Larry Wellikson, MD, FACP

M­arch is an important month for SHM. It is DVT Awareness Month, and once again SHM is leading a coalition of almost 40 organizations to raise the understanding of this disease. DVT causes complications that kill more people every year than AIDS and breast cancer combined. This coalition includes the American College of Physicians, the American Public Health Association, the American College of Chest Physicians, the American Society of Health System Pharmacists, the American Association of Critical Care Nurses, and many more.

The goals of the coalition are to use our knowledge and influence to inform not only the public at large, but health professionals as well. And if our success in 2005 is any measure, the DVT Awareness campaign has really had an impact.

Last year more than 400 million people saw on TV or read our message in magazines and newspapers. Utilizing the compelling story of our national spokesperson, Melanie Bloom, a mother of three girls who lost her young, athletic NBC war-correspondent husband, David, to a fatal pulmonary embolism (PE), our message was seen on “Larry King Live” on CNN, on the “Jane Pauley Show,” on “Access Hollywood,” and in Ladies Home Journal.

Often Melanie was accompanied by hospitalists such as Frank Michota, MD, the head of the Hospital Medicine Division at Cleveland Clinic. Dr. Michota answered the clinical questions in the interviews. Who can forget when Larry King turned to Dr. Michota and asked, “Are you a cardiologist?”

“No, Larry, I am a hospitalist,” said Dr. Michota.

And when Larry King asked “What is a hospitalist?” Dr. Michota spread the gospel according to hospital medicine to a nationwide audience.

Later in the year a billboard on Rockefeller Center in New York City proclaimed the DVT Awareness message along with the SHM logo. If you can make it there, you can make it anywhere.

But this campaign isn’t just about TV appearances and magazine articles. This is about using awareness to save lives. And save lives we did. More than a thousand letters and e-mails were sent to the coalition in 2005 from patients and family members with personal stories of how exposure to our campaign led them to go to their doctors or show up in an ED. They were treated early for DVT—before they developed a potentially fatal PE. They credit the DVT Awareness Campaign with saving their lives.

In 2006 SHM is back at the head of the coalition. In January at the National Press Club, I was fortunate enough to help roll out the details of our 2006 campaign. Joining me on the dais were Dr. Michota; Geno Merli, MD, from Jefferson Medical College and a frequent speaker at SHM meetings; and Sam Goldhaber, MD, from Harvard’s Brigham and Women’s in Boston.

This year we have set a goal of further engaging the public by telling our patients’ stories, by forming patient affinity groups, by providing the tools for health professionals to provide the best care for DVT and PE, and by continuing to use the media to spread our message.

SHM has a robust set of educational and quality improvement tools in the DVT Resource Room on the SHM Web site at www.hospitalmedicine.org under the “Quality/Patient Safety” tab. There hospitalists can find an SHM DVT workbook to help measure their performance and improve their outcomes. At the SHM 2006 Annual Meeting on May 3, from 8 a.m. to 5:30 p.m., SHM will host a precourse on quality improvement, and one of the key conditions is DVT. SHM hopes to raise funds for future demonstration projects to improve patient outcomes in DVT and even to set up skilled mentors who can help hospitalists trying to affect change at their hospitals for the first time.

SHM is a young, enthusiastic organization that lacks the cynicism of entrenchment. We actually do believe with some help and support we can make quality matter, even without pay for performance and before regulated performance standards.

We see the DVT Awareness Coalition as a template for SHM’s call to action. It involves participation across the continuum involving other physicians, nurses, pharmacists, and patients. It is proactive and targeted with not only improving public knowledge, but recognizing that maybe not every doctor and nurse knows all the latest information, either. It is focused on making a tangible difference, not just writing a white paper or a guideline and declaring victory. It is about saving lives in 2005 and again in 2006. It is about multiplying the efforts of SHM by the multiple of the number of hospitals that now have hospitalists.

There is much promise to hospital medicine. Some see this as a future play with only a foundation being built today. There are surely many great things ahead for hospital medicine as we grow to more than 30,000 hospitalists at virtually every hospital in America. There are many skills left for us to learn. But hospitalists and SHM are making a difference today. We are not doing it alone, but through teamwork and coalition-building. We are proud to be a partner in the DVT Awareness Coalition and we are glad to provide leadership when asked. The payoff is in the lives we have saved and the lives we have changed for the better. TH

Dr. Wellikson has been CEO of SHM since 2000.

M­arch is an important month for SHM. It is DVT Awareness Month, and once again SHM is leading a coalition of almost 40 organizations to raise the understanding of this disease. DVT causes complications that kill more people every year than AIDS and breast cancer combined. This coalition includes the American College of Physicians, the American Public Health Association, the American College of Chest Physicians, the American Society of Health System Pharmacists, the American Association of Critical Care Nurses, and many more.

The goals of the coalition are to use our knowledge and influence to inform not only the public at large, but health professionals as well. And if our success in 2005 is any measure, the DVT Awareness campaign has really had an impact.

Last year more than 400 million people saw on TV or read our message in magazines and newspapers. Utilizing the compelling story of our national spokesperson, Melanie Bloom, a mother of three girls who lost her young, athletic NBC war-correspondent husband, David, to a fatal pulmonary embolism (PE), our message was seen on “Larry King Live” on CNN, on the “Jane Pauley Show,” on “Access Hollywood,” and in Ladies Home Journal.

Often Melanie was accompanied by hospitalists such as Frank Michota, MD, the head of the Hospital Medicine Division at Cleveland Clinic. Dr. Michota answered the clinical questions in the interviews. Who can forget when Larry King turned to Dr. Michota and asked, “Are you a cardiologist?”

“No, Larry, I am a hospitalist,” said Dr. Michota.

And when Larry King asked “What is a hospitalist?” Dr. Michota spread the gospel according to hospital medicine to a nationwide audience.

Later in the year a billboard on Rockefeller Center in New York City proclaimed the DVT Awareness message along with the SHM logo. If you can make it there, you can make it anywhere.

But this campaign isn’t just about TV appearances and magazine articles. This is about using awareness to save lives. And save lives we did. More than a thousand letters and e-mails were sent to the coalition in 2005 from patients and family members with personal stories of how exposure to our campaign led them to go to their doctors or show up in an ED. They were treated early for DVT—before they developed a potentially fatal PE. They credit the DVT Awareness Campaign with saving their lives.

In 2006 SHM is back at the head of the coalition. In January at the National Press Club, I was fortunate enough to help roll out the details of our 2006 campaign. Joining me on the dais were Dr. Michota; Geno Merli, MD, from Jefferson Medical College and a frequent speaker at SHM meetings; and Sam Goldhaber, MD, from Harvard’s Brigham and Women’s in Boston.

This year we have set a goal of further engaging the public by telling our patients’ stories, by forming patient affinity groups, by providing the tools for health professionals to provide the best care for DVT and PE, and by continuing to use the media to spread our message.

SHM has a robust set of educational and quality improvement tools in the DVT Resource Room on the SHM Web site at www.hospitalmedicine.org under the “Quality/Patient Safety” tab. There hospitalists can find an SHM DVT workbook to help measure their performance and improve their outcomes. At the SHM 2006 Annual Meeting on May 3, from 8 a.m. to 5:30 p.m., SHM will host a precourse on quality improvement, and one of the key conditions is DVT. SHM hopes to raise funds for future demonstration projects to improve patient outcomes in DVT and even to set up skilled mentors who can help hospitalists trying to affect change at their hospitals for the first time.

SHM is a young, enthusiastic organization that lacks the cynicism of entrenchment. We actually do believe with some help and support we can make quality matter, even without pay for performance and before regulated performance standards.

We see the DVT Awareness Coalition as a template for SHM’s call to action. It involves participation across the continuum involving other physicians, nurses, pharmacists, and patients. It is proactive and targeted with not only improving public knowledge, but recognizing that maybe not every doctor and nurse knows all the latest information, either. It is focused on making a tangible difference, not just writing a white paper or a guideline and declaring victory. It is about saving lives in 2005 and again in 2006. It is about multiplying the efforts of SHM by the multiple of the number of hospitals that now have hospitalists.

There is much promise to hospital medicine. Some see this as a future play with only a foundation being built today. There are surely many great things ahead for hospital medicine as we grow to more than 30,000 hospitalists at virtually every hospital in America. There are many skills left for us to learn. But hospitalists and SHM are making a difference today. We are not doing it alone, but through teamwork and coalition-building. We are proud to be a partner in the DVT Awareness Coalition and we are glad to provide leadership when asked. The payoff is in the lives we have saved and the lives we have changed for the better. TH

Dr. Wellikson has been CEO of SHM since 2000.

M­arch is an important month for SHM. It is DVT Awareness Month, and once again SHM is leading a coalition of almost 40 organizations to raise the understanding of this disease. DVT causes complications that kill more people every year than AIDS and breast cancer combined. This coalition includes the American College of Physicians, the American Public Health Association, the American College of Chest Physicians, the American Society of Health System Pharmacists, the American Association of Critical Care Nurses, and many more.

The goals of the coalition are to use our knowledge and influence to inform not only the public at large, but health professionals as well. And if our success in 2005 is any measure, the DVT Awareness campaign has really had an impact.

Last year more than 400 million people saw on TV or read our message in magazines and newspapers. Utilizing the compelling story of our national spokesperson, Melanie Bloom, a mother of three girls who lost her young, athletic NBC war-correspondent husband, David, to a fatal pulmonary embolism (PE), our message was seen on “Larry King Live” on CNN, on the “Jane Pauley Show,” on “Access Hollywood,” and in Ladies Home Journal.

Often Melanie was accompanied by hospitalists such as Frank Michota, MD, the head of the Hospital Medicine Division at Cleveland Clinic. Dr. Michota answered the clinical questions in the interviews. Who can forget when Larry King turned to Dr. Michota and asked, “Are you a cardiologist?”

“No, Larry, I am a hospitalist,” said Dr. Michota.

And when Larry King asked “What is a hospitalist?” Dr. Michota spread the gospel according to hospital medicine to a nationwide audience.

Later in the year a billboard on Rockefeller Center in New York City proclaimed the DVT Awareness message along with the SHM logo. If you can make it there, you can make it anywhere.

But this campaign isn’t just about TV appearances and magazine articles. This is about using awareness to save lives. And save lives we did. More than a thousand letters and e-mails were sent to the coalition in 2005 from patients and family members with personal stories of how exposure to our campaign led them to go to their doctors or show up in an ED. They were treated early for DVT—before they developed a potentially fatal PE. They credit the DVT Awareness Campaign with saving their lives.

In 2006 SHM is back at the head of the coalition. In January at the National Press Club, I was fortunate enough to help roll out the details of our 2006 campaign. Joining me on the dais were Dr. Michota; Geno Merli, MD, from Jefferson Medical College and a frequent speaker at SHM meetings; and Sam Goldhaber, MD, from Harvard’s Brigham and Women’s in Boston.

This year we have set a goal of further engaging the public by telling our patients’ stories, by forming patient affinity groups, by providing the tools for health professionals to provide the best care for DVT and PE, and by continuing to use the media to spread our message.

SHM has a robust set of educational and quality improvement tools in the DVT Resource Room on the SHM Web site at www.hospitalmedicine.org under the “Quality/Patient Safety” tab. There hospitalists can find an SHM DVT workbook to help measure their performance and improve their outcomes. At the SHM 2006 Annual Meeting on May 3, from 8 a.m. to 5:30 p.m., SHM will host a precourse on quality improvement, and one of the key conditions is DVT. SHM hopes to raise funds for future demonstration projects to improve patient outcomes in DVT and even to set up skilled mentors who can help hospitalists trying to affect change at their hospitals for the first time.

SHM is a young, enthusiastic organization that lacks the cynicism of entrenchment. We actually do believe with some help and support we can make quality matter, even without pay for performance and before regulated performance standards.

We see the DVT Awareness Coalition as a template for SHM’s call to action. It involves participation across the continuum involving other physicians, nurses, pharmacists, and patients. It is proactive and targeted with not only improving public knowledge, but recognizing that maybe not every doctor and nurse knows all the latest information, either. It is focused on making a tangible difference, not just writing a white paper or a guideline and declaring victory. It is about saving lives in 2005 and again in 2006. It is about multiplying the efforts of SHM by the multiple of the number of hospitals that now have hospitalists.

There is much promise to hospital medicine. Some see this as a future play with only a foundation being built today. There are surely many great things ahead for hospital medicine as we grow to more than 30,000 hospitalists at virtually every hospital in America. There are many skills left for us to learn. But hospitalists and SHM are making a difference today. We are not doing it alone, but through teamwork and coalition-building. We are proud to be a partner in the DVT Awareness Coalition and we are glad to provide leadership when asked. The payoff is in the lives we have saved and the lives we have changed for the better. TH

Dr. Wellikson has been CEO of SHM since 2000.

H­as the time come for a major overhaul of internal medicine training to better prepare new physicians for the reality of medical practice they will face in the 21st century? Has hospital medicine’s rapid growth been one indication that the roles internists are being asked to perform are in many ways different from just a decade earlier? Are these concerns just as applicable for young family practitioners and pediatricians?

On Dec. 2, 2005, the Alliance for Academic Internal Medicine (AAIM) and the American Board of Internal Medicine (ABIM) brought together more than 40 of the key opinion leaders in internal medicine to look into these very issues. This watershed meeting included the top leaders at ABIM, the American College of Physicians (ACP), the Association of Program Directors in Internal Medicine (APDIM), the Association of Professors of Medicine (APM), all of the medical subspecialty societies, the American Medical Association (AMA), the AMA/Specialty Society RVS Update Committee (RUC), and the American Association of Medical Colleges (AAMC). And, yes, SHM, was well represented.

In addition to agreeing that an overhaul of internal medicine residency training is long overdue, part of this meeting was also devoted to potential changes in the maintenance of certification process to allow for formal recognition of expertise in hospital medicine and ambulatory internal medicine. More about that later.

APDIM and APM, representing the collective organizations in AAIM, presented a plan for revision in training that would identify a core of internal medicine that could form the basis for the front end of training (e.g., possibly the first two years) and allow for a concentration in the later stages of internal medicine residencies. This might take the form of a third year with an emphasis in hospital medicine, ambulatory medicine, traditional internal medicine, or one of the medical subspecialties.

Amazingly, this approach was almost universally accepted by the attendees at the Dec. 2 meeting. With this broad support, AAIM plans to push forward in the coming months, disseminating details of their plan with an opportunity for a broader comment on just what would constitute the “core” of internal medicine. APM and APDIM then plan to take this input and come back by midyear with a more fleshed out proposal.

Of interest is that SHM is publishing the Core Competencies in Hospital Medicine as a supplement to the first issue of the Journal of Hospital Medicine. The work hospitalist thought leaders have put into defining these core competencies over the last few years should be helpful in providing the hospital medicine slant on the core of internal medicine as well as forming the basis for the curriculum with concentration in hospital medicine in the third year of training.

While the goal is to allow training to reflect the career choices of today’s internists and to better prepare them for their professional lives, the devil is truly in the details. Besides serving as a platform for education, internal medicine residency has evolved into a major service load supporting many health systems. Any revision to internal medicine residency needs to accommodate for the service load. In addition, any changes need to be blended into subspecialty fellowship training.

Weaved into this entire discussion was the evolving reshaping of internal medicine. At one time the well-trained general internist was the consummate well-rounded physician serving as a consultant on many diseases to surgeons and other physicians. The last quarter of the 20th century saw the blossoming of many subspecialties in internal medicine and in the last decade a further sub-subspecialization with endoscopists, electrophysiologists, and the like. As the complexity and demands increased in recent years in both the hospital and the outpatient arena, some internists chose to limit their practice to the hospital or the office, and hospital medicine grew and its competencies became more defined.

As internists further refined their skills and narrowed their professional focus, their expectations of their certification and especially their maintenance of certification (MOC) by the ABIM became an issue. Is the MOC process relevant to what they feel they do and should know?

In addition, many subspecialty societies have concerns about how maintaining a basis in internal medicine fits in with MOC in their subspecialties. At this meeting it became clear that many subspecialists feel there is a core of internal medicine they should continue to know and be evaluated on without being expected to know everything a practicing hospitalist or ambulatory internist knows. For example, a cardiologist may be expected to know when their diabetic patients are getting into trouble and need consultation but may not need to know the intricacies of managing extremes in glycemic control.

Many at this meeting felt that the time is now here for using the MOC process to offer those initially credentialed in general internal medicine to have their MOC evaluation tailored to their real-life practice as a hospitalist or an internist with an ambulatory practice and to allow for them to be identified as having expertise in hospital or ambulatory medicine. This was a recognition that these aspects of what have traditionally been lumped together as general internal medicine have key defined skills and knowledge and needs to be recognized as more than just an internist who is not a subspecialist.

Once again there is still much work to be done. SHM, ACP, SGIM, and others will need to work with ABIM and RUC and others to define the skills and the competencies that would form the basis for the training and evaluation of new and improved internists in the 21st century.

