HR, Recruiting & Staffing

Dysfunction Isn’t Fun

I was talking with a colleague in another section today and she was noting the difference between our hospitalist group and her section.  She has somewhat intimate knowledge of our section because she did a year with us before moving on to her specialty fellowship.  She is a bit frustrated with her new home and its team members because she feels like there are a lot of "B's".  You know- b*tching, bickering and backbiting. I was asking her to tell me the reasons she thought this is occurring. Is it a top down issue, is it just a personality problem with people attracted to her specialty, is it that there is instability with the people and processes that make up that section?  What is it?  No answer was forthcoming.  In the clinical setting, when no answers are clear and forthcoming we say the problem is "multifactorial". After speaking with  her,…

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.

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…

Have we hit peak hospitalist?

I have detected something unusual.  Take a look at the cited quotes below and see if you can spot what I am referring to.  Both come from a national newspaper.  Here's the first: On arrival, Larson was put in a room and examined by a physician assistant. He didn’t stop at the admissions office because his information and treatment orders already had been placed into the hospital computer system. Larson was subsequently seen by an internal medicine hospitalist, an infectious-disease doctor and an orthopedic surgeon, who conferred regularly about his care over the next four days. He required 12 days of intravenous antibiotics after discharge; medical supplies were delivered within an hour of his arrival home. A nurse followed shortly to teach him how to administer the medication and give him a 24-hour phone number for a nurse and pharmacist. And here is the second: The hospitalist treating Albright told her that…

Engaging Hospitalists: What Makes You Tick?

by Jerome Siy, MD, SFHM, CHIE It would be easy to deliver on the triple aim if all hospitalists had to do was run a checklist.  But, it’s pretty obvious that we need more than a checklist to be successful.  How many of us are graduated in the top 10% of our class, but can’t get a score above 70% on our HCAPS scores?  A checklist is something we should be familiar with.  It’s how we got through medical school, and how we passed our boards.  Are we passing in our hospital medicine practice? Don’t get me wrong.  The checklist helps. A gentle reminder to foam in and foam out, a cue to sit down before I begin a conversation with a vulnerable patient, or a nudge to lend a hand at the next ED to inpatient lean project are all important ways we can improve upon our hospitalist mission.  If…
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