Dear Ms. Bernstein:
I’m writing this letter to let you know about some of the things happening in hospital medicine, to ensure we are always improving the care we provide.
While we talked on New Year’s Eve, you reluctantly told me that you and many of your friends were not happy with the move toward hospital care being provided by hospitalists, rather than the PCP you know. I didn’t respond because we were having a nice lunch and I didn’t want to distract you from praising my kids and talking about your grandbaby and her sibling on the way. So I thought I’d respond by writing this open letter to you on the chance it might also be thought provoking for some of my hospitalist colleagues.
I think your reluctance to share with me the unflattering opinion you and many of your friends have of the hospitalist model of care stemmed from a desire not to offend me rather than any uncertainty in your conclusion. It isn’t difficult to find others, both healthcare providers and consumers, who share your opinion.
As I’ve told you before, outside of my own parents, you and Mr. B. are among the people who had the most influence on my upbringing, and your opinion still matters to me. So I’m writing this hoping to change your view, at least a little.
Updated Numbers of Hospitalists
Our field is now larger than many other specialties, and we are experiencing ever-increasing pressure to “get it right.” A 2012 survey of hospitals conducted by the American Hospital Association found more than 38,000 doctors who identify themselves as hospitalists. This number has been increasing rapidly for more than a decade. The Society of Hospital Medicine (SHM) estimates that the number has grown to more than 44,000 in 2014, and that there are hospitalists in 72% of U.S. hospitals—90% at hospitals with over 200 beds. In 1996, there were fewer than 1,000 hospitalists.
The rapid growth in our field has brought challenges, and we’re lucky to have attracted many dedicated and talented people who are helping all of us make strides to do better, both by providing better technical care (e.g. ensuring careful assessments and ordering the best tests and treatments) and by doing so in a way that ensures patients and their families are highly satisfied.
Tools to Support Ongoing Improvements in Hospitalist Practice
There are many outlets hospitalists can turn to for education on essentially any aspect of their practice. Several years ago, the SHM published “The Core Competencies in Hospital Medicine: A Framework for Curriculum Development,” a publication that continues to be valuable in guiding hospitalists’ professional scope of clinical skills as well as educational curricula for training programs and continuing education. SHM and other organizations generate a great deal of educational content for hospitalists, which is available in many forms, including in-person conferences, webinars, and written materials. And there are several scientific journals that have significant content for hospitalists, including SHM’s own Journal of Hospital Medicine.
Our field encourages and recognizes ongoing commitment to hospitalists’ growth and development in a number of ways. When it is time for a doctor to renew his/her board certification, the American Board of Internal Medicine (ABIM) offers the option to pursue “Focused Practice in Hospital Medicine.” And SHM’s designation of Fellow, Senior Fellow and Master in Hospital Medicine recognizes those who have “demonstrated a commitment to hospital medicine, system change, and quality improvement principles.” Many in our field have achieved one or both of these distinctions, and countless others are pursuing them now.
Through its foundation, the ABIM developed a campaign known as “Choosing Wisely” to “promote conversations between physicians and patients by helping patients choose care that is: supported by evidence, not duplicative of other tests or procedures already received, free from harm, and truly necessary.” SHM joined in this effort by developing separate criteria for hospitalists who care for adults or children.
New Tool Encourages High Performance
In February, an SHM workgroup published “The Key Principles and Characteristics of an Effective Hospital Medicine Group: An Assessment Guide for Hospitals and Hospitalists,” a document meant to serve as a road map for hospitalist groups to follow to improve their performance. I’m particularly interested in this, since I have spent much of my career thinking about and working with hospitalist groups to improve the way they perform, and I helped develop the characteristics and co-authored the document. But the real value of the document comes from the input of hundreds of people within and outside of SHM who provided thoughtful advice and feedback to identify those attributes of hospitalist groups that are most likely to ensure success.
The document describes 47 characteristics grouped into 10 different categories (“principles”). Some of the principles that you as a patient might be most interested in are ones specifying that a hospitalist group:
— Implements a practice model that is patient- and family-centered, is team-based, and emphasizes care coordination and effective communication.
— Supports care coordination across care settings; and
— Plays a leadership role in addressing key clinical issues in the hospital and/or health system: teaching, quality, safety, efficiency, and the patient/family experience.
Current State of Hospital Medicine
If you’ve had a less than satisfactory experience with care by a hospitalist, the things I’ve described here might not improve your opinion of hospitalists, or that of your friends. But maybe you can take some measure of comfort in knowing that our field as a whole is working hard to continuously improve all aspects of what we do. We’re serious about being good at what we do.
And, since this is published in a magazine read by hospitalists, maybe some of them will be reminded of the many ways our field encourages, supports, and recognizes their professional development.
Dr. Nelson has been a practicing hospitalist since 1988. He is co-founder and past president of SHM, and principal in Nelson Flores Hospital Medicine Consultants. He is co-director for SHM’s “Best Practices in Managing a Hospital Medicine Program” course. Write to him at [email protected].