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Deaf Hospitalist Focuses on Teaching, Co-Management, Patient-Centered Care
"What’s the bigger picture here?” Hospitalist Christopher Moreland, MD, MPH, FACP, drops his question neatly into the pause in resident Adrienne Victor, MD’s presentation of patient status and lab results.
We’re on the bustling 9th floor of University Hospital at the University of Texas Health Science Center (UTHSCSA) in San Antonio during fast-paced morning rounds. As attending physician, Dr. Moreland is focusing intently on Dr. Victor’s face, simultaneously monitoring the American Sign Language (ASL) interpretation of Todd Agan, CI/CT, BEI Master Interpreter. Immediately after his question to Dr. Victor, the discussion—conducted in both ASL and spoken English—shifts to the patient’s psychosocial issues and whether a palliative care consult would be advisable.
It’s clear that for Dr. Moreland, the work, not his lack of hearing, is the main point here. A hospitalist with the UTHSCSA team since 2010, Dr. Moreland quickly established himself not only as a valuable HM team member and educator, but also as a leader in other domains. For example, in addition to his academic appointment as assistant clinical professor of medicine, he previously was co-director of the medicine consult and co-management service at University Hospital and now serves as UTHSCSA’s associate program director for the internal medicine residency program.
Dr. Moreland’s question this morning is typical of his teaching, says Bret Simon, PhD, an educational development specialist and assistant professor with the division of hospital medicine at UTHSCSA.
–Christopher Moreland, MD, MPH, FACP
“He’s very good at using questions to teach, promoting reflection rather than simply telling the student what to do,” Dr. Simon explains.
Why Medicine?
Chris Moreland’s parents discovered their son was deaf at age two, by which time he had acquired very few spoken words. After multiple visits to healthcare professionals, a physician finally identified his deafness. The family then embarked on a bimodal approach to his education, using both signed and spoken English. He learned ASL in college. As a result, he communicates through a variety of channels: ASL with interpreters Agan and Keri Richardson, speech reading, and spoken English. When examining patients, he uses an electronic stethoscope that interfaces with his cochlear implant.
Medicine was not Dr. Moreland’s first academic choice.
“I went into college thinking I wanted to do computer science,” he says, speaking of his undergraduate studies at the University of Texas in Austin. When he realized computers were not for him, he switched his major to theater arts, continuing an interest he had had in high school. After that, research seemed appealing, and he became a research assistant in a lab in the Department of Anthropology. Finally, after shadowing a number of physicians, his interest in medical science was stimulated.
“Medicine,” he says, “became a nice culmination of everything I was interested in doing.” From computer science, he learned to appreciate an understanding of algorithms; from theater arts came the ability to understand where people are coming from; and from his link with research in linguistics and anthropology came the contribution of problem solving and methodology.
Fearless Communicator
Dr. Moreland says his deafness presents no impediments to his practice of medicine. “I grew up working with interpreters, so I’m used to that process,” he says. “It forces you to become less inhibited about what you’re doing. People have questions [‘who is that other person in the room?’], and you learn how to handle those questions quickly, without interfering with communication in order to advance the work.”
When Dr. Moreland started his clinical rotations as a third-year medical student, he grappled with the best way to introduce himself and his interpreter to patients. His first attempt at explaining the interpretive process “went on for quite a while” and was too much information. “It ended up overwhelming the patient,” he says.
The next time he chose not to introduce the interpreter but to simply address the patient directly. “That didn’t work either, because the patient’s eyes kept wandering to that other person in the room.”
Finally, “I realized that it wasn’t about me,” he says. “It was about the patient.” So he simply shortened the introduction to himself and the interpreter and asked the patients how they were doing.
“Once I became more professional about the situation, the more positive and patient-centered it became, and it went well.” He says he’s had no negative experiences since then, at least not related to his deafness. He approaches each new patient interaction proactively, and he and his interpreters become part of the flow of care.
Teaching’s Missing Pieces
As illustrated with his first question, Dr. Moreland intends for his trainees to learn to think globally about their patients.
“Although rote information has its role,” he explains later in the conference room, “I’m always afraid of overemphasizing it. When I trained in medical school, we didn’t learn that much about communication skills and teamwork. We talked a lot about information we use as physicians—the mechanism of disease, the drugs we use.
“What I try to emphasize with trainees is, what skills in communication, teamwork, and self-education can we develop so that we can use those skills continuously throughout our practice?”
Dr. Moreland takes setting resident-generated learning goals seriously, says Dr. Simon, for which he and trainees give him high marks.
“He is very supportive and encourages us to make our own management decisions,” Dr. Victor says. “Though, of course, he will let us know if something is likely the wrong choice, usually by discussing it first.”
Patrick S. Romano, MD, MPH, professor of general medicine and pediatrics and former director of the Primary Care Outcomes Research (PCOR) faculty development program at the University of California Davis, where Dr. Moreland was a resident and then a fellow, found his trainee was always “very thoughtful and conscientious, presenting different ways of looking at problems and asking the right questions. And, of course, that’s what we look for in teachers: people who know how to ask the right questions, because, then, of course, they are able to answer students’ questions.”
Transformational and Inspirational
For many of Dr. Moreland’s colleagues and trainees, working with him has been their first exposure to a hearing-impaired physician. Richard L. Kravitz, MD, MSPH, professor and co-vice chair of research in the department of medicine at UC Davis, supervised Dr. Moreland during his residency and later during his PCOR fellowship. The American Disabilities Act-mandated interpreter for Dr. Moreland introduced a “change in standard operating procedure,” Dr. Kravitz notes. “None of us knew what to expect when he came onboard the residency program. But, very quickly, any unease was put to rest because he was just so talented.”
For visitors, Dr. Moreland seamlessly addresses his hearing impairment and makes sure that everyone on the team is following the discussion. Luci K. Leykum, MD, MBA, MSc, hospital medicine division chief and associate dean for clinical affairs at UTHSCSA, says that Dr. Moreland has brought “a lot of positive energy to the group—and in ways I would not have expected.” She praised his talents as both a clinician and teacher.
John G. Rees, DBA, RN, patient care coordinator in the 5th Acute Care Unit, says that Dr. Moreland immediately “blended” with the staff on his service. “The rapport was perfect,” he adds.
Robert L. Talbert, PharmD, the SmithKline Centennial Professor of Pharmacy at the College of Pharmacy at the University of Texas at Austin, often participates in teaching rounds. Dr. Moreland, he says, “has an excellent fund of knowledge; he’s very rational and evidence-based in decisions he makes. He’s exactly what a physician should be.”
Watching interpreters Agan and Richardson during group meetings, Dr. Leykum believes, has influenced their group dynamics. “On a subtle level, having Chris in the group has made us more aware of how we interact with each other.”
Nilam Soni, MD, FHM associate professor in the department of medicine and leader of ultrasound education, has noticed that he has become attuned to Dr. Moreland’s way of communicating and often does not need the interpreters to decipher the conversation between them. Working with Dr. Moreland has given Dr. Soni “a better understanding of how to communicate effectively with patients that have difficulty hearing.”
After working with Dr. Moreland at UC Davis, Dr. Kravitz observed that employing physicians with hearing impairment or other disabilities brings additional benefits to the institution. Dr. Moreland’s presence “probably raised the level of understanding of the entire internal medicine staff, because it demonstrated that a disability is what you make of it,” he says. “One recognizes how porous the barriers are, provided that people with disabilities are supported appropriately. In that way, Chris was inspiring, and may have changed the way some of us look at this specific disability that he had, but also other disabilities.”
A bigger picture, indeed.
Gretchen Henkel is a freelance writer in California.
Reference
"What’s the bigger picture here?” Hospitalist Christopher Moreland, MD, MPH, FACP, drops his question neatly into the pause in resident Adrienne Victor, MD’s presentation of patient status and lab results.
We’re on the bustling 9th floor of University Hospital at the University of Texas Health Science Center (UTHSCSA) in San Antonio during fast-paced morning rounds. As attending physician, Dr. Moreland is focusing intently on Dr. Victor’s face, simultaneously monitoring the American Sign Language (ASL) interpretation of Todd Agan, CI/CT, BEI Master Interpreter. Immediately after his question to Dr. Victor, the discussion—conducted in both ASL and spoken English—shifts to the patient’s psychosocial issues and whether a palliative care consult would be advisable.
It’s clear that for Dr. Moreland, the work, not his lack of hearing, is the main point here. A hospitalist with the UTHSCSA team since 2010, Dr. Moreland quickly established himself not only as a valuable HM team member and educator, but also as a leader in other domains. For example, in addition to his academic appointment as assistant clinical professor of medicine, he previously was co-director of the medicine consult and co-management service at University Hospital and now serves as UTHSCSA’s associate program director for the internal medicine residency program.
Dr. Moreland’s question this morning is typical of his teaching, says Bret Simon, PhD, an educational development specialist and assistant professor with the division of hospital medicine at UTHSCSA.
–Christopher Moreland, MD, MPH, FACP
“He’s very good at using questions to teach, promoting reflection rather than simply telling the student what to do,” Dr. Simon explains.
Why Medicine?
Chris Moreland’s parents discovered their son was deaf at age two, by which time he had acquired very few spoken words. After multiple visits to healthcare professionals, a physician finally identified his deafness. The family then embarked on a bimodal approach to his education, using both signed and spoken English. He learned ASL in college. As a result, he communicates through a variety of channels: ASL with interpreters Agan and Keri Richardson, speech reading, and spoken English. When examining patients, he uses an electronic stethoscope that interfaces with his cochlear implant.
Medicine was not Dr. Moreland’s first academic choice.
“I went into college thinking I wanted to do computer science,” he says, speaking of his undergraduate studies at the University of Texas in Austin. When he realized computers were not for him, he switched his major to theater arts, continuing an interest he had had in high school. After that, research seemed appealing, and he became a research assistant in a lab in the Department of Anthropology. Finally, after shadowing a number of physicians, his interest in medical science was stimulated.
“Medicine,” he says, “became a nice culmination of everything I was interested in doing.” From computer science, he learned to appreciate an understanding of algorithms; from theater arts came the ability to understand where people are coming from; and from his link with research in linguistics and anthropology came the contribution of problem solving and methodology.
Fearless Communicator
Dr. Moreland says his deafness presents no impediments to his practice of medicine. “I grew up working with interpreters, so I’m used to that process,” he says. “It forces you to become less inhibited about what you’re doing. People have questions [‘who is that other person in the room?’], and you learn how to handle those questions quickly, without interfering with communication in order to advance the work.”
When Dr. Moreland started his clinical rotations as a third-year medical student, he grappled with the best way to introduce himself and his interpreter to patients. His first attempt at explaining the interpretive process “went on for quite a while” and was too much information. “It ended up overwhelming the patient,” he says.
The next time he chose not to introduce the interpreter but to simply address the patient directly. “That didn’t work either, because the patient’s eyes kept wandering to that other person in the room.”
Finally, “I realized that it wasn’t about me,” he says. “It was about the patient.” So he simply shortened the introduction to himself and the interpreter and asked the patients how they were doing.
“Once I became more professional about the situation, the more positive and patient-centered it became, and it went well.” He says he’s had no negative experiences since then, at least not related to his deafness. He approaches each new patient interaction proactively, and he and his interpreters become part of the flow of care.
Teaching’s Missing Pieces
As illustrated with his first question, Dr. Moreland intends for his trainees to learn to think globally about their patients.
“Although rote information has its role,” he explains later in the conference room, “I’m always afraid of overemphasizing it. When I trained in medical school, we didn’t learn that much about communication skills and teamwork. We talked a lot about information we use as physicians—the mechanism of disease, the drugs we use.
“What I try to emphasize with trainees is, what skills in communication, teamwork, and self-education can we develop so that we can use those skills continuously throughout our practice?”
Dr. Moreland takes setting resident-generated learning goals seriously, says Dr. Simon, for which he and trainees give him high marks.
“He is very supportive and encourages us to make our own management decisions,” Dr. Victor says. “Though, of course, he will let us know if something is likely the wrong choice, usually by discussing it first.”
Patrick S. Romano, MD, MPH, professor of general medicine and pediatrics and former director of the Primary Care Outcomes Research (PCOR) faculty development program at the University of California Davis, where Dr. Moreland was a resident and then a fellow, found his trainee was always “very thoughtful and conscientious, presenting different ways of looking at problems and asking the right questions. And, of course, that’s what we look for in teachers: people who know how to ask the right questions, because, then, of course, they are able to answer students’ questions.”
Transformational and Inspirational
For many of Dr. Moreland’s colleagues and trainees, working with him has been their first exposure to a hearing-impaired physician. Richard L. Kravitz, MD, MSPH, professor and co-vice chair of research in the department of medicine at UC Davis, supervised Dr. Moreland during his residency and later during his PCOR fellowship. The American Disabilities Act-mandated interpreter for Dr. Moreland introduced a “change in standard operating procedure,” Dr. Kravitz notes. “None of us knew what to expect when he came onboard the residency program. But, very quickly, any unease was put to rest because he was just so talented.”
For visitors, Dr. Moreland seamlessly addresses his hearing impairment and makes sure that everyone on the team is following the discussion. Luci K. Leykum, MD, MBA, MSc, hospital medicine division chief and associate dean for clinical affairs at UTHSCSA, says that Dr. Moreland has brought “a lot of positive energy to the group—and in ways I would not have expected.” She praised his talents as both a clinician and teacher.
John G. Rees, DBA, RN, patient care coordinator in the 5th Acute Care Unit, says that Dr. Moreland immediately “blended” with the staff on his service. “The rapport was perfect,” he adds.
Robert L. Talbert, PharmD, the SmithKline Centennial Professor of Pharmacy at the College of Pharmacy at the University of Texas at Austin, often participates in teaching rounds. Dr. Moreland, he says, “has an excellent fund of knowledge; he’s very rational and evidence-based in decisions he makes. He’s exactly what a physician should be.”
Watching interpreters Agan and Richardson during group meetings, Dr. Leykum believes, has influenced their group dynamics. “On a subtle level, having Chris in the group has made us more aware of how we interact with each other.”
Nilam Soni, MD, FHM associate professor in the department of medicine and leader of ultrasound education, has noticed that he has become attuned to Dr. Moreland’s way of communicating and often does not need the interpreters to decipher the conversation between them. Working with Dr. Moreland has given Dr. Soni “a better understanding of how to communicate effectively with patients that have difficulty hearing.”
