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Miscommunication Sometimes a Stumbling Block in Hospitalist-Provider Interactions
—Tracy Cardin, ACNP-BC, nurse practitioner, hospital medicine section, University of Chicago Medical Center, Team Hospitalist member
As leaders of patient-care teams, hospitalists communicate with a wide array of care providers—case managers, nurses, pharmacists, trainees, and social workers to name a few. When the number of regular contacts increases, so, too, does the chance for miscommunication.
“Hospitalists are very non-discriminatory. We can miscommunicate with anybody,” says Jack Percelay, MD, FAAP, MP, SFHM, a pediatric hospitalist at Hunterdon Medical Center in New York City. “We all get burned at different times and that reminds us of the need to be careful, redundant, and very specific when communicating.”
How a hospitalist expresses important information with members of the care team affects the quality of patient care and the efficiency with which it’s delivered, says Sandeep Sachdeva, MD, FACP, a hospitalist at Swedish Medical Center in Seattle and a clinical assistant professor of medicine at the University of Washington. The following five scenarios demonstrate general areas of hospitalist-provider miscommunication and corrective actions that can be taken to reduce communication errors.
Facilitate Teamwork
Scenario: An attending hospitalist quickly discusses with residents the plan of care for several patients and doesn’t invite questions, assuming the residents understand everything he is saying. For the most part, the residents comprehend the information, but some are uncertain on the more complex points. Nonetheless, no one asks questions for fear of being perceived as unintelligent or unprepared.
Corrective action: Miscommunication often is not about what’s said, but about what’s unsaid, says Sandeep Sachdeva, MD, FACP, a hospitalist at Swedish Medical Center in Seattle and a clinical assistant professor of medicine at the University of Washington. Opportunities for communication are missed when hierarchical barriers lead more experienced physicians to skip over information they believe others know and less experienced physicians to refrain from asking questions, he says.
Adopting a team approach that encourages inquiry helps to open lines of communication between attendings and residents, Dr. Sachdeva says. “In my experience, the more questions I ask not only helps me, but helps the other person, too,” he says. “The intellectual back and forth stimulates the mind and fosters collaboration.”
To facilitate teamwork, hospitalists must be respectful of other people’s experience, Dr. Percelay says.
“A hospitalist might feel his knowledge area is up to a level 8 out of 10, but he has to realize that something very clear to him won’t be as clear to someone used to working at the 5 or 6 level,” he says. “The hospitalist really needs to talk out loud and explain the situation to make sure everyone is on the same page.”
Seek to Understand
Scenario: A nurse practitioner comprehensively communicates the plan of care to a patient and her family. A short time later, and before advising the nurse practitioner, a hospitalist visits the patient and outlines substantial changes to the plan. The nurse practitioner loses credibility with the patient and family, and throughout the rest of the hospital stay the patient questions the accuracy of the information the nurse practitioner provided. The patient also wonders if the entire HM team is on the same page and providing a high level of care.
Corrective action: A hospitalist should communicate changes in a patient’s plan of care with all pertinent care-team members before informing the patient or the family, says Tracy Cardin, ACNP-BC, a nurse practitioner in the hospital medicine section at University of Chicago Medical Center and Team Hospitalist member.
It demonstrates to the patient that the HM team is in sync and avoids patient confusion. It also gives the hospitalist and team members an opportunity to discuss the change and the reasoning behind it, Cardin says.
“I think it’s important for hospitalists to stop and understand where other providers are coming from before they try to make themselves understood,” she says. “Once they understand why someone is proposing to manage a patient a certain way, it may help them communicate their plan and what they want to do differently.”
By first seeking to understand, Cardin says, a hospitalist might also realize that their plan isn’t the best option, or that a better plan can be developed through compromise.
“There have been times where I’ve had a particular treatment modality that I believed was correct and a non-physician provider recommended another, and I leaned toward what they recommended because they presented a solid case for it,” says O’Neil Pyke, MD, SFHM, chief medical officer for Medicus Healthcare Solutions, a healthcare consulting and staffing company based in Salem, N.H. “Similarly, there have been times where they’ve explained their treatment plan and I’ve said no.”
The key is listening before making a final decision, he notes.
Standardize Handoffs
Scenario: A hospitalist signing out fails to communicate a patient’s end-of-life wishes to the hospitalist assuming care. The patient has a DNR, however, when the patient stops breathing, a Code Blue is called and the patient is revived.
Corrective action: It’s essential for hospitalist teams to adopt a standard process for handing off patients to new providers during shift changes, says Peter Thompson, MD, chief of clinical operations for Apogee Physicians, a physician-owned and operated hospitalist group based in Phoenix.
Mandatory off-service notes that follow a set template are one simple approach, says Kenneth G. Simone, DO, SFHM, president of Hospitalist and Practice Solutions, a hospitalist practice management consultation company based in Veazie, Maine. The off-service notes can include a patient’s SOAP (subject, objective, assessment, and plan) note, as well as address code status, current medication list, primary-care physician, and family contact name and number.
“This simple tool dramatically reduces miscommunication and errors that occur during care transitions,” Dr. Simone says. “I implemented this approach when I was directing a hospitalist program and it worked remarkably well.”
Experts agree handoffs always work best when providers can communicate face-to-face. The incoming provider can get a better feel of what’s happening with the patient; the outgoing provider can make sure that the information conveyed is understood, says Christina Lackner, PA-C, lead physician assistant for the Collaborative Inpatient Medical Service (CIMS) at Johns Hopkins Bayview Medical Center in Baltimore.
Regardless of how the handoffs are conducted, Lackner says they should be as detailed as possible.
“Physicians that I’ve gotten the best sign out from are the ones who clearly convey what they want, state specifically what they did and what they’re looking for, and give me a little background on the patient,” she says. “Also, to double check that I’m comprehending the information, they ask me questions to make sure I’m giving them the right answers.”
—O’Neil Pyke, MD, SFHM, chief medical officer, Medicus Healthcare Solutions, Salem, N.H.
Organized Rounds
Scenario: A hospitalist neglects to inform the social worker that a stroke patient is resistant to outpatient physical therapy because he can’t afford the care and lacks a means of transportation to the facility. The social worker spends considerable time arranging for the physical therapy. After being discharged from the hospital, the patient doesn’t adhere to the therapy regimen.
Corrective action: Holding multidisciplinary patient-care rounds in which the social worker and other providers (nurses, pharmacists, case managers, etc.) actively participate can have a positive impact on communication and collaboration, Dr. Simone says. In addition to reviewing the treatment approach and clinical response, teams can discuss discharge planning, insurance coverage, and patient adherence.
“These rounds must be well organized, so they do not become time consuming and decrease the efficiency of all involved,” Dr. Simone says, adding some HM groups impose a time limit of two minutes per patient or discuss only the most acute patients or those approaching discharge.
If interdisciplinary rounds aren’t possible, hospitalists can work with other providers to develop content expectations that should be entered in the patient’s chart daily or as appropriate, Dr, Simone says. Each provider would then be required to read the daily entry in the patient’s progress note.
“As the head of the interdisciplinary team, hospitalists have to make sure what they are trying to do gets dispersed to all the members of the team,” Dr. Pyke says. “The progress record is probably the most consistent way to do that.”
Many electronic health record (EHR) systems don’t provide as much detail as traditional written records, Dr. Pyke says. He advises hospitalists teams use an EHR that, in addition to providing templated information, can transcribe doctors’ dictated notes in real time.
Proven Methods
Scenario: An expensive, broad-spectrum antibiotic is administered to a patient in the ED because doctors haven’t identified the offending organism. Once stabilized, the patient is transferred to the medical floor. Rather than switching to a less expensive, equally effective medication when the culture results come back, the hospitalist continues ordering the expensive drug.
Corrective action: HM teams can develop treatment approaches to common medical conditions based on data in the literature that defines best practices, Dr. Simone says. These evidence-based clinical order sets can be pre-printed so that each hospitalist can approach the same diagnostic workup and treatment in a standardized manner.
“It encourages physicians to utilize proven methods,” he says.
Dr. Pyke recommends hospitalists input medication orders in the computer system. Physician order entry forces the hospitalist to look at the patient record, which makes it more likely they order the appropriate intervention, he says.
“Because the physician is going off of solid information about that particular patient, there’s less chance of a mistake happening or something getting overlooked,” Dr. Pyke says.
Lisa Ryan is a freelance writer in New Jersey.
—Tracy Cardin, ACNP-BC, nurse practitioner, hospital medicine section, University of Chicago Medical Center, Team Hospitalist member
As leaders of patient-care teams, hospitalists communicate with a wide array of care providers—case managers, nurses, pharmacists, trainees, and social workers to name a few. When the number of regular contacts increases, so, too, does the chance for miscommunication.
“Hospitalists are very non-discriminatory. We can miscommunicate with anybody,” says Jack Percelay, MD, FAAP, MP, SFHM, a pediatric hospitalist at Hunterdon Medical Center in New York City. “We all get burned at different times and that reminds us of the need to be careful, redundant, and very specific when communicating.”
How a hospitalist expresses important information with members of the care team affects the quality of patient care and the efficiency with which it’s delivered, says Sandeep Sachdeva, MD, FACP, a hospitalist at Swedish Medical Center in Seattle and a clinical assistant professor of medicine at the University of Washington. The following five scenarios demonstrate general areas of hospitalist-provider miscommunication and corrective actions that can be taken to reduce communication errors.
Facilitate Teamwork
Scenario: An attending hospitalist quickly discusses with residents the plan of care for several patients and doesn’t invite questions, assuming the residents understand everything he is saying. For the most part, the residents comprehend the information, but some are uncertain on the more complex points. Nonetheless, no one asks questions for fear of being perceived as unintelligent or unprepared.
Corrective action: Miscommunication often is not about what’s said, but about what’s unsaid, says Sandeep Sachdeva, MD, FACP, a hospitalist at Swedish Medical Center in Seattle and a clinical assistant professor of medicine at the University of Washington. Opportunities for communication are missed when hierarchical barriers lead more experienced physicians to skip over information they believe others know and less experienced physicians to refrain from asking questions, he says.
Adopting a team approach that encourages inquiry helps to open lines of communication between attendings and residents, Dr. Sachdeva says. “In my experience, the more questions I ask not only helps me, but helps the other person, too,” he says. “The intellectual back and forth stimulates the mind and fosters collaboration.”
To facilitate teamwork, hospitalists must be respectful of other people’s experience, Dr. Percelay says.
“A hospitalist might feel his knowledge area is up to a level 8 out of 10, but he has to realize that something very clear to him won’t be as clear to someone used to working at the 5 or 6 level,” he says. “The hospitalist really needs to talk out loud and explain the situation to make sure everyone is on the same page.”
Seek to Understand
Scenario: A nurse practitioner comprehensively communicates the plan of care to a patient and her family. A short time later, and before advising the nurse practitioner, a hospitalist visits the patient and outlines substantial changes to the plan. The nurse practitioner loses credibility with the patient and family, and throughout the rest of the hospital stay the patient questions the accuracy of the information the nurse practitioner provided. The patient also wonders if the entire HM team is on the same page and providing a high level of care.
Corrective action: A hospitalist should communicate changes in a patient’s plan of care with all pertinent care-team members before informing the patient or the family, says Tracy Cardin, ACNP-BC, a nurse practitioner in the hospital medicine section at University of Chicago Medical Center and Team Hospitalist member.
It demonstrates to the patient that the HM team is in sync and avoids patient confusion. It also gives the hospitalist and team members an opportunity to discuss the change and the reasoning behind it, Cardin says.
“I think it’s important for hospitalists to stop and understand where other providers are coming from before they try to make themselves understood,” she says. “Once they understand why someone is proposing to manage a patient a certain way, it may help them communicate their plan and what they want to do differently.”
By first seeking to understand, Cardin says, a hospitalist might also realize that their plan isn’t the best option, or that a better plan can be developed through compromise.
“There have been times where I’ve had a particular treatment modality that I believed was correct and a non-physician provider recommended another, and I leaned toward what they recommended because they presented a solid case for it,” says O’Neil Pyke, MD, SFHM, chief medical officer for Medicus Healthcare Solutions, a healthcare consulting and staffing company based in Salem, N.H. “Similarly, there have been times where they’ve explained their treatment plan and I’ve said no.”
The key is listening before making a final decision, he notes.
Standardize Handoffs
Scenario: A hospitalist signing out fails to communicate a patient’s end-of-life wishes to the hospitalist assuming care. The patient has a DNR, however, when the patient stops breathing, a Code Blue is called and the patient is revived.
Corrective action: It’s essential for hospitalist teams to adopt a standard process for handing off patients to new providers during shift changes, says Peter Thompson, MD, chief of clinical operations for Apogee Physicians, a physician-owned and operated hospitalist group based in Phoenix.
Mandatory off-service notes that follow a set template are one simple approach, says Kenneth G. Simone, DO, SFHM, president of Hospitalist and Practice Solutions, a hospitalist practice management consultation company based in Veazie, Maine. The off-service notes can include a patient’s SOAP (subject, objective, assessment, and plan) note, as well as address code status, current medication list, primary-care physician, and family contact name and number.
“This simple tool dramatically reduces miscommunication and errors that occur during care transitions,” Dr. Simone says. “I implemented this approach when I was directing a hospitalist program and it worked remarkably well.”
Experts agree handoffs always work best when providers can communicate face-to-face. The incoming provider can get a better feel of what’s happening with the patient; the outgoing provider can make sure that the information conveyed is understood, says Christina Lackner, PA-C, lead physician assistant for the Collaborative Inpatient Medical Service (CIMS) at Johns Hopkins Bayview Medical Center in Baltimore.
Regardless of how the handoffs are conducted, Lackner says they should be as detailed as possible.
“Physicians that I’ve gotten the best sign out from are the ones who clearly convey what they want, state specifically what they did and what they’re looking for, and give me a little background on the patient,” she says. “Also, to double check that I’m comprehending the information, they ask me questions to make sure I’m giving them the right answers.”
—O’Neil Pyke, MD, SFHM, chief medical officer, Medicus Healthcare Solutions, Salem, N.H.
Organized Rounds
Scenario: A hospitalist neglects to inform the social worker that a stroke patient is resistant to outpatient physical therapy because he can’t afford the care and lacks a means of transportation to the facility. The social worker spends considerable time arranging for the physical therapy. After being discharged from the hospital, the patient doesn’t adhere to the therapy regimen.
Corrective action: Holding multidisciplinary patient-care rounds in which the social worker and other providers (nurses, pharmacists, case managers, etc.) actively participate can have a positive impact on communication and collaboration, Dr. Simone says. In addition to reviewing the treatment approach and clinical response, teams can discuss discharge planning, insurance coverage, and patient adherence.
“These rounds must be well organized, so they do not become time consuming and decrease the efficiency of all involved,” Dr. Simone says, adding some HM groups impose a time limit of two minutes per patient or discuss only the most acute patients or those approaching discharge.
If interdisciplinary rounds aren’t possible, hospitalists can work with other providers to develop content expectations that should be entered in the patient’s chart daily or as appropriate, Dr, Simone says. Each provider would then be required to read the daily entry in the patient’s progress note.
“As the head of the interdisciplinary team, hospitalists have to make sure what they are trying to do gets dispersed to all the members of the team,” Dr. Pyke says. “The progress record is probably the most consistent way to do that.”
Many electronic health record (EHR) systems don’t provide as much detail as traditional written records, Dr. Pyke says. He advises hospitalists teams use an EHR that, in addition to providing templated information, can transcribe doctors’ dictated notes in real time.
Proven Methods
Scenario: An expensive, broad-spectrum antibiotic is administered to a patient in the ED because doctors haven’t identified the offending organism. Once stabilized, the patient is transferred to the medical floor. Rather than switching to a less expensive, equally effective medication when the culture results come back, the hospitalist continues ordering the expensive drug.
Corrective action: HM teams can develop treatment approaches to common medical conditions based on data in the literature that defines best practices, Dr. Simone says. These evidence-based clinical order sets can be pre-printed so that each hospitalist can approach the same diagnostic workup and treatment in a standardized manner.
“It encourages physicians to utilize proven methods,” he says.
Dr. Pyke recommends hospitalists input medication orders in the computer system. Physician order entry forces the hospitalist to look at the patient record, which makes it more likely they order the appropriate intervention, he says.
“Because the physician is going off of solid information about that particular patient, there’s less chance of a mistake happening or something getting overlooked,” Dr. Pyke says.
Lisa Ryan is a freelance writer in New Jersey.
—Tracy Cardin, ACNP-BC, nurse practitioner, hospital medicine section, University of Chicago Medical Center, Team Hospitalist member
As leaders of patient-care teams, hospitalists communicate with a wide array of care providers—case managers, nurses, pharmacists, trainees, and social workers to name a few. When the number of regular contacts increases, so, too, does the chance for miscommunication.
“Hospitalists are very non-discriminatory. We can miscommunicate with anybody,” says Jack Percelay, MD, FAAP, MP, SFHM, a pediatric hospitalist at Hunterdon Medical Center in New York City. “We all get burned at different times and that reminds us of the need to be careful, redundant, and very specific when communicating.”
How a hospitalist expresses important information with members of the care team affects the quality of patient care and the efficiency with which it’s delivered, says Sandeep Sachdeva, MD, FACP, a hospitalist at Swedish Medical Center in Seattle and a clinical assistant professor of medicine at the University of Washington. The following five scenarios demonstrate general areas of hospitalist-provider miscommunication and corrective actions that can be taken to reduce communication errors.
Facilitate Teamwork
Scenario: An attending hospitalist quickly discusses with residents the plan of care for several patients and doesn’t invite questions, assuming the residents understand everything he is saying. For the most part, the residents comprehend the information, but some are uncertain on the more complex points. Nonetheless, no one asks questions for fear of being perceived as unintelligent or unprepared.
Corrective action: Miscommunication often is not about what’s said, but about what’s unsaid, says Sandeep Sachdeva, MD, FACP, a hospitalist at Swedish Medical Center in Seattle and a clinical assistant professor of medicine at the University of Washington. Opportunities for communication are missed when hierarchical barriers lead more experienced physicians to skip over information they believe others know and less experienced physicians to refrain from asking questions, he says.
Adopting a team approach that encourages inquiry helps to open lines of communication between attendings and residents, Dr. Sachdeva says. “In my experience, the more questions I ask not only helps me, but helps the other person, too,” he says. “The intellectual back and forth stimulates the mind and fosters collaboration.”
To facilitate teamwork, hospitalists must be respectful of other people’s experience, Dr. Percelay says.
“A hospitalist might feel his knowledge area is up to a level 8 out of 10, but he has to realize that something very clear to him won’t be as clear to someone used to working at the 5 or 6 level,” he says. “The hospitalist really needs to talk out loud and explain the situation to make sure everyone is on the same page.”
