Higher, Faster, Farther
Another method to tackle the hospitalist shortage is to see more patients with the same amount of providers. Doing this requires more than just increasing the patient numerator as you hold the provider denominator steady. Rather, it requires real systems changes to enhance provider efficiency. A significant amount of a hospitalists’ daily workload consists of non-patient care activity, such as searching for charts, waiting for consultants to call back and scheduling follow-up appointments. The challenge to future hospitalists will be to tame these inefficiencies by developing more streamlined hospital systems and care processes.
This may include hiring assistants, rounding staff, and/or mid-level providers to incrementally increase the number of patients the group can see per physician. These are not without risks and barriers, and many groups currently are wrestling with how to best utilize and integrate these providers in a cost-effective manner. However, I think it is likely these components will provide the future scaffolding to allow groups to care for ever increasing numbers of patients.
Prime the Pump
Perhaps, most importantly, we need to develop ways to attract more medical students and residents to hospitalist careers. This will be challenging and falls squarely to my academic hospital medicine colleagues, as our learners see us as the yardstick for a hospitalist career. Unfortunately, the growth trend in academic hospital medicine has been in non-teaching or uncovered services. These jobs often are an academic necropolis, with the providers routinely being overworked and devalued by their institution.
As a result, academic hospitalist positions often times are filled by recent residency graduates awaiting a fellowship. These “R4” or “pretending” positions provide very rickety underpinnings from which to build the foundation of hospital medicine. Don’t for an instant think this goes unnoticed by our student and resident colleagues who choose their career based on the role models they see early in their training.
It is essential hospital medicine develops truly sustainable academic careers replete with opportunities to fulfill the inimitable tenets of academic medicine—teaching and scholarly work. For these reasons, SHM has partnered with the Society of General Internal Medicine and the Association of Chiefs in General Internal Medicine to develop the Academic Hospitalist Academy. The four-day academy premiers next fall. Its goal is to enable academic hospitalists to become exceptional educators, institutional leaders, and successful scholars—the exact type of role models that will attract the best and the brightest to the field of hospital medicine for generations to come. TH
Dr. Glasheen is associate professor of medicine at the University of Colorado Denver, where he serves as director of the hospital medicine program and the hospitalist training program, and as associate program director of the Internal Medicine Residency Program.
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