After working with Dr. Moreland at UC Davis, Dr. Kravitz observed that employing physicians with hearing impairment or other disabilities brings additional benefits to the institution. Dr. Moreland’s presence “probably raised the level of understanding of the entire internal medicine staff, because it demonstrated that a disability is what you make of it,” he says. “One recognizes how porous the barriers are, provided that people with disabilities are supported appropriately. In that way, Chris was inspiring, and may have changed the way some of us look at this specific disability that he had, but also other disabilities.”
A bigger picture, indeed.
Gretchen Henkel is a freelance writer in California.
Reference
"What’s the bigger picture here?” Hospitalist Christopher Moreland, MD, MPH, FACP, drops his question neatly into the pause in resident Adrienne Victor, MD’s presentation of patient status and lab results.
We’re on the bustling 9th floor of University Hospital at the University of Texas Health Science Center (UTHSCSA) in San Antonio during fast-paced morning rounds. As attending physician, Dr. Moreland is focusing intently on Dr. Victor’s face, simultaneously monitoring the American Sign Language (ASL) interpretation of Todd Agan, CI/CT, BEI Master Interpreter. Immediately after his question to Dr. Victor, the discussion—conducted in both ASL and spoken English—shifts to the patient’s psychosocial issues and whether a palliative care consult would be advisable.
It’s clear that for Dr. Moreland, the work, not his lack of hearing, is the main point here. A hospitalist with the UTHSCSA team since 2010, Dr. Moreland quickly established himself not only as a valuable HM team member and educator, but also as a leader in other domains. For example, in addition to his academic appointment as assistant clinical professor of medicine, he previously was co-director of the medicine consult and co-management service at University Hospital and now serves as UTHSCSA’s associate program director for the internal medicine residency program.
Dr. Moreland’s question this morning is typical of his teaching, says Bret Simon, PhD, an educational development specialist and assistant professor with the division of hospital medicine at UTHSCSA.
–Christopher Moreland, MD, MPH, FACP
“He’s very good at using questions to teach, promoting reflection rather than simply telling the student what to do,” Dr. Simon explains.
Why Medicine?
Chris Moreland’s parents discovered their son was deaf at age two, by which time he had acquired very few spoken words. After multiple visits to healthcare professionals, a physician finally identified his deafness. The family then embarked on a bimodal approach to his education, using both signed and spoken English. He learned ASL in college. As a result, he communicates through a variety of channels: ASL with interpreters Agan and Keri Richardson, speech reading, and spoken English. When examining patients, he uses an electronic stethoscope that interfaces with his cochlear implant.
Medicine was not Dr. Moreland’s first academic choice.
“I went into college thinking I wanted to do computer science,” he says, speaking of his undergraduate studies at the University of Texas in Austin. When he realized computers were not for him, he switched his major to theater arts, continuing an interest he had had in high school. After that, research seemed appealing, and he became a research assistant in a lab in the Department of Anthropology. Finally, after shadowing a number of physicians, his interest in medical science was stimulated.
“Medicine,” he says, “became a nice culmination of everything I was interested in doing.” From computer science, he learned to appreciate an understanding of algorithms; from theater arts came the ability to understand where people are coming from; and from his link with research in linguistics and anthropology came the contribution of problem solving and methodology.
Fearless Communicator
Dr. Moreland says his deafness presents no impediments to his practice of medicine. “I grew up working with interpreters, so I’m used to that process,” he says. “It forces you to become less inhibited about what you’re doing. People have questions [‘who is that other person in the room?’], and you learn how to handle those questions quickly, without interfering with communication in order to advance the work.”
When Dr. Moreland started his clinical rotations as a third-year medical student, he grappled with the best way to introduce himself and his interpreter to patients. His first attempt at explaining the interpretive process “went on for quite a while” and was too much information. “It ended up overwhelming the patient,” he says.
The next time he chose not to introduce the interpreter but to simply address the patient directly. “That didn’t work either, because the patient’s eyes kept wandering to that other person in the room.”
Finally, “I realized that it wasn’t about me,” he says. “It was about the patient.” So he simply shortened the introduction to himself and the interpreter and asked the patients how they were doing.
“Once I became more professional about the situation, the more positive and patient-centered it became, and it went well.” He says he’s had no negative experiences since then, at least not related to his deafness. He approaches each new patient interaction proactively, and he and his interpreters become part of the flow of care.
Teaching’s Missing Pieces
As illustrated with his first question, Dr. Moreland intends for his trainees to learn to think globally about their patients.
“Although rote information has its role,” he explains later in the conference room, “I’m always afraid of overemphasizing it. When I trained in medical school, we didn’t learn that much about communication skills and teamwork. We talked a lot about information we use as physicians—the mechanism of disease, the drugs we use.
“What I try to emphasize with trainees is, what skills in communication, teamwork, and self-education can we develop so that we can use those skills continuously throughout our practice?”
Dr. Moreland takes setting resident-generated learning goals seriously, says Dr. Simon, for which he and trainees give him high marks.
“He is very supportive and encourages us to make our own management decisions,” Dr. Victor says. “Though, of course, he will let us know if something is likely the wrong choice, usually by discussing it first.”
Patrick S. Romano, MD, MPH, professor of general medicine and pediatrics and former director of the Primary Care Outcomes Research (PCOR) faculty development program at the University of California Davis, where Dr. Moreland was a resident and then a fellow, found his trainee was always “very thoughtful and conscientious, presenting different ways of looking at problems and asking the right questions. And, of course, that’s what we look for in teachers: people who know how to ask the right questions, because, then, of course, they are able to answer students’ questions.”
Transformational and Inspirational
For many of Dr. Moreland’s colleagues and trainees, working with him has been their first exposure to a hearing-impaired physician. Richard L. Kravitz, MD, MSPH, professor and co-vice chair of research in the department of medicine at UC Davis, supervised Dr. Moreland during his residency and later during his PCOR fellowship. The American Disabilities Act-mandated interpreter for Dr. Moreland introduced a “change in standard operating procedure,” Dr. Kravitz notes. “None of us knew what to expect when he came onboard the residency program. But, very quickly, any unease was put to rest because he was just so talented.”
For visitors, Dr. Moreland seamlessly addresses his hearing impairment and makes sure that everyone on the team is following the discussion. Luci K. Leykum, MD, MBA, MSc, hospital medicine division chief and associate dean for clinical affairs at UTHSCSA, says that Dr. Moreland has brought “a lot of positive energy to the group—and in ways I would not have expected.” She praised his talents as both a clinician and teacher.
John G. Rees, DBA, RN, patient care coordinator in the 5th Acute Care Unit, says that Dr. Moreland immediately “blended” with the staff on his service. “The rapport was perfect,” he adds.
Robert L. Talbert, PharmD, the SmithKline Centennial Professor of Pharmacy at the College of Pharmacy at the University of Texas at Austin, often participates in teaching rounds. Dr. Moreland, he says, “has an excellent fund of knowledge; he’s very rational and evidence-based in decisions he makes. He’s exactly what a physician should be.”
Watching interpreters Agan and Richardson during group meetings, Dr. Leykum believes, has influenced their group dynamics. “On a subtle level, having Chris in the group has made us more aware of how we interact with each other.”
Nilam Soni, MD, FHM associate professor in the department of medicine and leader of ultrasound education, has noticed that he has become attuned to Dr. Moreland’s way of communicating and often does not need the interpreters to decipher the conversation between them. Working with Dr. Moreland has given Dr. Soni “a better understanding of how to communicate effectively with patients that have difficulty hearing.”
After working with Dr. Moreland at UC Davis, Dr. Kravitz observed that employing physicians with hearing impairment or other disabilities brings additional benefits to the institution. Dr. Moreland’s presence “probably raised the level of understanding of the entire internal medicine staff, because it demonstrated that a disability is what you make of it,” he says. “One recognizes how porous the barriers are, provided that people with disabilities are supported appropriately. In that way, Chris was inspiring, and may have changed the way some of us look at this specific disability that he had, but also other disabilities.”
A bigger picture, indeed.
Gretchen Henkel is a freelance writer in California.
Reference
Community Service Helps Hospitalists Build Connections, Earn Credibility
Hospitalist Brian Bossard, MD, FACP, FHM, founder and medical director of Inpatient Physician Associates, which serves Bryan Health Medical Center in Lincoln, Neb., as well as Columbus (Neb.) Community Hospital and Great Plains Regional Medical Center in North Platte, recalls a time when the suggestion of community involvement was a non-starter for physicians. Twenty years ago, he says, “the idea was that physicians work so many hours that there wasn’t time for community involvement.” In the ensuing years, the advent of shift-based work has created an opportunity for hospitalists to connect to community.
Learning the ropes takes the majority of a physician’s time in the first year or two on a new assignment right after residency, Dr. Bossard says. But after initial orientation, young hospitalists in their group are encouraged to become “joiners.”
“We identify activities that the physicians can participate in—many of them medically related, such as sitting on the board of a local blood bank,” he says. “Feeling a part of something bigger, and participating in areas outside of your direct control, can add to satisfaction.”
And that, in turn, can lead to engaged, satisfied, happy, and retained physicians.
Closing the Credibility Gap
David Grace, MD, FHM, SFHM area medical officer for The Schumacher Group’s Hospital Medicine Division in Lafayette, La., agrees that community involvement can lead to improved engagement, as well as a better sense of belonging and job satisfaction. He also encourages younger hospitalists to become engaged in their local communities. Participating in volunteer activities can lead to:
- Better public understanding of what hospitalists do;
- Better relationships with key hospital and community stakeholders; and
- Better use of down time for long-distance hospitalist commuters.
Regarding his first point, Dr. Grace finds that despite the growth of the hospitalist movement, many consumers still do not understand the role hospitalists play in patient care. Encountering hospitalists in the community helps patients put a public and familiar face on the concept. Community involvement can function as “direct-to-consumer advertising,” he says, when patients express a preference for hospitals based on their interface with hospitalists in the community. He notes that “the smaller the town, the more likely there will be a dividing line between the community and ‘outsiders.’ The chance to go from being an outsider to an insider can have a profound effect on your success, your future, and your happiness.”
Because the business of healthcare is based on relationships, interacting with hospital stakeholders at youth sporting events and other gatherings gives hospitalists a chance to build relationships away from the pressures of the work environment. At the core of community involvement, Dr. Grace says, is the reality that “we are social creatures. There’s something about developing a bond away from the hospital that provides a unique strength, compared to a bond formed solely in the hospital environment.”
Manikandan Nagendran, MD, medical director of the hospital medicine program at Dauterive Hospital in New Iberia, La., has strengthened his professional relationships through community participation. After completing his residency, he joined the Schumacher hospitalist program at Dauterive Hospital. Burt Bujard, MD, who had begun the HM program just two years prior, took Dr. Nagendran under his wing. Not only did he introduce Dr. Nagendran to community primary care providers and specialists, he also fostered his involvement with some of the hospital’s traditions, such as the Gumbo Cook-Off and annual Berry Ball. Organized by all the physicians and their spouses, “the Berry Ball is a great social event to meet lots of nurses, doctors, and administrative people,” Dr. Nagendran says.
During last year’s cook-off, he volunteered to help his group’s nurse practitioner and her husband, both New Iberia residents, set up their booth and serve gumbo to the public.
“When you encounter another physician or hospital administrator at an event, you always get to know something different about that person,” he says. “When you meet people on a different level at a social event, and exchange phone numbers, your relationship changes in many ways.”
Since he maintains his home in Lafayette, a 30-minute commute away, he wanted to invest time in New Iberia community activities. “One of the reasons I go to these events,” he says, “is so they understand that I’m part of their community here.
“When you meet these people in the hospital after an event, you are seen as more approachable. Especially for hospitalists, we need to build relationships.”
Six years ago, the Dauterive hospital medicine program had 15 contracts with community PCPs. That number is now up to 58.
And when Dr. Bujard retired in 2011, Dr. Nagendran became medical director.
Dr. Grace notes that community involvement can also serve to keep one’s life in balance. Referring to the “systolic/diastolic lifestyle” of hospitalist shifts, he says that “introducing a little bit of community and enjoyment into your down time can also increase job satisfaction during your work time.”
Gretchen Henkel is a freelance writer in San Luis Obispo, Calif.
Hospitalist Brian Bossard, MD, FACP, FHM, founder and medical director of Inpatient Physician Associates, which serves Bryan Health Medical Center in Lincoln, Neb., as well as Columbus (Neb.) Community Hospital and Great Plains Regional Medical Center in North Platte, recalls a time when the suggestion of community involvement was a non-starter for physicians. Twenty years ago, he says, “the idea was that physicians work so many hours that there wasn’t time for community involvement.” In the ensuing years, the advent of shift-based work has created an opportunity for hospitalists to connect to community.
Learning the ropes takes the majority of a physician’s time in the first year or two on a new assignment right after residency, Dr. Bossard says. But after initial orientation, young hospitalists in their group are encouraged to become “joiners.”
“We identify activities that the physicians can participate in—many of them medically related, such as sitting on the board of a local blood bank,” he says. “Feeling a part of something bigger, and participating in areas outside of your direct control, can add to satisfaction.”
And that, in turn, can lead to engaged, satisfied, happy, and retained physicians.
Closing the Credibility Gap
David Grace, MD, FHM, SFHM area medical officer for The Schumacher Group’s Hospital Medicine Division in Lafayette, La., agrees that community involvement can lead to improved engagement, as well as a better sense of belonging and job satisfaction. He also encourages younger hospitalists to become engaged in their local communities. Participating in volunteer activities can lead to:
- Better public understanding of what hospitalists do;
- Better relationships with key hospital and community stakeholders; and
- Better use of down time for long-distance hospitalist commuters.
Regarding his first point, Dr. Grace finds that despite the growth of the hospitalist movement, many consumers still do not understand the role hospitalists play in patient care. Encountering hospitalists in the community helps patients put a public and familiar face on the concept. Community involvement can function as “direct-to-consumer advertising,” he says, when patients express a preference for hospitals based on their interface with hospitalists in the community. He notes that “the smaller the town, the more likely there will be a dividing line between the community and ‘outsiders.’ The chance to go from being an outsider to an insider can have a profound effect on your success, your future, and your happiness.”
