When William D. Atchley Jr., MD, FACP, SFHM, left private practice for hospital medicine in 1995, he didn’t realize he was helping to make history. Dr. Atchley was practicing with an internal-medicine multispecialty group when a medical school withdrew its residency program from the community hospital next door. Soon after, physicians in the group began experiencing frequent disruptions in order to care for a handful of hospitalized patients.
Dr. Atchley and two colleagues, all of whom enjoyed the hospital setting, solved the problem by forming an inpatient rounding team at Sentara Leigh Hospital in Norfolk, Va. They believe it was the first hospitalist program in Virginia.
“When we first started doing this, we were looking at each other saying, ‘Is this something for the long run … or is it going to be something that is a flash in the pan?’ ” says Dr. Atchley, chief of the Division of Hospital Medicine at Sentara Medical Group, which operates hospitalist programs at five sites in southeastern Virginia. “If you had asked me to look into a crystal ball, I would not have projected hospital medicine would have grown so quickly. It truly is phenomenal, and it’s been an exciting ride. It was great to be on the ground floor of this, and it’s been nice to see how things have evolved.”
Question: You studied biomedical engineering prior to medical school. Are there similarities between that field and HM?
Answer: Engineering teaches you how to approach problem-solving. That’s particularly helpful with some of the system issues we talk about, such as dealing with throughput or applications of electronic medical records and computerized physician order entry. It’s given me a good background to understand issues that come up regarding quality and patient safety, and trying to take a systemwide viewpoint about looking at how care is delivered.
Q: What’s the biggest change you’ve seen in HM over the past 16 years?
A: The job I had in 1995 is vastly different from the job I have now. At that time, it was all about taking care of internal-medicine adult patients. We’ve seen the evolution of surgical comanagement, and hospitalists have truly become leaders of change in terms of how care is being delivered in the hospital. Things like patient safety, quality, and learning to deal with the limited resources we have, in terms of the cost of healthcare, were not even on the radar screen 16 years ago.
Q: Why is it important for you to continue seeing patients?
A: To have validity with your fellow hospitalists who are working in the trenches. You can only appreciate what their day-to-day challenges are when you roll up your sleeves and you’re out there with them. I think it gives me “street cred” with them. I still understand the things that are great about the job, but at the same time, I see the things that are frustrating about the job.
Q: What is your biggest professional reward?
A: Being actively engaged in SHM. I served on its board of directors, and I’ve served as secretary and treasurer. I continue to be active in the society. I was honored to be elected as a senior fellow (SFHM) in the organization.
Q: What did it mean to you to be elected a senior fellow?
A: I’m very humbled and gracious to the organization. That’s been my greatest professional achievement.
Q: You also serve as a facilitator with SHM’s Leadership Academy. Why are you so passionate about that program?
A: It gives hospitalists the essential tools they need to be able to roll up their sleeves and start tackling problems at their hospitals. It’s a great opportunity for anybody who is thinking about running a group or taking a leading role in a healthcare system.
Q: What is your biggest professional challenge?
A: It’s learning to be able to lead the next generation of hospitalists, to get them to be as enthusiastic about practicing hospital medicine as I am.
Q: Why is that so challenging?
A: If you have ever practiced in a traditional general internal-medicine practice (office-based), and then you become a hospitalist, you don’t want to go back to office-based. It’s more difficult to generate that enthusiasm for what hospital medicine is all about to people who are just coming on.
Q: Have you found a strategy that works?
A: It’s much easier said than done. It’s really about getting them energized and getting them excited about what they’re doing. Part of that is explaining it’s about more than just the patient in front of them. The hospital really is their site of practice, and there are opportunities for them to advance. If they want to do research or if they want to be involved with quality or patient safety, the opportunities are unlimited.
Q: Do you encourage the next generation of hospitalists to seek out committee assignments, research, or other opportunities outside of clinical work?
A: It’s definitely something for them to embrace. What’s important is crafting a type of staffing or schedule model that allows them to do clinical work but at the same time have a protected time to do their committee work.
In the old model I grew up with, doctors basically did committee work before they started seeing patients or after they were finished. There needs to be time carved out so they can be focused on that and don’t have to do it on the fly. … That’s what makes things successful with hospital medicine. There are programs across the country that (protect physician time), and they serve as a model for what I think our profession should be.
Q: What’s next professionally?
A: Right now, I’m thinking about what I want to be doing for the next 10 years. Is it going back and just doing clinical work? Is it continuing to be the clinical chief, or is it being involved with other things systemwide? I’ll certainly continue to be actively engaged on a national level with SHM, because that’s my passion. But after being a hospitalist for 16 years, I’m pausing and reflecting on what I’ve been doing, what my options are, and what I want to do for the remainder of the time before I retire. TH
Mark Leiser is a freelance writer based in New Jersey.