any subset of internal medicine—and, if approved, the first time the umbrella organization, the American Board of Medical Specialties (ABMS), will offer a focused recognition for a subset of any specialty.

“This is a brand new idea,” stressed Dr. Wachter. “One of the exciting things—the challenging things—is that this is a first step toward the broader issue of how to certify based on experience rather than just training.”

A Look at Digital Medicine

Informally known as the “health technology czar,” David J. Brailer, MD, PhD, served as the first national coordinator for Health Information Technology, at the Department of Health and Human Services until he resigned in April 2006. He is vice chairman of the American Health Information Community, and based on his plenary session “Health Care’s Digital Era: Implications for Hospitalists,” he is obviously familiar with hospital medicine.

“Hospitalists and health IT are co-factors in the same equation of change in healthcare,” said Dr. Brailer. “I can’t see how one can exist without the other.”

He went on to explain that hospitals must lead the way for digital medicine, as they are the institutions with the most opportunity for cost reductions in healthcare, the most opportunity for error reduction (“I’m not saying hospitals have the most errors, but that the corporatized process allows them to reduce errors that occur there,” he clarified), and the best site for innovation to move to a virtual model such as e-ICUs and new tele-specialties.

“And who can we turn to who ‘gets it,’ who can make all this happen?” asked Dr. Brailer of the innovations. “It won’t be the cardiologists, or the emergency department doctors. The obvious answer is that it will be the hospitalists.”

He warned that in order for hospitalists to be change agents, they must first take on the role of leaders of other doctors in inpatient care. “Some [hospitalists] don’t want to take on this role; others are already doing it,” he said. “I think that doctors need this leadership and I can’t think of a better group to do it than hospitalists. They’re going to have to step up to the plate on this.”

Dr. Brailer listed big issues coming up for hospitals, predicting that they will become “the hub of chronic-care management, leaders in adopting state-of-the-art technology, and leaders in quality improvement. Hospitalists are attached to each of these.” He explained that in chronic-care management, patients with chronic illnesses are cared for in a continuum-based way. Currently, inpatient care is the anchor not just for treatment, but for monitoring weight or assessing daily function levels. With chronic-care management, doctors can monitor patients without having them come into the office or the hospital.

“Primary-care doctors won’t be able to perform this off-site monitoring; they don’t have the time or the infrastructure,” explained Dr. Brailer. “But this is exactly what hospitals already do. Electronic monitoring is a real opportunity for them—and for hospitalists—to expand their care offerings.”

In spite of this expansion, he warned that hospitals will be in danger if they don’t change with the times. “The world is moving away from hospital-based care and toward [patient]-centered care,” he stated. “This is apparent in the current push for portability of patient-care information, and in today’s healthcare transparency issues. These are not hospital-friendly measures; in fact, they threaten hospitals to some degree. I hope that these trends will challenge hospitals to question how changes apply to them.”

Dr. Brailer ended with an update on public policy regarding healthcare—not a pretty picture from his insider’s view.

“Not much will happen in the next two years,” he predicted. “The FDA will pass the Prescription Drug User Fee program, and SCHIP [State Children’s Health Insurance Program] will pass in Washington D.C. I don’t think anything else will make it through the thicket of everything else going on.”

He also warned that regardless of who the next president of the U.S. is, nothing much will happen with healthcare reform. “It’s a high-priority item, but not high enough to warrant significant attention,” he said. “In the long term, it will get major attention, but probably only as a result of a catastrophe.”

Factors That Will Shape Our Future

On Friday morning, attendees heard from Jonathan B. Perlin, MD, PhD, MSHA, former under secretary for health at the Veterans Affairs, and currently the chief medical officer and senior vice-president of quality for Hospital Corporation of America (HCA) in Nashville, Tenn.—the nation’s largest hospital group.

In presenting, “Healthcare 2015: Challenges and Opportunities in the Decade Ahead,” Dr. Perlin threaded together the factors that will drive healthcare to a new level in the next eight years: the health needs of the population, including aging and the complications of diabetes, the increased requirements for delivering value, the economic pressures, and the technological changes and decentralization of healthcare delivery. Dr. Perlin, a leader in healthcare transformation and health information technology who has been termed a “clinical futurist,” pointed out that the result of these factors will be a transformation from an industrial to an information age model of healthcare.

Dr. Perlin traced the path being shaped by these challenges and opportunities, explaining that the economics of healthcare are creating pressure on the environment and disrupting the status quo. “Costs are increasing rapidly,” he stated. “It’s pretty clear that we’ve already hit some statutory alarms in the Medicare trust fund. Estimates now indicate that the trust fund will be bankrupt by 2018; we can either limit what we do or we can find better value in delivery of care.”

Response to economic pressure by Medicare and private insurers, said Dr. Perlin, provides a construct for change.

“The private sector, the government, and employers are all saying that we’re not going to buy units of healthcare services any more, we’re going to buy outcomes,” stressed Dr. Perlin. “The result is that performance becomes a gate function for even doing business in the new world.”

Toying with modest incentives in current pay-for-performance models will soon be trumped. “Medicare is changing from an incentive for simply reporting [with the current “Reporting Hospital Quality Data for Annual Payment Update” program] to value-based purchasing,” Dr. Perlin pointed out. Similarly, private insurers are differentiating performance levels and using lower co-pays to direct patients to better performers and high co-pays to redirect patients away from lower performers.

To participate in this new world of value-based purchasing and what Dr. Perlin termed “tiering and steering,” the healthcare industry must reorganize ways that it has traditionally provided care. Pen and paper are replaced by electronic health records. A locus of care is replaced by an interoperable, coordinated cooperative information network.

“The patient is the point of care in the new system, whether supported by glucometers that feed data into a central system,” said Dr. Perlin, “or a heart failure patient is tracked after discharge with a digital scale … or whether it is a hospitalist who reaches into the traditional healthcare setting with remote monitoring to provide round-the-clock support to a critically ill patient.”

In addition to providing enhanced safety, quality, continuity, and efficiency, new systems like these will provide central information sources, powerful in providing real-time, clinical decision-support, as well as generating new knowledge about disease, treatment and service delivery. The tremendous data available will reveal previously unnoticed patterns and provide more support for evidence-based care.

“Medicare and private insurers are focusing more on evidence-based care and are increasingly ambivalent about decisions not supported by evidence,” observed Dr. Perlin.

His view of the near future of healthcare was followed later that day with another plenary session that mulled how hospital medicine might look a decade from now.

Now It’s Time to Say Goodbye …

Dr. Wachter traditionally closes each Annual Meeting with a review of how far the young field of hospital medicine has come.

But at the 10th Annual Meeting, Dr. Wachter chose not to look back but to peer into his crystal ball. His presentation, “The Hospitalist Movement Two Decades Later: A Letter from the Future,” took the form of a letter from his future self, written in 2017, to SHM CEO Larry Wellikson, MD, as each man settles into a long-term care facility.

Dr. Wachter outlined the major forces starting to affect hospital medicine and imagined where they would lead us. And he couldn’t resist one glimpse back in time: “Think about the change we’ve seen already,” he marveled. “There’s no field in modern medical history that’s grown this quickly. We’re both leading the way and riding the waves.”

Dr. Wachter admitted his initial estimates for phenomenal growth of the field are already surpassed. “We originally projected that there would be 20,000 or 30,000 hospitalists,” he said. “Well, we’re already over 20,000. Now I’m thinking the final number will be around 50,000 or 60,000.”