Because the business of healthcare is based on relationships, interacting with hospital stakeholders at youth sporting events and other gatherings gives hospitalists a chance to build relationships away from the pressures of the work environment. At the core of community involvement, Dr. Grace says, is the reality that “we are social creatures. There’s something about developing a bond away from the hospital that provides a unique strength, compared to a bond formed solely in the hospital environment.”
Manikandan Nagendran, MD, medical director of the hospital medicine program at Dauterive Hospital in New Iberia, La., has strengthened his professional relationships through community participation. After completing his residency, he joined the Schumacher hospitalist program at Dauterive Hospital. Burt Bujard, MD, who had begun the HM program just two years prior, took Dr. Nagendran under his wing. Not only did he introduce Dr. Nagendran to community primary care providers and specialists, he also fostered his involvement with some of the hospital’s traditions, such as the Gumbo Cook-Off and annual Berry Ball. Organized by all the physicians and their spouses, “the Berry Ball is a great social event to meet lots of nurses, doctors, and administrative people,” Dr. Nagendran says.
During last year’s cook-off, he volunteered to help his group’s nurse practitioner and her husband, both New Iberia residents, set up their booth and serve gumbo to the public.
“When you encounter another physician or hospital administrator at an event, you always get to know something different about that person,” he says. “When you meet people on a different level at a social event, and exchange phone numbers, your relationship changes in many ways.”
Since he maintains his home in Lafayette, a 30-minute commute away, he wanted to invest time in New Iberia community activities. “One of the reasons I go to these events,” he says, “is so they understand that I’m part of their community here.
“When you meet these people in the hospital after an event, you are seen as more approachable. Especially for hospitalists, we need to build relationships.”
Six years ago, the Dauterive hospital medicine program had 15 contracts with community PCPs. That number is now up to 58.
And when Dr. Bujard retired in 2011, Dr. Nagendran became medical director.
Dr. Grace notes that community involvement can also serve to keep one’s life in balance. Referring to the “systolic/diastolic lifestyle” of hospitalist shifts, he says that “introducing a little bit of community and enjoyment into your down time can also increase job satisfaction during your work time.”
Gretchen Henkel is a freelance writer in San Luis Obispo, Calif.
Hospitalist Brian Bossard, MD, FACP, FHM, founder and medical director of Inpatient Physician Associates, which serves Bryan Health Medical Center in Lincoln, Neb., as well as Columbus (Neb.) Community Hospital and Great Plains Regional Medical Center in North Platte, recalls a time when the suggestion of community involvement was a non-starter for physicians. Twenty years ago, he says, “the idea was that physicians work so many hours that there wasn’t time for community involvement.” In the ensuing years, the advent of shift-based work has created an opportunity for hospitalists to connect to community.
Learning the ropes takes the majority of a physician’s time in the first year or two on a new assignment right after residency, Dr. Bossard says. But after initial orientation, young hospitalists in their group are encouraged to become “joiners.”
“We identify activities that the physicians can participate in—many of them medically related, such as sitting on the board of a local blood bank,” he says. “Feeling a part of something bigger, and participating in areas outside of your direct control, can add to satisfaction.”
And that, in turn, can lead to engaged, satisfied, happy, and retained physicians.
Closing the Credibility Gap
David Grace, MD, FHM, SFHM area medical officer for The Schumacher Group’s Hospital Medicine Division in Lafayette, La., agrees that community involvement can lead to improved engagement, as well as a better sense of belonging and job satisfaction. He also encourages younger hospitalists to become engaged in their local communities. Participating in volunteer activities can lead to:
- Better public understanding of what hospitalists do;
- Better relationships with key hospital and community stakeholders; and
- Better use of down time for long-distance hospitalist commuters.
Regarding his first point, Dr. Grace finds that despite the growth of the hospitalist movement, many consumers still do not understand the role hospitalists play in patient care. Encountering hospitalists in the community helps patients put a public and familiar face on the concept. Community involvement can function as “direct-to-consumer advertising,” he says, when patients express a preference for hospitals based on their interface with hospitalists in the community. He notes that “the smaller the town, the more likely there will be a dividing line between the community and ‘outsiders.’ The chance to go from being an outsider to an insider can have a profound effect on your success, your future, and your happiness.”
Because the business of healthcare is based on relationships, interacting with hospital stakeholders at youth sporting events and other gatherings gives hospitalists a chance to build relationships away from the pressures of the work environment. At the core of community involvement, Dr. Grace says, is the reality that “we are social creatures. There’s something about developing a bond away from the hospital that provides a unique strength, compared to a bond formed solely in the hospital environment.”
Manikandan Nagendran, MD, medical director of the hospital medicine program at Dauterive Hospital in New Iberia, La., has strengthened his professional relationships through community participation. After completing his residency, he joined the Schumacher hospitalist program at Dauterive Hospital. Burt Bujard, MD, who had begun the HM program just two years prior, took Dr. Nagendran under his wing. Not only did he introduce Dr. Nagendran to community primary care providers and specialists, he also fostered his involvement with some of the hospital’s traditions, such as the Gumbo Cook-Off and annual Berry Ball. Organized by all the physicians and their spouses, “the Berry Ball is a great social event to meet lots of nurses, doctors, and administrative people,” Dr. Nagendran says.
During last year’s cook-off, he volunteered to help his group’s nurse practitioner and her husband, both New Iberia residents, set up their booth and serve gumbo to the public.
“When you encounter another physician or hospital administrator at an event, you always get to know something different about that person,” he says. “When you meet people on a different level at a social event, and exchange phone numbers, your relationship changes in many ways.”
Since he maintains his home in Lafayette, a 30-minute commute away, he wanted to invest time in New Iberia community activities. “One of the reasons I go to these events,” he says, “is so they understand that I’m part of their community here.
“When you meet these people in the hospital after an event, you are seen as more approachable. Especially for hospitalists, we need to build relationships.”
Six years ago, the Dauterive hospital medicine program had 15 contracts with community PCPs. That number is now up to 58.
And when Dr. Bujard retired in 2011, Dr. Nagendran became medical director.
Dr. Grace notes that community involvement can also serve to keep one’s life in balance. Referring to the “systolic/diastolic lifestyle” of hospitalist shifts, he says that “introducing a little bit of community and enjoyment into your down time can also increase job satisfaction during your work time.”
Gretchen Henkel is a freelance writer in San Luis Obispo, Calif.
University of Chicago Hospitalist Evan Lyon, MD, Chats about Rational Testing and Social Context in Low-Resource Areas
Hospitalists Are Uniquely Qualified for Global Health Initiatives
Hospitalist Vincent DeGennaro, Jr., MD, MPH, didn’t train as an oncologist. But during the course of his daily duties at the Hospital Bernard Mevs in Port-au-Prince, Haiti, he administers chemotherapy at the hospital’s women’s cancer center.
“Chemotherapy was outside the realm of my specialty, but under the training and remote consultation of U.S. oncologists, I have become more comfortable with it,” says Dr. DeGennaro, an assistant professor in the division of hospital medicine at the University of Florida College of Medicine in Gainesville. Along with performing echocardiograms and working in Haiti’s only ICU, it’s an example of how global health forces him to be a “true generalist.” That’s also true of hospital medicine. In fact, the flexible schedule hospital medicine offers was a deciding factor in his career choice. Shift work in a discrete time period would allow him, he reasoned, to also follow his passion of global health.
Volunteering in low-resource settings was something that “felt right to me from the beginning,” Dr. DeGennaro says. He worked in Honduras and the Dominican Republic during medical school, mostly through medical missions organizations. Work with Partners in Health during medical school and in Rwanda after residency exposed him to the capacity-building goals of that organization. He now spends seven months of the academic year in Haiti, where he is helping Project Medishare (www.projectmedishare.org) in its efforts to build capacity and infrastructure at the country’s major trauma hospital. In July, he will be supervising clinical fellows as the director of the University of Florida’s first HM global health fellowship program.
Haitian patients have to pay for their own tests, so Dr. DeGennaro must carefully choose those that will guide his management decisions for patients. “Low-resource utilization forces you to become a better clinician,” he says. “I think we have gotten intellectually lazy in the United States, where we can order a dozen tests and let the results guide us instead of using our clinical skills to narrow what tests to order.”
Delivering care in under-resourced countries, he adds, has changed him: “I’m a much better doctor for it.”
Gretchen Henkel is a freelance writer in California.
Hospitalist Vincent DeGennaro, Jr., MD, MPH, didn’t train as an oncologist. But during the course of his daily duties at the Hospital Bernard Mevs in Port-au-Prince, Haiti, he administers chemotherapy at the hospital’s women’s cancer center.
“Chemotherapy was outside the realm of my specialty, but under the training and remote consultation of U.S. oncologists, I have become more comfortable with it,” says Dr. DeGennaro, an assistant professor in the division of hospital medicine at the University of Florida College of Medicine in Gainesville. Along with performing echocardiograms and working in Haiti’s only ICU, it’s an example of how global health forces him to be a “true generalist.” That’s also true of hospital medicine. In fact, the flexible schedule hospital medicine offers was a deciding factor in his career choice. Shift work in a discrete time period would allow him, he reasoned, to also follow his passion of global health.
Volunteering in low-resource settings was something that “felt right to me from the beginning,” Dr. DeGennaro says. He worked in Honduras and the Dominican Republic during medical school, mostly through medical missions organizations. Work with Partners in Health during medical school and in Rwanda after residency exposed him to the capacity-building goals of that organization. He now spends seven months of the academic year in Haiti, where he is helping Project Medishare (www.projectmedishare.org) in its efforts to build capacity and infrastructure at the country’s major trauma hospital. In July, he will be supervising clinical fellows as the director of the University of Florida’s first HM global health fellowship program.
Haitian patients have to pay for their own tests, so Dr. DeGennaro must carefully choose those that will guide his management decisions for patients. “Low-resource utilization forces you to become a better clinician,” he says. “I think we have gotten intellectually lazy in the United States, where we can order a dozen tests and let the results guide us instead of using our clinical skills to narrow what tests to order.”
Delivering care in under-resourced countries, he adds, has changed him: “I’m a much better doctor for it.”
Gretchen Henkel is a freelance writer in California.
Hospitalist Vincent DeGennaro, Jr., MD, MPH, didn’t train as an oncologist. But during the course of his daily duties at the Hospital Bernard Mevs in Port-au-Prince, Haiti, he administers chemotherapy at the hospital’s women’s cancer center.
“Chemotherapy was outside the realm of my specialty, but under the training and remote consultation of U.S. oncologists, I have become more comfortable with it,” says Dr. DeGennaro, an assistant professor in the division of hospital medicine at the University of Florida College of Medicine in Gainesville. Along with performing echocardiograms and working in Haiti’s only ICU, it’s an example of how global health forces him to be a “true generalist.” That’s also true of hospital medicine. In fact, the flexible schedule hospital medicine offers was a deciding factor in his career choice. Shift work in a discrete time period would allow him, he reasoned, to also follow his passion of global health.
Volunteering in low-resource settings was something that “felt right to me from the beginning,” Dr. DeGennaro says. He worked in Honduras and the Dominican Republic during medical school, mostly through medical missions organizations. Work with Partners in Health during medical school and in Rwanda after residency exposed him to the capacity-building goals of that organization. He now spends seven months of the academic year in Haiti, where he is helping Project Medishare (www.projectmedishare.org) in its efforts to build capacity and infrastructure at the country’s major trauma hospital. In July, he will be supervising clinical fellows as the director of the University of Florida’s first HM global health fellowship program.
Haitian patients have to pay for their own tests, so Dr. DeGennaro must carefully choose those that will guide his management decisions for patients. “Low-resource utilization forces you to become a better clinician,” he says. “I think we have gotten intellectually lazy in the United States, where we can order a dozen tests and let the results guide us instead of using our clinical skills to narrow what tests to order.”
Delivering care in under-resourced countries, he adds, has changed him: “I’m a much better doctor for it.”
Gretchen Henkel is a freelance writer in California.
Global Health Hospitalists Share a Passion for Their Work
Global health hospitalists are passionate about their work. The Hospitalist asked them to expand on the reasons they choose this work.
“Working in Haiti has been the most compelling work in my life,” says Michelle Morse, MD, MPH, an instructor in medicine at Harvard Medical School and deputy chief medical officer for Partners in Health (PIH) in Boston. She has worked with the Navajo Nation in conjunction with PIH’s Community Outreach and Patient Empowerment (COPE) program. The sharing of information is “bi-directional,” Dr. Morse says.
Her Haitian colleagues, she says, have developed “transformative” systems improvements, and she’s found that her own diagnostic and physical exam skills have strengthened because of her work abroad.
“You really have to think bigger than your group of patients and bigger than your community, and think about the whole system to make things better around the world,” she says. “I think that is a fundamental part of becoming a physician.”
UCSF clinical fellow Varun Verma, MD, says he was tired of working in “fragmented volunteer assignments” with relief organizations. Three-month clinical rotations, in which he essentially functions as a teaching attending, have solved the “filling in” feeling he’d grown weary of.
“Here at St. Thérèse Hospital [in Hinche, Haiti], they do not need us to take care of patients on a moment-to-moment basis. There are Haitian clinicians for that,” he says. “Part of our job is to do medical teaching of residents and try to involve everyone in quality improvement projects. It’s sometimes challenging discussing best practices of managing conditions, given the resources at hand, but I find that the Haitian doctors are always interested in learning how we do things in the U.S.”
Evan Lyon, MD, assistant professor of medicine in the section of hospital medicine, supervises clinical fellows in the department of medicine at the University of Chicago. He believes hospitalists who take on global health assignments gain a deeper appreciation for assessing patients’ social histories.
“There’s no better way to deepen your learning of physical exam and history-taking skills than to be out here on the edge and have to rely on those skills,” he says. “Back in the states, you might order an echocardiogram before you listen to the patient’s heart. I think all of us have a different relationship to labs, testing, and X-rays when we return. But the deepest influence for me has been around understanding patients’ social histories and their social context, which is a neglected piece of American medicine.”
Sharing resources and knowledge is what drives Marwa Shoeb MD, MS, assistant professor in the division of hospital medicine at UCSF. “I see this as an extension of our daily work,” she says. “We are just taking it to a different context.”
Gretchen Henkel is a freelance writer in southern California.
Global health hospitalists are passionate about their work. The Hospitalist asked them to expand on the reasons they choose this work.