Seek to Understand
Scenario: A nurse practitioner comprehensively communicates the plan of care to a patient and her family. A short time later, and before advising the nurse practitioner, a hospitalist visits the patient and outlines substantial changes to the plan. The nurse practitioner loses credibility with the patient and family, and throughout the rest of the hospital stay the patient questions the accuracy of the information the nurse practitioner provided. The patient also wonders if the entire HM team is on the same page and providing a high level of care.
Corrective action: A hospitalist should communicate changes in a patient’s plan of care with all pertinent care-team members before informing the patient or the family, says Tracy Cardin, ACNP-BC, a nurse practitioner in the hospital medicine section at University of Chicago Medical Center and Team Hospitalist member.
It demonstrates to the patient that the HM team is in sync and avoids patient confusion. It also gives the hospitalist and team members an opportunity to discuss the change and the reasoning behind it, Cardin says.
“I think it’s important for hospitalists to stop and understand where other providers are coming from before they try to make themselves understood,” she says. “Once they understand why someone is proposing to manage a patient a certain way, it may help them communicate their plan and what they want to do differently.”
By first seeking to understand, Cardin says, a hospitalist might also realize that their plan isn’t the best option, or that a better plan can be developed through compromise.
“There have been times where I’ve had a particular treatment modality that I believed was correct and a non-physician provider recommended another, and I leaned toward what they recommended because they presented a solid case for it,” says O’Neil Pyke, MD, SFHM, chief medical officer for Medicus Healthcare Solutions, a healthcare consulting and staffing company based in Salem, N.H. “Similarly, there have been times where they’ve explained their treatment plan and I’ve said no.”
The key is listening before making a final decision, he notes.
Standardize Handoffs
Scenario: A hospitalist signing out fails to communicate a patient’s end-of-life wishes to the hospitalist assuming care. The patient has a DNR, however, when the patient stops breathing, a Code Blue is called and the patient is revived.
Corrective action: It’s essential for hospitalist teams to adopt a standard process for handing off patients to new providers during shift changes, says Peter Thompson, MD, chief of clinical operations for Apogee Physicians, a physician-owned and operated hospitalist group based in Phoenix.
Mandatory off-service notes that follow a set template are one simple approach, says Kenneth G. Simone, DO, SFHM, president of Hospitalist and Practice Solutions, a hospitalist practice management consultation company based in Veazie, Maine. The off-service notes can include a patient’s SOAP (subject, objective, assessment, and plan) note, as well as address code status, current medication list, primary-care physician, and family contact name and number.
“This simple tool dramatically reduces miscommunication and errors that occur during care transitions,” Dr. Simone says. “I implemented this approach when I was directing a hospitalist program and it worked remarkably well.”
Experts agree handoffs always work best when providers can communicate face-to-face. The incoming provider can get a better feel of what’s happening with the patient; the outgoing provider can make sure that the information conveyed is understood, says Christina Lackner, PA-C, lead physician assistant for the Collaborative Inpatient Medical Service (CIMS) at Johns Hopkins Bayview Medical Center in Baltimore.
Regardless of how the handoffs are conducted, Lackner says they should be as detailed as possible.
“Physicians that I’ve gotten the best sign out from are the ones who clearly convey what they want, state specifically what they did and what they’re looking for, and give me a little background on the patient,” she says. “Also, to double check that I’m comprehending the information, they ask me questions to make sure I’m giving them the right answers.”
—O’Neil Pyke, MD, SFHM, chief medical officer, Medicus Healthcare Solutions, Salem, N.H.
Organized Rounds
Scenario: A hospitalist neglects to inform the social worker that a stroke patient is resistant to outpatient physical therapy because he can’t afford the care and lacks a means of transportation to the facility. The social worker spends considerable time arranging for the physical therapy. After being discharged from the hospital, the patient doesn’t adhere to the therapy regimen.
Corrective action: Holding multidisciplinary patient-care rounds in which the social worker and other providers (nurses, pharmacists, case managers, etc.) actively participate can have a positive impact on communication and collaboration, Dr. Simone says. In addition to reviewing the treatment approach and clinical response, teams can discuss discharge planning, insurance coverage, and patient adherence.
“These rounds must be well organized, so they do not become time consuming and decrease the efficiency of all involved,” Dr. Simone says, adding some HM groups impose a time limit of two minutes per patient or discuss only the most acute patients or those approaching discharge.
If interdisciplinary rounds aren’t possible, hospitalists can work with other providers to develop content expectations that should be entered in the patient’s chart daily or as appropriate, Dr, Simone says. Each provider would then be required to read the daily entry in the patient’s progress note.
“As the head of the interdisciplinary team, hospitalists have to make sure what they are trying to do gets dispersed to all the members of the team,” Dr. Pyke says. “The progress record is probably the most consistent way to do that.”
Many electronic health record (EHR) systems don’t provide as much detail as traditional written records, Dr. Pyke says. He advises hospitalists teams use an EHR that, in addition to providing templated information, can transcribe doctors’ dictated notes in real time.
Proven Methods
Scenario: An expensive, broad-spectrum antibiotic is administered to a patient in the ED because doctors haven’t identified the offending organism. Once stabilized, the patient is transferred to the medical floor. Rather than switching to a less expensive, equally effective medication when the culture results come back, the hospitalist continues ordering the expensive drug.
Corrective action: HM teams can develop treatment approaches to common medical conditions based on data in the literature that defines best practices, Dr. Simone says. These evidence-based clinical order sets can be pre-printed so that each hospitalist can approach the same diagnostic workup and treatment in a standardized manner.
“It encourages physicians to utilize proven methods,” he says.
Dr. Pyke recommends hospitalists input medication orders in the computer system. Physician order entry forces the hospitalist to look at the patient record, which makes it more likely they order the appropriate intervention, he says.
“Because the physician is going off of solid information about that particular patient, there’s less chance of a mistake happening or something getting overlooked,” Dr. Pyke says.
Lisa Ryan is a freelance writer in New Jersey.
How to Bridge Common Patient-Hospitalist Communication Gaps
Hospitalists coordinate the care of large numbers of very sick, very complicated patients, making patient-hospitalist communication very important. When done effectively, communication can help hospitalists improve their patients’ sense of well-being and reinforce their adherence to medical treatments post-discharge. It also can build trust and help patients better understand their illnesses.
Nonetheless, communication gaps do occur. The main culprits include time pressures, the lack of a pre-existing patient relationship, patient emotions, medical jargon, and physicians’ tendencies to lecture.
The following five examples outline common communication pitfalls, followed by fundamental skills that can be used to solve communication problems.
Tick, Tock Goes the Clock
Scenario: A hospitalist mentions a medication change during a brief patient visit in the midst of a hectic day. The hospitalist pauses for a moment, glances at his watch, and reaches for the room’s door handle. When no question is forthcoming, he excuses himself to visit the next patient.
The patient has questions about the new medication but feels guilty about taking up the hospitalist’s time. The patient decides she can ask about the medication and the reason for the change when the hospitalist isn’t in such a hurry.
Skill: Creating an environment in which patients are encouraged to ask questions need not result in lengthy conversations. The key is having a clear framework for directing conversations, says Cindy Lien, MD, an academic hospitalist at Beth Israel Deaconess Medical Center in Boston. Dr. Lien uses “Ask-Tell-Ask” as a mnemonic when teaching communication skills to internal-medicine trainees.
“We have a tendency to just tell, tell, tell information,” she says. “Ask-Tell-Ask reminds you that one of the most important things to do is to ask the patient to describe what their understanding is of the situation so you have a sense of where they’re coming from.”
Opening questions can include “What is the most important issue on your mind today?” and “What do you understand about your medications?”
After listening to the patient’s response, tell the patient in a few straightforward sentences the information you need to communicate, Dr. Lien says. Then ask the patient if they understand the information conveyed to them, which will give them a chance to ask questions. Additional questions for the patient can include “Do you need further information at this point?” and “How do you feel about what we’ve discussed?”
—Anthony Back, MD, professor of medicine, University of Washington, Seattle
What’s Your Name Again?
Scenario: A hospitalist wearing professional dress with no nametag enters a patient room and introduces herself before informing the patient that she’s ordered additional tests. The hospitalist visits the patient several times during his hospital stay to discuss test results and self-care instructions upon discharge but never reintroduces herself.
The patient was exhausted and in discomfort when the clinician first introduced herself as a hospitalist. She said her name so quickly that the patient didn’t catch it. The patient sees the hospitalist more often than other providers during his admission, but he’s not sure what her role is and he finds it too awkward to ask.
Skill: First impressions are lasting, so make a solid introduction, says David Meltzer, MD, PhD, FHM, associate professor in the department of medicine at the University of Chicago. Because patients are more likely to identify a hospitalist if they understand the hospitalist has a relationship with their primary-care physician (PCP), the initial greeting should be stated clearly, slowly, and include a reference to the PCP.
“After providing your name, you can say something like, ‘I see you’re Dr. Smith’s patient. I’ve worked with Dr. Smith for many years. We’ll make sure we communicate what happens during your hospitalization. I hope to develop a good relationship with you while you’re in the hospital,’” Dr. Meltzer says.
The hospitalist team should also consider providing brochures with photos of the hospitalists and an explanation of what hospitalists do, says Michael Pistoria, DO, FACP, SFHM, associate chief of the division of general internal medicine at Lehigh Valley Health Network in Allentown, Pa.
“Brochures can be handed to patients at the time of admission with the hospitalist explaining, ‘I’m going to be the doctor in charge of coordinating your care,’” he explains.
Mind Over Matter
Scenario: A hospitalist explains to the patient that her illness is getting worse and more aggressive treatment is advised. While reviewing treatment options, the hospitalist notices the patient is staring out the window, her chin quivering. The hospitalist presses on with what she has to say.
The patient can hear the hospitalist talking, but she’s thinking about how this setback will affect her family. She’s doing all she can to keep from crying and nods her head out of politeness to feign understanding of the information being provided.
Skill: Acknowledging patient emotion is imperative, because doctors who ignore these signals do so at their own professional peril, says Anthony Back, MD, professor of medicine at the University of Washington in Seattle.
“The way our brains are built, emotion will trump cognition every time,” he says. “If you as the doctor keep talking when someone is having an emotional moment, they will generally miss all the information you provided.
“If you see the patient has a lot of emotion, you can say, ‘I notice you are really concerned about this. Can you tell me more?’” Dr. Back says. “Just the act of getting it out in the open will often enable a patient to process the emotion enough so that you can go on to medical issues that are important for the patient to know.”
In most cases, respectfully acknowledging the emotion won’t take long. He says most patients recognize they have limited time with the doctor, and they want to get to the important medical information, too.
It’s Gibberish to Me
Scenario: A hospitalist believes a patient has a solid understanding of his diagnosis. The hospitalist sends the patient for several tests and discusses with him the risks and benefits of various medications and interventions, sometimes using complex terminology.
The patient doesn’t know why he’s had to undergo so many tests. He’s tried to follow along as the hospitalist talks about treatment options and has even asked his daughter to look up medical terminology on her smartphone so he can better understand what is going on. He wishes the hospitalist would explain his condition in basic terms.
Skill: Simplify the language used to communicate with patients by speaking in plain English, says Jeff Greenwald, MD, SFHM, associate professor of medicine at Harvard Medical School and a teaching hospitalist at Massachusetts General Hospital in Boston. Hospitalists should be aware that words and terminology they think are commonplace many times are medical jargon and confusing to patients, he adds.
“For example, when I say ‘take this medication orally,’ that doesn’t strike me as technical language. But ‘orally’ is a word that is not understood by a significant percentage of the population,” Dr. Greenwald says.
A good rule of thumb is to continually check in with patients about the words and terms being used, Dr. Meltzer adds.
“Ask patients if they would like you to explain a term,” he says. “You can say something like, ‘I know this is a term many people aren’t familiar with. Would you like me to tell you more about what it means?’”
—Cindy Lien, MD, academic hospitalist, Beth Israel Deaconess Medical Center, Boston
Data-Dumping
Scenario: A hospitalist checks in on a patient with atrial fibrillation and uses the visit to talk about Coumadin. She instructs the patient on how the drug works in the body, how it increases the chance of bleeding, and how the medication should be taken and monitored.
Later that day, the patient tells her daughter about the hospitalist’s instructions regarding her new medication. The patient remembers that she should avoid certain foods and beverages while on Coumadin but can’t immediately recall what they are. The patient also has trouble recounting what danger signs she should look out for when taking Coumadin.
Skill: Teach-back is an effective tool that can—and should—be used anytime a hospitalist is providing important information to a patient, Dr. Greenwald says. The hospitalist asks the patient to explain back the information in his or her own words in order to determine the patient’s understanding. If errors are identified, the hospitalist can explain the information again to ensure the patient’s comprehension.
“You might say, ‘How are you going to explain to your primary-care doctor about why you’re on an antibiotic?’ or ‘What are you going to tell your son about how your diet has to change?’” Dr. Greenwald says.
He outlines three important elements of teach-back:
- Concentrate on the critical information that patients need to know in order to function;
- Provide information in small bites that the patient can digest; and
- Repeat and reinforce the information with the help of all the members of the care team.
Teach-back should be used consistently, he says, so hospitalists can build on the information taught previously by adding layers to the patient’s knowledge.
Lisa Ryan is a freelance writer in New Jersey.
Hospitalists coordinate the care of large numbers of very sick, very complicated patients, making patient-hospitalist communication very important. When done effectively, communication can help hospitalists improve their patients’ sense of well-being and reinforce their adherence to medical treatments post-discharge. It also can build trust and help patients better understand their illnesses.
Nonetheless, communication gaps do occur. The main culprits include time pressures, the lack of a pre-existing patient relationship, patient emotions, medical jargon, and physicians’ tendencies to lecture.
The following five examples outline common communication pitfalls, followed by fundamental skills that can be used to solve communication problems.
Tick, Tock Goes the Clock
Scenario: A hospitalist mentions a medication change during a brief patient visit in the midst of a hectic day. The hospitalist pauses for a moment, glances at his watch, and reaches for the room’s door handle. When no question is forthcoming, he excuses himself to visit the next patient.
The patient has questions about the new medication but feels guilty about taking up the hospitalist’s time. The patient decides she can ask about the medication and the reason for the change when the hospitalist isn’t in such a hurry.
Skill: Creating an environment in which patients are encouraged to ask questions need not result in lengthy conversations. The key is having a clear framework for directing conversations, says Cindy Lien, MD, an academic hospitalist at Beth Israel Deaconess Medical Center in Boston. Dr. Lien uses “Ask-Tell-Ask” as a mnemonic when teaching communication skills to internal-medicine trainees.
“We have a tendency to just tell, tell, tell information,” she says. “Ask-Tell-Ask reminds you that one of the most important things to do is to ask the patient to describe what their understanding is of the situation so you have a sense of where they’re coming from.”
Opening questions can include “What is the most important issue on your mind today?” and “What do you understand about your medications?”
After listening to the patient’s response, tell the patient in a few straightforward sentences the information you need to communicate, Dr. Lien says. Then ask the patient if they understand the information conveyed to them, which will give them a chance to ask questions. Additional questions for the patient can include “Do you need further information at this point?” and “How do you feel about what we’ve discussed?”
—Anthony Back, MD, professor of medicine, University of Washington, Seattle
What’s Your Name Again?
Scenario: A hospitalist wearing professional dress with no nametag enters a patient room and introduces herself before informing the patient that she’s ordered additional tests. The hospitalist visits the patient several times during his hospital stay to discuss test results and self-care instructions upon discharge but never reintroduces herself.
The patient was exhausted and in discomfort when the clinician first introduced herself as a hospitalist. She said her name so quickly that the patient didn’t catch it. The patient sees the hospitalist more often than other providers during his admission, but he’s not sure what her role is and he finds it too awkward to ask.
Skill: First impressions are lasting, so make a solid introduction, says David Meltzer, MD, PhD, FHM, associate professor in the department of medicine at the University of Chicago. Because patients are more likely to identify a hospitalist if they understand the hospitalist has a relationship with their primary-care physician (PCP), the initial greeting should be stated clearly, slowly, and include a reference to the PCP.
“After providing your name, you can say something like, ‘I see you’re Dr. Smith’s patient. I’ve worked with Dr. Smith for many years. We’ll make sure we communicate what happens during your hospitalization. I hope to develop a good relationship with you while you’re in the hospital,’” Dr. Meltzer says.
The hospitalist team should also consider providing brochures with photos of the hospitalists and an explanation of what hospitalists do, says Michael Pistoria, DO, FACP, SFHM, associate chief of the division of general internal medicine at Lehigh Valley Health Network in Allentown, Pa.
“Brochures can be handed to patients at the time of admission with the hospitalist explaining, ‘I’m going to be the doctor in charge of coordinating your care,’” he explains.
Mind Over Matter
Scenario: A hospitalist explains to the patient that her illness is getting worse and more aggressive treatment is advised. While reviewing treatment options, the hospitalist notices the patient is staring out the window, her chin quivering. The hospitalist presses on with what she has to say.
The patient can hear the hospitalist talking, but she’s thinking about how this setback will affect her family. She’s doing all she can to keep from crying and nods her head out of politeness to feign understanding of the information being provided.
Skill: Acknowledging patient emotion is imperative, because doctors who ignore these signals do so at their own professional peril, says Anthony Back, MD, professor of medicine at the University of Washington in Seattle.
“The way our brains are built, emotion will trump cognition every time,” he says. “If you as the doctor keep talking when someone is having an emotional moment, they will generally miss all the information you provided.
“If you see the patient has a lot of emotion, you can say, ‘I notice you are really concerned about this. Can you tell me more?’” Dr. Back says. “Just the act of getting it out in the open will often enable a patient to process the emotion enough so that you can go on to medical issues that are important for the patient to know.”
In most cases, respectfully acknowledging the emotion won’t take long. He says most patients recognize they have limited time with the doctor, and they want to get to the important medical information, too.
It’s Gibberish to Me
Scenario: A hospitalist believes a patient has a solid understanding of his diagnosis. The hospitalist sends the patient for several tests and discusses with him the risks and benefits of various medications and interventions, sometimes using complex terminology.
The patient doesn’t know why he’s had to undergo so many tests. He’s tried to follow along as the hospitalist talks about treatment options and has even asked his daughter to look up medical terminology on her smartphone so he can better understand what is going on. He wishes the hospitalist would explain his condition in basic terms.
Skill: Simplify the language used to communicate with patients by speaking in plain English, says Jeff Greenwald, MD, SFHM, associate professor of medicine at Harvard Medical School and a teaching hospitalist at Massachusetts General Hospital in Boston. Hospitalists should be aware that words and terminology they think are commonplace many times are medical jargon and confusing to patients, he adds.
“For example, when I say ‘take this medication orally,’ that doesn’t strike me as technical language. But ‘orally’ is a word that is not understood by a significant percentage of the population,” Dr. Greenwald says.
A good rule of thumb is to continually check in with patients about the words and terms being used, Dr. Meltzer adds.
