Society of Hospital Medicine (SHM): Hospital Medicine 2011 (SHM Annual Meeting)

GRAPEVINE, TEX. – The combination of the aging baby boomers, growing minority populations, and the millions of Americans who will gain coverage under the Affordable Care Act, will stress the U.S. health care system and create a "crisis of access to care" in the near future, warned Dr. Cecil B. Wilson, president of the American Medical Association.

Dr. Wilson, who recently spoke at the annual meeting of the Society of Hospital Medicine, said there is already a physician shortage in many areas and specialties, but it is likely to get worse if steps aren’t taken to recruit more young people into medicine.

"The situation is serious for the patients who do not have or cannot get a physician’s care," he said. "It also presents considerable challenges for those of us in medical practice as well."

Right now, the AMA estimates that there will be a shortage of at least 125,000 physicians by 2025. The problem is not just the number of the physicians but who they are and where they practice. Some of the greatest physician shortages are in rural areas and in minority communities. Recruiting minority physicians has been a challenge, he said, in part because of the high cost of medical school, but also because there are few minority role models in the medical community. And the result is that health care disparities are increasing, Dr. Wilson said.

There has been some good news, Dr. Wilson said. The Affordable Care Act includes some provisions to address these issues, including bonuses to primary care physicians to help deal with the pay differential with specialists, loan repayment programs, and a provision to shift unused residency slots to primary care. And medical schools are expanding. In the past 3 years, nearly two dozen new medical schools have either been opened, announced, or sought accreditation, Dr. Wilson said.

But there not has been a parallel growth in residency training slots. With the cap on federally funded residency positions, it’s difficult to expand training programs, he said. One possible solution is to move to an "all-payer system" that would be financed not just by Medicare, but also by insurance companies and others with a stake in the health care system, Dr. Wilson said.

GRAPEVINE, TEX. – The combination of the aging baby boomers, growing minority populations, and the millions of Americans who will gain coverage under the Affordable Care Act, will stress the U.S. health care system and create a "crisis of access to care" in the near future, warned Dr. Cecil B. Wilson, president of the American Medical Association.

Dr. Wilson, who recently spoke at the annual meeting of the Society of Hospital Medicine, said there is already a physician shortage in many areas and specialties, but it is likely to get worse if steps aren’t taken to recruit more young people into medicine.

"The situation is serious for the patients who do not have or cannot get a physician’s care," he said. "It also presents considerable challenges for those of us in medical practice as well."

Right now, the AMA estimates that there will be a shortage of at least 125,000 physicians by 2025. The problem is not just the number of the physicians but who they are and where they practice. Some of the greatest physician shortages are in rural areas and in minority communities. Recruiting minority physicians has been a challenge, he said, in part because of the high cost of medical school, but also because there are few minority role models in the medical community. And the result is that health care disparities are increasing, Dr. Wilson said.

There has been some good news, Dr. Wilson said. The Affordable Care Act includes some provisions to address these issues, including bonuses to primary care physicians to help deal with the pay differential with specialists, loan repayment programs, and a provision to shift unused residency slots to primary care. And medical schools are expanding. In the past 3 years, nearly two dozen new medical schools have either been opened, announced, or sought accreditation, Dr. Wilson said.

But there not has been a parallel growth in residency training slots. With the cap on federally funded residency positions, it’s difficult to expand training programs, he said. One possible solution is to move to an "all-payer system" that would be financed not just by Medicare, but also by insurance companies and others with a stake in the health care system, Dr. Wilson said.

GRAPEVINE, TEX. – The combination of the aging baby boomers, growing minority populations, and the millions of Americans who will gain coverage under the Affordable Care Act, will stress the U.S. health care system and create a "crisis of access to care" in the near future, warned Dr. Cecil B. Wilson, president of the American Medical Association.

Dr. Wilson, who recently spoke at the annual meeting of the Society of Hospital Medicine, said there is already a physician shortage in many areas and specialties, but it is likely to get worse if steps aren’t taken to recruit more young people into medicine.

"The situation is serious for the patients who do not have or cannot get a physician’s care," he said. "It also presents considerable challenges for those of us in medical practice as well."

Right now, the AMA estimates that there will be a shortage of at least 125,000 physicians by 2025. The problem is not just the number of the physicians but who they are and where they practice. Some of the greatest physician shortages are in rural areas and in minority communities. Recruiting minority physicians has been a challenge, he said, in part because of the high cost of medical school, but also because there are few minority role models in the medical community. And the result is that health care disparities are increasing, Dr. Wilson said.

There has been some good news, Dr. Wilson said. The Affordable Care Act includes some provisions to address these issues, including bonuses to primary care physicians to help deal with the pay differential with specialists, loan repayment programs, and a provision to shift unused residency slots to primary care. And medical schools are expanding. In the past 3 years, nearly two dozen new medical schools have either been opened, announced, or sought accreditation, Dr. Wilson said.

But there not has been a parallel growth in residency training slots. With the cap on federally funded residency positions, it’s difficult to expand training programs, he said. One possible solution is to move to an "all-payer system" that would be financed not just by Medicare, but also by insurance companies and others with a stake in the health care system, Dr. Wilson said.

GRAPEVINE, TEX. – The combination of the aging baby boomers, growing minority populations, and the millions of Americans who will gain coverage under the Affordable Care Act, will stress the U.S. health care system and create a "crisis of access to care" in the near future, warned Dr. Cecil B. Wilson, president of the American Medical Association.

Dr. Wilson, who recently spoke at the annual meeting of the Society of Hospital Medicine, said there is already a physician shortage in many areas and specialties, but it is likely to get worse if steps aren’t taken to recruit more young people into medicine.

"The situation is serious for the patients who do not have or cannot get a physician’s care," he said. "It also presents considerable challenges for those of us in medical practice as well."

Right now, the AMA estimates that there will be a shortage of at least 125,000 physicians by 2025. The problem is not just the number of the physicians but who they are and where they practice. Some of the greatest physician shortages are in rural areas and in minority communities. Recruiting minority physicians has been a challenge, he said, in part because of the high cost of medical school, but also because there are few minority role models in the medical community. And the result is that health care disparities are increasing, Dr. Wilson said.

There has been some good news, Dr. Wilson said. The Affordable Care Act includes some provisions to address these issues, including bonuses to primary care physicians to help deal with the pay differential with specialists, loan repayment programs, and a provision to shift unused residency slots to primary care. And medical schools are expanding. In the past 3 years, nearly two dozen new medical schools have either been opened, announced, or sought accreditation, Dr. Wilson said.

But there not has been a parallel growth in residency training slots. With the cap on federally funded residency positions, it’s difficult to expand training programs, he said. One possible solution is to move to an "all-payer system" that would be financed not just by Medicare, but also by insurance companies and others with a stake in the health care system, Dr. Wilson said.

GRAPEVINE, TEX. – The combination of the aging baby boomers, growing minority populations, and the millions of Americans who will gain coverage under the Affordable Care Act, will stress the U.S. health care system and create a "crisis of access to care" in the near future, warned Dr. Cecil B. Wilson, president of the American Medical Association.

Dr. Wilson, who recently spoke at the annual meeting of the Society of Hospital Medicine, said there is already a physician shortage in many areas and specialties, but it is likely to get worse if steps aren’t taken to recruit more young people into medicine.

"The situation is serious for the patients who do not have or cannot get a physician’s care," he said. "It also presents considerable challenges for those of us in medical practice as well."

Right now, the AMA estimates that there will be a shortage of at least 125,000 physicians by 2025. The problem is not just the number of the physicians but who they are and where they practice. Some of the greatest physician shortages are in rural areas and in minority communities. Recruiting minority physicians has been a challenge, he said, in part because of the high cost of medical school, but also because there are few minority role models in the medical community. And the result is that health care disparities are increasing, Dr. Wilson said.

There has been some good news, Dr. Wilson said. The Affordable Care Act includes some provisions to address these issues, including bonuses to primary care physicians to help deal with the pay differential with specialists, loan repayment programs, and a provision to shift unused residency slots to primary care. And medical schools are expanding. In the past 3 years, nearly two dozen new medical schools have either been opened, announced, or sought accreditation, Dr. Wilson said.

But there not has been a parallel growth in residency training slots. With the cap on federally funded residency positions, it’s difficult to expand training programs, he said. One possible solution is to move to an "all-payer system" that would be financed not just by Medicare, but also by insurance companies and others with a stake in the health care system, Dr. Wilson said.

GRAPEVINE, TEX. – The combination of the aging baby boomers, growing minority populations, and the millions of Americans who will gain coverage under the Affordable Care Act, will stress the U.S. health care system and create a "crisis of access to care" in the near future, warned Dr. Cecil B. Wilson, president of the American Medical Association.

Dr. Wilson, who recently spoke at the annual meeting of the Society of Hospital Medicine, said there is already a physician shortage in many areas and specialties, but it is likely to get worse if steps aren’t taken to recruit more young people into medicine.

"The situation is serious for the patients who do not have or cannot get a physician’s care," he said. "It also presents considerable challenges for those of us in medical practice as well."

Right now, the AMA estimates that there will be a shortage of at least 125,000 physicians by 2025. The problem is not just the number of the physicians but who they are and where they practice. Some of the greatest physician shortages are in rural areas and in minority communities. Recruiting minority physicians has been a challenge, he said, in part because of the high cost of medical school, but also because there are few minority role models in the medical community. And the result is that health care disparities are increasing, Dr. Wilson said.

There has been some good news, Dr. Wilson said. The Affordable Care Act includes some provisions to address these issues, including bonuses to primary care physicians to help deal with the pay differential with specialists, loan repayment programs, and a provision to shift unused residency slots to primary care. And medical schools are expanding. In the past 3 years, nearly two dozen new medical schools have either been opened, announced, or sought accreditation, Dr. Wilson said.

But there not has been a parallel growth in residency training slots. With the cap on federally funded residency positions, it’s difficult to expand training programs, he said. One possible solution is to move to an "all-payer system" that would be financed not just by Medicare, but also by insurance companies and others with a stake in the health care system, Dr. Wilson said.

