Posts by Leslie Flores

Will Nurses Be Part of the Answer to HM Sustainability?

by Leslie Flores
In my last post I suggested that in order for hospital medicine to be both financially and professionally sustainable, we need to figure out how hospitalists can see more patients each day while at the same time be more satisfied with their work. One possible approach to achieving this aim is to support physician hospitalists with less costly staff doing work not requiring a physician’s license or expertise. The most common skill mix diversification approach in Hospital Medicine Groups (HMGs) has been to add NPs and/or PAs to the team. SHM’s 2014 State of Hospital Medicine Report indicates that more than 65% of HMGs serving adults have one or more NP/PAs practicing in them. Over the last year or two, though, I’ve increasingly encountered the presence of nurses (usually RNs, though sometimes LPNs) in clinical roles supporting hospitalist practices. A few groups have incorporated nurses for years, but now more…
Leslie Flores is a founding partner at Nelson Flores Hospital Medicine Consultants, a consulting practice that has specialized in helping clients enhance the effectiveness and value of hospital medicine programs as well as those in other hospital-focused practice specialties since 20104. Ms. Flores began her career as a hospital executive, after receiving a BS degree in biological sciences at the University of California at Irvine and a Master’s in healthcare administration from the University of Minnesota. In addition to her leadership experience in hospital operations, business development, managed care and physician relations, she has provided consulting, training and leadership coaching services for hospitals, physician groups, and other healthcare organizations. Ms. Flores is an active speaker and writer on hospitalist practice management topics and serves on SHM’s Practice Analysis and Annual Meeting Committees. She serves as an informal advisor to SHM on practice management-related issues and helps to coordinate SHM’s bi-annual State of Hospital Medicine Survey.

Making Hospital Medicine a Sustainable Specialty

Despite hospital medicine’s meteoric rise as the fastest-growing specialty in history and the fact that there are almost 50,000 hospitalists in the U.S. today, I’m a little worried about the future of the specialty. There are two conflicting messages I’m hearing increasingly in the work we do with hospitalist practices around the country. Hospital executives are telling us, “Our hospitalist program is too expensive and the cost is simply unsustainable.” But at the same time we are hearing too many hospitalists saying, “This job is way too hard and just not rewarding – I’m not sure how much longer I can do it.” Over the last couple of years I’ve noticed what appears to be a trend of declining hospitalist morale. There are probably a variety of factors at play, including: Rising cost pressures, as hospitals struggle with supporting more physicians across multiple specialties on declining revenue. The widespread adoption of…

Do Hospitalists Need Paid Time Off?

by Leslie Flores, MHA, SFHM Does paid time off (PTO) make sense for physicians like hospitalists and ED docs who are largely shift workers? I guess it depends on your perspective, though I have some definite opinions of my own. But before sharing my thoughts on the value of PTO for hospitalists, it might be instructive to understand a bit about the current state of PTO in hospital medicine groups. It’s hard to know what to make of the information that’s currently available about PTO for hospitalists. Only about 31% of hospital medicine groups serving adult patients provide some paid time off, according to SHM’s 2014 State of Hospital Medicine Survey, though the prevalence of PTO is much higher in academic groups (55%) than non-academic groups (27%). And academic groups provide a median of 208 hours of PTO annually while non-academic groups provide a median of 120 hours annually. But…

Hospitalist Turnover’s a Big Problem – Or is it?

Leslie Flores writes... When you ask hospitalist physician leaders or practice administrators about their most pressing challenges and concerns, physician recruitment and retention are always high on the list.  You have a heck of a time finding a hospitalist to join your practice, and the minute you do one of your existing hospitalists decides to leave – so you are always playing catch-up.  In fact the Phoenix Group, a think tank comprised of representatives from many of the nation’s largest private hospital medicine groups, recently identified the hospitalist workforce shortage as the single most urgent issue demanding the specialty’s attention (see the Phoenix Group’s white paper “Confronting the Hospitalist Workforce Shortage”). (more…)

Welcome to SHM’s newest online endeavor, The Hospitalist Leader blog

Leslie Flores writes... Welcome to SHM's newest online endeavor, The Hospitalist Leader blog.  Your blogging team is excited about this great opportunity to explore a wide range of practice management topics, and we hope that our posts invite a lot of member interaction, interesting dialogue, and the regular expression of differing opinions and points of view. Our goal is to offer commentaries about current hospitalist practice management issues that are interesting, insightful, original, and even occasionally a bit provocative.  We aim to serve as a resource and to educate - but even more important, we want to foster broader thinking and a free exchange of perspectives and ideas that will ultimately lead to innovation and new best practices. (more…)