Jason Carris

Listen to the complete interview with Dr. Bowman here

Listen to the complete interview with Dr. Bowman here

Listen to the complete interview with Dr. Bowman here

When William D. Atchley Jr., MD, FACP, SFHM, left private practice for hospital medicine in 1995, he didn’t realize he was helping to make history. Dr. Atchley was practicing with an internal-medicine multispecialty group when a medical school withdrew its residency program from the community hospital next door. Soon after, physicians in the group began experiencing frequent disruptions in order to care for a handful of hospitalized patients.

Dr. Atchley and two colleagues, all of whom enjoyed the hospital setting, solved the problem by forming an inpatient rounding team at Sentara Leigh Hospital in Norfolk, Va. They believe it was the first hospitalist program in Virginia.

“When we first started doing this, we were looking at each other saying, ‘Is this something for the long run … or is it going to be something that is a flash in the pan?’ ” says Dr. Atchley, chief of the Division of Hospital Medicine at Sentara Medical Group, which operates hospitalist programs at five sites in southeastern Virginia. “If you had asked me to look into a crystal ball, I would not have projected hospital medicine would have grown so quickly. It truly is phenomenal, and it’s been an exciting ride. It was great to be on the ground floor of this, and it’s been nice to see how things have evolved.”

I’m thinking about what I want to be doing for the next 10 years. I’ll certainly continue to be actively engaged on a national level with SHM, because that’s my passion. ... I’m pausing and reflecting on what I’ve been doing, what my options are, and what I want to do for the remainder of the time before I retire.

Question: You studied biomedical engineering prior to medical school. Are there similarities between that field and HM?

Answer: Engineering teaches you how to approach problem-solving. That’s particularly helpful with some of the system issues we talk about, such as dealing with throughput or applications of electronic medical records and computerized physician order entry. It’s given me a good background to understand issues that come up regarding quality and patient safety, and trying to take a systemwide viewpoint about looking at how care is delivered.

Q: What’s the biggest change you’ve seen in HM over the past 16 years?

A: The job I had in 1995 is vastly different from the job I have now. At that time, it was all about taking care of internal-medicine adult patients. We’ve seen the evolution of surgical comanagement, and hospitalists have truly become leaders of change in terms of how care is being delivered in the hospital. Things like patient safety, quality, and learning to deal with the limited resources we have, in terms of the cost of healthcare, were not even on the radar screen 16 years ago.

Q: Why is it important for you to continue seeing patients?

A: To have validity with your fellow hospitalists who are working in the trenches. You can only appreciate what their day-to-day challenges are when you roll up your sleeves and you’re out there with them. I think it gives me “street cred” with them. I still understand the things that are great about the job, but at the same time, I see the things that are frustrating about the job.

Q: What is your biggest professional reward?

A: Being actively engaged in SHM. I served on its board of directors, and I’ve served as secretary and treasurer. I continue to be active in the society. I was honored to be elected as a senior fellow (SFHM) in the organization.

Q: What did it mean to you to be elected a senior fellow?

A: I’m very humbled and gracious to the organization. That’s been my greatest professional achievement.

Q: You also serve as a facilitator with SHM’s Leadership Academy. Why are you so passionate about that program?

A: It gives hospitalists the essential tools they need to be able to roll up their sleeves and start tackling problems at their hospitals. It’s a great opportunity for anybody who is thinking about running a group or taking a leading role in a healthcare system.

Q: What is your biggest professional challenge?

A: It’s learning to be able to lead the next generation of hospitalists, to get them to be as enthusiastic about practicing hospital medicine as I am.

Q: Why is that so challenging?

A: If you have ever practiced in a traditional general internal-medicine practice (office-based), and then you become a hospitalist, you don’t want to go back to office-based. It’s more difficult to generate that enthusiasm for what hospital medicine is all about to people who are just coming on.

Q: Have you found a strategy that works?

A: It’s much easier said than done. It’s really about getting them energized and getting them excited about what they’re doing. Part of that is explaining it’s about more than just the patient in front of them. The hospital really is their site of practice, and there are opportunities for them to advance. If they want to do research or if they want to be involved with quality or patient safety, the opportunities are unlimited.

Q: Do you encourage the next generation of hospitalists to seek out committee assignments, research, or other opportunities outside of clinical work?

A: It’s definitely something for them to embrace. What’s important is crafting a type of staffing or schedule model that allows them to do clinical work but at the same time have a protected time to do their committee work.

In the old model I grew up with, doctors basically did committee work before they started seeing patients or after they were finished. There needs to be time carved out so they can be focused on that and don’t have to do it on the fly. … That’s what makes things successful with hospital medicine. There are programs across the country that (protect physician time), and they serve as a model for what I think our profession should be.

Q: What’s next professionally?

A: Right now, I’m thinking about what I want to be doing for the next 10 years. Is it going back and just doing clinical work? Is it continuing to be the clinical chief, or is it being involved with other things systemwide? I’ll certainly continue to be actively engaged on a national level with SHM, because that’s my passion. But after being a hospitalist for 16 years, I’m pausing and reflecting on what I’ve been doing, what my options are, and what I want to do for the remainder of the time before I retire. TH

Mark Leiser is a freelance writer based in New Jersey.

When William D. Atchley Jr., MD, FACP, SFHM, left private practice for hospital medicine in 1995, he didn’t realize he was helping to make history. Dr. Atchley was practicing with an internal-medicine multispecialty group when a medical school withdrew its residency program from the community hospital next door. Soon after, physicians in the group began experiencing frequent disruptions in order to care for a handful of hospitalized patients.

Dr. Atchley and two colleagues, all of whom enjoyed the hospital setting, solved the problem by forming an inpatient rounding team at Sentara Leigh Hospital in Norfolk, Va. They believe it was the first hospitalist program in Virginia.

“When we first started doing this, we were looking at each other saying, ‘Is this something for the long run … or is it going to be something that is a flash in the pan?’ ” says Dr. Atchley, chief of the Division of Hospital Medicine at Sentara Medical Group, which operates hospitalist programs at five sites in southeastern Virginia. “If you had asked me to look into a crystal ball, I would not have projected hospital medicine would have grown so quickly. It truly is phenomenal, and it’s been an exciting ride. It was great to be on the ground floor of this, and it’s been nice to see how things have evolved.”

