SAN DIEGO — Hospital medicine’s annual extravaganza nestled into the southwestern corner of the country in March, with a record 4,000 hospitalists and others expanding their knowledge of clinical care, management, leadership, technology, and quality improvement.
They listened, they laughed, they learned.
Read more about the knowledge, experiences hospitalists shared at HM16.
Between the nitty-gritty of the workshops, expert panels, and forums, three high-profile speakers offered broad and insightful perspectives:
- U.S. Surgeon General Vivek Murthy, MD, MBA, a hospitalist by training, on his experiences as a hospitalist and his thoughts on the importance of public health in America;
- New SHM President Brian Harte, MD, SFHM, on the role of hospital medicine in cultivating leadership; and
- Hospitalist pioneer Robert Wachter, MD, MHM, on the future of hospital medicine as it reaches its 20th year since he introduced the term “hospitalist” in a New England Journal of Medicine article.
Dr. Murthy, formerly a hospitalist at Brigham and Women’s Hospital in Boston who in 2009 founded Doctors for America, an organization for healthcare improvement in the U.S., said his career as a hospitalist came as a surprise to him.
“When I was in medical school, I didn’t even know what a hospitalist was,” he said. “When I became a hospitalist, I thought it would be a temporary gig, something I did for a couple of years while I figured out what I really wanted to do. But as it turned out, I really loved what I did as a hospitalist. I love teaching. I love caring for patients. I love being part of a tight-knit team.”
He called good health “the key to opportunity,” explaining health is “intrinsically connected to the American dream.”
Hospitalists can play a role in building a “foundation for health,” he said. Four ingredients to this, he said, are creating a culture in which “healthy is equated with happiness” rather than associated with an attitude of “suck it up and eat your spinach”; changing our environment, such as adding sidewalks to encourage walking, to promote healthy behavior change; focusing on the spirit and mind as well as the body; and cultivating our ability to give and receive kindness, which he called “a source of healing.”
Dr. Harte described hospital medicine as “fertile ground” for leadership development.
“Our day-to-day experiences provide a leadership incubator that really no other specialty can claim,” he said.
He said he hopes that over the next several years, hospitalists and SHM make strides in these areas:
- Continuing and expanding membership;
- Continuing to push members and projects to focus on the Triple Aim, particularly patient- and family-centered care; and
- Better understanding hospitalists’ role in the era of risk.
“We need to clarify our position regarding specialty training and our training programs,” he added.
Dr. Harte recognized that such a discussion can get “difficult and contentious and political,” but that “when we look at what we have to do to be clinically effective, and what our current training programs and family medicine, internal medicine, and pediatrics provide for us, that gap to me only appears to be increasing.”
He said SHM has and will “continue to step up with curricula to fill those gaps.” However, he also said hospitalists “have to question what is the best way to train physicians for the roles of providers in the acute-care setting.”
Dr. Wachter, keeping his tradition of giving the final talk of the four-day conference, retraced the roots and successes of the field over the last 20 years. It was part history lesson, part report card, and part prognostication.
What the field has gotten wrong, so far, amounts to “an amazingly short list,” he said, but it’s not a nonexistent list.
“I think one thing we got wrong was a 7-days-on/7-days-off schedule,” he said, drawing applause. While it might be appealing to a 35-year-old doctor, he added, “I don’t believe this is a viable schedule for a 60-year-old.”
HM modeled itself after its closest cousin, emergency medicine, in which doctors frequently work 10- to 12-hour shifts every other day. Since that every-other-day schedule is not good for continuity, HM essentially strung together shifts for as many consecutive days as possible, leading to the 7-on/7-off. Now, many clinicians won’t consider positions without such a schedule even though it’s not a schedule suitable for everyone.
“I think we’ve shot ourselves in the foot,” he said. “Because what it means is you take all the work that needs to be done and you shove it into a very small amount of space. Therefore, the amount of intensity in that work that you have is, I think, undoable over time. I hope we rethink that.”
He cautioned that SHM is near the age when, all too often, societies begin to be complacent and needs to guard against the instinct to keep doing things as they have always been done.
“We need to instinctively say, ‘Wait a second, am I turning into all of those other societies that have become irrelevant—or less relevant—because of that reflex?’” he questioned.
He predicted that, even though value in care is now becoming an obsession, the digitization of healthcare ultimately will have a deeper impact on medicine.
“You ask me 10 years from now, I’m guessing that the fact that we’ve just gone from analog to digital will have turned out to be a bigger transformation,” he explained. “And the reason I say that is if you look at the history of every other industry that went from analog to digital, eventually the industries got turned upside down.”
Burnout, a prominent topic at the meeting, still doesn’t seem to be worse in hospital medicine than in many other specialties, he said, but it is a concern.
“We need to rethink this. We need to come up with some new practice models using information technology in new ways, collaborating with members of the team in different ways,” he said. “We have to take this issue and figure out a way of solving it.”
Dr. Wachter said hospital medicine needs to keep innovating and finding ways to add value; otherwise, the financial support hospitals give to hospital medicine could begin to shrink.
The field is facing challenges, he said, but he is clearly proud of its accomplishments. He said that before he went out on the stage at an early conference he organized in 1998, during the early days of hospital medicine, his wife asked him, “Are you sure this is a good idea?”
“What I said to her was, ‘It is a good idea, and it will be a good idea if we are successful in recruiting and retaining young people, innovative people who want to change the world,’” he said. “I think we have done that, and I thank all of you for turning this into a good idea.” TH
Thomas R. Collins is a freelance writer in South Florida.