“Working in Haiti has been the most compelling work in my life,” says Michelle Morse, MD, MPH, an instructor in medicine at Harvard Medical School and deputy chief medical officer for Partners in Health (PIH) in Boston. She has worked with the Navajo Nation in conjunction with PIH’s Community Outreach and Patient Empowerment (COPE) program. The sharing of information is “bi-directional,” Dr. Morse says.
Her Haitian colleagues, she says, have developed “transformative” systems improvements, and she’s found that her own diagnostic and physical exam skills have strengthened because of her work abroad.
“You really have to think bigger than your group of patients and bigger than your community, and think about the whole system to make things better around the world,” she says. “I think that is a fundamental part of becoming a physician.”
UCSF clinical fellow Varun Verma, MD, says he was tired of working in “fragmented volunteer assignments” with relief organizations. Three-month clinical rotations, in which he essentially functions as a teaching attending, have solved the “filling in” feeling he’d grown weary of.
“Here at St. Thérèse Hospital [in Hinche, Haiti], they do not need us to take care of patients on a moment-to-moment basis. There are Haitian clinicians for that,” he says. “Part of our job is to do medical teaching of residents and try to involve everyone in quality improvement projects. It’s sometimes challenging discussing best practices of managing conditions, given the resources at hand, but I find that the Haitian doctors are always interested in learning how we do things in the U.S.”
Evan Lyon, MD, assistant professor of medicine in the section of hospital medicine, supervises clinical fellows in the department of medicine at the University of Chicago. He believes hospitalists who take on global health assignments gain a deeper appreciation for assessing patients’ social histories.
“There’s no better way to deepen your learning of physical exam and history-taking skills than to be out here on the edge and have to rely on those skills,” he says. “Back in the states, you might order an echocardiogram before you listen to the patient’s heart. I think all of us have a different relationship to labs, testing, and X-rays when we return. But the deepest influence for me has been around understanding patients’ social histories and their social context, which is a neglected piece of American medicine.”
Sharing resources and knowledge is what drives Marwa Shoeb MD, MS, assistant professor in the division of hospital medicine at UCSF. “I see this as an extension of our daily work,” she says. “We are just taking it to a different context.”
Gretchen Henkel is a freelance writer in southern California.
Global health hospitalists are passionate about their work. The Hospitalist asked them to expand on the reasons they choose this work.
“Working in Haiti has been the most compelling work in my life,” says Michelle Morse, MD, MPH, an instructor in medicine at Harvard Medical School and deputy chief medical officer for Partners in Health (PIH) in Boston. She has worked with the Navajo Nation in conjunction with PIH’s Community Outreach and Patient Empowerment (COPE) program. The sharing of information is “bi-directional,” Dr. Morse says.
Her Haitian colleagues, she says, have developed “transformative” systems improvements, and she’s found that her own diagnostic and physical exam skills have strengthened because of her work abroad.
“You really have to think bigger than your group of patients and bigger than your community, and think about the whole system to make things better around the world,” she says. “I think that is a fundamental part of becoming a physician.”
UCSF clinical fellow Varun Verma, MD, says he was tired of working in “fragmented volunteer assignments” with relief organizations. Three-month clinical rotations, in which he essentially functions as a teaching attending, have solved the “filling in” feeling he’d grown weary of.
“Here at St. Thérèse Hospital [in Hinche, Haiti], they do not need us to take care of patients on a moment-to-moment basis. There are Haitian clinicians for that,” he says. “Part of our job is to do medical teaching of residents and try to involve everyone in quality improvement projects. It’s sometimes challenging discussing best practices of managing conditions, given the resources at hand, but I find that the Haitian doctors are always interested in learning how we do things in the U.S.”
Evan Lyon, MD, assistant professor of medicine in the section of hospital medicine, supervises clinical fellows in the department of medicine at the University of Chicago. He believes hospitalists who take on global health assignments gain a deeper appreciation for assessing patients’ social histories.
“There’s no better way to deepen your learning of physical exam and history-taking skills than to be out here on the edge and have to rely on those skills,” he says. “Back in the states, you might order an echocardiogram before you listen to the patient’s heart. I think all of us have a different relationship to labs, testing, and X-rays when we return. But the deepest influence for me has been around understanding patients’ social histories and their social context, which is a neglected piece of American medicine.”
Sharing resources and knowledge is what drives Marwa Shoeb MD, MS, assistant professor in the division of hospital medicine at UCSF. “I see this as an extension of our daily work,” she says. “We are just taking it to a different context.”
Gretchen Henkel is a freelance writer in southern California.
Brett Hendel-Paterson, MD, Discusses Advantages of Needs Assessments
Listen to more of our interview with Dr. Hendel-Paterson, as he discusses the advantages of a good needs assessment.
Listen to more of our interview with Dr. Hendel-Paterson, as he discusses the advantages of a good needs assessment.
Listen to more of our interview with Dr. Hendel-Paterson, as he discusses the advantages of a good needs assessment.
Hospitalists Join Together, Raise Bar on Global Health Initiatives
Western medicine has a long tradition of humanitarian service in developing countries. But, over the past two decades, the manner in which medical services are provided to under-resourced nations has evolved. Rather than volunteering to deliver acute care through humanitarian missions, a new generation of global health physicians aims to become dispensable. Through new nonprofit and collaborative models, they are establishing ongoing relationships with medical professionals in host countries to actively promote capacity building, from construction of new facilities to medical education and training.
“Global health work needs to be collaborative and bilateral, not just an export of our Western medical model to a low-resource setting,” says HealthPartners hospitalist Brett R. Hendel-Paterson, MD, an assistant professor of medicine at the University of Minnesota who also practices in HealthPartners’ Travel and Tropical Medicine Center in St. Paul, Minn., and is co-director of the UM/CDC online global health course.
Sriram Shamasunder, MD, DTM&H, hospitalist, health sciences assistant clinical professor, and co-director of the University of California San Francisco (UCSF) Global Health-Hospital Medicine Fellowship, agrees. “Mission medicine has incredibly well-meaning and committed people, but to address the upstream problems that bring people to the hospital, there need to be systems-based solutions,” he says.
And that is where hospitalists come in.
Growing numbers of hospitalists are joining in global health efforts, as Marwa Shoeb, MD, MS, and Phuoc Le, MD, MPH, DTM&H, discovered when they surveyed SHM members about participation in global health activities. Drs. Shoeb and Le are assistant clinical professors in the division of hospital medicine at UCSF. The survey (J Hosp Med. 2013;8(13):162-163) revealed that 51% of 232 respondents had done global health work prior to becoming a hospitalist; another third continued global health work after they began their HM careers.
Many believe hospitalists are uniquely qualified for global health initiatives. HM’s emphasis on systems of care delivery and quality improvement can supply much-needed knowledge as under-resourced countries strive to increase access to health care, says Michelle Morse, MD, MPH, an instructor in medicine at Harvard Medical School in Boston and deputy chief medical officer of Partners in Health (PIH) in Haiti (www.pih.org).
“Being a hospitalist is incredibly complementary to doing global health work,” Dr. Morse says. PIH has maintained a presence in Haiti for more than two decades and just recently celebrated a milestone with the Haitian medical community: establishment of the country’s newest medical residency training at University Hospital in Mirebalais.
Embrace Challenges
In early December, a group of UCSF hospitalists visited another PIH site, a Haitian Ministry of Health hospital in Hinche, located in the central plateau region of the country. Robin Tittle, MD, and Varun Verma, MD, were nearing the end of their first three-month rotation in the country as clinical fellows in the two-year-old Global Health-Hospital Medicine Fellowship.
According to Dr. Tittle, working in a resource-challenged hospital such as the one in Hinche is an irreplaceable experience. She and Dr. Verma discovered new levels of meaning in the term “workaround.” For example, “we have really limited lab capacity,” Dr. Tittle says. “One interesting thing I learned is how much your lab depends on access to reliable electricity. A number of our machines have been ruined because of electrical power surges. There are only certain people in the lab who know how to run certain tests.”
Dr. Tittle has learned that “you can’t practice medicine [in Haiti] without addressing the system.” Exposure to QI methods during training have been useful, she says, as she and Dr. Verma designed a medical education seminar for their Haitian colleagues by identifying the top 10 diagnoses in the nursing discharge registry. Still, she admits that the effort was hampered by nonspecific diagnoses—again a result of their inability to run diagnostic tests.
The learning has been reciprocal, notes Dr. Jacquelin Pierre Auguste, one of the Haitian internists in Hinche.
“We share a lot of knowledge,” he says, enthusiastically.
One example Dr. Pierre shared was being able to bring the clinical fellows into the case of a young mother who had developed postpartum cardiomyopathy. For unknown reasons, the condition is 10-20 times as common in Haiti as in the U.S., according to Dr. Le, who is co-director of the UCSF Global Health-Hospital Medicine Fellowship program. “Our fellows are also learning much more about the management of late-stage disease in tuberculosis and HIV,” he adds.
Several hospitalists have witnessed misappropriation of resources in global health projects, which can occur during emergency situations, such as in post-earthquake Haiti. For benefits to be sustainable, it’s best not to “charge in,” but to carefully assess the needs of the host setting. Although needs assessment should be handled by the sponsoring organization, hospitalists can contribute to this effort so that well-intentioned relief efforts do not cause unintended consequences, Dr. Hendel-Paterson says.
Hospitalists Unite
In the global health survey conducted in 2012, Drs. Shoeb and Le found that 46% of respondents were interested in collaborating with other hospitalists in order to increase their impact on health equity. In response to these and other observations about a need for mentorship, SHM established a Global Health and Human Rights Section, chaired by Drs. Shoeb and Le. They will be hosting a special global health forum at HM14 later this month in Las Vegas (www.hospitalmedicine2014.org).
The section goals are to:
- Provide a forum for like-minded hospitalists to share experiences and knowledge;
- Enhance the skill sets of hospitalists to apply their expertise in resource-poor settings; and
- Strengthen the capacity of local health systems through long-term collaborations and training in quality improvement.
Dr. Le, who has been affiliated with Partners in Health since his residency at Harvard Medical School, has spent time in sub-Saharan Africa as well as Haiti. He has been instrumental in advancing the HM global health agenda at UCSF and helped to organize the first national retreat on global health in HM last year. The program held its second annual retreat in February 2014.
Besides UCSF, two other global health fellowships are designed specifically for hospitalists: the University of Chicago Global Hospital Medicine Fellowship is headed by Evan Lyon, MD, an assistant professor of medicine in the section of hospital medicine in the UC Department of Medicine; the University of Florida College of Medicine’s Global Health-Hospitalist Fellowship program in Gainesville is headed by Vincent DeGennaro, Jr., MD, MPH, assistant professor in the division of hospital medicine.
In addition, hospitalist Deepak Asudani, MD, MPH, FHM, health sciences assistant clinical professor at the University of California San Diego, reports that his department is interested in organizing a global health fellowship program. A firm believer in the distinction between global health and international health, Dr. Asudani explains that the UCSD program will be geared to teach U.S.-trained physicians how to practice medicine in resource-limited countries. It will have a track for physicians from other countries to study hospital medicine here.
Sustainable Care
During their rotations in Haiti, Dr. Le says the UCSF clinical fellows’ mission is capacity building, meaning they usually do not deliver care as primary physicians but rather engage in what he calls “clinical accompaniment.” They assist with care delivery and teach clinical skills to Haitian trainees.
“We do not want to be a substitute for doctors who are there,” he says. “We want to support Haitian residents and give consultative advice on difficult cases. We do not want to go, provide care, and leave. We are moving toward long-term relationships that foster systemic change.”
Clinical fellows teach quality improvement methods, and then the local partners, whether in Liberia or Haiti, generate ideas for QI projects around their most pressing needs. The fellows then offer support in the development and implementation of those projects.
Congruent Practice
The global health program at the University of Minnesota, led by Patricia Walker, MD, DTM&H, has established a medical teaching collaboration with Selian Lutheran Hospital in Arusha, Tanzania. Its name, Tufundishane, is a Swahili word meaning “let us all teach one another” and points out one of the many benefits for hospitalists who pursue this type of work. They report that the work changes the way they practice when they resume clinical duties back home.
Dr. Verma, a UCSF clinical fellow, can attest to those changes. After a three-month stint at St. Thérèse Hospital in Hinche, Dr. Verma says he intended to challenge his residents on the teaching service to “think about every single test they’re ordering.” That resolve was just one consequence of working in a resource-challenged hospital environment.
Speaking from Hinche in December, Dr. Verma says that in the U.S., “you can order a complete blood count and electrolytes for your patients every day they’re in the hospital. But here, if I want to get a renal test on a patient, I have to find the lab manager and find out if we have the reagents for those tests. It makes me question whether I really need that test or whether I am ordering it to make myself feel better.”
Dr. Verma views the workaround challenges as a net positive.
“Many times, you can do a lot of good for patients with an incomplete picture,” he says. It’s a view shared by other hospitalists who incorporate global health work into their clinical duties back in the U.S.
Dr. Hendel-Paterson has a wealth of global health experience: He worked in India and Zimbabwe during medical school, conducted research in Uganda, volunteered in Haiti, and has taught a tropical medicine course in Thailand. He says hospitalists can benefit from knowledge about global health when treating their own patients. For example, seeing patients with malaria or dengue fever during volunteer or service work can help providers recognize, diagnose, and treat those diseases in returning U.S. travelers. It also can help hospitalists avoid causing iatrogenic disease, as in the case of disseminated strongyloidiasis, which can result when people who have lived in or visited endemic areas are treated with immunosuppressants like corticosteroids.
Even if the experience does not give enough expertise to diagnose and treat, he says it can help providers realize that they should be asking for more testing or consultation in appropriate settings.
—Brett R. Hendel-Paterson, MD, assistant professor of medicine, University of Minnesota, hospitalist, HealthPartners’ Travel and Tropical Medicine Center in St. Paul, Minn., co-director, UM/CDC online global health course.
Expand Your Thinking
Global health hospitalists interviewed by The Hospitalist believe good medicine is not tied to any particular place. Many find that work in other countries enriches their own core competencies as physicians.
As partnerships between health systems in other countries and the U.S. continue to grow, leaders hope the exchange will bring improvements for all parties. Dr. Shamasunder points out that as the healthcare dollar becomes scarcer in the U.S., those who work abroad might have much to contribute to the systems they work.
For Dr. Shamasunder and his colleagues, global health is not just about making people’s lives better but is also about taking into consideration the social determinants of health. What becomes clear after doing this work, he says, is that resource-challenged environments are everywhere and that patients’ social histories are relevant no matter the locale.
