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Rachel George, MD, MBA, FHM, CPE, acknowledges she found her calling through a fluke. After completing an internal-medicine residency in Chicago in 2002, she knew she wanted to stay in the region. She hadn’t decided much else.

“I was not excited about private practice, and I had thought about a cardiology fellowship,” Dr. George recalls. “I was trying to figure out what I wanted to do when I grew up, so to speak.”

She found a job as the lone hospitalist with OSF Medical Group in Rockford, Ill. Despite knowing she’d see “a ridiculous number of patients”—up to 30 per day on weekends—she liked it enough to sign on. “I decided I’d give it a chance for six months or a year while I figured out what I was really going to do,” she says.

Before long, she realized she already was doing it.

“I absolutely loved it,” says Dr. George, one of six new Team Hospitalist members who joined our reader advisory group in April. She now oversees five hospitalist programs in three states as regional medical director and vice president of operations for Brentwood, Tenn.-based Cogent Healthcare. “It was perfect. It was the niche I was looking for.”

Question: What did you enjoy so much about being a hospitalist?

Answer: The acuity of care, the instant gratification of fixing someone and sending them on their way, the intensity in the hospital, not feeling like I was being pulled in 15 different directions like you are in primary-care practice—all the good things about being a hospitalist.

Q: Within a year of joining OSF, you became medical director of its hospitalist service and oversaw its expansion. Did you always envision yourself moving into a leadership role?

A: When I started, I probably would have said my ultimate goal was to get my MBA and think about hospital administration. That was the 10-year plan, or maybe even the 15- or 20-year plan. But when people at the hospital began talking about expanding the [HM] program, I got thrust into the [medical director] role. By that point, I was hooked.

Q: Within three years, you grew the service from one physician to nine. How did you approach expansion?

A: The goal was sustainable growth—growth without sacrificing quality of patient care. When PCPs approached me about taking over their patient population, I’d say we’d take them on as we hired more people. I didn’t want to take off more than we could chew, and I didn’t want to have ridiculous turnover. That wouldn’t do anybody any good.

If everyone understands getting high-quality care to the patient is the most important thing, and we’re all working together to make sure that happens, everything else—core measure performance, decreasing the length of stay—will follow.

Q: You joined Cogent in 2006. What prompted the move?

A: I knew Cogent through SHM, and it was too good of an opportunity to pass up. The chance to expand my management responsibilities also was very appealing.

Q: What do you see as the biggest advantage of Cogent’s model?

A: I was part of an in-house program, and I think they’re great in a lot of ways. What they can’t do is economies of scale. There are certain things you can’t do just because it doesn’t make sense financially.

Q: Can you give an example?

A: The classic example I’ll give is discharge summaries in less than 24 hours. [At OSF], I did everything short of getting on my hands and knees and begging them to transcribe discharge summaries in less than 24 hours. They wouldn’t, and I understand why. It was a financial decision.

Cogent, from its inception, said this is too important and we’re going to make sure PCPs get information at discharge. Those types of economies of scale are very difficult to do in a small program, if you’re trying to do it yourself.

Q: What do you consider your biggest professional reward?

A: Seeing a really high-functioning HM team that I’ve helped make that way.

Q: What are the essential elements of such a team?

A: It’s the culture, that patient-first attitude. If everyone understands getting high-quality care to the patient is the most important thing, and we’re all working together to make sure that happens, everything else—core measure performance, decreasing the length of stay—will follow.

Q: What is your biggest challenge?

A: Trying to revamp broken programs.

Q: How do you begin that process?

A: Once the wrong attitude, wrong vision, and wrong culture have set in, we have to decide “How do we improve this?” It’s very difficult. You can’t just close the service and stop seeing patients until you’ve done what you need to do. It’s like trying to fix an airplane in midair.

Q: Despite an already full plate, you continue to see patients. Why?

A: I do it for myself. I don’t want to quit patient care. I enjoy talking to my patients, figuring out what’s wrong, and trying to help them.

Q: You attended the SHM Leadership Academy and have since facilitated academy sessions. What do you see as its benefit?

A: Hospital medicine is a business, whether we like to accept it or not. It’s important for physicians to understand the business drivers, not only for our own practice but for the hospital as well. The academy gives a great overview of the fundamentals of those business drivers.

Q: Would you recommend it for a physician who doesn’t intend to move into a leadership position?

A: I would. It’s valuable for anyone committed to hospital medicine. It helps them understand how their leaders are thinking and why they’re thinking the way they are.

Q: You are former chair of SHM’s Women in Hospital Medicine Task Force, and you pride yourself on balancing life and work. Is HM conducive to that balance?

A: It absolutely can be. Women sometimes think they have to be all things to all people all the time. It’s really about figuring out what your priorities are. I have two young kids and spending time with them is a bigger priority to me than cooking and cleaning. I’d rather live with a messy house and dishes in the sink than not spend time with them.

As a hospitalist, you have that flexibility, too. Most HM programs would love to have a stable, part-time physician. You can do that if you want, or you can be a nocturnist so you can be home with your kids during the day. You are in control of your own life. Understanding that is important, and you can make your choices accordingly.

Q: How do you think HM fares regarding the inclusion of women?

A: There isn’t as much of a good-old-boys’ club as opposed to other fields, which is really refreshing. Women are very well represented on boards and committees. What strikes me is the percentage of women hospitalist leaders is significantly lower.

Q: Why do you think that is?

A: I haven’t wrapped my mind around whether that’s because they aren’t interested because of the choices they made in their lives—which is perfectly fine—or if it’s a lack of opportunity. I do think some women choose not to have a leadership role because their priorities are different, and that’s wonderful. But I wonder if there are cases when women are being passed over for those positions for men instead. The percentages are something we need to keep an eye on so we can better understand why that’s happening. TH

Mark Leiser is a freelance writer in New Jersey.

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