What’s Next for Hospital Medicine?
At the Medical University of South Carolina (MUSC) in Charleston, a familiar scene plays out in the hospitalist program. New hospitalists express an interest in a certain area and the university tries to accommodate them, making time for them to pursue additional training as they juggle the daily demands of treating patients, says Patrick Cawley, MD, MBA, SFHM, associate professor at the university and a former SHM president.
“We try to have a personal growth plan for each hospitalist that aligns with their interest,” Dr. Cawley says. “So if we have a hospitalist that’s very, very interested in quality improvement, we’ll seek out opportunities to get that hospitalist experience, and start with smaller projects and then bigger projects.”
As the field of HM hits a notable mark in its history—it’s been 15 years since the term “hospitalist” was coined—more advanced training will continue to emerge as a key issue and obstacle in the field, say experts who were asked to take a look into HM’s crystal ball.
They also predict continued growth of the field, with tens of thousands of new hospitalists emerging in the next decade or so. They also say that hospitalists will emerge as leaders in the application and use of new technology, and that there will be more demands placed on hospitalists to show their worth in hard data.
There also promises to be a growing presence of private management firms providing hospitalists to hospitals, which doctors both inside and outside of those firms say could have a beneficial effect on the overall quality of patient care.
I think there’s a recognition that [training] is important and that hospitals and hospitalists need to get better aligned. This is something that will continue to mature over the next 10 years.
-Patrick Cawley, MD, MBA, SFHM, associate professor, Medical University of South Carolina, Charleston, former SHM president
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For now, Dr. Cawley says, at MUSC and elsewhere, hospitalist programs are scrambling for time to enhance the skills needed to tend to increased demands.
“You have to carve out time. That’s literally what you have to do,” he explains. “That’s expensive to take a doctor away from clinical service for a week, or an even an hour or two a week. I mean, somebody’s got to pay for that.”
Training on hospitalist-specific management topics, he says, needs to evolve further. “I think there’s a recognition that this stuff is important and that hospitals and hospitalists need to get better aligned,” he says. “This is something that will continue to mature over the next 10 years.”
The range of tasks is growing ever broader for the hospitalist, and so the need for enhanced training is greater, says Larry Wellikson, MD, SFHM, CEO of SHM.
“They’re being asked to do bedside patient care, but they’re being asked to do more. They’re asked to be systems engineers, they’re asked to be safety experts, they’re asked to be the information manager, if you will, the IT guys,” he says. “These skills they have not been trained to do and they need … either to say, ‘No, I can’t do that because I haven’t been trained,’ or they need to go and look where they can get that expertise.
“That’s what we try to do at SHM, with our Leadership Academy and our Practice Management Academy.”
Frank Michota, MD, FHM, director of academic affairs in the Department of Hospital Medicine at The Cleveland Clinic, says that one of the biggest challenges the field needs to tackle over the next several years is to better standardize the education of hospitalists, saying there is “incredible inconsistency from hospitalist to hospitalist in terms of knowledge base, experience and … understanding the scope of practice.”