“If you simply treat a patient who has anemia from lead exposure, and you have no mechanism to address the presence of that toxin in their substandard housing, that patient may end up with lead poisoning,” he says.
As Dr. Hendel-Paterson sums it up: “There is no such thing as healthcare over here and healthcare over there.” That’s why he and other global health hospitalists are convinced that “global is local.”
Gretchen Henkel is a freelance writer in southern California.
Western medicine has a long tradition of humanitarian service in developing countries. But, over the past two decades, the manner in which medical services are provided to under-resourced nations has evolved. Rather than volunteering to deliver acute care through humanitarian missions, a new generation of global health physicians aims to become dispensable. Through new nonprofit and collaborative models, they are establishing ongoing relationships with medical professionals in host countries to actively promote capacity building, from construction of new facilities to medical education and training.
“Global health work needs to be collaborative and bilateral, not just an export of our Western medical model to a low-resource setting,” says HealthPartners hospitalist Brett R. Hendel-Paterson, MD, an assistant professor of medicine at the University of Minnesota who also practices in HealthPartners’ Travel and Tropical Medicine Center in St. Paul, Minn., and is co-director of the UM/CDC online global health course.
Sriram Shamasunder, MD, DTM&H, hospitalist, health sciences assistant clinical professor, and co-director of the University of California San Francisco (UCSF) Global Health-Hospital Medicine Fellowship, agrees. “Mission medicine has incredibly well-meaning and committed people, but to address the upstream problems that bring people to the hospital, there need to be systems-based solutions,” he says.
And that is where hospitalists come in.
Growing numbers of hospitalists are joining in global health efforts, as Marwa Shoeb, MD, MS, and Phuoc Le, MD, MPH, DTM&H, discovered when they surveyed SHM members about participation in global health activities. Drs. Shoeb and Le are assistant clinical professors in the division of hospital medicine at UCSF. The survey (J Hosp Med. 2013;8(13):162-163) revealed that 51% of 232 respondents had done global health work prior to becoming a hospitalist; another third continued global health work after they began their HM careers.
Many believe hospitalists are uniquely qualified for global health initiatives. HM’s emphasis on systems of care delivery and quality improvement can supply much-needed knowledge as under-resourced countries strive to increase access to health care, says Michelle Morse, MD, MPH, an instructor in medicine at Harvard Medical School in Boston and deputy chief medical officer of Partners in Health (PIH) in Haiti (www.pih.org).
“Being a hospitalist is incredibly complementary to doing global health work,” Dr. Morse says. PIH has maintained a presence in Haiti for more than two decades and just recently celebrated a milestone with the Haitian medical community: establishment of the country’s newest medical residency training at University Hospital in Mirebalais.
Embrace Challenges
In early December, a group of UCSF hospitalists visited another PIH site, a Haitian Ministry of Health hospital in Hinche, located in the central plateau region of the country. Robin Tittle, MD, and Varun Verma, MD, were nearing the end of their first three-month rotation in the country as clinical fellows in the two-year-old Global Health-Hospital Medicine Fellowship.
According to Dr. Tittle, working in a resource-challenged hospital such as the one in Hinche is an irreplaceable experience. She and Dr. Verma discovered new levels of meaning in the term “workaround.” For example, “we have really limited lab capacity,” Dr. Tittle says. “One interesting thing I learned is how much your lab depends on access to reliable electricity. A number of our machines have been ruined because of electrical power surges. There are only certain people in the lab who know how to run certain tests.”
Dr. Tittle has learned that “you can’t practice medicine [in Haiti] without addressing the system.” Exposure to QI methods during training have been useful, she says, as she and Dr. Verma designed a medical education seminar for their Haitian colleagues by identifying the top 10 diagnoses in the nursing discharge registry. Still, she admits that the effort was hampered by nonspecific diagnoses—again a result of their inability to run diagnostic tests.
The learning has been reciprocal, notes Dr. Jacquelin Pierre Auguste, one of the Haitian internists in Hinche.
“We share a lot of knowledge,” he says, enthusiastically.
One example Dr. Pierre shared was being able to bring the clinical fellows into the case of a young mother who had developed postpartum cardiomyopathy. For unknown reasons, the condition is 10-20 times as common in Haiti as in the U.S., according to Dr. Le, who is co-director of the UCSF Global Health-Hospital Medicine Fellowship program. “Our fellows are also learning much more about the management of late-stage disease in tuberculosis and HIV,” he adds.
Several hospitalists have witnessed misappropriation of resources in global health projects, which can occur during emergency situations, such as in post-earthquake Haiti. For benefits to be sustainable, it’s best not to “charge in,” but to carefully assess the needs of the host setting. Although needs assessment should be handled by the sponsoring organization, hospitalists can contribute to this effort so that well-intentioned relief efforts do not cause unintended consequences, Dr. Hendel-Paterson says.
Hospitalists Unite
In the global health survey conducted in 2012, Drs. Shoeb and Le found that 46% of respondents were interested in collaborating with other hospitalists in order to increase their impact on health equity. In response to these and other observations about a need for mentorship, SHM established a Global Health and Human Rights Section, chaired by Drs. Shoeb and Le. They will be hosting a special global health forum at HM14 later this month in Las Vegas (www.hospitalmedicine2014.org).
The section goals are to:
- Provide a forum for like-minded hospitalists to share experiences and knowledge;
- Enhance the skill sets of hospitalists to apply their expertise in resource-poor settings; and
- Strengthen the capacity of local health systems through long-term collaborations and training in quality improvement.
Dr. Le, who has been affiliated with Partners in Health since his residency at Harvard Medical School, has spent time in sub-Saharan Africa as well as Haiti. He has been instrumental in advancing the HM global health agenda at UCSF and helped to organize the first national retreat on global health in HM last year. The program held its second annual retreat in February 2014.
Besides UCSF, two other global health fellowships are designed specifically for hospitalists: the University of Chicago Global Hospital Medicine Fellowship is headed by Evan Lyon, MD, an assistant professor of medicine in the section of hospital medicine in the UC Department of Medicine; the University of Florida College of Medicine’s Global Health-Hospitalist Fellowship program in Gainesville is headed by Vincent DeGennaro, Jr., MD, MPH, assistant professor in the division of hospital medicine.
In addition, hospitalist Deepak Asudani, MD, MPH, FHM, health sciences assistant clinical professor at the University of California San Diego, reports that his department is interested in organizing a global health fellowship program. A firm believer in the distinction between global health and international health, Dr. Asudani explains that the UCSD program will be geared to teach U.S.-trained physicians how to practice medicine in resource-limited countries. It will have a track for physicians from other countries to study hospital medicine here.
Sustainable Care
During their rotations in Haiti, Dr. Le says the UCSF clinical fellows’ mission is capacity building, meaning they usually do not deliver care as primary physicians but rather engage in what he calls “clinical accompaniment.” They assist with care delivery and teach clinical skills to Haitian trainees.
“We do not want to be a substitute for doctors who are there,” he says. “We want to support Haitian residents and give consultative advice on difficult cases. We do not want to go, provide care, and leave. We are moving toward long-term relationships that foster systemic change.”
Clinical fellows teach quality improvement methods, and then the local partners, whether in Liberia or Haiti, generate ideas for QI projects around their most pressing needs. The fellows then offer support in the development and implementation of those projects.
Congruent Practice
The global health program at the University of Minnesota, led by Patricia Walker, MD, DTM&H, has established a medical teaching collaboration with Selian Lutheran Hospital in Arusha, Tanzania. Its name, Tufundishane, is a Swahili word meaning “let us all teach one another” and points out one of the many benefits for hospitalists who pursue this type of work. They report that the work changes the way they practice when they resume clinical duties back home.
Dr. Verma, a UCSF clinical fellow, can attest to those changes. After a three-month stint at St. Thérèse Hospital in Hinche, Dr. Verma says he intended to challenge his residents on the teaching service to “think about every single test they’re ordering.” That resolve was just one consequence of working in a resource-challenged hospital environment.
Speaking from Hinche in December, Dr. Verma says that in the U.S., “you can order a complete blood count and electrolytes for your patients every day they’re in the hospital. But here, if I want to get a renal test on a patient, I have to find the lab manager and find out if we have the reagents for those tests. It makes me question whether I really need that test or whether I am ordering it to make myself feel better.”
Dr. Verma views the workaround challenges as a net positive.
“Many times, you can do a lot of good for patients with an incomplete picture,” he says. It’s a view shared by other hospitalists who incorporate global health work into their clinical duties back in the U.S.
Dr. Hendel-Paterson has a wealth of global health experience: He worked in India and Zimbabwe during medical school, conducted research in Uganda, volunteered in Haiti, and has taught a tropical medicine course in Thailand. He says hospitalists can benefit from knowledge about global health when treating their own patients. For example, seeing patients with malaria or dengue fever during volunteer or service work can help providers recognize, diagnose, and treat those diseases in returning U.S. travelers. It also can help hospitalists avoid causing iatrogenic disease, as in the case of disseminated strongyloidiasis, which can result when people who have lived in or visited endemic areas are treated with immunosuppressants like corticosteroids.
Even if the experience does not give enough expertise to diagnose and treat, he says it can help providers realize that they should be asking for more testing or consultation in appropriate settings.
—Brett R. Hendel-Paterson, MD, assistant professor of medicine, University of Minnesota, hospitalist, HealthPartners’ Travel and Tropical Medicine Center in St. Paul, Minn., co-director, UM/CDC online global health course.
Expand Your Thinking
Global health hospitalists interviewed by The Hospitalist believe good medicine is not tied to any particular place. Many find that work in other countries enriches their own core competencies as physicians.
As partnerships between health systems in other countries and the U.S. continue to grow, leaders hope the exchange will bring improvements for all parties. Dr. Shamasunder points out that as the healthcare dollar becomes scarcer in the U.S., those who work abroad might have much to contribute to the systems they work.
For Dr. Shamasunder and his colleagues, global health is not just about making people’s lives better but is also about taking into consideration the social determinants of health. What becomes clear after doing this work, he says, is that resource-challenged environments are everywhere and that patients’ social histories are relevant no matter the locale.
“If you simply treat a patient who has anemia from lead exposure, and you have no mechanism to address the presence of that toxin in their substandard housing, that patient may end up with lead poisoning,” he says.
As Dr. Hendel-Paterson sums it up: “There is no such thing as healthcare over here and healthcare over there.” That’s why he and other global health hospitalists are convinced that “global is local.”
Gretchen Henkel is a freelance writer in southern California.
Western medicine has a long tradition of humanitarian service in developing countries. But, over the past two decades, the manner in which medical services are provided to under-resourced nations has evolved. Rather than volunteering to deliver acute care through humanitarian missions, a new generation of global health physicians aims to become dispensable. Through new nonprofit and collaborative models, they are establishing ongoing relationships with medical professionals in host countries to actively promote capacity building, from construction of new facilities to medical education and training.
“Global health work needs to be collaborative and bilateral, not just an export of our Western medical model to a low-resource setting,” says HealthPartners hospitalist Brett R. Hendel-Paterson, MD, an assistant professor of medicine at the University of Minnesota who also practices in HealthPartners’ Travel and Tropical Medicine Center in St. Paul, Minn., and is co-director of the UM/CDC online global health course.
Sriram Shamasunder, MD, DTM&H, hospitalist, health sciences assistant clinical professor, and co-director of the University of California San Francisco (UCSF) Global Health-Hospital Medicine Fellowship, agrees. “Mission medicine has incredibly well-meaning and committed people, but to address the upstream problems that bring people to the hospital, there need to be systems-based solutions,” he says.
And that is where hospitalists come in.
Growing numbers of hospitalists are joining in global health efforts, as Marwa Shoeb, MD, MS, and Phuoc Le, MD, MPH, DTM&H, discovered when they surveyed SHM members about participation in global health activities. Drs. Shoeb and Le are assistant clinical professors in the division of hospital medicine at UCSF. The survey (J Hosp Med. 2013;8(13):162-163) revealed that 51% of 232 respondents had done global health work prior to becoming a hospitalist; another third continued global health work after they began their HM careers.
Many believe hospitalists are uniquely qualified for global health initiatives. HM’s emphasis on systems of care delivery and quality improvement can supply much-needed knowledge as under-resourced countries strive to increase access to health care, says Michelle Morse, MD, MPH, an instructor in medicine at Harvard Medical School in Boston and deputy chief medical officer of Partners in Health (PIH) in Haiti (www.pih.org).
“Being a hospitalist is incredibly complementary to doing global health work,” Dr. Morse says. PIH has maintained a presence in Haiti for more than two decades and just recently celebrated a milestone with the Haitian medical community: establishment of the country’s newest medical residency training at University Hospital in Mirebalais.
Embrace Challenges
In early December, a group of UCSF hospitalists visited another PIH site, a Haitian Ministry of Health hospital in Hinche, located in the central plateau region of the country. Robin Tittle, MD, and Varun Verma, MD, were nearing the end of their first three-month rotation in the country as clinical fellows in the two-year-old Global Health-Hospital Medicine Fellowship.
According to Dr. Tittle, working in a resource-challenged hospital such as the one in Hinche is an irreplaceable experience. She and Dr. Verma discovered new levels of meaning in the term “workaround.” For example, “we have really limited lab capacity,” Dr. Tittle says. “One interesting thing I learned is how much your lab depends on access to reliable electricity. A number of our machines have been ruined because of electrical power surges. There are only certain people in the lab who know how to run certain tests.”
Dr. Tittle has learned that “you can’t practice medicine [in Haiti] without addressing the system.” Exposure to QI methods during training have been useful, she says, as she and Dr. Verma designed a medical education seminar for their Haitian colleagues by identifying the top 10 diagnoses in the nursing discharge registry. Still, she admits that the effort was hampered by nonspecific diagnoses—again a result of their inability to run diagnostic tests.
The learning has been reciprocal, notes Dr. Jacquelin Pierre Auguste, one of the Haitian internists in Hinche.
“We share a lot of knowledge,” he says, enthusiastically.
One example Dr. Pierre shared was being able to bring the clinical fellows into the case of a young mother who had developed postpartum cardiomyopathy. For unknown reasons, the condition is 10-20 times as common in Haiti as in the U.S., according to Dr. Le, who is co-director of the UCSF Global Health-Hospital Medicine Fellowship program. “Our fellows are also learning much more about the management of late-stage disease in tuberculosis and HIV,” he adds.
