Mark Leiser

Mark Chassin, MD, isn’t quite sure what he’ll say when he steps to the podium to deliver the keynote address at sold-out HM09.

“At the pace everything is changing, it’s hard to know exactly what I’ll want to talk about,” says Chassin, president of The Joint Commission.

He is certain about one thing, however: the importance of reaching out to and connecting with hospital-based physicians. “Accreditation alone is not enough,” Dr. Chassin says. “We need active engagement of the hospital medicine practitioners in all of the quality and safety initiatives The Joint Commission has set in motion.

“It’s also important," he continues, "for us to hear from physicians on the front lines ... about how our efforts are working and where we need to fill in gaps.”

Since taking over as president of The Joint Commission in January 2008, Dr. Chassin has pushed for the organization to adopt business management strategies like Six Sigma and the Toyota Production System. The goal is to work with hospitals and health systems that also use these strategies to rectify recurring safety and quality problems, such as medication reconciliation, infection control breakdown, and wrong-site/wrong-side surgery.

His ultimate goal is to make sure the commission and organizations that deliver care work together to transform healthcare into a high-reliability industry.

“The legacy of what The Joint Commission used to be sometimes gets caricatured as a bunch of silly rules and hoops people have to jump through that have nothing to do with patient care,” Dr. Chassin says. “That caricature really is a thing of the past.”

To read an in-depth interview with Dr. Chassin, see the June issue of The Hospitalist.

HM 2009 will take place May 14-17 in Chicago. For more information, visit SHM's Web site.

Mark Chassin, MD, isn’t quite sure what he’ll say when he steps to the podium to deliver the keynote address at sold-out HM09.

“At the pace everything is changing, it’s hard to know exactly what I’ll want to talk about,” says Chassin, president of The Joint Commission.

He is certain about one thing, however: the importance of reaching out to and connecting with hospital-based physicians. “Accreditation alone is not enough,” Dr. Chassin says. “We need active engagement of the hospital medicine practitioners in all of the quality and safety initiatives The Joint Commission has set in motion.

“It’s also important," he continues, "for us to hear from physicians on the front lines ... about how our efforts are working and where we need to fill in gaps.”

Since taking over as president of The Joint Commission in January 2008, Dr. Chassin has pushed for the organization to adopt business management strategies like Six Sigma and the Toyota Production System. The goal is to work with hospitals and health systems that also use these strategies to rectify recurring safety and quality problems, such as medication reconciliation, infection control breakdown, and wrong-site/wrong-side surgery.

His ultimate goal is to make sure the commission and organizations that deliver care work together to transform healthcare into a high-reliability industry.

“The legacy of what The Joint Commission used to be sometimes gets caricatured as a bunch of silly rules and hoops people have to jump through that have nothing to do with patient care,” Dr. Chassin says. “That caricature really is a thing of the past.”

To read an in-depth interview with Dr. Chassin, see the June issue of The Hospitalist.

HM 2009 will take place May 14-17 in Chicago. For more information, visit SHM's Web site.

Mark Chassin, MD, isn’t quite sure what he’ll say when he steps to the podium to deliver the keynote address at sold-out HM09.

“At the pace everything is changing, it’s hard to know exactly what I’ll want to talk about,” says Chassin, president of The Joint Commission.

He is certain about one thing, however: the importance of reaching out to and connecting with hospital-based physicians. “Accreditation alone is not enough,” Dr. Chassin says. “We need active engagement of the hospital medicine practitioners in all of the quality and safety initiatives The Joint Commission has set in motion.

“It’s also important," he continues, "for us to hear from physicians on the front lines ... about how our efforts are working and where we need to fill in gaps.”

Since taking over as president of The Joint Commission in January 2008, Dr. Chassin has pushed for the organization to adopt business management strategies like Six Sigma and the Toyota Production System. The goal is to work with hospitals and health systems that also use these strategies to rectify recurring safety and quality problems, such as medication reconciliation, infection control breakdown, and wrong-site/wrong-side surgery.

