GRAPEVINE, Texas—New SHM President Joseph Li, MD, SFHM, associate professor of medicine at Harvard Medical School and director of the hospital medicine division at Beth Israel Deaconess Medical Center in Boston, asked a question at HM11 that might be a first for the relatively nascent field. After explaining to the crowd in the ballroom at the Gaylord Texan Resort and Convention Center that the average hospitalist is 37 years old, Dr. Li asked: “What’s going to happen when the hospitalist gets older and their priorities change?”
A hopeful, if wary, eye on the future of the still-growing field was a common thread throughout HM11, as SHM leaders from the new president to CEO Larry Wellikson, MD, SFHM, laid out the pathway of growth for a 15-year-old specialty. Although each acknowledged uncertainties as they adjust to a domestic healthcare system in the throes of its largest reform in a generation, they agree on a few mainstays.
First, HM should continue to take ownership of quality-improvement (QI) and patient-safety initiatives that improve outcomes and reduce costs for hospitals, as the dual reward of better care for patients and lower costs for chief financial officers can serve as change agents for healthcare and leverage for the next contract.
Second, hospitalists should be careful to balance expansion of their duties—be it via such “hyphenated hospitalists” as laborists, say, or through comanagement of surgical and ED patients—with an appropriate amount of dedicated resources.
Finally, academic hospitalists, from residents to attendings, should continue to plan for this summer’s reduction in work hours and patient caps for residents, new rules from the Accreditation Council for Graduate Medical Education (ACGME) that some fear could create a future cast of ill-prepared internists.
“There’s a lot that’s bearing down on physicians and it’s been compressed in a short period of time,” said AMA President Cecil Wilson, MD. “We cannot go back to where we were and we cannot stay where we are. … We may not have a choice about change, but we do have a choice on how we respond to change and how we influence it.”
Dr. Li sees SHM sitting at the intersection of practical application and influence. He wants to continue with society-sponsored training academies and leadership programs that both impress upon hospitalists how important it is for them to take leadership roles in their hospitals and make sure they have the skills to do so. Dr. Li says the field needs to look no further than other fields adopting the in-hospital practice model as proof that the care model is vital to improving equality.
“We need to be laser-focused in terms of what we want to do. [We] want to improve the quality of care of patients both inside and outside the hospital,” he adds. “I say both inside and outside because, oftentimes, that transition is somewhere in between it. We have many hospitalists, like at my place, who provide care in the outpatient setting, in post-discharge clinics, and other places.”
Dr. Li also says that collaborations with fellow medical societies and organizations are key to SHM’s advocacy role. Society leaders are attending other specialty conferences to build and strengthen relationships that help extend HM’s reach into policy circles. In perhaps one of the strongest relationships, SHM leadership is meeting this summer with Donald Berwick, MD, administrator of the Centers for Medicare & Medicaid Services (CMS). The meeting is even more valuable in context of Dr. Berwick’s recent selection of Patrick Conway, MD, MSc, SFHM, a pediatric hospitalist and director of hospital medicine at Cincinnati Children’s Hospital Medical Center, as CMS’ chief medical officer. The government position is the highest-ranking policy role ever held by a hospitalist (see “Hospitalist Takes Charge” p. 28).
“We’re in a position going forward where we don’t talk alone,” says immediate past SHM president Jeff Wiese, MD, FACP, SFHM, associate professor of medicine at Tulane University Health Sciences Center in New Orleans. “It’s us and our partners talking together. That moves what is currently a loud voice to a stentorian voice. You can imagine where SHM and ACP [American College of Physicians] and the VA [Veterans Administration] and Society of Critical Care Medicine … if they’re all saying the same thing, that’s a very different message than if one organization is saying it alone.”
Adds SHM board member and former SHM Public Policy Committee chairman Eric Siegal, MD, SFHM, a critical-care fellow at the University of Wisconsin School of Medicine and Public Health in Madison, “We’re absolutely at the table in a way that’s, frankly, almost stunning how fast we have evolved [from] several years ago, when we first went to Washington, D.C., for our first advocacy day, and we had to explain to people that hospitalists were not in the hospitality industry. We punch well above our weight class right now.”
It’s a tall order for any specialty society to push the national healthcare discussion, but Dr. Li sees HM as perfectly perched “to train the trainers.” The field has grown to more than 30,000 hospitalists, well beyond the estimated ceiling of 20,000 hospitalists forecasted in the field’s earliest days. That rapid-fire growth–hospitalists are now present in the vast majority of hospitals that can either afford them or need them–means the field can now evolve past simply swelling numbers to creating better physicians. By encouraging more rank-and-file practitioners to become leaders, the logic goes, the number of groups will increase as practices sprout in those remaining hospitals without HM services: more practices, more hospitalists, more presence in future policy discussions.
To that end, Dr. Wellikson notes that SHM continues to introduce training courses and research repositories. Two recent additions are eQUIPS (Electronic Quality Improvement Programs), a series of QI and patient toolkits aimed at transitional care, glycemic control, and VTE prevention, and SQUINT, SHM’s new QI repository, which allows users to upload research projects to a searchable database that other physicians can then mine for data.
“We’re really only at the very beginning,” Dr. Li says. “All of hospital medicine only started 10, 15 years ago. For some folks, they believe that’s a long time. But this really is the very beginning of this movement.”
Richard Quinn is a freelance writer based in New Jersey.