He attributed part of that growth to several changes, including the additional responsibility of hospitalists for caring for surgical patients—something he sees as eventually becoming the norm. Another factor is the role hospitalists play in replacing residents in teaching hospitals, an area that has seen unplanned growth.

And finally, Dr. Wachter speculated that the quality measures movement will also boost the ranks of hospitalists. “We’re already seeing tremendous pressure on hospitalists to help their hospitals achieve success in pay-for-performance programs and in publicly reported measures,” he said. “This type of responsibility was originally considered a nice add-on for using hospitalists, but now it’s getting to be a crucial part. There’s a building expectation that hospitalists will guarantee superb performance.”

Dr. Wachter also touched on how information technology might change hospital medicine. “IT will definitely have an impact, in some exciting ways, and in other ways that have not been thought through,” he warned. “For example, consultation may be very different.” For example, a hospitalist in 2017 may be able to use a video link at a patient’s bedside to consult with one of 100 cardiologists around the country or around the world.

Following Dr. Wachter’s view of the future, Sylvia C. McKean, MD, had the last word at the meeting. As the chair in charge of next year’s Annual Meeting in San Diego, she presented the wrap-up on Friday afternoon, covering “What Have We Learned.”

Looking back on the previous three days, Dr. Mc­Kean pronounced, “The future is now.” Pointing to the number of meeting sessions, abstracts and poster presentations that emphasized recent innovations in hospital medicine, she said, “The Annual Meeting helps us find our expertise as hospitalists.” The Annual Meeting, along with SHM’s published Core Competencies helps define the role that hospitalists play in patient-centered care and in patient safety.

Dr. McKean thanked Chad Whelan, chair of the Annual Meeting Committee, for all his work, and said she was looking forward to 2008.

SHM Elects New Members to Board of Directors

Two new members announced; one member re-elected

SHM is pleased to announce the election of Joseph Li, MD, and Mahalakshmi Halasyamani, MD, and the re-election of Patrick Cawley, MD, to its board of directors for terms that began at the SHM Annual Meeting May 23-25 in Dallas.

“One of the strengths that keeps SHM on the cutting edge is the infusion of new talent on the board. SHM is fortunate to have a continued source of hospitalist leaders who willingly share their time and talents to help SHM shape and grow the hospital medicine specialty,” says Larry Wellikson, MD, CEO of SHM.

Each of the newly elected SHM board members comes from distinguished programs and institutions.

Dr. Li

Dr. Li is the director of the hospital medicine program at Beth Israel Deaconess Medical Center in Boston and an assistant professor of medicine at the Harvard Medical School. He has been an active member of SHM, serving on the Education and Annual Meeting Committees, as well as the Procedures Task Force. Dr. Li earned his bachelor’s degree in pharmacy at the University of Oklahoma College of Pharmacy and his medical degree at the University of Oklahoma College of Medicine. He completed his residency at the Beth Israel Deaconess Medical Center.

Dr. Cawley

Dr. Cawley is executive medical director at the Medical University Hospital of South Carolina. Prior to this, he was chief of staff at Conway Medical Center, S.C. He has served on the SHM board of directors since 2004 and is its treasurer. As an active member of SHM, he serves on the Public Policy Committee, Leadership Task Force, and on the advisory board for the Practice Management and Coding Courses. Dr. Cawley earned his bachelor’s degree in biology and chemistry from the University of Scranton (Penn.) and his medical degree from Georgetown University School of Medicine in Wash., D.C. He completed his residency at the Duke University Medical Center in Durham, N.C.

Dr. Halasyamani

Dr. Halasyamani is the medical director of the heart failure program at Saint Joseph Mercy Hospital in Ann Arbor, Mich. Before that, she served as director of academic internal medicine inpatient services. She is also a clinical instructor of internal medicine at the University of Michigan and associate chair of the department of internal medicine at Saint Joseph Mercy Hospital. Dr. Halasyamani earned her bachelor’s degree in English and chemistry from Saint Louis University (Mo.) and her medical degree from Harvard Medical School, Boston. She completed her residency at Brigham and Women’s Hospital.

Congratulations to the newest members of the SHM Board of Directors.

The 10-year anniversary of SHM was an occasion not for looking back on the first decade of the organization, but for looking ahead.

In addition to seven tracks of educational sessions and ample opportunities for networking, SHM’s 10th Annual Meeting, held May 23-25 in Dallas, provided opportunities to get a big-picture glimpse into the future of hospital medicine, in the form of some eye-opening plenary sessions.

Coming Soon: Hospital Medicine Certification

Annual Meeting attendees heard from Robert M. Wachter, MD, and past-SHM President Mary Jo Gorman, MD, MBA, on “Certification in Hospital Medicine: What Does This Mean to Hospitalists? To Employers? To Patients?” The two outlined how the American Board of Internal Medicine (ABIM) is developing a Focused Recognition for Hospital Medicine through its Maintenance of Certification (MOC) system.

Dr. Wachter, who chairs the ABIM Committee on Hospital Medicine Focused Recognition, explained that the focused recognition would give hospitalists a formal credential that recognizes hospital medicine as a distinct field within internal medicine. This is the first time ABIM has offered focused recognition for any subset of internal medicine—and, if approved, the first time the umbrella organization, the American Board of Medical Specialties (ABMS), will offer a focused recognition for a subset of any specialty.

“This is a brand new idea,” stressed Dr. Wachter. “One of the exciting things—the challenging things—is that this is a first step toward the broader issue of how to certify based on experience rather than just training.”

A Look at Digital Medicine

Informally known as the “health technology czar,” David J. Brailer, MD, PhD, served as the first national coordinator for Health Information Technology, at the Department of Health and Human Services until he resigned in April 2006. He is vice chairman of the American Health Information Community, and based on his plenary session “Health Care’s Digital Era: Implications for Hospitalists,” he is obviously familiar with hospital medicine.

“Hospitalists and health IT are co-factors in the same equation of change in healthcare,” said Dr. Brailer. “I can’t see how one can exist without the other.”

He went on to explain that hospitals must lead the way for digital medicine, as they are the institutions with the most opportunity for cost reductions in healthcare, the most opportunity for error reduction (“I’m not saying hospitals have the most errors, but that the corporatized process allows them to reduce errors that occur there,” he clarified), and the best site for innovation to move to a virtual model such as e-ICUs and new tele-specialties.

“And who can we turn to who ‘gets it,’ who can make all this happen?” asked Dr. Brailer of the innovations. “It won’t be the cardiologists, or the emergency department doctors. The obvious answer is that it will be the hospitalists.”

He warned that in order for hospitalists to be change agents, they must first take on the role of leaders of other doctors in inpatient care. “Some [hospitalists] don’t want to take on this role; others are already doing it,” he said. “I think that doctors need this leadership and I can’t think of a better group to do it than hospitalists. They’re going to have to step up to the plate on this.”

Dr. Brailer listed big issues coming up for hospitals, predicting that they will become “the hub of chronic-care management, leaders in adopting state-of-the-art technology, and leaders in quality improvement. Hospitalists are attached to each of these.” He explained that in chronic-care management, patients with chronic illnesses are cared for in a continuum-based way. Currently, inpatient care is the anchor not just for treatment, but for monitoring weight or assessing daily function levels. With chronic-care management, doctors can monitor patients without having them come into the office or the hospital.

