Hospitalists are moving into hospitalwide management roles. What’s driving the trend and what does it mean for the future of healthcare?
by Joen Pritchard Kinnan
Dr. Z has practiced hospital medicine at his local community hospital for the past three years. When he came on staff he quickly volunteered for a committee, and today he is its chair. Though he has a heavy workload, he has found the time to take several business courses at a nearby college, and he rarely turns down an opportunity to address a group.
Since he began his practice, he has never missed a local or national meeting of the professional associations to which he belongs. Dr. Z is a hospitalist with an ardent desire to make a difference. He believes he can be most effective in a hospital-wide administrative position, and he is preparing himself.
Dr. Z is a hypothetical example of a growing number of practicing hospitalists who are moving—or desire to move—into hospital-wide decision-making positions. What is the likelihood for their advancement to the higher echelons of hospital administration? Very good for those who have the right stuff for leadership, according to Larry Wellikson, MD, CEO of SHM.
Consider this: Just a decade ago, there were about 100 pioneering hospitalists caring for patients in 20 hospitals. Today there are 20,000 hospitalists serving patients in 2,500 hospitals across the country. Hospital medicine is the fastest growing medical specialty in the United States. The time is right for hospitalists to rise to the fore—not just as leaders of their hospitalist groups but also as system-wide decision makers.
Stacy Goldsholl, MD, represents the new breed: hospitalist as leader. Dr. Goldsholl has been a hospitalist for 12 years. “I got my first job as a community hospitalist before the term was even coined,” she says. “After about five years, I really hit a low point in my career. I was dissatisfied with the way the system was working; I didn’t feel there was enough emphasis on quality patient care. I was at a crossroad. I even considered giving up medicine altogether and going to rabbinical school,” she says, laughing. “But I was very passionate about making things better, so instead of quitting medicine, I embarked on a solo jaunt around the country trying to interest people in improving hospital medicine.”
Today Dr. Goldsholl is president of the Hospital Medicine Division of TeamHealth (Knoxville, Tenn.), a nationwide outsourcing provider of hospitalists in areas as far flung as Puerto Rico and Hawaii.
Though there are no hard-and-fast statistics on how many hospitalists now have leadership roles, Dr. Wellikson says the numbers are swelling. “It’s getting harder and harder to find someone who has strong leadership skills who’s five years into practice who is still just seeing patients,” he says. “There’s such a crying need for leadership in managing the team, leading the hospital medicine group, improving the hospital, improving the quality of care … there’s an enormous void. The first time somebody shows up who has an interest or an aptitude, someone will say, ‘Why don’t you be in charge?’ ”
Study after study indicates hospitals employing hospitalists experience an improvement in the bottom line that is due, in part, to greater efficiency. This is an important consideration in the current economic crunch in which many hospitals find themselves, but today there is an increased focus on improving patient care as well.
In both efficiency and patient care, hospitalists are uniquely positioned to bring something to the leadership table that other candidates might not. “Hospitalists have a holistic view of the hospital,” says Dr. Goldsholl. “Private physicians don’t have the same connectedness to all the parts. That kind of experience is very valuable. After all, that’s what the hospital is all about.”
Jack M. Percelay, MD, a member of SHM’s Board of Directors, puts it another way. “Clearly, administrative positions require some knowledge of hospital function,” he says. “On-site physicians are certainly more aware of where the problems are. They face them on a daily basis.”
Dr. Wellikson adds, “From the very beginning of their medical careers, even when their main role is seeing patients, hospitalists are looking at the hospital as a system as an institution. They may be members of a quality-improvement team or a group that looks at the flow of patients from the emergency room to the hospital. It becomes sort of second nature to them. Our doctors learn these competencies from the beginning. In their training and their involvement with SHM, whole sections are devoted to systems improvement, leadership, and things like that.”
Dr. Wellikson suggests a demographic reason so many hospitalists look forward to climbing the administrative ladder: “It’s the times. Older doctors may be counting the days till retirement, whereas most hospitalists are younger—the average age is 37—and they say, ‘Hey, I’m going to have 20 more years of this. If I don’t change things, who will?’