GRAPEVINE, TEX. – The combination of the aging baby boomers, growing minority populations, and the millions of Americans who will gain coverage under the Affordable Care Act, will stress the U.S. health care system and create a "crisis of access to care" in the near future, warned Dr. Cecil B. Wilson, president of the American Medical Association.

Dr. Wilson, who recently spoke at the annual meeting of the Society of Hospital Medicine, said there is already a physician shortage in many areas and specialties, but it is likely to get worse if steps aren’t taken to recruit more young people into medicine.

"The situation is serious for the patients who do not have or cannot get a physician’s care," he said. "It also presents considerable challenges for those of us in medical practice as well."

Right now, the AMA estimates that there will be a shortage of at least 125,000 physicians by 2025. The problem is not just the number of the physicians but who they are and where they practice. Some of the greatest physician shortages are in rural areas and in minority communities. Recruiting minority physicians has been a challenge, he said, in part because of the high cost of medical school, but also because there are few minority role models in the medical community. And the result is that health care disparities are increasing, Dr. Wilson said.

There has been some good news, Dr. Wilson said. The Affordable Care Act includes some provisions to address these issues, including bonuses to primary care physicians to help deal with the pay differential with specialists, loan repayment programs, and a provision to shift unused residency slots to primary care. And medical schools are expanding. In the past 3 years, nearly two dozen new medical schools have either been opened, announced, or sought accreditation, Dr. Wilson said.

But there not has been a parallel growth in residency training slots. With the cap on federally funded residency positions, it’s difficult to expand training programs, he said. One possible solution is to move to an "all-payer system" that would be financed not just by Medicare, but also by insurance companies and others with a stake in the health care system, Dr. Wilson said.

GRAPEVINE, TEX. – The combination of the aging baby boomers, growing minority populations, and the millions of Americans who will gain coverage under the Affordable Care Act, will stress the U.S. health care system and create a "crisis of access to care" in the near future, warned Dr. Cecil B. Wilson, president of the American Medical Association.

Dr. Wilson, who recently spoke at the annual meeting of the Society of Hospital Medicine, said there is already a physician shortage in many areas and specialties, but it is likely to get worse if steps aren’t taken to recruit more young people into medicine.

"The situation is serious for the patients who do not have or cannot get a physician’s care," he said. "It also presents considerable challenges for those of us in medical practice as well."

Right now, the AMA estimates that there will be a shortage of at least 125,000 physicians by 2025. The problem is not just the number of the physicians but who they are and where they practice. Some of the greatest physician shortages are in rural areas and in minority communities. Recruiting minority physicians has been a challenge, he said, in part because of the high cost of medical school, but also because there are few minority role models in the medical community. And the result is that health care disparities are increasing, Dr. Wilson said.

There has been some good news, Dr. Wilson said. The Affordable Care Act includes some provisions to address these issues, including bonuses to primary care physicians to help deal with the pay differential with specialists, loan repayment programs, and a provision to shift unused residency slots to primary care. And medical schools are expanding. In the past 3 years, nearly two dozen new medical schools have either been opened, announced, or sought accreditation, Dr. Wilson said.

But there not has been a parallel growth in residency training slots. With the cap on federally funded residency positions, it’s difficult to expand training programs, he said. One possible solution is to move to an "all-payer system" that would be financed not just by Medicare, but also by insurance companies and others with a stake in the health care system, Dr. Wilson said.

GRAPEVINE, TEX. – The combination of the aging baby boomers, growing minority populations, and the millions of Americans who will gain coverage under the Affordable Care Act, will stress the U.S. health care system and create a "crisis of access to care" in the near future, warned Dr. Cecil B. Wilson, president of the American Medical Association.

Dr. Wilson, who recently spoke at the annual meeting of the Society of Hospital Medicine, said there is already a physician shortage in many areas and specialties, but it is likely to get worse if steps aren’t taken to recruit more young people into medicine.

"The situation is serious for the patients who do not have or cannot get a physician’s care," he said. "It also presents considerable challenges for those of us in medical practice as well."

Right now, the AMA estimates that there will be a shortage of at least 125,000 physicians by 2025. The problem is not just the number of the physicians but who they are and where they practice. Some of the greatest physician shortages are in rural areas and in minority communities. Recruiting minority physicians has been a challenge, he said, in part because of the high cost of medical school, but also because there are few minority role models in the medical community. And the result is that health care disparities are increasing, Dr. Wilson said.

There has been some good news, Dr. Wilson said. The Affordable Care Act includes some provisions to address these issues, including bonuses to primary care physicians to help deal with the pay differential with specialists, loan repayment programs, and a provision to shift unused residency slots to primary care. And medical schools are expanding. In the past 3 years, nearly two dozen new medical schools have either been opened, announced, or sought accreditation, Dr. Wilson said.

But there not has been a parallel growth in residency training slots. With the cap on federally funded residency positions, it’s difficult to expand training programs, he said. One possible solution is to move to an "all-payer system" that would be financed not just by Medicare, but also by insurance companies and others with a stake in the health care system, Dr. Wilson said.

GRAPEVINE, TEX. – The combination of the aging baby boomers, growing minority populations, and the millions of Americans who will gain coverage under the Affordable Care Act, will stress the U.S. health care system and create a "crisis of access to care" in the near future, warned Dr. Cecil B. Wilson, president of the American Medical Association.

Dr. Wilson, who recently spoke at the annual meeting of the Society of Hospital Medicine, said there is already a physician shortage in many areas and specialties, but it is likely to get worse if steps aren’t taken to recruit more young people into medicine.

"The situation is serious for the patients who do not have or cannot get a physician’s care," he said. "It also presents considerable challenges for those of us in medical practice as well."

Right now, the AMA estimates that there will be a shortage of at least 125,000 physicians by 2025. The problem is not just the number of the physicians but who they are and where they practice. Some of the greatest physician shortages are in rural areas and in minority communities. Recruiting minority physicians has been a challenge, he said, in part because of the high cost of medical school, but also because there are few minority role models in the medical community. And the result is that health care disparities are increasing, Dr. Wilson said.

There has been some good news, Dr. Wilson said. The Affordable Care Act includes some provisions to address these issues, including bonuses to primary care physicians to help deal with the pay differential with specialists, loan repayment programs, and a provision to shift unused residency slots to primary care. And medical schools are expanding. In the past 3 years, nearly two dozen new medical schools have either been opened, announced, or sought accreditation, Dr. Wilson said.

But there not has been a parallel growth in residency training slots. With the cap on federally funded residency positions, it’s difficult to expand training programs, he said. One possible solution is to move to an "all-payer system" that would be financed not just by Medicare, but also by insurance companies and others with a stake in the health care system, Dr. Wilson said.

GRAPEVINE, TEX. – The combination of the aging baby boomers, growing minority populations, and the millions of Americans who will gain coverage under the Affordable Care Act, will stress the U.S. health care system and create a "crisis of access to care" in the near future, warned Dr. Cecil B. Wilson, president of the American Medical Association.

Dr. Wilson, who recently spoke at the annual meeting of the Society of Hospital Medicine, said there is already a physician shortage in many areas and specialties, but it is likely to get worse if steps aren’t taken to recruit more young people into medicine.

"The situation is serious for the patients who do not have or cannot get a physician’s care," he said. "It also presents considerable challenges for those of us in medical practice as well."

Right now, the AMA estimates that there will be a shortage of at least 125,000 physicians by 2025. The problem is not just the number of the physicians but who they are and where they practice. Some of the greatest physician shortages are in rural areas and in minority communities. Recruiting minority physicians has been a challenge, he said, in part because of the high cost of medical school, but also because there are few minority role models in the medical community. And the result is that health care disparities are increasing, Dr. Wilson said.

There has been some good news, Dr. Wilson said. The Affordable Care Act includes some provisions to address these issues, including bonuses to primary care physicians to help deal with the pay differential with specialists, loan repayment programs, and a provision to shift unused residency slots to primary care. And medical schools are expanding. In the past 3 years, nearly two dozen new medical schools have either been opened, announced, or sought accreditation, Dr. Wilson said.

But there not has been a parallel growth in residency training slots. With the cap on federally funded residency positions, it’s difficult to expand training programs, he said. One possible solution is to move to an "all-payer system" that would be financed not just by Medicare, but also by insurance companies and others with a stake in the health care system, Dr. Wilson said.

GRAPEVINE, TEX. – The combination of the aging baby boomers, growing minority populations, and the millions of Americans who will gain coverage under the Affordable Care Act, will stress the U.S. health care system and create a "crisis of access to care" in the near future, warned Dr. Cecil B. Wilson, president of the American Medical Association.

Dr. Wilson, who recently spoke at the annual meeting of the Society of Hospital Medicine, said there is already a physician shortage in many areas and specialties, but it is likely to get worse if steps aren’t taken to recruit more young people into medicine.

"The situation is serious for the patients who do not have or cannot get a physician’s care," he said. "It also presents considerable challenges for those of us in medical practice as well."

Right now, the AMA estimates that there will be a shortage of at least 125,000 physicians by 2025. The problem is not just the number of the physicians but who they are and where they practice. Some of the greatest physician shortages are in rural areas and in minority communities. Recruiting minority physicians has been a challenge, he said, in part because of the high cost of medical school, but also because there are few minority role models in the medical community. And the result is that health care disparities are increasing, Dr. Wilson said.

There has been some good news, Dr. Wilson said. The Affordable Care Act includes some provisions to address these issues, including bonuses to primary care physicians to help deal with the pay differential with specialists, loan repayment programs, and a provision to shift unused residency slots to primary care. And medical schools are expanding. In the past 3 years, nearly two dozen new medical schools have either been opened, announced, or sought accreditation, Dr. Wilson said.

But there not has been a parallel growth in residency training slots. With the cap on federally funded residency positions, it’s difficult to expand training programs, he said. One possible solution is to move to an "all-payer system" that would be financed not just by Medicare, but also by insurance companies and others with a stake in the health care system, Dr. Wilson said.