The good news from the Dec. 2, 2005, meeting in Dallas is that the national leadership in internal medicine recognizes the need to change internal medicine residency training and to have an MOC process that is relevant to all internists—general internists, subspecialists, and hospitalists. There was also a sense that this process needs to move forward with reasoned speed. We don’t need to write another white paper and declare victory. Today’s and tomorrow’s internists and our patients need us to provide the leadership to produce the best trained and motivated internists and subspecialists to meet the increasing needs of a sophisticated and aging population.

As always SHM will be there, playing an active role. Whatever we come up with for internal medicine I hope can be applicable to family practice and pediatrics as well. Because this is the professional world you will live in, we will continue to invite your input and ideas. TH

Dr. Wellikson has been CEO of SHM since 2000.

H­as the time come for a major overhaul of internal medicine training to better prepare new physicians for the reality of medical practice they will face in the 21st century? Has hospital medicine’s rapid growth been one indication that the roles internists are being asked to perform are in many ways different from just a decade earlier? Are these concerns just as applicable for young family practitioners and pediatricians?

On Dec. 2, 2005, the Alliance for Academic Internal Medicine (AAIM) and the American Board of Internal Medicine (ABIM) brought together more than 40 of the key opinion leaders in internal medicine to look into these very issues. This watershed meeting included the top leaders at ABIM, the American College of Physicians (ACP), the Association of Program Directors in Internal Medicine (APDIM), the Association of Professors of Medicine (APM), all of the medical subspecialty societies, the American Medical Association (AMA), the AMA/Specialty Society RVS Update Committee (RUC), and the American Association of Medical Colleges (AAMC). And, yes, SHM, was well represented.

In addition to agreeing that an overhaul of internal medicine residency training is long overdue, part of this meeting was also devoted to potential changes in the maintenance of certification process to allow for formal recognition of expertise in hospital medicine and ambulatory internal medicine. More about that later.

APDIM and APM, representing the collective organizations in AAIM, presented a plan for revision in training that would identify a core of internal medicine that could form the basis for the front end of training (e.g., possibly the first two years) and allow for a concentration in the later stages of internal medicine residencies. This might take the form of a third year with an emphasis in hospital medicine, ambulatory medicine, traditional internal medicine, or one of the medical subspecialties.

Amazingly, this approach was almost universally accepted by the attendees at the Dec. 2 meeting. With this broad support, AAIM plans to push forward in the coming months, disseminating details of their plan with an opportunity for a broader comment on just what would constitute the “core” of internal medicine. APM and APDIM then plan to take this input and come back by midyear with a more fleshed out proposal.

Of interest is that SHM is publishing the Core Competencies in Hospital Medicine as a supplement to the first issue of the Journal of Hospital Medicine. The work hospitalist thought leaders have put into defining these core competencies over the last few years should be helpful in providing the hospital medicine slant on the core of internal medicine as well as forming the basis for the curriculum with concentration in hospital medicine in the third year of training.

While the goal is to allow training to reflect the career choices of today’s internists and to better prepare them for their professional lives, the devil is truly in the details. Besides serving as a platform for education, internal medicine residency has evolved into a major service load supporting many health systems. Any revision to internal medicine residency needs to accommodate for the service load. In addition, any changes need to be blended into subspecialty fellowship training.

Weaved into this entire discussion was the evolving reshaping of internal medicine. At one time the well-trained general internist was the consummate well-rounded physician serving as a consultant on many diseases to surgeons and other physicians. The last quarter of the 20th century saw the blossoming of many subspecialties in internal medicine and in the last decade a further sub-subspecialization with endoscopists, electrophysiologists, and the like. As the complexity and demands increased in recent years in both the hospital and the outpatient arena, some internists chose to limit their practice to the hospital or the office, and hospital medicine grew and its competencies became more defined.

As internists further refined their skills and narrowed their professional focus, their expectations of their certification and especially their maintenance of certification (MOC) by the ABIM became an issue. Is the MOC process relevant to what they feel they do and should know?

In addition, many subspecialty societies have concerns about how maintaining a basis in internal medicine fits in with MOC in their subspecialties. At this meeting it became clear that many subspecialists feel there is a core of internal medicine they should continue to know and be evaluated on without being expected to know everything a practicing hospitalist or ambulatory internist knows. For example, a cardiologist may be expected to know when their diabetic patients are getting into trouble and need consultation but may not need to know the intricacies of managing extremes in glycemic control.

Many at this meeting felt that the time is now here for using the MOC process to offer those initially credentialed in general internal medicine to have their MOC evaluation tailored to their real-life practice as a hospitalist or an internist with an ambulatory practice and to allow for them to be identified as having expertise in hospital or ambulatory medicine. This was a recognition that these aspects of what have traditionally been lumped together as general internal medicine have key defined skills and knowledge and needs to be recognized as more than just an internist who is not a subspecialist.

Once again there is still much work to be done. SHM, ACP, SGIM, and others will need to work with ABIM and RUC and others to define the skills and the competencies that would form the basis for the training and evaluation of new and improved internists in the 21st century.

The good news from the Dec. 2, 2005, meeting in Dallas is that the national leadership in internal medicine recognizes the need to change internal medicine residency training and to have an MOC process that is relevant to all internists—general internists, subspecialists, and hospitalists. There was also a sense that this process needs to move forward with reasoned speed. We don’t need to write another white paper and declare victory. Today’s and tomorrow’s internists and our patients need us to provide the leadership to produce the best trained and motivated internists and subspecialists to meet the increasing needs of a sophisticated and aging population.

As always SHM will be there, playing an active role. Whatever we come up with for internal medicine I hope can be applicable to family practice and pediatrics as well. Because this is the professional world you will live in, we will continue to invite your input and ideas. TH

Dr. Wellikson has been CEO of SHM since 2000.

H­as the time come for a major overhaul of internal medicine training to better prepare new physicians for the reality of medical practice they will face in the 21st century? Has hospital medicine’s rapid growth been one indication that the roles internists are being asked to perform are in many ways different from just a decade earlier? Are these concerns just as applicable for young family practitioners and pediatricians?

On Dec. 2, 2005, the Alliance for Academic Internal Medicine (AAIM) and the American Board of Internal Medicine (ABIM) brought together more than 40 of the key opinion leaders in internal medicine to look into these very issues. This watershed meeting included the top leaders at ABIM, the American College of Physicians (ACP), the Association of Program Directors in Internal Medicine (APDIM), the Association of Professors of Medicine (APM), all of the medical subspecialty societies, the American Medical Association (AMA), the AMA/Specialty Society RVS Update Committee (RUC), and the American Association of Medical Colleges (AAMC). And, yes, SHM, was well represented.

In addition to agreeing that an overhaul of internal medicine residency training is long overdue, part of this meeting was also devoted to potential changes in the maintenance of certification process to allow for formal recognition of expertise in hospital medicine and ambulatory internal medicine. More about that later.

APDIM and APM, representing the collective organizations in AAIM, presented a plan for revision in training that would identify a core of internal medicine that could form the basis for the front end of training (e.g., possibly the first two years) and allow for a concentration in the later stages of internal medicine residencies. This might take the form of a third year with an emphasis in hospital medicine, ambulatory medicine, traditional internal medicine, or one of the medical subspecialties.

Amazingly, this approach was almost universally accepted by the attendees at the Dec. 2 meeting. With this broad support, AAIM plans to push forward in the coming months, disseminating details of their plan with an opportunity for a broader comment on just what would constitute the “core” of internal medicine. APM and APDIM then plan to take this input and come back by midyear with a more fleshed out proposal.

Of interest is that SHM is publishing the Core Competencies in Hospital Medicine as a supplement to the first issue of the Journal of Hospital Medicine. The work hospitalist thought leaders have put into defining these core competencies over the last few years should be helpful in providing the hospital medicine slant on the core of internal medicine as well as forming the basis for the curriculum with concentration in hospital medicine in the third year of training.

While the goal is to allow training to reflect the career choices of today’s internists and to better prepare them for their professional lives, the devil is truly in the details. Besides serving as a platform for education, internal medicine residency has evolved into a major service load supporting many health systems. Any revision to internal medicine residency needs to accommodate for the service load. In addition, any changes need to be blended into subspecialty fellowship training.

Weaved into this entire discussion was the evolving reshaping of internal medicine. At one time the well-trained general internist was the consummate well-rounded physician serving as a consultant on many diseases to surgeons and other physicians. The last quarter of the 20th century saw the blossoming of many subspecialties in internal medicine and in the last decade a further sub-subspecialization with endoscopists, electrophysiologists, and the like. As the complexity and demands increased in recent years in both the hospital and the outpatient arena, some internists chose to limit their practice to the hospital or the office, and hospital medicine grew and its competencies became more defined.

As internists further refined their skills and narrowed their professional focus, their expectations of their certification and especially their maintenance of certification (MOC) by the ABIM became an issue. Is the MOC process relevant to what they feel they do and should know?

In addition, many subspecialty societies have concerns about how maintaining a basis in internal medicine fits in with MOC in their subspecialties. At this meeting it became clear that many subspecialists feel there is a core of internal medicine they should continue to know and be evaluated on without being expected to know everything a practicing hospitalist or ambulatory internist knows. For example, a cardiologist may be expected to know when their diabetic patients are getting into trouble and need consultation but may not need to know the intricacies of managing extremes in glycemic control.

Many at this meeting felt that the time is now here for using the MOC process to offer those initially credentialed in general internal medicine to have their MOC evaluation tailored to their real-life practice as a hospitalist or an internist with an ambulatory practice and to allow for them to be identified as having expertise in hospital or ambulatory medicine. This was a recognition that these aspects of what have traditionally been lumped together as general internal medicine have key defined skills and knowledge and needs to be recognized as more than just an internist who is not a subspecialist.

Once again there is still much work to be done. SHM, ACP, SGIM, and others will need to work with ABIM and RUC and others to define the skills and the competencies that would form the basis for the training and evaluation of new and improved internists in the 21st century.

The good news from the Dec. 2, 2005, meeting in Dallas is that the national leadership in internal medicine recognizes the need to change internal medicine residency training and to have an MOC process that is relevant to all internists—general internists, subspecialists, and hospitalists. There was also a sense that this process needs to move forward with reasoned speed. We don’t need to write another white paper and declare victory. Today’s and tomorrow’s internists and our patients need us to provide the leadership to produce the best trained and motivated internists and subspecialists to meet the increasing needs of a sophisticated and aging population.

As always SHM will be there, playing an active role. Whatever we come up with for internal medicine I hope can be applicable to family practice and pediatrics as well. Because this is the professional world you will live in, we will continue to invite your input and ideas. TH

Dr. Wellikson has been CEO of SHM since 2000.

Welcome to 2006 and another coming-out party for SHM and hospitalists. In just a few short months more than a thousand hospitalists will come together in our nation’s capitol for the SHM Annual Meeting May 3-5, 2006. In addition to the largest convention of hospitalists, hundreds of other stakeholders in hospital medicine will gather for what has become the centerpiece of their year.

In addition to the opportunity to hear our nation’s experts talk about the up-to-date, state-of-the art medical knowledge for hospitalists, the SHM Annual Meeting is the place to find your next job, reconnect with colleagues from around the country, express your own opinions and vision for hospital medicine at the Special Interest Forums, and so much more.

SHM will be literally in the center of our nation’s capitol. It will be an opportunity for hospitalists to not only see the power center for our country, but with SHM’s help, a time for hospitalists to engage our legislators about issues important to hospitalists and our patients.

Taking advantage of the location of this year’s Annual Meeting, SHM’s Public Policy Committee has organized the first SHM Legislative Day on May 3, 2006. SHM meeting attendees can voluntarily sign up to meet with their congressmen and senators and their staffs.

SHM will make all the appointments for these Congressional visits. In addition, May 3 will kick off with a Washington overview and practical sessions on how best to approach your legislators to get your message across.

In addition, SHM has been working with HPA, a nationally recognized information resource in D.C. to put together a “Hospital Medicine White Paper” to concisely describe the emerging specialty of hospital medicine and how our perspectives and ideas are important to the healthcare debate.

The white paper will be a useful document to leave with your legislator and to use as a reference for your discussions. It will also contain some suggested policy recommendations supported by the SHM Board that can form the basis of what we would like to see move forward in Congress and on the Hill.

I have participated in many of these Legislative Days in my time on the ASIM and ACP Boards. I have found the legislators and their staffs interested in hearing from a passionate, informed part of their constituencies. Often these conversations were informal and personal and led to an ongoing relationship that continued when we were back home. I looked forward to coming back to Washington to renew our discussions.

And there can be real tangible changes as a result of these Congressional visits. I have seen changes in Medicare scope of benefits and reimbursement and methodologies based on messages I carried with the support of my professional medical societies.

Hospitalists are in a unique position to influence the current and future medical debates in Washington. We are young (average age 37) with a long professional career ahead of us. Hospitalists are at the center of many issues and initiatives that affect hospitals and the acutely ill patients they treat. Hospitalists measure and improve inpatient healthcare in an era of decreasing resources and increasing expectations.

Right now there is significant activity in pay for performance and in developing quality performance measures. There is also debate on gain-sharing and discussions of reducing and reshaping reimbursement for physicians. There are discussions on how to fund medical education and how to make sure all Americans get healthcare—even the 45 million without any insurance coverage. There are issues of access and limitations of crowded emergency departments and hospitals running at capacity.

There is no shortage of ideas and proposals, and most of these will affect hospitalists and the patients we treat and the hospitals we work in. In many ways these issues will shape our professional futures and determine how satisfying a career as a physician and specifically as a hospitalist will be.

Hospitalists and SHM must be part of the dialogue. We must clearly state where we stand and be prepared to back this up with data and to propose realistic solutions we are prepared to implement.

So clear your schedules May 3-5, 2006, and come to Washington, D.C., to join more than a thousand of your hospitalist colleagues as we take our first determined steps at the power center of our country. SHM will provide the support and materials for your success. But you must supply the voice and the presence. We owe no less to our profession and our patients now and in the future. TH

Dr. Wellikson has been CEO of SHM since 2000.

Welcome to 2006 and another coming-out party for SHM and hospitalists. In just a few short months more than a thousand hospitalists will come together in our nation’s capitol for the SHM Annual Meeting May 3-5, 2006. In addition to the largest convention of hospitalists, hundreds of other stakeholders in hospital medicine will gather for what has become the centerpiece of their year.

In addition to the opportunity to hear our nation’s experts talk about the up-to-date, state-of-the art medical knowledge for hospitalists, the SHM Annual Meeting is the place to find your next job, reconnect with colleagues from around the country, express your own opinions and vision for hospital medicine at the Special Interest Forums, and so much more.

SHM will be literally in the center of our nation’s capitol. It will be an opportunity for hospitalists to not only see the power center for our country, but with SHM’s help, a time for hospitalists to engage our legislators about issues important to hospitalists and our patients.

Taking advantage of the location of this year’s Annual Meeting, SHM’s Public Policy Committee has organized the first SHM Legislative Day on May 3, 2006. SHM meeting attendees can voluntarily sign up to meet with their congressmen and senators and their staffs.

SHM will make all the appointments for these Congressional visits. In addition, May 3 will kick off with a Washington overview and practical sessions on how best to approach your legislators to get your message across.

In addition, SHM has been working with HPA, a nationally recognized information resource in D.C. to put together a “Hospital Medicine White Paper” to concisely describe the emerging specialty of hospital medicine and how our perspectives and ideas are important to the healthcare debate.

The white paper will be a useful document to leave with your legislator and to use as a reference for your discussions. It will also contain some suggested policy recommendations supported by the SHM Board that can form the basis of what we would like to see move forward in Congress and on the Hill.

I have participated in many of these Legislative Days in my time on the ASIM and ACP Boards. I have found the legislators and their staffs interested in hearing from a passionate, informed part of their constituencies. Often these conversations were informal and personal and led to an ongoing relationship that continued when we were back home. I looked forward to coming back to Washington to renew our discussions.

And there can be real tangible changes as a result of these Congressional visits. I have seen changes in Medicare scope of benefits and reimbursement and methodologies based on messages I carried with the support of my professional medical societies.

Hospitalists are in a unique position to influence the current and future medical debates in Washington. We are young (average age 37) with a long professional career ahead of us. Hospitalists are at the center of many issues and initiatives that affect hospitals and the acutely ill patients they treat. Hospitalists measure and improve inpatient healthcare in an era of decreasing resources and increasing expectations.

Right now there is significant activity in pay for performance and in developing quality performance measures. There is also debate on gain-sharing and discussions of reducing and reshaping reimbursement for physicians. There are discussions on how to fund medical education and how to make sure all Americans get healthcare—even the 45 million without any insurance coverage. There are issues of access and limitations of crowded emergency departments and hospitals running at capacity.

There is no shortage of ideas and proposals, and most of these will affect hospitalists and the patients we treat and the hospitals we work in. In many ways these issues will shape our professional futures and determine how satisfying a career as a physician and specifically as a hospitalist will be.

Hospitalists and SHM must be part of the dialogue. We must clearly state where we stand and be prepared to back this up with data and to propose realistic solutions we are prepared to implement.

