Change Happens—Make Sure You Are Prepared

My hospitalist group is imploding. What do I do?

—Concerned in Georgia

Dr. Hospitalist responds:

Well, if there is one thing HM lacks, it’s certainty. When I first started out as a hospitalist oh-so-many years ago (it was the 1990s), our field was nascent, and we all figured we’d do this for a year or two, then be out of a job. Once it became clear that the work was here to stay, the day-to-day unpredictability of the job came to the fore. How would we ever get to level staffing? How was it possible to get 20 admissions one day and two the next? Why would you have a unit full of raging, naked, withdrawing alcoholics one week, and the next, your service would be sweet grandmas who broke their hips? I mean, variety can be delightful, but yeesh, this was nuts.

Fast-forward to 2012, and HM is here to stay. The volumes may vary, but the work isn’t going away—and primary-care physicians (PCPs) aren’t coming back to make rounds. The uncertainty still exists, but it centers more around insurance payments (27% pay cut narrowly avoided!), hospital contracts, and employment models. This scenario is by no means unique to hospitalists. Just look at the wrenching changes that the cardiologists have gone through in the past few years with the cut in outpatient procedure payments. For better or for worse, even in HM Year 15+, change is the only constant.

Your group is imploding. There are a few scenarios there:

• Maybe you’ve been mismanaged (been there);
• Perhaps the hospital decided not to renew your contract (been there, too);
• Your group was acquired by a larger group; or
• Another local group just took a big chunk of your business, and that means staffing cuts.

My point is, whether all or none of these situations have ever happened to you as a hospitalist, they all exist. I just don’t think you can safely look at any physician job in 2012 and say, “Yeah, this job will be good for the next 10 years.” We have way too much uncertainty in the business model. This is not to say that the profession is going to deteriorate, but that you need to be prepared for ongoing evolution.

If luck is the product of preparation and opportunity, then disaster comes from complacency and assumption. So keep your CV updated. No need to broadcast it; just pull up the file once a year and make the needed changes. Expand your skill set. FCCS certification might make sense if you do a lot of ICU work. Document your committee experience (don’t tell me your hospital committees are all full).

Apply for Fellow in Hospital Medicine designation (www.hospitalmedicine.org/fellow). Maintain your certification through the Focused Practice in HM pathway (www.abim.org).

Maintain your connections, whether it’s through local chapter meetings and CME or attending SHM’s annual meeting (www.hospitalmedicine.org/events).

Know the work environment in your community: Which job would you take if your current one went away?

Even if you are reading this thinking, “There is just no way this kind of change could happen to my group,” trust me, it can. And quickly. You should expect change, and know what your options are when it comes along.