I’m thinking about what I want to be doing for the next 10 years. I’ll certainly continue to be actively engaged on a national level with SHM, because that’s my passion. ... I’m pausing and reflecting on what I’ve been doing, what my options are, and what I want to do for the remainder of the time before I retire.

Question: You studied biomedical engineering prior to medical school. Are there similarities between that field and HM?

Answer: Engineering teaches you how to approach problem-solving. That’s particularly helpful with some of the system issues we talk about, such as dealing with throughput or applications of electronic medical records and computerized physician order entry. It’s given me a good background to understand issues that come up regarding quality and patient safety, and trying to take a systemwide viewpoint about looking at how care is delivered.

Q: What’s the biggest change you’ve seen in HM over the past 16 years?

A: The job I had in 1995 is vastly different from the job I have now. At that time, it was all about taking care of internal-medicine adult patients. We’ve seen the evolution of surgical comanagement, and hospitalists have truly become leaders of change in terms of how care is being delivered in the hospital. Things like patient safety, quality, and learning to deal with the limited resources we have, in terms of the cost of healthcare, were not even on the radar screen 16 years ago.

Q: Why is it important for you to continue seeing patients?

A: To have validity with your fellow hospitalists who are working in the trenches. You can only appreciate what their day-to-day challenges are when you roll up your sleeves and you’re out there with them. I think it gives me “street cred” with them. I still understand the things that are great about the job, but at the same time, I see the things that are frustrating about the job.

Q: What is your biggest professional reward?

A: Being actively engaged in SHM. I served on its board of directors, and I’ve served as secretary and treasurer. I continue to be active in the society. I was honored to be elected as a senior fellow (SFHM) in the organization.

Q: What did it mean to you to be elected a senior fellow?

A: I’m very humbled and gracious to the organization. That’s been my greatest professional achievement.

Q: You also serve as a facilitator with SHM’s Leadership Academy. Why are you so passionate about that program?

A: It gives hospitalists the essential tools they need to be able to roll up their sleeves and start tackling problems at their hospitals. It’s a great opportunity for anybody who is thinking about running a group or taking a leading role in a healthcare system.

Q: What is your biggest professional challenge?

A: It’s learning to be able to lead the next generation of hospitalists, to get them to be as enthusiastic about practicing hospital medicine as I am.

Q: Why is that so challenging?

A: If you have ever practiced in a traditional general internal-medicine practice (office-based), and then you become a hospitalist, you don’t want to go back to office-based. It’s more difficult to generate that enthusiasm for what hospital medicine is all about to people who are just coming on.

Q: Have you found a strategy that works?

A: It’s much easier said than done. It’s really about getting them energized and getting them excited about what they’re doing. Part of that is explaining it’s about more than just the patient in front of them. The hospital really is their site of practice, and there are opportunities for them to advance. If they want to do research or if they want to be involved with quality or patient safety, the opportunities are unlimited.

Q: Do you encourage the next generation of hospitalists to seek out committee assignments, research, or other opportunities outside of clinical work?

A: It’s definitely something for them to embrace. What’s important is crafting a type of staffing or schedule model that allows them to do clinical work but at the same time have a protected time to do their committee work.

In the old model I grew up with, doctors basically did committee work before they started seeing patients or after they were finished. There needs to be time carved out so they can be focused on that and don’t have to do it on the fly. … That’s what makes things successful with hospital medicine. There are programs across the country that (protect physician time), and they serve as a model for what I think our profession should be.

Q: What’s next professionally?

A: Right now, I’m thinking about what I want to be doing for the next 10 years. Is it going back and just doing clinical work? Is it continuing to be the clinical chief, or is it being involved with other things systemwide? I’ll certainly continue to be actively engaged on a national level with SHM, because that’s my passion. But after being a hospitalist for 16 years, I’m pausing and reflecting on what I’ve been doing, what my options are, and what I want to do for the remainder of the time before I retire. TH

Mark Leiser is a freelance writer based in New Jersey.

When William D. Atchley Jr., MD, FACP, SFHM, left private practice for hospital medicine in 1995, he didn’t realize he was helping to make history. Dr. Atchley was practicing with an internal-medicine multispecialty group when a medical school withdrew its residency program from the community hospital next door. Soon after, physicians in the group began experiencing frequent disruptions in order to care for a handful of hospitalized patients.

Dr. Atchley and two colleagues, all of whom enjoyed the hospital setting, solved the problem by forming an inpatient rounding team at Sentara Leigh Hospital in Norfolk, Va. They believe it was the first hospitalist program in Virginia.

“When we first started doing this, we were looking at each other saying, ‘Is this something for the long run … or is it going to be something that is a flash in the pan?’ ” says Dr. Atchley, chief of the Division of Hospital Medicine at Sentara Medical Group, which operates hospitalist programs at five sites in southeastern Virginia. “If you had asked me to look into a crystal ball, I would not have projected hospital medicine would have grown so quickly. It truly is phenomenal, and it’s been an exciting ride. It was great to be on the ground floor of this, and it’s been nice to see how things have evolved.”

I’m thinking about what I want to be doing for the next 10 years. I’ll certainly continue to be actively engaged on a national level with SHM, because that’s my passion. ... I’m pausing and reflecting on what I’ve been doing, what my options are, and what I want to do for the remainder of the time before I retire.

Question: You studied biomedical engineering prior to medical school. Are there similarities between that field and HM?

Answer: Engineering teaches you how to approach problem-solving. That’s particularly helpful with some of the system issues we talk about, such as dealing with throughput or applications of electronic medical records and computerized physician order entry. It’s given me a good background to understand issues that come up regarding quality and patient safety, and trying to take a systemwide viewpoint about looking at how care is delivered.

Q: What’s the biggest change you’ve seen in HM over the past 16 years?

A: The job I had in 1995 is vastly different from the job I have now. At that time, it was all about taking care of internal-medicine adult patients. We’ve seen the evolution of surgical comanagement, and hospitalists have truly become leaders of change in terms of how care is being delivered in the hospital. Things like patient safety, quality, and learning to deal with the limited resources we have, in terms of the cost of healthcare, were not even on the radar screen 16 years ago.