“Ask patients if they would like you to explain a term,” he says. “You can say something like, ‘I know this is a term many people aren’t familiar with. Would you like me to tell you more about what it means?’”
—Cindy Lien, MD, academic hospitalist, Beth Israel Deaconess Medical Center, Boston
Data-Dumping
Scenario: A hospitalist checks in on a patient with atrial fibrillation and uses the visit to talk about Coumadin. She instructs the patient on how the drug works in the body, how it increases the chance of bleeding, and how the medication should be taken and monitored.
Later that day, the patient tells her daughter about the hospitalist’s instructions regarding her new medication. The patient remembers that she should avoid certain foods and beverages while on Coumadin but can’t immediately recall what they are. The patient also has trouble recounting what danger signs she should look out for when taking Coumadin.
Skill: Teach-back is an effective tool that can—and should—be used anytime a hospitalist is providing important information to a patient, Dr. Greenwald says. The hospitalist asks the patient to explain back the information in his or her own words in order to determine the patient’s understanding. If errors are identified, the hospitalist can explain the information again to ensure the patient’s comprehension.
“You might say, ‘How are you going to explain to your primary-care doctor about why you’re on an antibiotic?’ or ‘What are you going to tell your son about how your diet has to change?’” Dr. Greenwald says.
He outlines three important elements of teach-back:
- Concentrate on the critical information that patients need to know in order to function;
- Provide information in small bites that the patient can digest; and
- Repeat and reinforce the information with the help of all the members of the care team.
Teach-back should be used consistently, he says, so hospitalists can build on the information taught previously by adding layers to the patient’s knowledge.
Lisa Ryan is a freelance writer in New Jersey.
Hospitalists coordinate the care of large numbers of very sick, very complicated patients, making patient-hospitalist communication very important. When done effectively, communication can help hospitalists improve their patients’ sense of well-being and reinforce their adherence to medical treatments post-discharge. It also can build trust and help patients better understand their illnesses.
Nonetheless, communication gaps do occur. The main culprits include time pressures, the lack of a pre-existing patient relationship, patient emotions, medical jargon, and physicians’ tendencies to lecture.
The following five examples outline common communication pitfalls, followed by fundamental skills that can be used to solve communication problems.
Tick, Tock Goes the Clock
Scenario: A hospitalist mentions a medication change during a brief patient visit in the midst of a hectic day. The hospitalist pauses for a moment, glances at his watch, and reaches for the room’s door handle. When no question is forthcoming, he excuses himself to visit the next patient.
The patient has questions about the new medication but feels guilty about taking up the hospitalist’s time. The patient decides she can ask about the medication and the reason for the change when the hospitalist isn’t in such a hurry.
Skill: Creating an environment in which patients are encouraged to ask questions need not result in lengthy conversations. The key is having a clear framework for directing conversations, says Cindy Lien, MD, an academic hospitalist at Beth Israel Deaconess Medical Center in Boston. Dr. Lien uses “Ask-Tell-Ask” as a mnemonic when teaching communication skills to internal-medicine trainees.
“We have a tendency to just tell, tell, tell information,” she says. “Ask-Tell-Ask reminds you that one of the most important things to do is to ask the patient to describe what their understanding is of the situation so you have a sense of where they’re coming from.”
Opening questions can include “What is the most important issue on your mind today?” and “What do you understand about your medications?”
After listening to the patient’s response, tell the patient in a few straightforward sentences the information you need to communicate, Dr. Lien says. Then ask the patient if they understand the information conveyed to them, which will give them a chance to ask questions. Additional questions for the patient can include “Do you need further information at this point?” and “How do you feel about what we’ve discussed?”
—Anthony Back, MD, professor of medicine, University of Washington, Seattle
What’s Your Name Again?
Scenario: A hospitalist wearing professional dress with no nametag enters a patient room and introduces herself before informing the patient that she’s ordered additional tests. The hospitalist visits the patient several times during his hospital stay to discuss test results and self-care instructions upon discharge but never reintroduces herself.
The patient was exhausted and in discomfort when the clinician first introduced herself as a hospitalist. She said her name so quickly that the patient didn’t catch it. The patient sees the hospitalist more often than other providers during his admission, but he’s not sure what her role is and he finds it too awkward to ask.
Skill: First impressions are lasting, so make a solid introduction, says David Meltzer, MD, PhD, FHM, associate professor in the department of medicine at the University of Chicago. Because patients are more likely to identify a hospitalist if they understand the hospitalist has a relationship with their primary-care physician (PCP), the initial greeting should be stated clearly, slowly, and include a reference to the PCP.
“After providing your name, you can say something like, ‘I see you’re Dr. Smith’s patient. I’ve worked with Dr. Smith for many years. We’ll make sure we communicate what happens during your hospitalization. I hope to develop a good relationship with you while you’re in the hospital,’” Dr. Meltzer says.
The hospitalist team should also consider providing brochures with photos of the hospitalists and an explanation of what hospitalists do, says Michael Pistoria, DO, FACP, SFHM, associate chief of the division of general internal medicine at Lehigh Valley Health Network in Allentown, Pa.
“Brochures can be handed to patients at the time of admission with the hospitalist explaining, ‘I’m going to be the doctor in charge of coordinating your care,’” he explains.
Mind Over Matter
Scenario: A hospitalist explains to the patient that her illness is getting worse and more aggressive treatment is advised. While reviewing treatment options, the hospitalist notices the patient is staring out the window, her chin quivering. The hospitalist presses on with what she has to say.
The patient can hear the hospitalist talking, but she’s thinking about how this setback will affect her family. She’s doing all she can to keep from crying and nods her head out of politeness to feign understanding of the information being provided.
Skill: Acknowledging patient emotion is imperative, because doctors who ignore these signals do so at their own professional peril, says Anthony Back, MD, professor of medicine at the University of Washington in Seattle.
“The way our brains are built, emotion will trump cognition every time,” he says. “If you as the doctor keep talking when someone is having an emotional moment, they will generally miss all the information you provided.
“If you see the patient has a lot of emotion, you can say, ‘I notice you are really concerned about this. Can you tell me more?’” Dr. Back says. “Just the act of getting it out in the open will often enable a patient to process the emotion enough so that you can go on to medical issues that are important for the patient to know.”
In most cases, respectfully acknowledging the emotion won’t take long. He says most patients recognize they have limited time with the doctor, and they want to get to the important medical information, too.
It’s Gibberish to Me
Scenario: A hospitalist believes a patient has a solid understanding of his diagnosis. The hospitalist sends the patient for several tests and discusses with him the risks and benefits of various medications and interventions, sometimes using complex terminology.
The patient doesn’t know why he’s had to undergo so many tests. He’s tried to follow along as the hospitalist talks about treatment options and has even asked his daughter to look up medical terminology on her smartphone so he can better understand what is going on. He wishes the hospitalist would explain his condition in basic terms.
Skill: Simplify the language used to communicate with patients by speaking in plain English, says Jeff Greenwald, MD, SFHM, associate professor of medicine at Harvard Medical School and a teaching hospitalist at Massachusetts General Hospital in Boston. Hospitalists should be aware that words and terminology they think are commonplace many times are medical jargon and confusing to patients, he adds.
“For example, when I say ‘take this medication orally,’ that doesn’t strike me as technical language. But ‘orally’ is a word that is not understood by a significant percentage of the population,” Dr. Greenwald says.
A good rule of thumb is to continually check in with patients about the words and terms being used, Dr. Meltzer adds.
“Ask patients if they would like you to explain a term,” he says. “You can say something like, ‘I know this is a term many people aren’t familiar with. Would you like me to tell you more about what it means?’”
—Cindy Lien, MD, academic hospitalist, Beth Israel Deaconess Medical Center, Boston
Data-Dumping
Scenario: A hospitalist checks in on a patient with atrial fibrillation and uses the visit to talk about Coumadin. She instructs the patient on how the drug works in the body, how it increases the chance of bleeding, and how the medication should be taken and monitored.
Later that day, the patient tells her daughter about the hospitalist’s instructions regarding her new medication. The patient remembers that she should avoid certain foods and beverages while on Coumadin but can’t immediately recall what they are. The patient also has trouble recounting what danger signs she should look out for when taking Coumadin.
Skill: Teach-back is an effective tool that can—and should—be used anytime a hospitalist is providing important information to a patient, Dr. Greenwald says. The hospitalist asks the patient to explain back the information in his or her own words in order to determine the patient’s understanding. If errors are identified, the hospitalist can explain the information again to ensure the patient’s comprehension.
“You might say, ‘How are you going to explain to your primary-care doctor about why you’re on an antibiotic?’ or ‘What are you going to tell your son about how your diet has to change?’” Dr. Greenwald says.
He outlines three important elements of teach-back:
- Concentrate on the critical information that patients need to know in order to function;
- Provide information in small bites that the patient can digest; and
- Repeat and reinforce the information with the help of all the members of the care team.
Teach-back should be used consistently, he says, so hospitalists can build on the information taught previously by adding layers to the patient’s knowledge.
Lisa Ryan is a freelance writer in New Jersey.
ONLINE EXCLUSIVE: Is Part-Time Hospitalist Work Right for You?
Part-time physicians report higher work satisfaction, less burnout, and greater work control.1 They also cite more time for family, community, and self-care activities, as well as more research time and ability to focus on career goals.2
Those are attractive benefits, to be sure. But is part time right for you?
“They need to look at all the factors of their whole life,” says Jennifer Owens, director of the Working Mother Research Institute in New York City. “Are they trying to compete to get ahead and do they feel they can’t give up hours at work? Are they taking an assignment that’s so big, they just need to be at work to try to get it going? Are there factors in their life, like their kids are sick or their spouse has an illness? It all comes down to a personal, individual assessment. There are tradeoffs.”
A major tradeoff is income. Part-time physicians earn less money and have fewer benefits, which might not be financially feasible, says Iris Grimm, creator of the Atlanta-based Balanced Physician coaching program.
Some part-time female physicians surveyed in a recent study published in Academic Medicine cited slower promotion trajectory or even demotion, getting overlooked for career opportunities, given less desirable work, or being marginalized within their division.2
Physicians who decide to work part time should set goals for themselves based on their personal definition of work-life balance, says Maria Bailey, founder and CEO of BlueSuitMom.com, a Pompano Beach, Fla.-based company that provides information on work and family balance for professional working mothers and their employers. If they haven’t reached those goals within two to three months, they should re-evaluate their part-time status.
——Maria Bailey, founder and CEO, BlueSuitMom.com, Pompano Beach, Fla.
“Some of us just have the personality where we’re going to create work for ourselves. It’s really hard to break the habits that we’ve developed over many, many years,” Bailey says. “Working part-time may be a reality check that what we thought we wanted isn’t what we wanted at all.”
Lisa Ryan is a freelance writer in New Jersey.
References
1. Mechaber FH, Levine RB, Manwell LB, et al. Part-time physicians … prevalent, connected, and satisfied. J Gen Intern Med. 2008;23(3):300-303.
2. Harrison RA, Gregg JL. A time for change: an exploration of attitudes toward part-time work in academia among women internists and their division chiefs. Acad Med. 2009;84(1):80-86.
Part-time physicians report higher work satisfaction, less burnout, and greater work control.1 They also cite more time for family, community, and self-care activities, as well as more research time and ability to focus on career goals.2
Those are attractive benefits, to be sure. But is part time right for you?
“They need to look at all the factors of their whole life,” says Jennifer Owens, director of the Working Mother Research Institute in New York City. “Are they trying to compete to get ahead and do they feel they can’t give up hours at work? Are they taking an assignment that’s so big, they just need to be at work to try to get it going? Are there factors in their life, like their kids are sick or their spouse has an illness? It all comes down to a personal, individual assessment. There are tradeoffs.”
A major tradeoff is income. Part-time physicians earn less money and have fewer benefits, which might not be financially feasible, says Iris Grimm, creator of the Atlanta-based Balanced Physician coaching program.
Some part-time female physicians surveyed in a recent study published in Academic Medicine cited slower promotion trajectory or even demotion, getting overlooked for career opportunities, given less desirable work, or being marginalized within their division.2
Physicians who decide to work part time should set goals for themselves based on their personal definition of work-life balance, says Maria Bailey, founder and CEO of BlueSuitMom.com, a Pompano Beach, Fla.-based company that provides information on work and family balance for professional working mothers and their employers. If they haven’t reached those goals within two to three months, they should re-evaluate their part-time status.
——Maria Bailey, founder and CEO, BlueSuitMom.com, Pompano Beach, Fla.
“Some of us just have the personality where we’re going to create work for ourselves. It’s really hard to break the habits that we’ve developed over many, many years,” Bailey says. “Working part-time may be a reality check that what we thought we wanted isn’t what we wanted at all.”
Lisa Ryan is a freelance writer in New Jersey.
References
1. Mechaber FH, Levine RB, Manwell LB, et al. Part-time physicians … prevalent, connected, and satisfied. J Gen Intern Med. 2008;23(3):300-303.
2. Harrison RA, Gregg JL. A time for change: an exploration of attitudes toward part-time work in academia among women internists and their division chiefs. Acad Med. 2009;84(1):80-86.
Part-time physicians report higher work satisfaction, less burnout, and greater work control.1 They also cite more time for family, community, and self-care activities, as well as more research time and ability to focus on career goals.2
Those are attractive benefits, to be sure. But is part time right for you?
“They need to look at all the factors of their whole life,” says Jennifer Owens, director of the Working Mother Research Institute in New York City. “Are they trying to compete to get ahead and do they feel they can’t give up hours at work? Are they taking an assignment that’s so big, they just need to be at work to try to get it going? Are there factors in their life, like their kids are sick or their spouse has an illness? It all comes down to a personal, individual assessment. There are tradeoffs.”
A major tradeoff is income. Part-time physicians earn less money and have fewer benefits, which might not be financially feasible, says Iris Grimm, creator of the Atlanta-based Balanced Physician coaching program.
Some part-time female physicians surveyed in a recent study published in Academic Medicine cited slower promotion trajectory or even demotion, getting overlooked for career opportunities, given less desirable work, or being marginalized within their division.2
Physicians who decide to work part time should set goals for themselves based on their personal definition of work-life balance, says Maria Bailey, founder and CEO of BlueSuitMom.com, a Pompano Beach, Fla.-based company that provides information on work and family balance for professional working mothers and their employers. If they haven’t reached those goals within two to three months, they should re-evaluate their part-time status.
——Maria Bailey, founder and CEO, BlueSuitMom.com, Pompano Beach, Fla.
“Some of us just have the personality where we’re going to create work for ourselves. It’s really hard to break the habits that we’ve developed over many, many years,” Bailey says. “Working part-time may be a reality check that what we thought we wanted isn’t what we wanted at all.”
Lisa Ryan is a freelance writer in New Jersey.
References
1. Mechaber FH, Levine RB, Manwell LB, et al. Part-time physicians … prevalent, connected, and satisfied. J Gen Intern Med. 2008;23(3):300-303.
2. Harrison RA, Gregg JL. A time for change: an exploration of attitudes toward part-time work in academia among women internists and their division chiefs. Acad Med. 2009;84(1):80-86.
ONLINE EXCLUSIVE: Experts speak about work-life issues for female hospitalists
Work-Life Balance for Hospitalists a People Issue, Not a Women's Issue
When recounting her HM career, Janet Nagamine, RN, MD, SFHM, often tells people she went from being the chief of everything to the chief of nothing, by choice. She can remember the whirlwind of being a quality-improvement (QI) chief, patient safety officer, risk management team member, and new mother who felt more married to her beeper than to her husband.
“I felt incredibly stressed and pulled in so many different directions,” says Dr. Nagamine, a hospitalist at Kaiser Permanente Medical Center in Santa Clara, Calif., and an SHM board member. “What really concerned me was that I was starting to feel that I wasn’t doing anything well, that I was dropping balls here and there.”
A revelation came to Dr. Nagamine at a time-management workshop. The speaker asked participants to list the three most important things in their lives, then add up the hours spent doing them.
“There was obviously a disconnect when I looked at the actual waking hours I spent with my family,” says Dr. Nagamine, who placed family at the top of her list. “That’s where I made the decision that I could always come back to doing these leadership things at a later time.”
Now pursuing an MBA, she intends to return to leadership positions to focus on QI, patient safety, and hospitalist work-life issues—for both women and men.
“Work-life balance is a key anchor for us,” says Dr. Nagamine, who helped organize a “Women in Hospital Medicine” session at HM12 last month in San Diego. “Whether you’re male or female, work-life [balance] is a challenge. We need to do better on that.”
In today’s era of ever-increasing healthcare demands, the future of hospitalist practice rests, in no small part, on the work-life satisfaction of its physicians. Recent studies suggest hospitalists are experiencing more stress and burnout now than in the past, a phenomenon HM groups would be wise to address by offering more flexible work options and workload support, regardless of gender, experts say. But individual hospitalists can mitigate strain and dissatisfaction by assessing their life and goals, and developing a work-life balance that is right for them.
“Work-life balance is really not something that is ‘a nice thing to have,’” says Iris Grimm, creator of the Atlanta-based Balanced Physician program, which helps physicians meet work, life, and leadership challenges. “It is a necessity for them if they want to sustain a long-term career.”
Defining Balance
So what causes tension between work and life outside of work? The list is long and growing.
“We still define the ideal worker as someone who starts to work in early adulthood and works full time, full force, for 40 years straight, available for overtime as needed,” says Joan Williams, distinguished professor of law, founding director of the Center of WorkLife Law at the University of California’s Hastings College of the Law in San Francisco, and author of “Unbending Gender: Why Family and Work Conflict and What To Do About It.” “That basically describes a man married to a homemaker, and that’s not who the work force is.”
In general, workplaces—including those in the hospital work environment—have been slow to adjust to the changing work force, Williams says. In time, friction arises, which leads to dissatisfied workers.
Work-life balance is when a person can rise above the conflict and align their responsibilities with their values and priorities, says Maria Bailey, founder and CEO of BlueSuitMom.com, a Pompano Beach, Fla.-based company that provides work-life balance information for professional working mothers and their employers.
“It is being satisfied with one’s entire life, with the work side as well as with the personal side,” Grimm says.
—Janet Nagamine, RN, MD, SFHM, Kaiser Permanente Medical Center, Santa Clara, Calif., SHM board member
Young physicians of both genders view work-life balance as essential, and are willing to risk career advancement to achieve it, according to a 2006 survey of U.S. doctors under age 50 conducted by the Association of American Medical Colleges and the American Medical Association.1 When asked to rate factors that are very important to a desirable position, 71% identified work-life balance. Two out of 3 young physicians said they were not interested in working longer hours for more money—a sharp contrast from previous generations.
“It started in the 1990s, but I think in the early 2000s was when the medical world began to take a much more honest appraisal of the long-term impact of an unbalanced life and what that meant for physicians,” says Erin Stucky Fisher, MD, MHM, medical director for quality at Rady Children’s Hospital San Diego, associate program director for the University of California at San Diego Pediatric Residency Program, and an SHM board member.