“Primary-care doctors won’t be able to perform this off-site monitoring; they don’t have the time or the infrastructure,” explained Dr. Brailer. “But this is exactly what hospitals already do. Electronic monitoring is a real opportunity for them—and for hospitalists—to expand their care offerings.”

In spite of this expansion, he warned that hospitals will be in danger if they don’t change with the times. “The world is moving away from hospital-based care and toward [patient]-centered care,” he stated. “This is apparent in the current push for portability of patient-care information, and in today’s healthcare transparency issues. These are not hospital-friendly measures; in fact, they threaten hospitals to some degree. I hope that these trends will challenge hospitals to question how changes apply to them.”

Dr. Brailer ended with an update on public policy regarding healthcare—not a pretty picture from his insider’s view.

“Not much will happen in the next two years,” he predicted. “The FDA will pass the Prescription Drug User Fee program, and SCHIP [State Children’s Health Insurance Program] will pass in Washington D.C. I don’t think anything else will make it through the thicket of everything else going on.”

He also warned that regardless of who the next president of the U.S. is, nothing much will happen with healthcare reform. “It’s a high-priority item, but not high enough to warrant significant attention,” he said. “In the long term, it will get major attention, but probably only as a result of a catastrophe.”

Factors That Will Shape Our Future

On Friday morning, attendees heard from Jonathan B. Perlin, MD, PhD, MSHA, former under secretary for health at the Veterans Affairs, and currently the chief medical officer and senior vice-president of quality for Hospital Corporation of America (HCA) in Nashville, Tenn.—the nation’s largest hospital group.

In presenting, “Healthcare 2015: Challenges and Opportunities in the Decade Ahead,” Dr. Perlin threaded together the factors that will drive healthcare to a new level in the next eight years: the health needs of the population, including aging and the complications of diabetes, the increased requirements for delivering value, the economic pressures, and the technological changes and decentralization of healthcare delivery. Dr. Perlin, a leader in healthcare transformation and health information technology who has been termed a “clinical futurist,” pointed out that the result of these factors will be a transformation from an industrial to an information age model of healthcare.

Dr. Perlin traced the path being shaped by these challenges and opportunities, explaining that the economics of healthcare are creating pressure on the environment and disrupting the status quo. “Costs are increasing rapidly,” he stated. “It’s pretty clear that we’ve already hit some statutory alarms in the Medicare trust fund. Estimates now indicate that the trust fund will be bankrupt by 2018; we can either limit what we do or we can find better value in delivery of care.”

Response to economic pressure by Medicare and private insurers, said Dr. Perlin, provides a construct for change.

“The private sector, the government, and employers are all saying that we’re not going to buy units of healthcare services any more, we’re going to buy outcomes,” stressed Dr. Perlin. “The result is that performance becomes a gate function for even doing business in the new world.”

Toying with modest incentives in current pay-for-performance models will soon be trumped. “Medicare is changing from an incentive for simply reporting [with the current “Reporting Hospital Quality Data for Annual Payment Update” program] to value-based purchasing,” Dr. Perlin pointed out. Similarly, private insurers are differentiating performance levels and using lower co-pays to direct patients to better performers and high co-pays to redirect patients away from lower performers.

To participate in this new world of value-based purchasing and what Dr. Perlin termed “tiering and steering,” the healthcare industry must reorganize ways that it has traditionally provided care. Pen and paper are replaced by electronic health records. A locus of care is replaced by an interoperable, coordinated cooperative information network.

“The patient is the point of care in the new system, whether supported by glucometers that feed data into a central system,” said Dr. Perlin, “or a heart failure patient is tracked after discharge with a digital scale … or whether it is a hospitalist who reaches into the traditional healthcare setting with remote monitoring to provide round-the-clock support to a critically ill patient.”

In addition to providing enhanced safety, quality, continuity, and efficiency, new systems like these will provide central information sources, powerful in providing real-time, clinical decision-support, as well as generating new knowledge about disease, treatment and service delivery. The tremendous data available will reveal previously unnoticed patterns and provide more support for evidence-based care.

“Medicare and private insurers are focusing more on evidence-based care and are increasingly ambivalent about decisions not supported by evidence,” observed Dr. Perlin.

His view of the near future of healthcare was followed later that day with another plenary session that mulled how hospital medicine might look a decade from now.

Now It’s Time to Say Goodbye …

Dr. Wachter traditionally closes each Annual Meeting with a review of how far the young field of hospital medicine has come.

But at the 10th Annual Meeting, Dr. Wachter chose not to look back but to peer into his crystal ball. His presentation, “The Hospitalist Movement Two Decades Later: A Letter from the Future,” took the form of a letter from his future self, written in 2017, to SHM CEO Larry Wellikson, MD, as each man settles into a long-term care facility.

Dr. Wachter outlined the major forces starting to affect hospital medicine and imagined where they would lead us. And he couldn’t resist one glimpse back in time: “Think about the change we’ve seen already,” he marveled. “There’s no field in modern medical history that’s grown this quickly. We’re both leading the way and riding the waves.”

Dr. Wachter admitted his initial estimates for phenomenal growth of the field are already surpassed. “We originally projected that there would be 20,000 or 30,000 hospitalists,” he said. “Well, we’re already over 20,000. Now I’m thinking the final number will be around 50,000 or 60,000.”

He attributed part of that growth to several changes, including the additional responsibility of hospitalists for caring for surgical patients—something he sees as eventually becoming the norm. Another factor is the role hospitalists play in replacing residents in teaching hospitals, an area that has seen unplanned growth.

And finally, Dr. Wachter speculated that the quality measures movement will also boost the ranks of hospitalists. “We’re already seeing tremendous pressure on hospitalists to help their hospitals achieve success in pay-for-performance programs and in publicly reported measures,” he said. “This type of responsibility was originally considered a nice add-on for using hospitalists, but now it’s getting to be a crucial part. There’s a building expectation that hospitalists will guarantee superb performance.”

Dr. Wachter also touched on how information technology might change hospital medicine. “IT will definitely have an impact, in some exciting ways, and in other ways that have not been thought through,” he warned. “For example, consultation may be very different.” For example, a hospitalist in 2017 may be able to use a video link at a patient’s bedside to consult with one of 100 cardiologists around the country or around the world.

Following Dr. Wachter’s view of the future, Sylvia C. McKean, MD, had the last word at the meeting. As the chair in charge of next year’s Annual Meeting in San Diego, she presented the wrap-up on Friday afternoon, covering “What Have We Learned.”

Looking back on the previous three days, Dr. Mc­Kean pronounced, “The future is now.” Pointing to the number of meeting sessions, abstracts and poster presentations that emphasized recent innovations in hospital medicine, she said, “The Annual Meeting helps us find our expertise as hospitalists.” The Annual Meeting, along with SHM’s published Core Competencies helps define the role that hospitalists play in patient-centered care and in patient safety.

Dr. McKean thanked Chad Whelan, chair of the Annual Meeting Committee, for all his work, and said she was looking forward to 2008.

SHM Elects New Members to Board of Directors

Two new members announced; one member re-elected

SHM is pleased to announce the election of Joseph Li, MD, and Mahalakshmi Halasyamani, MD, and the re-election of Patrick Cawley, MD, to its board of directors for terms that began at the SHM Annual Meeting May 23-25 in Dallas.

“One of the strengths that keeps SHM on the cutting edge is the infusion of new talent on the board. SHM is fortunate to have a continued source of hospitalist leaders who willingly share their time and talents to help SHM shape and grow the hospital medicine specialty,” says Larry Wellikson, MD, CEO of SHM.

