Practice Management

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…

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…

What We Expect and What We Get from Work

Are American workers becoming happier with less? An interesting article in last Friday’s Wall Street Journal reported on the findings of a recent survey of U.S. workers by the Conference Board, a research organization. Although the survey wasn’t specific to healthcare, much less hospitalists, I see some parallels that might cause many of us to stop and think more carefully about what we expect from our work. The Conference Board’s findings highlight how American workers’ employment relationships are evolving and how that is impacting what Americans think of as a “good” job. The biggest shift has come in the nature of the implied compact between workers and their employers; unlike a generation or two ago, U.S. workers no longer expect to receive a generous benefits and lifelong employment in exchange for hard work and loyalty. In fact, I suspect many younger workers today would face the prospect of lifelong employment…

Why 7 On/7 Off Doesn’t Meet the Needs of Long-Stay Hospital Patients

by Lauren Doctoroff, MD
By: Lauren Doctoroff, MD Much has been written about the loss of the perspective of the primary care doctor for hospitalized patients and the impact on their hospitalization. However, few have reflected on the challenges posed by the 7 on/7 off hospitalist schedule for complicated long-stay patients. I have been a hospitalist for more than 10 years, and, for the past 3, I have been responsible for a complex patient strategy for my hospital. Having looked at the charts of hundreds of patients with long and complicated hospital stays, it is clear that there is an incompatibility between the on again/off again hospitalist schedule and the needs of these patients. With frequently changing providers, patients suffer not only from their own medical fluctuations, but also the changing plans of their providers. These are not the patients awaiting guardianship or insurance to allow for an adequate discharge plan. These are the…
Dr. Lauren Doctoroff is a hospitalist at the Beth Israel Deaconess Medical Center in Boston, Massachusetts. She completed medical school at the University of California at San Francisco in 2003, and a primary care internal medicine internship and residency at Massachusetts General Hospital in 2006. Her clinical responsibilities include hospitalist work on a teaching and a non-teaching service at the BIDMC. In addition, she was the founding medical director of the Healthcare Associates Post Discharge Clinic, a hospitalist-staffed, primary care-based post hospitalization clinic from 2009-2015. She also serves as the medical director of the PACT Transitional Care Program. As of 2015, she serves as the Medical Director for Utilization Management for the BIDMC, and chairs the Utilization Review Committee, and leads multiple initiatives on hospital utilization. She is a fellow of the Society of Hospital Medicine and serves on the SHM Public Policy Committee. She is an Assistant Professor at Harvard Medical School. Her academic interests include transitions in care and post discharge care, as well as hospital utilization particularly among patients with prolonged stays. She has published on post discharge care and outlier patients and has spoken locally and nationally on topics of transitions of care and post discharge care.
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