Dr. Nagamine agrees the tide has shifted in terms of physician attitudes toward work hours, compensation, and personal time. “Now that we have work-hour rules in residency, the doctors coming out don’t buy that you have to be on 24/7, 365 days a year,” she says.
The Survey Says...
Recent research on hospitalist work-life satisfaction indicates that while hospitalists generally are satisfied with their job and specialty, burnout rates appear higher than the 13% previously reported in 2001.2
Earlier this year, a study in the Journal of General Internal Medicine found that 29.9% of respondents to a national survey of hospitalists reported job burnout symptoms.3 Hospitalists surveyed also reported low satisfaction with personal time (28.3%), autonomy (17.4%), organizational climate (10.7%), and organizational fairness (31.2%). The results are somewhat alarming to longtime hospitalists, in that hospitalist work models might be less flexible and less sustainable than originally thought.
Results from an email survey published in 2011 showed that 67% of academic hospitalists reported high levels of stress, and 23% described some level of burnout.4 Additionally, 57% of the respondents had 20% or less of protected time for scholarly activity—a disconnect between career goals and actual work that could lead to career dissatisfaction. More than half of the academic hospitalists surveyed, however, did express high or somewhat high satisfaction with personal and family time, and control over work schedules.
“Hospital medicine is still a new field, and people are trying to find the right balance in the work,” says Rebecca Harrison, MD, associate professor of medicine and section chief of the division of hospital medicine at Oregon Health & Science University in Portland. “I think we’re in a very critical time now where we have to look at scheduling, patient load, fulfillment factors. A physician’s sense of commitment, happiness, and enjoyment in their work is going to be much higher if you pay attention to the things they want to pursue.”
What Women Really Want
Female physicians are far less able to control their work environments than men, says Mark Linzer, MD. He helped design and conduct the Society of General Internal Medicine’s Physician Work Life Study, which found that aside from less work control, the female doctors surveyed said they faced a more difficult patient mix, more time pressure in patient examinations, and a 60% greater chance of burnout compared with their male counterparts.5
“One of those factors, we think, is what has been called ‘gendered expectations for listening,’” says Dr. Linzer, division director for general internal medicine at Hennepin County Medical Center in Minneapolis and professor of medicine at the University of Minnesota. Patients prefer female doctors because they believe women are better listeners than men, he explains. But listening takes time, and female physicians generally aren’t afforded more time for patient visits than male physicians are.
“This is an issue I see many times with female physicians, with hospitalists in particular,” Grimm says. “They just can’t seem to stay in the time frame that has been given to them for their patients. They think that the more time they spend with their patients, the more the patients appreciate them and feel like they are heard.”
Another factor is extra work outside the office. “If you measure the total number of work hours performed, including work and home, it is considerably higher for women,” Dr. Linzer says.
Even if a working woman has help at home or a spouse who works part time or stays at home, she never really relinquishes responsibility of the home, Bailey says.
“A woman carries social pressures that she needs to—even if she has a career—carry out the role of a traditional wife and mother,” she says.
Regardless of whether they have a spouse and children, women generally feel a responsibility to care for their loved ones’ needs, whether it’s an aging parent, an ailing sibling, or a friend facing a difficult situation, says Jennifer Owens, director of the Working Mother Research Institute in New York City. One thing working in female physicians’ favor, however, is they are less likely to lose their careers due to work-family conflicts than are women in such high-skill professions as finance or law, because part-time work is readily available for female doctors, Williams says.
—Rebecca Harrison, MD, associate professor of medicine, section chief, division of hospital medicine, Oregon Health & Science University, Portland
“The number of hours that women work has been increasing. So there’s incredible stress on women,” says Owens. “Just to have the support that you’re not stigmatized for dialing back and not working a 60-hour-plus work week means a lot.”
The Flip Side
Men also have partners, families, children, and outside interests. Therefore, if hospitalist groups are going to create flexible work opportunities, they have to market them and make them available to everyone, regardless of gender, Dr. Fisher says.
The key work-life balance battle today, Williams says, centers around male workers and the stereotypes surrounding masculinity. Increasing numbers of young men want to participate in the day-to-day caregiving of their children. Most workplaces, however, have been slow to adjust.
“Women have the cultural room to make workplace adjustments to ease work-family conflict, and men often don’t,” Williams says. “The ideas of masculinity are closely intertwined with the idea of being a provider. So if a man leaves work to care for his child or ailing mother, people not only think of him as a poor worker, they often think of him as less of a man. The stereotypes that hit people who make their caregiving responsibilities salient on the job are extremely hostile and even more powerful for men than for women.”
Similarly, if male physicians want to structure their schedules around personal interests or take extended time off to pursue a life passion, they often are viewed unfavorably because the culture of medicine for years has been complete dedication to patients and career over personal needs, Dr. Harrison says.
“For example, a single person or someone who doesn’t have a family might want to go climbing the Himalayas and take three months off. Or perhaps a staff member wants to go part time in order to go back to school for an MBA,” Dr. Nagamine says. “We’re not prepared to deal with those types of requests.”
Stop the Churn
HM groups around the country—big and small, academic and community—deal with work-life balance issues on a regular basis. Some have solved the issue; many have not. Too many hospitalist groups are stuck in a churn cycle: hire hospitalist, fail to meet their needs, see them leave after a year or two, repeat.
“When you see people churning their staff, especially when they’re losing good ones, it’s a financial and human capital drain,” Dr. Nagamine says. “Think about the care that’s being delivered within the system, what’s happening to the other members in the group, the return on investment for keeping your staff happy. We argue over pennies sometimes, but we don’t calculate these types of losses of personnel.”
Dr. Nagamine says hospitalist groups should approach work-life balance not just on a day-to-day or week-to-week basis, but also in terms of extended leave for child or elder care, travel, volunteer work, professional development, etc.
Compensation and workload are used to recruit and retain hospitalists. But recent research suggests that leaders might find more nuanced approaches to improving their hospitalists’ overall satisfaction.6 For example, leaders of local community-based hospitalist groups might find their hospitalists tolerant of heavier workloads, provided they are financially rewarded and given autonomy over their work. And rather than using higher salaries to be competitive, leaders of academic programs might find it more effective to provide their hospitalists with time and training to pursue scholarly work.
“Physicians and faculty are the most valuable commodities for moving the work forward,” Dr. Harrison says, “and good leaders pay attention to this data.”
HM groups should think about surveying their employees to find out where problems exist, Bailey says. Once you determine what work-life benefits and/or flexible employment opportunities will work, train supervisors to manage workplace flexibility, then hold them accountable for executing the policies, Owens says.
“It makes sense to take care of your people,” Dr. Nagamine says. “First, it’s the right thing to do. Second, it’s financially and fiscally a good move. It’s not just work-life balance for the sake of work-life balance; it’s critically important to your operations and your overall success in delivering good care.”
Lisa Ryan is a freelance writer in New Jersey.
Take Ownership of Your Time Off
The only way to fully achieve work-life balance is if you’re trying to achieve balance, according to experts in physician career satisfaction. In other words, work-life balance starts with you. Here are six steps you can take to improve your balancing act:
Define balance. Draw a picture of what you look like when your life is in balance, Bailey says. Or write a description in a journal. The goal is to determine what balance means for you at this point in your life, Grimm says.
Conduct a personal assessment. Look at every area of your life to assess what’s working and what’s not working, Owens says. Where things aren’t working, identify what you would have to add or subtract from your life to make improvements, says Grimm.
Eliminate stressors. Pinpoint your primary stressors and work to resolve or mitigate them, Grimm says. If it’s new software at work, find ways to master the technology. If it’s lack of spousal support, practice effective communication and teamwork.
Maximize energy. Create a workplace with the least amount of friction by investing energy in areas where you can make a positive impact, Grimm says. Don’t waste time or effort on things that cannot be changed.
Practice self-care. To be effective at caring for loved ones and patients, you have to care for yourself, Dr. Harrison says. Self-care can include protecting time with friends and family, taking short breaks during the workday, exercising, and getting regular sleep and meals. Hospitalists also should schedule vacations.
Consider job fit. Read recent research on the job characteristics of hospitalist practice models.6 If you’re someone who’s less concerned about workload but want to be paid well and have more autonomy, a local, community-based hospitalist group might be right for you. Academic HM might fit better if you’re willing to sacrifice some compensation for a variety of activities beyond direct clinical care.
—Lisa Ryan
References
- Kirch DG, Salsberg E. The physician workforce challenge: response of the academic community. Ann Surg. 2007;246(4):535-540.
- Hoff TH, Whitcomb WF, Williams K, Nelson JR, Cheesman RA. Characteristics and work experiences of hospitalists in the United States. Arch Intern Med. 2001;161(6):851-8.
- Hinami K, Whelan CT, Wolosin RJ, Miller JA, Wetterneck TB. Worklife and satisfaction of hospitalists: toward flourishing careers. J Gen Intern Med. 2012;27(1):28-36.
- Glasheen JJ, Misky GJ, Reid MB, Harrison RA, Sharpe B, Auerbach A. Career satisfaction and burnout in academic hospital medicine. Arch Intern Med. 2011;171(8):782-785.
- McMurray JE, Linzer M, Konrad TR, Douglas J, Shugerman R, Nelson K. The work lives of women physicians results from the physician work life study. The SGIM Career Satisfaction Study Group. J Gen Intern Med. 2000;15(6):372-380.
- Hinami K, Whelan CT, Miller JA, Wolosin RJ, Wetterneck TB. Job characteristics, satisfaction, and burnout across hospitalist practice models. Journal of Hospital Medicine website. Available at: http://onlinelibrary.wiley.com/doi/10.1002/jhm.1907/full. Accessed March 21, 2012.
When recounting her HM career, Janet Nagamine, RN, MD, SFHM, often tells people she went from being the chief of everything to the chief of nothing, by choice. She can remember the whirlwind of being a quality-improvement (QI) chief, patient safety officer, risk management team member, and new mother who felt more married to her beeper than to her husband.
“I felt incredibly stressed and pulled in so many different directions,” says Dr. Nagamine, a hospitalist at Kaiser Permanente Medical Center in Santa Clara, Calif., and an SHM board member. “What really concerned me was that I was starting to feel that I wasn’t doing anything well, that I was dropping balls here and there.”
A revelation came to Dr. Nagamine at a time-management workshop. The speaker asked participants to list the three most important things in their lives, then add up the hours spent doing them.
“There was obviously a disconnect when I looked at the actual waking hours I spent with my family,” says Dr. Nagamine, who placed family at the top of her list. “That’s where I made the decision that I could always come back to doing these leadership things at a later time.”
Now pursuing an MBA, she intends to return to leadership positions to focus on QI, patient safety, and hospitalist work-life issues—for both women and men.
“Work-life balance is a key anchor for us,” says Dr. Nagamine, who helped organize a “Women in Hospital Medicine” session at HM12 last month in San Diego. “Whether you’re male or female, work-life [balance] is a challenge. We need to do better on that.”
In today’s era of ever-increasing healthcare demands, the future of hospitalist practice rests, in no small part, on the work-life satisfaction of its physicians. Recent studies suggest hospitalists are experiencing more stress and burnout now than in the past, a phenomenon HM groups would be wise to address by offering more flexible work options and workload support, regardless of gender, experts say. But individual hospitalists can mitigate strain and dissatisfaction by assessing their life and goals, and developing a work-life balance that is right for them.
“Work-life balance is really not something that is ‘a nice thing to have,’” says Iris Grimm, creator of the Atlanta-based Balanced Physician program, which helps physicians meet work, life, and leadership challenges. “It is a necessity for them if they want to sustain a long-term career.”
Defining Balance
So what causes tension between work and life outside of work? The list is long and growing.
“We still define the ideal worker as someone who starts to work in early adulthood and works full time, full force, for 40 years straight, available for overtime as needed,” says Joan Williams, distinguished professor of law, founding director of the Center of WorkLife Law at the University of California’s Hastings College of the Law in San Francisco, and author of “Unbending Gender: Why Family and Work Conflict and What To Do About It.” “That basically describes a man married to a homemaker, and that’s not who the work force is.”
In general, workplaces—including those in the hospital work environment—have been slow to adjust to the changing work force, Williams says. In time, friction arises, which leads to dissatisfied workers.
Work-life balance is when a person can rise above the conflict and align their responsibilities with their values and priorities, says Maria Bailey, founder and CEO of BlueSuitMom.com, a Pompano Beach, Fla.-based company that provides work-life balance information for professional working mothers and their employers.
“It is being satisfied with one’s entire life, with the work side as well as with the personal side,” Grimm says.
—Janet Nagamine, RN, MD, SFHM, Kaiser Permanente Medical Center, Santa Clara, Calif., SHM board member
Young physicians of both genders view work-life balance as essential, and are willing to risk career advancement to achieve it, according to a 2006 survey of U.S. doctors under age 50 conducted by the Association of American Medical Colleges and the American Medical Association.1 When asked to rate factors that are very important to a desirable position, 71% identified work-life balance. Two out of 3 young physicians said they were not interested in working longer hours for more money—a sharp contrast from previous generations.
“It started in the 1990s, but I think in the early 2000s was when the medical world began to take a much more honest appraisal of the long-term impact of an unbalanced life and what that meant for physicians,” says Erin Stucky Fisher, MD, MHM, medical director for quality at Rady Children’s Hospital San Diego, associate program director for the University of California at San Diego Pediatric Residency Program, and an SHM board member.
Dr. Nagamine agrees the tide has shifted in terms of physician attitudes toward work hours, compensation, and personal time. “Now that we have work-hour rules in residency, the doctors coming out don’t buy that you have to be on 24/7, 365 days a year,” she says.
The Survey Says...
Recent research on hospitalist work-life satisfaction indicates that while hospitalists generally are satisfied with their job and specialty, burnout rates appear higher than the 13% previously reported in 2001.2
Earlier this year, a study in the Journal of General Internal Medicine found that 29.9% of respondents to a national survey of hospitalists reported job burnout symptoms.3 Hospitalists surveyed also reported low satisfaction with personal time (28.3%), autonomy (17.4%), organizational climate (10.7%), and organizational fairness (31.2%). The results are somewhat alarming to longtime hospitalists, in that hospitalist work models might be less flexible and less sustainable than originally thought.
Results from an email survey published in 2011 showed that 67% of academic hospitalists reported high levels of stress, and 23% described some level of burnout.4 Additionally, 57% of the respondents had 20% or less of protected time for scholarly activity—a disconnect between career goals and actual work that could lead to career dissatisfaction. More than half of the academic hospitalists surveyed, however, did express high or somewhat high satisfaction with personal and family time, and control over work schedules.
“Hospital medicine is still a new field, and people are trying to find the right balance in the work,” says Rebecca Harrison, MD, associate professor of medicine and section chief of the division of hospital medicine at Oregon Health & Science University in Portland. “I think we’re in a very critical time now where we have to look at scheduling, patient load, fulfillment factors. A physician’s sense of commitment, happiness, and enjoyment in their work is going to be much higher if you pay attention to the things they want to pursue.”
What Women Really Want
Female physicians are far less able to control their work environments than men, says Mark Linzer, MD. He helped design and conduct the Society of General Internal Medicine’s Physician Work Life Study, which found that aside from less work control, the female doctors surveyed said they faced a more difficult patient mix, more time pressure in patient examinations, and a 60% greater chance of burnout compared with their male counterparts.5
“One of those factors, we think, is what has been called ‘gendered expectations for listening,’” says Dr. Linzer, division director for general internal medicine at Hennepin County Medical Center in Minneapolis and professor of medicine at the University of Minnesota. Patients prefer female doctors because they believe women are better listeners than men, he explains. But listening takes time, and female physicians generally aren’t afforded more time for patient visits than male physicians are.
“This is an issue I see many times with female physicians, with hospitalists in particular,” Grimm says. “They just can’t seem to stay in the time frame that has been given to them for their patients. They think that the more time they spend with their patients, the more the patients appreciate them and feel like they are heard.”
Another factor is extra work outside the office. “If you measure the total number of work hours performed, including work and home, it is considerably higher for women,” Dr. Linzer says.
Even if a working woman has help at home or a spouse who works part time or stays at home, she never really relinquishes responsibility of the home, Bailey says.
“A woman carries social pressures that she needs to—even if she has a career—carry out the role of a traditional wife and mother,” she says.
Regardless of whether they have a spouse and children, women generally feel a responsibility to care for their loved ones’ needs, whether it’s an aging parent, an ailing sibling, or a friend facing a difficult situation, says Jennifer Owens, director of the Working Mother Research Institute in New York City. One thing working in female physicians’ favor, however, is they are less likely to lose their careers due to work-family conflicts than are women in such high-skill professions as finance or law, because part-time work is readily available for female doctors, Williams says.
—Rebecca Harrison, MD, associate professor of medicine, section chief, division of hospital medicine, Oregon Health & Science University, Portland
“The number of hours that women work has been increasing. So there’s incredible stress on women,” says Owens. “Just to have the support that you’re not stigmatized for dialing back and not working a 60-hour-plus work week means a lot.”
The Flip Side
Men also have partners, families, children, and outside interests. Therefore, if hospitalist groups are going to create flexible work opportunities, they have to market them and make them available to everyone, regardless of gender, Dr. Fisher says.
The key work-life balance battle today, Williams says, centers around male workers and the stereotypes surrounding masculinity. Increasing numbers of young men want to participate in the day-to-day caregiving of their children. Most workplaces, however, have been slow to adjust.
“Women have the cultural room to make workplace adjustments to ease work-family conflict, and men often don’t,” Williams says. “The ideas of masculinity are closely intertwined with the idea of being a provider. So if a man leaves work to care for his child or ailing mother, people not only think of him as a poor worker, they often think of him as less of a man. The stereotypes that hit people who make their caregiving responsibilities salient on the job are extremely hostile and even more powerful for men than for women.”
Similarly, if male physicians want to structure their schedules around personal interests or take extended time off to pursue a life passion, they often are viewed unfavorably because the culture of medicine for years has been complete dedication to patients and career over personal needs, Dr. Harrison says.
“For example, a single person or someone who doesn’t have a family might want to go climbing the Himalayas and take three months off. Or perhaps a staff member wants to go part time in order to go back to school for an MBA,” Dr. Nagamine says. “We’re not prepared to deal with those types of requests.”
Stop the Churn
HM groups around the country—big and small, academic and community—deal with work-life balance issues on a regular basis. Some have solved the issue; many have not. Too many hospitalist groups are stuck in a churn cycle: hire hospitalist, fail to meet their needs, see them leave after a year or two, repeat.
“When you see people churning their staff, especially when they’re losing good ones, it’s a financial and human capital drain,” Dr. Nagamine says. “Think about the care that’s being delivered within the system, what’s happening to the other members in the group, the return on investment for keeping your staff happy. We argue over pennies sometimes, but we don’t calculate these types of losses of personnel.”
