Posts by Leslie Flores

Hospitalist Career Sustainability in the Face of Clinical Scope Expansion

We all know that hospitalists’ scope of clinical practice has been evolving in significant ways for a number of years. At many hospitals virtually all medical subspecialists have backed away from active attending roles and serve only as consultants. Surgeons are demanding greater hospitalist participation in surgical co-management, often as admitting/attending physician. For example, I’m guessing that around 70 or 75% of non-academic hospitalist practices now serve as admitting/attending physician for all hip fracture patients – though my experience is anecdotal and I’m not aware of any hard data about this. In larger hospitalist programs we are seeing some hospitalists dedicate their full professional focus to the general medical care of oncology patients, or stroke patients, or hip fracture patients. Hard-pressed intensivists are asking hospitalists to care for more ICU or step-down patients or to provide nighttime ICU coverage. And hospital administrators increasingly see their hospitalists as the answer to…

A Perfect Storm

What’s a hospitalist leader to do when everything seems to be conspiring against your efforts to ensure a stable, successful hospital medicine practice? I talked recently with a hospitalist leader who is dealing with just such a scenario right now. When I visited his hospitalist practice at a small private health system of around 300 beds in a very attractive – but fairly rural – part of the country a couple of years ago, the hospitalist group of 21 docs and 5 NP/PAs was stable and high-functioning. They wanted help primarily with a few schedule and compensation issues, and they also wanted to be proactive in addressing some nascent angst related to a couple of recently-piloted work flow changes. Through our work together the group made several adjustments that were well received by the providers, and the last time I talked with the medical director things seemed to be going…

What I Did on My Summer Vacation

One of the best parts of my “job” as a more-or-less emeritus member of SHM’s Practice Analysis Committee is the chance to be involved up close and personal in the development, analysis, and reporting of the biannual State of Hospital Medicine (SoHM) survey. In fact, I’ve either led or been integrally involved in every SoHM survey since 2006, and that has enabled me to gain an extremely valuable perspective on how the specialty of hospital medicine has evolved over the last 10 years. During the last few weeks, I’ve been up to my eyeballs reviewing sections of the new 2016 survey report that were drafted – as was the case in 2014 – by Patrick Vulgamore, MPH, SHM staffer extraordinaire. While some of the data is still being analyzed, my excitement is growing about the new survey results. The State of Hospital Medicine Report will be available to the public…

Next Step in Sustainability: Re-Thinking How Hospitalists Organize Their Work

Do we really need another commentary on the shortcomings of the 7-on/7-off work schedule?  My colleague John Nelson has written and spoken about this extensively, most recently in his January 2016 column in The Hospitalist.  And while I’ve been planning to write this post for a while, Bob Wachter got the jump on me by famously declaring at his HM16 closing presentation in March that “I think one thing we got wrong was a 7-days-on/7-days-off schedule.”  Nevertheless, I can’t resist weighing in. When I first started working with hospitalist groups more than a dozen years ago, hospitalists routinely told me that the 7-on/7-off schedule was one of the main reasons they chose to go into this specialty.  But too often when I visit groups today there are at least a few more experienced doctors who say they are thinking of leaving the field if they can’t find an alternative to…

A Link between Hospitalist Morale and Retention?

Many observers of our specialty tend to think of hospitalists as itinerant shift workers, many of whom have little emotional commitment to the organization that employs them and will quickly decide to leave for another job where the grass is greener.  Even my colleague John Nelson often describes hospitalists as preferring to “date” rather than “marry” their practice.  And more than one hospital executive has told me, “They’re just going to leave in a couple years anyway, so why should we invest a lot in their development and morale?”   But there’s at least one organization where hospitalist group leaders see things differently, and are working hard to understand the determinants of hospitalist wellbeing and the relationship between wellbeing and retention.  I recently spoke with Dr. Shalini Chandra at Johns Hopkins Bayview Medical Center (JHBMC), lead author of an article recently posted online by the Journal of Hospital Medicine about…