GRAPEVINE, TEX. – The combination of the aging baby boomers, growing minority populations, and the millions of Americans who will gain coverage under the Affordable Care Act, will stress the U.S. health care system and create a "crisis of access to care" in the near future, warned Dr. Cecil B. Wilson, president of the American Medical Association.

Dr. Wilson, who recently spoke at the annual meeting of the Society of Hospital Medicine, said there is already a physician shortage in many areas and specialties, but it is likely to get worse if steps aren’t taken to recruit more young people into medicine.

"The situation is serious for the patients who do not have or cannot get a physician's care," he said. "It also presents considerable challenges for those of us in medical practice as well."

Right now, the AMA estimates that there will be a shortage of at least 125,000 physicians by 2025. The problem is not just the number of the physicians but who they are and where they practice. Some of the greatest physician shortages are in rural areas and in minority communities. Recruiting minority physicians has been a challenge, he said, in part because of the high cost of medical school, but also because there are few minority role models in the medical community. And the result is that health care disparities are increasing, Dr. Wilson said.

There has been some good news, Dr. Wilson said. The Affordable Care Act includes some provisions to address these issues, including bonuses to primary care physicians to help deal with the pay differential with specialists, loan repayment programs, and a provision to shift unused residency slots to primary care. And medical schools are expanding. In the past 3 years, nearly two dozen new medical schools have either been opened, announced, or sought accreditation, Dr. Wilson said.

But there not has been a parallel growth in residency training slots. With the cap on federally funded residency positions, it’s difficult to expand training programs, he said. One possible solution is to move to an "all-payer system" that would be financed not just by Medicare, but also by insurance companies and others with a stake in the health care system, Dr. Wilson said.

GRAPEVINE, TEX. – The combination of the aging baby boomers, growing minority populations, and the millions of Americans who will gain coverage under the Affordable Care Act, will stress the U.S. health care system and create a "crisis of access to care" in the near future, warned Dr. Cecil B. Wilson, president of the American Medical Association.

Dr. Wilson, who recently spoke at the annual meeting of the Society of Hospital Medicine, said there is already a physician shortage in many areas and specialties, but it is likely to get worse if steps aren’t taken to recruit more young people into medicine.

"The situation is serious for the patients who do not have or cannot get a physician's care," he said. "It also presents considerable challenges for those of us in medical practice as well."

Right now, the AMA estimates that there will be a shortage of at least 125,000 physicians by 2025. The problem is not just the number of the physicians but who they are and where they practice. Some of the greatest physician shortages are in rural areas and in minority communities. Recruiting minority physicians has been a challenge, he said, in part because of the high cost of medical school, but also because there are few minority role models in the medical community. And the result is that health care disparities are increasing, Dr. Wilson said.

There has been some good news, Dr. Wilson said. The Affordable Care Act includes some provisions to address these issues, including bonuses to primary care physicians to help deal with the pay differential with specialists, loan repayment programs, and a provision to shift unused residency slots to primary care. And medical schools are expanding. In the past 3 years, nearly two dozen new medical schools have either been opened, announced, or sought accreditation, Dr. Wilson said.

But there not has been a parallel growth in residency training slots. With the cap on federally funded residency positions, it’s difficult to expand training programs, he said. One possible solution is to move to an "all-payer system" that would be financed not just by Medicare, but also by insurance companies and others with a stake in the health care system, Dr. Wilson said.

GRAPEVINE, TEX. – The combination of the aging baby boomers, growing minority populations, and the millions of Americans who will gain coverage under the Affordable Care Act, will stress the U.S. health care system and create a "crisis of access to care" in the near future, warned Dr. Cecil B. Wilson, president of the American Medical Association.

Dr. Wilson, who recently spoke at the annual meeting of the Society of Hospital Medicine, said there is already a physician shortage in many areas and specialties, but it is likely to get worse if steps aren’t taken to recruit more young people into medicine.

"The situation is serious for the patients who do not have or cannot get a physician's care," he said. "It also presents considerable challenges for those of us in medical practice as well."

Right now, the AMA estimates that there will be a shortage of at least 125,000 physicians by 2025. The problem is not just the number of the physicians but who they are and where they practice. Some of the greatest physician shortages are in rural areas and in minority communities. Recruiting minority physicians has been a challenge, he said, in part because of the high cost of medical school, but also because there are few minority role models in the medical community. And the result is that health care disparities are increasing, Dr. Wilson said.

There has been some good news, Dr. Wilson said. The Affordable Care Act includes some provisions to address these issues, including bonuses to primary care physicians to help deal with the pay differential with specialists, loan repayment programs, and a provision to shift unused residency slots to primary care. And medical schools are expanding. In the past 3 years, nearly two dozen new medical schools have either been opened, announced, or sought accreditation, Dr. Wilson said.

But there not has been a parallel growth in residency training slots. With the cap on federally funded residency positions, it’s difficult to expand training programs, he said. One possible solution is to move to an "all-payer system" that would be financed not just by Medicare, but also by insurance companies and others with a stake in the health care system, Dr. Wilson said.

GRAPEVINE, TEX.  – Hospitalist salaries continue to rise, according to new data from a survey of more than 400 community hospitalist practices.

Nationally, hospitalist compensation was up 3% in 2010, with hospitalists earning on average between $212,000 and $246,000 depending on the area of the country where they worked.

The change from 2009 isn’t especially significant, Dr. John Nelson, a past president of the Society of Hospital Medicine, said in an interview. But it continues the trend over the past decade of rising salaries. That rise has been fueled partially because the demand for hospitalists continues to outstrip the supply, he said. Hospitalists’ productivity has also generally been increasing over the years, leading to greater compensation. And some of the rise is simply the result of cost of living increases and inflation, said Dr. Nelson, who presented the survey data at the SHM annual meeting.

The survey findings provide some interesting macro-level trend data, but compensation is usually determined by market forces on a "micro" level, Dr. Robert Bessler, president and CEO of Sound Physicians, said during a discussion on the survey findings at the annual meeting. He said it’s unlikely that salaries will decline anytime soon since demand for high-quality physicians is likely to remain high.

The survey, which was conducted jointly by SHM and the Medical Group Management Association, includes responses from 414 hospital medicine practices, representing 4,666 adult hospitalists. For the first time, the survey does not include academic practices. The survey, which includes 2010 fiscal year data, asked respondents to report their total compensation, including bonuses. Additional data will be released in September.

The survey also sheds some light on how productive hospitalists were in 2010. The figures are about the same as in 2009. Hospitalists in the Northeast and Southeast did the most work, as measured by billable encounters and work relative value units (RVUs). In the Northeast, hospitalists on average had 2,297 billable encounters annually with 4,092 work RVUs. In the Southeast, hospitalists reported 2,747 annual encounters on average, with 4,931 work RVUs. Annual productivity was slightly lower in the West and Midwest regions, where hospitalists reported on average 1,745 encounters (3,892 work RVUs) and 1,928 encounters (3,858 work RVUs) respectively.

The productivity figures also help to put the salary numbers in perspective, Dr. Nelson explained. By combining the productivity and salary figures, Dr. Nelson explained the "juice-to-squeeze" ratio or the compensation per work RVU. While hospitalists in the Southeast earn the highest annual salaries on average at $246,000, they also have the highest number of work RVUs. That means that hospitalists in the Southeast region actually have the lowest compensation for each unit of work at $52/work RVU. Hospitalists in the Midwest did the best under the juice-to-squeeze ratio at $56/work RVU, even though they in the middle of the pack salary wise at $224,000 annually.

Hospitalists in the Northeast and the West had similar salaries and earnings per work RVU. Those working in the Northeast had average salaries of $212,000 a year or $54/work RVU; while hospitalists in the West earned $213,000 a year or $55/unit of work.

Dr. Nelson said not enough people take the work component into account when evaluating salaries. "It would be like focusing on someone’s weight without also considering their height," he said in an interview. "You have to put both numbers together if you really want to know the situation."

The survey also looked at support for hospitalist programs. In 2010, the level of hospital support reached $132,000 annually for each full-time employee, up from $98,000 in 2009. Dr. Nelson said he’s unsure why the support figured jumped so much in a single year. The economic downturn and the increase in uninsured patients could result for part of that increase, he said. Since, in most cases, hospitals make up the difference between what programs bring in and what’s needed to operate, a drop in collections might explain some of the change. But some of the increase may simply be due to a change in the survey between 2009 and 2010, he said.

GRAPEVINE, TEX.  – Hospitalist salaries continue to rise, according to new data from a survey of more than 400 community hospitalist practices.

Nationally, hospitalist compensation was up 3% in 2010, with hospitalists earning on average between $212,000 and $246,000 depending on the area of the country where they worked.

The change from 2009 isn’t especially significant, Dr. John Nelson, a past president of the Society of Hospital Medicine, said in an interview. But it continues the trend over the past decade of rising salaries. That rise has been fueled partially because the demand for hospitalists continues to outstrip the supply, he said. Hospitalists’ productivity has also generally been increasing over the years, leading to greater compensation. And some of the rise is simply the result of cost of living increases and inflation, said Dr. Nelson, who presented the survey data at the SHM annual meeting.

The survey findings provide some interesting macro-level trend data, but compensation is usually determined by market forces on a "micro" level, Dr. Robert Bessler, president and CEO of Sound Physicians, said during a discussion on the survey findings at the annual meeting. He said it’s unlikely that salaries will decline anytime soon since demand for high-quality physicians is likely to remain high.

The survey, which was conducted jointly by SHM and the Medical Group Management Association, includes responses from 414 hospital medicine practices, representing 4,666 adult hospitalists. For the first time, the survey does not include academic practices. The survey, which includes 2010 fiscal year data, asked respondents to report their total compensation, including bonuses. Additional data will be released in September.