Q: Why is it important for you to continue seeing patients?

A: To have validity with your fellow hospitalists who are working in the trenches. You can only appreciate what their day-to-day challenges are when you roll up your sleeves and you’re out there with them. I think it gives me “street cred” with them. I still understand the things that are great about the job, but at the same time, I see the things that are frustrating about the job.

Q: What is your biggest professional reward?

A: Being actively engaged in SHM. I served on its board of directors, and I’ve served as secretary and treasurer. I continue to be active in the society. I was honored to be elected as a senior fellow (SFHM) in the organization.

Q: What did it mean to you to be elected a senior fellow?

A: I’m very humbled and gracious to the organization. That’s been my greatest professional achievement.

Q: You also serve as a facilitator with SHM’s Leadership Academy. Why are you so passionate about that program?

A: It gives hospitalists the essential tools they need to be able to roll up their sleeves and start tackling problems at their hospitals. It’s a great opportunity for anybody who is thinking about running a group or taking a leading role in a healthcare system.

Q: What is your biggest professional challenge?

A: It’s learning to be able to lead the next generation of hospitalists, to get them to be as enthusiastic about practicing hospital medicine as I am.

Q: Why is that so challenging?

A: If you have ever practiced in a traditional general internal-medicine practice (office-based), and then you become a hospitalist, you don’t want to go back to office-based. It’s more difficult to generate that enthusiasm for what hospital medicine is all about to people who are just coming on.

Q: Have you found a strategy that works?

A: It’s much easier said than done. It’s really about getting them energized and getting them excited about what they’re doing. Part of that is explaining it’s about more than just the patient in front of them. The hospital really is their site of practice, and there are opportunities for them to advance. If they want to do research or if they want to be involved with quality or patient safety, the opportunities are unlimited.

Q: Do you encourage the next generation of hospitalists to seek out committee assignments, research, or other opportunities outside of clinical work?

A: It’s definitely something for them to embrace. What’s important is crafting a type of staffing or schedule model that allows them to do clinical work but at the same time have a protected time to do their committee work.

In the old model I grew up with, doctors basically did committee work before they started seeing patients or after they were finished. There needs to be time carved out so they can be focused on that and don’t have to do it on the fly. … That’s what makes things successful with hospital medicine. There are programs across the country that (protect physician time), and they serve as a model for what I think our profession should be.

Q: What’s next professionally?

A: Right now, I’m thinking about what I want to be doing for the next 10 years. Is it going back and just doing clinical work? Is it continuing to be the clinical chief, or is it being involved with other things systemwide? I’ll certainly continue to be actively engaged on a national level with SHM, because that’s my passion. But after being a hospitalist for 16 years, I’m pausing and reflecting on what I’ve been doing, what my options are, and what I want to do for the remainder of the time before I retire. TH

Mark Leiser is a freelance writer based in New Jersey.

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Even though she'd completed the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) in 2009, Melinda Johnson, MD, was excited to learn about the ABIM's new Focused Practice in Hospital Medicine (FPHM) pathway in 2010. So pleased was Dr. Johnson that she immediately signed up for the program and joined 141 others taking the first FPHM exam in October.

Now Dr. Johnson, an associate professor of internal medicine at the University of Iowa Hospitals and Clinics in Iowa City, is among 67 hospitalists in the first class of FPHMs. They not only passed the exam, but also fulfilled all of the MOC requirements (attestation, education modules, and practice-improvement modules).

"I'm really excited about it," says Dr. Johnson, who has been a hospitalist since 2007. "It really helps me to feel like I'm defining myself and helping to define our new, young group."

Dr. Johnson says passing the secure exam, which differs slightly from the internal-medicine exam, places her at what she calls the "forefront of the hospitalist movement."

"I find exams very helpful from the standpoint that they give me a good reason to study," she says. "It's important to me to be as up-to-date and as good at what I do as possible. We have residents with us all the time, medical students, and I really want to do this right."

Unlike the traditional recertification pathway, FPHM diplomates are required to complete the practice-improvement modules, or PIMs, every three years. Dr. Johnson completed the ABIM's teammate assessment PIM, which is designed to help hospitalists assess and improve how they work with other professionals and care for patients.

"It was marvelous," she says. "You send out surveys to the people from your interdisciplinary team, and you could only have one or so physicians. The rest were social workers, physical therapists, nurses—you name it. Since inpatient [care] is so much a team sport, if you will, I was really glad I could take part in that."

ABIM recently approved two SHM initiatives, Project BOOST and the VTE Prevention Collaborative, for MOC credit. Hospitalists can receive 20 practice-improvement points toward their MOC.

The next FPHM exam is in April. Registration for the fall exam opens May 1.

Even though she'd completed the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) in 2009, Melinda Johnson, MD, was excited to learn about the ABIM's new Focused Practice in Hospital Medicine (FPHM) pathway in 2010. So pleased was Dr. Johnson that she immediately signed up for the program and joined 141 others taking the first FPHM exam in October.

Now Dr. Johnson, an associate professor of internal medicine at the University of Iowa Hospitals and Clinics in Iowa City, is among 67 hospitalists in the first class of FPHMs. They not only passed the exam, but also fulfilled all of the MOC requirements (attestation, education modules, and practice-improvement modules).

"I'm really excited about it," says Dr. Johnson, who has been a hospitalist since 2007. "It really helps me to feel like I'm defining myself and helping to define our new, young group."

Dr. Johnson says passing the secure exam, which differs slightly from the internal-medicine exam, places her at what she calls the "forefront of the hospitalist movement."

"I find exams very helpful from the standpoint that they give me a good reason to study," she says. "It's important to me to be as up-to-date and as good at what I do as possible. We have residents with us all the time, medical students, and I really want to do this right."

Unlike the traditional recertification pathway, FPHM diplomates are required to complete the practice-improvement modules, or PIMs, every three years. Dr. Johnson completed the ABIM's teammate assessment PIM, which is designed to help hospitalists assess and improve how they work with other professionals and care for patients.

