Wanted – Master of None

Troy Ahlstrom writes…

Our group has partnered with facilities that have need for Hospitalists capable of the fullest spectrum of hospital-based patient care.  The ICUs are busy.  Step-down and med-surg floors turn patients over quickly.  A steady stream of stress tests rolls through non-invasive cardiology.  But they’re not all busy at the same time… excepting the occasions when they really are all busy concurrently.  Meanwhile, everyone’s sicker.  It seems acuity doubles every two years matching Moore’s Law.  Yet, there’s no Intel, Apple, Microsoft, Oracle, or HP inventing increasingly capable providers to meet the pressing need.

Much to the contrary, I find myself wondering, “Are we actually training physicians to be less adaptable?”

Bear with me here.  Let me first say that I’ve worked with some wonderfully capable Hospitalists from near and far.  I’d be happy to share the load with them, especially on a tough day.  But, we’ve seen some real stinkers too.  If you accept a position that involves critical care work, general medicine and a variety of procedures, then you actually need to be capable of effectively performing all of those roles.  Not all Intensivists feel comfortable on the floors.  Some won’t stoop to the level of coordinating discharges or, perish the thought, speaking with a patient or family.  Yet an Internist whose experience amounts to “see one, do one, teach one” doesn’t really cut it in the ICU either.  And yes, you do have to go down to the ED or the stress lab at the most inopportune times of the day; because while lymphedema with cellulitis isn’t sexy, it pays the bills.  It’s all part of the job if you and I have agreed to help staff a smaller facility that needs to keep us busy in a variety of areas to help recuperate its investment.  We’ll rarely see more rewarding, stimulating, and at times, uncomfortable situations in our profession.  Such opportunities refine my skills as a physician and also keep me grounded as a person.  Yet most of us stay in the larger medical communities and university hospitals where we can get a consult or code team as easily as a chai latte.

So why do we continue to follow the medical mentorship mantra of super-subspecialization when the sign in many Hospital Medicine postings flashes, “Help Wanted – Jack of All Trades, Master of None”?

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