Hospital medicine needs a “Thursday Night Out.”

By  |  August 29, 2019 | 

In my community, they have an event every Thursday call “Thursday Night Out.” The village sets up tables, blocks off a street, arranges for a band, some wine/beer, arts and crafts for the kids. It’s low-key and low commitment, both of which make the exponential joy generated from this event all the more wondersome. As I sat there watching the toddlers cavorting with bubbles, the teenagers with their mystifying clothing choices, the couples all jamming to the blues, I looked around. Really looked. And I saw people of every race, size, color, age. I saw people in wheelchairs, same sex couples, the tattooed and the pearl wearing in utter and complete coexistence. It was the essence of diversity. Every single person pulsed with joy and life.

And then I thought: I have a blog post due – what is at the top of my mind? And then I realized, it is one and the same!

I’ve been really thinking a lot about the why – why should groups hire NP/PAs in hospital medicine?

Surely, not just because I say so. Of course, there are many compelling reasons. There is a huge and looming physician shortage, and the physicians we do have are aging. And yes, many non-urban hospitals are truly struggling under the weight of shrinking reimbursements, and NP/PA providers are a cost-effective way to deliver care. And those are compelling reasons.

But the real why is that I believe, and have experienced, in the true joy and high function of a diverse HM team. This high function is where everyone adds a little of their special spice and abilities to the day’s gumbo. For instance, I’m skilled at placing feeding tubes – really at all procedures – and I can soothe the most difficult patient and family. But my colleague Jina is incredibly talented at diagnosis. I would put her diagnostic reasoning up against anyone’s. Laura knows everything about GI – especially cirrhosis. Truly an expert. Sunny is brilliant at nephrology and acid base issues. Madhu is great at navigating end of life conversations. Brian just makes the tedium of any day fun. Who was a doctor? Who was an NP? Who was a PA? Who was brown? Who was black? Who cares?

There is a fair amount of data looking at diversity of teams:

“Diversity is the key to creativity.” –Jeffrey Baumgartner, Author of The Way of the Innovation Master

“Diversity fosters creativity. We need to generate the best ideas from our people in all levels of the company and incorporate them into our business practices.” –Frédéric Rozé, CEO at L’Oréal USA

“New research makes it increasingly clear that companies with more diverse workforces perform better financially.” –Vivian Hunt, Managing Partner at McKinsey & Company

“If your industry is stable and relatively predictable, you may be better off sticking to the traditional sources of advantage. But if your competitive reality is uncertain and rapidly changing, as is true in an increasing number of industries, you need a dynamic and sustainable way to stay ahead.” –Martin Reeves, Senior Partner & Managing Director at Boston Consulting Group

“Homogenous teams feel easier – but easy is bad for performance” –David Rock, CEO NeuroLeadership Institute & Writer for Harvard Business Review

Read those quotes and note that every single one of them applies to medicine – especially now. We are living in “interesting times,” as the old proverb says. We need to embrace the idea that hospital medicine is a team sport. It definitely takes a village to care for patients these days – what with increasing acuity, complexity and shifting payment models. This is not a competition between “us” versus “them.” This is about all of us. Our team.

And just like other teams, you have a variety of skill sets and players. To maximize this utility, you should take a look at your site, your patients and your team. Is the site new to NP/PA providers? Are your patients unusually complex? Is your NP/PA workforce on the greener side? Then consider these factors and plan accordingly. NP/PA often bring unique skill sets to the HM team. A new APP may have been a flight nurse. A PA may have been a medic in the military. One may be outstanding at volume, thinking and moving fast. One may be great at the deeper dive of highly complex patients. In general, NP/PAs tend to be uniquely skilled at communication with patients and families – in part, because the type of people attracted to this profession are those that crave the connection with others. They can build your coalition with external consultants, with the ED, with the nurses. If you aren’t sure what your NP/PA is good at, ask them. They would love to tell you.

I’m not naïve about the effort it takes to implement these diverse teams. People come with different training, expectations, experiences and those pesky opinions. But the payoff is huge and far outweighs the effort.

Hospital medicine needs its own version of Thursday Night Out.


  1. Avatar
    Melanie Mabrey August 29, 2019 at 10:37 am - Reply

    Great piece! Bringing together and valuing talented individuals from diverse backgrounds makes for a great team and optimal patient outcomes. Melanie E Mabrey, NP

  2. Avatar
    Tonya Williams August 30, 2019 at 5:47 pm - Reply

    There is already diversity in medicine although not a good reflection of our country’s population. Hiring people with far less training is not the way to increase diversity. The answer is more women and minorities in medical school. Unless the “experts” in each area have had a minimum of 4 years of medical school and 4 years of real residency (60-80 hours per week), I don’t call them “experts”. NP/PA professional have a place in health care but it is not as a replacement for physicians, especially sub-specialist who have the above training plus a real fellowship of 3 or more years.

  3. Avatar
    Elle August 30, 2019 at 6:02 pm - Reply

    In believe that diversity refers to cultural diversity, not diversity in educational levels. If I have a complex medical issue, I prefer the best trained person who has received formal education and length training in that field. That would be a physician who is board verified in their specialty.

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About the Author: Tracy Cardin

Tracy Cardin
Tracy Cardin, ACNP-BC, SFHM is currently the Vice President, Advanced Practice Providers, at Sound Physicians and serves on SHM’s Board of Directors as its secretary. Prior to this, she was the Associate Director of Clinical Integration at Adfinitas Health, 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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