“I’ll give you an analogy. When you go to a hotel and your towels aren’t delivered, you might complain until you get them, but you don’t try to manage the hotel. That’s the way practicing doctors felt 20 years ago. But hospitalists, because they’re going to go to work every day in that hospital, if it’s not working tip-top, they’re going to get involved. It’s an evolution in healthcare.”
We asked our experts what advice they would give hospitalists who aspire to critical decision-making positions. “Even if you have natural skills as a leader—you’re charismatic, you take on responsibility—leadership is a skill like any other,” says Dr. Wellikson. “Take the time early in your career to develop that skill. Get involved in some project you feel passionate about. Part of leadership is getting other people to move in the right direction and part is dealing with the people who won’t follow. That can be frustrating. See how this feels to you. Get the education you need, and don’t be afraid to fail. Everybody has failures.”
Dr. Percelay suggests finding activities in your group where you can take initiative. “Clinical legitimacy is key, too, together with a systems viewpoint,” he says. “I would also recommend CME [continuing medical education]-type activities to develop leadership skills. There are the [SHM] Leadership Academy, local business schools, and the American College of Physician Executives, but learn mostly by doing and participating. Joining national organizations is also helpful because you will interact with other like-minded individuals.”
Dr. Goldsholl advises hospitalists to be passionate about their beliefs and to have confidence in what they do. She remembers a seminar she attended at which the speaker—a prominent business executive—gave this advice: “If you’ve never been fired, you are afraid to stand up for what you believe.”
Decision-making positions require hard work and long hours, Dr. Goldsholl cautions. “You have to keep a balance between your personal life and your career. And never underestimate the power of networking at regional and national levels as well as locally. Make your voice heard in print and [at] speaking engagements too. Get published in the Journal of Hospital Medicine. People do read these articles.”
Everyone with whom we spoke predicts a bright future for hospitalists who want to become critical decision makers. “Hospitalists understand the important manifestations of the way all pieces fit together to impact even a single event,” says Dr. Goldsholl. “Already hospitalists are vice presidents of medical affairs, chief operating officers, and so forth. This trend toward placing hospitalists in management roles is being driven, in large part, by the institutional knowledge that hospitalists have. I expect the trend will only expand.”
“There is so much overlap in medicine that what I see developing is a spirit of collaboration,” says Dr. Percelay. “What’s good for the hospitalist is good for the hospital and ultimately good for the patient. I believe that an alignment of incentives is driving the trend toward the appointment of hospitalists to general leadership positions.”
Hospitalists can create a healthcare system driven by teams of healthcare professionals and based on delivering measurable quality, according to Dr. Wellikson, who says hospitalists will play a major role in leading the quality revolution in this country. “We are moving to a time when business and Medicare are driving toward pay for performance,” he says. “Not just, ‘Did you do the surgery?’ but, ‘How well did you do the surgery?’ ”
Most importantly, Dr. Wellikson believes hospitalists are positioned incredibly well to be leaders in this movement. “The first thing people have to do is agree there is a problem. Then they have to measure the performance, try to improve the situation, and then measure the performance again. This is the wave of the future. We [hospitalists] are working with the government, with the National Quality Forum, with the Institute for Healthcare Improvement. Improvement in quality of care is the number one trend upon which hospitalist leaders will have an impact.”
Another emerging trend: Hospitalist decision makers will influence a redesigned hospital of the future. (Dr. Wellikson is one of 20 people on the Joint Commission Hospital of the Future Work Group.) “The hospital of the future will be very different,” explains Dr. Wellikson. “There’s going to be a home team in the new hospital. It will consist of the ED doctors, critical-care doctors, and hospitalists, working with nurses, pharmacists, and the administration as a team to deliver more technology and do more for sicker people.”
These efforts will be on a collision course with the hospital’s ability to afford them, he believes, so hospitalist leadership will be key to creating an efficient hospital that uses its resources in the best way possible and works as a team.
As more and more hospitalists gravitate toward hospitalwide leadership positions, they will confront some of their own. “It’s going to be very interesting,” says Dr. Percelay, “when the hospital medicine group leader differs with the vice president of medical affairs and they both share the same background. The hospital medicine group leader will no longer be able to say, ‘You don’t know where I’m coming from.’ ” TH
Joen Kinnan is a medical journalist based in Chicago.
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.