So clear your schedules May 3-5, 2006, and come to Washington, D.C., to join more than a thousand of your hospitalist colleagues as we take our first determined steps at the power center of our country. SHM will provide the support and materials for your success. But you must supply the voice and the presence. We owe no less to our profession and our patients now and in the future. TH

Dr. Wellikson has been CEO of SHM since 2000.

Welcome to 2006 and another coming-out party for SHM and hospitalists. In just a few short months more than a thousand hospitalists will come together in our nation’s capitol for the SHM Annual Meeting May 3-5, 2006. In addition to the largest convention of hospitalists, hundreds of other stakeholders in hospital medicine will gather for what has become the centerpiece of their year.

In addition to the opportunity to hear our nation’s experts talk about the up-to-date, state-of-the art medical knowledge for hospitalists, the SHM Annual Meeting is the place to find your next job, reconnect with colleagues from around the country, express your own opinions and vision for hospital medicine at the Special Interest Forums, and so much more.

SHM will be literally in the center of our nation’s capitol. It will be an opportunity for hospitalists to not only see the power center for our country, but with SHM’s help, a time for hospitalists to engage our legislators about issues important to hospitalists and our patients.

Taking advantage of the location of this year’s Annual Meeting, SHM’s Public Policy Committee has organized the first SHM Legislative Day on May 3, 2006. SHM meeting attendees can voluntarily sign up to meet with their congressmen and senators and their staffs.

SHM will make all the appointments for these Congressional visits. In addition, May 3 will kick off with a Washington overview and practical sessions on how best to approach your legislators to get your message across.

In addition, SHM has been working with HPA, a nationally recognized information resource in D.C. to put together a “Hospital Medicine White Paper” to concisely describe the emerging specialty of hospital medicine and how our perspectives and ideas are important to the healthcare debate.

The white paper will be a useful document to leave with your legislator and to use as a reference for your discussions. It will also contain some suggested policy recommendations supported by the SHM Board that can form the basis of what we would like to see move forward in Congress and on the Hill.

I have participated in many of these Legislative Days in my time on the ASIM and ACP Boards. I have found the legislators and their staffs interested in hearing from a passionate, informed part of their constituencies. Often these conversations were informal and personal and led to an ongoing relationship that continued when we were back home. I looked forward to coming back to Washington to renew our discussions.

And there can be real tangible changes as a result of these Congressional visits. I have seen changes in Medicare scope of benefits and reimbursement and methodologies based on messages I carried with the support of my professional medical societies.

Hospitalists are in a unique position to influence the current and future medical debates in Washington. We are young (average age 37) with a long professional career ahead of us. Hospitalists are at the center of many issues and initiatives that affect hospitals and the acutely ill patients they treat. Hospitalists measure and improve inpatient healthcare in an era of decreasing resources and increasing expectations.

Right now there is significant activity in pay for performance and in developing quality performance measures. There is also debate on gain-sharing and discussions of reducing and reshaping reimbursement for physicians. There are discussions on how to fund medical education and how to make sure all Americans get healthcare—even the 45 million without any insurance coverage. There are issues of access and limitations of crowded emergency departments and hospitals running at capacity.

There is no shortage of ideas and proposals, and most of these will affect hospitalists and the patients we treat and the hospitals we work in. In many ways these issues will shape our professional futures and determine how satisfying a career as a physician and specifically as a hospitalist will be.

Hospitalists and SHM must be part of the dialogue. We must clearly state where we stand and be prepared to back this up with data and to propose realistic solutions we are prepared to implement.

So clear your schedules May 3-5, 2006, and come to Washington, D.C., to join more than a thousand of your hospitalist colleagues as we take our first determined steps at the power center of our country. SHM will provide the support and materials for your success. But you must supply the voice and the presence. We owe no less to our profession and our patients now and in the future. TH

Dr. Wellikson has been CEO of SHM since 2000.

One of the potential benefits of hospital medicine is the tangible opportunity to change healthcare in a meaningful way. Although much of the initial ballyhoo for hospital medicine has been around service-related issues, that is about to change.

Hospitalists have been willing to take on the inpatient responsibilities for primarily outpatient-based internists, family practitioners, and pediatricians. We have been available to admit and manage the patients who present to emergency rooms with acute illnesses and who have no physician of record. We have actively worked with surgeons and subspecialists to co-manage their patient’s medical problems.

In addition, because hospitalists are much more readily available to acutely ill inpatients, because we have more expertise with these medical problems, and because practice generally makes for better performance, hospitalists have been expected to provide more effective and more efficient care.

But that is just the front end of what is creating the enormous energy behind the hospital medicine movement. We are moving into an era of measurement of defined patient outcomes and expectations from insurance companies, Medicare, the business community, and—yes—even our patients. That era will require us to step up and deliver higher quality healthcare.

This is the driver to the pay-for-performance movement and a shift from just rewarding physicians and hospitals for doing the procedure or “visiting” the patient and moving to where those who can demonstrate expertise and performance are rewarded financially and by reputation.

Hospitalists and SHM take this very seriously and are creating alliances and programs to help hospitalists become leaders in the quality and performance arenas.

Walking through the approach that SHM is taking in improving glycemic control in hospitalized patients (see below) will serve as a template for other activities SHM has planned in heart failure, VTE, hospitalized infections, and other illnesses hospitalists see and treat every day.

In a practical way, hospitals and health professionals finally came into the performance era with the first publication of the individual hospital performance results to performance measures developed by JCAHO and co-promoted with CMS in their Hospital Compare Web site. This was promulgated widely, especially at www.hospitalcompare.hhs.gov.

Because Hospital Compare was picked up by The New York Times, the Los Angeles Times, and many local papers, hospitals were soon trying to explain why their performance in heart failure, pneumonia, and heart attack looked like a failing grade. Now that the public is involved, hospitals are scrambling to quickly improve their performance rather than attacking the data.

Looking to the future, SHM is working with JCAHO to develop performance standards for glycemic control for inpatients as a way to assess how our hospitals and physicians are doing in managing diabetes. SHM is also allying with many other key stakeholders to form a steering committee for this project. These standards will take almost three years to develop, test, and implement. So the first reporting of how every hospital is doing in diabetes is most likely a 2008 or 2009 event.

Expecting that many hospitals will improve their performance in diabetic care during 2008 and 2009, SHM is now developing the tools and the training to allow hospitalists to be ready with practical solutions.

In October 2005 SHM convened a Working Group on Inpatient Glycemic Control in Chicago. This meeting under the leadership of Greg Maynard, MD, associate clinical professor of medicine, chief of the division of hospital medicine, University of California at San Diego, brought together nationally recognized diabetologists and endocrinologists with hospitalist leaders, as well as experts in the field of nursing, case management, pharmacy, risk management, and nutrition. The end result is an understanding of what constitutes an ideal management of inpatient diabetes and what role hospitalists can play.

This work group now is analyzing what resources currently exist and what gaps need to be filled. Next SHM will develop an implementation plan to get this information out to our nation’s hospitalists.

SHM has some experience in developing quality improvement tools, as you can see in our Resource Rooms on the SHM Web site. For a current working example, take a look at the DVT Quality Improvement Resource Room at www.hospitalmedicine.org/AM/Template.cfm?Section=Quality_Improvement_Resource_Rooms1&Template=/CM/HTMLDisplay.cfm&ContentID=6312.

But SHM plans a more aggressive approach with proposed training sessions at the SHM Annual Meeting quality pre-course and taking these tools and approaches out to our hospitalists at local meetings throughout the country. SHM is also looking into creating a network of quality mentors that will work with individual hospitalists groups as they put SHM quality improvement tools into the workflow at their hospitals. SHM will also develop strategies for baseline measurement, ongoing data collection, involvement of team members, and procurement of local resources. SHM hopes to support research to further develop best practices and approaches.

The game plan goes something like this: SHM will develop the resources hospitalists need to improve management of inpatient diabetes in 2006. In 2007 and 2008 SHM will roll out this strategy to as many hospitalists as we can train. By 2008 JCAHO and CMS will have deployed their Performance Measures in Diabetes. When the first scores show the same deficiencies as we have seen this year in MI and heart failure, our nation’s hospitalists will be well armed to provide practical tangible solutions to improve quality.

And the beauty of this approach is that SHM is working on similar strategies right now for heart failure, DVT, pneumonia, and other key clinical conditions.

Those who pay for and receive care in our hospitals are looking at our current performance and demanding improvements. For the first time hospitals and those with resources are ready to make measurable quality a high priority. The presence of hospitalists in more than 2,000 hospitals (and more in the near future) ideally positions hospitalists to be a key change agent. The tools SHM is developing will give hospitalists the strategies and the expertise to make this happen.

This is a watershed moment in American healthcare. There is a palpable swing in the priorities of our patients. Hospitalists can help the healthcare team find real solutions. SHM has the vision and the plan to provide you with as much help as you need. Together we will do great things. TH

Dr. Wellikson has been CEO of SHM since 2000.

One of the potential benefits of hospital medicine is the tangible opportunity to change healthcare in a meaningful way. Although much of the initial ballyhoo for hospital medicine has been around service-related issues, that is about to change.

Hospitalists have been willing to take on the inpatient responsibilities for primarily outpatient-based internists, family practitioners, and pediatricians. We have been available to admit and manage the patients who present to emergency rooms with acute illnesses and who have no physician of record. We have actively worked with surgeons and subspecialists to co-manage their patient’s medical problems.

In addition, because hospitalists are much more readily available to acutely ill inpatients, because we have more expertise with these medical problems, and because practice generally makes for better performance, hospitalists have been expected to provide more effective and more efficient care.

But that is just the front end of what is creating the enormous energy behind the hospital medicine movement. We are moving into an era of measurement of defined patient outcomes and expectations from insurance companies, Medicare, the business community, and—yes—even our patients. That era will require us to step up and deliver higher quality healthcare.

This is the driver to the pay-for-performance movement and a shift from just rewarding physicians and hospitals for doing the procedure or “visiting” the patient and moving to where those who can demonstrate expertise and performance are rewarded financially and by reputation.

Hospitalists and SHM take this very seriously and are creating alliances and programs to help hospitalists become leaders in the quality and performance arenas.

Walking through the approach that SHM is taking in improving glycemic control in hospitalized patients (see below) will serve as a template for other activities SHM has planned in heart failure, VTE, hospitalized infections, and other illnesses hospitalists see and treat every day.

In a practical way, hospitals and health professionals finally came into the performance era with the first publication of the individual hospital performance results to performance measures developed by JCAHO and co-promoted with CMS in their Hospital Compare Web site. This was promulgated widely, especially at www.hospitalcompare.hhs.gov.

Because Hospital Compare was picked up by The New York Times, the Los Angeles Times, and many local papers, hospitals were soon trying to explain why their performance in heart failure, pneumonia, and heart attack looked like a failing grade. Now that the public is involved, hospitals are scrambling to quickly improve their performance rather than attacking the data.

Looking to the future, SHM is working with JCAHO to develop performance standards for glycemic control for inpatients as a way to assess how our hospitals and physicians are doing in managing diabetes. SHM is also allying with many other key stakeholders to form a steering committee for this project. These standards will take almost three years to develop, test, and implement. So the first reporting of how every hospital is doing in diabetes is most likely a 2008 or 2009 event.

Expecting that many hospitals will improve their performance in diabetic care during 2008 and 2009, SHM is now developing the tools and the training to allow hospitalists to be ready with practical solutions.

In October 2005 SHM convened a Working Group on Inpatient Glycemic Control in Chicago. This meeting under the leadership of Greg Maynard, MD, associate clinical professor of medicine, chief of the division of hospital medicine, University of California at San Diego, brought together nationally recognized diabetologists and endocrinologists with hospitalist leaders, as well as experts in the field of nursing, case management, pharmacy, risk management, and nutrition. The end result is an understanding of what constitutes an ideal management of inpatient diabetes and what role hospitalists can play.

This work group now is analyzing what resources currently exist and what gaps need to be filled. Next SHM will develop an implementation plan to get this information out to our nation’s hospitalists.

SHM has some experience in developing quality improvement tools, as you can see in our Resource Rooms on the SHM Web site. For a current working example, take a look at the DVT Quality Improvement Resource Room at www.hospitalmedicine.org/AM/Template.cfm?Section=Quality_Improvement_Resource_Rooms1&Template=/CM/HTMLDisplay.cfm&ContentID=6312.

But SHM plans a more aggressive approach with proposed training sessions at the SHM Annual Meeting quality pre-course and taking these tools and approaches out to our hospitalists at local meetings throughout the country. SHM is also looking into creating a network of quality mentors that will work with individual hospitalists groups as they put SHM quality improvement tools into the workflow at their hospitals. SHM will also develop strategies for baseline measurement, ongoing data collection, involvement of team members, and procurement of local resources. SHM hopes to support research to further develop best practices and approaches.

The game plan goes something like this: SHM will develop the resources hospitalists need to improve management of inpatient diabetes in 2006. In 2007 and 2008 SHM will roll out this strategy to as many hospitalists as we can train. By 2008 JCAHO and CMS will have deployed their Performance Measures in Diabetes. When the first scores show the same deficiencies as we have seen this year in MI and heart failure, our nation’s hospitalists will be well armed to provide practical tangible solutions to improve quality.

And the beauty of this approach is that SHM is working on similar strategies right now for heart failure, DVT, pneumonia, and other key clinical conditions.

Those who pay for and receive care in our hospitals are looking at our current performance and demanding improvements. For the first time hospitals and those with resources are ready to make measurable quality a high priority. The presence of hospitalists in more than 2,000 hospitals (and more in the near future) ideally positions hospitalists to be a key change agent. The tools SHM is developing will give hospitalists the strategies and the expertise to make this happen.

This is a watershed moment in American healthcare. There is a palpable swing in the priorities of our patients. Hospitalists can help the healthcare team find real solutions. SHM has the vision and the plan to provide you with as much help as you need. Together we will do great things. TH

Dr. Wellikson has been CEO of SHM since 2000.

One of the potential benefits of hospital medicine is the tangible opportunity to change healthcare in a meaningful way. Although much of the initial ballyhoo for hospital medicine has been around service-related issues, that is about to change.

Hospitalists have been willing to take on the inpatient responsibilities for primarily outpatient-based internists, family practitioners, and pediatricians. We have been available to admit and manage the patients who present to emergency rooms with acute illnesses and who have no physician of record. We have actively worked with surgeons and subspecialists to co-manage their patient’s medical problems.

In addition, because hospitalists are much more readily available to acutely ill inpatients, because we have more expertise with these medical problems, and because practice generally makes for better performance, hospitalists have been expected to provide more effective and more efficient care.

But that is just the front end of what is creating the enormous energy behind the hospital medicine movement. We are moving into an era of measurement of defined patient outcomes and expectations from insurance companies, Medicare, the business community, and—yes—even our patients. That era will require us to step up and deliver higher quality healthcare.

This is the driver to the pay-for-performance movement and a shift from just rewarding physicians and hospitals for doing the procedure or “visiting” the patient and moving to where those who can demonstrate expertise and performance are rewarded financially and by reputation.

Hospitalists and SHM take this very seriously and are creating alliances and programs to help hospitalists become leaders in the quality and performance arenas.

Walking through the approach that SHM is taking in improving glycemic control in hospitalized patients (see below) will serve as a template for other activities SHM has planned in heart failure, VTE, hospitalized infections, and other illnesses hospitalists see and treat every day.

In a practical way, hospitals and health professionals finally came into the performance era with the first publication of the individual hospital performance results to performance measures developed by JCAHO and co-promoted with CMS in their Hospital Compare Web site. This was promulgated widely, especially at www.hospitalcompare.hhs.gov.

Because Hospital Compare was picked up by The New York Times, the Los Angeles Times, and many local papers, hospitals were soon trying to explain why their performance in heart failure, pneumonia, and heart attack looked like a failing grade. Now that the public is involved, hospitals are scrambling to quickly improve their performance rather than attacking the data.

Looking to the future, SHM is working with JCAHO to develop performance standards for glycemic control for inpatients as a way to assess how our hospitals and physicians are doing in managing diabetes. SHM is also allying with many other key stakeholders to form a steering committee for this project. These standards will take almost three years to develop, test, and implement. So the first reporting of how every hospital is doing in diabetes is most likely a 2008 or 2009 event.

Expecting that many hospitals will improve their performance in diabetic care during 2008 and 2009, SHM is now developing the tools and the training to allow hospitalists to be ready with practical solutions.

In October 2005 SHM convened a Working Group on Inpatient Glycemic Control in Chicago. This meeting under the leadership of Greg Maynard, MD, associate clinical professor of medicine, chief of the division of hospital medicine, University of California at San Diego, brought together nationally recognized diabetologists and endocrinologists with hospitalist leaders, as well as experts in the field of nursing, case management, pharmacy, risk management, and nutrition. The end result is an understanding of what constitutes an ideal management of inpatient diabetes and what role hospitalists can play.

This work group now is analyzing what resources currently exist and what gaps need to be filled. Next SHM will develop an implementation plan to get this information out to our nation’s hospitalists.

