Career Development

Who Is Driving the Bus?

You are a hospitalist. Like all hospitalists, you struggle with the pace, the hours, the complexity of demands placed upon your clinical time, the dratted medical record, burnout. You sometimes feel the collaborative process with your consulting colleagues could be improved. You often feel that you are treated like a “glorified resident”, with consultants, or others, dictating the care to you. You resent that is seems you are there only to admit or discharge or cover the less appealing weekend and holiday shifts. These feelings are legitimate. They are also common. But allow me to ask: Are you driving the care? Are you owning the hospital space? Are you reaching out to communicate with your consultants? Are you discussing the case? Are you driving the bus? Because as a hospitalist, you can’t have it both ways. You can’t complain that you aren’t treated with the respect that I know your…

Survey Says…

It’s that time of (every other) year! Once again, your hospital medicine group (HMG) has a unique opportunity to contribute to our collective understanding of the current state of hospital medicine in the United States. SHM’s State of Hospital Medicine Survey kicked off this week and will be open until February 16th. I strongly urge you to take the time to participate. I have been integrally involved in SHM’s survey processes since 2006 and am deeply committed to this important work that SHM does on behalf of its members and the entire specialty of hospital medicine. Here are several reasons why it’s more important than ever that your group participate this year. The information contained in the State of Hospital Medicine Report is used by HMGs – and by hospital and physician enterprise leaders – to justify proposals and make operational decisions. The field of hospital medicine is evolving rapidly…

Augh! I Just Got Laid Off! What Now?

Wait a minute. Isn’t there an ongoing national shortage of hospitalists? Don’t most hospital medicine groups have trouble recruiting enough providers? You wouldn’t think hospitalists would be at much risk for being laid off. But believe it or not, it does happen. Management companies lose contracts. Hospitals get acquired or lose a big book of business. Some administrator decides NP/PAs are more cost-effective than doctors. And – if our work with hospitalist groups around the country is any indicator – large integrated delivery systems are increasingly expecting top-quartile productivity from their physicians across all specialties, which means more work with fewer resources. I worked with a hospitalist program recently that has laid off several NP/PAs in an effort to improve productivity and financial performance; they haven’t yet laid off any doctors, but it could still happen. While it’s still rare, I expect that hospitalists will become more vulnerable to layoffs…

Rounds: Are We Spinning our Wheels?

As a Johns Hopkins undergraduate, I used to run the Welch lecture series in medical history. Through this role, I learned about an interesting tidbit – the origin of the word “rounds.” Johns Hopkins Hospital had a circular ward where the infamous and quotable Dr. Osler made his “rounds” to see patients. While medicine has come a long way since Osler’s days, have rounds? This is the crux of a paper in the Journal of Hospital Medicine by led one of our former Pritzker students Olliver Hulland along with mentors and hospitalists Dr. Jeanne Farnan and Dr. Barrett Fromme. In a 3-site study with UCSF and Georgetown, they conducted focus groups with attendings and medical students to ask the quintessential question, “What is the purpose of rounds?” Interestingly, the answers were markedly similar and revealed the multi-faceted nature of rounds: Communication, which included coordination of patient care team, patient/family communication,…

Making the Implicit Explicit

Last month, I wrote about some interesting workplace trends, in particular about how the implied compact between U.S. workers and their employers is evolving rapidly. Few of us in the workforce today can conceive of an employment relationship in which we are guaranteed lifelong employment and a generous benefits package including full healthcare and retirement in exchange for hard work and loyalty to a single employer. Since then, I’ve had several conversations about the term “compact” as I used it in that post. At its most fundamental, a compact is an agreement between two or more parties. In my recent post, I used the term to refer to the generally accepted but rarely articulated set of expectations that workers and their employers have of each other. There is an implied compact between physicians and the hospitals where they practice as well. Historically that compact assumed that doctors would refer lots…
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