The survey also sheds some light on how productive hospitalists were in 2010. The figures are about the same as in 2009. Hospitalists in the Northeast and Southeast did the most work, as measured by billable encounters and work relative value units (RVUs). In the Northeast, hospitalists on average had 2,297 billable encounters annually with 4,092 work RVUs. In the Southeast, hospitalists reported 2,747 annual encounters on average, with 4,931 work RVUs. Annual productivity was slightly lower in the West and Midwest regions, where hospitalists reported on average 1,745 encounters (3,892 work RVUs) and 1,928 encounters (3,858 work RVUs) respectively.

The productivity figures also help to put the salary numbers in perspective, Dr. Nelson explained. By combining the productivity and salary figures, Dr. Nelson explained the "juice-to-squeeze" ratio or the compensation per work RVU. While hospitalists in the Southeast earn the highest annual salaries on average at $246,000, they also have the highest number of work RVUs. That means that hospitalists in the Southeast region actually have the lowest compensation for each unit of work at $52/work RVU. Hospitalists in the Midwest did the best under the juice-to-squeeze ratio at $56/work RVU, even though they in the middle of the pack salary wise at $224,000 annually.

Hospitalists in the Northeast and the West had similar salaries and earnings per work RVU. Those working in the Northeast had average salaries of $212,000 a year or $54/work RVU; while hospitalists in the West earned $213,000 a year or $55/unit of work.

Dr. Nelson said not enough people take the work component into account when evaluating salaries. "It would be like focusing on someone’s weight without also considering their height," he said in an interview. "You have to put both numbers together if you really want to know the situation."

The survey also looked at support for hospitalist programs. In 2010, the level of hospital support reached $132,000 annually for each full-time employee, up from $98,000 in 2009. Dr. Nelson said he’s unsure why the support figured jumped so much in a single year. The economic downturn and the increase in uninsured patients could result for part of that increase, he said. Since, in most cases, hospitals make up the difference between what programs bring in and what’s needed to operate, a drop in collections might explain some of the change. But some of the increase may simply be due to a change in the survey between 2009 and 2010, he said.

GRAPEVINE, TEX.  – Hospitalist salaries continue to rise, according to new data from a survey of more than 400 community hospitalist practices.

Nationally, hospitalist compensation was up 3% in 2010, with hospitalists earning on average between $212,000 and $246,000 depending on the area of the country where they worked.

The change from 2009 isn’t especially significant, Dr. John Nelson, a past president of the Society of Hospital Medicine, said in an interview. But it continues the trend over the past decade of rising salaries. That rise has been fueled partially because the demand for hospitalists continues to outstrip the supply, he said. Hospitalists’ productivity has also generally been increasing over the years, leading to greater compensation. And some of the rise is simply the result of cost of living increases and inflation, said Dr. Nelson, who presented the survey data at the SHM annual meeting.

The survey findings provide some interesting macro-level trend data, but compensation is usually determined by market forces on a "micro" level, Dr. Robert Bessler, president and CEO of Sound Physicians, said during a discussion on the survey findings at the annual meeting. He said it’s unlikely that salaries will decline anytime soon since demand for high-quality physicians is likely to remain high.

The survey, which was conducted jointly by SHM and the Medical Group Management Association, includes responses from 414 hospital medicine practices, representing 4,666 adult hospitalists. For the first time, the survey does not include academic practices. The survey, which includes 2010 fiscal year data, asked respondents to report their total compensation, including bonuses. Additional data will be released in September.

The survey also sheds some light on how productive hospitalists were in 2010. The figures are about the same as in 2009. Hospitalists in the Northeast and Southeast did the most work, as measured by billable encounters and work relative value units (RVUs). In the Northeast, hospitalists on average had 2,297 billable encounters annually with 4,092 work RVUs. In the Southeast, hospitalists reported 2,747 annual encounters on average, with 4,931 work RVUs. Annual productivity was slightly lower in the West and Midwest regions, where hospitalists reported on average 1,745 encounters (3,892 work RVUs) and 1,928 encounters (3,858 work RVUs) respectively.

The productivity figures also help to put the salary numbers in perspective, Dr. Nelson explained. By combining the productivity and salary figures, Dr. Nelson explained the "juice-to-squeeze" ratio or the compensation per work RVU. While hospitalists in the Southeast earn the highest annual salaries on average at $246,000, they also have the highest number of work RVUs. That means that hospitalists in the Southeast region actually have the lowest compensation for each unit of work at $52/work RVU. Hospitalists in the Midwest did the best under the juice-to-squeeze ratio at $56/work RVU, even though they in the middle of the pack salary wise at $224,000 annually.

Hospitalists in the Northeast and the West had similar salaries and earnings per work RVU. Those working in the Northeast had average salaries of $212,000 a year or $54/work RVU; while hospitalists in the West earned $213,000 a year or $55/unit of work.

Dr. Nelson said not enough people take the work component into account when evaluating salaries. "It would be like focusing on someone’s weight without also considering their height," he said in an interview. "You have to put both numbers together if you really want to know the situation."

The survey also looked at support for hospitalist programs. In 2010, the level of hospital support reached $132,000 annually for each full-time employee, up from $98,000 in 2009. Dr. Nelson said he’s unsure why the support figured jumped so much in a single year. The economic downturn and the increase in uninsured patients could result for part of that increase, he said. Since, in most cases, hospitals make up the difference between what programs bring in and what’s needed to operate, a drop in collections might explain some of the change. But some of the increase may simply be due to a change in the survey between 2009 and 2010, he said.

GRAPEVINE, TEX. – Researchers found no evidence that the length of resident-covered inpatient rotations – whether 2 or 4 weeks – significantly detracts from hospitalists’ quality of life, or from the quality of care they provide.

However, although nonhospitalists’ patients did just as well as did those of hospitalists, their work/life balance suffered significantly when they worked 4-week inpatient shifts, Dr. Brian Lucas said at the annual meeting of the Society of Hospital Medicine.

Dr. Lucas’s randomized controlled trial on a general medicine teaching ward service was not powered to detect a difference in outcomes between hospitalists and nonhospitalists. Nonetheless, his findings suggest that hospitalists and nonhospitalists experience rotation duration differently, Dr. Lucas said in an interview. It simply may have to do with being accustomed to the rhythm of a hospitalist’s professional life.

"My sense is that hospitalists have the chance to return to a more ‘normal’ schedule after their rotations are over and regain their composure," said Dr. Lucas, chief of hospital medicine at the John H. Stroger Hospital of Cook County, Chicago. "The nonhospitalists don’t experience that. They work at the hospital for 2 or 4 weeks, put their clinic on hold, and at the end, go back to a clinic that has become overburdened. There’s a lot of stress dealing with that."

Dr. Lucas presented the overall findings of the same study at the Society of General Internal Medicine meeting in Phoenix the week earlier. The subanalysis explored at SHM examined work/life balance between the two rotation durations and among the different providers.

The study randomized 62 physicians – 18 hospitalists and 44 nonhospitalists – to sequences of 2- and 4-week rotations, with a total of 130 2-week shifts and 76 4-week shifts. The investigators examined 30-day outcomes in 12,352 patients discharged during these rotations, as well as physicians’ life stressors.

At the end of the study, physicians completed a survey containing portions of three validated life stress measures. Items from the Human Services Survey of the Maslach Burnout Inventory assessed emotional exhaustion; items from the Cohen Perceived Stress Scale measured stress; and items from the Physicians Worklife Study II (Med. Care 1999;37:1140-54) assessed feelings of control in the workplace.

The median number of rotations per physician was three; there was a median of 10 weeks between rotations.

Rotation length did not affect 30-day unplanned patient revisits for either schedule; the rate was 25% for both 2- and 4-week rotations. Residents, who were asked to evaluate their attending physician at the end of the study, did not give significantly different scores according to whether their supervisor worked the 2- or 4-week schedule.

However, Dr. Lucas said, physicians overall did report a significant worsening of work/life balance during the 4-week rotation as opposed to the 2-week rotation. To explore this finding, the investigators first added five characteristics to the model: number of children, being a hospitalist, being an international medical graduate, being a woman, and years of experience.

Three factors significantly affected the overall model. For each child, the attending physician’s work/life became significantly worse, which Dr. Lucas, who has three children of his own, said "is certainly intuitive." Being a hospitalist or an international medical graduate also was significantly protective of work/life balance overall. But whether being a hospitalist limits the imbalance of 4-week rotations depended on which facet of work/life balance was examined.

When considering the entire cohort and both rotation durations combined, the median score in the emotional exhaustion measure was 22. In this measure, the higher the score, the more emotional exhaustion is present. The median life-stress score – which increases as stress increases – was 6. The median score of perceived control at work was 19; this score goes down as perceived control decreases.

All of the scores improved significantly when the physicians worked 2-week shifts rather than 4-week shifts. The difference appeared to be driven by nonhospitalists, however. Their summary scores – which included reactions to both shift schedules – were worse than those of the overall cohort. Working a 2-week shift significantly improved all of these scores, compared with a 4-week shift.

Among hospitalists, however, the summary scores for both schedules were better: 11.8 for emotional exhaustion, 4.6 for life stress, and 21.5 for perceived control. Working a 2-week shift did not significantly improve any of these scores, compared with a 4-week shift, showing, Dr. Lucas said, that hospitalists coped equally well with both rotation lengths.

"In a multivariate model, however, the only significant interaction was perceived control," Dr. Lucas said. "In other words, we found that being a hospitalist protects against loss of control during 4-week rotation, but not that being a hospitalist protects against worsened emotional exhaustion or life stress.

"Overall, these findings suggest that everyone has a little more work/life imbalance after a 4-week rotation, and that those feelings are greater for nonhospitalists," he said.

Before this study, Dr. Lucas said his hospital only offered 4-week rotations. Based on these data, it now allows physicians to choose which schedule might be the best fit. "Despite our findings, about a quarter of our attendings choose to do the 4-week rotation," he said. "My thought is that it works better for some people who don’t have some of these other personal or professional commitments."

As for trainee supervision, he expressed a different thought. "I think you have a better sense of your residents and medical students if you are with them for a full month at a time, rather than 2 weeks."

Dr. Lucas had no financial disclosures with regard to the study.

