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Why Hospitalists are Important, Integral, and Irreplaceable


 

As an introduction to my new role as physician editor, I should explain why I took this on. Simply stated: I drank the Kool-Aid. As most of you know, drinking brightly colored sugar water is a metaphor for a sincere and dedicated belief in a philosophy (though the basis of the term resides in the Jonestown massacre of 1978, let’s put that aside for now). The philosophy to which I am referring is that which defines our field. I firmly believe in the power and the future of hospital medicine, now 30,000 strong.

I am not exactly sure when I first drank the Kool-Aid. I suspect that, like for many hospitalists, it was a slow progression in the beginning, a sip or two here and there, interspersed with 7-Eleven-sized gulps at SHM annual meetings. But I do know HM, as a specialty, is firmly ingrained in me, the super-sweet beverage running deep in my veins.

Our specialty has borne monumental accomplishments in a very short sprint, and we are well on our way to dozens more in the near future. Here are a few reasons I believe in our future:

Healthcare Can’t Live without Us

Of hospitals with more than 200 beds, hospitalists practice in more than 80% of them. I would venture the same is not true of dermatologists or neurosurgeons. We have extended our tentacles into most every area of the hospital, from the ED to post-operative holding, from the blood bank to the C-suite.

We are integral to the success of almost every area under the hospital roof. The surgeons need sharp and skillful partners. The ED physicians need reliable receivers. The quality department needs informed observers. The admitting department needs sensible triagers. The utilization review department needs thorough documenters. The primary-care doctor needs discharge coordinators.

We have been all of those things and more. Hospitalists will continue to forge into new terrain, to fill the needed voids, to bridge the gap between the seamless hospital system patients deserve and the disjointed hospital system patients often traverse through. No other specialty is doing this with such remarkable flexibility and affability.

We Now Own Some Very Tough Problems

Value, efficiency, throughput, care transitions: These are not exactly issues with effortless solutions. But through ingenuity, innovation, and elbow grease, we are chiseling away at reliable solutions for each of these areas.

Few other specialties have tackled such nebulous and multifaceted problems. We have gone so far as to build them into our core competencies and maintenance of certification. This is testimony to our dedication and willingness to create a better system.

We Are Shaping the Pipeline

Hospitalists have an immense influence over trainees in many specialties; virtually all major academic medical centers employ hospitalists for the majority of their teaching services. We likely have more face time with medical students than any other specialty. We define for them what it means to be a doctor in the 21st century.

It is certainly no longer as simple as knowing facts and figures, and possessing adequate beside rapport. Those competencies constitute less than half of what we now need to seamlessly perform. With our visibility, we are defining for the pipeline what modern doctors “look” like. Much more than think tanks, we are communicators, coordinators, and patient advocates, maneuvering them through the maze of what we currently call healthcare.

We are integral to the success of almost every area under the hospital roof. The surgeons need sharp and skillful partners. The ED physicians need reliable receivers. The quality department needs informed observers. The admitting department needs sensible triagers. The utilization review department needs thorough documenters. The primary-care doctor needs discharge coordinators.

We Have Incredible Leadership

I have been repeatedly awestruck with the volume and quality of leaders within SHM and the larger hospital medicine community. Hospitalist leaders have energized all aspects of the healthcare industry, including the Centers for Medicare & Medicaid Services, the American Board of Internal Medicine, and innumerable other professional societies and medical organizations.

We routinely occupy leadership seats among residency and fellowship programs, quality and safety structures, and C-suites around the country, within hospitals of all shapes, sizes, and structures. We are leading multi-million-dollar research teams at local, regional, state, and national levels.

SHM has been instrumental in providing training opportunities for hospitalists yearning for the skill set needed to take them and their organizations to the next level. There is no doubt hospitalists will continue to expand in leadership positions around the country—and beyond.

We Are a Bargain

One of the continually unsettling statistics that gets bantered around is how “expensive” we are to hospitals. That annual sum, when last surveyed, topped out at well over $100,000 per year per full-time equivalent hospitalist. That sure sounds like a lot of money—worth a few reliable vehicles, a few years of college education, or a sizable medical school loan repayment.

But I would counter that if a hospitalist is really being a hospitalist, by diligently operating within all those facets listed above, then administrators should consider us a heap of cheap dates. This would not include hospitalists with a truncated vision of their role in the hospital, which starts and ends in sharply demarcated 12-hour shifts. The latter approach, the limited perch, could certainly be perceived as a lavish investment. In the current cost-conscious healthcare environment, it’s better to be viewed as a cheap date.

My Mission

So that is a bit about why I am here: to discourse, praise, and evangelize about hospital medicine, past, present, and future; to summarize and speculate, why we are here, and where we are going next; to regularly shower each of you with the Kool-Aid; to buffer you from the daily difficulties of a very laborious yet very rewarding career. It will be an honor and a challenge to maintain this momentum, but I do believe I can execute.

Let me end with a few words about my predecessor, Jeffrey Glasheen, MD, SFHM, who successfully shepherded the previous four-plus years of The Hospitalist. Jeff is intelligent, witty, thoughtful, and an exceptional writer. He has graciously transitioned me into the publication, and I owe him my gratitude. Jeff, just don’t go too far away, in case I ever need a sprinkle of Kool-Aid myself.

Dr. Scheurer is physician editor for The Hospitalist, and is a hospitalist and chief quality officer at the Medical University of South Carolina, Charleston, S.C. Send your comments and questions to scheured@musc.edu.

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