SHM has some experience in developing quality improvement tools, as you can see in our Resource Rooms on the SHM Web site. For a current working example, take a look at the DVT Quality Improvement Resource Room at www.hospitalmedicine.org/AM/Template.cfm?Section=Quality_Improvement_Resource_Rooms1&Template=/CM/HTMLDisplay.cfm&ContentID=6312.

But SHM plans a more aggressive approach with proposed training sessions at the SHM Annual Meeting quality pre-course and taking these tools and approaches out to our hospitalists at local meetings throughout the country. SHM is also looking into creating a network of quality mentors that will work with individual hospitalists groups as they put SHM quality improvement tools into the workflow at their hospitals. SHM will also develop strategies for baseline measurement, ongoing data collection, involvement of team members, and procurement of local resources. SHM hopes to support research to further develop best practices and approaches.

The game plan goes something like this: SHM will develop the resources hospitalists need to improve management of inpatient diabetes in 2006. In 2007 and 2008 SHM will roll out this strategy to as many hospitalists as we can train. By 2008 JCAHO and CMS will have deployed their Performance Measures in Diabetes. When the first scores show the same deficiencies as we have seen this year in MI and heart failure, our nation’s hospitalists will be well armed to provide practical tangible solutions to improve quality.

And the beauty of this approach is that SHM is working on similar strategies right now for heart failure, DVT, pneumonia, and other key clinical conditions.

Those who pay for and receive care in our hospitals are looking at our current performance and demanding improvements. For the first time hospitals and those with resources are ready to make measurable quality a high priority. The presence of hospitalists in more than 2,000 hospitals (and more in the near future) ideally positions hospitalists to be a key change agent. The tools SHM is developing will give hospitalists the strategies and the expertise to make this happen.

This is a watershed moment in American healthcare. There is a palpable swing in the priorities of our patients. Hospitalists can help the healthcare team find real solutions. SHM has the vision and the plan to provide you with as much help as you need. Together we will do great things. TH

Dr. Wellikson has been CEO of SHM since 2000.

It is clear to most of us in hospital medicine that the lines are rapidly blurring between the ED, and the floor, and the ICUs. Some of this has been brought about by the transitional units and the ability to place the patient in the most appropriate area with the correct level of monitoring equipment and nurse-to-patient ratio. Some of this has come about with the increased presence of hospitalists and intensivists in-house to complement the already ever-present ED physicians.

But now there is a movement afoot to both increase the use of observation units (OUs) and to change the physician oversight. Once thought to be an extension of the ED, OUs are now part of the hospitalists’ domain as these patients are thought to be more inpatient-light rather than long-term ED patients. And this makes sense when you realize that hospitalists are better suited to managing patients over time rather than ED physicians who favor shorter term relationships; you’re either admitted or “treated and streeted.”

This is further pushed toward the hospitalists’ realm as some OUs continue to treat patients for up to 48 hours (how can you be in a hospital bed for two days and still not be an inpatient?) and helped by the hospitalist’s 24/7 availability.

Having hospitalists serve as the medical directors for the OUs also makes sense because it gets these patients “out of the ED” from a logistic standpoint and shifts the responsibility to the hospitalist, freeing up the ED physicians to better do their primary job. This is just another in a list of examples of how hospitalists can improve ED throughput.

Further, now that governmental payers require closer on-site management of patients in OUs, this makes it virtually impossible for the outpatient-based primary care physicians to have a significant role.

According to The Advisory Board, Washington, D.C., and others, diseases such as CHF readily treated by hospitalists are well-suited to management in OUs. I thought I’d use CHF as an example of how a well-constructed OU might function. Obviously, there are clear classifications and criteria for those patients who are eligible to have their heart failure managed in an OU. And recent data have shown that appropriate management of CHF in OUs can lead to a lower admission rate, better use of resources, and better outcomes.

The OU setting can deliver a more extended course of therapy than traditionally available in the ED or a physician’s office for patients who may not need an acute hospitalization, but who are decompensating. With the best outcomes, management of CHF in an OU can prevent a hospitalization, delay a revisit to the ED, and improve the quality of the patient’s life by decreasing their symptoms and allowing them more time away form the hospital setting.

Not all patients who present to the ED with worsening CHF are candidates for OU management. Some clearly must be admitted. According to the American Heart Association/American College of Cardiology Guidelines the admission criteria for managing a CHF patient in an OU are:

• Adequate systemic perfusion;
• B-type natriuretic peptide < 100pg/mL;
• CXR consistent with CHF; and
• Demonstration of hemodynamic stability as evidenced by one of the following:

  • Heart rate >50 or <130;
  • Systolic blood pressure >90 and <175; or
  • Oxygen saturation >90%.

As more physicians become aware of the benefits of OU care for these patients, there has been a >9% increase in the number of OU patients in both 2003 and 2004, according to Medicare data. And the increased use is even more dramatic for CHF patients.

As one looks at the elements to design and staff a functioning OU, it is apparent this falls clearly in the hospitalist’s capabilities. The idea is to develop more than just a place to stay longer in the ED, but to create an evidence-based, cost-effective management solution for difficult patients. Key components would include:

• Criteria for admission and exclusion based on risk stratification models;
• Protocols for treatment using evidence-based practice guidelines;
• Clear discharge process supported by patient education materials and discharge criteria; and
• Performance standards and an ongoing data collection and quality improvement process.

CHF is an expensive condition to manage, fraught with frequent episodes of decompensation and admission. This takes an economic toll on the system and results in a poorer quality of life for those patients burdened with the disease. Because many physician offices are not set up to handle patients with increasing symptoms related to CHF, the ED becomes the treatment center of last resort. Thoughtful management of those patients correctly suited to OU care can lead to more directed treatment and avoid hospitalizations that are expensive to the system and unnecessary for the patient.

All data point to an increased prevalence of OUs as more hospitals develop them and more patients are treated in OUs. In addition, professional societies are establishing guidelines and criteria for the appropriate use of OUs for certain ED patients. At the same time, management of patients in the OUs and for the OU itself is evolving to the hospitalist, who is the expert in longitudinal management of the hospitalized (and near hospitalized) patient.

Once again the hospitalist is at the center of new initiatives that are a win-win-win. OUs can minimize the patient’s time away from home, improve their functional capacity, relieve congestion in the ED, allow the ED physicians to concentrate on true ED patients, uncrowd the hospital and the ED and improve throughput, and save the system money. And hospitalists with a plan can make this happen.

Not bad for a specialty that is still the new kid on the block. TH

Dr. Wellikson has been CEO of SHM since 2000.

It is clear to most of us in hospital medicine that the lines are rapidly blurring between the ED, and the floor, and the ICUs. Some of this has been brought about by the transitional units and the ability to place the patient in the most appropriate area with the correct level of monitoring equipment and nurse-to-patient ratio. Some of this has come about with the increased presence of hospitalists and intensivists in-house to complement the already ever-present ED physicians.

But now there is a movement afoot to both increase the use of observation units (OUs) and to change the physician oversight. Once thought to be an extension of the ED, OUs are now part of the hospitalists’ domain as these patients are thought to be more inpatient-light rather than long-term ED patients. And this makes sense when you realize that hospitalists are better suited to managing patients over time rather than ED physicians who favor shorter term relationships; you’re either admitted or “treated and streeted.”

This is further pushed toward the hospitalists’ realm as some OUs continue to treat patients for up to 48 hours (how can you be in a hospital bed for two days and still not be an inpatient?) and helped by the hospitalist’s 24/7 availability.

Having hospitalists serve as the medical directors for the OUs also makes sense because it gets these patients “out of the ED” from a logistic standpoint and shifts the responsibility to the hospitalist, freeing up the ED physicians to better do their primary job. This is just another in a list of examples of how hospitalists can improve ED throughput.

Further, now that governmental payers require closer on-site management of patients in OUs, this makes it virtually impossible for the outpatient-based primary care physicians to have a significant role.

According to The Advisory Board, Washington, D.C., and others, diseases such as CHF readily treated by hospitalists are well-suited to management in OUs. I thought I’d use CHF as an example of how a well-constructed OU might function. Obviously, there are clear classifications and criteria for those patients who are eligible to have their heart failure managed in an OU. And recent data have shown that appropriate management of CHF in OUs can lead to a lower admission rate, better use of resources, and better outcomes.

The OU setting can deliver a more extended course of therapy than traditionally available in the ED or a physician’s office for patients who may not need an acute hospitalization, but who are decompensating. With the best outcomes, management of CHF in an OU can prevent a hospitalization, delay a revisit to the ED, and improve the quality of the patient’s life by decreasing their symptoms and allowing them more time away form the hospital setting.

Not all patients who present to the ED with worsening CHF are candidates for OU management. Some clearly must be admitted. According to the American Heart Association/American College of Cardiology Guidelines the admission criteria for managing a CHF patient in an OU are:

• Adequate systemic perfusion;
• B-type natriuretic peptide < 100pg/mL;
• CXR consistent with CHF; and
• Demonstration of hemodynamic stability as evidenced by one of the following:

  • Heart rate >50 or <130;
  • Systolic blood pressure >90 and <175; or
  • Oxygen saturation >90%.

As more physicians become aware of the benefits of OU care for these patients, there has been a >9% increase in the number of OU patients in both 2003 and 2004, according to Medicare data. And the increased use is even more dramatic for CHF patients.

As one looks at the elements to design and staff a functioning OU, it is apparent this falls clearly in the hospitalist’s capabilities. The idea is to develop more than just a place to stay longer in the ED, but to create an evidence-based, cost-effective management solution for difficult patients. Key components would include:

• Criteria for admission and exclusion based on risk stratification models;
• Protocols for treatment using evidence-based practice guidelines;
• Clear discharge process supported by patient education materials and discharge criteria; and
• Performance standards and an ongoing data collection and quality improvement process.

CHF is an expensive condition to manage, fraught with frequent episodes of decompensation and admission. This takes an economic toll on the system and results in a poorer quality of life for those patients burdened with the disease. Because many physician offices are not set up to handle patients with increasing symptoms related to CHF, the ED becomes the treatment center of last resort. Thoughtful management of those patients correctly suited to OU care can lead to more directed treatment and avoid hospitalizations that are expensive to the system and unnecessary for the patient.

All data point to an increased prevalence of OUs as more hospitals develop them and more patients are treated in OUs. In addition, professional societies are establishing guidelines and criteria for the appropriate use of OUs for certain ED patients. At the same time, management of patients in the OUs and for the OU itself is evolving to the hospitalist, who is the expert in longitudinal management of the hospitalized (and near hospitalized) patient.

Once again the hospitalist is at the center of new initiatives that are a win-win-win. OUs can minimize the patient’s time away from home, improve their functional capacity, relieve congestion in the ED, allow the ED physicians to concentrate on true ED patients, uncrowd the hospital and the ED and improve throughput, and save the system money. And hospitalists with a plan can make this happen.

Not bad for a specialty that is still the new kid on the block. TH

Dr. Wellikson has been CEO of SHM since 2000.

It is clear to most of us in hospital medicine that the lines are rapidly blurring between the ED, and the floor, and the ICUs. Some of this has been brought about by the transitional units and the ability to place the patient in the most appropriate area with the correct level of monitoring equipment and nurse-to-patient ratio. Some of this has come about with the increased presence of hospitalists and intensivists in-house to complement the already ever-present ED physicians.

But now there is a movement afoot to both increase the use of observation units (OUs) and to change the physician oversight. Once thought to be an extension of the ED, OUs are now part of the hospitalists’ domain as these patients are thought to be more inpatient-light rather than long-term ED patients. And this makes sense when you realize that hospitalists are better suited to managing patients over time rather than ED physicians who favor shorter term relationships; you’re either admitted or “treated and streeted.”

This is further pushed toward the hospitalists’ realm as some OUs continue to treat patients for up to 48 hours (how can you be in a hospital bed for two days and still not be an inpatient?) and helped by the hospitalist’s 24/7 availability.

Having hospitalists serve as the medical directors for the OUs also makes sense because it gets these patients “out of the ED” from a logistic standpoint and shifts the responsibility to the hospitalist, freeing up the ED physicians to better do their primary job. This is just another in a list of examples of how hospitalists can improve ED throughput.

Further, now that governmental payers require closer on-site management of patients in OUs, this makes it virtually impossible for the outpatient-based primary care physicians to have a significant role.

According to The Advisory Board, Washington, D.C., and others, diseases such as CHF readily treated by hospitalists are well-suited to management in OUs. I thought I’d use CHF as an example of how a well-constructed OU might function. Obviously, there are clear classifications and criteria for those patients who are eligible to have their heart failure managed in an OU. And recent data have shown that appropriate management of CHF in OUs can lead to a lower admission rate, better use of resources, and better outcomes.

The OU setting can deliver a more extended course of therapy than traditionally available in the ED or a physician’s office for patients who may not need an acute hospitalization, but who are decompensating. With the best outcomes, management of CHF in an OU can prevent a hospitalization, delay a revisit to the ED, and improve the quality of the patient’s life by decreasing their symptoms and allowing them more time away form the hospital setting.

Not all patients who present to the ED with worsening CHF are candidates for OU management. Some clearly must be admitted. According to the American Heart Association/American College of Cardiology Guidelines the admission criteria for managing a CHF patient in an OU are:

• Adequate systemic perfusion;
• B-type natriuretic peptide < 100pg/mL;
• CXR consistent with CHF; and
• Demonstration of hemodynamic stability as evidenced by one of the following:

  • Heart rate >50 or <130;
  • Systolic blood pressure >90 and <175; or
  • Oxygen saturation >90%.

As more physicians become aware of the benefits of OU care for these patients, there has been a >9% increase in the number of OU patients in both 2003 and 2004, according to Medicare data. And the increased use is even more dramatic for CHF patients.

As one looks at the elements to design and staff a functioning OU, it is apparent this falls clearly in the hospitalist’s capabilities. The idea is to develop more than just a place to stay longer in the ED, but to create an evidence-based, cost-effective management solution for difficult patients. Key components would include:

• Criteria for admission and exclusion based on risk stratification models;
• Protocols for treatment using evidence-based practice guidelines;
• Clear discharge process supported by patient education materials and discharge criteria; and
• Performance standards and an ongoing data collection and quality improvement process.

CHF is an expensive condition to manage, fraught with frequent episodes of decompensation and admission. This takes an economic toll on the system and results in a poorer quality of life for those patients burdened with the disease. Because many physician offices are not set up to handle patients with increasing symptoms related to CHF, the ED becomes the treatment center of last resort. Thoughtful management of those patients correctly suited to OU care can lead to more directed treatment and avoid hospitalizations that are expensive to the system and unnecessary for the patient.

All data point to an increased prevalence of OUs as more hospitals develop them and more patients are treated in OUs. In addition, professional societies are establishing guidelines and criteria for the appropriate use of OUs for certain ED patients. At the same time, management of patients in the OUs and for the OU itself is evolving to the hospitalist, who is the expert in longitudinal management of the hospitalized (and near hospitalized) patient.

Once again the hospitalist is at the center of new initiatives that are a win-win-win. OUs can minimize the patient’s time away from home, improve their functional capacity, relieve congestion in the ED, allow the ED physicians to concentrate on true ED patients, uncrowd the hospital and the ED and improve throughput, and save the system money. And hospitalists with a plan can make this happen.

Not bad for a specialty that is still the new kid on the block. TH

Dr. Wellikson has been CEO of SHM since 2000.

Hospital medicine has arrived at just the right moment for a healthcare delivery system in need of change. Medical errors and cost escalation continue to dominate the headlines. With regard to quality the National Quality Foundation is attempting to define standards and health plans are creating incentives through Pay for Performance programs. With regard to costs, there are expectations that they will rise even higher as the baby boomer population ages.

Providing high-quality, cost-effective care to acutely ill patients in the hospital is becoming more complex. It requires physicians who can focus on inpatient care, allowing primary care physicians, surgeons, and subspecialists to concentrate on what they do best. Providing the best care available to the hospitalized patients can no longer be done by one health professional acting alone, no matter how wise and well meaning. Hospitalists have dedicated their professional careers to providing team-based, patient-centered care that achieves cost-effective, quality outcomes.

As the specialty society for hospital medicine, SHM provides a vehicle to define this new specialty. We are doing this with our surveys of hospitalist productivity and compensation, by articles that appear in the medical and lay press, and by the Core Curriculum for Hospital Medicine that will be published in the coming months.

Hospitalists provide significant value to their healthcare communities and to patients, physicians, other health professionals, and administrators well beyond the benefits of direct patient care. This supplement to The Hospitalist, the official publication of SHM, is a compendium of papers designed to further define the full range of benefits provided by the specialty of hospital medicine.

Physician Methods of Payment Outdated

As the American healthcare system is reshaped, we must recognize that part of the problem is the outdated way in which we pay for medical services. Physicians are rewarded as piece workers by the unit of the visit or the procedure. This has led to a culture of doing more things for one individual patient rather than attempting to make the hospital work better for all patients. In addition, this unit-based payment does not reward efficiency or effectiveness.