GRAPEVINE, TEX. – Researchers found no evidence that the length of resident-covered inpatient rotations – whether 2 or 4 weeks – significantly detracts from hospitalists’ quality of life, or from the quality of care they provide.

However, although nonhospitalists’ patients did just as well as did those of hospitalists, their work/life balance suffered significantly when they worked 4-week inpatient shifts, Dr. Brian Lucas said at the annual meeting of the Society of Hospital Medicine.

Dr. Lucas’s randomized controlled trial on a general medicine teaching ward service was not powered to detect a difference in outcomes between hospitalists and nonhospitalists. Nonetheless, his findings suggest that hospitalists and nonhospitalists experience rotation duration differently, Dr. Lucas said in an interview. It simply may have to do with being accustomed to the rhythm of a hospitalist’s professional life.

"My sense is that hospitalists have the chance to return to a more ‘normal’ schedule after their rotations are over and regain their composure," said Dr. Lucas, chief of hospital medicine at the John H. Stroger Hospital of Cook County, Chicago. "The nonhospitalists don’t experience that. They work at the hospital for 2 or 4 weeks, put their clinic on hold, and at the end, go back to a clinic that has become overburdened. There’s a lot of stress dealing with that."

Dr. Lucas presented the overall findings of the same study at the Society of General Internal Medicine meeting in Phoenix the week earlier. The subanalysis explored at SHM examined work/life balance between the two rotation durations and among the different providers.

The study randomized 62 physicians – 18 hospitalists and 44 nonhospitalists – to sequences of 2- and 4-week rotations, with a total of 130 2-week shifts and 76 4-week shifts. The investigators examined 30-day outcomes in 12,352 patients discharged during these rotations, as well as physicians’ life stressors.

At the end of the study, physicians completed a survey containing portions of three validated life stress measures. Items from the Human Services Survey of the Maslach Burnout Inventory assessed emotional exhaustion; items from the Cohen Perceived Stress Scale measured stress; and items from the Physicians Worklife Study II (Med. Care 1999;37:1140-54) assessed feelings of control in the workplace.

The median number of rotations per physician was three; there was a median of 10 weeks between rotations.

Rotation length did not affect 30-day unplanned patient revisits for either schedule; the rate was 25% for both 2- and 4-week rotations. Residents, who were asked to evaluate their attending physician at the end of the study, did not give significantly different scores according to whether their supervisor worked the 2- or 4-week schedule.

However, Dr. Lucas said, physicians overall did report a significant worsening of work/life balance during the 4-week rotation as opposed to the 2-week rotation. To explore this finding, the investigators first added five characteristics to the model: number of children, being a hospitalist, being an international medical graduate, being a woman, and years of experience.

Three factors significantly affected the overall model. For each child, the attending physician’s work/life became significantly worse, which Dr. Lucas, who has three children of his own, said "is certainly intuitive." Being a hospitalist or an international medical graduate also was significantly protective of work/life balance overall. But whether being a hospitalist limits the imbalance of 4-week rotations depended on which facet of work/life balance was examined.

When considering the entire cohort and both rotation durations combined, the median score in the emotional exhaustion measure was 22. In this measure, the higher the score, the more emotional exhaustion is present. The median life-stress score – which increases as stress increases – was 6. The median score of perceived control at work was 19; this score goes down as perceived control decreases.

All of the scores improved significantly when the physicians worked 2-week shifts rather than 4-week shifts. The difference appeared to be driven by nonhospitalists, however. Their summary scores – which included reactions to both shift schedules – were worse than those of the overall cohort. Working a 2-week shift significantly improved all of these scores, compared with a 4-week shift.

Among hospitalists, however, the summary scores for both schedules were better: 11.8 for emotional exhaustion, 4.6 for life stress, and 21.5 for perceived control. Working a 2-week shift did not significantly improve any of these scores, compared with a 4-week shift, showing, Dr. Lucas said, that hospitalists coped equally well with both rotation lengths.

"In a multivariate model, however, the only significant interaction was perceived control," Dr. Lucas said. "In other words, we found that being a hospitalist protects against loss of control during 4-week rotation, but not that being a hospitalist protects against worsened emotional exhaustion or life stress.

"Overall, these findings suggest that everyone has a little more work/life imbalance after a 4-week rotation, and that those feelings are greater for nonhospitalists," he said.

Before this study, Dr. Lucas said his hospital only offered 4-week rotations. Based on these data, it now allows physicians to choose which schedule might be the best fit. "Despite our findings, about a quarter of our attendings choose to do the 4-week rotation," he said. "My thought is that it works better for some people who don’t have some of these other personal or professional commitments."

As for trainee supervision, he expressed a different thought. "I think you have a better sense of your residents and medical students if you are with them for a full month at a time, rather than 2 weeks."

Dr. Lucas had no financial disclosures with regard to the study.

GRAPEVINE, TEX. – Researchers found no evidence that the length of resident-covered inpatient rotations – whether 2 or 4 weeks – significantly detracts from hospitalists’ quality of life, or from the quality of care they provide.

However, although nonhospitalists’ patients did just as well as did those of hospitalists, their work/life balance suffered significantly when they worked 4-week inpatient shifts, Dr. Brian Lucas said at the annual meeting of the Society of Hospital Medicine.

Dr. Lucas’s randomized controlled trial on a general medicine teaching ward service was not powered to detect a difference in outcomes between hospitalists and nonhospitalists. Nonetheless, his findings suggest that hospitalists and nonhospitalists experience rotation duration differently, Dr. Lucas said in an interview. It simply may have to do with being accustomed to the rhythm of a hospitalist’s professional life.

"My sense is that hospitalists have the chance to return to a more ‘normal’ schedule after their rotations are over and regain their composure," said Dr. Lucas, chief of hospital medicine at the John H. Stroger Hospital of Cook County, Chicago. "The nonhospitalists don’t experience that. They work at the hospital for 2 or 4 weeks, put their clinic on hold, and at the end, go back to a clinic that has become overburdened. There’s a lot of stress dealing with that."

Dr. Lucas presented the overall findings of the same study at the Society of General Internal Medicine meeting in Phoenix the week earlier. The subanalysis explored at SHM examined work/life balance between the two rotation durations and among the different providers.

The study randomized 62 physicians – 18 hospitalists and 44 nonhospitalists – to sequences of 2- and 4-week rotations, with a total of 130 2-week shifts and 76 4-week shifts. The investigators examined 30-day outcomes in 12,352 patients discharged during these rotations, as well as physicians’ life stressors.

At the end of the study, physicians completed a survey containing portions of three validated life stress measures. Items from the Human Services Survey of the Maslach Burnout Inventory assessed emotional exhaustion; items from the Cohen Perceived Stress Scale measured stress; and items from the Physicians Worklife Study II (Med. Care 1999;37:1140-54) assessed feelings of control in the workplace.

The median number of rotations per physician was three; there was a median of 10 weeks between rotations.

Rotation length did not affect 30-day unplanned patient revisits for either schedule; the rate was 25% for both 2- and 4-week rotations. Residents, who were asked to evaluate their attending physician at the end of the study, did not give significantly different scores according to whether their supervisor worked the 2- or 4-week schedule.

However, Dr. Lucas said, physicians overall did report a significant worsening of work/life balance during the 4-week rotation as opposed to the 2-week rotation. To explore this finding, the investigators first added five characteristics to the model: number of children, being a hospitalist, being an international medical graduate, being a woman, and years of experience.

Three factors significantly affected the overall model. For each child, the attending physician’s work/life became significantly worse, which Dr. Lucas, who has three children of his own, said "is certainly intuitive." Being a hospitalist or an international medical graduate also was significantly protective of work/life balance overall. But whether being a hospitalist limits the imbalance of 4-week rotations depended on which facet of work/life balance was examined.

When considering the entire cohort and both rotation durations combined, the median score in the emotional exhaustion measure was 22. In this measure, the higher the score, the more emotional exhaustion is present. The median life-stress score – which increases as stress increases – was 6. The median score of perceived control at work was 19; this score goes down as perceived control decreases.

All of the scores improved significantly when the physicians worked 2-week shifts rather than 4-week shifts. The difference appeared to be driven by nonhospitalists, however. Their summary scores – which included reactions to both shift schedules – were worse than those of the overall cohort. Working a 2-week shift significantly improved all of these scores, compared with a 4-week shift.

Among hospitalists, however, the summary scores for both schedules were better: 11.8 for emotional exhaustion, 4.6 for life stress, and 21.5 for perceived control. Working a 2-week shift did not significantly improve any of these scores, compared with a 4-week shift, showing, Dr. Lucas said, that hospitalists coped equally well with both rotation lengths.

"In a multivariate model, however, the only significant interaction was perceived control," Dr. Lucas said. "In other words, we found that being a hospitalist protects against loss of control during 4-week rotation, but not that being a hospitalist protects against worsened emotional exhaustion or life stress.

"Overall, these findings suggest that everyone has a little more work/life imbalance after a 4-week rotation, and that those feelings are greater for nonhospitalists," he said.

Before this study, Dr. Lucas said his hospital only offered 4-week rotations. Based on these data, it now allows physicians to choose which schedule might be the best fit. "Despite our findings, about a quarter of our attendings choose to do the 4-week rotation," he said. "My thought is that it works better for some people who don’t have some of these other personal or professional commitments."

As for trainee supervision, he expressed a different thought. "I think you have a better sense of your residents and medical students if you are with them for a full month at a time, rather than 2 weeks."

Dr. Lucas had no financial disclosures with regard to the study.

GRAPEVINE, TEX. – E-mailing the results of tests still pending at patient discharge is a feasible solution to the "I never got this message" scenario.

Such a pilot project performed well for hospitalists and primary care doctors in the Partners HealthCare System’s "partners.org" database, Dr. Anuj K. Dalal said at the annual meeting of the Society of Hospital Medicine.

However, he warned, unless system bugs are hunted down and exterminated before deployment, one inaccurate discharge entry could set up a domino-effect deluge of e-mails to peeved primary care physicians.

