Career Development

Male Versus Female Hospitalists

If you have paid attention to the news, you picked up the study out in JAMA concerning how male versus female physicians deliver inpatient care.  Not just any inpatient docs, though, but hospitalists. The investigators were meticulous in their analysis of over a million Medicare beneficiaries and looked at readmit and mortality rates.  They examined various diagnoses and adjusted for the usual doctor and hospital characteristics. Across the board, males took a drubbing and the NNT for both outcomes of interest hovered around 200 (0.5% absolute difference). Ashish Jha, one of the investigators and a leader in the study of hospital quality and safety (who really needs to speak at an SHM annual, incidentally) goes into more depth over at his blog: (more…)

How I Realized QI Could Be a Dirty Word

With the recent election, there has been a new recognition of the various “bubbles” we all seem to be living in. It reminds me of the parable I like to often mention, popularized by the late great writer David Foster Wallace: Two fish were swimming along when an older fish swam by, nodded his head at them and said, “Mornin’ boys, how’s the water?” The two young fish nod back and swim for a bit, then one turns to the other and says, “What the hell is water?” Recently, I read a paper that helped me realize I had been swimming in a different lake from most of the “real world” in medicine. I trained and then spent the first 4 years of my post-residency career at UCSF, where quality improvement (QI) was well established and celebrated. Sure, I suppose there were some eye rolls from a few surgeons, or…

Pressure Drop

A famous joke in hospital medicine is Mitch Wilson’s oft quoted statement: “When you have seen one hospitalist group you have seen one hospitalist group.” It is true that there is much variety in comparing one practice to another. Maybe that’s why our specialty has such vigor; we are constantly trying to learn from each other and decipher and decode the problems in hospital medicine. But there is definitely one commonality in hospital medicine: pressure. We are pressured to take more patients and own more aspects of the in-hospital and post-hospital space. We are pressured to find providers, and that’s not easy to do in an environment where your neighbor might be offering more money or fewer hours to that treasured provider. This pressure on adequate and stable staffing is worsened by the shrinking reimbursements on the hospital side. A model where there is fierce competition for providers and shrinking…

Next on #JHMChat: Ideas from Residents to Root Out Routine Labs

While the saying goes, “you can’t teach an old dog new tricks”, I think we all assume you can teach a new dog new tricks… or at least all of us in medical education believe this! However, new research in the Journal of Hospital Medicine highlights that maybe the old dog is the key to the puzzle after all. In the case of routine labs, a practice that has already been called into question by the Society of Hospital Medicine’s Choosing Wisely list, the majority of medicine and surgery residents at University of Pennsylvania admitted that they engaged in unnecessary ordering of inpatient labs, with over a third of them occurring on a daily basis! Why is this so hard to change? Not surprisingly, one of the key culprits was it was hard-to-break habit. However, several of the top reasons were also related to the “old dog”, also known as…

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…
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