"It was marvelous," she says. "You send out surveys to the people from your interdisciplinary team, and you could only have one or so physicians. The rest were social workers, physical therapists, nurses—you name it. Since inpatient [care] is so much a team sport, if you will, I was really glad I could take part in that."

ABIM recently approved two SHM initiatives, Project BOOST and the VTE Prevention Collaborative, for MOC credit. Hospitalists can receive 20 practice-improvement points toward their MOC.

The next FPHM exam is in April. Registration for the fall exam opens May 1.

Even though she'd completed the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) in 2009, Melinda Johnson, MD, was excited to learn about the ABIM's new Focused Practice in Hospital Medicine (FPHM) pathway in 2010. So pleased was Dr. Johnson that she immediately signed up for the program and joined 141 others taking the first FPHM exam in October.

Now Dr. Johnson, an associate professor of internal medicine at the University of Iowa Hospitals and Clinics in Iowa City, is among 67 hospitalists in the first class of FPHMs. They not only passed the exam, but also fulfilled all of the MOC requirements (attestation, education modules, and practice-improvement modules).

"I'm really excited about it," says Dr. Johnson, who has been a hospitalist since 2007. "It really helps me to feel like I'm defining myself and helping to define our new, young group."

Dr. Johnson says passing the secure exam, which differs slightly from the internal-medicine exam, places her at what she calls the "forefront of the hospitalist movement."

"I find exams very helpful from the standpoint that they give me a good reason to study," she says. "It's important to me to be as up-to-date and as good at what I do as possible. We have residents with us all the time, medical students, and I really want to do this right."

Unlike the traditional recertification pathway, FPHM diplomates are required to complete the practice-improvement modules, or PIMs, every three years. Dr. Johnson completed the ABIM's teammate assessment PIM, which is designed to help hospitalists assess and improve how they work with other professionals and care for patients.

"It was marvelous," she says. "You send out surveys to the people from your interdisciplinary team, and you could only have one or so physicians. The rest were social workers, physical therapists, nurses—you name it. Since inpatient [care] is so much a team sport, if you will, I was really glad I could take part in that."

ABIM recently approved two SHM initiatives, Project BOOST and the VTE Prevention Collaborative, for MOC credit. Hospitalists can receive 20 practice-improvement points toward their MOC.

The next FPHM exam is in April. Registration for the fall exam opens May 1.

I was musing one morning about my day ahead. I was doing one of those subcortical activities of daily living in which the mind can wander freely. Have you ever jumped in the car with the intention of stopping at the store on the way home, only to find yourself pulling into your driveway after spending the drive contemplating those issues on your plate that day? You drive home on autopilot. It occurred to me that it can happen in much the same way in our daily practice of medicine—how easy it is to slip into autopilot when admitting patients and doing our daily rounds.

During this particular morning, I mulled over many things: the translocation between chromosomes 9 and 22 in CML, the obstructive PFTs one generally sees in cadmium exposure, debating whether to give corticosteroids or to induce delivery in a 33-week pregnant woman with HELLP syndrome. Maybe you’re wondering: Am I a physician practicing in a remote rural area that has no access to oncologists? Do I practice in an underserved industrial town next to an old battery factory? Or am I an old-fashioned GP who still delivers babies?

No, no, and no. I am a board-certified internist who was preparing for my Maintenance of Certification (MOC) examination.

A New Way of Thinking

I am 42 years old, I have a busy medical practice, I am the medical director of the 14-person HM group at Wentworth-Douglass Hospital in Dover, N.H., and I am the mother of two children, ages 9 and 11. And I found myself, on top of all these things, a student, too.

I’ve been practicing medicine for 11 years. I’ve gone from practicing primary care in a small community in Maine to working at a larger community medical center in New Hampshire, becoming a hospitalist in 2005, then taking on the job of director of my hospitalist group in 2006. With more than a decade of experience under my belt, I felt I had the depth of knowledge experience brings.

However, as I traveled through the process of preparing for the American Board of Internal Medicine’s (ABIM’s) new Focused Practice in Hospital Medicine (FPHM) secure exam, it began to dawn on me: Medicine is a complicated profession that not only requires careful attention to the details of every case, it also demands it. In order to avoid the pitfall of practicing distracted medicine, we must carefully foster our own continuing education.

Going through the studying process has enabled me to think about the medicine I practice in a much more academic way. True, I don’t necessarily need to know some of the things I’ve encountered in my study sessions for my everyday practice, but I find myself spouting off random facts to anyone who will listen—colleagues, nurses, even patients. “Did you know that only about one-fourth of crystalloid remains in the intravascular space, where the rest goes into the tissues?” “If the triglycerides in this fluid are greater than 115, this is a chylothorax!” I’m paying attention again to the theory and pathophysiology behind medical illnesses, not just to the drudgery of writing routine orders or checking off boxes on a protocol.

It has not been easy. Although I’ve known I needed to recertify in internal medicine since I took the exam the first time, I did not actively start looking into the exam and preparing until about a year and a half before my exam, when I talked to a colleague who had already started preparing. That’s when I learned that this was not only an exam, but also a process. This process is intended by the board to be an active part of maintaining certification during the 10 years before it is due again, not just to be crammed into the last year or two before certification expires. I recommend to anyone going through this process to familiarize yourself with the ABIM website (www.abim.org). Initially, it was a little unwieldy to maneuver around the site, and it wasn’t entirely clear to me what exactly was needed to recertify until I spent some time maneuvering through the site.

HM-Focused Pathway

To add to this, at around the time I was getting ready to register for the exam, it was announced that this would be the first year ABIM would be offering the FPHM pathway, which is designed to recognize those of us who concentrate our practices on hospital medicine. This to me was an excellent opportunity to recertify in a field in which I actively practice, hopefully making the exam more applicable to what I do, but the flip side was that no one would have taken this particular exam before. Admittedly, when I first signed up, I felt like I was either a guinea pig or a pioneer.

To obtain the FPHM, one must do not one but two projects requiring turning in data on process-improvement projects. Hospitalists who intend to certify with the FPHM will be well served by participating in safety, quality, and process-improvement projects, as we often already do. These projects can be used to complete the required Practice Improvement Modules.