Dr. Nagamine says hospitalist groups should approach work-life balance not just on a day-to-day or week-to-week basis, but also in terms of extended leave for child or elder care, travel, volunteer work, professional development, etc.
Compensation and workload are used to recruit and retain hospitalists. But recent research suggests that leaders might find more nuanced approaches to improving their hospitalists’ overall satisfaction.6 For example, leaders of local community-based hospitalist groups might find their hospitalists tolerant of heavier workloads, provided they are financially rewarded and given autonomy over their work. And rather than using higher salaries to be competitive, leaders of academic programs might find it more effective to provide their hospitalists with time and training to pursue scholarly work.
“Physicians and faculty are the most valuable commodities for moving the work forward,” Dr. Harrison says, “and good leaders pay attention to this data.”
HM groups should think about surveying their employees to find out where problems exist, Bailey says. Once you determine what work-life benefits and/or flexible employment opportunities will work, train supervisors to manage workplace flexibility, then hold them accountable for executing the policies, Owens says.
“It makes sense to take care of your people,” Dr. Nagamine says. “First, it’s the right thing to do. Second, it’s financially and fiscally a good move. It’s not just work-life balance for the sake of work-life balance; it’s critically important to your operations and your overall success in delivering good care.”
Lisa Ryan is a freelance writer in New Jersey.
Take Ownership of Your Time Off
The only way to fully achieve work-life balance is if you’re trying to achieve balance, according to experts in physician career satisfaction. In other words, work-life balance starts with you. Here are six steps you can take to improve your balancing act:
Define balance. Draw a picture of what you look like when your life is in balance, Bailey says. Or write a description in a journal. The goal is to determine what balance means for you at this point in your life, Grimm says.
Conduct a personal assessment. Look at every area of your life to assess what’s working and what’s not working, Owens says. Where things aren’t working, identify what you would have to add or subtract from your life to make improvements, says Grimm.
Eliminate stressors. Pinpoint your primary stressors and work to resolve or mitigate them, Grimm says. If it’s new software at work, find ways to master the technology. If it’s lack of spousal support, practice effective communication and teamwork.
Maximize energy. Create a workplace with the least amount of friction by investing energy in areas where you can make a positive impact, Grimm says. Don’t waste time or effort on things that cannot be changed.
Practice self-care. To be effective at caring for loved ones and patients, you have to care for yourself, Dr. Harrison says. Self-care can include protecting time with friends and family, taking short breaks during the workday, exercising, and getting regular sleep and meals. Hospitalists also should schedule vacations.
Consider job fit. Read recent research on the job characteristics of hospitalist practice models.6 If you’re someone who’s less concerned about workload but want to be paid well and have more autonomy, a local, community-based hospitalist group might be right for you. Academic HM might fit better if you’re willing to sacrifice some compensation for a variety of activities beyond direct clinical care.
—Lisa Ryan
References
- Kirch DG, Salsberg E. The physician workforce challenge: response of the academic community. Ann Surg. 2007;246(4):535-540.
- Hoff TH, Whitcomb WF, Williams K, Nelson JR, Cheesman RA. Characteristics and work experiences of hospitalists in the United States. Arch Intern Med. 2001;161(6):851-8.
- Hinami K, Whelan CT, Wolosin RJ, Miller JA, Wetterneck TB. Worklife and satisfaction of hospitalists: toward flourishing careers. J Gen Intern Med. 2012;27(1):28-36.
- Glasheen JJ, Misky GJ, Reid MB, Harrison RA, Sharpe B, Auerbach A. Career satisfaction and burnout in academic hospital medicine. Arch Intern Med. 2011;171(8):782-785.
- McMurray JE, Linzer M, Konrad TR, Douglas J, Shugerman R, Nelson K. The work lives of women physicians results from the physician work life study. The SGIM Career Satisfaction Study Group. J Gen Intern Med. 2000;15(6):372-380.
- Hinami K, Whelan CT, Miller JA, Wolosin RJ, Wetterneck TB. Job characteristics, satisfaction, and burnout across hospitalist practice models. Journal of Hospital Medicine website. Available at: http://onlinelibrary.wiley.com/doi/10.1002/jhm.1907/full. Accessed March 21, 2012.
When recounting her HM career, Janet Nagamine, RN, MD, SFHM, often tells people she went from being the chief of everything to the chief of nothing, by choice. She can remember the whirlwind of being a quality-improvement (QI) chief, patient safety officer, risk management team member, and new mother who felt more married to her beeper than to her husband.
“I felt incredibly stressed and pulled in so many different directions,” says Dr. Nagamine, a hospitalist at Kaiser Permanente Medical Center in Santa Clara, Calif., and an SHM board member. “What really concerned me was that I was starting to feel that I wasn’t doing anything well, that I was dropping balls here and there.”
A revelation came to Dr. Nagamine at a time-management workshop. The speaker asked participants to list the three most important things in their lives, then add up the hours spent doing them.
“There was obviously a disconnect when I looked at the actual waking hours I spent with my family,” says Dr. Nagamine, who placed family at the top of her list. “That’s where I made the decision that I could always come back to doing these leadership things at a later time.”
Now pursuing an MBA, she intends to return to leadership positions to focus on QI, patient safety, and hospitalist work-life issues—for both women and men.
“Work-life balance is a key anchor for us,” says Dr. Nagamine, who helped organize a “Women in Hospital Medicine” session at HM12 last month in San Diego. “Whether you’re male or female, work-life [balance] is a challenge. We need to do better on that.”
In today’s era of ever-increasing healthcare demands, the future of hospitalist practice rests, in no small part, on the work-life satisfaction of its physicians. Recent studies suggest hospitalists are experiencing more stress and burnout now than in the past, a phenomenon HM groups would be wise to address by offering more flexible work options and workload support, regardless of gender, experts say. But individual hospitalists can mitigate strain and dissatisfaction by assessing their life and goals, and developing a work-life balance that is right for them.
“Work-life balance is really not something that is ‘a nice thing to have,’” says Iris Grimm, creator of the Atlanta-based Balanced Physician program, which helps physicians meet work, life, and leadership challenges. “It is a necessity for them if they want to sustain a long-term career.”
Defining Balance
So what causes tension between work and life outside of work? The list is long and growing.
“We still define the ideal worker as someone who starts to work in early adulthood and works full time, full force, for 40 years straight, available for overtime as needed,” says Joan Williams, distinguished professor of law, founding director of the Center of WorkLife Law at the University of California’s Hastings College of the Law in San Francisco, and author of “Unbending Gender: Why Family and Work Conflict and What To Do About It.” “That basically describes a man married to a homemaker, and that’s not who the work force is.”
In general, workplaces—including those in the hospital work environment—have been slow to adjust to the changing work force, Williams says. In time, friction arises, which leads to dissatisfied workers.
Work-life balance is when a person can rise above the conflict and align their responsibilities with their values and priorities, says Maria Bailey, founder and CEO of BlueSuitMom.com, a Pompano Beach, Fla.-based company that provides work-life balance information for professional working mothers and their employers.
“It is being satisfied with one’s entire life, with the work side as well as with the personal side,” Grimm says.
—Janet Nagamine, RN, MD, SFHM, Kaiser Permanente Medical Center, Santa Clara, Calif., SHM board member
Young physicians of both genders view work-life balance as essential, and are willing to risk career advancement to achieve it, according to a 2006 survey of U.S. doctors under age 50 conducted by the Association of American Medical Colleges and the American Medical Association.1 When asked to rate factors that are very important to a desirable position, 71% identified work-life balance. Two out of 3 young physicians said they were not interested in working longer hours for more money—a sharp contrast from previous generations.
“It started in the 1990s, but I think in the early 2000s was when the medical world began to take a much more honest appraisal of the long-term impact of an unbalanced life and what that meant for physicians,” says Erin Stucky Fisher, MD, MHM, medical director for quality at Rady Children’s Hospital San Diego, associate program director for the University of California at San Diego Pediatric Residency Program, and an SHM board member.
Dr. Nagamine agrees the tide has shifted in terms of physician attitudes toward work hours, compensation, and personal time. “Now that we have work-hour rules in residency, the doctors coming out don’t buy that you have to be on 24/7, 365 days a year,” she says.
The Survey Says...
Recent research on hospitalist work-life satisfaction indicates that while hospitalists generally are satisfied with their job and specialty, burnout rates appear higher than the 13% previously reported in 2001.2
Earlier this year, a study in the Journal of General Internal Medicine found that 29.9% of respondents to a national survey of hospitalists reported job burnout symptoms.3 Hospitalists surveyed also reported low satisfaction with personal time (28.3%), autonomy (17.4%), organizational climate (10.7%), and organizational fairness (31.2%). The results are somewhat alarming to longtime hospitalists, in that hospitalist work models might be less flexible and less sustainable than originally thought.
Results from an email survey published in 2011 showed that 67% of academic hospitalists reported high levels of stress, and 23% described some level of burnout.4 Additionally, 57% of the respondents had 20% or less of protected time for scholarly activity—a disconnect between career goals and actual work that could lead to career dissatisfaction. More than half of the academic hospitalists surveyed, however, did express high or somewhat high satisfaction with personal and family time, and control over work schedules.
“Hospital medicine is still a new field, and people are trying to find the right balance in the work,” says Rebecca Harrison, MD, associate professor of medicine and section chief of the division of hospital medicine at Oregon Health & Science University in Portland. “I think we’re in a very critical time now where we have to look at scheduling, patient load, fulfillment factors. A physician’s sense of commitment, happiness, and enjoyment in their work is going to be much higher if you pay attention to the things they want to pursue.”
What Women Really Want
Female physicians are far less able to control their work environments than men, says Mark Linzer, MD. He helped design and conduct the Society of General Internal Medicine’s Physician Work Life Study, which found that aside from less work control, the female doctors surveyed said they faced a more difficult patient mix, more time pressure in patient examinations, and a 60% greater chance of burnout compared with their male counterparts.5
“One of those factors, we think, is what has been called ‘gendered expectations for listening,’” says Dr. Linzer, division director for general internal medicine at Hennepin County Medical Center in Minneapolis and professor of medicine at the University of Minnesota. Patients prefer female doctors because they believe women are better listeners than men, he explains. But listening takes time, and female physicians generally aren’t afforded more time for patient visits than male physicians are.
“This is an issue I see many times with female physicians, with hospitalists in particular,” Grimm says. “They just can’t seem to stay in the time frame that has been given to them for their patients. They think that the more time they spend with their patients, the more the patients appreciate them and feel like they are heard.”
Another factor is extra work outside the office. “If you measure the total number of work hours performed, including work and home, it is considerably higher for women,” Dr. Linzer says.
Even if a working woman has help at home or a spouse who works part time or stays at home, she never really relinquishes responsibility of the home, Bailey says.
“A woman carries social pressures that she needs to—even if she has a career—carry out the role of a traditional wife and mother,” she says.
Regardless of whether they have a spouse and children, women generally feel a responsibility to care for their loved ones’ needs, whether it’s an aging parent, an ailing sibling, or a friend facing a difficult situation, says Jennifer Owens, director of the Working Mother Research Institute in New York City. One thing working in female physicians’ favor, however, is they are less likely to lose their careers due to work-family conflicts than are women in such high-skill professions as finance or law, because part-time work is readily available for female doctors, Williams says.
—Rebecca Harrison, MD, associate professor of medicine, section chief, division of hospital medicine, Oregon Health & Science University, Portland
“The number of hours that women work has been increasing. So there’s incredible stress on women,” says Owens. “Just to have the support that you’re not stigmatized for dialing back and not working a 60-hour-plus work week means a lot.”
The Flip Side
Men also have partners, families, children, and outside interests. Therefore, if hospitalist groups are going to create flexible work opportunities, they have to market them and make them available to everyone, regardless of gender, Dr. Fisher says.
The key work-life balance battle today, Williams says, centers around male workers and the stereotypes surrounding masculinity. Increasing numbers of young men want to participate in the day-to-day caregiving of their children. Most workplaces, however, have been slow to adjust.
“Women have the cultural room to make workplace adjustments to ease work-family conflict, and men often don’t,” Williams says. “The ideas of masculinity are closely intertwined with the idea of being a provider. So if a man leaves work to care for his child or ailing mother, people not only think of him as a poor worker, they often think of him as less of a man. The stereotypes that hit people who make their caregiving responsibilities salient on the job are extremely hostile and even more powerful for men than for women.”
Similarly, if male physicians want to structure their schedules around personal interests or take extended time off to pursue a life passion, they often are viewed unfavorably because the culture of medicine for years has been complete dedication to patients and career over personal needs, Dr. Harrison says.
“For example, a single person or someone who doesn’t have a family might want to go climbing the Himalayas and take three months off. Or perhaps a staff member wants to go part time in order to go back to school for an MBA,” Dr. Nagamine says. “We’re not prepared to deal with those types of requests.”
Stop the Churn
HM groups around the country—big and small, academic and community—deal with work-life balance issues on a regular basis. Some have solved the issue; many have not. Too many hospitalist groups are stuck in a churn cycle: hire hospitalist, fail to meet their needs, see them leave after a year or two, repeat.
“When you see people churning their staff, especially when they’re losing good ones, it’s a financial and human capital drain,” Dr. Nagamine says. “Think about the care that’s being delivered within the system, what’s happening to the other members in the group, the return on investment for keeping your staff happy. We argue over pennies sometimes, but we don’t calculate these types of losses of personnel.”
Dr. Nagamine says hospitalist groups should approach work-life balance not just on a day-to-day or week-to-week basis, but also in terms of extended leave for child or elder care, travel, volunteer work, professional development, etc.
Compensation and workload are used to recruit and retain hospitalists. But recent research suggests that leaders might find more nuanced approaches to improving their hospitalists’ overall satisfaction.6 For example, leaders of local community-based hospitalist groups might find their hospitalists tolerant of heavier workloads, provided they are financially rewarded and given autonomy over their work. And rather than using higher salaries to be competitive, leaders of academic programs might find it more effective to provide their hospitalists with time and training to pursue scholarly work.
“Physicians and faculty are the most valuable commodities for moving the work forward,” Dr. Harrison says, “and good leaders pay attention to this data.”
HM groups should think about surveying their employees to find out where problems exist, Bailey says. Once you determine what work-life benefits and/or flexible employment opportunities will work, train supervisors to manage workplace flexibility, then hold them accountable for executing the policies, Owens says.
“It makes sense to take care of your people,” Dr. Nagamine says. “First, it’s the right thing to do. Second, it’s financially and fiscally a good move. It’s not just work-life balance for the sake of work-life balance; it’s critically important to your operations and your overall success in delivering good care.”
Lisa Ryan is a freelance writer in New Jersey.
Take Ownership of Your Time Off
The only way to fully achieve work-life balance is if you’re trying to achieve balance, according to experts in physician career satisfaction. In other words, work-life balance starts with you. Here are six steps you can take to improve your balancing act:
Define balance. Draw a picture of what you look like when your life is in balance, Bailey says. Or write a description in a journal. The goal is to determine what balance means for you at this point in your life, Grimm says.
Conduct a personal assessment. Look at every area of your life to assess what’s working and what’s not working, Owens says. Where things aren’t working, identify what you would have to add or subtract from your life to make improvements, says Grimm.
Eliminate stressors. Pinpoint your primary stressors and work to resolve or mitigate them, Grimm says. If it’s new software at work, find ways to master the technology. If it’s lack of spousal support, practice effective communication and teamwork.
Maximize energy. Create a workplace with the least amount of friction by investing energy in areas where you can make a positive impact, Grimm says. Don’t waste time or effort on things that cannot be changed.
Practice self-care. To be effective at caring for loved ones and patients, you have to care for yourself, Dr. Harrison says. Self-care can include protecting time with friends and family, taking short breaks during the workday, exercising, and getting regular sleep and meals. Hospitalists also should schedule vacations.
Consider job fit. Read recent research on the job characteristics of hospitalist practice models.6 If you’re someone who’s less concerned about workload but want to be paid well and have more autonomy, a local, community-based hospitalist group might be right for you. Academic HM might fit better if you’re willing to sacrifice some compensation for a variety of activities beyond direct clinical care.
—Lisa Ryan
References
- Kirch DG, Salsberg E. The physician workforce challenge: response of the academic community. Ann Surg. 2007;246(4):535-540.
- Hoff TH, Whitcomb WF, Williams K, Nelson JR, Cheesman RA. Characteristics and work experiences of hospitalists in the United States. Arch Intern Med. 2001;161(6):851-8.
- Hinami K, Whelan CT, Wolosin RJ, Miller JA, Wetterneck TB. Worklife and satisfaction of hospitalists: toward flourishing careers. J Gen Intern Med. 2012;27(1):28-36.
- Glasheen JJ, Misky GJ, Reid MB, Harrison RA, Sharpe B, Auerbach A. Career satisfaction and burnout in academic hospital medicine. Arch Intern Med. 2011;171(8):782-785.
- McMurray JE, Linzer M, Konrad TR, Douglas J, Shugerman R, Nelson K. The work lives of women physicians results from the physician work life study. The SGIM Career Satisfaction Study Group. J Gen Intern Med. 2000;15(6):372-380.
- Hinami K, Whelan CT, Miller JA, Wolosin RJ, Wetterneck TB. Job characteristics, satisfaction, and burnout across hospitalist practice models. Journal of Hospital Medicine website. Available at: http://onlinelibrary.wiley.com/doi/10.1002/jhm.1907/full. Accessed March 21, 2012.
ONLINE EXCLUSIVE: How the School of Medicine at Stanford University Is Addressing Female Physicians and Leadership
Whenever Hannah Valantine, MD, needs reassurance that female leadership interventions at Stanford University’s School of Medicine are working, she looks at the numbers.
—Janet Nagamine, RN, MD, SFHM, hospitalist, Kaiser Permanente Medical Center, Santa Clara, Calif., SHM board member
In the span of five to six years, the medical school has increased the percentage of women at each faculty rank so that it now surpasses national averages as calculated by the Association of American Medical Colleges. Indeed, the percentage of women at the full professor rank jumped to 22% from 14.5%.
“We really are making progress,” says Dr. Valantine, full professor of medicine and the medical school’s senior associate dean for diversity and leadership.
With structural elements, such as tenure clock extension, extended maternity and family leave, onsite childcare, early-stage research funding support, and mentoring in place, Dr. Valantine is turning her attention to the next round of interventions, which focus more on the psychological and social factors that impair women’s advancement. She will use a National Institutes of Health grant to develop interventions for the phenomenon of stereotype threat, which is the fear that one's behavior will confirm an existing stereotype about one’s social group. This fear may lead to an impairment of performance.