Hospitalists are, in many ways, change agents in the inpatient environment. Hospitalists can spend as much as 50% of their professional time improving the entire enterprise by taking on the responsibilities of other physicians, developing plans to improve quality educating hospital staff or medical trainees, addressing efficiencies through earlier discharge or improved throughput in the ED or ICU, creating teams of health professionals, or being available around the clock.

The diverse work that hospitalizes perform is very important and time consuming. However, the traditional payment scheme for physicians does not provide a direct way to compensate the hospitalist for this skill and expertise.

Hospitals have realized that these hospitalist skills bring real value to their health communities. And hospitals have been willing to invest their own funds to grow and support their hospital medicine groups to the tune of $75,000 or more per hospitalist per year. This is not a hand-out or a subsidy. This is true commerce. Hospitals continue to get significant benefits from their hospitalists.

In fact, when confronted with the choice of whether to ask the hospitalists to ''just see patients'' to generate more direct patient fees or to continue to improve the effectiveness and efficiency of their health communities, enlightened hospital executives vote with their money and ask the hospitalists to improve quality, build teams, reduce LOS, improve throughput, educate their staff, and generally build the hospital of the future.

With regard to paying physicians, SHM believes that the Pay for Performance movement is an important step in the right direction. Hospitalists welcome a reimbursement scheme that rewards institutions that follow best practices and achieve superior outcomes.

Audiences for this Supplement

This supplement, How Hospitalists Add Value, has two major audiences. First, hospitalists need to categorize what they can and will do for their hospitals and healthcare communities. They need to understand that this is not voluntary work to be done in their spare time. The provision of these services provides strategic and market benefits to their hospital.

Second, there are hospital administrators and leaders at 1,500 hospitals who have been crucial to growing hospital medicine to more than 12,000 hospitalists. They recognize that hospitalists are core to their future. This supplement will further confirm and document the ways in which hospitalists can help their organizations. The facts put forth in these papers can create a rationale for continued support with dollars and manpower, not as a subsidy but as an intelligent investment for the hospital.

Hospitalists Add Value

• Hospitalists can provide measurable quality improvement through setting standards and compliance.
• Hospitalists can save money and resources by reducing LOS and achieving better utilization.
• Hospitalists can improve the efficiency of the hospital by early discharge, better throughput in the ED, and the opening up of ICU beds.
• Hospitalists can create a seamless continuity from inpatient to outpatient care, from the ED to the floor, and from the ICU to the floor.
• Hospitalists can make other physicians' lives better and help hospitals to recruit and retain PCPs, surgeons, and specialists.
• Hospitalists can do things other physicians have given up by admitting patients without health insurance or by serving on hospital committees.
• Hospitalists can be instrumental in creating teams of healthcare professionals that make better use of the talent at the hospital and create a better working environment for nurses and others.
• Hospitalists can have a leading role in educating nurses, other hospital staff, and physicals in training.
• And hospitalizes can take care of the acutely ill complex hospitalized patients.

Add it all up and it is clear that hospitalists are a resource to hospitals in meeting the complex challenges of their healthcare communities. Hopefully, this set of important papers will define these issues more clearly and assist hospitalists and their hospital leaders in creating a stable and supportive environment for collaboration that can lead to better healthcare for our patients.

Hospital medicine has arrived at just the right moment for a healthcare delivery system in need of change. Medical errors and cost escalation continue to dominate the headlines. With regard to quality the National Quality Foundation is attempting to define standards and health plans are creating incentives through Pay for Performance programs. With regard to costs, there are expectations that they will rise even higher as the baby boomer population ages.

Providing high-quality, cost-effective care to acutely ill patients in the hospital is becoming more complex. It requires physicians who can focus on inpatient care, allowing primary care physicians, surgeons, and subspecialists to concentrate on what they do best. Providing the best care available to the hospitalized patients can no longer be done by one health professional acting alone, no matter how wise and well meaning. Hospitalists have dedicated their professional careers to providing team-based, patient-centered care that achieves cost-effective, quality outcomes.

As the specialty society for hospital medicine, SHM provides a vehicle to define this new specialty. We are doing this with our surveys of hospitalist productivity and compensation, by articles that appear in the medical and lay press, and by the Core Curriculum for Hospital Medicine that will be published in the coming months.

Hospitalists provide significant value to their healthcare communities and to patients, physicians, other health professionals, and administrators well beyond the benefits of direct patient care. This supplement to The Hospitalist, the official publication of SHM, is a compendium of papers designed to further define the full range of benefits provided by the specialty of hospital medicine.

Physician Methods of Payment Outdated

As the American healthcare system is reshaped, we must recognize that part of the problem is the outdated way in which we pay for medical services. Physicians are rewarded as piece workers by the unit of the visit or the procedure. This has led to a culture of doing more things for one individual patient rather than attempting to make the hospital work better for all patients. In addition, this unit-based payment does not reward efficiency or effectiveness.

Hospitalists are, in many ways, change agents in the inpatient environment. Hospitalists can spend as much as 50% of their professional time improving the entire enterprise by taking on the responsibilities of other physicians, developing plans to improve quality educating hospital staff or medical trainees, addressing efficiencies through earlier discharge or improved throughput in the ED or ICU, creating teams of health professionals, or being available around the clock.

The diverse work that hospitalizes perform is very important and time consuming. However, the traditional payment scheme for physicians does not provide a direct way to compensate the hospitalist for this skill and expertise.

Hospitals have realized that these hospitalist skills bring real value to their health communities. And hospitals have been willing to invest their own funds to grow and support their hospital medicine groups to the tune of $75,000 or more per hospitalist per year. This is not a hand-out or a subsidy. This is true commerce. Hospitals continue to get significant benefits from their hospitalists.

In fact, when confronted with the choice of whether to ask the hospitalists to ''just see patients'' to generate more direct patient fees or to continue to improve the effectiveness and efficiency of their health communities, enlightened hospital executives vote with their money and ask the hospitalists to improve quality, build teams, reduce LOS, improve throughput, educate their staff, and generally build the hospital of the future.

With regard to paying physicians, SHM believes that the Pay for Performance movement is an important step in the right direction. Hospitalists welcome a reimbursement scheme that rewards institutions that follow best practices and achieve superior outcomes.

Audiences for this Supplement

This supplement, How Hospitalists Add Value, has two major audiences. First, hospitalists need to categorize what they can and will do for their hospitals and healthcare communities. They need to understand that this is not voluntary work to be done in their spare time. The provision of these services provides strategic and market benefits to their hospital.

Second, there are hospital administrators and leaders at 1,500 hospitals who have been crucial to growing hospital medicine to more than 12,000 hospitalists. They recognize that hospitalists are core to their future. This supplement will further confirm and document the ways in which hospitalists can help their organizations. The facts put forth in these papers can create a rationale for continued support with dollars and manpower, not as a subsidy but as an intelligent investment for the hospital.

Hospitalists Add Value

• Hospitalists can provide measurable quality improvement through setting standards and compliance.
• Hospitalists can save money and resources by reducing LOS and achieving better utilization.
• Hospitalists can improve the efficiency of the hospital by early discharge, better throughput in the ED, and the opening up of ICU beds.
• Hospitalists can create a seamless continuity from inpatient to outpatient care, from the ED to the floor, and from the ICU to the floor.
• Hospitalists can make other physicians' lives better and help hospitals to recruit and retain PCPs, surgeons, and specialists.
• Hospitalists can do things other physicians have given up by admitting patients without health insurance or by serving on hospital committees.
• Hospitalists can be instrumental in creating teams of healthcare professionals that make better use of the talent at the hospital and create a better working environment for nurses and others.
• Hospitalists can have a leading role in educating nurses, other hospital staff, and physicals in training.
• And hospitalizes can take care of the acutely ill complex hospitalized patients.

Add it all up and it is clear that hospitalists are a resource to hospitals in meeting the complex challenges of their healthcare communities. Hopefully, this set of important papers will define these issues more clearly and assist hospitalists and their hospital leaders in creating a stable and supportive environment for collaboration that can lead to better healthcare for our patients.

Hospital medicine has arrived at just the right moment for a healthcare delivery system in need of change. Medical errors and cost escalation continue to dominate the headlines. With regard to quality the National Quality Foundation is attempting to define standards and health plans are creating incentives through Pay for Performance programs. With regard to costs, there are expectations that they will rise even higher as the baby boomer population ages.

Providing high-quality, cost-effective care to acutely ill patients in the hospital is becoming more complex. It requires physicians who can focus on inpatient care, allowing primary care physicians, surgeons, and subspecialists to concentrate on what they do best. Providing the best care available to the hospitalized patients can no longer be done by one health professional acting alone, no matter how wise and well meaning. Hospitalists have dedicated their professional careers to providing team-based, patient-centered care that achieves cost-effective, quality outcomes.

As the specialty society for hospital medicine, SHM provides a vehicle to define this new specialty. We are doing this with our surveys of hospitalist productivity and compensation, by articles that appear in the medical and lay press, and by the Core Curriculum for Hospital Medicine that will be published in the coming months.

Hospitalists provide significant value to their healthcare communities and to patients, physicians, other health professionals, and administrators well beyond the benefits of direct patient care. This supplement to The Hospitalist, the official publication of SHM, is a compendium of papers designed to further define the full range of benefits provided by the specialty of hospital medicine.

Physician Methods of Payment Outdated

As the American healthcare system is reshaped, we must recognize that part of the problem is the outdated way in which we pay for medical services. Physicians are rewarded as piece workers by the unit of the visit or the procedure. This has led to a culture of doing more things for one individual patient rather than attempting to make the hospital work better for all patients. In addition, this unit-based payment does not reward efficiency or effectiveness.

Hospitalists are, in many ways, change agents in the inpatient environment. Hospitalists can spend as much as 50% of their professional time improving the entire enterprise by taking on the responsibilities of other physicians, developing plans to improve quality educating hospital staff or medical trainees, addressing efficiencies through earlier discharge or improved throughput in the ED or ICU, creating teams of health professionals, or being available around the clock.

The diverse work that hospitalizes perform is very important and time consuming. However, the traditional payment scheme for physicians does not provide a direct way to compensate the hospitalist for this skill and expertise.

Hospitals have realized that these hospitalist skills bring real value to their health communities. And hospitals have been willing to invest their own funds to grow and support their hospital medicine groups to the tune of $75,000 or more per hospitalist per year. This is not a hand-out or a subsidy. This is true commerce. Hospitals continue to get significant benefits from their hospitalists.

In fact, when confronted with the choice of whether to ask the hospitalists to ''just see patients'' to generate more direct patient fees or to continue to improve the effectiveness and efficiency of their health communities, enlightened hospital executives vote with their money and ask the hospitalists to improve quality, build teams, reduce LOS, improve throughput, educate their staff, and generally build the hospital of the future.

With regard to paying physicians, SHM believes that the Pay for Performance movement is an important step in the right direction. Hospitalists welcome a reimbursement scheme that rewards institutions that follow best practices and achieve superior outcomes.

Audiences for this Supplement

This supplement, How Hospitalists Add Value, has two major audiences. First, hospitalists need to categorize what they can and will do for their hospitals and healthcare communities. They need to understand that this is not voluntary work to be done in their spare time. The provision of these services provides strategic and market benefits to their hospital.

Second, there are hospital administrators and leaders at 1,500 hospitals who have been crucial to growing hospital medicine to more than 12,000 hospitalists. They recognize that hospitalists are core to their future. This supplement will further confirm and document the ways in which hospitalists can help their organizations. The facts put forth in these papers can create a rationale for continued support with dollars and manpower, not as a subsidy but as an intelligent investment for the hospital.

Hospitalists Add Value

• Hospitalists can provide measurable quality improvement through setting standards and compliance.
• Hospitalists can save money and resources by reducing LOS and achieving better utilization.
• Hospitalists can improve the efficiency of the hospital by early discharge, better throughput in the ED, and the opening up of ICU beds.
• Hospitalists can create a seamless continuity from inpatient to outpatient care, from the ED to the floor, and from the ICU to the floor.
• Hospitalists can make other physicians' lives better and help hospitals to recruit and retain PCPs, surgeons, and specialists.
• Hospitalists can do things other physicians have given up by admitting patients without health insurance or by serving on hospital committees.
• Hospitalists can be instrumental in creating teams of healthcare professionals that make better use of the talent at the hospital and create a better working environment for nurses and others.
• Hospitalists can have a leading role in educating nurses, other hospital staff, and physicals in training.
• And hospitalizes can take care of the acutely ill complex hospitalized patients.

Add it all up and it is clear that hospitalists are a resource to hospitals in meeting the complex challenges of their healthcare communities. Hopefully, this set of important papers will define these issues more clearly and assist hospitalists and their hospital leaders in creating a stable and supportive environment for collaboration that can lead to better healthcare for our patients.

I have mentioned in previous columns and often in public speeches that hospitalists will actively create and implement the hospital of the future. This is not an idle promise but an inevitability, and SHM is working actively with other key players to make this happen.

This new era will have as its hallmark 3 essential features:

• Care will be patient-centered;
• Quality standards will be met, measured, and documented; and
• Hospital care will be delivered by empowered teams of health professionals.

If you think this is already the standard of care, you either practice in a utopian hospital that I am not aware of or your definitions are different than mine. Let me walk you through what I foresee.

Patient-Centered Care

Today’s hospitals are set up, for the most part, to accommodate the physician rather than the patient. We live in an on-demand world where the “consumers” expect to have as much information as they want and to have it when they want it. When a patient at your hospital has a test performed, does someone stop by within the hour with the results and an explanation of what the results mean to the patient? When the patient first arrives, does someone on the healthcare team sit down and ask the patient what his or her expectations are for this hospitalization (e.g., cure, diagnosis, pain relief, a good death)? Does the patient have immediate access to caregivers (e.g., cell phone or pager numbers) and has he or she been genuinely told to “call me if I can help”? Do patients even know when their doctor will be back to see them?

Do their doctors talk to them in terms meant for the patient and not for grand rounds? Do they use words like “blood clot” rather than “deep vein thrombosis”? Do they understand that health literacy is a major problem for many of our patients?

If patients have a hospitalist as their care manager and if this hospitalist works in a state-of-the-art hospital medicine group, then maybe this is already happening. But hospitalists will need to make this happen, if this is ever to be a universal focus of our hospital care.

Quality Is Job 1

For the 30 years I have been a physician we have “talked” about quality. Any quality we have in our system is largely a function of the altruism and hard work of the healthcare professionals and advances in science. It certainly is not baked into the culture, the data collection, or the compensation structure. Today doctors are paid for doing more, not for doing better. In fact, there is almost no incentive for even knowing how good a job you do. Has anyone ever been denied payment or denied the ability to manage diabetes because they have never checked a glycohemoglobin?

This will change, and hospitalists need to be at the center of this revolution. There are forces amassing that may nudge this movement forward. Leapfrog and other forces in the business community are demanding that something happen, and soon. The National Quality Forum (NQF) is trying to set and enforce standards. There are rumblings of pay for performance (P4P), although I think this will translate more into paying less for poor performance. JCAHO, IHI, AHRQ, and so many others have projects centered around patient safety and quality improvement that just from sheer effort alone things will change.

At the same time, patients seem to have noticed all this commotion and wonder why all of a sudden there are so many concerns about both the safety of their hospital and the quality they receive in it. This is definitely on the radar screen.

Hospitalists will be both the measured and the measurers. We will need to work with others to decide what data will help tell us how well we are doing, what changes in the systems need to be installed to improve quality, and how to harness all the resources available to be better tomorrow than we are today.

True Teamwork

And this leads me to the third leg of this triad. Hospitalists and other physicians can’t do this alone, and we can’t do this under the old model where the doctor has the steering wheel and everyone else waits to see where the ship is going. This may evolve into more of an orchestra, where the physician is the conductor and others are the virtuoso musicians.

Current legal limitations aside, we markedly underutilize the perspective and expertise of nurses, pharmacists, social workers, therapists, and case managers. These other team members often know important information about our patients and about the hospital and available resources. If we had a seamless way to incorporate this knowledge base, patients would get better care, the entire team would feel empowered, and job satisfaction would improve for everyone.

Critical-Care Collaborative

For the past year, senior leaders from SHM have met with senior leaders from the American College of Chest Physicians (ACCP), the American Association of Critical Care Nurses (AACN), the American Society of Health System Pharmacists (ASHP), and representatives of respiratory therapy to examine our current management of acutely ill patients in the hospital and to develop plans to move to a new health system that is patient centered and team driven. AACN has started giving out Beacon Awards to hospital units that demonstrate these values. SHM will partner with ASHP in 2005 on joint research of teams of hospitalists and pharmacists. The Collaborative will look at any examples of collaborative efforts that are in place and working today.

Those of you who think this is pie in the sky should look back at some history. About 15 to 20 years ago, about 10 physicians got together and decided to make California smoke free. Our goal was to remove cigarettes from restaurants, businesses, and the work place by 2000. The doubters said we were up against a multibillion dollar industry and trying to outlaw an addictive substance. Today about the only public place you can still smoke a cigarette in California is out in front of a hospital.