Each of the newly elected SHM board members comes from distinguished programs and institutions.

Dr. Li

Dr. Li is the director of the hospital medicine program at Beth Israel Deaconess Medical Center in Boston and an assistant professor of medicine at the Harvard Medical School. He has been an active member of SHM, serving on the Education and Annual Meeting Committees, as well as the Procedures Task Force. Dr. Li earned his bachelor’s degree in pharmacy at the University of Oklahoma College of Pharmacy and his medical degree at the University of Oklahoma College of Medicine. He completed his residency at the Beth Israel Deaconess Medical Center.

Dr. Cawley

Dr. Cawley is executive medical director at the Medical University Hospital of South Carolina. Prior to this, he was chief of staff at Conway Medical Center, S.C. He has served on the SHM board of directors since 2004 and is its treasurer. As an active member of SHM, he serves on the Public Policy Committee, Leadership Task Force, and on the advisory board for the Practice Management and Coding Courses. Dr. Cawley earned his bachelor’s degree in biology and chemistry from the University of Scranton (Penn.) and his medical degree from Georgetown University School of Medicine in Wash., D.C. He completed his residency at the Duke University Medical Center in Durham, N.C.

Dr. Halasyamani

Dr. Halasyamani is the medical director of the heart failure program at Saint Joseph Mercy Hospital in Ann Arbor, Mich. Before that, she served as director of academic internal medicine inpatient services. She is also a clinical instructor of internal medicine at the University of Michigan and associate chair of the department of internal medicine at Saint Joseph Mercy Hospital. Dr. Halasyamani earned her bachelor’s degree in English and chemistry from Saint Louis University (Mo.) and her medical degree from Harvard Medical School, Boston. She completed her residency at Brigham and Women’s Hospital.

Congratulations to the newest members of the SHM Board of Directors.

Each career path within hospital medicine offers distinct responsibilities, opportunities, and rewards. One of the biggest decisions you’ll make as a hospitalist is whether to enter an academic or a community-based hospital medicine field—but there are additional factors to take into account. Here’s an overview of the career paths within these two areas that may help you with your decision.

Choices in Academic Hospital Medicine

Only a small percentage of hospitalists go into academic jobs, and residents are—obviously—most familiar with these choices.

“[The environment] is familiar to you, and you’re able to grow professionally because … people are always asking you questions,” says Sanjay Saint, MD, MPH, hospitalist and professor of internal medicine at the Ann Arbor Veterans Affairs Medical Center and the University of Michigan Medical School. “The opportunity to be around learners—residents and medical students—is very exciting to residents.”

There are other reasons you may prefer academic over community-based hospital medicine. “The types of patients you treat are different,” says Dr. Saint. “They may be more complicated, and thus you can improve your clinical skills. Also, there’s prestige in being associated with an academic medical center. That appeals to some people.”

The rigorousness of the schedule varies with the institution. “Theoretically, you have residents, so you don’t have to take calls,” explains Dr. Saint. “But when you’re on, say, for a month there’s often no attending coverage on weekends or holidays.”

Hospital medicine work in an academic setting falls into four categories:

1) Hospitalist clinician-investigator: “These hospitalists typically spend the minority of their time doing clinical work—maybe 20% to 40% of their time,” says Dr. Saint. “The rest is spent developing their research agenda, applying for and obtaining grants to fund their research. The investigative focus is usually inpatient-oriented to provide synergy between their clinical work and their research.” This track typically leads to tenure, and usually requires some type of fellowship.

2) Hospitalist-educator: “There are a large number of these positions in academic medical centers,” says Dr. Saint. “These hospitalists spend about 80% of their time seeing patients and teaching residents and medical students.”

Typical hospitalist-educator activities include ward attending, medical consultation, and preoperative evaluations. “They spend about 20% of their time doing some type of scholarly activity, whether writing articles or developing educational curricula that can be disseminated,” estimates Dr. Saint.

Hospitalist-educator is usually a non-tenured position and these academicians are promoted primarily based on their clinical expertise and perceived skills as teachers. You don’t need to have a fellowship for this position; usually, the hospitalist director will hire individuals from his or her program—often a former chief resident.

3) Hospitalist-clinician: “These hospitalists primarily focus on patient care,” explains Dr. Saint. “A lot of them have been hired recently because of the limits on work hours for residents. There is minimal teaching and scholarly activity.”

Often, people do this for one or two years between residency and a fellowship, or to pay off school loans.

4) Hospitalist-administrator: “A major portion of their day is spent on administrative tasks,” says Dr. Saint. “They may run the hospital medicine program, or have educational administrative tasks, like residency directors.” However, he warns, “a resident isn’t going to go straight into one of these positions; you have to pay your dues first. But this can be an opportunity to think about for the future.”

What is the job market like for these academic positions? “There are huge opportunities for residents wanting to become hospitalists, regardless of which track they want to follow,” says Dr. Saint. “There are only a handful of clinician-investigators in hospital medicine now, and I see tremendous growth in this field. There’s also a growing need for hospitalist-clinicians because of the restrictions imposed on the workweek [for residents]. And as the number of hospitalists grows, there will obviously be a need for more hospitalist-administrators. Of course, there will always be a need for hospitalist-educators—but many are already in those roles.”

Choices in Community-Based Hospital Medicine

The first thing to realize about community-based hospital medicine is that there are various employers involved.

“Programs will have different mandates; a lot depends on the financial drivers,” says Sanjiv Panwala, MD, hospitalist at Providence Medical Center, Portland, Ore. “If you’re paid by the hospital, your priorities will be theirs: coverage of uncovered patients, shorter length of stay, etc. It trickles down.”

Michael-Anthony Williams, MD, regional CMO of Sound Inpatient Physicians in Denver, agrees. “It’s important to understand who the employer is and what their values are,” he says. “Is it the hospital or a local, regional, or national practice? If you’re employed by a hospital, you may be one of several employed specialists.” That can impact what types of clinical work you handle.

Regardless of whom you work for, says Dr. Williams, “The biggest differences [from an academic institution] are a much greater focus on patient care, and the fact that community-based groups change and evolve more quickly than academic groups.”

But there can be more to community-based hospitalists than direct patient care. “Ask if the job is limited to clinical duties or if there are ways to branch out and expand, maybe by becoming a medical director for a hospital or by designing quality programs,” suggests Dr. Williams.

Working Within Managed Care

Cara Steinkeler, MD, a hospitalist at Kaiser Permanente Sunnyside Medical Center, Clackamas, Ore., worked in private practice before she signed on with managed-care giant Kaiser. “Overall, the schedules—in terms of number of days per month and shifts—are pretty similar” for managed care and private practice, she says. “In terms of quality of life, they’re also about equivalent.”

The difference may be in how hospitalists spend their time. “I’m relatively isolated from the business of medicine,” says Dr. Steinkeler. “We’re able to concentrate on treating patients. When I was in private practice, I’d spend 10 or 15 hours a week doing my own coding and billing; here, we [now] have coding experts that do that.”

Dr. Steinkeler’s group is primarily salary-based, so she isn’t tied to productivity. While the salaries may not always be as high as other hospitalist options, there are trade-offs. “I know that the starting salaries for hospitalists in private practices in Portland were a little higher than for HMOs,” says Dr. Steinkeler. “The financial payoff for working here is really when you stay long enough be vested; it’s in the benefits. But we tried to rectify that [starting salary discrepancy] because we were having trouble hiring.”

