Ed note: This article is the first in a series of interviews with members of Team Hospitalist: 12 hospital medicine experts who are serving a two-year term as special editorial consultants to our magazine.
Raajev Alexander, MD, is one busy hospitalist. For the past three years, he has been the lead hospitalist for the Oregon Medical Group, a group that caters to McKenzie-Willamette Medical Center in Springfield, Ore., and Sacred Heart Medical Center in Eugene, Ore. In addition to seeing about 15 patients a day, Dr. Alexander’s expertise in systems development has made him an attractive local expert. He serves on about five hospital committees (“I’ve lost track.”) and often attends meetings on his days off.
Dr. Alexander graduated from the University of Utah School of Medicine in 1995. After completing an internship and residency at Legacy Portland Hospital’s Internal Medicine program in 1998, he was recruited into the Oregon Medical Group.
He recently spoke with The Hospitalist about what he likes about his job, but why he also feels hospitalists should be compensated for the extra duties they undertake.
What attracted you to hospital medicine?
There is this kind of patient acuity where the sort of problems you’re solving seem important. Patients can have serious illnesses so you’re using your skills as an internist. I also like that there is a discreet arch to the hospitalization: There is the beginning of the hospitalization, the middle, the end, and then you’re sort of done. And I like that there is an interdisciplinary aspect; you work with nurses, care management, speech therapists, physical therapists, and ancillary therapists.
What are the challenges of leading a hospitalist group?
I do more than the full number of shifts per year. In addition to that, I go to meetings and deal with everything from a nurse calls and complaints about a hospitalist, to administration of the group. The CEO [of Oregon Medical Group] and I talk about staffing plans and how we can better serve the two hospitals in our area. I also sit on several hospital committees where I contribute my opinions on how to deploy pharmacists to how to redesign the case management program. My group finally decided to compensate me for certain meetings, but I still don’t get paid for half the meetings I go to.
Is this an issue other groups have?
I’m almost positive this is an ongoing issue for all hospitalist groups—at least I think it ought to be.
Hospitalists provide quality improvement on two different levels. One level is that, because we are in the hospital every day, we get to know the nurses, case managers, unit managers, lead respiratory therapists, and physical therapists. So, we effect change just by standing in the hallway.
The cross-education of pharmacists, nurses, and doctors is getting better every day. This is different from the way it used to be when a doctor had to run to the hospital at noon to see two patients, then run back to the office. Another way we improve quality is through committees. For all of the committees I sit on, the hospital gets get all my knowledge and ideas about systems, medications, and cross-reactions of drugs for free. But there isn’t enough time in my day to see patients, do nurse education and respiratory therapy education, to create protocols, and to sit on committees.
What’s the solution?
There are certain business models in hospital medicine that don’t make it possible to last as a hospitalist for 25 to 30 years. For example, there are some models where you get a bonus if you hit 18 to 20 patient encounters a day—even though those numbers are outside the SHM guidelines. If you’re seeing that many patients, you’re not providing optimal patient care.
A good business model is one where you can have 12 encounters per day and make a good living. Or see eight encounters per day and do administrative work, and still make a good living. The way to get there is for the specialty to better identify its mission and who its constituents are. TH