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Increased Diversity Strengthens Hospital Medicine


My path to the SHM presidency has been a long and winding one. After paying back some student loans courtesy of the U.S. Air Force, I joined a busy traditional family medicine practice. Routinely, we would have a census of 20-25 patients in our local community hospital on any given day, and we shared the hospital duties as the “hospital doc” for a week at a time. I truly enjoyed the hospital-based portion of my practice, and this eventually led me to start and build a hospitalist program at our small community hospital. I’ve been a hospitalist ever since and have never looked back.

My story is similar to the experiences of thousands of hospitalists across the country today. Many physicians who entered medical school with the intention of working in an office-based or traditional practice have been drawn into the fast-growing hospital medicine field—where they’ve happily stayed.

Today, according to our best estimates, there are more than 44,000 hospitalists practicing in the U.S. Most have come to the specialty from the internal medicine field, but that is rapidly changing. As the first hospitalist trained in family medicine to serve as SHM president, I couldn’t be more excited or encouraged by the increasing diversity in the types of healthcare practitioners who call themselves hospitalists.

A Changing Profession

Today’s hospitalists come from diverse training environments. In addition to internal medicine, hospitalists are trained in family medicine, pediatrics, intensive care, obstetrics and gynecology, surgery, orthopedics, neurology, oncology, and a variety of other specialties and subspecialties. The specialty hospitalist movement has grown on the back of the same forces that gave a dramatic push to the hospitalist movement over the past 15 years—in-house provider availability, the need for greater inpatient efficiency, the aging physician workforce, and the enormous difficulty of staying competent in both an ambulatory and inpatient setting, just to name a few. Needless to say, it’s become a well-established dynamic with evidence pointing to its long-term benefits for both patients and healthcare delivery systems.

In addition, as demand for hospitalist services continues to grow, hospitals and hospital medicine groups are increasingly adding nurse practitioners (NPs), physician assistants (PAs), and other advanced practice providers to their ranks. According to the 2014 State of Hospital Medicine Report, the use of NPs and PAs in hospital medicine programs serving adults has risen nearly 12% since 2012. Today, more than 65% of hospital medicine groups employ NPs or PAs.

Within SHM, we’re seeing these changes begin to play out in our membership makeup, as well. Though the vast majority of our 14,000 members are internal medicine physicians, more than 10% are hospitalists trained in family medicine (HTFMs), 3% are trained in pediatrics, and 3% are internal medicine/pediatrics. Our fastest growing segments are family medicine and NPs/PAs.

SHM is stronger when we can draw upon a membership of varying types of training, opinions, and expertise in developing

initiatives and educational programs in support of our mission...

Strength in Diversity

The expansion of the hospitalist field to include so many different kinds of providers is beneficial to both SHM and the broader profession.

On a macro level, the increasing diversity of the field has the potential to improve care for hospitalized patients. For example, when more hospital providers are based within the facility, there’s an opportunity for providers to develop improved relationships and communication, which leads to better patient handoffs and expedited care across the inpatient care continuum. Studies have shown that hospitalist practices have a positive impact on patient lengths of stay, readmission rates, and patient satisfaction scores.

Among our peers in healthcare, this diversity opens up opportunities for even more physicians and clinicians to work as hospitalists and improve care delivery in America’s hospitals. For instance, the American Academy of Family Physicians (AAFP) and SHM recently endorsed the growing contribution of hospitalists trained in family medicine. Together, our two organizations stated that “the opportunity to participate as a hospitalist should be granted to all physicians commensurate with their documented training and/or experience, demonstrated abilities and current competencies.”

SHM is stronger when we can draw upon a membership of varying types of training, opinions, and expertise in developing initiatives and educational programs in support of our mission to promote exceptional care for hospitalized patients. Diverse membership also provides an additional level of authority to our organization and is one of the reasons we are often invited to Washington, D.C., to testify in front of Congress about various medical topics. Because we represent many constituencies among physicians and maintain close working relationships with clinical and business leaders throughout the hospital, we can provide unique insight into healthcare reform, quality initiatives, and other issues shaping the healthcare industry today.

Expanding Membership

Although we are seeing the increasing diversity in the hospital medicine field play out in SHM membership, many specialty hospitalists, advanced practice providers, and even family medicine and pediatric physicians don’t yet consider SHM a professional “home.” And our membership ranks represent only a fraction of the hospitalists practicing across the country.

One of the goals for my presidency is to help spread the word that SHM isn’t just for internal medicine hospitalists—though they certainly make up a majority of our membership and we owe them a debt of gratitude for getting us to where we are today—but for all providers involved in the hospital-based care of patients. We are an organization that truly represents all of the professionals across the continuum of hospital-based medicine. We can be a valuable professional resource for the growing number of physicians, advanced practice providers, administrators, and other care providers who choose to focus their careers on the care of hospitalized patients.

Looking Ahead

Though I happened into the hospital medicine field by chance, making my career in the field was no accident. I’m proud to work in a specialty that is so uniquely positioned to enhance the care and experience for hospitalized patients. I’m excited to see so many providers from various fields of medicine choosing hospital-based practice.

I hope the trend will continue and that our organization will have the opportunity to welcome many of them in the months ahead.

Dr. Harrington is chief medical officer at Reliant Post-Acute Care Solutions in Atlanta, Ga., and president of SHM.

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