Furthermore, I found that doing such projects is the best way to prepare for the new content, which deals specifically with HM on the actual exam. The internal-medicine topics were covered, just as they are in the nonfocused exam, and anyone who reviews for the exam with available study aids (e.g. review books, courses, or practice questions) will have adequate exposure to these topics.

However, a colleague in my HM group chose not to take the focused practice exam, largely because there was no previously established review material to use as study aids. I anticipate that future study aids will contain references to these questions, but for now I felt that material was adequately covered just by completing the Practice Improvement Modules and by being involved in process improvement projects at my hospital. In fact, attendance at one Institute for Healthcare Improvement (www.ihi.org/IHI/Programs) conference would probably cover the topics nicely.

To all of my colleages considering the MOC in FPHM exam, I wish you luck. I feel that any practicing hospitalist is likely to be able to satisfy the requirements of the FPHM pathway without doing too much more than they would in their daily practice or their usual exam preparation. I also found the ABIM staff useful and helpful, and recommend you use the “contact ABIM” link on their website with any questions.

Focused practice is exactly what we should be driving for. TH

Dr. Ammann is medical director of the hospital medicine division at Wentworth-Douglass Hospital in Dover, N.H.

I was musing one morning about my day ahead. I was doing one of those subcortical activities of daily living in which the mind can wander freely. Have you ever jumped in the car with the intention of stopping at the store on the way home, only to find yourself pulling into your driveway after spending the drive contemplating those issues on your plate that day? You drive home on autopilot. It occurred to me that it can happen in much the same way in our daily practice of medicine—how easy it is to slip into autopilot when admitting patients and doing our daily rounds.

During this particular morning, I mulled over many things: the translocation between chromosomes 9 and 22 in CML, the obstructive PFTs one generally sees in cadmium exposure, debating whether to give corticosteroids or to induce delivery in a 33-week pregnant woman with HELLP syndrome. Maybe you’re wondering: Am I a physician practicing in a remote rural area that has no access to oncologists? Do I practice in an underserved industrial town next to an old battery factory? Or am I an old-fashioned GP who still delivers babies?

No, no, and no. I am a board-certified internist who was preparing for my Maintenance of Certification (MOC) examination.

A New Way of Thinking

I am 42 years old, I have a busy medical practice, I am the medical director of the 14-person HM group at Wentworth-Douglass Hospital in Dover, N.H., and I am the mother of two children, ages 9 and 11. And I found myself, on top of all these things, a student, too.

I’ve been practicing medicine for 11 years. I’ve gone from practicing primary care in a small community in Maine to working at a larger community medical center in New Hampshire, becoming a hospitalist in 2005, then taking on the job of director of my hospitalist group in 2006. With more than a decade of experience under my belt, I felt I had the depth of knowledge experience brings.

However, as I traveled through the process of preparing for the American Board of Internal Medicine’s (ABIM’s) new Focused Practice in Hospital Medicine (FPHM) secure exam, it began to dawn on me: Medicine is a complicated profession that not only requires careful attention to the details of every case, it also demands it. In order to avoid the pitfall of practicing distracted medicine, we must carefully foster our own continuing education.

Going through the studying process has enabled me to think about the medicine I practice in a much more academic way. True, I don’t necessarily need to know some of the things I’ve encountered in my study sessions for my everyday practice, but I find myself spouting off random facts to anyone who will listen—colleagues, nurses, even patients. “Did you know that only about one-fourth of crystalloid remains in the intravascular space, where the rest goes into the tissues?” “If the triglycerides in this fluid are greater than 115, this is a chylothorax!” I’m paying attention again to the theory and pathophysiology behind medical illnesses, not just to the drudgery of writing routine orders or checking off boxes on a protocol.

It has not been easy. Although I’ve known I needed to recertify in internal medicine since I took the exam the first time, I did not actively start looking into the exam and preparing until about a year and a half before my exam, when I talked to a colleague who had already started preparing. That’s when I learned that this was not only an exam, but also a process. This process is intended by the board to be an active part of maintaining certification during the 10 years before it is due again, not just to be crammed into the last year or two before certification expires. I recommend to anyone going through this process to familiarize yourself with the ABIM website (www.abim.org). Initially, it was a little unwieldy to maneuver around the site, and it wasn’t entirely clear to me what exactly was needed to recertify until I spent some time maneuvering through the site.

HM-Focused Pathway

To add to this, at around the time I was getting ready to register for the exam, it was announced that this would be the first year ABIM would be offering the FPHM pathway, which is designed to recognize those of us who concentrate our practices on hospital medicine. This to me was an excellent opportunity to recertify in a field in which I actively practice, hopefully making the exam more applicable to what I do, but the flip side was that no one would have taken this particular exam before. Admittedly, when I first signed up, I felt like I was either a guinea pig or a pioneer.

To obtain the FPHM, one must do not one but two projects requiring turning in data on process-improvement projects. Hospitalists who intend to certify with the FPHM will be well served by participating in safety, quality, and process-improvement projects, as we often already do. These projects can be used to complete the required Practice Improvement Modules.

Furthermore, I found that doing such projects is the best way to prepare for the new content, which deals specifically with HM on the actual exam. The internal-medicine topics were covered, just as they are in the nonfocused exam, and anyone who reviews for the exam with available study aids (e.g. review books, courses, or practice questions) will have adequate exposure to these topics.

However, a colleague in my HM group chose not to take the focused practice exam, largely because there was no previously established review material to use as study aids. I anticipate that future study aids will contain references to these questions, but for now I felt that material was adequately covered just by completing the Practice Improvement Modules and by being involved in process improvement projects at my hospital. In fact, attendance at one Institute for Healthcare Improvement (www.ihi.org/IHI/Programs) conference would probably cover the topics nicely.

To all of my colleages considering the MOC in FPHM exam, I wish you luck. I feel that any practicing hospitalist is likely to be able to satisfy the requirements of the FPHM pathway without doing too much more than they would in their daily practice or their usual exam preparation. I also found the ABIM staff useful and helpful, and recommend you use the “contact ABIM” link on their website with any questions.