Several hospitalists have witnessed misappropriation of resources in global health projects, which can occur during emergency situations, such as in post-earthquake Haiti. For benefits to be sustainable, it’s best not to “charge in,” but to carefully assess the needs of the host setting. Although needs assessment should be handled by the sponsoring organization, hospitalists can contribute to this effort so that well-intentioned relief efforts do not cause unintended consequences, Dr. Hendel-Paterson says.
Hospitalists Unite
In the global health survey conducted in 2012, Drs. Shoeb and Le found that 46% of respondents were interested in collaborating with other hospitalists in order to increase their impact on health equity. In response to these and other observations about a need for mentorship, SHM established a Global Health and Human Rights Section, chaired by Drs. Shoeb and Le. They will be hosting a special global health forum at HM14 later this month in Las Vegas (www.hospitalmedicine2014.org).
The section goals are to:
- Provide a forum for like-minded hospitalists to share experiences and knowledge;
- Enhance the skill sets of hospitalists to apply their expertise in resource-poor settings; and
- Strengthen the capacity of local health systems through long-term collaborations and training in quality improvement.
Dr. Le, who has been affiliated with Partners in Health since his residency at Harvard Medical School, has spent time in sub-Saharan Africa as well as Haiti. He has been instrumental in advancing the HM global health agenda at UCSF and helped to organize the first national retreat on global health in HM last year. The program held its second annual retreat in February 2014.
Besides UCSF, two other global health fellowships are designed specifically for hospitalists: the University of Chicago Global Hospital Medicine Fellowship is headed by Evan Lyon, MD, an assistant professor of medicine in the section of hospital medicine in the UC Department of Medicine; the University of Florida College of Medicine’s Global Health-Hospitalist Fellowship program in Gainesville is headed by Vincent DeGennaro, Jr., MD, MPH, assistant professor in the division of hospital medicine.
In addition, hospitalist Deepak Asudani, MD, MPH, FHM, health sciences assistant clinical professor at the University of California San Diego, reports that his department is interested in organizing a global health fellowship program. A firm believer in the distinction between global health and international health, Dr. Asudani explains that the UCSD program will be geared to teach U.S.-trained physicians how to practice medicine in resource-limited countries. It will have a track for physicians from other countries to study hospital medicine here.
Sustainable Care
During their rotations in Haiti, Dr. Le says the UCSF clinical fellows’ mission is capacity building, meaning they usually do not deliver care as primary physicians but rather engage in what he calls “clinical accompaniment.” They assist with care delivery and teach clinical skills to Haitian trainees.
“We do not want to be a substitute for doctors who are there,” he says. “We want to support Haitian residents and give consultative advice on difficult cases. We do not want to go, provide care, and leave. We are moving toward long-term relationships that foster systemic change.”
Clinical fellows teach quality improvement methods, and then the local partners, whether in Liberia or Haiti, generate ideas for QI projects around their most pressing needs. The fellows then offer support in the development and implementation of those projects.
Congruent Practice
The global health program at the University of Minnesota, led by Patricia Walker, MD, DTM&H, has established a medical teaching collaboration with Selian Lutheran Hospital in Arusha, Tanzania. Its name, Tufundishane, is a Swahili word meaning “let us all teach one another” and points out one of the many benefits for hospitalists who pursue this type of work. They report that the work changes the way they practice when they resume clinical duties back home.
Dr. Verma, a UCSF clinical fellow, can attest to those changes. After a three-month stint at St. Thérèse Hospital in Hinche, Dr. Verma says he intended to challenge his residents on the teaching service to “think about every single test they’re ordering.” That resolve was just one consequence of working in a resource-challenged hospital environment.
Speaking from Hinche in December, Dr. Verma says that in the U.S., “you can order a complete blood count and electrolytes for your patients every day they’re in the hospital. But here, if I want to get a renal test on a patient, I have to find the lab manager and find out if we have the reagents for those tests. It makes me question whether I really need that test or whether I am ordering it to make myself feel better.”
Dr. Verma views the workaround challenges as a net positive.
“Many times, you can do a lot of good for patients with an incomplete picture,” he says. It’s a view shared by other hospitalists who incorporate global health work into their clinical duties back in the U.S.
Dr. Hendel-Paterson has a wealth of global health experience: He worked in India and Zimbabwe during medical school, conducted research in Uganda, volunteered in Haiti, and has taught a tropical medicine course in Thailand. He says hospitalists can benefit from knowledge about global health when treating their own patients. For example, seeing patients with malaria or dengue fever during volunteer or service work can help providers recognize, diagnose, and treat those diseases in returning U.S. travelers. It also can help hospitalists avoid causing iatrogenic disease, as in the case of disseminated strongyloidiasis, which can result when people who have lived in or visited endemic areas are treated with immunosuppressants like corticosteroids.
Even if the experience does not give enough expertise to diagnose and treat, he says it can help providers realize that they should be asking for more testing or consultation in appropriate settings.
—Brett R. Hendel-Paterson, MD, assistant professor of medicine, University of Minnesota, hospitalist, HealthPartners’ Travel and Tropical Medicine Center in St. Paul, Minn., co-director, UM/CDC online global health course.
Expand Your Thinking
Global health hospitalists interviewed by The Hospitalist believe good medicine is not tied to any particular place. Many find that work in other countries enriches their own core competencies as physicians.
As partnerships between health systems in other countries and the U.S. continue to grow, leaders hope the exchange will bring improvements for all parties. Dr. Shamasunder points out that as the healthcare dollar becomes scarcer in the U.S., those who work abroad might have much to contribute to the systems they work.
For Dr. Shamasunder and his colleagues, global health is not just about making people’s lives better but is also about taking into consideration the social determinants of health. What becomes clear after doing this work, he says, is that resource-challenged environments are everywhere and that patients’ social histories are relevant no matter the locale.
“If you simply treat a patient who has anemia from lead exposure, and you have no mechanism to address the presence of that toxin in their substandard housing, that patient may end up with lead poisoning,” he says.
As Dr. Hendel-Paterson sums it up: “There is no such thing as healthcare over here and healthcare over there.” That’s why he and other global health hospitalists are convinced that “global is local.”
Gretchen Henkel is a freelance writer in southern California.
Hospital Medicine Blends Academic, Clinical Pursuits to Create Optimal Career Path
Are you attracted to research but not sure if it’s your sole calling as a prospective hospitalist? Whether you think you might want to steer quality improvement (QI) studies in the community setting or veer toward an academic/research career, hospital medicine offers an array of paths to career satisfaction.
“There is so much room in hospital medicine to find your research niche,” says Luci K. Leykum, MD, MBA, MSc, SFHM, hospital medicine division chief and associate dean for clinical affairs at University of Texas Health Science Center in San Antonio. As chair of SHM’s Research Committee, Dr. Leykum can attest to the range of hospitalists’ research pursuits: from basic science (what biomarkers best predict poor outcomes in patients with acute lung injury?) to care organization (are hospitalist schedules and workload associated with patient outcomes?) to implementation (how do we most effectively implement best practices for care transitions?) studies.1-6
In addition to Dr. Leykum, The Hospitalist consulted Vineet Arora, MD, MPP, FACP, SFHM, associate professor of medicine at the University of Chicago and chair of SHM’s Physicians in Training Committee, and Margaret Fang, MD, MPH, FHM, associate professor and clinician-investigator in the department of medicine at University of California San Francisco (UCSF) Medical Center and a member of the SHM Research Committee. Critical to research success, they agree, is acquiring skills in research methodology and project design, finding the right mentor(s) to help guide your career, and committing to and preserving time to focus on your research.
“After residency,” Dr. Arora notes, “you have accumulated the clinical skills to become a hospitalist, but you usually have not accumulated the skill it takes to be a researcher, which is why you need to do additional training.”
Is a Fellowship Necessary?
The paths to incorporating research into one’s HM career can be diverse. Although a fellowship is often the recommended route, there are other ways to acquire research methodology and experience with project design. Dr. Leykum began her career as a clinician-educator at Columbia University in New York. Although she found the QI work enjoyable, she realized she wanted to understand how to create more meaningful and sustainable changes in inpatient care delivery. She later acquired a master’s degree in clinical investigation. She has published more than 25 journal articles, several in collaboration with other SHM colleagues.
As a result, perhaps, of her own experience—and the fact that HM is still a young subspecialty with limited HM-specific fellowship opportunities—Dr. Leykum says that she would consider hiring a junior faculty member who had not yet completed a fellowship. “I think you have to consider people who might be talented candidates that you are willing to groom,” she says. However, she says she would structure the position so that the faculty member could immediately pursue additional research training.
–Dr. Fang
Dr. Fang completed a two-year, general medical research fellowship right after her residency and obtained her master of public health degree at that time. “I do agree,” she says, “that the fastest way to doing research well is to get some additional training.”
Even if you are not aiming to become a full-time investigator, Dr. Arora says a research fellowship “gives you very marketable skills. You will still gain skills that will be helpful to your career—and not all research is done by clinician investigators in academic settings.”
Another advantage of a fellowship, Dr. Arora says, is that it allows you to explore whether you are truly suited for a research career. All three hospitalists agreed that researchers share many of the same abilities: to focus, accept uncertainty, persevere, work in teams, and handle rejection.
The Right Mentorship
Dr. Fang says working with an experienced mentor is a vital ingredient to launching a research career. One key factor in selecting a fellowship program, according to Dr. Leykum, is the institution’s or group’s track record in developing junior faculty. To gain an understanding of how the partnership would work on a practical level, the candidate should ask specific questions of prospective mentors, such as:
- How well do research interests and methodological expertise match?
- How often would we meet?
- Who would be involved in the mentorship team?
- What would each person contribute?
In hospital medicine, it could be challenging to find a mentor within one’s own division. Dr. Fang points out that there are a variety of other ways to obtain career, academic, and research mentorship: For example, SHM’s Research Committee has a fledgling mentoring program, and the Society of General Internal Medicine offers both one-on-one and longitudinal year-long mentoring. “You can also look to other specialty divisions that are complementary,” she suggests. If you’re interested in antimicrobial stewardship, for example, your institution’s division of infectious disease might be a logical choice for your mentorship and collaboration search.
Balance Clinical, Research Time
Although securing protected research time concerns trainees as well as academic faculty (see “Protect, Make the Most of Your Time,”), deleting clinical time from the equation is not the answer.
“I find, from being a researcher,” says Dr. Arora, “that sometimes you need a break from research. And clinical work can provide that break. Whatever you do, you need a balance.”
Dr. Leykum says she learned, about five years ago, that 10 weeks of clinical rotation was too little. By choice, she elects to put in more clinical time. Why? “Being in that [clinical] environment helps you hone your questions, especially if they concern how to better deliver care,” she says. “In addition, you interact with specialists and learn about the new research that they are implementing.”
The cross-feed between clinical and research pursuits can be particularly rich, Dr. Fang says. In addition to her other posts at UCSF, she is medical director of the anticoagulation clinic.
“I find a lot of my research ideas flow very naturally out of the situations I see as a hospitalist,” she says. “You often see something that you want to improve and design a project to try and achieve those aims.”
Gretchen Henkel is a freelance writer in southern California.
Protect, Make the Most of Your Time
Transitioning from a research fellowship to your first job, you will be negotiating for protected research time. A typical junior faculty position might involve 70% research time and 30% clinical time, says Dr. Arora, who cautions candidates to clarify how the 30% clinical time will be structured. “In a hospitalist group, 30% clinical time can look quite different and have varying amounts of nights and undesirable shifts.” It is appropriate, she noted, to ask this question, because this may have implications for your research time.
Candidates also need clarity from prospective institutions about funding expectations. Be prepared to secure your own funding as soon as possible. “You need to always look ahead,” says Dr. Arora, who suggests that young investigators view their first job as a “mini-grant” and use their time during that period to develop other funding sources, such as the NIH K, or career development, awards. —GH
References
- Leykum LK, Parekh VI, Sharpe B, Boonyasai RT, Centor RM. Tried and true: a survey of successfully promoted academic hospitalists. J Hosp Med. 2011;6(7):411-415.
- McKenna K, Leykum LK, McDaniel RR. The role of improvising in patient care. Health Care Manage Rev. 2013;38(1):1-8.
- Arora VM, Fish M, Basu A, et al. Relationship between quality of care of hospitalized vulnerable elders and postdischarge mortality. J Am Geriatr Soc. 2010;58(9):1642-1648.
- Arora VM, Georgitis E, Siddique J, et al. Association of workload of on-call medical interns with on-call sleep duration, shift duration, and participation in educational activities. JAMA. 2008;300(10):1146-1153.
- Fang MC, Go AS, Chang Y, et al. A new risk scheme to predict warfarin-associated hemorrhage: the ATRIA (Anticoagulation and Risk Factors in Atrial Fibrillation) Study. J Am Coll Cardiol. 2011;58(4): 395-401.
- Mission JF, Kerlan RK, Tan JH, Fang MC. Rates and predictors of plans for inferior vena cava filter retrieval in hospitalized patients. J Gen Intern Med. 2010;25(4):321-325.
Are you attracted to research but not sure if it’s your sole calling as a prospective hospitalist? Whether you think you might want to steer quality improvement (QI) studies in the community setting or veer toward an academic/research career, hospital medicine offers an array of paths to career satisfaction.
“There is so much room in hospital medicine to find your research niche,” says Luci K. Leykum, MD, MBA, MSc, SFHM, hospital medicine division chief and associate dean for clinical affairs at University of Texas Health Science Center in San Antonio. As chair of SHM’s Research Committee, Dr. Leykum can attest to the range of hospitalists’ research pursuits: from basic science (what biomarkers best predict poor outcomes in patients with acute lung injury?) to care organization (are hospitalist schedules and workload associated with patient outcomes?) to implementation (how do we most effectively implement best practices for care transitions?) studies.1-6
In addition to Dr. Leykum, The Hospitalist consulted Vineet Arora, MD, MPP, FACP, SFHM, associate professor of medicine at the University of Chicago and chair of SHM’s Physicians in Training Committee, and Margaret Fang, MD, MPH, FHM, associate professor and clinician-investigator in the department of medicine at University of California San Francisco (UCSF) Medical Center and a member of the SHM Research Committee. Critical to research success, they agree, is acquiring skills in research methodology and project design, finding the right mentor(s) to help guide your career, and committing to and preserving time to focus on your research.