Over the next six months, Dr. Valantine and her team will also conduct several pilot programs involving map career customization, a model that encourages people to chart their careers over the next five to 10 to 20 years, taking into consideration their life outside of work. The intent is to help individuals identify their priorities and goals and how they change over time, and also help supervisors better match the ebbs and flows of a person’s life to the workplace and identify and develop aspiring leaders.
Stanford’s medical school is organized around teams of doctors that care for groups of patients. Each team must achieve excellence in four academic missions: clinical care, education, research, and administration. The map career customization pilot programs are aimed at helping doctors within the team plan their career paths around these four missions, then put the individual plans together in a team context in order to meet the team’s goals, says Dr. Valantine.
“This way, the work and the four missions are entirely covered,” she says. “We create a vibrant academic environment where we create new things and have time to think and integrate our life and work. … It’s a little countercultural, but I think people are crying out for that, and I think it stands a great chance of making the culture change.”
Stanford’s burgeoning efforts in map career customization have intrigued SHM board member Janet Nagamine, RN, MD, SFHM, a hospitalist at Kaiser Permanente Medical Center in Santa Clara, Calif., and Stanford alum. She hopes to collaborate with Dr. Valantine and incorporate into hospital medicine the interventions that Stanford is doing while conducting studies and developing workforce planning initiatives specific to hospitalists. The goal is to create a hospital medicine model that replicates Stanford’s success in cultivating female physician leaders.
“We make this false assumption that your career is going to look the same throughout your life,” Dr. Nagamine says. “That’s just not realistic.”
Lisa Ryan is a freelance writer in New Jersey.
Whenever Hannah Valantine, MD, needs reassurance that female leadership interventions at Stanford University’s School of Medicine are working, she looks at the numbers.
—Janet Nagamine, RN, MD, SFHM, hospitalist, Kaiser Permanente Medical Center, Santa Clara, Calif., SHM board member
In the span of five to six years, the medical school has increased the percentage of women at each faculty rank so that it now surpasses national averages as calculated by the Association of American Medical Colleges. Indeed, the percentage of women at the full professor rank jumped to 22% from 14.5%.
“We really are making progress,” says Dr. Valantine, full professor of medicine and the medical school’s senior associate dean for diversity and leadership.
With structural elements, such as tenure clock extension, extended maternity and family leave, onsite childcare, early-stage research funding support, and mentoring in place, Dr. Valantine is turning her attention to the next round of interventions, which focus more on the psychological and social factors that impair women’s advancement. She will use a National Institutes of Health grant to develop interventions for the phenomenon of stereotype threat, which is the fear that one's behavior will confirm an existing stereotype about one’s social group. This fear may lead to an impairment of performance.
Over the next six months, Dr. Valantine and her team will also conduct several pilot programs involving map career customization, a model that encourages people to chart their careers over the next five to 10 to 20 years, taking into consideration their life outside of work. The intent is to help individuals identify their priorities and goals and how they change over time, and also help supervisors better match the ebbs and flows of a person’s life to the workplace and identify and develop aspiring leaders.
Stanford’s medical school is organized around teams of doctors that care for groups of patients. Each team must achieve excellence in four academic missions: clinical care, education, research, and administration. The map career customization pilot programs are aimed at helping doctors within the team plan their career paths around these four missions, then put the individual plans together in a team context in order to meet the team’s goals, says Dr. Valantine.
“This way, the work and the four missions are entirely covered,” she says. “We create a vibrant academic environment where we create new things and have time to think and integrate our life and work. … It’s a little countercultural, but I think people are crying out for that, and I think it stands a great chance of making the culture change.”
Stanford’s burgeoning efforts in map career customization have intrigued SHM board member Janet Nagamine, RN, MD, SFHM, a hospitalist at Kaiser Permanente Medical Center in Santa Clara, Calif., and Stanford alum. She hopes to collaborate with Dr. Valantine and incorporate into hospital medicine the interventions that Stanford is doing while conducting studies and developing workforce planning initiatives specific to hospitalists. The goal is to create a hospital medicine model that replicates Stanford’s success in cultivating female physician leaders.
“We make this false assumption that your career is going to look the same throughout your life,” Dr. Nagamine says. “That’s just not realistic.”
Lisa Ryan is a freelance writer in New Jersey.
Whenever Hannah Valantine, MD, needs reassurance that female leadership interventions at Stanford University’s School of Medicine are working, she looks at the numbers.
—Janet Nagamine, RN, MD, SFHM, hospitalist, Kaiser Permanente Medical Center, Santa Clara, Calif., SHM board member
In the span of five to six years, the medical school has increased the percentage of women at each faculty rank so that it now surpasses national averages as calculated by the Association of American Medical Colleges. Indeed, the percentage of women at the full professor rank jumped to 22% from 14.5%.
“We really are making progress,” says Dr. Valantine, full professor of medicine and the medical school’s senior associate dean for diversity and leadership.
With structural elements, such as tenure clock extension, extended maternity and family leave, onsite childcare, early-stage research funding support, and mentoring in place, Dr. Valantine is turning her attention to the next round of interventions, which focus more on the psychological and social factors that impair women’s advancement. She will use a National Institutes of Health grant to develop interventions for the phenomenon of stereotype threat, which is the fear that one's behavior will confirm an existing stereotype about one’s social group. This fear may lead to an impairment of performance.
Over the next six months, Dr. Valantine and her team will also conduct several pilot programs involving map career customization, a model that encourages people to chart their careers over the next five to 10 to 20 years, taking into consideration their life outside of work. The intent is to help individuals identify their priorities and goals and how they change over time, and also help supervisors better match the ebbs and flows of a person’s life to the workplace and identify and develop aspiring leaders.
Stanford’s medical school is organized around teams of doctors that care for groups of patients. Each team must achieve excellence in four academic missions: clinical care, education, research, and administration. The map career customization pilot programs are aimed at helping doctors within the team plan their career paths around these four missions, then put the individual plans together in a team context in order to meet the team’s goals, says Dr. Valantine.
“This way, the work and the four missions are entirely covered,” she says. “We create a vibrant academic environment where we create new things and have time to think and integrate our life and work. … It’s a little countercultural, but I think people are crying out for that, and I think it stands a great chance of making the culture change.”
Stanford’s burgeoning efforts in map career customization have intrigued SHM board member Janet Nagamine, RN, MD, SFHM, a hospitalist at Kaiser Permanente Medical Center in Santa Clara, Calif., and Stanford alum. She hopes to collaborate with Dr. Valantine and incorporate into hospital medicine the interventions that Stanford is doing while conducting studies and developing workforce planning initiatives specific to hospitalists. The goal is to create a hospital medicine model that replicates Stanford’s success in cultivating female physician leaders.
“We make this false assumption that your career is going to look the same throughout your life,” Dr. Nagamine says. “That’s just not realistic.”
Lisa Ryan is a freelance writer in New Jersey.
ONLINE EXCLUSIVE: Listen to a Hospitalist and Career Expert Discuss What It Takes to Be a Leader
Women in Hospital Medicine Have to be Ready, Willing, Proactive
Several years into her hospitalist career, committee work had satisfied Sarita Satpathy, MD’s desire to positively impact patient care. Then she attended SHM’s Leadership Academy and was inspired to do more.
“I thought, ‘I want to do something and actually have a title where I can effect change,’” says Dr. Satpathy, now the hospitalist program medical director for Cogent HMG at Seton Medical Center in Daly City, Calif.
A year and a half after starting from scratch, Dr. Satpathy’s program has improved patient-care continuity, implemented 24/7 coverage, and earned buy-in from specialists, surgeons, and hospital leaders—most of whom are men.
“There aren’t as many female physician leaders, period,” says Dr. Satpathy, speaking of Seton Medical Center.
She could be talking about medicine in general.
Despite the fact that women have made up nearly half of all medical school graduates since 2005-2006 and make up 30% of the total physician population, only 16% of MD faculty at the full professor rank are female.1,2,3 Just 11% and 13% of medical school permanent deans and department chairs are women, respectively.4
Beyond academia, results from surveys conducted by the American College of Healthcare Executives show that female healthcare executives are less likely to be CEOs and chief operating officers than their male counterparts. The results also indicate that the proportion of female CEOs remained fairly stable between surveys in 1990, 1995, 2000, and 2006; the proportion of female vice presidents actually decreased.5
This reality, experts say, undercuts America’s ability to remain at the leading edge of medical research, impedes women’s health improvements, and leaves fewer role models for future generations of physicians. In looking at why female physicians are underrepresented in leadership, key issues emerge, including unconscious bias, outdated work structures, lack of sponsorship, and conflict between the biological and professional time clocks. Although not all female doctors have faced these obstacles, many of them have and still do.
But opportunities are there—especially in HM—for female doctors to step into leadership roles. The onus is on women to seize them and on institutions to create a fertile environment for diverse leadership, physician leaders say.
Leadership Obstacles
Men often are associated with leadership by virtue of a phenomenon called unconscious bias, which posits that people identify certain genders with certain roles due to subconscious cues accumulated over time, says Hannah Valantine, MD, professor of medicine and senior associate dean for diversity and leadership at the Stanford
University School of Medicine in Palo Alto, Calif.
“These biases exist in all of us in the way we evaluate women and their work, in the way we evaluate them for leadership positions and when they’re in leadership positions, and in the thought processes that they have of their own qualifications and actions,” says Molly Carnes, MD, MS, a professor of medicine and industrial and systems engineering and co-director of the Women in Science and Engineering Leadership Institute at the University of Wisconsin at Madison.
Bias also exists in how institutions write their job announcements, performance evaluations, and grant and award applications, Dr. Carnes explains. When such terms as “aggressive” and “risk-taking” are used, women are less likely to be seen as viable candidates, she says.
What often impedes female physicians from taking leadership roles are a lack of sponsorship and obsolete work structures that don’t reflect life in the 21st century.
“There is some thought out there that women nowadays are overmentored and undersponsored,” says Dr. Valantine, a cardiologist. “By ‘sponsored,’ we mean going that extra mile to make sure a woman is promoted into the next level of leadership and into the next level of opportunities. It’s the ‘old boys’ network,’ and, unfortunately for women, there isn’t an old girls’ network that’s as well-oiled.”
Work environments are largely designed for the single breadwinner, even though most households, including physicians, have two earners. As a result, women who seek work flexibility or work part time often are labeled as “not serious about their careers,” Dr. Valantine says. This label affects women, who begin to think they can’t pursue leadership roles because they’re working less than full time, says Rachel George, MD, MBA, CPE, FHM, chief operating officer of the West and North-Central regions and chief medical officer of the West region for Nashville, Tenn.-based Cogent HMG, the largest privately held HM and critical-care company in the nation with partnerships in more than 100 hospitals.
There’s an inherent conflict between the professional and biological time clocks in that when female hospitalists are trained, working for a few years, and ready to accept new challenges, they’re also starting families, says Kim Bell, MD, FACP, SFHM, regional medical director of the Pacific West region for Dallas-based EmCare, a company that provides outsourced physician services, including hospitalist care, in more than 500 hospitals in 40 states.
“Part of the problem is that we look at this as an all or none, that you have to be fully immersed in whatever leadership role it is, and be willing to give a tremendous amount of hours, but that’s really not true,” Dr. George says. “There are different levels of leadership. It’s OK to take it slow and do a little bit, whatever the reasoning may be.”
Dr. Carnes says many women who achieve leadership positions find themselves outside the behavioral norms assigned to women and, therefore, often confront negative reactions and perceptions that they’re disagreeable, arrogant, and superior-minded. Women sometimes get pushback from other women, too.
“When you talk to stay-at-home moms and part-time moms, I think they try and put the guilt trip on you all the time,” says Theresa Rohr-Kirchgraber, MD, board member of the American Women’s Medical Association and executive director of the National Center of Excellence in Women’s Health at Indiana University in Indianapolis.
That, in turn, often compounds the internal guilt many women feel, pitting their work and leadership goals against their responsibilities at home, she says. “There is still a big pull for women to be at home, and when you’re not, you feel guilty about it,” Dr. Rohr-Kirchgraber explains.
Good Things Don’t Come to Those Who Wait
—Kay Cannon, MBA, MCC
Female hospitalists who aspire to lead must take the initiative, experts say.
“Regardless of gender, those individuals who are known to get results, be proactive, and be part of a solution are the ones who gain the attention and, many times, have opportunities open up for advancement,” says Kay Cannon, MBA, MCC, an executive leadership consultant and coach who teaches advanced courses at SHM’s Leadership Academy.
Cathleen Ammann, MD, can attest to that. A year after joining the then-fledgling hospitalist program at Wentworth-Douglass Hospital in Dover, N.H., Dr. Ammann thought she could lead it in a positive direction.
“With zero leadership experience, I went to our CMO, who was basically the administrator for our group, and said, ‘I think I could do a good job with this,’” she says. The CMO concurred, and in October 2006, Dr. Ammann took over the hospitalist program, which she continues to lead today. “They really took a chance with me, and I’m glad they did.”
Dr. Bell says HM, as a whole, has more leadership opportunities than there are trained, capable physicians to do the job—something female hospitalists can take advantage of. But it’s up to women to seize the opportunity, says Mary Jo Gorman, MD, MBA, MHM, who started her career as a hospitalist and is now CEO of Advanced ICU Care, a St. Louis-based firm that connects intensivists to hospital ICU patients via telemedicine.
“Every leadership position that I’ve been in, I got there because I was trying to solve a problem,” says Dr. Gorman, a past president of SHM. “The No. 1 mistake that women make is they don’t step up to volunteer to take responsibility for things; they expect somebody to notice their good work and ask them to lead. Culturally, that’s been shown not to be what happens and not very successful.”
—Mary Jo Gorman, MD, MBA, MHM, CEO, Advanced ICU Care, St. Louis
Where There’s a Will, There’s a Way
Female hospitalists who are interested in leadership need to find an organization that values and encourages their employees to make meaningful contributions, Cannon says. Then they need to join projects and committees in order to develop some leadership qualities, Dr. Ammann says.
“Being involved in one or two committees initially that you strongly believe in, being active, voicing your opinion, and finding ways to find solutions─that’s where you get seen and known,” Dr. Satpathy says. “You actually gain credibility because it’s authentic.”
The old adage “from small beginnings come great things” applies to leadership, Dr. Gorman says.
“If you can complete things regularly and successfully, if you can do that, then the next time you go to a slightly bigger project and then a bigger project and a bigger project, until you’re directing a couple hundred people,” she says.
It’s also important for female physicians to find multiple mentors, Dr. Valantine notes. “You may need a mentor that is within your own discipline who can help guide you about planning your career, writing a grant, doing a project. You might need someone else entirely different who will help you think about when is the right time for you to consider having a family, taking sabbatical, and just integrating your work with life,” she says.
Additionally, female hospitalists pursuing leadership roles must remember that every time they say “yes” to something, they’re saying “no” to something else, Cannon says.
“Too often what I see is women are so eager to please and they’re so driven to be their best, they end up saying ‘yes’ in their career. Then, all of a sudden, they arrive at a point and they say, ‘Something is really missing,’” she says. “If you can get ahead of that and think through things, it’s really going to help your planning.”
Dr. Valantine says female physicians should “take the long view” of leadership and pace themselves.
“Look at this along the entire career path and say, ‘I may not be able to do everything right now, but there might be periods of flexing up and flexing down in my career, and that’s fine,’” she says. “The important thing is to stay in it.”
Dr. Bell and others urge hospitalists who are motivated to lead to tell people in positions of authority that they’re interested; otherwise, they’re not going to be thought of when a position opens.
Dr. Rohr-Kirchgarber has made appointments with deans, associate deans, and faculty affairs staff to introduce herself, explain her expertise, and find ways to use her skill sets in initiatives and committees that are important to the institution.
“Rather than waiting for three or four years for them to find out who I am and think about me for a committee, I need to get out there from Day One,” she says. “It’s proven to be successful.”
Drs. Ammann and Bell encourage hospitalists in community settings to approach their CMOs or other hospital administrators about their leadership aspirations. “And, of course, networking in a professional organization helps,” Dr. Satpathy says.
Meet Halfway
Female physicians can take the initiative and position themselves for leadership roles. They can acquire necessary skills by attending SHM’s Leadership Academy, management classes offered by the American College of Physicians and the American College of Physician Executives, and even adult education courses taught at business schools. But in order for them to be successful leaders, institutions must be invested in the effort.
Organizations can start by defining what they mean by “leadership.”
“‘Leader’ is actually a very abstract concept,” Dr. Carnes says. “But if you break it down into very specific activities, then I think you will get more women saying ‘yes.’ The first thing is getting women to see what leadership can allow them to do.”
—Rachel George, MBA, MCC
Men—and women—also have to acknowledge they have unconscious biases, then work to change the cultural norms, she says.
“Smoking is a really good example,” Dr. Carnes explains. “It took multilevel intervention at the individual and institutional level to change the cultural norms for smoking. You have to have a clear statement by the institution endorsed by all the institutional leaders that this is an institutional priority.” Examples of priorities include eliminating male-gendered words from job announcements and performance evaluations, and ensuring a fair and open application process for leadership positions that allow female physicians to make a case for themselves, she says.
Institutions can implement structural elements to help women—and men—better manage their careers and assume leadership roles, Dr. Valantine says. These include tenure clock extension, extended maternity and family leave, short- and long-term sabbaticals, onsite childcare, and emergency backup childcare.(Read about how Stanford University’s School of Medicine encourages women to seek leadership positions at the-hospitalist.org.)
“When I give talks to women about leadership, I tell them about all the programs we’re doing. I say to them, ‘I hope that you will go out and ask for these programs to be set up in your institutions,” she says. “But, more importantly, I tell women, ‘You have a responsibility to remain standing. It’s going to be tough sometimes, but if you don’t remain standing, we won’t have the role models that we need. It’s going to be a vicious cycle. We just won’t advance and increase the numbers of women leaders.”
Lisa Ryan is a freelance writer based in New Jersey.
References
- Association of American Medical Colleges. Women in U.S. Academic Medicine: Statistics and Benchmarking Report 2009-2010, Table 1. Association of American Medical Colleges website. Available at: https://www.aamc.org/download/170248/data/2010_table1.pdf. Accessed March 2, 2012.
- American Medical Association. Physician Characteristics and Distribution in the US. American Medical Association, 2012. 2012 ed. Chicago: American Medical Association Press; 2011.
- Association of American Medical Colleges. Women in U.S. Academic Medicine: Statistics and Benchmarking Report 2009-2010, Table 4A. Association of American Medical Colleges website. Available at: https://www.aamc.org/download/170254/data/2009_table04a.pdf. Accessed March 2, 2012.
- Association of American Medical Colleges. Women in U.S. Academic Medicine: Statistics and Benchmarking Report 2009-2010, Figure 5. Association of American Medical Colleges website. Available at: https://www.aamc.org/download/179458/data/2009_figure05.pdf. Accessed March 2, 2012.
