It was only natural when SHM started hosting Special Interest Forums a few meetings ago that a chat devoted to quality would emerge. So it was no surprise when some 60 HM11 attendees crowded into a room to talk about just that. But part of preaching the value of quality is knowing how to preach.
To that end, Mangla Gulati, MD, FACP, assistant professor in the Department of Medicine at the University of Maryland School of Medicine in Baltimore, wants resources to teach her how to talk with administrators on their level. “We need to know the language to parlay with our CFO or CEO,” she says. “That’s what’s helpful for us.”
Joe Miller, SHM’s senior vice president and chief solutions officer, suggested the society could create a microsite within www.hospitalmedicine.org dedicated to the topic. He says there are online toolkits the society has developed in the past, and will continue to develop, that will help introduce hospitalists to already-existing quality initiatives they simply don’t know about. He particularly noted SQUINT, SHM’s searchable database for quality projects that is just getting off the ground.
“The stuff that’s there, I use and I love it,” says Dorothy Pusateri, MD, of Allegheny Hospitalist Service in Pittsburgh. “The stuff on Project BOOST [Better Outcomes for Older Adults through Safer Transitions] was enough to teach me.”
Small-town hospitalists from every corner of the country discussed recruiting issues, scheduling solutions, advocacy concerns, and more. A group of 15 rural hospitalists shared concerns about brutal, “72-hour” shifts and potential solutions to hiring and staffing issues, including growing your own hospitalists and hiring nonphysician providers (NPPs) to supplement 24/7 coverage.
“You can’t sustain mentally if you are doing all of it by yourself all day, all night,” said Martin Johns, MD, a hospitalist at 25-bed Gifford Medical Center in Randolph, Vt. Dr. Johns suggested rural groups think about utilizing NPPs and physician assistants (PAs) to fill coverage gaps; however, the opinions varied widely in what was considered proper compensation and responsibilities for nonphysicians.
“Our PAs make almost as much as our docs,” said Dale Vizcarra, MD, medical director of the hospitalist group at St. Mary’s Healthcare, a 68-bed critical-care hospital in Pierre, S.D.
The group also discussed at length the difficulties in bringing doctors to small towns. Although compensation can be higher than in large urban centers, the group agreed that the “one-man show” aspect of working as a small-town hospitalist is a detractor.
“I hear it all the time,” said forum moderator Alan Himmelstein, a regional vice president for Sound Physicians. “I can take care of gunshot wounds, but I forgot everything I know about community-acquired pneumonia. You aren’t surrounded by 23 specialists; in rural communities, you guys are the top of the heap. Your skill set, by definition, has to make you comfortable to take care of everything that comes through the door. You don’t have another facility a half-hour away; a lot of your geography doesn’t allow helicopters to fly 365 days.”
Rural hospitalists, who as a group admit nearly 40% of all hospital admissions nationwide, also are looking for a voice. “We’re a huge constituency,” Dr. Johns said, “and we are under-represented.”
Jason Carris, editor of The Hospitalist, contributed to this report.