Operations

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…

Up Your Game in APP Integration

I receive lots of calls and emails from HM group leaders, APP leads and others looking to up their game in APP integration. The calls fall into certain domains, and I thought it might be a good time to address some of these concerns. Training/Onboarding: This is the number one domain I get questions about. And it is important. Poor onboarding and lack of standardized training for APPs is a major barrier to success in HM practices looking to maximize their APP providers. Didactic that is congruent with SHM’s Core Competencies in Hospital Medicine is a good place to start. But before you embark on this fabulous onboarding program that is the envy of all who survey, realize that another key to success is appropriate expectations.The best onboarding or training program cannot “season” an APP the way time does. New grads can easily take nine months to a year to…

The Return of #JHMChat and Choosing Wisely

by Charlie M. Wray DO, MS
By: Charlie M. Wray DO, MS I’ll be honest – I can’t remember who won the 2012 Super Bowl, World Series or any other pop culture phenomenon*, but I do recall stumbling across something called Choosing Wisely® one afternoon while sitting in my clinic. With a burgeoning awareness that much of the care I was providing seemed superfluous and wasteful, the discovery that there was a group of physicians who shared this same sentiment was exciting! Five years in, the Choosing Wisely® campaign has published more than 500 specialty recommendations – with the Society of Hospital Medicine working on the upcoming version 2.0 (all are welcome to contribute!). Just as Choosing Wisely is gearing up for round 2, the Journal of Hospital Medicine’s (JHM) online journal club, #JHMChat, is rebooting as well! After a brief summer hiatus, we’re happy to announce that #JHMChat will be returning to discuss “Against Medical…
Charlie M. Wray DO, MS is an Assistant Professor of Medicine at the University of California, Francisco and the San Francisco VA Medical Center. He completed medical school at Western University – College of Osteopathic Medicine, residency at Loma Linda University Medical Center, and a Hospital Medicine Research Fellowship at The University of Chicago. Dr. Wray’s research interests are focused on inpatient care transitions, care fragmentation in the hospital setting, and overutilization of hospital resources. Additionally, he has strong interests in medical education, with specific focus in evidence-based medicine, the implementation of value-based care, and how learners negotiate medical uncertainty. Dr. Wray can often be found tweeting under @WrayCharles.

Navigating a Near Miss

When my daughter was around 5 years old, she disappeared. We were outside, my wife and I doing some work around the house, and our 5-year-old playing on the driveway. She was deeply engrossed in some colored chalk, creating an infinite hopscotch board. I stepped inside to grab something, and my wife went to grab something else on the side of the house. We both returned to the driveway to find chalk rolling down towards the sidewalk – and no daughter. She couldn’t have run into the house; that’s where I was. Nor the backyard, where my wife had been. We call her name, look around, and then realize she must have run off down the sidewalk. But we don’t see her. Images flash by. She runs into the street and gets struck by a car. She turns towards a backyard and vanishes in the next neighborhood. She hides behind…

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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