- American College of Healthcare Executives. A Comparison of the Career Attainments of Men and Women Healthcare Executives: 2006, Table 2. American College of Healthcare Executives website. Available at: http://www.ache.org/pubs/research/gender_study_full_report.pdf. Accessed March 2, 2012.
Several years into her hospitalist career, committee work had satisfied Sarita Satpathy, MD’s desire to positively impact patient care. Then she attended SHM’s Leadership Academy and was inspired to do more.
“I thought, ‘I want to do something and actually have a title where I can effect change,’” says Dr. Satpathy, now the hospitalist program medical director for Cogent HMG at Seton Medical Center in Daly City, Calif.
A year and a half after starting from scratch, Dr. Satpathy’s program has improved patient-care continuity, implemented 24/7 coverage, and earned buy-in from specialists, surgeons, and hospital leaders—most of whom are men.
“There aren’t as many female physician leaders, period,” says Dr. Satpathy, speaking of Seton Medical Center.
She could be talking about medicine in general.
Despite the fact that women have made up nearly half of all medical school graduates since 2005-2006 and make up 30% of the total physician population, only 16% of MD faculty at the full professor rank are female.1,2,3 Just 11% and 13% of medical school permanent deans and department chairs are women, respectively.4
Beyond academia, results from surveys conducted by the American College of Healthcare Executives show that female healthcare executives are less likely to be CEOs and chief operating officers than their male counterparts. The results also indicate that the proportion of female CEOs remained fairly stable between surveys in 1990, 1995, 2000, and 2006; the proportion of female vice presidents actually decreased.5
This reality, experts say, undercuts America’s ability to remain at the leading edge of medical research, impedes women’s health improvements, and leaves fewer role models for future generations of physicians. In looking at why female physicians are underrepresented in leadership, key issues emerge, including unconscious bias, outdated work structures, lack of sponsorship, and conflict between the biological and professional time clocks. Although not all female doctors have faced these obstacles, many of them have and still do.
But opportunities are there—especially in HM—for female doctors to step into leadership roles. The onus is on women to seize them and on institutions to create a fertile environment for diverse leadership, physician leaders say.
Leadership Obstacles
Men often are associated with leadership by virtue of a phenomenon called unconscious bias, which posits that people identify certain genders with certain roles due to subconscious cues accumulated over time, says Hannah Valantine, MD, professor of medicine and senior associate dean for diversity and leadership at the Stanford
University School of Medicine in Palo Alto, Calif.
“These biases exist in all of us in the way we evaluate women and their work, in the way we evaluate them for leadership positions and when they’re in leadership positions, and in the thought processes that they have of their own qualifications and actions,” says Molly Carnes, MD, MS, a professor of medicine and industrial and systems engineering and co-director of the Women in Science and Engineering Leadership Institute at the University of Wisconsin at Madison.
Bias also exists in how institutions write their job announcements, performance evaluations, and grant and award applications, Dr. Carnes explains. When such terms as “aggressive” and “risk-taking” are used, women are less likely to be seen as viable candidates, she says.
What often impedes female physicians from taking leadership roles are a lack of sponsorship and obsolete work structures that don’t reflect life in the 21st century.
“There is some thought out there that women nowadays are overmentored and undersponsored,” says Dr. Valantine, a cardiologist. “By ‘sponsored,’ we mean going that extra mile to make sure a woman is promoted into the next level of leadership and into the next level of opportunities. It’s the ‘old boys’ network,’ and, unfortunately for women, there isn’t an old girls’ network that’s as well-oiled.”
Work environments are largely designed for the single breadwinner, even though most households, including physicians, have two earners. As a result, women who seek work flexibility or work part time often are labeled as “not serious about their careers,” Dr. Valantine says. This label affects women, who begin to think they can’t pursue leadership roles because they’re working less than full time, says Rachel George, MD, MBA, CPE, FHM, chief operating officer of the West and North-Central regions and chief medical officer of the West region for Nashville, Tenn.-based Cogent HMG, the largest privately held HM and critical-care company in the nation with partnerships in more than 100 hospitals.
There’s an inherent conflict between the professional and biological time clocks in that when female hospitalists are trained, working for a few years, and ready to accept new challenges, they’re also starting families, says Kim Bell, MD, FACP, SFHM, regional medical director of the Pacific West region for Dallas-based EmCare, a company that provides outsourced physician services, including hospitalist care, in more than 500 hospitals in 40 states.
“Part of the problem is that we look at this as an all or none, that you have to be fully immersed in whatever leadership role it is, and be willing to give a tremendous amount of hours, but that’s really not true,” Dr. George says. “There are different levels of leadership. It’s OK to take it slow and do a little bit, whatever the reasoning may be.”
Dr. Carnes says many women who achieve leadership positions find themselves outside the behavioral norms assigned to women and, therefore, often confront negative reactions and perceptions that they’re disagreeable, arrogant, and superior-minded. Women sometimes get pushback from other women, too.
“When you talk to stay-at-home moms and part-time moms, I think they try and put the guilt trip on you all the time,” says Theresa Rohr-Kirchgraber, MD, board member of the American Women’s Medical Association and executive director of the National Center of Excellence in Women’s Health at Indiana University in Indianapolis.
That, in turn, often compounds the internal guilt many women feel, pitting their work and leadership goals against their responsibilities at home, she says. “There is still a big pull for women to be at home, and when you’re not, you feel guilty about it,” Dr. Rohr-Kirchgraber explains.
Good Things Don’t Come to Those Who Wait
—Kay Cannon, MBA, MCC
Female hospitalists who aspire to lead must take the initiative, experts say.
“Regardless of gender, those individuals who are known to get results, be proactive, and be part of a solution are the ones who gain the attention and, many times, have opportunities open up for advancement,” says Kay Cannon, MBA, MCC, an executive leadership consultant and coach who teaches advanced courses at SHM’s Leadership Academy.
Cathleen Ammann, MD, can attest to that. A year after joining the then-fledgling hospitalist program at Wentworth-Douglass Hospital in Dover, N.H., Dr. Ammann thought she could lead it in a positive direction.
“With zero leadership experience, I went to our CMO, who was basically the administrator for our group, and said, ‘I think I could do a good job with this,’” she says. The CMO concurred, and in October 2006, Dr. Ammann took over the hospitalist program, which she continues to lead today. “They really took a chance with me, and I’m glad they did.”
Dr. Bell says HM, as a whole, has more leadership opportunities than there are trained, capable physicians to do the job—something female hospitalists can take advantage of. But it’s up to women to seize the opportunity, says Mary Jo Gorman, MD, MBA, MHM, who started her career as a hospitalist and is now CEO of Advanced ICU Care, a St. Louis-based firm that connects intensivists to hospital ICU patients via telemedicine.
“Every leadership position that I’ve been in, I got there because I was trying to solve a problem,” says Dr. Gorman, a past president of SHM. “The No. 1 mistake that women make is they don’t step up to volunteer to take responsibility for things; they expect somebody to notice their good work and ask them to lead. Culturally, that’s been shown not to be what happens and not very successful.”
—Mary Jo Gorman, MD, MBA, MHM, CEO, Advanced ICU Care, St. Louis
Where There’s a Will, There’s a Way
Female hospitalists who are interested in leadership need to find an organization that values and encourages their employees to make meaningful contributions, Cannon says. Then they need to join projects and committees in order to develop some leadership qualities, Dr. Ammann says.
“Being involved in one or two committees initially that you strongly believe in, being active, voicing your opinion, and finding ways to find solutions─that’s where you get seen and known,” Dr. Satpathy says. “You actually gain credibility because it’s authentic.”
The old adage “from small beginnings come great things” applies to leadership, Dr. Gorman says.
“If you can complete things regularly and successfully, if you can do that, then the next time you go to a slightly bigger project and then a bigger project and a bigger project, until you’re directing a couple hundred people,” she says.
It’s also important for female physicians to find multiple mentors, Dr. Valantine notes. “You may need a mentor that is within your own discipline who can help guide you about planning your career, writing a grant, doing a project. You might need someone else entirely different who will help you think about when is the right time for you to consider having a family, taking sabbatical, and just integrating your work with life,” she says.
Additionally, female hospitalists pursuing leadership roles must remember that every time they say “yes” to something, they’re saying “no” to something else, Cannon says.
“Too often what I see is women are so eager to please and they’re so driven to be their best, they end up saying ‘yes’ in their career. Then, all of a sudden, they arrive at a point and they say, ‘Something is really missing,’” she says. “If you can get ahead of that and think through things, it’s really going to help your planning.”
Dr. Valantine says female physicians should “take the long view” of leadership and pace themselves.
“Look at this along the entire career path and say, ‘I may not be able to do everything right now, but there might be periods of flexing up and flexing down in my career, and that’s fine,’” she says. “The important thing is to stay in it.”
Dr. Bell and others urge hospitalists who are motivated to lead to tell people in positions of authority that they’re interested; otherwise, they’re not going to be thought of when a position opens.
Dr. Rohr-Kirchgarber has made appointments with deans, associate deans, and faculty affairs staff to introduce herself, explain her expertise, and find ways to use her skill sets in initiatives and committees that are important to the institution.
“Rather than waiting for three or four years for them to find out who I am and think about me for a committee, I need to get out there from Day One,” she says. “It’s proven to be successful.”
Drs. Ammann and Bell encourage hospitalists in community settings to approach their CMOs or other hospital administrators about their leadership aspirations. “And, of course, networking in a professional organization helps,” Dr. Satpathy says.
Meet Halfway
Female physicians can take the initiative and position themselves for leadership roles. They can acquire necessary skills by attending SHM’s Leadership Academy, management classes offered by the American College of Physicians and the American College of Physician Executives, and even adult education courses taught at business schools. But in order for them to be successful leaders, institutions must be invested in the effort.
Organizations can start by defining what they mean by “leadership.”
“‘Leader’ is actually a very abstract concept,” Dr. Carnes says. “But if you break it down into very specific activities, then I think you will get more women saying ‘yes.’ The first thing is getting women to see what leadership can allow them to do.”
—Rachel George, MBA, MCC
Men—and women—also have to acknowledge they have unconscious biases, then work to change the cultural norms, she says.
“Smoking is a really good example,” Dr. Carnes explains. “It took multilevel intervention at the individual and institutional level to change the cultural norms for smoking. You have to have a clear statement by the institution endorsed by all the institutional leaders that this is an institutional priority.” Examples of priorities include eliminating male-gendered words from job announcements and performance evaluations, and ensuring a fair and open application process for leadership positions that allow female physicians to make a case for themselves, she says.
Institutions can implement structural elements to help women—and men—better manage their careers and assume leadership roles, Dr. Valantine says. These include tenure clock extension, extended maternity and family leave, short- and long-term sabbaticals, onsite childcare, and emergency backup childcare.(Read about how Stanford University’s School of Medicine encourages women to seek leadership positions at the-hospitalist.org.)
“When I give talks to women about leadership, I tell them about all the programs we’re doing. I say to them, ‘I hope that you will go out and ask for these programs to be set up in your institutions,” she says. “But, more importantly, I tell women, ‘You have a responsibility to remain standing. It’s going to be tough sometimes, but if you don’t remain standing, we won’t have the role models that we need. It’s going to be a vicious cycle. We just won’t advance and increase the numbers of women leaders.”
Lisa Ryan is a freelance writer based in New Jersey.
References
- Association of American Medical Colleges. Women in U.S. Academic Medicine: Statistics and Benchmarking Report 2009-2010, Table 1. Association of American Medical Colleges website. Available at: https://www.aamc.org/download/170248/data/2010_table1.pdf. Accessed March 2, 2012.
- American Medical Association. Physician Characteristics and Distribution in the US. American Medical Association, 2012. 2012 ed. Chicago: American Medical Association Press; 2011.
- Association of American Medical Colleges. Women in U.S. Academic Medicine: Statistics and Benchmarking Report 2009-2010, Table 4A. Association of American Medical Colleges website. Available at: https://www.aamc.org/download/170254/data/2009_table04a.pdf. Accessed March 2, 2012.
- Association of American Medical Colleges. Women in U.S. Academic Medicine: Statistics and Benchmarking Report 2009-2010, Figure 5. Association of American Medical Colleges website. Available at: https://www.aamc.org/download/179458/data/2009_figure05.pdf. Accessed March 2, 2012.
- American College of Healthcare Executives. A Comparison of the Career Attainments of Men and Women Healthcare Executives: 2006, Table 2. American College of Healthcare Executives website. Available at: http://www.ache.org/pubs/research/gender_study_full_report.pdf. Accessed March 2, 2012.
Several years into her hospitalist career, committee work had satisfied Sarita Satpathy, MD’s desire to positively impact patient care. Then she attended SHM’s Leadership Academy and was inspired to do more.
“I thought, ‘I want to do something and actually have a title where I can effect change,’” says Dr. Satpathy, now the hospitalist program medical director for Cogent HMG at Seton Medical Center in Daly City, Calif.
A year and a half after starting from scratch, Dr. Satpathy’s program has improved patient-care continuity, implemented 24/7 coverage, and earned buy-in from specialists, surgeons, and hospital leaders—most of whom are men.
“There aren’t as many female physician leaders, period,” says Dr. Satpathy, speaking of Seton Medical Center.
She could be talking about medicine in general.
Despite the fact that women have made up nearly half of all medical school graduates since 2005-2006 and make up 30% of the total physician population, only 16% of MD faculty at the full professor rank are female.1,2,3 Just 11% and 13% of medical school permanent deans and department chairs are women, respectively.4
Beyond academia, results from surveys conducted by the American College of Healthcare Executives show that female healthcare executives are less likely to be CEOs and chief operating officers than their male counterparts. The results also indicate that the proportion of female CEOs remained fairly stable between surveys in 1990, 1995, 2000, and 2006; the proportion of female vice presidents actually decreased.5
This reality, experts say, undercuts America’s ability to remain at the leading edge of medical research, impedes women’s health improvements, and leaves fewer role models for future generations of physicians. In looking at why female physicians are underrepresented in leadership, key issues emerge, including unconscious bias, outdated work structures, lack of sponsorship, and conflict between the biological and professional time clocks. Although not all female doctors have faced these obstacles, many of them have and still do.
But opportunities are there—especially in HM—for female doctors to step into leadership roles. The onus is on women to seize them and on institutions to create a fertile environment for diverse leadership, physician leaders say.
Leadership Obstacles
Men often are associated with leadership by virtue of a phenomenon called unconscious bias, which posits that people identify certain genders with certain roles due to subconscious cues accumulated over time, says Hannah Valantine, MD, professor of medicine and senior associate dean for diversity and leadership at the Stanford
University School of Medicine in Palo Alto, Calif.
“These biases exist in all of us in the way we evaluate women and their work, in the way we evaluate them for leadership positions and when they’re in leadership positions, and in the thought processes that they have of their own qualifications and actions,” says Molly Carnes, MD, MS, a professor of medicine and industrial and systems engineering and co-director of the Women in Science and Engineering Leadership Institute at the University of Wisconsin at Madison.
Bias also exists in how institutions write their job announcements, performance evaluations, and grant and award applications, Dr. Carnes explains. When such terms as “aggressive” and “risk-taking” are used, women are less likely to be seen as viable candidates, she says.
What often impedes female physicians from taking leadership roles are a lack of sponsorship and obsolete work structures that don’t reflect life in the 21st century.
“There is some thought out there that women nowadays are overmentored and undersponsored,” says Dr. Valantine, a cardiologist. “By ‘sponsored,’ we mean going that extra mile to make sure a woman is promoted into the next level of leadership and into the next level of opportunities. It’s the ‘old boys’ network,’ and, unfortunately for women, there isn’t an old girls’ network that’s as well-oiled.”
Work environments are largely designed for the single breadwinner, even though most households, including physicians, have two earners. As a result, women who seek work flexibility or work part time often are labeled as “not serious about their careers,” Dr. Valantine says. This label affects women, who begin to think they can’t pursue leadership roles because they’re working less than full time, says Rachel George, MD, MBA, CPE, FHM, chief operating officer of the West and North-Central regions and chief medical officer of the West region for Nashville, Tenn.-based Cogent HMG, the largest privately held HM and critical-care company in the nation with partnerships in more than 100 hospitals.
There’s an inherent conflict between the professional and biological time clocks in that when female hospitalists are trained, working for a few years, and ready to accept new challenges, they’re also starting families, says Kim Bell, MD, FACP, SFHM, regional medical director of the Pacific West region for Dallas-based EmCare, a company that provides outsourced physician services, including hospitalist care, in more than 500 hospitals in 40 states.
“Part of the problem is that we look at this as an all or none, that you have to be fully immersed in whatever leadership role it is, and be willing to give a tremendous amount of hours, but that’s really not true,” Dr. George says. “There are different levels of leadership. It’s OK to take it slow and do a little bit, whatever the reasoning may be.”
Dr. Carnes says many women who achieve leadership positions find themselves outside the behavioral norms assigned to women and, therefore, often confront negative reactions and perceptions that they’re disagreeable, arrogant, and superior-minded. Women sometimes get pushback from other women, too.
“When you talk to stay-at-home moms and part-time moms, I think they try and put the guilt trip on you all the time,” says Theresa Rohr-Kirchgraber, MD, board member of the American Women’s Medical Association and executive director of the National Center of Excellence in Women’s Health at Indiana University in Indianapolis.
That, in turn, often compounds the internal guilt many women feel, pitting their work and leadership goals against their responsibilities at home, she says. “There is still a big pull for women to be at home, and when you’re not, you feel guilty about it,” Dr. Rohr-Kirchgraber explains.
Good Things Don’t Come to Those Who Wait
—Kay Cannon, MBA, MCC
Female hospitalists who aspire to lead must take the initiative, experts say.
“Regardless of gender, those individuals who are known to get results, be proactive, and be part of a solution are the ones who gain the attention and, many times, have opportunities open up for advancement,” says Kay Cannon, MBA, MCC, an executive leadership consultant and coach who teaches advanced courses at SHM’s Leadership Academy.
Cathleen Ammann, MD, can attest to that. A year after joining the then-fledgling hospitalist program at Wentworth-Douglass Hospital in Dover, N.H., Dr. Ammann thought she could lead it in a positive direction.
“With zero leadership experience, I went to our CMO, who was basically the administrator for our group, and said, ‘I think I could do a good job with this,’” she says. The CMO concurred, and in October 2006, Dr. Ammann took over the hospitalist program, which she continues to lead today. “They really took a chance with me, and I’m glad they did.”
Dr. Bell says HM, as a whole, has more leadership opportunities than there are trained, capable physicians to do the job—something female hospitalists can take advantage of. But it’s up to women to seize the opportunity, says Mary Jo Gorman, MD, MBA, MHM, who started her career as a hospitalist and is now CEO of Advanced ICU Care, a St. Louis-based firm that connects intensivists to hospital ICU patients via telemedicine.
“Every leadership position that I’ve been in, I got there because I was trying to solve a problem,” says Dr. Gorman, a past president of SHM. “The No. 1 mistake that women make is they don’t step up to volunteer to take responsibility for things; they expect somebody to notice their good work and ask them to lead. Culturally, that’s been shown not to be what happens and not very successful.”
