John Nelson writes…
At Hospital Medicine 2009, SHM’s sold out national conference in May, I moderated a panel discussion titled “Who says 15 patients a day is the right number?” It was packed – so packed that it was one of a handful of sessions offered twice.
I don’t think a similar session at other specialty society meetings would be as popular. Can you imagine a session on “How many cholecystectomies should you do annually” being so popular at the Amer. College of Surgeons? Sure, nearly every medical society devotes attention to workload and its effect on patient safety, maintaining skills, career sustainability and economic health. But I don’t think these are usually as popular as this session was at the SHM meeting.
Assuming you agree with my premise (based on my experience and not hard facts), a question presents itself: why are hospitalists more interested in discussions about workload than other specialties? Maybe it was the terrific panelists at this particular session? They were really good, but I don’t think that was the biggest factor.
Clearly the fact that the meeting was sold out was a big part of the popularity of the session. Everyone had to go somewhere.
But I’m guessing the biggest factor is that most hospitalist are paid such that a large (usually the largest by a long shot) portion of their compensation is fixed. That means the party providing the compensation, usually a hospital, ends up caring a lot about how hard hospitalists work, e.g., how many patients they see. So I suspect many in attendance were there to collect ammunition for their future conversations about how hard they should work for their pay.
Most other specialties still earn the majority of their income via fee for service payments, so they are able to decide for themselves how hard they should work and don’t need to convince others, like hospital executives, what is the right workload for them.
Mark Williams and Kevin O’Leary at Northwestern presented some really interesting time-motion studies of their hospitalists that you might want to review. Go here, enter your SHM user name and password, then click on “Saturday, May 16″ at the top of the page, and search on “Who says 15 patients…” Or try this link which might take you there directly.