Nancy Zeitoun, MD, FHM, sees her expanding role as a leader at Long Island Jewish Medical Center in New Hyde Park, N.Y., as a chance to make a difference. As co-site director for clinical affairs in the division of hospital medicine and assistant professor at Hofstra North Shore-LIJ School of Medicine, she can introduce her “own ideas to our evolving and growing program.”
Now she’s brought that desire to share ideas to Team Hospitalist, the volunteer editorial advisory board of The Hospitalist.
Question: Why did you choose a career in medicine?
Answer: I consider it among the most challenging professions, both intellectually [conceptually] and physically [tangible].
Q: How/when did you decide to become a hospitalist?
A: Ten years ago, I was entering the third year of my four-year residency with the motivation to pursue critical care medicine and with much less enthusiasm for primary care than I had anticipated. One of the junior faculty was my internal medicine teaching attending, and he described his new role as a hospitalist. He preferred inpatient care with a structured schedule, less call time, and no outpatient responsibilities that required running between the hospital and an office practice. He told me this was where the future of medicine was heading. It was the best of both worlds.
Q: Tell us about your mentor. What did she mean to you?
A: My mentor was my program director. I admired her for being a distinguished woman in medicine with an academic position. She was a natural leader with passion and vision that were electrifying. She motivated and inspired. She saw potential in her residents and gave opportunity for any willing participant to advance.
Q: You say a structured yet flexible day and multidisciplinary work appeal to you. What do you like most about being a hospitalist?
A: Hospitalists have a unique and global vantage point of a hospital’s intricate network, making them the most valuable players on the field. They see opportunity in instability and uncertainty. Hospitalists are resourceful and efficient, adhering to the business concepts of competition, sustainability, conservation, and stewardship. The challenges of the field are vast but include a balance of clinical and administrative roles, leading and implementing changes to daily practice and being the constant in a sea of subspecialists.
The flexibility of the day allows for multitasking and setting priorities, so that patient care is never compromised in an acute care setting. A clinician can spend as much time with a patient as needed without the constraints of set appointments.
Q: What do you dislike most about being a hospitalist?
A: Having to balance clinical work with administrative and committee work.
Q: What’s the best advice you ever received?
A: Be proactive and be a part of the solution, rather than wait for change to be imposed. “Change is the only constant in life.”—Heraclitus
Q: What’s the worst advice you ever received?
A: Be friends with your boss.
Q: You’ve said you’d like to see hospitalists have more impact on lobbying and legislation. Can you explain what you’d like to see, and what you would see as the benefit of that?
A: Legislative action is spearheaded by the leaders of large medical organizations speaking on behalf of all of their members. These leaders tend to be either non-clinicians or non-practicing physicians. However, differing viewpoints exist. Physicians don’t want to be politicians or lobbyists. They have a hard time agreeing on things and working as a cohesive entity. So they leave others to speak for them. Then they complain when laws are passed without their say.
Hospitalists work in and help lead such complex organizations. SHM is led by physicians in practice. Events like Hospitalists on the Hill [at SHM’s annual meeting] encourage us to be more involved in legislative advocacy.
Q: As an administrator, at least part time, why is it important for you to continue seeing patients?
A: Clinical skills directly affect ability to understand the “day to day” and target the areas that need change. It also allows you to be an effective leader when you continue to do the same work your colleagues do. You are legitimate in their eyes!
Q: As a hospitalist, seeing most of your patients for the very first time, what aspect of patient care is most challenging for you?
A: Establishing trust and confidence by first impressions.
Q: What aspect of patient care is most rewarding?
A: Patient/family appreciation.
Q: As an assistant professor, what aspect of teaching in the 21st century do you find most difficult? And, what is most enjoyable?
A: Less focus on protected/dedicated teaching time, because money drivers take precedence (i.e., length of stay, dispo, utilization, billing and documentation). The new label is “system-based practice.” This has led to decreased bedside teaching.
Most enjoyable is working with eager learners.
Q: You call your biggest professional challenge taking credit for your ideas. Why is that difficult? Do you think that’s an issue for a lot of hospitalists, particularly given the specialty focus on the multidisciplinary team?
A: Hospital medicine focuses on teamwork. Hospitalists have figured out how to step out of their silos and reach across the aisle to accomplish some daunting tasks. Clinical competence is obviously important, but the ability to work together, check egos at the door, and make individual sacrifices when necessary is the only way a team succeeds. The unintentional consequence is that they don’t take credit because it’s the collective effort that counts.
Richard Quinn is a freelance writer in New Jersey.