"One unit clerk inadvertently ‘discharged’ a patient on day 4 of a 10-day hospital stay," he said. "The system then detected 510 pending tests at discharge, which resulted in nine e-mails to one very frustrated physician. I can’t tell you how important it is to have the process crisp before you jump into something like this. You have to remember the computer adage, ‘Garbage in, garbage out.’ "

He points to the not-uncommon scenario of patients who are discharged before all the lab results come back. Those results are returned to the physician who ordered them – most likely the hospitalist – and frequently stop there. "No one ever communicates the results to the PCP [primary care physician], and the attendings don’t review them," because the patient is no longer under their care, said Dr. Dalal, a hospitalist at Brigham and Women’s Hospital in Boston.

To address the problem, he conceived of and helped create a computer algorithm that automatically detects incoming test results and generates a single e-mail to the patient’s hospital attending and primary care physician. The system updates at midnight and keeps generating one e-mail a day to each provider until all results are finalized.

"Every e-mail has the date it was generated, the patient’s name, name of the discharging attending physician, the day of discharge, and the results of each test," Dr. Dalal said.

While the system is feasible in a large, interconnected health care system, it isn’t foolproof, he added. Sometimes, physicians outside the Partners e-mail system admit a patient; in that case only the hospitalist gets the e-mail. "But it always has the phone number of the primary care doc, so the hospitalist can call and relay the results."

The 1-month pilot period included chemistry/hematology, radiology/pathology, and microbiology results. It was tested on 83 discharges – including the one that caused the electronic mayhem. After excluding that one, Dr. Dalal said, the computer program found 405 pending tests, most of which (55%) were chemistry, while the remainder were hematology; 18% were abnormal. This generated 136 e-mails – about 1.7 per patient, although 34% of the patients had 2 or more e-mails sent. Aside from complaints about the inaccurate discharge, only three physicians (two PCPs and one hospitalist) said they received incorrect e-mails.

A survey of 70 physician users found that 84% were satisfied or very satisfied with the system, while 6% were neutral and 10% dissatisfied or very dissatisfied.

Comments from both sides of the issue included remarks such as "I found this extremely useful, knowing the final results of tests, both those that are positive as well as negative," and "Test was not needed and not ordered by me."

Dr. Dalal also presented a poster that examined the system’s 6-month outcomes among 36 discharging physicians who got the e-mails and 43 who did not. Physicians who got the e-mails were six times more likely to be aware of the results of any pending test, and five times more aware of any pending tests that required action on their part.

They were also significantly more likely to be satisfied with the automatic notification system than with the usual care system (84% vs. 21%).

In considering the impact of this novel collaboration on patient care, Dr. Dalal said, "I would challenge you on the thought that our responsibility as hospitalists ends when the patient is discharged. Does it really, especially as we are doing all this work on care transition and decreased readmission? We are going to become the care transition experts; we need to think of whether we are responsible for these results."

Dr. Dalal reported having no financial disclosures.

GRAPEVINE, TEX. – E-mailing the results of tests still pending at patient discharge is a feasible solution to the "I never got this message" scenario.

Such a pilot project performed well for hospitalists and primary care doctors in the Partners HealthCare System’s "partners.org" database, Dr. Anuj K. Dalal said at the annual meeting of the Society of Hospital Medicine.

However, he warned, unless system bugs are hunted down and exterminated before deployment, one inaccurate discharge entry could set up a domino-effect deluge of e-mails to peeved primary care physicians.

"One unit clerk inadvertently ‘discharged’ a patient on day 4 of a 10-day hospital stay," he said. "The system then detected 510 pending tests at discharge, which resulted in nine e-mails to one very frustrated physician. I can’t tell you how important it is to have the process crisp before you jump into something like this. You have to remember the computer adage, ‘Garbage in, garbage out.’ "

He points to the not-uncommon scenario of patients who are discharged before all the lab results come back. Those results are returned to the physician who ordered them – most likely the hospitalist – and frequently stop there. "No one ever communicates the results to the PCP [primary care physician], and the attendings don’t review them," because the patient is no longer under their care, said Dr. Dalal, a hospitalist at Brigham and Women’s Hospital in Boston.

To address the problem, he conceived of and helped create a computer algorithm that automatically detects incoming test results and generates a single e-mail to the patient’s hospital attending and primary care physician. The system updates at midnight and keeps generating one e-mail a day to each provider until all results are finalized.

"Every e-mail has the date it was generated, the patient’s name, name of the discharging attending physician, the day of discharge, and the results of each test," Dr. Dalal said.

While the system is feasible in a large, interconnected health care system, it isn’t foolproof, he added. Sometimes, physicians outside the Partners e-mail system admit a patient; in that case only the hospitalist gets the e-mail. "But it always has the phone number of the primary care doc, so the hospitalist can call and relay the results."

The 1-month pilot period included chemistry/hematology, radiology/pathology, and microbiology results. It was tested on 83 discharges – including the one that caused the electronic mayhem. After excluding that one, Dr. Dalal said, the computer program found 405 pending tests, most of which (55%) were chemistry, while the remainder were hematology; 18% were abnormal. This generated 136 e-mails – about 1.7 per patient, although 34% of the patients had 2 or more e-mails sent. Aside from complaints about the inaccurate discharge, only three physicians (two PCPs and one hospitalist) said they received incorrect e-mails.

A survey of 70 physician users found that 84% were satisfied or very satisfied with the system, while 6% were neutral and 10% dissatisfied or very dissatisfied.

Comments from both sides of the issue included remarks such as "I found this extremely useful, knowing the final results of tests, both those that are positive as well as negative," and "Test was not needed and not ordered by me."

Dr. Dalal also presented a poster that examined the system’s 6-month outcomes among 36 discharging physicians who got the e-mails and 43 who did not. Physicians who got the e-mails were six times more likely to be aware of the results of any pending test, and five times more aware of any pending tests that required action on their part.

They were also significantly more likely to be satisfied with the automatic notification system than with the usual care system (84% vs. 21%).

In considering the impact of this novel collaboration on patient care, Dr. Dalal said, "I would challenge you on the thought that our responsibility as hospitalists ends when the patient is discharged. Does it really, especially as we are doing all this work on care transition and decreased readmission? We are going to become the care transition experts; we need to think of whether we are responsible for these results."

Dr. Dalal reported having no financial disclosures.

GRAPEVINE, TEX. – E-mailing the results of tests still pending at patient discharge is a feasible solution to the "I never got this message" scenario.

Such a pilot project performed well for hospitalists and primary care doctors in the Partners HealthCare System’s "partners.org" database, Dr. Anuj K. Dalal said at the annual meeting of the Society of Hospital Medicine.

However, he warned, unless system bugs are hunted down and exterminated before deployment, one inaccurate discharge entry could set up a domino-effect deluge of e-mails to peeved primary care physicians.

"One unit clerk inadvertently ‘discharged’ a patient on day 4 of a 10-day hospital stay," he said. "The system then detected 510 pending tests at discharge, which resulted in nine e-mails to one very frustrated physician. I can’t tell you how important it is to have the process crisp before you jump into something like this. You have to remember the computer adage, ‘Garbage in, garbage out.’ "

He points to the not-uncommon scenario of patients who are discharged before all the lab results come back. Those results are returned to the physician who ordered them – most likely the hospitalist – and frequently stop there. "No one ever communicates the results to the PCP [primary care physician], and the attendings don’t review them," because the patient is no longer under their care, said Dr. Dalal, a hospitalist at Brigham and Women’s Hospital in Boston.

To address the problem, he conceived of and helped create a computer algorithm that automatically detects incoming test results and generates a single e-mail to the patient’s hospital attending and primary care physician. The system updates at midnight and keeps generating one e-mail a day to each provider until all results are finalized.

"Every e-mail has the date it was generated, the patient’s name, name of the discharging attending physician, the day of discharge, and the results of each test," Dr. Dalal said.

While the system is feasible in a large, interconnected health care system, it isn’t foolproof, he added. Sometimes, physicians outside the Partners e-mail system admit a patient; in that case only the hospitalist gets the e-mail. "But it always has the phone number of the primary care doc, so the hospitalist can call and relay the results."

The 1-month pilot period included chemistry/hematology, radiology/pathology, and microbiology results. It was tested on 83 discharges – including the one that caused the electronic mayhem. After excluding that one, Dr. Dalal said, the computer program found 405 pending tests, most of which (55%) were chemistry, while the remainder were hematology; 18% were abnormal. This generated 136 e-mails – about 1.7 per patient, although 34% of the patients had 2 or more e-mails sent. Aside from complaints about the inaccurate discharge, only three physicians (two PCPs and one hospitalist) said they received incorrect e-mails.

A survey of 70 physician users found that 84% were satisfied or very satisfied with the system, while 6% were neutral and 10% dissatisfied or very dissatisfied.

Comments from both sides of the issue included remarks such as "I found this extremely useful, knowing the final results of tests, both those that are positive as well as negative," and "Test was not needed and not ordered by me."

Dr. Dalal also presented a poster that examined the system’s 6-month outcomes among 36 discharging physicians who got the e-mails and 43 who did not. Physicians who got the e-mails were six times more likely to be aware of the results of any pending test, and five times more aware of any pending tests that required action on their part.

They were also significantly more likely to be satisfied with the automatic notification system than with the usual care system (84% vs. 21%).

In considering the impact of this novel collaboration on patient care, Dr. Dalal said, "I would challenge you on the thought that our responsibility as hospitalists ends when the patient is discharged. Does it really, especially as we are doing all this work on care transition and decreased readmission? We are going to become the care transition experts; we need to think of whether we are responsible for these results."

Dr. Dalal reported having no financial disclosures.

GRAPEVINE, TEX. – E-mailing the results of tests still pending at patient discharge is a feasible solution to the "I never got this message" scenario.

Such a pilot project performed well for hospitalists and primary care doctors in the Partners HealthCare System’s "partners.org" database, Dr. Anuj K. Dalal said at the annual meeting of the Society of Hospital Medicine.

