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Welcome, New Residents

From: The Hospitalist, July 2012

What might not be of immediate concern to the newly minted, patient-focused doctor is the need to heal the medical system.

by Joshua Lapps

Every summer, a crop of fresh-faced residents greets the medical world. Freed from the travails of medical school, these new physicians embark on a journey of learning by doing, experiencing firsthand the successes and pitfalls of our medical system. Undoubtedly, the vast majority of residents enter the profession with a desire to do good, to heal.

What might not be of immediate concern to the newly minted, patient-focused doctor, however, is the need to heal the medical system.

For residents, policy might seem slightly tangential to the practice of medicine. Indeed, it is possible to practice medicine without becoming involved in policymaking; however, changes in policies and regulations affect the practice of medicine every day.

Whether at the organizational, local, or national level, policy is a vital consideration for practicing physicians. As a new resident, policy helps shape your day-to-day life, from how you interact with patients to the number of hours you are working.

In New York, for example, the 1989 Libby Zion law restricts the number of hours a resident may work to 80 hours per week, a limit formally endorsed in 2003 by the Accreditation Council for Graduate Medical Education (ACGME) for all accredited residency programs nationwide. These standards, which safeguard against the negative effects of sleep deprivation and chronic sleep loss, encourage better physical and mental care for residents and, ideally, promote better patient care. On the other hand, this rule changes the structure of residency programs and increases the number of patient handoffs to conform to hour restrictions. The challenge inherent in policy work is weighing competing interests and positions to find balance, or to justify imbalance.

Your paycheck, too, is directly influenced by health policy, with much of the funds for residency programs coming from the federal Department of Health and Human Services and the rest coming from hospital sources.

When you sit down at a computer to input information about a patient, you will be using an electronic health record (EHR). This program is governed by regulations for health information technology (HIT). In fact, SHM commented on a recent proposed rule for the Stage 2 EHR Meaningful Use incentive program and whether hospitalists qualify for a hospital-based provider exemption from the program. By providing feedback to federal agencies, SHM actively influences the development of regulations, changing the impact of policies for hospitalists nationwide.

Your paycheck, too, is directly influenced by health policy, with much of the funds for residency programs coming from the federal Department of Health and Human Services and the rest coming from hospital sources. Recently, SHM supported U.S. Reps. Allyson Schwartz (D-Pa.) and Joe Heck (R-Nev.) in their introduction of H.R. 5707, the Medicare Physician Payment Innovation Act, which would repeal the sustainable growth rate (SGR) that threatens deep cuts to Medicare reimbursements originally intended to control spending. SHM actively advocates for rewarding high-value not simply high quantities of care, reflecting the orientation of hospitalists’ desire to improve the healthcare system.

Try as you might to avoid it, policy is all around you.

Even if such macro-level policy issues as value-based purchasing, payment bundling, or quality reporting initiatives seem beyond your scope of influence, it is important to stay involved and informed. SHM provides a conduit for hospitalists to become involved on large-scale policy issues. Ultimately, the strength of our organizational policy positions and influence grows with increased physician engagement.

More robust participation and more voices represented at the discussion increase the likelihood that meaningful and productive changes will occur.

As the next generation of hospitalists, today’s residents will be agents of change in their hospitals, improving patient care and advancing quality initiatives. By sharing these experiences, hospitalists can expand the policy conversation to reflect their work on the front lines—and help shape the reality for residents to come.


This copy is for your personal, noncommercial use only. No part of this article can be reproduced without the written permission of the publisher. Order presentation-ready copies for distribution to your colleagues, clients, or customers by contacting our reprints department at reprints@wiley.com. Copyright © 2009 Society of Hospital Medicine, administered by John Wiley & Sons Inc.

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The Hospitalist newsmagazine reports on issues and trends in hospital medicine. The Hospitalist reaches more than 25,000 hospitalists, physician assistants, nurse practitioners, residents, and medical administrators interested in the practice and business of hospital medicine.

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ISSN: 1553-085X