Q: Most doctors at the executive level of The Schumacher Group—including yourself—still practice medicine. Why is that so integral to the mission?
A: When I served in the military, the best officers I served under were officers who had been enlisted men earlier in their career. The same follows suit in hospital medicine. When I make an administrative decision, it can affect thousands of patient lives tomorrow. I can mentally track the effects of my decision all the way back to how it will affect the patient laying in the bed. If you’re not having that constantly reinforced by seeing patients, it’s very easy to lose track of it, and that has such a profound effect on patient care.
Q: SHM recently designated you one of the inaugural “Fellows in Hospital Medicine.” What is the biggest reward of a HM career?
A: For me, there are two. One is the ability to see the fruits of your labor much more rapidly than in the outpatient world. I can have a patient in bed in front of me actively dying and watch them a week later walk out of hospital in good condition. That’s a very different timetable than the outpatient world, when you may put a patient on all the right medicines to reduce the risk of a heart attack and, over 60 years, watch them not have a heart attack. The other thing I find very rewarding is the amount of measurements and data collected on what we do. We get feedback ranging from patient satisfaction scores to referring physician scores to readmission rates to data that shows if we are able to get patients better outcomes at lower costs. You just don’t get that type of feedback in many other fields.
Q: What is the greatest challenge facing the profession?
A: One of the biggest is the supply and demand mismatch. Right now, one of the hardest jobs is a hospitalist recruiter. With every physician having five to 10 open job offers …recruiting is difficult, and recruiting the right physician is extremely difficult.
Q: How can that be addressed?
A: One way is to be efficient. Can we see more patients in the same amount of time with no decrease in quality? For us, it involves the use of what we call a practice coordinator. It’s an employee of The Schumacher Group who is located in the individual hospital who does everything from assisting with managing the practice to answering telephone calls. This really allows us to help us organize our time better, so we don’t get bogged down in nonclinical work. Every minute spent on the phone with an insurance company or home health agency is a minute not spent at the bedside. Another way is expanding the use of midlevel providers. The key is not to use them as a replacement for a physician, but as an assistant to the physician—again, to boost capacity.
Q: How did your background with the military, FEMA, and the Red Cross prepare you for what you’re doing now?
A: Business as usual is very difficult to do in a chaotic environment, so I began to appreciate the importance of systems. If you’re relying on an individual and that individual leaves, your entity is in trouble. If you put good systems into place, you’re not so reliant on any one individual. Systems can function long after any individual doctor has come and gone. In the world of hospitalists—where there’s still fairly high turnover, being a young field and there are many opportunities—it’s imperative the systems approach is taken. TH