Dysfunction Isn’t Fun

By  |  November 19, 2015 | 

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, I immediately thought  of “dark days” I have had in  hospital medicine. These bitter times were associated with tremendous instability in staffing, in clinical processes, in providers whose quality was maybe not what we had hoped. It was marked by massive turnover, burnout, bitterness, continued job searches, tears, frustration and most of all an inability to see a positive change in the future. That’s right.  The section was  depressed.

But we survived this depression and have become alive, engaged, growing, and aware again. Those are some of the things my colleague maybe noticed when cataloging the differences. Why did these “problems” related to our section’s depression occur? Why was everyone miserable? At the time it seemed so nebulous. We were working super hard, hitting maximum overdrive every day with no clear emergency back-up plan, cap on the volume or end to the misery.  There were workflow issues, including bickering over who takes what patient and when. There were personality and competence issues with providers: “How did that hole get in the wall?”.  When doing the post mortem of that time, initially it seemed there was no clearly identified harbinger of our success, our healing.  But with some distance I think I can better see why and how we got better.  Conversations with multiple hospital medicine leaders and my own observations have led me to the following semi-scientific conclusion:  We benefited from the acquisition of a strong leader and we achieved adequate staffing. And that’s it.

That’s right.  If you have those two things in your hospital medicine group, you are probably doing alright. Sure, there are aspects of quality you could improve, some RVU optimization, some betterment of patient experience. And those are all laudable goals.  But you can bet that if you don’t have meaty leadership and judicious staffing, you might as well forget those lofty aspirations. Won’t happen.

If you are a hospital medicine group leader, a huge majority of your time should be spent supporting and maintaining the good people you have.  The rest of the time should be devoted to vigorously recruiting adequate staffing and talented providers.  If you have both of those-well then the rest of the time can be spent either, a. counseling former hospitalists on why their section is sub optimum; b. working on moving from great to excellent; or c. putting your feet on the desk and shopping for your next Mercedes. OK just kidding about the Mercedes.  You are a hospitalist.  Not an interventional cardiologist.


  1. Irene S. Klotz, LMSW, CPT November 19, 2015 at 8:36 am - Reply

    What an optimistic and truthful article! Currently, I am a therapist, training to be a Life Coach and medical counsel and love working with hospitalists. But, you’re right leadership is key with an enthusiastic staff next on the list. Then comes the Mercedes!!! Thanks again for an article well spoken.

    • Tracy Cardin November 19, 2015 at 10:45 am - Reply

      Thanks for your comments Irene, I really appreciate it!

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About the Author:

Tracy Cardin
Tracy Cardin, ACNP-BC, SFHM is the Associate Director of Clinical Integration at Adfinitas Health and also serves on SHM’s Board of Directors. Prior to this, she was the Director of NP/PA Services for the University of Chicago and worked in private practice for a group of excellent pulmonologists/intensivists for over a decade. She has been a member of SHM for over ten years and has over twenty years of inpatient experience, which seems incredible as she cannot possibly be that old! Her interests include integration of NP/PA providers into hospital medicine groups and communication in difficult situations. In her free time, she likes to run and lift, read and write and hang out on the front porch of her semi-restored Victorian house with her dear family and friends while drinking a fine glass of red wine and listening to whatever music suits her whimsy.


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