Dr. Tahboub also had to figure out how to integrate two previously hired nurse practitioners (NPs) into the hospitalist service. “At first we were unsure how to work with them, but we learned that they enable us to see up to 17 patients on average per day rather than the 12-15 without them. They help us with ED admissions, patient education, and discharges,” says Dr. Tahboub. “The hospitalists love having NPs around and it has become a recruiting point in our favor.”
A recent hire—an office manager—helps the physicians keep paperwork on track.
Looking back, the professionals who have started hospitalist programs have some important lessons to share. Discerning the practice climate, both internal and external, is task number one.
“Make sure you understand the political climate in which you are starting the program, give community doctors time to get used to the idea, expect hospitalist turnover in the early stages, and be ready to hire new hospitalists quickly as demand builds,” advises Michael Pistoria, DO, chief of hospital medicine at Lehigh Valley Hospital and Health Network, Allentown, Pa.
Dr. Tahboub emphasizes the importance of hiring hospitalists in tune with the internal practice climate. “Rigid rules don’t work with us, and some physicians can’t tolerate the amount of flexibility in our program,” she notes.
For executives such as Sinai’s Malgoza, speaking with administrators at other institutions and going to conferences to learn about different hospitalist models helps design a program that fits the hospital’s culture.
Dallas Presbyterian’s Dr. Fitzgerald focuses on hiring great physicians. “Hire the best doctors from the best training programs you can,” he says. “Hiring warm bodies just doesn’t cut it. If you have poor quality docs someone else will take your spot.”
Dr. Fitzgerald also advises that slow program growth allows the chief hospitalist to find physicians who mesh with the group’s personalities and culture. “Find those who want a career as hospitalists rather than those putting in a year or two,” he concludes.
Dr. Borik points out that the hospitalist movement has boomed since she started in the 1990s, with hospitals much more in tune with hospitalist values because they save money and rates for malpractice insurance.
“After you’ve done the groundwork the program can operate like a well-oiled machine to accommodate physicians who want to work in this specialty,” she says, cautioning that ”we can’t ever forget that we don’t own the patients. Their loyalty is to their PCPs. If we drop the ball, either in service or communication, we can lose them.” TH
Marlene Piturro wrote about hospital business drivers in the March 2006 issue.