—Mary Jo Gorman, MD, MBA, MHM, CEO, Advanced ICU Care, St. Louis
Where There’s a Will, There’s a Way
Female hospitalists who are interested in leadership need to find an organization that values and encourages their employees to make meaningful contributions, Cannon says. Then they need to join projects and committees in order to develop some leadership qualities, Dr. Ammann says.
“Being involved in one or two committees initially that you strongly believe in, being active, voicing your opinion, and finding ways to find solutions─that’s where you get seen and known,” Dr. Satpathy says. “You actually gain credibility because it’s authentic.”
The old adage “from small beginnings come great things” applies to leadership, Dr. Gorman says.
“If you can complete things regularly and successfully, if you can do that, then the next time you go to a slightly bigger project and then a bigger project and a bigger project, until you’re directing a couple hundred people,” she says.
It’s also important for female physicians to find multiple mentors, Dr. Valantine notes. “You may need a mentor that is within your own discipline who can help guide you about planning your career, writing a grant, doing a project. You might need someone else entirely different who will help you think about when is the right time for you to consider having a family, taking sabbatical, and just integrating your work with life,” she says.
Additionally, female hospitalists pursuing leadership roles must remember that every time they say “yes” to something, they’re saying “no” to something else, Cannon says.
“Too often what I see is women are so eager to please and they’re so driven to be their best, they end up saying ‘yes’ in their career. Then, all of a sudden, they arrive at a point and they say, ‘Something is really missing,’” she says. “If you can get ahead of that and think through things, it’s really going to help your planning.”
Dr. Valantine says female physicians should “take the long view” of leadership and pace themselves.
“Look at this along the entire career path and say, ‘I may not be able to do everything right now, but there might be periods of flexing up and flexing down in my career, and that’s fine,’” she says. “The important thing is to stay in it.”
Dr. Bell and others urge hospitalists who are motivated to lead to tell people in positions of authority that they’re interested; otherwise, they’re not going to be thought of when a position opens.
Dr. Rohr-Kirchgarber has made appointments with deans, associate deans, and faculty affairs staff to introduce herself, explain her expertise, and find ways to use her skill sets in initiatives and committees that are important to the institution.
“Rather than waiting for three or four years for them to find out who I am and think about me for a committee, I need to get out there from Day One,” she says. “It’s proven to be successful.”
Drs. Ammann and Bell encourage hospitalists in community settings to approach their CMOs or other hospital administrators about their leadership aspirations. “And, of course, networking in a professional organization helps,” Dr. Satpathy says.
Meet Halfway
Female physicians can take the initiative and position themselves for leadership roles. They can acquire necessary skills by attending SHM’s Leadership Academy, management classes offered by the American College of Physicians and the American College of Physician Executives, and even adult education courses taught at business schools. But in order for them to be successful leaders, institutions must be invested in the effort.
Organizations can start by defining what they mean by “leadership.”
“‘Leader’ is actually a very abstract concept,” Dr. Carnes says. “But if you break it down into very specific activities, then I think you will get more women saying ‘yes.’ The first thing is getting women to see what leadership can allow them to do.”
—Rachel George, MBA, MCC
Men—and women—also have to acknowledge they have unconscious biases, then work to change the cultural norms, she says.
“Smoking is a really good example,” Dr. Carnes explains. “It took multilevel intervention at the individual and institutional level to change the cultural norms for smoking. You have to have a clear statement by the institution endorsed by all the institutional leaders that this is an institutional priority.” Examples of priorities include eliminating male-gendered words from job announcements and performance evaluations, and ensuring a fair and open application process for leadership positions that allow female physicians to make a case for themselves, she says.
Institutions can implement structural elements to help women—and men—better manage their careers and assume leadership roles, Dr. Valantine says. These include tenure clock extension, extended maternity and family leave, short- and long-term sabbaticals, onsite childcare, and emergency backup childcare.(Read about how Stanford University’s School of Medicine encourages women to seek leadership positions at the-hospitalist.org.)
“When I give talks to women about leadership, I tell them about all the programs we’re doing. I say to them, ‘I hope that you will go out and ask for these programs to be set up in your institutions,” she says. “But, more importantly, I tell women, ‘You have a responsibility to remain standing. It’s going to be tough sometimes, but if you don’t remain standing, we won’t have the role models that we need. It’s going to be a vicious cycle. We just won’t advance and increase the numbers of women leaders.”
Lisa Ryan is a freelance writer based in New Jersey.
References
- Association of American Medical Colleges. Women in U.S. Academic Medicine: Statistics and Benchmarking Report 2009-2010, Table 1. Association of American Medical Colleges website. Available at: https://www.aamc.org/download/170248/data/2010_table1.pdf. Accessed March 2, 2012.
- American Medical Association. Physician Characteristics and Distribution in the US. American Medical Association, 2012. 2012 ed. Chicago: American Medical Association Press; 2011.
- Association of American Medical Colleges. Women in U.S. Academic Medicine: Statistics and Benchmarking Report 2009-2010, Table 4A. Association of American Medical Colleges website. Available at: https://www.aamc.org/download/170254/data/2009_table04a.pdf. Accessed March 2, 2012.
- Association of American Medical Colleges. Women in U.S. Academic Medicine: Statistics and Benchmarking Report 2009-2010, Figure 5. Association of American Medical Colleges website. Available at: https://www.aamc.org/download/179458/data/2009_figure05.pdf. Accessed March 2, 2012.
- American College of Healthcare Executives. A Comparison of the Career Attainments of Men and Women Healthcare Executives: 2006, Table 2. American College of Healthcare Executives website. Available at: http://www.ache.org/pubs/research/gender_study_full_report.pdf. Accessed March 2, 2012.
Leadership Tools for Hospitalists
- Command of Clinical Care. “First and foremost, you have to be a good hospitalist,” Dr. George says. “You cannot lead a group of physicians unless they respect the quality of your medical care.”
- Transformational leadership. “This is inspiring members of an organization toward a common vision and getting workers to invest energies beyond their own self-interest,” Dr. Carnes says. “That includes things like mentoring your subordinates and taking a personal interest in trying to form a community.”
- Vision/strategic thinking. “You need to understand where your organization is today and envision what the threats to the organization could be or the opportunities for the organization,” Dr. Gorman says. “If a leader doesn’t have an idea of the direction they should go, then they can’t really lead anywhere.”
- Communication. “You have to be able to communicate with a large, diverse audience that includes your colleagues, the administration of the hospital, providers in the community, and your supervisor or direct report,” Dr. Bell says.
- Active listening. “This is really being able to listen to what an individual is saying and what they’re not saying, and to set aside your own preconceived notions, opinions, filters, and judgments, so that you’re truly hearing what the other person has to say,” Cannon says.
- Consensus-building. “A good leader has the ability to work with others, break down barriers, and get that buy-in,” Dr. Ammann says. “The more people you can bring into a project to work on it together, the better.”
- Determination. “If you have a goal, you have to really be steadfast in achieving it,” Dr. Satpathy says. “You’re going to have so many pitfalls along the way that you can’t ever just say, ‘This isn’t going to work.’”
- Open-mindedness. “You have to be able to be unbiased─i.e., try to evaluate whatever the circumstance is from more than one perspective,” Dr. Bell says. “When an issue or problem is brought to you, you really need to hear both sides of the story before you reach a conclusion.”
- Willingness to seek advice. “If you have a view of where you want to go and you’re not getting there, find the right people who can give you some thoughts on how you can approach the issue,” Dr. Gorman says.
- Managerial competence. “If the practice is not financially viable, then the practice will cease to exist,” Dr. Bell says. “So you have to understand the balance between the financial realities and clinical needs of the practice.”
- Command of Clinical Care. “First and foremost, you have to be a good hospitalist,” Dr. George says. “You cannot lead a group of physicians unless they respect the quality of your medical care.”
- Transformational leadership. “This is inspiring members of an organization toward a common vision and getting workers to invest energies beyond their own self-interest,” Dr. Carnes says. “That includes things like mentoring your subordinates and taking a personal interest in trying to form a community.”
- Vision/strategic thinking. “You need to understand where your organization is today and envision what the threats to the organization could be or the opportunities for the organization,” Dr. Gorman says. “If a leader doesn’t have an idea of the direction they should go, then they can’t really lead anywhere.”
- Communication. “You have to be able to communicate with a large, diverse audience that includes your colleagues, the administration of the hospital, providers in the community, and your supervisor or direct report,” Dr. Bell says.
- Active listening. “This is really being able to listen to what an individual is saying and what they’re not saying, and to set aside your own preconceived notions, opinions, filters, and judgments, so that you’re truly hearing what the other person has to say,” Cannon says.
- Consensus-building. “A good leader has the ability to work with others, break down barriers, and get that buy-in,” Dr. Ammann says. “The more people you can bring into a project to work on it together, the better.”
- Determination. “If you have a goal, you have to really be steadfast in achieving it,” Dr. Satpathy says. “You’re going to have so many pitfalls along the way that you can’t ever just say, ‘This isn’t going to work.’”
- Open-mindedness. “You have to be able to be unbiased─i.e., try to evaluate whatever the circumstance is from more than one perspective,” Dr. Bell says. “When an issue or problem is brought to you, you really need to hear both sides of the story before you reach a conclusion.”
- Willingness to seek advice. “If you have a view of where you want to go and you’re not getting there, find the right people who can give you some thoughts on how you can approach the issue,” Dr. Gorman says.
- Managerial competence. “If the practice is not financially viable, then the practice will cease to exist,” Dr. Bell says. “So you have to understand the balance between the financial realities and clinical needs of the practice.”
- Command of Clinical Care. “First and foremost, you have to be a good hospitalist,” Dr. George says. “You cannot lead a group of physicians unless they respect the quality of your medical care.”
- Transformational leadership. “This is inspiring members of an organization toward a common vision and getting workers to invest energies beyond their own self-interest,” Dr. Carnes says. “That includes things like mentoring your subordinates and taking a personal interest in trying to form a community.”
- Vision/strategic thinking. “You need to understand where your organization is today and envision what the threats to the organization could be or the opportunities for the organization,” Dr. Gorman says. “If a leader doesn’t have an idea of the direction they should go, then they can’t really lead anywhere.”
- Communication. “You have to be able to communicate with a large, diverse audience that includes your colleagues, the administration of the hospital, providers in the community, and your supervisor or direct report,” Dr. Bell says.
- Active listening. “This is really being able to listen to what an individual is saying and what they’re not saying, and to set aside your own preconceived notions, opinions, filters, and judgments, so that you’re truly hearing what the other person has to say,” Cannon says.
- Consensus-building. “A good leader has the ability to work with others, break down barriers, and get that buy-in,” Dr. Ammann says. “The more people you can bring into a project to work on it together, the better.”
- Determination. “If you have a goal, you have to really be steadfast in achieving it,” Dr. Satpathy says. “You’re going to have so many pitfalls along the way that you can’t ever just say, ‘This isn’t going to work.’”
- Open-mindedness. “You have to be able to be unbiased─i.e., try to evaluate whatever the circumstance is from more than one perspective,” Dr. Bell says. “When an issue or problem is brought to you, you really need to hear both sides of the story before you reach a conclusion.”
- Willingness to seek advice. “If you have a view of where you want to go and you’re not getting there, find the right people who can give you some thoughts on how you can approach the issue,” Dr. Gorman says.
- Managerial competence. “If the practice is not financially viable, then the practice will cease to exist,” Dr. Bell says. “So you have to understand the balance between the financial realities and clinical needs of the practice.”
ONLINE EXCLUSIVE: How the School of Medicine at Stanford University Is Addressing Women Physicians and Leadership
Whenever Hannah Valantine, MD, needs reassurance that women leadership interventions at Stanford University’s School of Medicine are working, she looks at the numbers.
In the span of five to six years, the medical school increased the percentage of women at each faculty rank so that it now surpasses national averages as calculated by the Association of American Medical Colleges. Indeed, the percentage of women at the full professor rank jumped from 14.5 percent to 22 percent.
“We really are making progress,” says Dr. Valantine, full professor of medicine and the medical school’s senior associate dean for diversity and leadership.
With structural elements such as tenure clock extension, extended maternity and family leave, onsite childcare, early stage research funding support, and mentoring in place, Dr. Valantine is turning her attention to the next round of interventions, which focus more on psychological and social factors impairing women’s advancement.
She will use a National Institutes of Health grant to develop interventions for the phenomenon of stereotype threat, which is the fear that one's behavior will confirm an existing stereotype about one’s social group. This fear may lead to an impairment of performance.
Over the next six months, Dr. Valantine and her team will also conduct several pilot programs involving map career customization, a model that encourages people to chart their career over the next 5 to 10 to 20 years, taking into consideration their life outside of work. The intent is to help individuals identify their priorities and goals and how they change over time, and also help supervisors better match the ebbs and flows of a person’s life to the workplace and identify and develop aspiring leaders.
Stanford’s medical school is organized around teams of doctors that care for groups of patients. Each team must achieve excellence in four academic missions: clinical care, education, research, and administration. The map career customization pilot programs are aimed at helping doctors within the team plan their career path around these four missions and then putting the individual plans together in a team context in order to meet the team’s goals, says Dr. Valantine.
“This way the work and the four missions are entirely covered,” she says. “We create a vibrant academic environment where we create new things and have time to think and integrate our life and work… It’s a little countercultural, but I think people are crying out for that and I think it stands a great chance of making the culture change.”
Stanford’s burgeoning efforts in map career customization have intrigued SHM board member Janet Nagamine, RN, MD, FHM, a hospitalist at Kaiser Permanente Medical Center in Santa Clara, Calif., and Stanford alum.
She hopes to collaborate with Dr. Valantine and incorporate in hospital medicine the interventions that Stanford is doing while conducting studies and developing workforce planning initiatives specific to hospitalists. The goal is to create a hospital medicine model that replicates Stanford’s success in cultivating women physician leaders.
“We make this false assumption that your career is going to look the same throughout your life and that’s just not realistic,” Dr. Nagamine says.
Whenever Hannah Valantine, MD, needs reassurance that women leadership interventions at Stanford University’s School of Medicine are working, she looks at the numbers.
In the span of five to six years, the medical school increased the percentage of women at each faculty rank so that it now surpasses national averages as calculated by the Association of American Medical Colleges. Indeed, the percentage of women at the full professor rank jumped from 14.5 percent to 22 percent.
“We really are making progress,” says Dr. Valantine, full professor of medicine and the medical school’s senior associate dean for diversity and leadership.
With structural elements such as tenure clock extension, extended maternity and family leave, onsite childcare, early stage research funding support, and mentoring in place, Dr. Valantine is turning her attention to the next round of interventions, which focus more on psychological and social factors impairing women’s advancement.
She will use a National Institutes of Health grant to develop interventions for the phenomenon of stereotype threat, which is the fear that one's behavior will confirm an existing stereotype about one’s social group. This fear may lead to an impairment of performance.
Over the next six months, Dr. Valantine and her team will also conduct several pilot programs involving map career customization, a model that encourages people to chart their career over the next 5 to 10 to 20 years, taking into consideration their life outside of work. The intent is to help individuals identify their priorities and goals and how they change over time, and also help supervisors better match the ebbs and flows of a person’s life to the workplace and identify and develop aspiring leaders.
Stanford’s medical school is organized around teams of doctors that care for groups of patients. Each team must achieve excellence in four academic missions: clinical care, education, research, and administration. The map career customization pilot programs are aimed at helping doctors within the team plan their career path around these four missions and then putting the individual plans together in a team context in order to meet the team’s goals, says Dr. Valantine.
“This way the work and the four missions are entirely covered,” she says. “We create a vibrant academic environment where we create new things and have time to think and integrate our life and work… It’s a little countercultural, but I think people are crying out for that and I think it stands a great chance of making the culture change.”
Stanford’s burgeoning efforts in map career customization have intrigued SHM board member Janet Nagamine, RN, MD, FHM, a hospitalist at Kaiser Permanente Medical Center in Santa Clara, Calif., and Stanford alum.
She hopes to collaborate with Dr. Valantine and incorporate in hospital medicine the interventions that Stanford is doing while conducting studies and developing workforce planning initiatives specific to hospitalists. The goal is to create a hospital medicine model that replicates Stanford’s success in cultivating women physician leaders.
“We make this false assumption that your career is going to look the same throughout your life and that’s just not realistic,” Dr. Nagamine says.
Whenever Hannah Valantine, MD, needs reassurance that women leadership interventions at Stanford University’s School of Medicine are working, she looks at the numbers.
In the span of five to six years, the medical school increased the percentage of women at each faculty rank so that it now surpasses national averages as calculated by the Association of American Medical Colleges. Indeed, the percentage of women at the full professor rank jumped from 14.5 percent to 22 percent.
“We really are making progress,” says Dr. Valantine, full professor of medicine and the medical school’s senior associate dean for diversity and leadership.
With structural elements such as tenure clock extension, extended maternity and family leave, onsite childcare, early stage research funding support, and mentoring in place, Dr. Valantine is turning her attention to the next round of interventions, which focus more on psychological and social factors impairing women’s advancement.
She will use a National Institutes of Health grant to develop interventions for the phenomenon of stereotype threat, which is the fear that one's behavior will confirm an existing stereotype about one’s social group. This fear may lead to an impairment of performance.
Over the next six months, Dr. Valantine and her team will also conduct several pilot programs involving map career customization, a model that encourages people to chart their career over the next 5 to 10 to 20 years, taking into consideration their life outside of work. The intent is to help individuals identify their priorities and goals and how they change over time, and also help supervisors better match the ebbs and flows of a person’s life to the workplace and identify and develop aspiring leaders.
Stanford’s medical school is organized around teams of doctors that care for groups of patients. Each team must achieve excellence in four academic missions: clinical care, education, research, and administration. The map career customization pilot programs are aimed at helping doctors within the team plan their career path around these four missions and then putting the individual plans together in a team context in order to meet the team’s goals, says Dr. Valantine.
“This way the work and the four missions are entirely covered,” she says. “We create a vibrant academic environment where we create new things and have time to think and integrate our life and work… It’s a little countercultural, but I think people are crying out for that and I think it stands a great chance of making the culture change.”
Stanford’s burgeoning efforts in map career customization have intrigued SHM board member Janet Nagamine, RN, MD, FHM, a hospitalist at Kaiser Permanente Medical Center in Santa Clara, Calif., and Stanford alum.
She hopes to collaborate with Dr. Valantine and incorporate in hospital medicine the interventions that Stanford is doing while conducting studies and developing workforce planning initiatives specific to hospitalists. The goal is to create a hospital medicine model that replicates Stanford’s success in cultivating women physician leaders.
“We make this false assumption that your career is going to look the same throughout your life and that’s just not realistic,” Dr. Nagamine says.