His ultimate goal is to make sure the commission and organizations that deliver care work together to transform healthcare into a high-reliability industry.

“The legacy of what The Joint Commission used to be sometimes gets caricatured as a bunch of silly rules and hoops people have to jump through that have nothing to do with patient care,” Dr. Chassin says. “That caricature really is a thing of the past.”

To read an in-depth interview with Dr. Chassin, see the June issue of The Hospitalist.

HM 2009 will take place May 14-17 in Chicago. For more information, visit SHM's Web site.

Continuing medical education (CME) is changing rapidly. The descriptions of courses offered at HM09 reflect one of the more prevalent trends: Didactic lectures are being replaced by more innovative, interactive training sessions.

It’s a big reason why CME will continue to serve as “the hallmark method” to help medical professionals continue increasing their knowledge and improving their skills, says Sally Wang, MD, FHM, a hospitalist at Brigham and Women’s Hospital in Boston. Dr. Wang relates the shift to a famous saying from Chinese philosopher Confucius: “Tell me and I’ll forget. Show me and I may remember. Involve me and I’ll understand.”

CME, which is required of most medical professionals to maintain licenses to practice medicine, is a rapidly growing enterprise. Since 1998, the number of accredited providers increased by 10%, while the number of activities and physician participants has increased by 40%, according to the Accreditation Council for Continuing Medical Education (ACCME).

“You can’t just sit in a lecture,” Dr. Wang emphasizes. “You’re not going to absorb anything. You need to understand how you’re going to apply what you learn in practice.”

HM09 is following suit, offering an unprecedented number of hands-on training sessions. In one course, through the use of simulator models, participants will learn how to use ultrasound for safe and accurate vascular access. They’ll also have the opportunity to practice skin biopsies and lumbar punctures.

“I think that’s a reflection of our field,” says course director Joseph Ming-Wah Li, MD, FHM, SHM board member and director of the HM group at Beth Israel Deaconess Medical Center in Boston. “Hospitalists roll up their sleeves and get to work. We don’t talk about quality; we develop and implement programs to ensure quality. We don’t talk about teaching; we do it. We really hope this meeting will always be cutting-edge and set the tone for what we do as hospitalists in this country.”

Spread the Wealth of Knowledge

In a growing field such as HM, the benefits are almost limitless, says James W. Levy, PA-C, a physician assistant and hospitalist at Munson Medical Center in Traverse City, Mich. “We have the luxury of working as a team, so it’s especially helpful when we go to CME events and bring back very current material. We can share that with the rest of the team, and that can extend the ‘bang for the buck,’ ” Levy says.

Levy acknowledges CMS isn’t the only way to keep current, but it’s an “important way,” he says. “With the hospitalist movement having caught on the way it has, we have a much bigger opportunity to standardize care and our approach from one provider to another. I think CME can play a vital role in that.”

Although CME opportunities vary, Levy prefers settings like SHM functions when interaction with colleagues complements—and often enhances—the lessons learned.

Dr. Li agrees, noting meetings such as HM09 provide an opportunity to get away from the daily grind and “get the juices flowing” in terms of thinking, learning, and sharing ideas with colleagues. He’s particularly excited about the diversity of this year’s course lineup, as well as the behind-the-scenes efforts intended to ensure participants get the most out of the experience.

The annual meeting committee provided considerable guidance to each presenter, outlining objectives for each talk and reviewing presentations to make sure those objectives were met. “More than ever, the quality of the talks are going to be very good and very consistent,” Dr. Li says.

For a complete course schedule and faculty lineup, or to register for HM09, visit www.hospitalmedicine.org/source/AM09/event.cfm?Event=AM09. TH

Mark Leiser is a freelance writer based in New Jersey.

Continuing medical education (CME) is changing rapidly. The descriptions of courses offered at HM09 reflect one of the more prevalent trends: Didactic lectures are being replaced by more innovative, interactive training sessions.

