Curbside Consequences
Question: I’m a hospitalist in a small hospitalist group, so I stay pretty busy and sometimes I have to turn away a lot of requests for help. Recently I did a curbside consult on a surgical patient with diabetes. It was a hectic day, as usual, but I made time to do it because, to be honest, I’m very interested in these kinds of cases (for personal reasons). Problem is, another physician saw me give the consult and then asked me to do one for him about an hour later … and I said no! I felt bad, but honestly, I had several patients to follow up with and felt I had to press on. I feel like I might have damaged my relationship with this doctor (a cardiologist). How can I help rebuild our relationship?
Boo-Boo in Beloit, Wis.
Dr. Hospitalist responds: Dear Boo Boo: Feel like you worked your way into a pile of doo doo? I generally go by the rule that if I feel something went wrong with an interaction, something probably did and damage control is in order.
Ignoring the encounter may lead the cardiologist to believe that you don’t value your relationship. I suggest you explain your predicament to the cardiologist and let him/her know that you are addressing problems with your schedule. To fix this “problem,” you need to examine why it occurred and understand how you can prevent it.
If you feel like you are “turn(ing) away a lot of requests for help,” I suspect you are missing a significant amount of business. You can view this as a problem or view this as an opportunity. Also recognize this is an opportunity for competitors. Referring physicians will send referrals elsewhere if you are not able to consistently provide the necessary service.
What’s not clear to me is whether your inability to accommodate requests for referrals is due to inadequate staffing, inefficiency, inappropriate billing, or a combination of factors.
To elucidate this situation, you need data. You will never know the facts until you gather the data.
If you are not measuring your program’s performance presently, it is never too late to start. Begin by tracking your work relative value units (wRVUs). This is a commonly used marker of productivity. SHM’s biannual productivity and compensation survey benchmarks this data. Are your wRVU data comparable with hospitalists with similar job descriptions? If so, consider adding staff to your program. If your wRVU data fall short of expectations, does the problem lie in billing? Are you billing for each encounter? Are you billing at appropriate levels for service provided? An audit of your notes and bills can be insightful. Or is inefficiency contributing to your problem? If so, consider an examination of your workflow. A workflow redesign with implementation of tools like templates may markedly improve your efficiency.
Career, Committee Work
Question: My career growth is very important to me. I’m presently the only hospitalist in our program, which I started about a year ago. I have many requests to serve on hospital committees. I’ve tried to serve on as many as possible but feel overstretched. Should I stop serving on committees and concentrate on my clinical work? Would this be bad for my career?
Too Busy in Ohio
Dr. Hospitalist responds: Dear Too Busy: Kudos for taking your job seriously, but don’t feel like you have to serve on all committees. Your concern about burnout is legitimate. There are many reasons hospitalists serve on hospital committees.