Size May Matter Most

Keep in mind that hospital medicine programs can vary widely, for both academic and community-based institutions. “Program differences are based on the size of the program,” explains Dr. Panwala. “In tertiary care centers, you won’t do much ICU work, but in a small or medium-sized hospital it’s very different. You can basically be the ICU doc.”

The plus side of working for a larger hospital medicine group is flexibility and opportunity for career growth. Dr. Steinkeler highlights another benefit: “One good thing about working in a large group … is the flexibility,” she says. “A large group has the ability to flex around people’s needs, so you can cut your hours or get time off if you have kids or aging parents.”

This basic information on the various employment options within hospital medicine should give you a good starting point in choosing the career path you’d like to take. Your decision, or preliminary preference, will influence how you prepare for, and go after, your first position as a working hospitalist. TH

Each career path within hospital medicine offers distinct responsibilities, opportunities, and rewards. One of the biggest decisions you’ll make as a hospitalist is whether to enter an academic or a community-based hospital medicine field—but there are additional factors to take into account. Here’s an overview of the career paths within these two areas that may help you with your decision.

Choices in Academic Hospital Medicine

Only a small percentage of hospitalists go into academic jobs, and residents are—obviously—most familiar with these choices.

“[The environment] is familiar to you, and you’re able to grow professionally because … people are always asking you questions,” says Sanjay Saint, MD, MPH, hospitalist and professor of internal medicine at the Ann Arbor Veterans Affairs Medical Center and the University of Michigan Medical School. “The opportunity to be around learners—residents and medical students—is very exciting to residents.”

There are other reasons you may prefer academic over community-based hospital medicine. “The types of patients you treat are different,” says Dr. Saint. “They may be more complicated, and thus you can improve your clinical skills. Also, there’s prestige in being associated with an academic medical center. That appeals to some people.”

The rigorousness of the schedule varies with the institution. “Theoretically, you have residents, so you don’t have to take calls,” explains Dr. Saint. “But when you’re on, say, for a month there’s often no attending coverage on weekends or holidays.”

Hospital medicine work in an academic setting falls into four categories:

1) Hospitalist clinician-investigator: “These hospitalists typically spend the minority of their time doing clinical work—maybe 20% to 40% of their time,” says Dr. Saint. “The rest is spent developing their research agenda, applying for and obtaining grants to fund their research. The investigative focus is usually inpatient-oriented to provide synergy between their clinical work and their research.” This track typically leads to tenure, and usually requires some type of fellowship.

2) Hospitalist-educator: “There are a large number of these positions in academic medical centers,” says Dr. Saint. “These hospitalists spend about 80% of their time seeing patients and teaching residents and medical students.”

Typical hospitalist-educator activities include ward attending, medical consultation, and preoperative evaluations. “They spend about 20% of their time doing some type of scholarly activity, whether writing articles or developing educational curricula that can be disseminated,” estimates Dr. Saint.

Hospitalist-educator is usually a non-tenured position and these academicians are promoted primarily based on their clinical expertise and perceived skills as teachers. You don’t need to have a fellowship for this position; usually, the hospitalist director will hire individuals from his or her program—often a former chief resident.

3) Hospitalist-clinician: “These hospitalists primarily focus on patient care,” explains Dr. Saint. “A lot of them have been hired recently because of the limits on work hours for residents. There is minimal teaching and scholarly activity.”

Often, people do this for one or two years between residency and a fellowship, or to pay off school loans.

4) Hospitalist-administrator: “A major portion of their day is spent on administrative tasks,” says Dr. Saint. “They may run the hospital medicine program, or have educational administrative tasks, like residency directors.” However, he warns, “a resident isn’t going to go straight into one of these positions; you have to pay your dues first. But this can be an opportunity to think about for the future.”

What is the job market like for these academic positions? “There are huge opportunities for residents wanting to become hospitalists, regardless of which track they want to follow,” says Dr. Saint. “There are only a handful of clinician-investigators in hospital medicine now, and I see tremendous growth in this field. There’s also a growing need for hospitalist-clinicians because of the restrictions imposed on the workweek [for residents]. And as the number of hospitalists grows, there will obviously be a need for more hospitalist-administrators. Of course, there will always be a need for hospitalist-educators—but many are already in those roles.”

Choices in Community-Based Hospital Medicine

The first thing to realize about community-based hospital medicine is that there are various employers involved.

“Programs will have different mandates; a lot depends on the financial drivers,” says Sanjiv Panwala, MD, hospitalist at Providence Medical Center, Portland, Ore. “If you’re paid by the hospital, your priorities will be theirs: coverage of uncovered patients, shorter length of stay, etc. It trickles down.”

Michael-Anthony Williams, MD, regional CMO of Sound Inpatient Physicians in Denver, agrees. “It’s important to understand who the employer is and what their values are,” he says. “Is it the hospital or a local, regional, or national practice? If you’re employed by a hospital, you may be one of several employed specialists.” That can impact what types of clinical work you handle.

Regardless of whom you work for, says Dr. Williams, “The biggest differences [from an academic institution] are a much greater focus on patient care, and the fact that community-based groups change and evolve more quickly than academic groups.”

But there can be more to community-based hospitalists than direct patient care. “Ask if the job is limited to clinical duties or if there are ways to branch out and expand, maybe by becoming a medical director for a hospital or by designing quality programs,” suggests Dr. Williams.

Working Within Managed Care

Cara Steinkeler, MD, a hospitalist at Kaiser Permanente Sunnyside Medical Center, Clackamas, Ore., worked in private practice before she signed on with managed-care giant Kaiser. “Overall, the schedules—in terms of number of days per month and shifts—are pretty similar” for managed care and private practice, she says. “In terms of quality of life, they’re also about equivalent.”

The difference may be in how hospitalists spend their time. “I’m relatively isolated from the business of medicine,” says Dr. Steinkeler. “We’re able to concentrate on treating patients. When I was in private practice, I’d spend 10 or 15 hours a week doing my own coding and billing; here, we [now] have coding experts that do that.”

Dr. Steinkeler’s group is primarily salary-based, so she isn’t tied to productivity. While the salaries may not always be as high as other hospitalist options, there are trade-offs. “I know that the starting salaries for hospitalists in private practices in Portland were a little higher than for HMOs,” says Dr. Steinkeler. “The financial payoff for working here is really when you stay long enough be vested; it’s in the benefits. But we tried to rectify that [starting salary discrepancy] because we were having trouble hiring.”

Size May Matter Most

Keep in mind that hospital medicine programs can vary widely, for both academic and community-based institutions. “Program differences are based on the size of the program,” explains Dr. Panwala. “In tertiary care centers, you won’t do much ICU work, but in a small or medium-sized hospital it’s very different. You can basically be the ICU doc.”

The plus side of working for a larger hospital medicine group is flexibility and opportunity for career growth. Dr. Steinkeler highlights another benefit: “One good thing about working in a large group … is the flexibility,” she says. “A large group has the ability to flex around people’s needs, so you can cut your hours or get time off if you have kids or aging parents.”

This basic information on the various employment options within hospital medicine should give you a good starting point in choosing the career path you’d like to take. Your decision, or preliminary preference, will influence how you prepare for, and go after, your first position as a working hospitalist. TH

Each career path within hospital medicine offers distinct responsibilities, opportunities, and rewards. One of the biggest decisions you’ll make as a hospitalist is whether to enter an academic or a community-based hospital medicine field—but there are additional factors to take into account. Here’s an overview of the career paths within these two areas that may help you with your decision.