Focused practice is exactly what we should be driving for. TH

Dr. Ammann is medical director of the hospital medicine division at Wentworth-Douglass Hospital in Dover, N.H.

I was musing one morning about my day ahead. I was doing one of those subcortical activities of daily living in which the mind can wander freely. Have you ever jumped in the car with the intention of stopping at the store on the way home, only to find yourself pulling into your driveway after spending the drive contemplating those issues on your plate that day? You drive home on autopilot. It occurred to me that it can happen in much the same way in our daily practice of medicine—how easy it is to slip into autopilot when admitting patients and doing our daily rounds.

During this particular morning, I mulled over many things: the translocation between chromosomes 9 and 22 in CML, the obstructive PFTs one generally sees in cadmium exposure, debating whether to give corticosteroids or to induce delivery in a 33-week pregnant woman with HELLP syndrome. Maybe you’re wondering: Am I a physician practicing in a remote rural area that has no access to oncologists? Do I practice in an underserved industrial town next to an old battery factory? Or am I an old-fashioned GP who still delivers babies?

No, no, and no. I am a board-certified internist who was preparing for my Maintenance of Certification (MOC) examination.

A New Way of Thinking

I am 42 years old, I have a busy medical practice, I am the medical director of the 14-person HM group at Wentworth-Douglass Hospital in Dover, N.H., and I am the mother of two children, ages 9 and 11. And I found myself, on top of all these things, a student, too.

I’ve been practicing medicine for 11 years. I’ve gone from practicing primary care in a small community in Maine to working at a larger community medical center in New Hampshire, becoming a hospitalist in 2005, then taking on the job of director of my hospitalist group in 2006. With more than a decade of experience under my belt, I felt I had the depth of knowledge experience brings.

However, as I traveled through the process of preparing for the American Board of Internal Medicine’s (ABIM’s) new Focused Practice in Hospital Medicine (FPHM) secure exam, it began to dawn on me: Medicine is a complicated profession that not only requires careful attention to the details of every case, it also demands it. In order to avoid the pitfall of practicing distracted medicine, we must carefully foster our own continuing education.

Going through the studying process has enabled me to think about the medicine I practice in a much more academic way. True, I don’t necessarily need to know some of the things I’ve encountered in my study sessions for my everyday practice, but I find myself spouting off random facts to anyone who will listen—colleagues, nurses, even patients. “Did you know that only about one-fourth of crystalloid remains in the intravascular space, where the rest goes into the tissues?” “If the triglycerides in this fluid are greater than 115, this is a chylothorax!” I’m paying attention again to the theory and pathophysiology behind medical illnesses, not just to the drudgery of writing routine orders or checking off boxes on a protocol.

It has not been easy. Although I’ve known I needed to recertify in internal medicine since I took the exam the first time, I did not actively start looking into the exam and preparing until about a year and a half before my exam, when I talked to a colleague who had already started preparing. That’s when I learned that this was not only an exam, but also a process. This process is intended by the board to be an active part of maintaining certification during the 10 years before it is due again, not just to be crammed into the last year or two before certification expires. I recommend to anyone going through this process to familiarize yourself with the ABIM website (www.abim.org). Initially, it was a little unwieldy to maneuver around the site, and it wasn’t entirely clear to me what exactly was needed to recertify until I spent some time maneuvering through the site.

HM-Focused Pathway

To add to this, at around the time I was getting ready to register for the exam, it was announced that this would be the first year ABIM would be offering the FPHM pathway, which is designed to recognize those of us who concentrate our practices on hospital medicine. This to me was an excellent opportunity to recertify in a field in which I actively practice, hopefully making the exam more applicable to what I do, but the flip side was that no one would have taken this particular exam before. Admittedly, when I first signed up, I felt like I was either a guinea pig or a pioneer.

To obtain the FPHM, one must do not one but two projects requiring turning in data on process-improvement projects. Hospitalists who intend to certify with the FPHM will be well served by participating in safety, quality, and process-improvement projects, as we often already do. These projects can be used to complete the required Practice Improvement Modules.

Furthermore, I found that doing such projects is the best way to prepare for the new content, which deals specifically with HM on the actual exam. The internal-medicine topics were covered, just as they are in the nonfocused exam, and anyone who reviews for the exam with available study aids (e.g. review books, courses, or practice questions) will have adequate exposure to these topics.

However, a colleague in my HM group chose not to take the focused practice exam, largely because there was no previously established review material to use as study aids. I anticipate that future study aids will contain references to these questions, but for now I felt that material was adequately covered just by completing the Practice Improvement Modules and by being involved in process improvement projects at my hospital. In fact, attendance at one Institute for Healthcare Improvement (www.ihi.org/IHI/Programs) conference would probably cover the topics nicely.

To all of my colleages considering the MOC in FPHM exam, I wish you luck. I feel that any practicing hospitalist is likely to be able to satisfy the requirements of the FPHM pathway without doing too much more than they would in their daily practice or their usual exam preparation. I also found the ABIM staff useful and helpful, and recommend you use the “contact ABIM” link on their website with any questions.

Focused practice is exactly what we should be driving for. TH

Dr. Ammann is medical director of the hospital medicine division at Wentworth-Douglass Hospital in Dover, N.H.

Click here to listen to Dr. Ammann's interview with TH editor Jason Carris

Click here to listen to Dr. Ammann's interview with TH editor Jason Carris

Click here to listen to Dr. Ammann's interview with TH editor Jason Carris

They have grown up in an era of reality television and hyperbolic politics. They prefer news alerts and fantasy football on their handhelds to daily newspapers and leather-bound novels. They text, they text, they text.

The generation known as millennials—those who were born in the years 1982 to 1995—is a breed unto itself. Millennials have grown up in the information age, are adept with new technologies, and have been trained under the umbrella of duty-hour guidelines that protect both the patient and the physician.

