Patient Care Talent Vacuum?

John Nelson writes…

Sometimes I think I hear something akin to the giant sucking sound first described by Ross Perot.  Perot was describing the loss of jobs as a result of NAFTA, but the loss of talent in the ranks of hospitalists that care for patients creates the sound I hear.

I just returned from SHM’s biggest event of the year – Hospital Medicine 2009.  Like all the meetings before it, I came away with a good dose of enthusiasm and education to help fuel my career for another year.  And like the last few meetings, Win Whitcomb and I reminisced about how far things have come since we first started talking about forming a medical society for the nation’s hospitalists in 1996.  (Win and I founded SHM.)

The meeting and reminiscing made me think about just how many of the long-time regulars were full-time patient caregivers way back when, but now have other roles and now see patients only part of their time or not at all.  For a variety of reasons these people have taken on roles other than patient care.  I’m in that category too, since I currently provide direct patient care only about 30% as much as the full-time hospitalists in the practice I’m in.

That many hospitalists will reduce or cease entirely their patient care activities was illustrated by Pat Cawley, SHM’s immediate Past President, when he predicted that 1,000 future Chief Medical Officers will come from the ranks of hospitalists in the coming years.

Why do all these people move away from patient care?  I suspect that because of their talent many are recruited into other roles, usually in hospital or medical group administrative leadership, and they just don’t have much time left for direct patient care.  And maybe some realize that patient care isn’t for them and look for other work.

I think it will be great for patients and our healthcare system if we the healthcare leaders of tomorrow come from the ranks of hospitalists.   But I worry a little about what it says about the career satisfaction and sustainability of full-time patient care in the role of a hospitalist.  I have the same concern about primary care.

It can seem like most hospitalists and primary care physicians (internists, family physicians, and pediatricians) make a choice to pursue work other than patient care much more often than doctors in other specialties.  One obvious reason is that other specialists tend to have higher incomes and would likely face a pay cut to take on non-patient care roles, but hospitalists and PCPs often earn the same or more in their administrative role.  But there are probably many additional factors.

In many ways the evolving career tracks and expanding roles of hospitalist is a really great thing.  I’m not suggesting we should try to lock everyone into full-time patient care for their whole career.  But I worry that patients may be losing some of the most talented caregivers.  Hopefully in their administrative roles these hospitalists can do good things for even more patients than they could through bedside care. We just need to make sure we aren’t sucking the best doctors away from patient care simply because we’ve failed to create a sustainable and rewarding career in patient care.