Tucked away in the University of Florida (UF), which is—with 50,000 students—the state’s largest university and the nation’s fourth largest, is its School of Medicine’s Community Health and Family Medicine (CHFM) department, along with that department’s hospital medicine program. The department remains a touchstone for its graduates, past and present, and has created hospitalist leaders to be proud of. Much of that pride emanates from R. Whit Curry Jr., MD, CHFM’s department chairman, who is a friend and mentor to several generations of family medicine physicians.
In late 2001, after a private hospital medicine group headed by John Nelson, MD, a UF graduate, SHM co-founder and columnist for this publication, it was natural for Shands Alachua General Hospital (SAGH) to turn to Dr. Curry to start a hospitalist program. Dr. Curry, who says wryly, “If you’ve seen one hospitalist program, you’ve seen one hospitalist program,” knew he could build a unique team of family medicine physicians into a cohesive hospital medicine group.
UF’s CHFM department had staffed SAGH with residents for years before the hospital asked Dr. Curry to start the hospitalist program. The group’s coverage had been limited to inpatient care for about 20 primary care physicians, with a similar arrangement for a for-profit HCA community hospital across town. SAGH needed a more ambitious hospitalist program, one that would cover unassigned patients as well as inpatient care for local doctors. At that point, SAGH issued a request for proposals (RFP) for a hospital medicine group, accepting UF’s CHFM proposal to fill the vacuum left by the departing group. Initially, SAGH would handle the 20 private physicians’ inpatients covered by the existing group, the overflow of unassigned patients from residency workload restrictions, and admitting and co-management for specialists.
Dr. Curry started building his team with Elizabeth Chmelik, MD, recruiting her as the program’s director straight from CHFM residency. The program’s first year—2002—was whirlwind hectic. Fortunately for the group, Marcia Miller, MD, a 1988 graduate of UF’s CHFM department, had burned herself out running a local private practice with two partners. She turned to Dr. Curry, her mentor and confidant. “I called him, told him I needed a job, and he hired me as the hospitalist program’s co-director,” says Dr. Miller. Her community-based partners endorsed her new career path, and she joined Dr. Chmelik in working every day of the program’s first year. “It was challenging,” she says, “but, with inpatient medicine, I became the doctor I was trained to be.”
Sherri Swilley, the department’s coordinator of administrative affairs, recalls the patient census growing so fast that she struggled to keep up with getting doctors temporary privileges while pursuing credentialing for the permanent staff. “The hospitalists had a fierce work ethic that carried us through those early years,” says Swilley.
Gainesville’s Medical Community
In spring 2003, the program added a local physician eager to exit private practice and a family medicine graduate who had worked in SAGH’s emergency department (ED) for 12 years. In June, they snagged two stellar family medicine graduates and a nocturnist. The nocturnist represents the program’s only turnover; her nightly 12 to 20 admissions proved too much to handle.
UF’s homegrown bunch of family physicians shaped this distinctive hospital medicine program. Dr. Chmelik, assistant professor and co-director of the UF College of Medicine’s hospitalist program at SAGH, says that although family physicians are outnumbered by internal medicine hospitalist physicians they add something special to the role.