Medicolegal Issues

Research Committee Chair Reflects


 

Dr. Auerbach

Before Andy Auerbach, MD, MPH, concludes a four-year term as chair of SHM’s Research Committee, I talked with him about his perspective on hospital medicine research. Dr. Auerbach is an associate professor of medicine at the University of California, San Francisco.

He received a career development award from the National Institutes of Health (NIH) early in his career and is the principal investigator of an R01 research project grant from the NHLBI titled “Improving use of perioperative beta-blockers through a multidimensional QI program.”

He is also a co-author of “Outcomes of Patients Treated by Hospitalists, General Internists, and Family Physicians” in the December 2007 New England Journal of Medicine, which found statistically significant differences in length of stay and cost. He received his medical degree from Dartmouth Medical School in Hanover, N.H., and did his residency training in internal medicine at Yale New Haven Hospital in Connecticut. He completed an MPH in clinical epidemiology at the Harvard School of Public Health in Boston in 1998.

Chapter Summary

Indiana

The Indiana chapter met Jan. 9, with representatives of nine area hospitalist groups attending. The meeting began with an introduction of new chapter President Angela Corea, MD, a hospitalist with St. Vincent Health in Indianapolis, and three new chapter vice presidents:

  • Gordon Reed, MD, director of hospital medicine, Hendricks Regional Health, Danville;
  • Cecilia May, MD, hospitalist, Sigma Medical Group in Lafayette; and
  • Zaneb Beams, MD, hospitalist, St. Vincent Health, Indianapolis.

An informal roundtable discussion focused on a range of topics, particularly patient co-management. TH

Q: So, is academia as glamorous as it sounds?

Dr. Auerbach: Way more glamorous—you should see my office. And yes, we are in a white tower.

Q: How did you get your start in research?

Dr. Auerbach: I actually started out my research fellowship wanting to be a cardiologist and go into the cath lab while developing the skills to participate in and teach research methods. I found I really enjoyed the work, particularly the creative and entrepreneurial aspects of developing a project or grant and seeing it through to completion.

Q: What are the research options for hospitalists practicing in nonteaching settings?

Dr. Auerbach: I think the most straightforward way to participate in research is to partner with a clinical research organization to help enroll patients in their trials. While you don’t get the opportunity to design the study, you do get to get a feel for consent/enrollment and internal review board [IRB] processes. 

The next best way to get involved with research is to partner with a researcher—and this need not be a hospitalist—at your site or very near by. Many QI projects are close to being research-ready and may provide an opportunity to make that work count twice. But it will require you to learn about analytic methods.

I’d also be remiss if I didn’t mention the value of other very useful academic products—rigorous reports of a QI intervention (think of both success and failure stories) and patient case reports. If well referenced and used as teaching documents, these can be very useful ways to advance knowledge.

Q: Are there any particular prerequisites in terms of training that you find especially helpful as you conduct your research? 

Dr. Auerbach: It is hard to be a capital-R “Researcher” and compete for career development grants and NIH funding without some advanced [degrees] and a clinical research fellowship. I hesitate to call these prerequisites, but they are nearly so. 

Hospital Medicine Fast Facts 8 Fundamentals to Improve Hospitalist Career Satisfaction

  1. Recognize each hospitalist as an individual. Each hospitalist has his/her own preferences, interests, and goals;
  2. Ensure there are adequate environmental resources. Before the more sophisticated satisfaction issues can be addressed, sufficient administrative support, space, and equipment must be in place;
  3. Ensure there is adequate professional development support in the form of peer groups or individual supervision and mentoring;
  4. Make informed decisions. Addressing hospitalist career satisfaction requires making sure there is an understanding of the current state of affairs and the available options;
  5. Build a cohesive team. Individual hospitalists will be more satisfied when they feel like they are part of a group with similar values, philosophies, and attitudes;
  6. Build positive relationships. The hospitalist practice does not operate in a vacuum. Addressing career satisfaction requires positive relationships with hospital leadership, members of the medical staff, and non-physician healthcare professionals;
  7. Create an ownership mentality. If hospitalists are to be treated with respect, they must view their group in a manner similar to private physicians in the community. This includes having a shared sense of accountability for the practice’s performance, including financial matters; and
  8. Operate the practice in a business-like manner. There should be some formality to the hospitalist practice (e.g., a business plan, negotiated service agreements, and annual budgets).

Q: What do you like best about your career as a hospitalist?

Dr. Auerbach: I really like acute care medicine, but didn’t want to subspecialize—otherwise I’d be wearing lead in a cath lab now. I also like the questions and processes in the hospital a bit more than the clinic setting.

Q: Who are your mentors and how did you find them? 

Dr. Auerbach: I’ve had a remarkable set of mentors from fellowship [Mary Beth Hamel, Roger Davis, Russ Phillips] through my early career [Lee Goldman, Bob Wachter, Ralph Gonzales]. Now that I am early-mid career, I’m trying to pass their teaching on.

Q: Any advice for hospitalists interested in research but daunted by the prospect of starting their own studies?

Dr. Auerbach: If you want to do a scholarly/academic project to round out your personal/career satisfaction, I think the daunting nature of research can be overcome with the right questions and right support—and by defining what these are well before you actually dive into a dataset or implementation project. You also have to decide how much satisfaction you will get from the project in the end compared to the incremental nights/weekends you will spend to plan and execute your project—not to mention publish.

If you are thinking of research as a career, be aware of what makes you happy. If you like to write, enjoy the process of hypothesis generating/testing, and take rejection well you may be happy as a researcher. There are still plenty of nights/weekends to be spent, though.

Making a switch from full-time clinical or administrative work to research means making a very big commitment to going back to get the skills as part of a fellowship.

Q: Do researchers interested in quality improvement questions still have to run their work past the IRB?

Dr. Auerbach: Unfortunately this is now an area of uncertainty for people—unnecessarily so. Until recent events, IRBs have not required approval for QI projects that seek to enhance care according to an evidence-based standard, especially if that standard is endorsed by the institution. If you plan to publish your findings—particularly if you talk to or touch patients, or collect personal health information—I think it is nearly always wise to at least call your local IRB to ask for how you can or should conduct the study. This is best done before you start the project, obviously.

If you want to publish your results using deidentified data after the project is done, our IRB would say that is exempt from review [e.g., no need for approval]. But I think even this case would be worth a phone call to ensure your IRB feels similarly.

Whether or not you get IRB approval, be very aware of how and where you store data. TH

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