Grand goals can happen when motivated people are willing to make them a priority. Making the patient the focus of health care, creating an environment where teams can flourish, and raising expectations for delivering a quality experience in every hospital will happen in my lifetime. And hospitalists (along with other key stakeholders) will be at the center of this effort. This is the right commitment at the right time. SHM will do our share, and we hope each of you will make this one of your core professional values.

I have mentioned in previous columns and often in public speeches that hospitalists will actively create and implement the hospital of the future. This is not an idle promise but an inevitability, and SHM is working actively with other key players to make this happen.

This new era will have as its hallmark 3 essential features:

• Care will be patient-centered;
• Quality standards will be met, measured, and documented; and
• Hospital care will be delivered by empowered teams of health professionals.

If you think this is already the standard of care, you either practice in a utopian hospital that I am not aware of or your definitions are different than mine. Let me walk you through what I foresee.

Patient-Centered Care

Today’s hospitals are set up, for the most part, to accommodate the physician rather than the patient. We live in an on-demand world where the “consumers” expect to have as much information as they want and to have it when they want it. When a patient at your hospital has a test performed, does someone stop by within the hour with the results and an explanation of what the results mean to the patient? When the patient first arrives, does someone on the healthcare team sit down and ask the patient what his or her expectations are for this hospitalization (e.g., cure, diagnosis, pain relief, a good death)? Does the patient have immediate access to caregivers (e.g., cell phone or pager numbers) and has he or she been genuinely told to “call me if I can help”? Do patients even know when their doctor will be back to see them?

Do their doctors talk to them in terms meant for the patient and not for grand rounds? Do they use words like “blood clot” rather than “deep vein thrombosis”? Do they understand that health literacy is a major problem for many of our patients?

If patients have a hospitalist as their care manager and if this hospitalist works in a state-of-the-art hospital medicine group, then maybe this is already happening. But hospitalists will need to make this happen, if this is ever to be a universal focus of our hospital care.

Quality Is Job 1

For the 30 years I have been a physician we have “talked” about quality. Any quality we have in our system is largely a function of the altruism and hard work of the healthcare professionals and advances in science. It certainly is not baked into the culture, the data collection, or the compensation structure. Today doctors are paid for doing more, not for doing better. In fact, there is almost no incentive for even knowing how good a job you do. Has anyone ever been denied payment or denied the ability to manage diabetes because they have never checked a glycohemoglobin?

This will change, and hospitalists need to be at the center of this revolution. There are forces amassing that may nudge this movement forward. Leapfrog and other forces in the business community are demanding that something happen, and soon. The National Quality Forum (NQF) is trying to set and enforce standards. There are rumblings of pay for performance (P4P), although I think this will translate more into paying less for poor performance. JCAHO, IHI, AHRQ, and so many others have projects centered around patient safety and quality improvement that just from sheer effort alone things will change.

At the same time, patients seem to have noticed all this commotion and wonder why all of a sudden there are so many concerns about both the safety of their hospital and the quality they receive in it. This is definitely on the radar screen.

Hospitalists will be both the measured and the measurers. We will need to work with others to decide what data will help tell us how well we are doing, what changes in the systems need to be installed to improve quality, and how to harness all the resources available to be better tomorrow than we are today.

True Teamwork

And this leads me to the third leg of this triad. Hospitalists and other physicians can’t do this alone, and we can’t do this under the old model where the doctor has the steering wheel and everyone else waits to see where the ship is going. This may evolve into more of an orchestra, where the physician is the conductor and others are the virtuoso musicians.

Current legal limitations aside, we markedly underutilize the perspective and expertise of nurses, pharmacists, social workers, therapists, and case managers. These other team members often know important information about our patients and about the hospital and available resources. If we had a seamless way to incorporate this knowledge base, patients would get better care, the entire team would feel empowered, and job satisfaction would improve for everyone.

Critical-Care Collaborative

For the past year, senior leaders from SHM have met with senior leaders from the American College of Chest Physicians (ACCP), the American Association of Critical Care Nurses (AACN), the American Society of Health System Pharmacists (ASHP), and representatives of respiratory therapy to examine our current management of acutely ill patients in the hospital and to develop plans to move to a new health system that is patient centered and team driven. AACN has started giving out Beacon Awards to hospital units that demonstrate these values. SHM will partner with ASHP in 2005 on joint research of teams of hospitalists and pharmacists. The Collaborative will look at any examples of collaborative efforts that are in place and working today.

Those of you who think this is pie in the sky should look back at some history. About 15 to 20 years ago, about 10 physicians got together and decided to make California smoke free. Our goal was to remove cigarettes from restaurants, businesses, and the work place by 2000. The doubters said we were up against a multibillion dollar industry and trying to outlaw an addictive substance. Today about the only public place you can still smoke a cigarette in California is out in front of a hospital.

Grand goals can happen when motivated people are willing to make them a priority. Making the patient the focus of health care, creating an environment where teams can flourish, and raising expectations for delivering a quality experience in every hospital will happen in my lifetime. And hospitalists (along with other key stakeholders) will be at the center of this effort. This is the right commitment at the right time. SHM will do our share, and we hope each of you will make this one of your core professional values.

I have mentioned in previous columns and often in public speeches that hospitalists will actively create and implement the hospital of the future. This is not an idle promise but an inevitability, and SHM is working actively with other key players to make this happen.

This new era will have as its hallmark 3 essential features:

• Care will be patient-centered;
• Quality standards will be met, measured, and documented; and
• Hospital care will be delivered by empowered teams of health professionals.

If you think this is already the standard of care, you either practice in a utopian hospital that I am not aware of or your definitions are different than mine. Let me walk you through what I foresee.

Patient-Centered Care

Today’s hospitals are set up, for the most part, to accommodate the physician rather than the patient. We live in an on-demand world where the “consumers” expect to have as much information as they want and to have it when they want it. When a patient at your hospital has a test performed, does someone stop by within the hour with the results and an explanation of what the results mean to the patient? When the patient first arrives, does someone on the healthcare team sit down and ask the patient what his or her expectations are for this hospitalization (e.g., cure, diagnosis, pain relief, a good death)? Does the patient have immediate access to caregivers (e.g., cell phone or pager numbers) and has he or she been genuinely told to “call me if I can help”? Do patients even know when their doctor will be back to see them?

Do their doctors talk to them in terms meant for the patient and not for grand rounds? Do they use words like “blood clot” rather than “deep vein thrombosis”? Do they understand that health literacy is a major problem for many of our patients?

If patients have a hospitalist as their care manager and if this hospitalist works in a state-of-the-art hospital medicine group, then maybe this is already happening. But hospitalists will need to make this happen, if this is ever to be a universal focus of our hospital care.

Quality Is Job 1

For the 30 years I have been a physician we have “talked” about quality. Any quality we have in our system is largely a function of the altruism and hard work of the healthcare professionals and advances in science. It certainly is not baked into the culture, the data collection, or the compensation structure. Today doctors are paid for doing more, not for doing better. In fact, there is almost no incentive for even knowing how good a job you do. Has anyone ever been denied payment or denied the ability to manage diabetes because they have never checked a glycohemoglobin?

This will change, and hospitalists need to be at the center of this revolution. There are forces amassing that may nudge this movement forward. Leapfrog and other forces in the business community are demanding that something happen, and soon. The National Quality Forum (NQF) is trying to set and enforce standards. There are rumblings of pay for performance (P4P), although I think this will translate more into paying less for poor performance. JCAHO, IHI, AHRQ, and so many others have projects centered around patient safety and quality improvement that just from sheer effort alone things will change.

At the same time, patients seem to have noticed all this commotion and wonder why all of a sudden there are so many concerns about both the safety of their hospital and the quality they receive in it. This is definitely on the radar screen.

Hospitalists will be both the measured and the measurers. We will need to work with others to decide what data will help tell us how well we are doing, what changes in the systems need to be installed to improve quality, and how to harness all the resources available to be better tomorrow than we are today.

True Teamwork

And this leads me to the third leg of this triad. Hospitalists and other physicians can’t do this alone, and we can’t do this under the old model where the doctor has the steering wheel and everyone else waits to see where the ship is going. This may evolve into more of an orchestra, where the physician is the conductor and others are the virtuoso musicians.

Current legal limitations aside, we markedly underutilize the perspective and expertise of nurses, pharmacists, social workers, therapists, and case managers. These other team members often know important information about our patients and about the hospital and available resources. If we had a seamless way to incorporate this knowledge base, patients would get better care, the entire team would feel empowered, and job satisfaction would improve for everyone.

Critical-Care Collaborative

For the past year, senior leaders from SHM have met with senior leaders from the American College of Chest Physicians (ACCP), the American Association of Critical Care Nurses (AACN), the American Society of Health System Pharmacists (ASHP), and representatives of respiratory therapy to examine our current management of acutely ill patients in the hospital and to develop plans to move to a new health system that is patient centered and team driven. AACN has started giving out Beacon Awards to hospital units that demonstrate these values. SHM will partner with ASHP in 2005 on joint research of teams of hospitalists and pharmacists. The Collaborative will look at any examples of collaborative efforts that are in place and working today.

Those of you who think this is pie in the sky should look back at some history. About 15 to 20 years ago, about 10 physicians got together and decided to make California smoke free. Our goal was to remove cigarettes from restaurants, businesses, and the work place by 2000. The doubters said we were up against a multibillion dollar industry and trying to outlaw an addictive substance. Today about the only public place you can still smoke a cigarette in California is out in front of a hospital.

Grand goals can happen when motivated people are willing to make them a priority. Making the patient the focus of health care, creating an environment where teams can flourish, and raising expectations for delivering a quality experience in every hospital will happen in my lifetime. And hospitalists (along with other key stakeholders) will be at the center of this effort. This is the right commitment at the right time. SHM will do our share, and we hope each of you will make this one of your core professional values.

The bomb. The franchise. Sine qua non. Must see. Must be there. How do you say it when something or someone just seems to be in the middle of everything? That is hospital medicine, and that is SHM.

Nowhere was this more evident than at the largest gathering of hospitalists to date, the SHM Annual Meeting held in Chicago at the end of April. If you have a stake in hospital medicine or in building and improving the hospital of the future, all roads led to Chicago and SHM.

Not only was the CME content cutting edge and geared specifically for hospitalists, but also the sessions were greeted with standing room attendance. Clearly we struck a nerve with our 1-day in-depth pre-courses on Perioperative Care and Critical Care. The Practice Management course continues to attract 250 to 300 people as everyone tries to figure out how to get the most out of their hospital medicine group.

SHM virtually took over the entire Sheraton Hotel in downtown Chicago. Everywhere you looked, all you saw were hospitalists or people who needed to talk to hospitalists. The exhibit hall was sold out, and the networking between all the industries that support and depend on hospitalists continued well beyond the boundaries of the exhibit hall.

The Research Abstract, Clinical Vignette, and Innovation Poster session had almost 200 entries. On display here was the new thinking that is so characteristic of hospital medicine. As much as anything, this gathering displayed the youthful energy and innovation that will continue to propel hospital medicine into the future.

Important people came to be heard and to hear from hospitalists. Dennis O’Leary, the CEO of JCAHO, challenged hospitalists to lead their hospitals into a future with improved measurable quality. Rick Wade, a senior leader at the American Hospital Association, saw hospitalists as key partners with other stakeholders to meet the increasing demands on hospitals to do a better job. Arnie Milstein, the CMO and one of the founders of the Leapfrog Group, placed hospitalists squarely in the center of delivering the effective and efficient health care now demanded by America’s businesses and patients. And our own Bob Wachter challenged hospitalists to continue to lead the patient safety revolution.

But hospitalists did not just come to Chicago to sit and listen. Hospitalists are faced with so many new and difficult challenges that they clearly came to ask questions and give answers. Networking was both informal and formal and almost constant. With hospitalists everywhere you turned it was clear that people were out seeking the next new idea, the solution to a real life problem back home, and maybe even their next job.

The SHM Special Interest Forums were lively and well attended. This is where SHM gets its ideas. This is where hospitalists have their voices heard. This is where the diversity of hospital medicine can be seen up close and personal. The world of the hospital and our specialty looks different if you are a pediatrician or a family practitioner or a woman or an NP or a PA or a group leader or a young hospitalist. The demands, and your needs to meet them, can be different if you are in academics or a community hospital. SHM must hear your perspective and, boy, did we hear from you in Chicago.

For me personally, it was an opportunity to see and talk to over 1000 people connected in some way to the growing hospital medicine movement. Many of the people I spoke with were frontline hospitalists, earnest and dedicated to making hospital medicine their life’s work. They want to work with SHM to create a specialty and a career that is satisfying and fulfilling.

Some were representatives from publishers or pharmaceutical companies or hospitalist staffing and recruitment companies trying to bring their unique take on hospital medicine to SHM’s attention. Some were key leaders of other national healthcare organizations looking to partner with hospital medicine, the fastest growing workforce component of the hospital of the future and a force for change and improvement.

There were so many good ideas flying around that there is enough to keep SHM busy for years to come. And you will be hearing and reading about these in the coming months and years. It is clear that the energy around hospital medicine is not waning any time in the near future. There will be much for us to do. And if the talent and the drive to succeed of those who came to Chicago last month are any indication, SHM and our nation’s hospitalists are up to the challenge. Stay tuned.

The bomb. The franchise. Sine qua non. Must see. Must be there. How do you say it when something or someone just seems to be in the middle of everything? That is hospital medicine, and that is SHM.

Nowhere was this more evident than at the largest gathering of hospitalists to date, the SHM Annual Meeting held in Chicago at the end of April. If you have a stake in hospital medicine or in building and improving the hospital of the future, all roads led to Chicago and SHM.

Not only was the CME content cutting edge and geared specifically for hospitalists, but also the sessions were greeted with standing room attendance. Clearly we struck a nerve with our 1-day in-depth pre-courses on Perioperative Care and Critical Care. The Practice Management course continues to attract 250 to 300 people as everyone tries to figure out how to get the most out of their hospital medicine group.

SHM virtually took over the entire Sheraton Hotel in downtown Chicago. Everywhere you looked, all you saw were hospitalists or people who needed to talk to hospitalists. The exhibit hall was sold out, and the networking between all the industries that support and depend on hospitalists continued well beyond the boundaries of the exhibit hall.

The Research Abstract, Clinical Vignette, and Innovation Poster session had almost 200 entries. On display here was the new thinking that is so characteristic of hospital medicine. As much as anything, this gathering displayed the youthful energy and innovation that will continue to propel hospital medicine into the future.

Important people came to be heard and to hear from hospitalists. Dennis O’Leary, the CEO of JCAHO, challenged hospitalists to lead their hospitals into a future with improved measurable quality. Rick Wade, a senior leader at the American Hospital Association, saw hospitalists as key partners with other stakeholders to meet the increasing demands on hospitals to do a better job. Arnie Milstein, the CMO and one of the founders of the Leapfrog Group, placed hospitalists squarely in the center of delivering the effective and efficient health care now demanded by America’s businesses and patients. And our own Bob Wachter challenged hospitalists to continue to lead the patient safety revolution.

But hospitalists did not just come to Chicago to sit and listen. Hospitalists are faced with so many new and difficult challenges that they clearly came to ask questions and give answers. Networking was both informal and formal and almost constant. With hospitalists everywhere you turned it was clear that people were out seeking the next new idea, the solution to a real life problem back home, and maybe even their next job.

The SHM Special Interest Forums were lively and well attended. This is where SHM gets its ideas. This is where hospitalists have their voices heard. This is where the diversity of hospital medicine can be seen up close and personal. The world of the hospital and our specialty looks different if you are a pediatrician or a family practitioner or a woman or an NP or a PA or a group leader or a young hospitalist. The demands, and your needs to meet them, can be different if you are in academics or a community hospital. SHM must hear your perspective and, boy, did we hear from you in Chicago.

For me personally, it was an opportunity to see and talk to over 1000 people connected in some way to the growing hospital medicine movement. Many of the people I spoke with were frontline hospitalists, earnest and dedicated to making hospital medicine their life’s work. They want to work with SHM to create a specialty and a career that is satisfying and fulfilling.

Some were representatives from publishers or pharmaceutical companies or hospitalist staffing and recruitment companies trying to bring their unique take on hospital medicine to SHM’s attention. Some were key leaders of other national healthcare organizations looking to partner with hospital medicine, the fastest growing workforce component of the hospital of the future and a force for change and improvement.

There were so many good ideas flying around that there is enough to keep SHM busy for years to come. And you will be hearing and reading about these in the coming months and years. It is clear that the energy around hospital medicine is not waning any time in the near future. There will be much for us to do. And if the talent and the drive to succeed of those who came to Chicago last month are any indication, SHM and our nation’s hospitalists are up to the challenge. Stay tuned.

The bomb. The franchise. Sine qua non. Must see. Must be there. How do you say it when something or someone just seems to be in the middle of everything? That is hospital medicine, and that is SHM.