However, he warned, unless system bugs are hunted down and exterminated before deployment, one inaccurate discharge entry could set up a domino-effect deluge of e-mails to peeved primary care physicians.

"One unit clerk inadvertently ‘discharged’ a patient on day 4 of a 10-day hospital stay," he said. "The system then detected 510 pending tests at discharge, which resulted in nine e-mails to one very frustrated physician. I can’t tell you how important it is to have the process crisp before you jump into something like this. You have to remember the computer adage, ‘Garbage in, garbage out.’ "

He points to the not-uncommon scenario of patients who are discharged before all the lab results come back. Those results are returned to the physician who ordered them – most likely the hospitalist – and frequently stop there. "No one ever communicates the results to the PCP [primary care physician], and the attendings don’t review them," because the patient is no longer under their care, said Dr. Dalal, a hospitalist at Brigham and Women’s Hospital in Boston.

To address the problem, he conceived of and helped create a computer algorithm that automatically detects incoming test results and generates a single e-mail to the patient’s hospital attending and primary care physician. The system updates at midnight and keeps generating one e-mail a day to each provider until all results are finalized.

"Every e-mail has the date it was generated, the patient’s name, name of the discharging attending physician, the day of discharge, and the results of each test," Dr. Dalal said.

While the system is feasible in a large, interconnected health care system, it isn’t foolproof, he added. Sometimes, physicians outside the Partners e-mail system admit a patient; in that case only the hospitalist gets the e-mail. "But it always has the phone number of the primary care doc, so the hospitalist can call and relay the results."

The 1-month pilot period included chemistry/hematology, radiology/pathology, and microbiology results. It was tested on 83 discharges – including the one that caused the electronic mayhem. After excluding that one, Dr. Dalal said, the computer program found 405 pending tests, most of which (55%) were chemistry, while the remainder were hematology; 18% were abnormal. This generated 136 e-mails – about 1.7 per patient, although 34% of the patients had 2 or more e-mails sent. Aside from complaints about the inaccurate discharge, only three physicians (two PCPs and one hospitalist) said they received incorrect e-mails.

A survey of 70 physician users found that 84% were satisfied or very satisfied with the system, while 6% were neutral and 10% dissatisfied or very dissatisfied.

Comments from both sides of the issue included remarks such as "I found this extremely useful, knowing the final results of tests, both those that are positive as well as negative," and "Test was not needed and not ordered by me."

Dr. Dalal also presented a poster that examined the system’s 6-month outcomes among 36 discharging physicians who got the e-mails and 43 who did not. Physicians who got the e-mails were six times more likely to be aware of the results of any pending test, and five times more aware of any pending tests that required action on their part.

They were also significantly more likely to be satisfied with the automatic notification system than with the usual care system (84% vs. 21%).

In considering the impact of this novel collaboration on patient care, Dr. Dalal said, "I would challenge you on the thought that our responsibility as hospitalists ends when the patient is discharged. Does it really, especially as we are doing all this work on care transition and decreased readmission? We are going to become the care transition experts; we need to think of whether we are responsible for these results."

Dr. Dalal reported having no financial disclosures.

GRAPEVINE, TEX. – E-mailing the results of tests still pending at patient discharge is a feasible solution to the "I never got this message" scenario.

Such a pilot project performed well for hospitalists and primary care doctors in the Partners HealthCare System’s "partners.org" database, Dr. Anuj K. Dalal said at the annual meeting of the Society of Hospital Medicine.

However, he warned, unless system bugs are hunted down and exterminated before deployment, one inaccurate discharge entry could set up a domino-effect deluge of e-mails to peeved primary care physicians.

"One unit clerk inadvertently ‘discharged’ a patient on day 4 of a 10-day hospital stay," he said. "The system then detected 510 pending tests at discharge, which resulted in nine e-mails to one very frustrated physician. I can’t tell you how important it is to have the process crisp before you jump into something like this. You have to remember the computer adage, ‘Garbage in, garbage out.’ "

He points to the not-uncommon scenario of patients who are discharged before all the lab results come back. Those results are returned to the physician who ordered them – most likely the hospitalist – and frequently stop there. "No one ever communicates the results to the PCP [primary care physician], and the attendings don’t review them," because the patient is no longer under their care, said Dr. Dalal, a hospitalist at Brigham and Women’s Hospital in Boston.

To address the problem, he conceived of and helped create a computer algorithm that automatically detects incoming test results and generates a single e-mail to the patient’s hospital attending and primary care physician. The system updates at midnight and keeps generating one e-mail a day to each provider until all results are finalized.

"Every e-mail has the date it was generated, the patient’s name, name of the discharging attending physician, the day of discharge, and the results of each test," Dr. Dalal said.

While the system is feasible in a large, interconnected health care system, it isn’t foolproof, he added. Sometimes, physicians outside the Partners e-mail system admit a patient; in that case only the hospitalist gets the e-mail. "But it always has the phone number of the primary care doc, so the hospitalist can call and relay the results."

The 1-month pilot period included chemistry/hematology, radiology/pathology, and microbiology results. It was tested on 83 discharges – including the one that caused the electronic mayhem. After excluding that one, Dr. Dalal said, the computer program found 405 pending tests, most of which (55%) were chemistry, while the remainder were hematology; 18% were abnormal. This generated 136 e-mails – about 1.7 per patient, although 34% of the patients had 2 or more e-mails sent. Aside from complaints about the inaccurate discharge, only three physicians (two PCPs and one hospitalist) said they received incorrect e-mails.

A survey of 70 physician users found that 84% were satisfied or very satisfied with the system, while 6% were neutral and 10% dissatisfied or very dissatisfied.

Comments from both sides of the issue included remarks such as "I found this extremely useful, knowing the final results of tests, both those that are positive as well as negative," and "Test was not needed and not ordered by me."

Dr. Dalal also presented a poster that examined the system’s 6-month outcomes among 36 discharging physicians who got the e-mails and 43 who did not. Physicians who got the e-mails were six times more likely to be aware of the results of any pending test, and five times more aware of any pending tests that required action on their part.

They were also significantly more likely to be satisfied with the automatic notification system than with the usual care system (84% vs. 21%).

In considering the impact of this novel collaboration on patient care, Dr. Dalal said, "I would challenge you on the thought that our responsibility as hospitalists ends when the patient is discharged. Does it really, especially as we are doing all this work on care transition and decreased readmission? We are going to become the care transition experts; we need to think of whether we are responsible for these results."

Dr. Dalal reported having no financial disclosures.

GRAPEVINE, TEX. – E-mailing the results of tests still pending at patient discharge is a feasible solution to the "I never got this message" scenario.

Such a pilot project performed well for hospitalists and primary care doctors in the Partners HealthCare System’s "partners.org" database, Dr. Anuj K. Dalal said at the annual meeting of the Society of Hospital Medicine.

However, he warned, unless system bugs are hunted down and exterminated before deployment, one inaccurate discharge entry could set up a domino-effect deluge of e-mails to peeved primary care physicians.

"One unit clerk inadvertently ‘discharged’ a patient on day 4 of a 10-day hospital stay," he said. "The system then detected 510 pending tests at discharge, which resulted in nine e-mails to one very frustrated physician. I can’t tell you how important it is to have the process crisp before you jump into something like this. You have to remember the computer adage, ‘Garbage in, garbage out.’ "

He points to the not-uncommon scenario of patients who are discharged before all the lab results come back. Those results are returned to the physician who ordered them – most likely the hospitalist – and frequently stop there. "No one ever communicates the results to the PCP [primary care physician], and the attendings don’t review them," because the patient is no longer under their care, said Dr. Dalal, a hospitalist at Brigham and Women’s Hospital in Boston.

To address the problem, he conceived of and helped create a computer algorithm that automatically detects incoming test results and generates a single e-mail to the patient’s hospital attending and primary care physician. The system updates at midnight and keeps generating one e-mail a day to each provider until all results are finalized.

"Every e-mail has the date it was generated, the patient’s name, name of the discharging attending physician, the day of discharge, and the results of each test," Dr. Dalal said.

While the system is feasible in a large, interconnected health care system, it isn’t foolproof, he added. Sometimes, physicians outside the Partners e-mail system admit a patient; in that case only the hospitalist gets the e-mail. "But it always has the phone number of the primary care doc, so the hospitalist can call and relay the results."

The 1-month pilot period included chemistry/hematology, radiology/pathology, and microbiology results. It was tested on 83 discharges – including the one that caused the electronic mayhem. After excluding that one, Dr. Dalal said, the computer program found 405 pending tests, most of which (55%) were chemistry, while the remainder were hematology; 18% were abnormal. This generated 136 e-mails – about 1.7 per patient, although 34% of the patients had 2 or more e-mails sent. Aside from complaints about the inaccurate discharge, only three physicians (two PCPs and one hospitalist) said they received incorrect e-mails.

A survey of 70 physician users found that 84% were satisfied or very satisfied with the system, while 6% were neutral and 10% dissatisfied or very dissatisfied.

Comments from both sides of the issue included remarks such as "I found this extremely useful, knowing the final results of tests, both those that are positive as well as negative," and "Test was not needed and not ordered by me."

Dr. Dalal also presented a poster that examined the system’s 6-month outcomes among 36 discharging physicians who got the e-mails and 43 who did not. Physicians who got the e-mails were six times more likely to be aware of the results of any pending test, and five times more aware of any pending tests that required action on their part.

They were also significantly more likely to be satisfied with the automatic notification system than with the usual care system (84% vs. 21%).

In considering the impact of this novel collaboration on patient care, Dr. Dalal said, "I would challenge you on the thought that our responsibility as hospitalists ends when the patient is discharged. Does it really, especially as we are doing all this work on care transition and decreased readmission? We are going to become the care transition experts; we need to think of whether we are responsible for these results."

Dr. Dalal reported having no financial disclosures.

GRAPEVINE, TEX. – E-mailing the results of tests still pending at patient discharge is a feasible solution to the "I never got this message" scenario.

