Whether obligatory or voluntary, service on committees is a reality for most hospitalists. “The 2005-2006 SHM Survey: State of the Hospital Medicine Movement” found that, for 92% of respondents, committee participation topped the list of non-clinical activities.1 Hospital medicine group leaders, consultants, and administrators interviewed for this article say time-pressed hospitalists must become more effective committee participants.
Civic Duty or Career Advancement?
Because of growing presence at the hospital and their knowledge of hospital operations, hospitalists are a logical choice for committee assignments. These can range from committees dedicated to care delivery (e.g., pharmacy and therapeutics) to the hospital board’s governance committees.
“Hospitalists, with their perspective of hospital operations and clinical care, could be a great part of broadening the perspective of the board, informing their decision-making and helping them to formulate policies,” says John Combes, MD, president of the Center for Healthcare Governance in Chicago, a subsidiary committee of the American Hospital Association.
Mark V. Williams, MD, professor of medicine and director, Emory Hospital Medicine Unit in Atlanta, and editor in chief of the Journal of Hospital Medicine, does not consider committee participation optional.
“I strongly encourage—if not almost require—all of the hospitalists in our group to be involved in at least one committee,” says Dr. Williams. “My belief is that hospitalists are integral to the functioning of the hospital, and as part of their responsibility, they need to be actively involved in committee work to move projects forward.”
Leslie Flores, MHA, co-principal of Nelson/Flores Associates, LLC, agrees. “It’s in the hospitalists’ best interest to be involved in committees,” she says. “Hospitalists are often in the best position to see what needs to be fixed, and they have the potential to have a significant impact on how effectively their hospital operates, which can make their own jobs easier.”
Further, she points out, “If the hospital, which is financially supporting them, is more successful and effective, there’s likely to be less financial pressure on their practice.”
Hospitalists’ perceptions about committee participation can be influenced by each hospitalist’s employment model. If one is working directly for the hospital and giving 110% to that employer, being asked to volunteer additional time to serve on a committee might be viewed as a burden. On the other hand, an independent hospital medicine group (HMG) contracting with the hospital to deliver services may view committee participation as an avenue for ensuring the group’s success. Whatever the employment model, and whatever the career goals of individual hospitalists, it often pays to target one’s participation in committees.
—John Combes, MD, president of the Center for Healthcare Governance, a subsidiary committee of the American Hospital Association.
Make Participation Count
Hospitalists will be playing more key roles in medical staff leadership, according to William D. Atchley Jr., MD, medical director of the Division of Hospital Medicine for Sentara Medical Group in Hampton, Va. His concern is that hospitalists will be asked to serve on more than one or two committees. He advises younger hospitalists to notify the president of the medical staff of which committees they would be interested in working on. Dr. Atchley is also a member of the SHM Board of Directors.
“It could be peer review, performance improvement, or ad hoc committees focused on developing evidence-based order sets, improving through-put or disaster preparedness,” says Dr. Atchley. Whatever the pick, “it should be something that they’re going to find enjoyable and that they feel will advance their stature within the hospital.”
To be an effective member of a hospital board committee, a hospitalist must represent the greater interests of all stakeholders—not just his or her own self-interest, cautions Dr. Combes. However, “as physicians become more stressed and production-oriented, giving up clinical time to participate in governance activities becomes more and more difficult,” he concedes. Hospitalists should choose committee assignments based on their interests and expertise.
Dr. Williams encourages hospitalists in his group to pick one committee—preferably one focused on care delivery (quality improvement, pharmacy and therapeutics, utilization review) and take an active role. “Then, over time, I encourage them to try to chair committees to obtain leadership experience,” he says.
Taking on too many extracurricular committee tasks can be counterproductive. To avoid this, Flores advises younger hospitalists to ask themselves the following:
- What will my committee participation do to support the goals of the committee and the organization?
- By participating in this committee, can I expand my own knowledge or understanding of the culture and politics of the organization?
- Can I become more comfortable interacting on an organizational level?
- Can I network and get to know people I wouldn’t otherwise encounter, who can be helpful to me personally?
In addition, Dr. Atchley believes rotating committee assignments is also beneficial, especially for the younger hospitalist. In his tenure as a hospitalist, Dr. Atchley has served as chairman of the Department of Medicine’s credentials and quality assurance committees, and as vice president of the medical staff. Each committee furnishes hospitalists with a different perspective about how the hospital functions.
“I think hospitalists should understand the medical staff bylaws and procedures,” says Dr. Atchley. “Each hospital medicine staff has this governance structure, and I have found it beneficial in resolving conflicts about patient care and interaction between physicians.”
Mary A. Dallas, MD, has seen the committee situation from both sides of the fence. She is medical information officer for Presbyterian Healthcare Services, an integrated healthcare delivery network in Albuquerque, N.M., but served as medical director of Presbyterian’s hospitalist group for five years before that.
“Hospitalists have a vested interest in making sure their work area is protected, so they need to plant some people in strategic places for the governance and medical staff,” says Dr. Dallas. “In order to be effective in the governance of the hospital, you have to be part of that medical substructure and get involved.”
For instance, as medical director, she sat on the hospital’s credential committee and found it allowed her to keep tabs on new HMG hires going through the credentialing process. “This [the hospital] is your work environment,” she explains. “You are here day in and day out, and you should shape that environment, have a say in policies and rules, so that you can make your job more successful and make patient care better.”
The Quandary over Compensation
Many hospitalists feel frustrated when committee obligations impinge on clinical duties. Is compensation the answer for filling committee slots? Opinions are mixed.
Dr. Williams says he is “a little uncomfortable with the concept of people getting paid every time they attend a committee meeting. For hospitalists who receive funding from the hospital to support their programs, it’s important for the leader [of the HMG] to ensure that they’re collaborating with hospital administration. The hospital has the expectation that, as part of our salary structure, we will be members of committees. That needs to be part of the job.”
Dr. Dallas agrees: “Regardless of whether you’re getting paid or not, this is your work environment. I think it’s very important to be involved, so that your voice is heard and so that you can help make the [hospital] structure better.”
Compensating physicians for their time does communicate that their time is valued and respected, says Dr. Combes, but payment does not necessarily guarantee a high level of committee members’ engagement. In addition, he says, if physicians are being compensated directly by the hospital for serving on committees, “this can threaten the perception of their objectivity, in terms of bringing an independent perspective to the board.” A better solution might be for the hospital medicine group to build its own compensation structure for non-clinical work so members retain independence when voicing opinions to the hospital board.
Dr. Atchley admits it’s sometimes a struggle to find people willing to serve on medical staff committees. He advocates compensation for those duties on a per-meeting or hourly basis. His hospital meets attendance requirements by giving credit to doctors who participate on selected medical staff committees.
Through her consulting assignments, Flores has observed that in some organizations where hospitalists are paid based on productivity, committee participation can be assigned a relative value unit so hospitalists are compensated on the same basis as for clinical work.
Flores concurs with Drs. Dallas and Williams: “In most organizations, a certain minimum level of participation in medical staff activities is expected of all staff members. I think that hospitalists should expect to do that to the same degree as other medical staff members, on a voluntary basis.
“If hospitalists truly want to impact how the medical staff and the hospital operate, and to be considered for high-level leadership positions, then their best way of becoming known and respected in the medical community is by participating on committees.” TH
Gretchen Henkel writes frequently for The Hospitalist.
- SHM’s “2005-2006 Survey: State of the Hospital Medicine Movement, 2006.” Available online at www.hospitalmedicine.org Last accessed April 5, 2007.