So when you hire a millennial for your hospitalist group, you’d better be clear about your expectations. “Millennials are looking for jobs that provide flexibility—time with family, time with friends, time to do other things,” says Troy Ahlstrom, MD, FHM, CFO of Traverse City-based Hospitalists of Northern Michigan and a member of SHM’s Practice Analysis committee. “There is nothing wrong with that, except that the baby boomers look at millennials and say, ‘Gosh, you slugs don’t want to work.’ ”

Dr. Ahlstrom says the influx of millennials into HM in recent years has had a significant impact on group administration—namely, an increase in use of 24/7 on-site coverage. The State of Hospital Medicine: 2010 Report Based on 2009 Data shows 68% of hospitalist groups provide on-site coverage at night. SHM’s 2007-2008 survey data showed only 53% of HM groups provided on-site coverage at night; the 2005-2006 figure was 51%. (Although the 2010 report includes a small percentage of truly academic hospitalist groups and, therefore, probably pushes the on-site coverage a little higher than in past years, Dr. Ahlstrom says he expects the trend toward on-site coverage at night to continue in the near future.)

“Baby boomers are perfectly fine with the idea of working more. They grew up working those horrifically long shifts, 36 hours straight,” Dr. Ahlstrom says. “The millennials would rather have clearly defined shifts, with nocturnists around to work the nights. Or maybe they get to be the nocturnist and work the nights. That’s the trend with younger physicians: They are more interested in seeing that split, where the days and nights are clearly set off.”

Then again, not all physicians, young or old, are against the idea of working long hours. And plenty of well-seasoned physicians are more than happy to have a nocturnist around, “but not if it’s going to cost them a lot of money or productivity,” Dr. Ahlstrom says.

They have grown up in an era of reality television and hyperbolic politics. They prefer news alerts and fantasy football on their handhelds to daily newspapers and leather-bound novels. They text, they text, they text.

The generation known as millennials—those who were born in the years 1982 to 1995—is a breed unto itself. Millennials have grown up in the information age, are adept with new technologies, and have been trained under the umbrella of duty-hour guidelines that protect both the patient and the physician.

So when you hire a millennial for your hospitalist group, you’d better be clear about your expectations. “Millennials are looking for jobs that provide flexibility—time with family, time with friends, time to do other things,” says Troy Ahlstrom, MD, FHM, CFO of Traverse City-based Hospitalists of Northern Michigan and a member of SHM’s Practice Analysis committee. “There is nothing wrong with that, except that the baby boomers look at millennials and say, ‘Gosh, you slugs don’t want to work.’ ”

Dr. Ahlstrom says the influx of millennials into HM in recent years has had a significant impact on group administration—namely, an increase in use of 24/7 on-site coverage. The State of Hospital Medicine: 2010 Report Based on 2009 Data shows 68% of hospitalist groups provide on-site coverage at night. SHM’s 2007-2008 survey data showed only 53% of HM groups provided on-site coverage at night; the 2005-2006 figure was 51%. (Although the 2010 report includes a small percentage of truly academic hospitalist groups and, therefore, probably pushes the on-site coverage a little higher than in past years, Dr. Ahlstrom says he expects the trend toward on-site coverage at night to continue in the near future.)

“Baby boomers are perfectly fine with the idea of working more. They grew up working those horrifically long shifts, 36 hours straight,” Dr. Ahlstrom says. “The millennials would rather have clearly defined shifts, with nocturnists around to work the nights. Or maybe they get to be the nocturnist and work the nights. That’s the trend with younger physicians: They are more interested in seeing that split, where the days and nights are clearly set off.”

Then again, not all physicians, young or old, are against the idea of working long hours. And plenty of well-seasoned physicians are more than happy to have a nocturnist around, “but not if it’s going to cost them a lot of money or productivity,” Dr. Ahlstrom says.

They have grown up in an era of reality television and hyperbolic politics. They prefer news alerts and fantasy football on their handhelds to daily newspapers and leather-bound novels. They text, they text, they text.

The generation known as millennials—those who were born in the years 1982 to 1995—is a breed unto itself. Millennials have grown up in the information age, are adept with new technologies, and have been trained under the umbrella of duty-hour guidelines that protect both the patient and the physician.

So when you hire a millennial for your hospitalist group, you’d better be clear about your expectations. “Millennials are looking for jobs that provide flexibility—time with family, time with friends, time to do other things,” says Troy Ahlstrom, MD, FHM, CFO of Traverse City-based Hospitalists of Northern Michigan and a member of SHM’s Practice Analysis committee. “There is nothing wrong with that, except that the baby boomers look at millennials and say, ‘Gosh, you slugs don’t want to work.’ ”

Dr. Ahlstrom says the influx of millennials into HM in recent years has had a significant impact on group administration—namely, an increase in use of 24/7 on-site coverage. The State of Hospital Medicine: 2010 Report Based on 2009 Data shows 68% of hospitalist groups provide on-site coverage at night. SHM’s 2007-2008 survey data showed only 53% of HM groups provided on-site coverage at night; the 2005-2006 figure was 51%. (Although the 2010 report includes a small percentage of truly academic hospitalist groups and, therefore, probably pushes the on-site coverage a little higher than in past years, Dr. Ahlstrom says he expects the trend toward on-site coverage at night to continue in the near future.)

“Baby boomers are perfectly fine with the idea of working more. They grew up working those horrifically long shifts, 36 hours straight,” Dr. Ahlstrom says. “The millennials would rather have clearly defined shifts, with nocturnists around to work the nights. Or maybe they get to be the nocturnist and work the nights. That’s the trend with younger physicians: They are more interested in seeing that split, where the days and nights are clearly set off.”

Then again, not all physicians, young or old, are against the idea of working long hours. And plenty of well-seasoned physicians are more than happy to have a nocturnist around, “but not if it’s going to cost them a lot of money or productivity,” Dr. Ahlstrom says.

MGMA analyst David Litzau discusses the new compensation and productivity report, and gives advice on how best to use benchmarking data in your practice

Click here to listen to the audio file

MGMA analyst David Litzau discusses the new compensation and productivity report, and gives advice on how best to use benchmarking data in your practice

Click here to listen to the audio file

MGMA analyst David Litzau discusses the new compensation and productivity report, and gives advice on how best to use benchmarking data in your practice

Click here to listen to the audio file

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Enter text here

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A self-described “numbers” guy, Troy Ahlstrom, MD, FHM, is always glad to get his hands on new data. As the CFO of Traverse City-based Hospitalists of Northern Michigan, he is a seasoned veteran of contract negotiations with new recruits or hospital administrators.

