As this pressure increases, the facilities’ search for solutions to the impact on cost will increase. In addition, the transparency of hospital results, as well as pay for performance, will drive a desire to improve quality results. The process improvement changes that will be needed cannot be accomplished without a committed medical staff. Hospitalists are uniquely positioned to take on this role. Thus, the demands on hospitalists for participation and leadership will increase.
Labor Shortage a Key Issue
It appears from our membership survey that the labor shortage is a key worry. Because we have no control over demand and we expect demand to increase, we will need to be creative about impacting supply. SHM may be able to address this issue. One approach is to increase supply in the following ways:
1. Design programs that attract individuals who want to be hospitalists into the primary residencies for hospitalists: internal medicine, pediatrics, and family medicine.
- Influencing training programs and educators to develop positive experiences for residents.
2. Create a model that includes nursing and physician assistants, as well as others, who can extend physicians’ capabilities
Another approach is to improve retention, a goal that might be accomplished by:
- Educating hospitals on their roles in creating a good working environment with excellent support systems for their hospitalists;
- Training group leaders to manage their programs for success;
- Creating alternative delivery models that enhance the physician lifestyle and practice experience; and
- Training individuals to matching their career goals with the right program.
Our members and their leaders seem to feel adequately prepared for clinical decision-making to deliver high quality care, but they see a gap when it comes to how they are equipped to provide leadership in a number of areas. These areas include transitions and coordination of care, resource utilization, and collaboration with multidisciplinary teams. SHM can respond to this need with training and mentoring. Perhaps we can also influence training programs and their curriculum.
Caring for the Uninsured
As many of you experience, hospitalists are increasingly called on to provide care for those without funds. When caring for the uninsured, physicians experience special challenges that create job dissatisfaction and affect the sustainability of the practice. In many cases, hospitals are willing to pay for this care because they are required by government regulation to provide it. As they see their profit margins erode, however, they are reluctant to compensate this work. It is important for SHM to be positioned to participate in these discussions as the payment and care of the uninsured gets increasing attention. Our public policy committee will continue to try to identify our best opportunities to impact this issue. How their mission will change is unclear, but this issue continues to be identified by our members as an important one.
This article only touches briefly on the many topics that SHM continues to explore as we try to see the future and take it into our hands. TH
Dr. Gorman is the president of SHM.