It’s a big reason why CME will continue to serve as “the hallmark method” to help medical professionals continue increasing their knowledge and improving their skills, says Sally Wang, MD, FHM, a hospitalist at Brigham and Women’s Hospital in Boston. Dr. Wang relates the shift to a famous saying from Chinese philosopher Confucius: “Tell me and I’ll forget. Show me and I may remember. Involve me and I’ll understand.”

CME, which is required of most medical professionals to maintain licenses to practice medicine, is a rapidly growing enterprise. Since 1998, the number of accredited providers increased by 10%, while the number of activities and physician participants has increased by 40%, according to the Accreditation Council for Continuing Medical Education (ACCME).

“You can’t just sit in a lecture,” Dr. Wang emphasizes. “You’re not going to absorb anything. You need to understand how you’re going to apply what you learn in practice.”

HM09 is following suit, offering an unprecedented number of hands-on training sessions. In one course, through the use of simulator models, participants will learn how to use ultrasound for safe and accurate vascular access. They’ll also have the opportunity to practice skin biopsies and lumbar punctures.

“I think that’s a reflection of our field,” says course director Joseph Ming-Wah Li, MD, FHM, SHM board member and director of the HM group at Beth Israel Deaconess Medical Center in Boston. “Hospitalists roll up their sleeves and get to work. We don’t talk about quality; we develop and implement programs to ensure quality. We don’t talk about teaching; we do it. We really hope this meeting will always be cutting-edge and set the tone for what we do as hospitalists in this country.”

Spread the Wealth of Knowledge

In a growing field such as HM, the benefits are almost limitless, says James W. Levy, PA-C, a physician assistant and hospitalist at Munson Medical Center in Traverse City, Mich. “We have the luxury of working as a team, so it’s especially helpful when we go to CME events and bring back very current material. We can share that with the rest of the team, and that can extend the ‘bang for the buck,’ ” Levy says.

Levy acknowledges CMS isn’t the only way to keep current, but it’s an “important way,” he says. “With the hospitalist movement having caught on the way it has, we have a much bigger opportunity to standardize care and our approach from one provider to another. I think CME can play a vital role in that.”

Although CME opportunities vary, Levy prefers settings like SHM functions when interaction with colleagues complements—and often enhances—the lessons learned.

Dr. Li agrees, noting meetings such as HM09 provide an opportunity to get away from the daily grind and “get the juices flowing” in terms of thinking, learning, and sharing ideas with colleagues. He’s particularly excited about the diversity of this year’s course lineup, as well as the behind-the-scenes efforts intended to ensure participants get the most out of the experience.

The annual meeting committee provided considerable guidance to each presenter, outlining objectives for each talk and reviewing presentations to make sure those objectives were met. “More than ever, the quality of the talks are going to be very good and very consistent,” Dr. Li says.

For a complete course schedule and faculty lineup, or to register for HM09, visit www.hospitalmedicine.org/source/AM09/event.cfm?Event=AM09. TH

Mark Leiser is a freelance writer based in New Jersey.

Continuing medical education (CME) is changing rapidly. The descriptions of courses offered at HM09 reflect one of the more prevalent trends: Didactic lectures are being replaced by more innovative, interactive training sessions.

It’s a big reason why CME will continue to serve as “the hallmark method” to help medical professionals continue increasing their knowledge and improving their skills, says Sally Wang, MD, FHM, a hospitalist at Brigham and Women’s Hospital in Boston. Dr. Wang relates the shift to a famous saying from Chinese philosopher Confucius: “Tell me and I’ll forget. Show me and I may remember. Involve me and I’ll understand.”

CME, which is required of most medical professionals to maintain licenses to practice medicine, is a rapidly growing enterprise. Since 1998, the number of accredited providers increased by 10%, while the number of activities and physician participants has increased by 40%, according to the Accreditation Council for Continuing Medical Education (ACCME).

“You can’t just sit in a lecture,” Dr. Wang emphasizes. “You’re not going to absorb anything. You need to understand how you’re going to apply what you learn in practice.”