Choices in Academic Hospital Medicine

Only a small percentage of hospitalists go into academic jobs, and residents are—obviously—most familiar with these choices.

“[The environment] is familiar to you, and you’re able to grow professionally because … people are always asking you questions,” says Sanjay Saint, MD, MPH, hospitalist and professor of internal medicine at the Ann Arbor Veterans Affairs Medical Center and the University of Michigan Medical School. “The opportunity to be around learners—residents and medical students—is very exciting to residents.”

There are other reasons you may prefer academic over community-based hospital medicine. “The types of patients you treat are different,” says Dr. Saint. “They may be more complicated, and thus you can improve your clinical skills. Also, there’s prestige in being associated with an academic medical center. That appeals to some people.”

The rigorousness of the schedule varies with the institution. “Theoretically, you have residents, so you don’t have to take calls,” explains Dr. Saint. “But when you’re on, say, for a month there’s often no attending coverage on weekends or holidays.”

Hospital medicine work in an academic setting falls into four categories:

1) Hospitalist clinician-investigator: “These hospitalists typically spend the minority of their time doing clinical work—maybe 20% to 40% of their time,” says Dr. Saint. “The rest is spent developing their research agenda, applying for and obtaining grants to fund their research. The investigative focus is usually inpatient-oriented to provide synergy between their clinical work and their research.” This track typically leads to tenure, and usually requires some type of fellowship.

2) Hospitalist-educator: “There are a large number of these positions in academic medical centers,” says Dr. Saint. “These hospitalists spend about 80% of their time seeing patients and teaching residents and medical students.”

Typical hospitalist-educator activities include ward attending, medical consultation, and preoperative evaluations. “They spend about 20% of their time doing some type of scholarly activity, whether writing articles or developing educational curricula that can be disseminated,” estimates Dr. Saint.

Hospitalist-educator is usually a non-tenured position and these academicians are promoted primarily based on their clinical expertise and perceived skills as teachers. You don’t need to have a fellowship for this position; usually, the hospitalist director will hire individuals from his or her program—often a former chief resident.

3) Hospitalist-clinician: “These hospitalists primarily focus on patient care,” explains Dr. Saint. “A lot of them have been hired recently because of the limits on work hours for residents. There is minimal teaching and scholarly activity.”

Often, people do this for one or two years between residency and a fellowship, or to pay off school loans.

4) Hospitalist-administrator: “A major portion of their day is spent on administrative tasks,” says Dr. Saint. “They may run the hospital medicine program, or have educational administrative tasks, like residency directors.” However, he warns, “a resident isn’t going to go straight into one of these positions; you have to pay your dues first. But this can be an opportunity to think about for the future.”

What is the job market like for these academic positions? “There are huge opportunities for residents wanting to become hospitalists, regardless of which track they want to follow,” says Dr. Saint. “There are only a handful of clinician-investigators in hospital medicine now, and I see tremendous growth in this field. There’s also a growing need for hospitalist-clinicians because of the restrictions imposed on the workweek [for residents]. And as the number of hospitalists grows, there will obviously be a need for more hospitalist-administrators. Of course, there will always be a need for hospitalist-educators—but many are already in those roles.”

Choices in Community-Based Hospital Medicine

The first thing to realize about community-based hospital medicine is that there are various employers involved.

“Programs will have different mandates; a lot depends on the financial drivers,” says Sanjiv Panwala, MD, hospitalist at Providence Medical Center, Portland, Ore. “If you’re paid by the hospital, your priorities will be theirs: coverage of uncovered patients, shorter length of stay, etc. It trickles down.”

Michael-Anthony Williams, MD, regional CMO of Sound Inpatient Physicians in Denver, agrees. “It’s important to understand who the employer is and what their values are,” he says. “Is it the hospital or a local, regional, or national practice? If you’re employed by a hospital, you may be one of several employed specialists.” That can impact what types of clinical work you handle.

Regardless of whom you work for, says Dr. Williams, “The biggest differences [from an academic institution] are a much greater focus on patient care, and the fact that community-based groups change and evolve more quickly than academic groups.”

But there can be more to community-based hospitalists than direct patient care. “Ask if the job is limited to clinical duties or if there are ways to branch out and expand, maybe by becoming a medical director for a hospital or by designing quality programs,” suggests Dr. Williams.

Working Within Managed Care

Cara Steinkeler, MD, a hospitalist at Kaiser Permanente Sunnyside Medical Center, Clackamas, Ore., worked in private practice before she signed on with managed-care giant Kaiser. “Overall, the schedules—in terms of number of days per month and shifts—are pretty similar” for managed care and private practice, she says. “In terms of quality of life, they’re also about equivalent.”

The difference may be in how hospitalists spend their time. “I’m relatively isolated from the business of medicine,” says Dr. Steinkeler. “We’re able to concentrate on treating patients. When I was in private practice, I’d spend 10 or 15 hours a week doing my own coding and billing; here, we [now] have coding experts that do that.”

Dr. Steinkeler’s group is primarily salary-based, so she isn’t tied to productivity. While the salaries may not always be as high as other hospitalist options, there are trade-offs. “I know that the starting salaries for hospitalists in private practices in Portland were a little higher than for HMOs,” says Dr. Steinkeler. “The financial payoff for working here is really when you stay long enough be vested; it’s in the benefits. But we tried to rectify that [starting salary discrepancy] because we were having trouble hiring.”

Size May Matter Most

Keep in mind that hospital medicine programs can vary widely, for both academic and community-based institutions. “Program differences are based on the size of the program,” explains Dr. Panwala. “In tertiary care centers, you won’t do much ICU work, but in a small or medium-sized hospital it’s very different. You can basically be the ICU doc.”

The plus side of working for a larger hospital medicine group is flexibility and opportunity for career growth. Dr. Steinkeler highlights another benefit: “One good thing about working in a large group … is the flexibility,” she says. “A large group has the ability to flex around people’s needs, so you can cut your hours or get time off if you have kids or aging parents.”

This basic information on the various employment options within hospital medicine should give you a good starting point in choosing the career path you’d like to take. Your decision, or preliminary preference, will influence how you prepare for, and go after, your first position as a working hospitalist. TH

The latest estimates from the National Coalition on Health Care (www.nchc.org/facts/coverage.shtml) show that 46 million Americans—nearly 16% of the population—have no health insurance, and those numbers are increasing. The federal government has been flirting with addressing this growing problem for years, but 2007 may be the turning point, when key legislation may help turn the rising tide of uninsured and underinsured patients.

“A couple of things create a more favorable milieu for this,” explains Eric Siegal, MD, regional medical director, Cogent Healthcare, Madison, Wis., and chair of SHM’s Public Policy Committee. “The first is that Massachusetts did it on their own—states are no longer waiting for Congress to do something. The second is that, with every passing year, there’s increased pressure to do something.”

Regardless of why this is happening now, some promising legislation has been introduced in Congress that may provide the beginnings of a solution.

The Health Partnership Act

Perhaps the most promising legislation on healthcare access is an innovative, bipartisan, bicameral effort known as the Health Partnership Act, which proposes a federal-state partnership to address the issue.

