Dr. Bolinger agrees: “I definitely think that hospital medicine will sustain itself because we’re constantly setting the standard, and we’re showing the way it should be, the way it can be. As a profession, and as physicians, we are constantly striving to improve our quality of care. I think we are setting the mark for evidence-based medicine, and trying to encourage more evidence-based research.”
Dr. Bossard, who is based in Lincoln, Neb., found the 9% program turnover rate to be a relatively healthy sign, as did Dr. Wachter. “The turnover rates do not strike me as being incredibly high, given the portability of the field,” says Dr. Wachter. “We know very well that it is easier for hospitalists to pick up and leave their institutions for another one. In a primary care practice, changing practices involves a fair amount of work and a moderate amount of angst: You’re saying goodbye to all your patients and changing practice structure and style.”
One statistic did strike Dr. Bossard as potentially troubling, however: the increase in the percentage of hospitalists employed by multi-state hospitalist-only group or management companies from 9% in the 2003-2004 survey to 19% in the current survey.
“I think we’re seeing larger entities infiltrating markets and I’m not sure it’s a healthy trend for the hospitalist movement,” he says. “If you bring in physicians who do things a certain way, who may not have a commitment to a certain community, then I think you potentially lose some of the benefit of hospitalist programs. I think the finances will change. There will be a profit issue: Neither the hospital systems nor the hospitalist will see [that profit], and that’s a concerning trend to me.”
A Service to Members
Dr. Bohnenblust believes SHM truly serves its members by conducting the survey. The particular work environments and conditions of hospitalists can only be appreciated by a survey this specific, he says: “I applaud them for this [survey]. This is exactly what SHM needs to do to keep us viable as a profession.”
Dr. Wachter also believes the surveys are an invaluable tool.
“ … [Because we work in a] still-new field, we [hospitalists] are operating in a complex marketplace,” he says. “We are trying to figure out the best practices across all dimensions: schedules, organization structure, reporting relationships, funding. These kinds of surveys do not necessarily tell you the best practices, but they tell you about the prevalent practices. And I think that often is helpful in examining your own system and seeing whether it’s organized in the way you want to organize it. Having the society be the source of such information is a useful thing to do. It also helps the society design programs.”
The survey highlights many of the strengths of the growing hospital medicine movement. “I think in medicine in general there has been a frustration with having so much to do in so little time that it brings on stress,” says Dr. Bode. “When you can have a practice that devotes itself to one area, like the hospital, when you’re not running back and forth from the office to the hospital, you feel that you can really do a good job.
“I think most of the general population has no idea how the [healthcare] system works,” he continues. “To have a few minutes to spend telling patients how it works and how their care is flowing along is neat. You don’t feel that you have got to rush in and rush out all the time. The system can be so complex and frustrating for patients. When you can dive into the middle of it and try to streamline and demystify it, it’s really exciting.”