Letter from SHM to the AMA

June 13, 2005

John Nelson, MD

President

American Medical Association

Chicago

Dear Dr. Nelson:

The Board of Directors of the Society of Hospital Medicine (SHM) and I strongly oppose the resolution based on Board of Trustees Report 19 that will be heard before the AMA’s House of Delegates later this week.

SHM represents more than 12,000 hospitalists nationwide who are engaged in delivering high-quality inpatient care as well as research, teaching, and leadership related to hospital care. Hospitalists are predominantly young physicians with an average age of 37, and their numbers are projected to exceed 30,000 in the next decade. SHM surveys show that 88% of hospitalists are internists, 9% are pediatricians, and 3% are family practitioners. Hospital medicine is now an important career choice for graduates of these training programs.

The resolution calls for the development of legislation that prohibits lay corporations, including hospitals, from directly employing physicians. SHM studies show that 34% of hospitalists are employed by hospitals and another 10% of hospitalists are employed by hospital medicine management companies. Hospitals often employ or support many different types of physicians including pediatricians, neonatologists, intensivists, emergency medicine physicians, obstetricians, anesthesiologists, pathologists, or radiologists. This is necessary to deliver sufficient care, especially in rural hospitals.

Arguments that physicians employed by corporations or hospitals are always adversely influenced in how they treat patients is false. In fact, numerous studies prove that hospitalists improve quality and patient satisfaction:

—Studies in the Annals of Internal Medicine, JAMA, and elsewhere show that hospitalists can improve quality.

—Studies at many hospitals demonstrate that hospitalists improve patient satisfaction as well as the satisfaction of referring physicians.

Primary care physicians, surgeons, and subspecialists increasingly are asking their hospitals to bring hospitalists onto their medical staffs to improve care. Because of the competition for the limited number of hospitalists in the face of the growing need, because of the lower reimbursement for what hospitalists accomplish in improving hospital care, and because hospitalists provide significant uncompensated care (multiple visits in one day, taking patients out of the emergency department), hospitals have had to employ hospitalists to develop successful programs. Enactment of legislation based on the AMA Board of Trustees Report 19 would make it much more difficult for a hospital to attract and retain hospitalists on its medical staff.

I hope you will share our concerns with Reference Committee B.

Thank you for the opportunity to provide the SHM perspective. I hope we can quickly establish a dialogue about the deleterious effects that action on the Board of Trustees Report 19 will have. As are other members of SHM’s leadership, I am available to discuss this further at your earliest convenience.

Respectfully,

Larry Wellikson, MD, FACP

CEO, Society of Hospital Medicine

cc: Jim Rohack, MD, AMA chairman of the board

Mike Maves, MD, AMA executive vice president