SAN DIEGO—Eleven years ago, about 100 physicians gathered in San Diego for a meeting of the National Association of Inpatient Physicians (NAIP). The term “hospitalist” had been coined only two years earlier for a fledgling specialty.
Fast forward to April 3, when NAIP—now SHM—returned to this city with 1,600 attendees for the largest gathering of hospitalists to date. This meeting, Hospital Medicine 2008, showcased a multitude of the society’s newest and boldest efforts.
Hot-off-the-presses data from the Society of Hospital Medicine 2007-2008 Survey were unveiled, showing hospitalists are getting paid more to do roughly the same amount of work they’d been doing. SHM also announced an upcoming Fellowship in Hospital Medicine credential, to be the first designation of commitment to the field. While handing over the reins to his successor Patrick J. Cawley, MD, outgoing SHM President Rusty Holman, MD, announced the development of a Hospital Care Collaborative that will foster cooperation among hospitalists, critical care nurses, pharmacists, and other hospital medicine stakeholders.
Attendees flocked to SHM’s new Rapid Fire clinical track for evidence-based answers to common question, delivered at a breakneck pace. For the first time, an award for Team Approaches in Quality Improvement was among those bestowed at the President’s Lunch. The winning project, “Optimizing Prevention of Hospital-Acquired Venous Thromboembolism,” was the creation of a team from the University of California, San Diego led by Gregory Maynard, MD, professor of clinical medicine and chief of the division of hospital medicine.
The future of our healthcare system and the role hospital medicine will play were uppermost on the minds of keynote speakers Don Berwick, MD, of the Institute for Healthcare Improvement (IHI), healthcare futurist Ian Morrison, PhD, and Robert Wachter, MD, each of whom peered into their crystal balls to give hospitalists glimpses of the challenges and opportunities they might expect. Each urged hospitalists to assert their place in the forefront of reimagining the U.S. care system and claim a leading role in whatever system that might be.
A First Time for Everything
The meeting produced many firsts in the educational content provided, thanks to SHM’s Annual Meeting Committee, led by course director Sylvia McKean, MD.
“We did change some things,” Dr. McKean said. “We had a call for proposals for speakers and sessions, and picked up a session in the operational track, in the clinical track and in Rapid Fire. We got a tremendous response to this, and this was the first time we’d ever had an open call like that.”
Several of the all-day pre-courses were revamped or entirely new. Also new was the Rapid Fire track, which provided answers to dilemmas in critical care, perioperative cardiac, care and more—all in rapid bursts of information.
There also were more special-interest forums, offering an opportunity for all subsets under the tent of hospital medicine—from geriatric hospitalists to women hospitalists to rural hospitalists—to network and compare notes.
Another opportunity to network for those with strong lungs was the inaugural SHM Fun Run early April 5. Participants ran a 5K course along San Diego’s waterfront.
SHM Announces Firsts
At the President’s Lunch on April 5, SHM leaders unveiled plans for several initiatives that will continue to foster and improve hospital medicine.
Dr. Holman outlined recent SHM successes and introduced upcoming initiatives. Successes include the society’s policy and advocacy agenda. SHM members generated 1,700 letters to Congress in 2007 through the online Legislative Action Center and added their voices to a successful lobby to postpone a 10.1% physician pay cut by Medicare last year. He also discussed his appearance at a Senate roundtable March 6 on Capitol Hill to discuss Medicare’s value-based purchasing of hospital care.
SHM is also front and center regarding transitions of care, and has been charged with developing transition quality measures for consideration in reporting initiatives.
As for future initiatives, Dr. Holman told attendees about SHM’s plan for a Hospital Care Collaborative. The society will partner with national organizations in allied health, including the American Association of Critical-Care Nurses and the American Society of Health-System Pharmacists. All will work together on common policies and implementation strategies.
The society also will provide more resources for hospitalist leaders. “SHM wants to be positioned to support leadership training,” Dr. Holman noted. “We have a multiyear plan” that includes creating core competencies for hospital medicine leadership, a possible leadership certification, a mentoring program, and leadership coaching.
SHM CEO Larry Wellikson, MD, summed up the tremendous growth of hospital medicine: “We’re large and in charge, and we’re only going to get bigger.” He elaborated on progress made on SHM initiatives that will enhance this growth, including:
- Continued monitoring of the first official certification for hospital medicine, the American Board of Internal Medicine (ABIM)-approved Focused Recognition for Hospital Medicine;
- Creation of the first designation of commitment to the practice of hospital medicine: the SHM Fellowship in Hospital Medicine (FHM) credential. A Senior Fellowship in Hospital Medicine and a Master in Hospital Medicine will also be available. Information and applications will be available this fall, and all SHM members can apply;
- Continued use of new media to educate and inform members; and
- One- or two-day regional educational forums across the U.S.
Dr. Cawley, chief medical officer of Medical University of South Carolina Medical Center in Charleston, closed the President’s Lunch by echoing the speakers’ message for hospitalists. “Change is in the air,” he asserted, recalling the last time healthcare was poised for big change, when President Clinton was prepared to overhaul the system in 1993. “The difference between 1993 and 2008 is you—it’s hospitalists,” Dr. Cawley urged. “You are the guiding team” for change.
Also during Saturday’s luncheon, outgoing SHM board members Bill Atchley, MD, and Mary Jo Gorman, MD, were honored for their six years of service.
Focus on the Future
Hospital Medicine 2008 was firmly focused on the future: the future of American healthcare, the future of hospital medicine, and what hospitalists will and should do to further their specialty. These themes surfaced again and again in the plenaries, in breakout sessions, and in casual hallway conversations.
Drs. Berwick and Morrison stirred up attendees with their morning addresses and had them debating the state of healthcare. Dr. Wachter, professor and associate chairman, department of medicine, and chief of the medical service, University of California, San Francisco, offered his unique perspective by taking Drs. Berwick and Morrison’s 35,000-foot-view and bringing it down to the day-to-day work of hospitalists. The creator of the popular healthcare blog “Wachter’s World” (www.wachtersworld. org) suggested “megatrends” hospitalists might expect to see, including:
- The growth of local pay-for-performance (bonuses based on performance) and state reporting systems, and a shift toward outcome measurement as opposed to process measures;
- The power of public reporting, driven by the “simple embarrassment of highlighting underperformers”;
- Zero tolerance for “disruptive” physicians;
- Ever-increasing hospitalist-surgical comanagement; and
- IT-induced “dislocation” of medicine as computerization decreases the need for physical presence, as well as the emergence of IT haves and have-nots.
Jane Jerrard, a Chicago-based medical journalist, writes the “Public Policy” and “Career Development” departments for The Hospitalist and has covered the SHM Annual Meeting the past three years.