Dr. Ahlstrom encourages HM group leaders to understand their local markets, their competitors, and their hospital culture. Use that information, along with benchmarks from national surveys, to formulate expectations for your providers, he says.

“Oftentimes you are measured against the guy next door,” Dr. Ahlstrom says. “You have to know the numbers, because [administrators] are going to know the numbers.”

That’s good to know when new data are dropped on your desk. On Friday, HM group leaders will have access to the State of Hospital Medicine: 2010 Report Based on 2009 Data. The new report shows national median compensation is $215,000 for adult hospitalists; median compensation was $183,900 per adult hospitalist, according to SHM’s 2007-2008 report.

The national median for work RVUs per hospitalist FTE is 4,107, according to the new data. The national median for wRVUs per encounter is 1.86, and collections per work RVU is $45.57. (Visit the-hospitalist.org for more about the 2010 report and benchmarking your practice.)

The report, which offers new metrics, new layers of detail, and new tools to help group leaders analyze the data, compiled data from 4,211 hospitalists in 443 groups, a 30% increase in respondents over SHM’s 2007-2008 report. Dr. Ahlstrom, a member of SHM’s Practice Analysis committee, offers these tips for incorporating benchmarking data into your practice:

1. Know your local market. “If you keep in mind your local needs, then you can look at the data and start to evaluate what parts are going to help you better formulate a practice that brings on the right people, does the right work, and continues to produce the amount of workload and compensation that makes sure they are happy in the future.” 

 

2. Evaluate how applicable the data is. “Pay attention to the total number of survey respondents in each category, and the standard deviation around the mean. … Find data sets that are most applicable to your practice.” 

 

3. Don’t focus on isolated data. “It’s important to look at trends in the data over time, and pick out where those trends are going to go.”

 

4. Involve your people. “The more we are involved in understanding the trends in HM, the better we are going to plan where we are going in the future.”

 

 

A self-described “numbers” guy, Troy Ahlstrom, MD, FHM, is always glad to get his hands on new data. As the CFO of Traverse City-based Hospitalists of Northern Michigan, he is a seasoned veteran of contract negotiations with new recruits or hospital administrators.

Dr. Ahlstrom encourages HM group leaders to understand their local markets, their competitors, and their hospital culture. Use that information, along with benchmarks from national surveys, to formulate expectations for your providers, he says.

“Oftentimes you are measured against the guy next door,” Dr. Ahlstrom says. “You have to know the numbers, because [administrators] are going to know the numbers.”

That’s good to know when new data are dropped on your desk. On Friday, HM group leaders will have access to the State of Hospital Medicine: 2010 Report Based on 2009 Data. The new report shows national median compensation is $215,000 for adult hospitalists; median compensation was $183,900 per adult hospitalist, according to SHM’s 2007-2008 report.

The national median for work RVUs per hospitalist FTE is 4,107, according to the new data. The national median for wRVUs per encounter is 1.86, and collections per work RVU is $45.57. (Visit the-hospitalist.org for more about the 2010 report and benchmarking your practice.)

The report, which offers new metrics, new layers of detail, and new tools to help group leaders analyze the data, compiled data from 4,211 hospitalists in 443 groups, a 30% increase in respondents over SHM’s 2007-2008 report. Dr. Ahlstrom, a member of SHM’s Practice Analysis committee, offers these tips for incorporating benchmarking data into your practice:

1. Know your local market. “If you keep in mind your local needs, then you can look at the data and start to evaluate what parts are going to help you better formulate a practice that brings on the right people, does the right work, and continues to produce the amount of workload and compensation that makes sure they are happy in the future.” 

 

2. Evaluate how applicable the data is. “Pay attention to the total number of survey respondents in each category, and the standard deviation around the mean. … Find data sets that are most applicable to your practice.” 

 

3. Don’t focus on isolated data. “It’s important to look at trends in the data over time, and pick out where those trends are going to go.”

 

4. Involve your people. “The more we are involved in understanding the trends in HM, the better we are going to plan where we are going in the future.”

 

 

A self-described “numbers” guy, Troy Ahlstrom, MD, FHM, is always glad to get his hands on new data. As the CFO of Traverse City-based Hospitalists of Northern Michigan, he is a seasoned veteran of contract negotiations with new recruits or hospital administrators.

Dr. Ahlstrom encourages HM group leaders to understand their local markets, their competitors, and their hospital culture. Use that information, along with benchmarks from national surveys, to formulate expectations for your providers, he says.

“Oftentimes you are measured against the guy next door,” Dr. Ahlstrom says. “You have to know the numbers, because [administrators] are going to know the numbers.”

That’s good to know when new data are dropped on your desk. On Friday, HM group leaders will have access to the State of Hospital Medicine: 2010 Report Based on 2009 Data. The new report shows national median compensation is $215,000 for adult hospitalists; median compensation was $183,900 per adult hospitalist, according to SHM’s 2007-2008 report.

The national median for work RVUs per hospitalist FTE is 4,107, according to the new data. The national median for wRVUs per encounter is 1.86, and collections per work RVU is $45.57. (Visit the-hospitalist.org for more about the 2010 report and benchmarking your practice.)

The report, which offers new metrics, new layers of detail, and new tools to help group leaders analyze the data, compiled data from 4,211 hospitalists in 443 groups, a 30% increase in respondents over SHM’s 2007-2008 report. Dr. Ahlstrom, a member of SHM’s Practice Analysis committee, offers these tips for incorporating benchmarking data into your practice:

1. Know your local market. “If you keep in mind your local needs, then you can look at the data and start to evaluate what parts are going to help you better formulate a practice that brings on the right people, does the right work, and continues to produce the amount of workload and compensation that makes sure they are happy in the future.” 

 

2. Evaluate how applicable the data is. “Pay attention to the total number of survey respondents in each category, and the standard deviation around the mean. … Find data sets that are most applicable to your practice.” 

 

3. Don’t focus on isolated data. “It’s important to look at trends in the data over time, and pick out where those trends are going to go.”

 

4. Involve your people. “The more we are involved in understanding the trends in HM, the better we are going to plan where we are going in the future.”