The rate of change within hospital medicine has been astounding over the past 11 years, and we have always tried to position SHM to remain nimble to respond to those changes. Racing legend Mario Andretti once said that if everything seems under control, you aren’t going fast enough.
Rapid responsiveness has become deeply ingrained within the culture of SHM. Every member should be proud because this is the result of the hard work and dedication of the many members who simply refuse to accept the status quo.
A few months ago, I met with a group of young hospitalists. We were discussing a variety of topics when one of the hospitalists asked in a frustrated tone, “When is the change going to stop?” Her program was experiencing rapid growth while still trying to recruit sufficient hospitalists. Yet at the same time, she was enjoying involvement in several quality improvement projects at her hospital.
I began to talk with her about schedules, smart growth, time management—all the management techniques I have picked up over time. But she pushed back: “No, when is it going to stop? I love my job, but all this change and push to see more patients and comply with increasing safety/quality mandates is really stressing me. I simply see no end in sight. Our program is going to end up admitting or consulting on almost every patient in this hospital. We can’t find enough hospitalists! When is it going to stop?”
Before answering her, I thought about all the accomplishments of hospital medicine, particularly those fostered by SHM. The list is numerous. I wondered whether, despite our nimbleness, we were still helping this frustrated hospitalist and her patients. She was asking what it’s going to take to move beyond the frustration despite 11 years of hospital medicine milestones.
My answer: It is not going to stop until we look beyond our current view. We have laid a great foundation at SHM and in hospital medicine, but we must embrace a different method of delivering care to our patients. Our long-term professional satisfaction demands it. Moreover, if we really want to deliver high-quality care to the many patients we are being asked to see, this change is an absolute necessity. It won’t come easily, but hospitalists are not alone in this; many other specialties must face it, as well.
During my 13 years as a hospitalist—half of which were spent in hospital medicine private practice—I have seen patients in 10 hospitals. These hospitals ranged from a 100-bed community hospital to a 600-bed academic medical center. Some have been for profit, some not for profit, and some government sponsored. What is interesting is that in each of these facilities, my ability to see patients was vastly different. In one hospital, I could comfortably see 25 to 30 patients a day. In another, I could barely see eight to 10. In some, the admission process took me 30 minutes, in another 90 minutes.
What is the difference in these hospitals? It usually isn’t much. Maybe it’s the fact the charts are always in one place. Maybe the electronic medical record is simply better, or the ward secretaries more helpful. Or maybe it’s several of these factors, and others. But the point is that it is possible to vastly improve things with some minor tweaks in the system. It usually happens when the hospital and physicians have communicated with each other to make these changes.