I vividly recall attending a faculty meeting at San Francisco General Hospital in the mid-1990s, soon after I joined the UCSF faculty. Our late, great chief of medicine Merle Sande was chronicling all the recent and predicted changes in the healthcare landscape: managed care, more transparency, new regulations, and more. The meeting turned glum; we were not a change-oriented crowd, and this was a lot to swallow. When Mel Cheitlin, a beloved senior cardiologist, took the floor, everyone hushed – Mel could be counted on for grandfatherly wisdom when the going was tough.
“You know,” Mel said softly, “this could be worse.” We all looked up – our predicament seemed pretty terrible. Mel paused, and then continued.
“I could be younger,” he said.
I wish Mel could have joined me for last week’s annual meeting of the Society of Hospital Medicine in Washington D.C. He would have rethought his stance on aging. He might have even questioned his career choice.
While Beckman’s recent article and the follow-up letters (including one by me) in the Annals of Internal Medicine leave no doubt that there are still boatloads of non-believers, it is hard to come away from the SHM meeting and not be sold on the hospitalist field’s boundless possibilities.
Beyond being wowed by the sheer size of the crowd (2,500 this year, up from 1,600 two years ago), outside visitors to the SHM meeting are always struck by one thing: the “woe is me” chatter that dominates many physician conferences is vanishingly rare. Rather, the twin mantras are change and improvement, and the meeting’s content and hallway conversations reflect this. While the odd session is about billing or call schedules, the majority address topics like reengineering hospital care, smoothing transitions, building teams, enhancing physician-patient communication, implementing palliative care programs…. In short, our field has branded itself as being about improving the quality, safety, patient-centeredness, and efficiency of hospital care. It is way cool, and it couldn’t be timelier.
Of course, in April 2010 in DC, health reform was in the air. Opening keynote speaker, Beth Israel Deaconess CEO (and blogger) Paul Levy, admonished us not to get too distracted by the events in Washington, focusing instead on doing the right things for our patients. In a fascinating health policy panel, the always-insightful Ron Greeno, Cogent’s chief physician, was asked whether the formation of Accountable Care Organizations (ACOs) risks creating a situation in which “we’re colluding with hospitals to limit care.” “I hope so,” said Ron, tongue only partly in cheek as he emphasized the necessity of hospitalists and hospitals partnering to ethically but purposefully rationalize our unsustainable use of healthcare resources.
In my closing keynote, I spoke about the new terms introduced during the yearlong healthcare reform debate, such as ACOs, death panels, “bending the cost curve”, and bundled payments. I appreciate those hardy souls who stayed till the bitter end; for the rest of you (yes, I know, you needed to get home before volcanic ash entered your air space), I summarized the talk in an article in this month’s Journal of Hospital Medicine.
I received a special honor at the meeting: SHM inaugurated its first three “Masters”, and I was one of them (along with my dearfriends Win Whitcomb and John Nelson, the co-founders of SHM). It was very sweet, particularly since SHM’s outgoing president Scott Flanders, my former protégé (who now directs the hospitalist program at the University of Michigan), gave out the awards. After an introduction in which Scott offered me far too much credit for his fantastic career success, he recalled that I was the first non-family member to see his kids after they were born at UCSF. And then, to my astonishment, his completely adorable, towheaded kids jumped onstage, wearing “I Love Bob” tee shirts. Seeing folks like Scott succeed (he handed off the SHM presidential gavel to Tulane’s Jeff Wiese, another UCSF residency product) is the epitome of professional gratification.
Speaking of which, I hope you’ll forgive me if I gush a bit about my own team of UCSF hospitalists. About three years ago, I began to worry that we were starting to lose our mojo: young faculty seemed somewhat blue and overwhelmed, our recruitment fell off, and our productivity dipped. Soon after we held a retreat that morphed into a Root Cause Analysis of the problems, everyone snapped into action: we restructured job descriptions, our mid-career faculty stepped up their mentoring, we launched a research “incubator” and a superb faculty development program for our junior faculty, and we paid much more attention to everyone’s job satisfaction and our overall culture. The result: our division has reached new pinnacles of success, and happiness. At the SHM meeting, the fruits of these efforts were everywhere: Brad Sharpe, Margaret Fang, Niraj Sehgal, Arpana Vidyarthi, and Andy Auerbach all spoke at or chaired major sessions; Margaret won SHM’s 2010 top researcher award; and Brad, Niraj, Steve Pantilat, and Adrienne Green became Senior Fellows of the Society.
While I was absolutely thrilled by the accomplishments of our “senior” (heck, they’re all kids to me) faculty, I was even more pleased by the achievements of our fellows and junior faculty. We all joked about Mourad Wall, where Michelle displayed her 3 posters. Fellow Kirsten Kangelaris won SHM’s first-ever young researcher award (which came with a $50,000 grant), fellow Patrick Kneeland had an award winning clinical vignette with one of our residents Jenny Wie, and our other fellows, Chase Coffey, and Brad Butcher, had outstanding research presentations, as did several other of our junior faculty. (Pictures of UCSF at SHM are here.)
It was a great week, one that left me confident that our field will continue to make pivotal contributions to improving both individual patient care and the overall system, particularly as today’s young hospitalists grow into positions of local and national leadership. I can’t speak for you, Mel, but personally, I’d love to be younger.