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).