Nowhere was this more evident than at the largest gathering of hospitalists to date, the SHM Annual Meeting held in Chicago at the end of April. If you have a stake in hospital medicine or in building and improving the hospital of the future, all roads led to Chicago and SHM.

Not only was the CME content cutting edge and geared specifically for hospitalists, but also the sessions were greeted with standing room attendance. Clearly we struck a nerve with our 1-day in-depth pre-courses on Perioperative Care and Critical Care. The Practice Management course continues to attract 250 to 300 people as everyone tries to figure out how to get the most out of their hospital medicine group.

SHM virtually took over the entire Sheraton Hotel in downtown Chicago. Everywhere you looked, all you saw were hospitalists or people who needed to talk to hospitalists. The exhibit hall was sold out, and the networking between all the industries that support and depend on hospitalists continued well beyond the boundaries of the exhibit hall.

The Research Abstract, Clinical Vignette, and Innovation Poster session had almost 200 entries. On display here was the new thinking that is so characteristic of hospital medicine. As much as anything, this gathering displayed the youthful energy and innovation that will continue to propel hospital medicine into the future.

Important people came to be heard and to hear from hospitalists. Dennis O’Leary, the CEO of JCAHO, challenged hospitalists to lead their hospitals into a future with improved measurable quality. Rick Wade, a senior leader at the American Hospital Association, saw hospitalists as key partners with other stakeholders to meet the increasing demands on hospitals to do a better job. Arnie Milstein, the CMO and one of the founders of the Leapfrog Group, placed hospitalists squarely in the center of delivering the effective and efficient health care now demanded by America’s businesses and patients. And our own Bob Wachter challenged hospitalists to continue to lead the patient safety revolution.

But hospitalists did not just come to Chicago to sit and listen. Hospitalists are faced with so many new and difficult challenges that they clearly came to ask questions and give answers. Networking was both informal and formal and almost constant. With hospitalists everywhere you turned it was clear that people were out seeking the next new idea, the solution to a real life problem back home, and maybe even their next job.

The SHM Special Interest Forums were lively and well attended. This is where SHM gets its ideas. This is where hospitalists have their voices heard. This is where the diversity of hospital medicine can be seen up close and personal. The world of the hospital and our specialty looks different if you are a pediatrician or a family practitioner or a woman or an NP or a PA or a group leader or a young hospitalist. The demands, and your needs to meet them, can be different if you are in academics or a community hospital. SHM must hear your perspective and, boy, did we hear from you in Chicago.

For me personally, it was an opportunity to see and talk to over 1000 people connected in some way to the growing hospital medicine movement. Many of the people I spoke with were frontline hospitalists, earnest and dedicated to making hospital medicine their life’s work. They want to work with SHM to create a specialty and a career that is satisfying and fulfilling.

Some were representatives from publishers or pharmaceutical companies or hospitalist staffing and recruitment companies trying to bring their unique take on hospital medicine to SHM’s attention. Some were key leaders of other national healthcare organizations looking to partner with hospital medicine, the fastest growing workforce component of the hospital of the future and a force for change and improvement.

There were so many good ideas flying around that there is enough to keep SHM busy for years to come. And you will be hearing and reading about these in the coming months and years. It is clear that the energy around hospital medicine is not waning any time in the near future. There will be much for us to do. And if the talent and the drive to succeed of those who came to Chicago last month are any indication, SHM and our nation’s hospitalists are up to the challenge. Stay tuned.

The vision of a re-engineered hospital with patient-centered care, delivered by a fully empowered team of professionals, which is data driven with clear quality measurements, where better performance is rewarded by better compensation is coming to a hospital near you during your professional career. And SHM and hospitalists are at the center of this revolution in the care of the acutely ill patient.

Hospitals are complex organizations with many moving parts and many unique constituencies often with different and, at times, competing definitions of success. What is clear is that even though many people have been talking about rewarding quality or making the hospital work for the patient, the current system is primarily physician centered and driven by increasing units of activity rather than how well a job is done. If we had the ideal system the patient would be able to demand that the physician appear when he wanted him to and we would be paying more for the best quality of care.

In order to change this complex system many institutions will need to be overhauled. The physical plant of the hospital may need to change from the noisy centralized nurses’ station where the health professionals congregate to a place designed to have data and nurses and doctors at the bedside. This would be the first concrete step to get the important members of the team (physicians, nurses, pharmacists, therapists) closer to the patient and closer to each other. The next step is to figure out how best to use everyone’s knowledge and perspective of the patient to provide more efficient and more effective care. SHM is working with Robert Wood Johnson Foundation and others on this initiative.

We will need to shift the data we collect from being mostly about getting paid to more about measuring how good a job we are doing. And while we are at it, it would be good if we could agree on what should be measured and if we could create a constant format so we can compare performance between institutions and groups. It would also be nice if physicians would agree to even be measured, and even better if physicians would be active participants in validating and responding to the data.

Then we would need to get the payers, the businesses and the insurers, and the government to care enough about quality to put their money where their measurements are and start paying for better performance rather than for more units of service (e.g., more visits, procedures, or surgeries, no matter the indications or the outcomes).

Before you start thinking this is the raving of someone who wants manna from heaven, let me point out what is happening right now in 2005.

SHM has partnered with the Critical Care Institute of the American College of Chest Physicians (ACCP), the American Association of Critical Care Nurses (AACCN), the American Society of Health System Pharmacists (ASHP), and others to form a Critical Care Collaborative. Together these organizations represent over 100,000 healthcare professionals and through their leadership will work towards designing a more patient-focused approach that relies on communication and cooperation from the entire team responsible for delivering patient care. The goal will be to design and test models of care, as well as to increase recognition and awareness of existing models by tapping into the resources of the participating organizations. Efforts will be directed at all elements of the system including the point of care, support systems (IT), administration, payers, and regulatory bodies.

SHM is also actively participating in quality and team-based initiatives with the endocrine societies and the cardiology communities. This will lead to a new way of managing care in diabetes, heart failure, coronary artery disease, and deep vein thrombosis and pulmonary embolism.

On a national level President Bush has appointed David Brailler as the “health IT czar” with the charge to expand and integrate the information capabilities in health care. This coupled with the work being done at the National Quality Forum by Ken Kizer and others will lead to practical front line applications of standards of care and the ability to measure our performance in the reality of today’s hospital.

And even the payers are getting into the mix. The new buzz words are “pay for performance” and it is all the rage. CMS and others are well into beta test programs to see just how this would play out. Peer pressure and restriction of privileges have been the only concrete drivers to improve quality in the past. The prospect that demonstrable, measurable better care will translate into more compensation or greater market share is being tested in today’s hospital.

This is not a pipe dream or a Ralph Waldo Emerson essay. These initiatives are being driven by capable action oriented leaders who have a history of making change happen. And hospitalists, who for the most part are in the beginning of a 20 to 30-year professional career, are primed to play significant roles in this changing dynamic.

In the most basic way, today’s 12,000 hospitalists and the next 20,000 who will join us in the coming years must be much more than just willing participants to make this fly. Sure hospitalists will be the effector arm of health system change in their hospitals, but hospitalists must have

the skills and the vision to help shape this better day in health care. Hospitalists need to embrace the patient-centered, performance-driven acute care system. Hospitalists need to demand care delivered by teams and have the leadership skills to help these teams manage and lead change.

This wasn’t taught in medical school or residency, but that doesn’t matter. Hospital medicine as a new specialty has arrived coincident to (or by design at) a special moment in health care. Our patients have expectations of excellent care. There are plenty of resources available to do the best job. We just aren’t organized to be the best that we can be. But this will all be sorted out in the coming years. It is an exciting time to be a health professional, and hospitalists are at the center. And SHM has the vision and will have the programs to help our hospitalists be an important part in creating this new era of health care.

The vision of a re-engineered hospital with patient-centered care, delivered by a fully empowered team of professionals, which is data driven with clear quality measurements, where better performance is rewarded by better compensation is coming to a hospital near you during your professional career. And SHM and hospitalists are at the center of this revolution in the care of the acutely ill patient.

Hospitals are complex organizations with many moving parts and many unique constituencies often with different and, at times, competing definitions of success. What is clear is that even though many people have been talking about rewarding quality or making the hospital work for the patient, the current system is primarily physician centered and driven by increasing units of activity rather than how well a job is done. If we had the ideal system the patient would be able to demand that the physician appear when he wanted him to and we would be paying more for the best quality of care.

In order to change this complex system many institutions will need to be overhauled. The physical plant of the hospital may need to change from the noisy centralized nurses’ station where the health professionals congregate to a place designed to have data and nurses and doctors at the bedside. This would be the first concrete step to get the important members of the team (physicians, nurses, pharmacists, therapists) closer to the patient and closer to each other. The next step is to figure out how best to use everyone’s knowledge and perspective of the patient to provide more efficient and more effective care. SHM is working with Robert Wood Johnson Foundation and others on this initiative.

We will need to shift the data we collect from being mostly about getting paid to more about measuring how good a job we are doing. And while we are at it, it would be good if we could agree on what should be measured and if we could create a constant format so we can compare performance between institutions and groups. It would also be nice if physicians would agree to even be measured, and even better if physicians would be active participants in validating and responding to the data.

Then we would need to get the payers, the businesses and the insurers, and the government to care enough about quality to put their money where their measurements are and start paying for better performance rather than for more units of service (e.g., more visits, procedures, or surgeries, no matter the indications or the outcomes).

Before you start thinking this is the raving of someone who wants manna from heaven, let me point out what is happening right now in 2005.

SHM has partnered with the Critical Care Institute of the American College of Chest Physicians (ACCP), the American Association of Critical Care Nurses (AACCN), the American Society of Health System Pharmacists (ASHP), and others to form a Critical Care Collaborative. Together these organizations represent over 100,000 healthcare professionals and through their leadership will work towards designing a more patient-focused approach that relies on communication and cooperation from the entire team responsible for delivering patient care. The goal will be to design and test models of care, as well as to increase recognition and awareness of existing models by tapping into the resources of the participating organizations. Efforts will be directed at all elements of the system including the point of care, support systems (IT), administration, payers, and regulatory bodies.

SHM is also actively participating in quality and team-based initiatives with the endocrine societies and the cardiology communities. This will lead to a new way of managing care in diabetes, heart failure, coronary artery disease, and deep vein thrombosis and pulmonary embolism.

On a national level President Bush has appointed David Brailler as the “health IT czar” with the charge to expand and integrate the information capabilities in health care. This coupled with the work being done at the National Quality Forum by Ken Kizer and others will lead to practical front line applications of standards of care and the ability to measure our performance in the reality of today’s hospital.

And even the payers are getting into the mix. The new buzz words are “pay for performance” and it is all the rage. CMS and others are well into beta test programs to see just how this would play out. Peer pressure and restriction of privileges have been the only concrete drivers to improve quality in the past. The prospect that demonstrable, measurable better care will translate into more compensation or greater market share is being tested in today’s hospital.

This is not a pipe dream or a Ralph Waldo Emerson essay. These initiatives are being driven by capable action oriented leaders who have a history of making change happen. And hospitalists, who for the most part are in the beginning of a 20 to 30-year professional career, are primed to play significant roles in this changing dynamic.

In the most basic way, today’s 12,000 hospitalists and the next 20,000 who will join us in the coming years must be much more than just willing participants to make this fly. Sure hospitalists will be the effector arm of health system change in their hospitals, but hospitalists must have

the skills and the vision to help shape this better day in health care. Hospitalists need to embrace the patient-centered, performance-driven acute care system. Hospitalists need to demand care delivered by teams and have the leadership skills to help these teams manage and lead change.

This wasn’t taught in medical school or residency, but that doesn’t matter. Hospital medicine as a new specialty has arrived coincident to (or by design at) a special moment in health care. Our patients have expectations of excellent care. There are plenty of resources available to do the best job. We just aren’t organized to be the best that we can be. But this will all be sorted out in the coming years. It is an exciting time to be a health professional, and hospitalists are at the center. And SHM has the vision and will have the programs to help our hospitalists be an important part in creating this new era of health care.

The vision of a re-engineered hospital with patient-centered care, delivered by a fully empowered team of professionals, which is data driven with clear quality measurements, where better performance is rewarded by better compensation is coming to a hospital near you during your professional career. And SHM and hospitalists are at the center of this revolution in the care of the acutely ill patient.

Hospitals are complex organizations with many moving parts and many unique constituencies often with different and, at times, competing definitions of success. What is clear is that even though many people have been talking about rewarding quality or making the hospital work for the patient, the current system is primarily physician centered and driven by increasing units of activity rather than how well a job is done. If we had the ideal system the patient would be able to demand that the physician appear when he wanted him to and we would be paying more for the best quality of care.

In order to change this complex system many institutions will need to be overhauled. The physical plant of the hospital may need to change from the noisy centralized nurses’ station where the health professionals congregate to a place designed to have data and nurses and doctors at the bedside. This would be the first concrete step to get the important members of the team (physicians, nurses, pharmacists, therapists) closer to the patient and closer to each other. The next step is to figure out how best to use everyone’s knowledge and perspective of the patient to provide more efficient and more effective care. SHM is working with Robert Wood Johnson Foundation and others on this initiative.

We will need to shift the data we collect from being mostly about getting paid to more about measuring how good a job we are doing. And while we are at it, it would be good if we could agree on what should be measured and if we could create a constant format so we can compare performance between institutions and groups. It would also be nice if physicians would agree to even be measured, and even better if physicians would be active participants in validating and responding to the data.

Then we would need to get the payers, the businesses and the insurers, and the government to care enough about quality to put their money where their measurements are and start paying for better performance rather than for more units of service (e.g., more visits, procedures, or surgeries, no matter the indications or the outcomes).

Before you start thinking this is the raving of someone who wants manna from heaven, let me point out what is happening right now in 2005.

SHM has partnered with the Critical Care Institute of the American College of Chest Physicians (ACCP), the American Association of Critical Care Nurses (AACCN), the American Society of Health System Pharmacists (ASHP), and others to form a Critical Care Collaborative. Together these organizations represent over 100,000 healthcare professionals and through their leadership will work towards designing a more patient-focused approach that relies on communication and cooperation from the entire team responsible for delivering patient care. The goal will be to design and test models of care, as well as to increase recognition and awareness of existing models by tapping into the resources of the participating organizations. Efforts will be directed at all elements of the system including the point of care, support systems (IT), administration, payers, and regulatory bodies.

SHM is also actively participating in quality and team-based initiatives with the endocrine societies and the cardiology communities. This will lead to a new way of managing care in diabetes, heart failure, coronary artery disease, and deep vein thrombosis and pulmonary embolism.

On a national level President Bush has appointed David Brailler as the “health IT czar” with the charge to expand and integrate the information capabilities in health care. This coupled with the work being done at the National Quality Forum by Ken Kizer and others will lead to practical front line applications of standards of care and the ability to measure our performance in the reality of today’s hospital.

And even the payers are getting into the mix. The new buzz words are “pay for performance” and it is all the rage. CMS and others are well into beta test programs to see just how this would play out. Peer pressure and restriction of privileges have been the only concrete drivers to improve quality in the past. The prospect that demonstrable, measurable better care will translate into more compensation or greater market share is being tested in today’s hospital.

This is not a pipe dream or a Ralph Waldo Emerson essay. These initiatives are being driven by capable action oriented leaders who have a history of making change happen. And hospitalists, who for the most part are in the beginning of a 20 to 30-year professional career, are primed to play significant roles in this changing dynamic.

In the most basic way, today’s 12,000 hospitalists and the next 20,000 who will join us in the coming years must be much more than just willing participants to make this fly. Sure hospitalists will be the effector arm of health system change in their hospitals, but hospitalists must have

the skills and the vision to help shape this better day in health care. Hospitalists need to embrace the patient-centered, performance-driven acute care system. Hospitalists need to demand care delivered by teams and have the leadership skills to help these teams manage and lead change.

This wasn’t taught in medical school or residency, but that doesn’t matter. Hospital medicine as a new specialty has arrived coincident to (or by design at) a special moment in health care. Our patients have expectations of excellent care. There are plenty of resources available to do the best job. We just aren’t organized to be the best that we can be. But this will all be sorted out in the coming years. It is an exciting time to be a health professional, and hospitalists are at the center. And SHM has the vision and will have the programs to help our hospitalists be an important part in creating this new era of health care.

This issue of The Hospitalist marks the beginning of my sixth year as the chief executive officer at SHM. Much has happened at SHM and in our specialty in the last 5 years, and

I thought I would use this space to share with everyone what we have accomplished together and to recognize the many individuals who have made all of this possible.

Past

When I first came to SHM in January of 2000, SHM had two employees, three or four committees, and about 500members. There were estimated to be 1000-2000 hospitalists in the country. SHM did stage an Annual Meeting with 300 attendees and published a newsletter of 16 pages with minimal ad revenue and a circulation of about 1000. SHM had no external grants and limited relationships with industry.

SHM was a fledgling national organization with no local presence. SHM had minimal assets or infrastructure and was very reliant on ACP for support and direction. Most of the innovation and direction fell to a few hospitalists around the country, who, while devoted to SHM (then NAIP) and our specialty, still had a very full plate just doing their day jobs, growing their hospital medicine groups. It was amazing what they had accomplished with minimal staff support or infrastructure.