Identical bills have been introduced in each house. The Health Partnership Act (S. 325) was introduced in the Senate by Jeff Bingaman (D-N.M.) and George Voinovich (R-Ohio), and the Health Partnership Act through Creative Federalism (HR 506) was introduced in the House by Tammy Baldwin (D-Wis.), Tom Price (R-Ga.), and John Tierney (D-Mass.). Similar legislation was introduced by some of these same parties in the last Congress; though the bill died before action was taken, it was immediately reintroduced in the new Congress this January.

If enacted, the Health Partnership Act would give state and local governments the opportunity to implement their own solutions for providing coverage to uninsured populations, allowing them to address the unique needs that exist within their boundaries. Interested states, groups of states, or even parts of states would apply for five-year federal grants by submitting proposals that demonstrate how their plans would reduce the number of uninsured and improve healthcare quality. Each plan would include information on the appropriate use of information technology to improve the availability of evidence-based medical and outcomes data to providers and patients.

The act would establish a new bipartisan State Health Innovation Commission (SHIC), which would be part of the Department of Health and Human Services. This commission would review the state proposals and submit to Congress a list of recommended applications. It would also work with an established organization—possibly the Institute of Medicine—to develop performance measures and goals regarding coverage, quality, and cost of state programs.

Participating states would eventually report their progress to the SHIC, which would then report to Congress on whether each state was meeting the goals of the act and would then recommend further action.

Giving individual states the flexibility to create their own programs could generate new ideas and would ultimately reveal which programs work best. “We’re not expecting states to hit the ball out of the park the first time, but it’s a start,” says Dr. Siegal. “It’s a step in the right direction.”

SHM supports the Health Partnership Act and has sent a letter of support to Senate sponsors. “This [legislation] may or may not be the most expedient way to get it done,” says Dr. Siegal. “But SHM supports this legislation and is currently drafting a letter of support for the House version.”

The Healthy Americans Act

Another, more comprehensive, bill was introduced in the Senate by Ron Wyden (D-Ore.) in December 2006.

The Healthy Americans Act would require businesses to replace their current health benefits with an increase in wages equal to the amount spent on health insurance premiums. It would require all employees to use these increased wages to purchase their own health plans and would provide subsidies to low-income workers to help pay their premiums.

Those employers not currently providing any health benefits would be required to begin making phased-in “Employer Shared Responsibility Payments,” which would be used to ensure that everyone is able to afford their health plans by funding premium reductions.

Wyden’s bill would have each state establish a Health Help Agency to educate residents about private health plans, to administer enrollment, and to assist income-eligible enrollees with sliding scale premium reductions. These agencies would be funded by the federal government and insurance companies.

Finally, insurance companies would be required to cover every individual who chooses to enroll and would not be allowed to raise prices or deny coverage if individuals are sick.

Some State-Level Solutions

Some states—Massachusetts, for one—have already taken action, implementing their own innovative policies and programs to expand coverage for their populations. Maine, Massachusetts, and Vermont have instituted comprehensive healthcare reform; Arkansas, Montana, New Mexico, Oklahoma, Rhode Island, Tennessee, and Utah have all implemented some form of public-private partnerships; and Illinois and Pennsylvania have initiatives that cover all children.

Maine, Massachusetts, and Vermont all use Medicaid funds to partially subsidize healthcare coverage for families with annual incomes as high as $53,000.

For details on all current state initiatives for healthcare coverage, download the report “State of the States 2007: Building Hope, Raising Expectations” from the Web site of the State Coverage Initiatives at www.statecoverage.net.

Why Hospitalists Should Care

Providing healthcare coverage to the uninsured is one of SHM’s public policy priorities. “There really is a crisis out there, and hospitalists are on the front line of it every day,” says Dr. Siegal.

As former SHM President Mary Jo Gorman states in SHM’s letter of support for the Senate’s Health Partnership Act: “Many hospitalist programs exist to manage the burgeoning population of uninsured and underinsured patients who require hospitalization. These patients are more likely to delay seeking care until their illnesses deteriorate to the point that they need emergency care. In many communities, hospitalists have become the safety net for this vulnerable patient population.”

For further information about federal legislation for improved access and to see if your representatives are cosponsors, visit SHM’s Legislative Action Center at http://capwiz.com/hospitalmedicine/home/. TH

Jane Jerrard writes “Public Policy” for The Hospitalist.

The latest estimates from the National Coalition on Health Care (www.nchc.org/facts/coverage.shtml) show that 46 million Americans—nearly 16% of the population—have no health insurance, and those numbers are increasing. The federal government has been flirting with addressing this growing problem for years, but 2007 may be the turning point, when key legislation may help turn the rising tide of uninsured and underinsured patients.

“A couple of things create a more favorable milieu for this,” explains Eric Siegal, MD, regional medical director, Cogent Healthcare, Madison, Wis., and chair of SHM’s Public Policy Committee. “The first is that Massachusetts did it on their own—states are no longer waiting for Congress to do something. The second is that, with every passing year, there’s increased pressure to do something.”

Regardless of why this is happening now, some promising legislation has been introduced in Congress that may provide the beginnings of a solution.

The Health Partnership Act

Perhaps the most promising legislation on healthcare access is an innovative, bipartisan, bicameral effort known as the Health Partnership Act, which proposes a federal-state partnership to address the issue.

Identical bills have been introduced in each house. The Health Partnership Act (S. 325) was introduced in the Senate by Jeff Bingaman (D-N.M.) and George Voinovich (R-Ohio), and the Health Partnership Act through Creative Federalism (HR 506) was introduced in the House by Tammy Baldwin (D-Wis.), Tom Price (R-Ga.), and John Tierney (D-Mass.). Similar legislation was introduced by some of these same parties in the last Congress; though the bill died before action was taken, it was immediately reintroduced in the new Congress this January.

If enacted, the Health Partnership Act would give state and local governments the opportunity to implement their own solutions for providing coverage to uninsured populations, allowing them to address the unique needs that exist within their boundaries. Interested states, groups of states, or even parts of states would apply for five-year federal grants by submitting proposals that demonstrate how their plans would reduce the number of uninsured and improve healthcare quality. Each plan would include information on the appropriate use of information technology to improve the availability of evidence-based medical and outcomes data to providers and patients.

The act would establish a new bipartisan State Health Innovation Commission (SHIC), which would be part of the Department of Health and Human Services. This commission would review the state proposals and submit to Congress a list of recommended applications. It would also work with an established organization—possibly the Institute of Medicine—to develop performance measures and goals regarding coverage, quality, and cost of state programs.

Participating states would eventually report their progress to the SHIC, which would then report to Congress on whether each state was meeting the goals of the act and would then recommend further action.

Giving individual states the flexibility to create their own programs could generate new ideas and would ultimately reveal which programs work best. “We’re not expecting states to hit the ball out of the park the first time, but it’s a start,” says Dr. Siegal. “It’s a step in the right direction.”

SHM supports the Health Partnership Act and has sent a letter of support to Senate sponsors. “This [legislation] may or may not be the most expedient way to get it done,” says Dr. Siegal. “But SHM supports this legislation and is currently drafting a letter of support for the House version.”

The Healthy Americans Act

Another, more comprehensive, bill was introduced in the Senate by Ron Wyden (D-Ore.) in December 2006.

The Healthy Americans Act would require businesses to replace their current health benefits with an increase in wages equal to the amount spent on health insurance premiums. It would require all employees to use these increased wages to purchase their own health plans and would provide subsidies to low-income workers to help pay their premiums.

