Editor’s note: Together with SHM’s Physicians In Training Committee, The Hospitalist is publishing articles that can help guide medical students and residents to careers as hospitalists. This profile is intended to give perspective on one of the many career options in the HM movement. Please share this with the students and residents you know.
Chris LaChance, MD, attended medical school at the University of Rochester (N.Y.) and in 2003 completed his residency at Baystate Medical Center in Springfield, Mass. He’s been a hospitalist ever since. In 2011, he became an academic hospitalist and now spends most of his time working with residents. He plans a lifelong career in hospital medicine.
Colleagues at Baystate voted Dr. LaChance the 2011 Hospitalist of the Year. He’s received numerous resident teaching awards in his career.
Question: What influenced your decision to become a hospitalist?
Answer: I did a rotation in residency where I actually performed the function of a primary care doctor doing inpatient and primary care at the same time. I realized it didn’t allow me to practice in the way I wanted. I really wanted to focus on one aspect. I like the challenge of working in the hospital. I also was exposed to a few people practicing at the time.
Q: What steps in your career do you think were the most significant in leading you to where you are today?
A: My initial job was at a startup program, which didn’t seem to have a lot of buy-in from the docs. They were being taken advantage of; everyone wanted them to be everything to everyone, including the subspecialists and the surgeons. It wasn’t well established, so I left and came back to Baystate, where I trained.
Q: What drew you to teaching?
A: I initially practiced for six years in a nonacademic attending. To be an academic hospitalist, you need a firm base of expertise in the nonacademic side. It helps that I’m able to do the work and help the residents with their efficiency in the teaching aspect. The fact that I was able to spend so much time developing myself as a good clinician made me a better educator.
Now that I have a great deal of practical experience, I think it really enhances my teaching. I enjoy making the residents enthusiastic about the medical literature and applying what they learn to practice. Watching their progression from timid interns to confident, knowledgeable senior residents is particularly rewarding.
Q: I know you have a particular interest in evidence-based medicine and that it is a focus of your teaching. Can you explain why that is?
A: I am encouraging the residents to focus on practical, high-yield articles and to utilize technology to allow diagnoses that are effective in expanding their knowledge. Practice guidelines, review articles, and resources—reading for general knowledge and understanding has been lost for some. I am trying to make a culture change to bring this back to residents.
Q: Do you see this as a sustainable career? What makes it sustainable?
A: I think the fact that I have so many different roles keeps it interesting and fresh—and the fact that things are constantly changing. Being a hospitalist in a larger institution allows for those variant roles. I’m not the type of person who likes to do the same thing day after day. I like that I’m not confined to one space during the course of the day, and I don’t have to be confined to a timeline.
Q: How has the practice of hospital medicine changed since you began?
A: Patients and families have become much more accepting of hospital medicine; they know their PCP won’t be coming in. For the most part, they are aware of hospitalists and [are] expecting us.
Q: Would you recommend hospital medicine as a career choice for a student or resident? Is there any specific advice you would provide them?
A: I would recommend it. I certainly find it worthwhile. The person who does well needs to be accepting of some uncertainty. [You] need to work well with other people, and you need some level of humility. If someone really likes spending time reading and being current and having lots of roles, it’s a good choice.
Q: Can you tell me about a patient encounter or teaching moment that stands out to you?
A: I had a patient who was on comfort measures only. I developed a good relationship with his wife. I was able to spend a lot of time with them and was able to help them with end-of-life decision-making. I was actually present when he took his last breath. I saw him open his eyes and look at his wife one last time and then he passed away.
He was unresponsive and on supplemental oxygen. I talked to his wife and said, “Let’s take it off, it’s not doing anything.” I knew it would be quick after that. It also gave her some measure of control. She wanted to be there. We took the oxygen off, and I sat in the corner. She talked to him, [and] he opened his eyes and gave her a quick smile and died.
Q: What are your major interests outside of the hospital, and how do you ensure you have time to do them?
A: I have five children, which takes a lot of my time. One of the nice benefits of HM is that it’s shift work, so there’s a defined amount of time that I’m working. I also try to be as efficient as I can at work so that I don’t need to work at home. As far as my interests at home, it’s time with the kids. Summer water sports are what we enjoy, so I try and take my vacations during the summer.
Q: What do you see as the future of hospital medicine?
A: Hospital medicine is here to stay. When I first started, there were questions as to whether HM would stick around. I think there are going to be more and more roles for hospitalists, and probably hospitalists that define certain areas of practice, especially in large institutions. I think subspecialist and surgery co-management will be developed further.
Q: Can you think of an HM “myth” that you feel your own experience has proven wrong?
A: There’s a common misperception that you don’t have continuity and don’t get to know patients. I have to say, every day when I’m walking in the hall, I have a patient I’ve cared for in the past call out to me and want to update me. I think [when you are] rounding on a daily basis on these patients, you get a few years’ worth of PCP visits. It’s a really concentrated interaction.
Dr. Bryson is a hospitalist, medical director of teaching services, and associate program director for internal medicine residency at Baystate Medical Center in Springfield, Mass. She is also an assistant professor of medicine at Tufts University.