Start Me Up
Hospital medicine groups, like the people who design and populate them, come in all shapes and sizes. Because the field has matured rapidly with the number of hospitalists growing from 8,700 to 12,000 in the past two years and 50% of hospitals with 200 beds or more having hospitalist programs according to Health and Hospitals Network, there’s naturally been some excessive exuberance, fits and starts, and successes and failures along the way. These stories from the trenches of hospitalist group start-ups reveal just how tricky it is to get it right.
Norma Malgoza, MPA, assistant vice president of Chicago-based Sinai Health Systems, launched that 532-bed academic medical center’s
hospital medicine program in July 2005. The department of internal medicine, which wanted to decrease patients’ length of stay, improve care quality, handle large numbers of unassigned patients, and provide 24/7 coverage, prompted Sinai to hire hospitalists.
After conducting a feasibility study and networking with peers at local hospitals that had hospitalist services, Malgoza struggled to start a program that wouldn’t bust the budget but would attract hospitalists attuned to the department of internal medicine’s goals. Attending an SHM one-day conference, “Best Practices in Managing a Hospital Medicine Program,” (see www.hospitalmedicine.org) helped her with financial modeling, projecting volumes, and devising schedules and compensation packages.
With a grasp of what’s involved in starting a hospitalist service, Malgoza launched the program with 6.5 full-time employees and a physician’s assistant who helped with busy emergency department (ED) night admissions. Now, with a hospitalist average daily census (ADC) of 22 and an attractive compensation system, Malgoza says of the hospitalists, “They are so energetic, always accessible, and will find a pharmacist to get a prescription filled, or push the social workers and nurses to get assessments done. It’s wonderful.”
Recognizing the limited amenities of the aging inner-city hospital, Malgoza hopes to offer hospitalists better facilities. “We want to keep them happy, to give them their own space and a library,” she says. In hindsight she’d add a case manager’s salary to the start-up budget and is working on getting that support.
Developing hospitalist programs using a business plan, such as that developed by Sinai Hospital Systems, is one approach. Anne Borik, MD, created an alternative plan. In the 1990s she grew a program in Phoenix from “ground zero,” as she calls it. Unsatisfied professionally in a large multi-specialty group, she sought a transition to inpatient work only.