“After residency,” Dr. Arora notes, “you have accumulated the clinical skills to become a hospitalist, but you usually have not accumulated the skill it takes to be a researcher, which is why you need to do additional training.”
Is a Fellowship Necessary?
The paths to incorporating research into one’s HM career can be diverse. Although a fellowship is often the recommended route, there are other ways to acquire research methodology and experience with project design. Dr. Leykum began her career as a clinician-educator at Columbia University in New York. Although she found the QI work enjoyable, she realized she wanted to understand how to create more meaningful and sustainable changes in inpatient care delivery. She later acquired a master’s degree in clinical investigation. She has published more than 25 journal articles, several in collaboration with other SHM colleagues.
As a result, perhaps, of her own experience—and the fact that HM is still a young subspecialty with limited HM-specific fellowship opportunities—Dr. Leykum says that she would consider hiring a junior faculty member who had not yet completed a fellowship. “I think you have to consider people who might be talented candidates that you are willing to groom,” she says. However, she says she would structure the position so that the faculty member could immediately pursue additional research training.
–Dr. Fang
Dr. Fang completed a two-year, general medical research fellowship right after her residency and obtained her master of public health degree at that time. “I do agree,” she says, “that the fastest way to doing research well is to get some additional training.”
Even if you are not aiming to become a full-time investigator, Dr. Arora says a research fellowship “gives you very marketable skills. You will still gain skills that will be helpful to your career—and not all research is done by clinician investigators in academic settings.”
Another advantage of a fellowship, Dr. Arora says, is that it allows you to explore whether you are truly suited for a research career. All three hospitalists agreed that researchers share many of the same abilities: to focus, accept uncertainty, persevere, work in teams, and handle rejection.
The Right Mentorship
Dr. Fang says working with an experienced mentor is a vital ingredient to launching a research career. One key factor in selecting a fellowship program, according to Dr. Leykum, is the institution’s or group’s track record in developing junior faculty. To gain an understanding of how the partnership would work on a practical level, the candidate should ask specific questions of prospective mentors, such as:
- How well do research interests and methodological expertise match?
- How often would we meet?
- Who would be involved in the mentorship team?
- What would each person contribute?
In hospital medicine, it could be challenging to find a mentor within one’s own division. Dr. Fang points out that there are a variety of other ways to obtain career, academic, and research mentorship: For example, SHM’s Research Committee has a fledgling mentoring program, and the Society of General Internal Medicine offers both one-on-one and longitudinal year-long mentoring. “You can also look to other specialty divisions that are complementary,” she suggests. If you’re interested in antimicrobial stewardship, for example, your institution’s division of infectious disease might be a logical choice for your mentorship and collaboration search.
Balance Clinical, Research Time
Although securing protected research time concerns trainees as well as academic faculty (see “Protect, Make the Most of Your Time,”), deleting clinical time from the equation is not the answer.
“I find, from being a researcher,” says Dr. Arora, “that sometimes you need a break from research. And clinical work can provide that break. Whatever you do, you need a balance.”
Dr. Leykum says she learned, about five years ago, that 10 weeks of clinical rotation was too little. By choice, she elects to put in more clinical time. Why? “Being in that [clinical] environment helps you hone your questions, especially if they concern how to better deliver care,” she says. “In addition, you interact with specialists and learn about the new research that they are implementing.”
The cross-feed between clinical and research pursuits can be particularly rich, Dr. Fang says. In addition to her other posts at UCSF, she is medical director of the anticoagulation clinic.
“I find a lot of my research ideas flow very naturally out of the situations I see as a hospitalist,” she says. “You often see something that you want to improve and design a project to try and achieve those aims.”
Gretchen Henkel is a freelance writer in southern California.
Protect, Make the Most of Your Time
Transitioning from a research fellowship to your first job, you will be negotiating for protected research time. A typical junior faculty position might involve 70% research time and 30% clinical time, says Dr. Arora, who cautions candidates to clarify how the 30% clinical time will be structured. “In a hospitalist group, 30% clinical time can look quite different and have varying amounts of nights and undesirable shifts.” It is appropriate, she noted, to ask this question, because this may have implications for your research time.
Candidates also need clarity from prospective institutions about funding expectations. Be prepared to secure your own funding as soon as possible. “You need to always look ahead,” says Dr. Arora, who suggests that young investigators view their first job as a “mini-grant” and use their time during that period to develop other funding sources, such as the NIH K, or career development, awards. —GH
References
- Leykum LK, Parekh VI, Sharpe B, Boonyasai RT, Centor RM. Tried and true: a survey of successfully promoted academic hospitalists. J Hosp Med. 2011;6(7):411-415.
- McKenna K, Leykum LK, McDaniel RR. The role of improvising in patient care. Health Care Manage Rev. 2013;38(1):1-8.
- Arora VM, Fish M, Basu A, et al. Relationship between quality of care of hospitalized vulnerable elders and postdischarge mortality. J Am Geriatr Soc. 2010;58(9):1642-1648.
- Arora VM, Georgitis E, Siddique J, et al. Association of workload of on-call medical interns with on-call sleep duration, shift duration, and participation in educational activities. JAMA. 2008;300(10):1146-1153.
- Fang MC, Go AS, Chang Y, et al. A new risk scheme to predict warfarin-associated hemorrhage: the ATRIA (Anticoagulation and Risk Factors in Atrial Fibrillation) Study. J Am Coll Cardiol. 2011;58(4): 395-401.
- Mission JF, Kerlan RK, Tan JH, Fang MC. Rates and predictors of plans for inferior vena cava filter retrieval in hospitalized patients. J Gen Intern Med. 2010;25(4):321-325.
Are you attracted to research but not sure if it’s your sole calling as a prospective hospitalist? Whether you think you might want to steer quality improvement (QI) studies in the community setting or veer toward an academic/research career, hospital medicine offers an array of paths to career satisfaction.
“There is so much room in hospital medicine to find your research niche,” says Luci K. Leykum, MD, MBA, MSc, SFHM, hospital medicine division chief and associate dean for clinical affairs at University of Texas Health Science Center in San Antonio. As chair of SHM’s Research Committee, Dr. Leykum can attest to the range of hospitalists’ research pursuits: from basic science (what biomarkers best predict poor outcomes in patients with acute lung injury?) to care organization (are hospitalist schedules and workload associated with patient outcomes?) to implementation (how do we most effectively implement best practices for care transitions?) studies.1-6
In addition to Dr. Leykum, The Hospitalist consulted Vineet Arora, MD, MPP, FACP, SFHM, associate professor of medicine at the University of Chicago and chair of SHM’s Physicians in Training Committee, and Margaret Fang, MD, MPH, FHM, associate professor and clinician-investigator in the department of medicine at University of California San Francisco (UCSF) Medical Center and a member of the SHM Research Committee. Critical to research success, they agree, is acquiring skills in research methodology and project design, finding the right mentor(s) to help guide your career, and committing to and preserving time to focus on your research.
“After residency,” Dr. Arora notes, “you have accumulated the clinical skills to become a hospitalist, but you usually have not accumulated the skill it takes to be a researcher, which is why you need to do additional training.”
Is a Fellowship Necessary?
The paths to incorporating research into one’s HM career can be diverse. Although a fellowship is often the recommended route, there are other ways to acquire research methodology and experience with project design. Dr. Leykum began her career as a clinician-educator at Columbia University in New York. Although she found the QI work enjoyable, she realized she wanted to understand how to create more meaningful and sustainable changes in inpatient care delivery. She later acquired a master’s degree in clinical investigation. She has published more than 25 journal articles, several in collaboration with other SHM colleagues.
As a result, perhaps, of her own experience—and the fact that HM is still a young subspecialty with limited HM-specific fellowship opportunities—Dr. Leykum says that she would consider hiring a junior faculty member who had not yet completed a fellowship. “I think you have to consider people who might be talented candidates that you are willing to groom,” she says. However, she says she would structure the position so that the faculty member could immediately pursue additional research training.
–Dr. Fang
Dr. Fang completed a two-year, general medical research fellowship right after her residency and obtained her master of public health degree at that time. “I do agree,” she says, “that the fastest way to doing research well is to get some additional training.”
Even if you are not aiming to become a full-time investigator, Dr. Arora says a research fellowship “gives you very marketable skills. You will still gain skills that will be helpful to your career—and not all research is done by clinician investigators in academic settings.”
Another advantage of a fellowship, Dr. Arora says, is that it allows you to explore whether you are truly suited for a research career. All three hospitalists agreed that researchers share many of the same abilities: to focus, accept uncertainty, persevere, work in teams, and handle rejection.
The Right Mentorship
Dr. Fang says working with an experienced mentor is a vital ingredient to launching a research career. One key factor in selecting a fellowship program, according to Dr. Leykum, is the institution’s or group’s track record in developing junior faculty. To gain an understanding of how the partnership would work on a practical level, the candidate should ask specific questions of prospective mentors, such as:
- How well do research interests and methodological expertise match?
- How often would we meet?
- Who would be involved in the mentorship team?
- What would each person contribute?
In hospital medicine, it could be challenging to find a mentor within one’s own division. Dr. Fang points out that there are a variety of other ways to obtain career, academic, and research mentorship: For example, SHM’s Research Committee has a fledgling mentoring program, and the Society of General Internal Medicine offers both one-on-one and longitudinal year-long mentoring. “You can also look to other specialty divisions that are complementary,” she suggests. If you’re interested in antimicrobial stewardship, for example, your institution’s division of infectious disease might be a logical choice for your mentorship and collaboration search.
Balance Clinical, Research Time
Although securing protected research time concerns trainees as well as academic faculty (see “Protect, Make the Most of Your Time,”), deleting clinical time from the equation is not the answer.
“I find, from being a researcher,” says Dr. Arora, “that sometimes you need a break from research. And clinical work can provide that break. Whatever you do, you need a balance.”
Dr. Leykum says she learned, about five years ago, that 10 weeks of clinical rotation was too little. By choice, she elects to put in more clinical time. Why? “Being in that [clinical] environment helps you hone your questions, especially if they concern how to better deliver care,” she says. “In addition, you interact with specialists and learn about the new research that they are implementing.”
The cross-feed between clinical and research pursuits can be particularly rich, Dr. Fang says. In addition to her other posts at UCSF, she is medical director of the anticoagulation clinic.
“I find a lot of my research ideas flow very naturally out of the situations I see as a hospitalist,” she says. “You often see something that you want to improve and design a project to try and achieve those aims.”
Gretchen Henkel is a freelance writer in southern California.
Protect, Make the Most of Your Time
Transitioning from a research fellowship to your first job, you will be negotiating for protected research time. A typical junior faculty position might involve 70% research time and 30% clinical time, says Dr. Arora, who cautions candidates to clarify how the 30% clinical time will be structured. “In a hospitalist group, 30% clinical time can look quite different and have varying amounts of nights and undesirable shifts.” It is appropriate, she noted, to ask this question, because this may have implications for your research time.
Candidates also need clarity from prospective institutions about funding expectations. Be prepared to secure your own funding as soon as possible. “You need to always look ahead,” says Dr. Arora, who suggests that young investigators view their first job as a “mini-grant” and use their time during that period to develop other funding sources, such as the NIH K, or career development, awards. —GH
References
- Leykum LK, Parekh VI, Sharpe B, Boonyasai RT, Centor RM. Tried and true: a survey of successfully promoted academic hospitalists. J Hosp Med. 2011;6(7):411-415.
- McKenna K, Leykum LK, McDaniel RR. The role of improvising in patient care. Health Care Manage Rev. 2013;38(1):1-8.
- Arora VM, Fish M, Basu A, et al. Relationship between quality of care of hospitalized vulnerable elders and postdischarge mortality. J Am Geriatr Soc. 2010;58(9):1642-1648.
- Arora VM, Georgitis E, Siddique J, et al. Association of workload of on-call medical interns with on-call sleep duration, shift duration, and participation in educational activities. JAMA. 2008;300(10):1146-1153.
- Fang MC, Go AS, Chang Y, et al. A new risk scheme to predict warfarin-associated hemorrhage: the ATRIA (Anticoagulation and Risk Factors in Atrial Fibrillation) Study. J Am Coll Cardiol. 2011;58(4): 395-401.
- Mission JF, Kerlan RK, Tan JH, Fang MC. Rates and predictors of plans for inferior vena cava filter retrieval in hospitalized patients. J Gen Intern Med. 2010;25(4):321-325.
Hospital Medicine Blends Academic and Clinical Pursuits to Create Optimal Career Path
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Veterans Affairs National Quality Scholars Fellowship Program Offers Hospitalists Training Opportunity
As he was completing his residency in 1998, hospitalist Peter J. Kaboli, MD, MS, was undecided about his career direction. He didn’t know whether he wanted a clinical job in which he could pursue “quality improvement projects or a job focused on research.”
He entered the Veterans Affairs (VA) National Quality Scholars Fellowship Program, first offered in 1999, and found that he actually enjoyed both pursuits. As co-director of the Center for Comprehensive Access and Delivery Research and Evaluation (CADRE) for the VA Iowa City Health Care System, Dr. Kaboli has continued to pursue his interest in clinical research, exploring such issues as quality indicators to guide prescription of medicines for older adults and regional differences in prescribing quality among older veterans.1,2 He credits his time as a fellow as a definitive period in his career growth.
Dr. Kaboli, who now directs the VAQS Fellowship Program at the Iowa City VAMC, suggests that young hospitalists seeking to focus career directions consider a similar path. In fact, Dr. Kaboli and colleague Greg Ogrinc, MD, MS, senior scholar and director of the VA Quality Scholars (VAQS) Fellowship Program at the White River Junction VA in Vermont, say the VA healthcare system offers several avenues for hospitalists to hone their clinical, research, quality improvement, and leadership skills.
Research Paths
A nearly 15-year history with electronic health records (EHR) and a large population of enrolled beneficiaries make the VA system a rich source of data for understanding systems and improving care, Dr. Ogrinc says.
The VAQS Fellowship Program, offered at eight VA centers nationally, is a 2-year interdisciplinary program that pairs physicians and doctorally prepared nurses. Several sites also provide master’s degree training at an affiliated university. The curriculum is designed to train physicians in new methods of improving the quality and safety of healthcare for veterans and the nation. All eight VAQS centers are affiliated with academic institutions. That’s the case with the program at White River Junction, where VAQS Senior Scholar Dr. Ogrinc also holds dual appointments with Geisel School of Medicine in Hanover, N.H. and The Dartmouth Institute for Health Policy and Clinical Practice in Lebanon, N.H.