At the start of the new millennium, SHM didn’t know how many hospitals had hospitalists. There was no data on how hard hospitalists should be expected to work or how much they should be paid. There was limited data on the background or training of those doctors who were going into hospital medicine, and there was no understanding of what the knowledge base was for this new specialty. There was a vague sense that the importance of hospitalists was more than just seeing their own patients, but there was little understanding of what value hospitalists could add to their health communities.

Present

Over the last 5 years, together we have made enormous progress. We have changed our name from the National Association of Inpatient Physicians to the Society of Hospital Medicine to better reflect all the stakeholders in our growing specialty. We have grown our Philadelphia staff to 13 and employ another five staff in Boston, Atlanta, and California. The Hospitalist newsletter is now the recognized publication in hospital medicine with 65-80 pages per issue, 2-3 supplements each year, and a circulation well over 10,000. There are more than $75,000 in recruitment ads in each issue, as much a testament to the growth of the specialty as anything else.

SHM’s Annual Meeting now attracts almost 1000 attendees and is the primary networking opportunity for the fastest-growing medical specialty. SHM has almost 5000 members, and there are an estimated 10,000-12,000 hospitalists now practicing in over 1500 hospitals. SHM currently has more than 40 local chapters meeting at least once a year throughout the country.

SHM has developed unique expertise in the management aspects of hospital medicine and holds practice management courses at least three times each year. In addition, SHM has realized that hospitalists will need to be the leaders of the hospitals of the future and has created Leadership Academies to train these future leaders. SHM has worked with grants from the Hartford Foundation to establish the hospitalist as the physician for the acutely ill elderly. SHM is working with the Robert Wood Johnson Foundation and others in helping to create the physical design of the hospital of the future.

SHM is just completing the Core Curriculum for Hospital Medicine, which will define the knowledge base for our specialty and serve as the basis for SHM’s growing educational enterprise. SHM is defining the value that hospitalists add beyond just direct patient care. This phenomenon has been the basis for hospitals looking for innovative ways to grow and support their hospital medicine groups. SHM will publish these white papers for hospitalists and hospital executives to use in designing their hospital medicine programs.

SHM has defined the productivity and compensation data for our specialty in our biannual surveys that are the best source for hospitalist data. SHM has developed a Washington presence and is defining the advocacy issues for hospital medicine, including substantial reform of payment to de-emphasize compensation based solely on the unit of the visit or the procedure.

SHM is now an organization with almost $3 million in assets, completely autonomous, and functioning on its own. We have a strong and growing relationship with ACP, and SHM has reached out to partner with many other organizations, including the AHA, ACCP, JCAHO, RWJ, Hartford Foundation, CDC, AACN, ASHP, ABIM, AAP, SGIM, AAIM and many others.

Future

And there is much to look forward to in the next 5 years. In the coming months, SHM will launch the first journal in hospital medicine in January 2006. SHM’s Web site will come into the 21st century with the ability for each member to have their own Web page. The Web site will be the one location that hospitalists can come to for CME and other educational information. SHM will be working with AACP, AACN, ASHP, and others to establish an Acute Care Collaborative, reorganizing hospital workflow to deliver measurable higher-quality health care using interdisciplinary teams of health professionals. This will help to define the hospital of the future.

There will be a certification for hospitalists in the near future. This will define how hospitalists add value and how we are different from other internists, pediatricians, and family practitioners. SHM will also be using the Core Curriculum to not only drive SHM post-graduate education, but to help redefine residency training to produce more and better-trained individuals for a future that includes 30,000 to 40,000 hospitalists.

This has been quite a ride in the last 5 years. I have been fortunate enough to have had a front row seat. And I am not going anywhere soon. This is way too much fun. I just wanted to share with you a few others who have been instrumental in growing SHM.

A Special Thank You to Those Who Did the Work

SHM Presidents

John Nelson

Win Whitcomb

Bob Wachter

Ron Angus

Mark Williams

Jeff Dichter

Jeanne Huddleston

SHM Board Members (in addition to all Presidents)

Bill Atchley

Brad Flansbaum

David Zipes

Diane Craig

Herb Rogove

Jan Merin

Lisa Kettering

Mark Aronson

Mary Jo Gorman

Mike Ruhlen

Mitch Wilson

Pat Cawley

Peter Lindenauer

Richard Slataper

Russ Holman

Steve Pantilat

Editors, The Hospitalist

Scott Flanders

Jim Pile

Committee & Council Chairs (in addition to Board members)

Alpesh Amin

Andy Auerbach

Don Krause

Jack Percelay

Joe Li

Lakshmi Halasyamani

Mike Pistoria

Natalie Correia

Neil Kripalani

Preetha Basaviah

Sanjay Saint

Shaun Frost

Stacy Goldsholl

Sylvia McKean

Teresa Jones

Tim Cornell

Vineet Arora

SHM Staff

Angela Musial

Erica Pearson

Jane Mihelic

Kevin Stevens

Marie Francois

Marilyn Rivera

Michelle D’Agostino

Vera Bensch

Vernita Jackson

Veronica BeUs

Joe Miller

Tina Budnitz

This issue of The Hospitalist marks the beginning of my sixth year as the chief executive officer at SHM. Much has happened at SHM and in our specialty in the last 5 years, and

I thought I would use this space to share with everyone what we have accomplished together and to recognize the many individuals who have made all of this possible.

Past

When I first came to SHM in January of 2000, SHM had two employees, three or four committees, and about 500members. There were estimated to be 1000-2000 hospitalists in the country. SHM did stage an Annual Meeting with 300 attendees and published a newsletter of 16 pages with minimal ad revenue and a circulation of about 1000. SHM had no external grants and limited relationships with industry.

SHM was a fledgling national organization with no local presence. SHM had minimal assets or infrastructure and was very reliant on ACP for support and direction. Most of the innovation and direction fell to a few hospitalists around the country, who, while devoted to SHM (then NAIP) and our specialty, still had a very full plate just doing their day jobs, growing their hospital medicine groups. It was amazing what they had accomplished with minimal staff support or infrastructure.

At the start of the new millennium, SHM didn’t know how many hospitals had hospitalists. There was no data on how hard hospitalists should be expected to work or how much they should be paid. There was limited data on the background or training of those doctors who were going into hospital medicine, and there was no understanding of what the knowledge base was for this new specialty. There was a vague sense that the importance of hospitalists was more than just seeing their own patients, but there was little understanding of what value hospitalists could add to their health communities.

Present

Over the last 5 years, together we have made enormous progress. We have changed our name from the National Association of Inpatient Physicians to the Society of Hospital Medicine to better reflect all the stakeholders in our growing specialty. We have grown our Philadelphia staff to 13 and employ another five staff in Boston, Atlanta, and California. The Hospitalist newsletter is now the recognized publication in hospital medicine with 65-80 pages per issue, 2-3 supplements each year, and a circulation well over 10,000. There are more than $75,000 in recruitment ads in each issue, as much a testament to the growth of the specialty as anything else.

SHM’s Annual Meeting now attracts almost 1000 attendees and is the primary networking opportunity for the fastest-growing medical specialty. SHM has almost 5000 members, and there are an estimated 10,000-12,000 hospitalists now practicing in over 1500 hospitals. SHM currently has more than 40 local chapters meeting at least once a year throughout the country.

SHM has developed unique expertise in the management aspects of hospital medicine and holds practice management courses at least three times each year. In addition, SHM has realized that hospitalists will need to be the leaders of the hospitals of the future and has created Leadership Academies to train these future leaders. SHM has worked with grants from the Hartford Foundation to establish the hospitalist as the physician for the acutely ill elderly. SHM is working with the Robert Wood Johnson Foundation and others in helping to create the physical design of the hospital of the future.

SHM is just completing the Core Curriculum for Hospital Medicine, which will define the knowledge base for our specialty and serve as the basis for SHM’s growing educational enterprise. SHM is defining the value that hospitalists add beyond just direct patient care. This phenomenon has been the basis for hospitals looking for innovative ways to grow and support their hospital medicine groups. SHM will publish these white papers for hospitalists and hospital executives to use in designing their hospital medicine programs.

SHM has defined the productivity and compensation data for our specialty in our biannual surveys that are the best source for hospitalist data. SHM has developed a Washington presence and is defining the advocacy issues for hospital medicine, including substantial reform of payment to de-emphasize compensation based solely on the unit of the visit or the procedure.

SHM is now an organization with almost $3 million in assets, completely autonomous, and functioning on its own. We have a strong and growing relationship with ACP, and SHM has reached out to partner with many other organizations, including the AHA, ACCP, JCAHO, RWJ, Hartford Foundation, CDC, AACN, ASHP, ABIM, AAP, SGIM, AAIM and many others.

Future

And there is much to look forward to in the next 5 years. In the coming months, SHM will launch the first journal in hospital medicine in January 2006. SHM’s Web site will come into the 21st century with the ability for each member to have their own Web page. The Web site will be the one location that hospitalists can come to for CME and other educational information. SHM will be working with AACP, AACN, ASHP, and others to establish an Acute Care Collaborative, reorganizing hospital workflow to deliver measurable higher-quality health care using interdisciplinary teams of health professionals. This will help to define the hospital of the future.

There will be a certification for hospitalists in the near future. This will define how hospitalists add value and how we are different from other internists, pediatricians, and family practitioners. SHM will also be using the Core Curriculum to not only drive SHM post-graduate education, but to help redefine residency training to produce more and better-trained individuals for a future that includes 30,000 to 40,000 hospitalists.

This has been quite a ride in the last 5 years. I have been fortunate enough to have had a front row seat. And I am not going anywhere soon. This is way too much fun. I just wanted to share with you a few others who have been instrumental in growing SHM.

A Special Thank You to Those Who Did the Work

SHM Presidents

John Nelson

Win Whitcomb

Bob Wachter

Ron Angus

Mark Williams

Jeff Dichter

Jeanne Huddleston

SHM Board Members (in addition to all Presidents)

Bill Atchley

Brad Flansbaum

David Zipes

Diane Craig

Herb Rogove

Jan Merin

Lisa Kettering

Mark Aronson

Mary Jo Gorman

Mike Ruhlen

Mitch Wilson

Pat Cawley

Peter Lindenauer

Richard Slataper

Russ Holman

Steve Pantilat

Editors, The Hospitalist

Scott Flanders

Jim Pile

Committee & Council Chairs (in addition to Board members)

Alpesh Amin

Andy Auerbach

Don Krause

Jack Percelay

Joe Li

Lakshmi Halasyamani

Mike Pistoria

Natalie Correia

Neil Kripalani

Preetha Basaviah

Sanjay Saint

Shaun Frost

Stacy Goldsholl

Sylvia McKean

Teresa Jones

Tim Cornell

Vineet Arora

SHM Staff

Angela Musial

Erica Pearson

Jane Mihelic

Kevin Stevens

Marie Francois

Marilyn Rivera

Michelle D’Agostino

Vera Bensch

Vernita Jackson

Veronica BeUs

Joe Miller

Tina Budnitz

This issue of The Hospitalist marks the beginning of my sixth year as the chief executive officer at SHM. Much has happened at SHM and in our specialty in the last 5 years, and

I thought I would use this space to share with everyone what we have accomplished together and to recognize the many individuals who have made all of this possible.

Past

When I first came to SHM in January of 2000, SHM had two employees, three or four committees, and about 500members. There were estimated to be 1000-2000 hospitalists in the country. SHM did stage an Annual Meeting with 300 attendees and published a newsletter of 16 pages with minimal ad revenue and a circulation of about 1000. SHM had no external grants and limited relationships with industry.

SHM was a fledgling national organization with no local presence. SHM had minimal assets or infrastructure and was very reliant on ACP for support and direction. Most of the innovation and direction fell to a few hospitalists around the country, who, while devoted to SHM (then NAIP) and our specialty, still had a very full plate just doing their day jobs, growing their hospital medicine groups. It was amazing what they had accomplished with minimal staff support or infrastructure.

At the start of the new millennium, SHM didn’t know how many hospitals had hospitalists. There was no data on how hard hospitalists should be expected to work or how much they should be paid. There was limited data on the background or training of those doctors who were going into hospital medicine, and there was no understanding of what the knowledge base was for this new specialty. There was a vague sense that the importance of hospitalists was more than just seeing their own patients, but there was little understanding of what value hospitalists could add to their health communities.

Present

Over the last 5 years, together we have made enormous progress. We have changed our name from the National Association of Inpatient Physicians to the Society of Hospital Medicine to better reflect all the stakeholders in our growing specialty. We have grown our Philadelphia staff to 13 and employ another five staff in Boston, Atlanta, and California. The Hospitalist newsletter is now the recognized publication in hospital medicine with 65-80 pages per issue, 2-3 supplements each year, and a circulation well over 10,000. There are more than $75,000 in recruitment ads in each issue, as much a testament to the growth of the specialty as anything else.

SHM’s Annual Meeting now attracts almost 1000 attendees and is the primary networking opportunity for the fastest-growing medical specialty. SHM has almost 5000 members, and there are an estimated 10,000-12,000 hospitalists now practicing in over 1500 hospitals. SHM currently has more than 40 local chapters meeting at least once a year throughout the country.

SHM has developed unique expertise in the management aspects of hospital medicine and holds practice management courses at least three times each year. In addition, SHM has realized that hospitalists will need to be the leaders of the hospitals of the future and has created Leadership Academies to train these future leaders. SHM has worked with grants from the Hartford Foundation to establish the hospitalist as the physician for the acutely ill elderly. SHM is working with the Robert Wood Johnson Foundation and others in helping to create the physical design of the hospital of the future.

SHM is just completing the Core Curriculum for Hospital Medicine, which will define the knowledge base for our specialty and serve as the basis for SHM’s growing educational enterprise. SHM is defining the value that hospitalists add beyond just direct patient care. This phenomenon has been the basis for hospitals looking for innovative ways to grow and support their hospital medicine groups. SHM will publish these white papers for hospitalists and hospital executives to use in designing their hospital medicine programs.

SHM has defined the productivity and compensation data for our specialty in our biannual surveys that are the best source for hospitalist data. SHM has developed a Washington presence and is defining the advocacy issues for hospital medicine, including substantial reform of payment to de-emphasize compensation based solely on the unit of the visit or the procedure.

SHM is now an organization with almost $3 million in assets, completely autonomous, and functioning on its own. We have a strong and growing relationship with ACP, and SHM has reached out to partner with many other organizations, including the AHA, ACCP, JCAHO, RWJ, Hartford Foundation, CDC, AACN, ASHP, ABIM, AAP, SGIM, AAIM and many others.

Future

And there is much to look forward to in the next 5 years. In the coming months, SHM will launch the first journal in hospital medicine in January 2006. SHM’s Web site will come into the 21st century with the ability for each member to have their own Web page. The Web site will be the one location that hospitalists can come to for CME and other educational information. SHM will be working with AACP, AACN, ASHP, and others to establish an Acute Care Collaborative, reorganizing hospital workflow to deliver measurable higher-quality health care using interdisciplinary teams of health professionals. This will help to define the hospital of the future.

There will be a certification for hospitalists in the near future. This will define how hospitalists add value and how we are different from other internists, pediatricians, and family practitioners. SHM will also be using the Core Curriculum to not only drive SHM post-graduate education, but to help redefine residency training to produce more and better-trained individuals for a future that includes 30,000 to 40,000 hospitalists.

This has been quite a ride in the last 5 years. I have been fortunate enough to have had a front row seat. And I am not going anywhere soon. This is way too much fun. I just wanted to share with you a few others who have been instrumental in growing SHM.

A Special Thank You to Those Who Did the Work

SHM Presidents

John Nelson

Win Whitcomb

Bob Wachter

Ron Angus

Mark Williams

Jeff Dichter

Jeanne Huddleston

SHM Board Members (in addition to all Presidents)

Bill Atchley

Brad Flansbaum

David Zipes

Diane Craig

Herb Rogove

Jan Merin

Lisa Kettering

Mark Aronson

Mary Jo Gorman

Mike Ruhlen

Mitch Wilson

Pat Cawley

Peter Lindenauer

Richard Slataper

Russ Holman

Steve Pantilat

Editors, The Hospitalist

Scott Flanders

Jim Pile

Committee & Council Chairs (in addition to Board members)

Alpesh Amin

Andy Auerbach

Don Krause

Jack Percelay

Joe Li

Lakshmi Halasyamani

Mike Pistoria

Natalie Correia

Neil Kripalani

Preetha Basaviah

Sanjay Saint

Shaun Frost

Stacy Goldsholl

Sylvia McKean

Teresa Jones

Tim Cornell

Vineet Arora

SHM Staff

Angela Musial

Erica Pearson

Jane Mihelic

Kevin Stevens

Marie Francois

Marilyn Rivera

Michelle D’Agostino

Vera Bensch

Vernita Jackson

Veronica BeUs

Joe Miller

Tina Budnitz