Those employers not currently providing any health benefits would be required to begin making phased-in “Employer Shared Responsibility Payments,” which would be used to ensure that everyone is able to afford their health plans by funding premium reductions.

Wyden’s bill would have each state establish a Health Help Agency to educate residents about private health plans, to administer enrollment, and to assist income-eligible enrollees with sliding scale premium reductions. These agencies would be funded by the federal government and insurance companies.

Finally, insurance companies would be required to cover every individual who chooses to enroll and would not be allowed to raise prices or deny coverage if individuals are sick.

Some State-Level Solutions

Some states—Massachusetts, for one—have already taken action, implementing their own innovative policies and programs to expand coverage for their populations. Maine, Massachusetts, and Vermont have instituted comprehensive healthcare reform; Arkansas, Montana, New Mexico, Oklahoma, Rhode Island, Tennessee, and Utah have all implemented some form of public-private partnerships; and Illinois and Pennsylvania have initiatives that cover all children.

Maine, Massachusetts, and Vermont all use Medicaid funds to partially subsidize healthcare coverage for families with annual incomes as high as $53,000.

For details on all current state initiatives for healthcare coverage, download the report “State of the States 2007: Building Hope, Raising Expectations” from the Web site of the State Coverage Initiatives at www.statecoverage.net.

Why Hospitalists Should Care

Providing healthcare coverage to the uninsured is one of SHM’s public policy priorities. “There really is a crisis out there, and hospitalists are on the front line of it every day,” says Dr. Siegal.

As former SHM President Mary Jo Gorman states in SHM’s letter of support for the Senate’s Health Partnership Act: “Many hospitalist programs exist to manage the burgeoning population of uninsured and underinsured patients who require hospitalization. These patients are more likely to delay seeking care until their illnesses deteriorate to the point that they need emergency care. In many communities, hospitalists have become the safety net for this vulnerable patient population.”

For further information about federal legislation for improved access and to see if your representatives are cosponsors, visit SHM’s Legislative Action Center at http://capwiz.com/hospitalmedicine/home/. TH

Jane Jerrard writes “Public Policy” for The Hospitalist.

The latest estimates from the National Coalition on Health Care (www.nchc.org/facts/coverage.shtml) show that 46 million Americans—nearly 16% of the population—have no health insurance, and those numbers are increasing. The federal government has been flirting with addressing this growing problem for years, but 2007 may be the turning point, when key legislation may help turn the rising tide of uninsured and underinsured patients.

“A couple of things create a more favorable milieu for this,” explains Eric Siegal, MD, regional medical director, Cogent Healthcare, Madison, Wis., and chair of SHM’s Public Policy Committee. “The first is that Massachusetts did it on their own—states are no longer waiting for Congress to do something. The second is that, with every passing year, there’s increased pressure to do something.”

Regardless of why this is happening now, some promising legislation has been introduced in Congress that may provide the beginnings of a solution.

The Health Partnership Act

Perhaps the most promising legislation on healthcare access is an innovative, bipartisan, bicameral effort known as the Health Partnership Act, which proposes a federal-state partnership to address the issue.

Identical bills have been introduced in each house. The Health Partnership Act (S. 325) was introduced in the Senate by Jeff Bingaman (D-N.M.) and George Voinovich (R-Ohio), and the Health Partnership Act through Creative Federalism (HR 506) was introduced in the House by Tammy Baldwin (D-Wis.), Tom Price (R-Ga.), and John Tierney (D-Mass.). Similar legislation was introduced by some of these same parties in the last Congress; though the bill died before action was taken, it was immediately reintroduced in the new Congress this January.

If enacted, the Health Partnership Act would give state and local governments the opportunity to implement their own solutions for providing coverage to uninsured populations, allowing them to address the unique needs that exist within their boundaries. Interested states, groups of states, or even parts of states would apply for five-year federal grants by submitting proposals that demonstrate how their plans would reduce the number of uninsured and improve healthcare quality. Each plan would include information on the appropriate use of information technology to improve the availability of evidence-based medical and outcomes data to providers and patients.

The act would establish a new bipartisan State Health Innovation Commission (SHIC), which would be part of the Department of Health and Human Services. This commission would review the state proposals and submit to Congress a list of recommended applications. It would also work with an established organization—possibly the Institute of Medicine—to develop performance measures and goals regarding coverage, quality, and cost of state programs.

Participating states would eventually report their progress to the SHIC, which would then report to Congress on whether each state was meeting the goals of the act and would then recommend further action.

Giving individual states the flexibility to create their own programs could generate new ideas and would ultimately reveal which programs work best. “We’re not expecting states to hit the ball out of the park the first time, but it’s a start,” says Dr. Siegal. “It’s a step in the right direction.”

SHM supports the Health Partnership Act and has sent a letter of support to Senate sponsors. “This [legislation] may or may not be the most expedient way to get it done,” says Dr. Siegal. “But SHM supports this legislation and is currently drafting a letter of support for the House version.”

The Healthy Americans Act

Another, more comprehensive, bill was introduced in the Senate by Ron Wyden (D-Ore.) in December 2006.

The Healthy Americans Act would require businesses to replace their current health benefits with an increase in wages equal to the amount spent on health insurance premiums. It would require all employees to use these increased wages to purchase their own health plans and would provide subsidies to low-income workers to help pay their premiums.

Those employers not currently providing any health benefits would be required to begin making phased-in “Employer Shared Responsibility Payments,” which would be used to ensure that everyone is able to afford their health plans by funding premium reductions.

Wyden’s bill would have each state establish a Health Help Agency to educate residents about private health plans, to administer enrollment, and to assist income-eligible enrollees with sliding scale premium reductions. These agencies would be funded by the federal government and insurance companies.

Finally, insurance companies would be required to cover every individual who chooses to enroll and would not be allowed to raise prices or deny coverage if individuals are sick.

Some State-Level Solutions

Some states—Massachusetts, for one—have already taken action, implementing their own innovative policies and programs to expand coverage for their populations. Maine, Massachusetts, and Vermont have instituted comprehensive healthcare reform; Arkansas, Montana, New Mexico, Oklahoma, Rhode Island, Tennessee, and Utah have all implemented some form of public-private partnerships; and Illinois and Pennsylvania have initiatives that cover all children.

Maine, Massachusetts, and Vermont all use Medicaid funds to partially subsidize healthcare coverage for families with annual incomes as high as $53,000.

For details on all current state initiatives for healthcare coverage, download the report “State of the States 2007: Building Hope, Raising Expectations” from the Web site of the State Coverage Initiatives at www.statecoverage.net.

Why Hospitalists Should Care

Providing healthcare coverage to the uninsured is one of SHM’s public policy priorities. “There really is a crisis out there, and hospitalists are on the front line of it every day,” says Dr. Siegal.

As former SHM President Mary Jo Gorman states in SHM’s letter of support for the Senate’s Health Partnership Act: “Many hospitalist programs exist to manage the burgeoning population of uninsured and underinsured patients who require hospitalization. These patients are more likely to delay seeking care until their illnesses deteriorate to the point that they need emergency care. In many communities, hospitalists have become the safety net for this vulnerable patient population.”

For further information about federal legislation for improved access and to see if your representatives are cosponsors, visit SHM’s Legislative Action Center at http://capwiz.com/hospitalmedicine/home/. TH

Jane Jerrard writes “Public Policy” for The Hospitalist.