Dr. Ogrinc has tracked the VA’s experience with the program since its inception. One summary, published in 2009, notes that one of the strengths of the program is its combination of healthcare improvement curricula with adult learning strategies.3 This, along with mentorship and meaningful projects, serves to prepare physicians to lead improvement initiatives in healthcare quality and safety.
At White River Junction, graduates of the fellowship program follow a wide range of career paths. Dr. Ogrinc says roughly 50% choose to remain with the VA. Wherever fellows land after the program, both Dr. Kaboli and Dr. Ogrinc agree that the two-year delay before going into practice is a worthwhile investment. “The upfront investment in time pays back in the long run,” Dr. Kaboli says.
Additional fellowships offered through the VA include Career Development Awards (akin to the National Institutes of Health career development K awards), often located at VA medical centers designated as Centers of Innovation. They supply research infrastructure and access to data. Some of the centers offering VAQS and patient safety fellowships are co-located with Veterans Engineering Resource Centers, so that cross-fertilization with experts in organizational engineering makes for an additional “rich learning environment,” notes Dr. Ogrinc.
Clinical Path
Like all U.S. healthcare systems, the VA is expanding its use of hospitalists.
“There are great opportunities for hospitalists in the VA as salaried physicians, with very reasonable work hours and an excellent electronic medical record,” Dr. Kaboli says.
Dr. Ogrinc points out that residency programs do not always prepare hospitalists for the administrative, system improvement, and organizational responsibilities that often fall under hospitalist purview. “Committee and improvement work can often be seen as bothersome by some,” he says, “especially if they don’t have the opportunity to learn the skills and methods to make their organizations work better from a patient outcome standpoint.”
In addition, either experiencing a fellowship program or simply working in a salaried position with the VA “can round out your skill set, make you a better hospitalist overall, and put you in a position to be a leader as a hospitalist in a practice,” Dr. Ogrinc says.
Dr. Kaboli agrees.
“The future of healthcare reform in this country is embracing the model of the accountable care organization,” he says. “The VA system, with capitated payment, salaried physicians, and comprehensive integrated care, is arguably the largest ACO [accountable care organization] in the country.”
Gretchen Henkel is a freelance writer in California.
Resources for VA Research Programs
Eight VA medical centers participate in the National Quality Scholars Fellowship Program: Greater Los Angeles, Atlanta, Birmingham, Cleveland, Iowa City, Nashville, San Francisco, and White River Junction. For more information on application requirements and deadlines, visit www.va.gov and search “National Quality Scholars Fellowship Program.”
There are three levels of Career Development Awards offered through the VA Office of Research and Development, including biomedical laboratory/clinical sciences and health services. For more information on award categories and submission deadlines, visit www.research.va.gov/funding.
The New England Veterans Engineering Resource Center (www.newengland.va.gov/verc) provides examples of the variety of systems engineering research projects being undertaken by the VA. —Gretchen Henkel
References
- Lund BC, Steinman MA, Chrischilles EA, Kaboli PJ. Beers criteria as a proxy for inappropriate prescribing of other medications among older adults. Ann Pharmacother. 2011;45:1363-1370.
- Lund BC, Charlton ME, Steinman MA, Kaboli PJ. Regional differences in prescribing quality among elder veterans and the impact of rural residence. J Rural Health. 2013;29:172-179.
- Splaine ME, Ogrinc G, Gilman SC, et al. The Department of Veterans Affairs National Quality Scholars Fellowship Program: experience from 10 year of training quality scholars. Acad Med. 2009;84:1741-1748.
As he was completing his residency in 1998, hospitalist Peter J. Kaboli, MD, MS, was undecided about his career direction. He didn’t know whether he wanted a clinical job in which he could pursue “quality improvement projects or a job focused on research.”
He entered the Veterans Affairs (VA) National Quality Scholars Fellowship Program, first offered in 1999, and found that he actually enjoyed both pursuits. As co-director of the Center for Comprehensive Access and Delivery Research and Evaluation (CADRE) for the VA Iowa City Health Care System, Dr. Kaboli has continued to pursue his interest in clinical research, exploring such issues as quality indicators to guide prescription of medicines for older adults and regional differences in prescribing quality among older veterans.1,2 He credits his time as a fellow as a definitive period in his career growth.
Dr. Kaboli, who now directs the VAQS Fellowship Program at the Iowa City VAMC, suggests that young hospitalists seeking to focus career directions consider a similar path. In fact, Dr. Kaboli and colleague Greg Ogrinc, MD, MS, senior scholar and director of the VA Quality Scholars (VAQS) Fellowship Program at the White River Junction VA in Vermont, say the VA healthcare system offers several avenues for hospitalists to hone their clinical, research, quality improvement, and leadership skills.
Research Paths
A nearly 15-year history with electronic health records (EHR) and a large population of enrolled beneficiaries make the VA system a rich source of data for understanding systems and improving care, Dr. Ogrinc says.
The VAQS Fellowship Program, offered at eight VA centers nationally, is a 2-year interdisciplinary program that pairs physicians and doctorally prepared nurses. Several sites also provide master’s degree training at an affiliated university. The curriculum is designed to train physicians in new methods of improving the quality and safety of healthcare for veterans and the nation. All eight VAQS centers are affiliated with academic institutions. That’s the case with the program at White River Junction, where VAQS Senior Scholar Dr. Ogrinc also holds dual appointments with Geisel School of Medicine in Hanover, N.H. and The Dartmouth Institute for Health Policy and Clinical Practice in Lebanon, N.H.
Dr. Ogrinc has tracked the VA’s experience with the program since its inception. One summary, published in 2009, notes that one of the strengths of the program is its combination of healthcare improvement curricula with adult learning strategies.3 This, along with mentorship and meaningful projects, serves to prepare physicians to lead improvement initiatives in healthcare quality and safety.
At White River Junction, graduates of the fellowship program follow a wide range of career paths. Dr. Ogrinc says roughly 50% choose to remain with the VA. Wherever fellows land after the program, both Dr. Kaboli and Dr. Ogrinc agree that the two-year delay before going into practice is a worthwhile investment. “The upfront investment in time pays back in the long run,” Dr. Kaboli says.
Additional fellowships offered through the VA include Career Development Awards (akin to the National Institutes of Health career development K awards), often located at VA medical centers designated as Centers of Innovation. They supply research infrastructure and access to data. Some of the centers offering VAQS and patient safety fellowships are co-located with Veterans Engineering Resource Centers, so that cross-fertilization with experts in organizational engineering makes for an additional “rich learning environment,” notes Dr. Ogrinc.
Clinical Path
Like all U.S. healthcare systems, the VA is expanding its use of hospitalists.
“There are great opportunities for hospitalists in the VA as salaried physicians, with very reasonable work hours and an excellent electronic medical record,” Dr. Kaboli says.
Dr. Ogrinc points out that residency programs do not always prepare hospitalists for the administrative, system improvement, and organizational responsibilities that often fall under hospitalist purview. “Committee and improvement work can often be seen as bothersome by some,” he says, “especially if they don’t have the opportunity to learn the skills and methods to make their organizations work better from a patient outcome standpoint.”
In addition, either experiencing a fellowship program or simply working in a salaried position with the VA “can round out your skill set, make you a better hospitalist overall, and put you in a position to be a leader as a hospitalist in a practice,” Dr. Ogrinc says.
Dr. Kaboli agrees.
“The future of healthcare reform in this country is embracing the model of the accountable care organization,” he says. “The VA system, with capitated payment, salaried physicians, and comprehensive integrated care, is arguably the largest ACO [accountable care organization] in the country.”
Gretchen Henkel is a freelance writer in California.
Resources for VA Research Programs
Eight VA medical centers participate in the National Quality Scholars Fellowship Program: Greater Los Angeles, Atlanta, Birmingham, Cleveland, Iowa City, Nashville, San Francisco, and White River Junction. For more information on application requirements and deadlines, visit www.va.gov and search “National Quality Scholars Fellowship Program.”
There are three levels of Career Development Awards offered through the VA Office of Research and Development, including biomedical laboratory/clinical sciences and health services. For more information on award categories and submission deadlines, visit www.research.va.gov/funding.
The New England Veterans Engineering Resource Center (www.newengland.va.gov/verc) provides examples of the variety of systems engineering research projects being undertaken by the VA. —Gretchen Henkel
References
- Lund BC, Steinman MA, Chrischilles EA, Kaboli PJ. Beers criteria as a proxy for inappropriate prescribing of other medications among older adults. Ann Pharmacother. 2011;45:1363-1370.
- Lund BC, Charlton ME, Steinman MA, Kaboli PJ. Regional differences in prescribing quality among elder veterans and the impact of rural residence. J Rural Health. 2013;29:172-179.
- Splaine ME, Ogrinc G, Gilman SC, et al. The Department of Veterans Affairs National Quality Scholars Fellowship Program: experience from 10 year of training quality scholars. Acad Med. 2009;84:1741-1748.
As he was completing his residency in 1998, hospitalist Peter J. Kaboli, MD, MS, was undecided about his career direction. He didn’t know whether he wanted a clinical job in which he could pursue “quality improvement projects or a job focused on research.”
He entered the Veterans Affairs (VA) National Quality Scholars Fellowship Program, first offered in 1999, and found that he actually enjoyed both pursuits. As co-director of the Center for Comprehensive Access and Delivery Research and Evaluation (CADRE) for the VA Iowa City Health Care System, Dr. Kaboli has continued to pursue his interest in clinical research, exploring such issues as quality indicators to guide prescription of medicines for older adults and regional differences in prescribing quality among older veterans.1,2 He credits his time as a fellow as a definitive period in his career growth.
Dr. Kaboli, who now directs the VAQS Fellowship Program at the Iowa City VAMC, suggests that young hospitalists seeking to focus career directions consider a similar path. In fact, Dr. Kaboli and colleague Greg Ogrinc, MD, MS, senior scholar and director of the VA Quality Scholars (VAQS) Fellowship Program at the White River Junction VA in Vermont, say the VA healthcare system offers several avenues for hospitalists to hone their clinical, research, quality improvement, and leadership skills.
Research Paths
A nearly 15-year history with electronic health records (EHR) and a large population of enrolled beneficiaries make the VA system a rich source of data for understanding systems and improving care, Dr. Ogrinc says.
The VAQS Fellowship Program, offered at eight VA centers nationally, is a 2-year interdisciplinary program that pairs physicians and doctorally prepared nurses. Several sites also provide master’s degree training at an affiliated university. The curriculum is designed to train physicians in new methods of improving the quality and safety of healthcare for veterans and the nation. All eight VAQS centers are affiliated with academic institutions. That’s the case with the program at White River Junction, where VAQS Senior Scholar Dr. Ogrinc also holds dual appointments with Geisel School of Medicine in Hanover, N.H. and The Dartmouth Institute for Health Policy and Clinical Practice in Lebanon, N.H.
Dr. Ogrinc has tracked the VA’s experience with the program since its inception. One summary, published in 2009, notes that one of the strengths of the program is its combination of healthcare improvement curricula with adult learning strategies.3 This, along with mentorship and meaningful projects, serves to prepare physicians to lead improvement initiatives in healthcare quality and safety.
At White River Junction, graduates of the fellowship program follow a wide range of career paths. Dr. Ogrinc says roughly 50% choose to remain with the VA. Wherever fellows land after the program, both Dr. Kaboli and Dr. Ogrinc agree that the two-year delay before going into practice is a worthwhile investment. “The upfront investment in time pays back in the long run,” Dr. Kaboli says.
Additional fellowships offered through the VA include Career Development Awards (akin to the National Institutes of Health career development K awards), often located at VA medical centers designated as Centers of Innovation. They supply research infrastructure and access to data. Some of the centers offering VAQS and patient safety fellowships are co-located with Veterans Engineering Resource Centers, so that cross-fertilization with experts in organizational engineering makes for an additional “rich learning environment,” notes Dr. Ogrinc.
Clinical Path
Like all U.S. healthcare systems, the VA is expanding its use of hospitalists.
“There are great opportunities for hospitalists in the VA as salaried physicians, with very reasonable work hours and an excellent electronic medical record,” Dr. Kaboli says.
Dr. Ogrinc points out that residency programs do not always prepare hospitalists for the administrative, system improvement, and organizational responsibilities that often fall under hospitalist purview. “Committee and improvement work can often be seen as bothersome by some,” he says, “especially if they don’t have the opportunity to learn the skills and methods to make their organizations work better from a patient outcome standpoint.”
In addition, either experiencing a fellowship program or simply working in a salaried position with the VA “can round out your skill set, make you a better hospitalist overall, and put you in a position to be a leader as a hospitalist in a practice,” Dr. Ogrinc says.
Dr. Kaboli agrees.
“The future of healthcare reform in this country is embracing the model of the accountable care organization,” he says. “The VA system, with capitated payment, salaried physicians, and comprehensive integrated care, is arguably the largest ACO [accountable care organization] in the country.”
Gretchen Henkel is a freelance writer in California.
Resources for VA Research Programs
Eight VA medical centers participate in the National Quality Scholars Fellowship Program: Greater Los Angeles, Atlanta, Birmingham, Cleveland, Iowa City, Nashville, San Francisco, and White River Junction. For more information on application requirements and deadlines, visit www.va.gov and search “National Quality Scholars Fellowship Program.”
There are three levels of Career Development Awards offered through the VA Office of Research and Development, including biomedical laboratory/clinical sciences and health services. For more information on award categories and submission deadlines, visit www.research.va.gov/funding.
The New England Veterans Engineering Resource Center (www.newengland.va.gov/verc) provides examples of the variety of systems engineering research projects being undertaken by the VA. —Gretchen Henkel
References
- Lund BC, Steinman MA, Chrischilles EA, Kaboli PJ. Beers criteria as a proxy for inappropriate prescribing of other medications among older adults. Ann Pharmacother. 2011;45:1363-1370.
- Lund BC, Charlton ME, Steinman MA, Kaboli PJ. Regional differences in prescribing quality among elder veterans and the impact of rural residence. J Rural Health. 2013;29:172-179.
- Splaine ME, Ogrinc G, Gilman SC, et al. The Department of Veterans Affairs National Quality Scholars Fellowship Program: experience from 10 year of training quality scholars. Acad Med. 2009;84:1741-1748.