“When you’re a division or a department, you have more autonomy over your own future, so I see this happening,” he says. “I think more and more will carve themselves out of general internal medicine, and a lot of that will come because of a demand for more independence and greater autonomy.” TH
Thomas R. Collins is a medical writer based in Florida.
More Value, More PATIENTs, More Technology
HM Pioneer Looks Into Crystal Ball
Robert Wachter, MD, MHM, one of the physicians who coined the term “hospitalist” 15 years ago and regarded as one of the field’s founding fathers, likes the idea of the field being a sentinel for the rest of healthcare. “It’s one of the fun things about being in the field,” says Dr. Wachter, professor and chief of the division of hospital medicine at the University of California at San Francisco. “If you look at what’s happening to hospitalists in the next two to four years, you can pretty much figure out what’s going to happen to the rest of medicine in five to 10 years.
“We’re that camel’s nose.”
With that in mind, what does Dr. Wachter predict for the next 15 years of HM? Here are his top three prognostications:
- A shift from the pressure to improve quality and safety to pressure to improve value, with more emphasis on cost and waste reduction.
“Hospitalist groups that are effective at [quality and safety] will continue to be popular in their organization, while hospitalist groups that aren’t will find that their standing is compromised,” he says.
How that is done will vary from institution to institution. It will require a complex process of literature and creation of algorithms, he adds, “but also rolling up your sleeves and meeting with the right people, and working through the politics and diplomacy in order to get this work done.”
- At teaching hospitals, a greater role for hospitalists to take care of patients who have traditionally been cared for by residents.
This is borne of the new Accreditation Council for Graduate Medical Education (ACGME) rules for residents’ work hours and supervision, which will require more hospitalists to fill voids in patient care and supervisory roles.
“If you like growth, that’s a great trend for hospitalists,” Dr. Wachter says. “But if you’re in the business of trying to hire enough hospitalists to fill all your needs, it’s not that great because the demand curve is just tremendous; there’s a national shortage of hospitalists.”
The trend also will affect what “a faculty job looks like,” because there will be more clinical needs that will take time away from more traditionally academic work, he explains.
“Academic hospitals are not very good at creating satisfying, sustainable jobs that are largely clinical,” Dr. Wachter says. “So how do you make sure that those people have fulfilling jobs, that they don’t feel like second-class citizens, that they can get promoted if they do what you’ve asked them to do well? I think that’s a huge challenge for the field, but it is a challenge borne of a new imperative.”
- A revolutionary move from a pen-and-paper hospital environment to a technology-driven workplace.
“It will change the way we do our work,” Dr. Wachter says, adding it will also mean other, more subtle changes.
“It takes away the importance of geography to some extent,” he adds. “I can be off in the doctor’s lounge or in my house and still do my work.
“And so how do you retain or enhance the relationships that are so fundamental to providing good care? That’s not only between doctors and patients and families, but also between doctors and nurses, and each other.”-TC