In 1999 the program hit a speed bump when the hospital threatened to reduce the group’s rates. The group, in turn, threatened to leave. “We resolved it by demonstrating that every dollar they paid us earned seven dollars for the hospital, not to mention the growing scope of our activities,” says Dr. Fitzgerald. “In the beginning we were forbidden to do consults, particularly for surgeons. Two years later, we were doing it all.”
He says that the hospital loves the group because it serves the medical staff’s goals and helps grow market share, as hospitalists continue to market to physician practices in outlying suburbs.
Rundsarah Tahboub, MD, medical director of the Hospital Medicine Service at Grant Medical Center in Columbus, Ohio, also succeeded the second time around. With a passion for inpatient medicine, she helped launched a hospitalist program in response to restrictions on residents’ hours at Ohio State University. Having just completed a residency herself, Dr. Tahboub struggled with her lack of experience and, she felt, credibility to lead the program.
“I felt I wasn’t being heard, that I had no autonomy or support,” she says. “When my mentor, the program director of family practice residency at Grant, contacted me to establish a hospitalist program there, I took the challenge.”
Dr. Tahboub evaluated her management style, realizing that she values communication and congeniality with colleagues, getting input and analysis before moving ahead, and flexibility in dealing with obstacles. Citing the example of night call, she explains that hospitalists started with day hours only, leaving residents swamped at night and needing an attending physician.
“We [hospitalists] all talked about it,” says Dr. Tahboub. “While we weren’t thrilled to take night call, we each agreed to cover every fourth night because it was necessary for us to do so.”