Such a pilot project performed well for hospitalists and primary care doctors in the Partners HealthCare System’s "partners.org" database, Dr. Anuj K. Dalal said at the annual meeting of the Society of Hospital Medicine.

However, he warned, unless system bugs are hunted down and exterminated before deployment, one inaccurate discharge entry could set up a domino-effect deluge of e-mails to peeved primary care physicians.

"One unit clerk inadvertently ‘discharged’ a patient on day 4 of a 10-day hospital stay," he said. "The system then detected 510 pending tests at discharge, which resulted in nine e-mails to one very frustrated physician. I can’t tell you how important it is to have the process crisp before you jump into something like this. You have to remember the computer adage, ‘Garbage in, garbage out.’ "

He points to the not-uncommon scenario of patients who are discharged before all the lab results come back. Those results are returned to the physician who ordered them – most likely the hospitalist – and frequently stop there. "No one ever communicates the results to the PCP [primary care physician], and the attendings don’t review them," because the patient is no longer under their care, said Dr. Dalal, a hospitalist at Brigham and Women’s Hospital in Boston.

To address the problem, he conceived of and helped create a computer algorithm that automatically detects incoming test results and generates a single e-mail to the patient’s hospital attending and primary care physician. The system updates at midnight and keeps generating one e-mail a day to each provider until all results are finalized.

"Every e-mail has the date it was generated, the patient’s name, name of the discharging attending physician, the day of discharge, and the results of each test," Dr. Dalal said.

While the system is feasible in a large, interconnected health care system, it isn’t foolproof, he added. Sometimes, physicians outside the Partners e-mail system admit a patient; in that case only the hospitalist gets the e-mail. "But it always has the phone number of the primary care doc, so the hospitalist can call and relay the results."

The 1-month pilot period included chemistry/hematology, radiology/pathology, and microbiology results. It was tested on 83 discharges – including the one that caused the electronic mayhem. After excluding that one, Dr. Dalal said, the computer program found 405 pending tests, most of which (55%) were chemistry, while the remainder were hematology; 18% were abnormal. This generated 136 e-mails – about 1.7 per patient, although 34% of the patients had 2 or more e-mails sent. Aside from complaints about the inaccurate discharge, only three physicians (two PCPs and one hospitalist) said they received incorrect e-mails.

A survey of 70 physician users found that 84% were satisfied or very satisfied with the system, while 6% were neutral and 10% dissatisfied or very dissatisfied.

Comments from both sides of the issue included remarks such as "I found this extremely useful, knowing the final results of tests, both those that are positive as well as negative," and "Test was not needed and not ordered by me."

Dr. Dalal also presented a poster that examined the system’s 6-month outcomes among 36 discharging physicians who got the e-mails and 43 who did not. Physicians who got the e-mails were six times more likely to be aware of the results of any pending test, and five times more aware of any pending tests that required action on their part.

They were also significantly more likely to be satisfied with the automatic notification system than with the usual care system (84% vs. 21%).

In considering the impact of this novel collaboration on patient care, Dr. Dalal said, "I would challenge you on the thought that our responsibility as hospitalists ends when the patient is discharged. Does it really, especially as we are doing all this work on care transition and decreased readmission? We are going to become the care transition experts; we need to think of whether we are responsible for these results."

Dr. Dalal reported having no financial disclosures.

GRAPEVINE, TEX. – E-mailing the results of tests still pending at patient discharge is a feasible solution to the "I never got this message" scenario.

Such a pilot project performed well for hospitalists and primary care doctors in the Partners HealthCare System’s "partners.org" database, Dr. Anuj K. Dalal said at the annual meeting of the Society of Hospital Medicine.

However, he warned, unless system bugs are hunted down and exterminated before deployment, one inaccurate discharge entry could set up a domino-effect deluge of e-mails to peeved primary care physicians.

"One unit clerk inadvertently ‘discharged’ a patient on day 4 of a 10-day hospital stay," he said. "The system then detected 510 pending tests at discharge, which resulted in nine e-mails to one very frustrated physician. I can’t tell you how important it is to have the process crisp before you jump into something like this. You have to remember the computer adage, ‘Garbage in, garbage out.’ "

He points to the not-uncommon scenario of patients who are discharged before all the lab results come back. Those results are returned to the physician who ordered them – most likely the hospitalist – and frequently stop there. "No one ever communicates the results to the PCP [primary care physician], and the attendings don’t review them," because the patient is no longer under their care, said Dr. Dalal, a hospitalist at Brigham and Women’s Hospital in Boston.

To address the problem, he conceived of and helped create a computer algorithm that automatically detects incoming test results and generates a single e-mail to the patient’s hospital attending and primary care physician. The system updates at midnight and keeps generating one e-mail a day to each provider until all results are finalized.

"Every e-mail has the date it was generated, the patient’s name, name of the discharging attending physician, the day of discharge, and the results of each test," Dr. Dalal said.

While the system is feasible in a large, interconnected health care system, it isn’t foolproof, he added. Sometimes, physicians outside the Partners e-mail system admit a patient; in that case only the hospitalist gets the e-mail. "But it always has the phone number of the primary care doc, so the hospitalist can call and relay the results."

The 1-month pilot period included chemistry/hematology, radiology/pathology, and microbiology results. It was tested on 83 discharges – including the one that caused the electronic mayhem. After excluding that one, Dr. Dalal said, the computer program found 405 pending tests, most of which (55%) were chemistry, while the remainder were hematology; 18% were abnormal. This generated 136 e-mails – about 1.7 per patient, although 34% of the patients had 2 or more e-mails sent. Aside from complaints about the inaccurate discharge, only three physicians (two PCPs and one hospitalist) said they received incorrect e-mails.

A survey of 70 physician users found that 84% were satisfied or very satisfied with the system, while 6% were neutral and 10% dissatisfied or very dissatisfied.

Comments from both sides of the issue included remarks such as "I found this extremely useful, knowing the final results of tests, both those that are positive as well as negative," and "Test was not needed and not ordered by me."

Dr. Dalal also presented a poster that examined the system’s 6-month outcomes among 36 discharging physicians who got the e-mails and 43 who did not. Physicians who got the e-mails were six times more likely to be aware of the results of any pending test, and five times more aware of any pending tests that required action on their part.

They were also significantly more likely to be satisfied with the automatic notification system than with the usual care system (84% vs. 21%).

In considering the impact of this novel collaboration on patient care, Dr. Dalal said, "I would challenge you on the thought that our responsibility as hospitalists ends when the patient is discharged. Does it really, especially as we are doing all this work on care transition and decreased readmission? We are going to become the care transition experts; we need to think of whether we are responsible for these results."

Dr. Dalal reported having no financial disclosures.

GRAPEVINE, TEX. – E-mailing the results of tests still pending at patient discharge is a feasible solution to the "I never got this message" scenario.

Such a pilot project performed well for hospitalists and primary care doctors in the Partners HealthCare System’s "partners.org" database, Dr. Anuj K. Dalal said at the annual meeting of the Society of Hospital Medicine.

However, he warned, unless system bugs are hunted down and exterminated before deployment, one inaccurate discharge entry could set up a domino-effect deluge of e-mails to peeved primary care physicians.

"One unit clerk inadvertently ‘discharged’ a patient on day 4 of a 10-day hospital stay," he said. "The system then detected 510 pending tests at discharge, which resulted in nine e-mails to one very frustrated physician. I can’t tell you how important it is to have the process crisp before you jump into something like this. You have to remember the computer adage, ‘Garbage in, garbage out.’ "

He points to the not-uncommon scenario of patients who are discharged before all the lab results come back. Those results are returned to the physician who ordered them – most likely the hospitalist – and frequently stop there. "No one ever communicates the results to the PCP [primary care physician], and the attendings don’t review them," because the patient is no longer under their care, said Dr. Dalal, a hospitalist at Brigham and Women’s Hospital in Boston.

To address the problem, he conceived of and helped create a computer algorithm that automatically detects incoming test results and generates a single e-mail to the patient’s hospital attending and primary care physician. The system updates at midnight and keeps generating one e-mail a day to each provider until all results are finalized.

"Every e-mail has the date it was generated, the patient’s name, name of the discharging attending physician, the day of discharge, and the results of each test," Dr. Dalal said.

While the system is feasible in a large, interconnected health care system, it isn’t foolproof, he added. Sometimes, physicians outside the Partners e-mail system admit a patient; in that case only the hospitalist gets the e-mail. "But it always has the phone number of the primary care doc, so the hospitalist can call and relay the results."

The 1-month pilot period included chemistry/hematology, radiology/pathology, and microbiology results. It was tested on 83 discharges – including the one that caused the electronic mayhem. After excluding that one, Dr. Dalal said, the computer program found 405 pending tests, most of which (55%) were chemistry, while the remainder were hematology; 18% were abnormal. This generated 136 e-mails – about 1.7 per patient, although 34% of the patients had 2 or more e-mails sent. Aside from complaints about the inaccurate discharge, only three physicians (two PCPs and one hospitalist) said they received incorrect e-mails.

A survey of 70 physician users found that 84% were satisfied or very satisfied with the system, while 6% were neutral and 10% dissatisfied or very dissatisfied.

Comments from both sides of the issue included remarks such as "I found this extremely useful, knowing the final results of tests, both those that are positive as well as negative," and "Test was not needed and not ordered by me."

Dr. Dalal also presented a poster that examined the system’s 6-month outcomes among 36 discharging physicians who got the e-mails and 43 who did not. Physicians who got the e-mails were six times more likely to be aware of the results of any pending test, and five times more aware of any pending tests that required action on their part.

They were also significantly more likely to be satisfied with the automatic notification system than with the usual care system (84% vs. 21%).

In considering the impact of this novel collaboration on patient care, Dr. Dalal said, "I would challenge you on the thought that our responsibility as hospitalists ends when the patient is discharged. Does it really, especially as we are doing all this work on care transition and decreased readmission? We are going to become the care transition experts; we need to think of whether we are responsible for these results."

Dr. Dalal reported having no financial disclosures.