HM09 is following suit, offering an unprecedented number of hands-on training sessions. In one course, through the use of simulator models, participants will learn how to use ultrasound for safe and accurate vascular access. They’ll also have the opportunity to practice skin biopsies and lumbar punctures.

“I think that’s a reflection of our field,” says course director Joseph Ming-Wah Li, MD, FHM, SHM board member and director of the HM group at Beth Israel Deaconess Medical Center in Boston. “Hospitalists roll up their sleeves and get to work. We don’t talk about quality; we develop and implement programs to ensure quality. We don’t talk about teaching; we do it. We really hope this meeting will always be cutting-edge and set the tone for what we do as hospitalists in this country.”

Spread the Wealth of Knowledge

In a growing field such as HM, the benefits are almost limitless, says James W. Levy, PA-C, a physician assistant and hospitalist at Munson Medical Center in Traverse City, Mich. “We have the luxury of working as a team, so it’s especially helpful when we go to CME events and bring back very current material. We can share that with the rest of the team, and that can extend the ‘bang for the buck,’ ” Levy says.

Levy acknowledges CMS isn’t the only way to keep current, but it’s an “important way,” he says. “With the hospitalist movement having caught on the way it has, we have a much bigger opportunity to standardize care and our approach from one provider to another. I think CME can play a vital role in that.”

Although CME opportunities vary, Levy prefers settings like SHM functions when interaction with colleagues complements—and often enhances—the lessons learned.

Dr. Li agrees, noting meetings such as HM09 provide an opportunity to get away from the daily grind and “get the juices flowing” in terms of thinking, learning, and sharing ideas with colleagues. He’s particularly excited about the diversity of this year’s course lineup, as well as the behind-the-scenes efforts intended to ensure participants get the most out of the experience.

The annual meeting committee provided considerable guidance to each presenter, outlining objectives for each talk and reviewing presentations to make sure those objectives were met. “More than ever, the quality of the talks are going to be very good and very consistent,” Dr. Li says.

For a complete course schedule and faculty lineup, or to register for HM09, visit www.hospitalmedicine.org/source/AM09/event.cfm?Event=AM09. TH

Mark Leiser is a freelance writer based in New Jersey.

Mark Chassin, MD, MPP, MPH, president of the Joint Commission, will deliver the keynote address at HM09 in Chicago. A board-certified internist who practiced emergency medicine for 12 years, Dr. Chassin is recognized as an expert in quality measurement and improvement.

He recently spoke to The Hospitalist about his views on the changing world of healthcare, the commission’s evolving role, and the importance of a stronger partnership between the accrediting body and hospital-based physicians.

Question: Why are you looking forward to speaking at HM09?

Answer: Hospitalists are an especially important group of physicians for [the Joint Commission] to connect with because of the close alignment between our mission and the way they practice medicine. Accreditation alone is not enough. We need active engagement of the HM practitioners in all of the quality and safety improvement initiatives the Joint Commission has set in motion. It’s also important for us to hear from the physicians on the front lines—and from those who have taken responsibility for oversight of quality programs in hospitals—about how our efforts are working and where we need to fill in gaps.

Q: Can you provide an overview of the topics you plan to talk about?

A: At the pace everything is changing, it’s hard to know exactly what I’ll want to talk about. I’ll probably say something about the major challenges we face across healthcare that are particularly magnified in hospitals. That’s where the most vulnerable patients are. That’s where the most dangerous procedures are done. That’s where the most dangerous drugs are used, and that’s where the most complicated devices are used. All these things have the potential for improving outcomes, but also increasing the potential for harm if they’re not used well.

The environment we’re in is going in one direction, and that is to demand more of all of us in healthcare with respect to the level of excellence at which care is provided and overseen. There’s a strong push on the part of public stakeholders for accountability in healthcare. I may talk about how we might respond to that demand and close the gap between what we know we could be providing in terms of safe, high-quality care, and what we are providing.

Q: You said accreditation by itself is not sufficient. What else is needed?

A: When I was exploring this job, I wanted to determine whether the Joint Commission and its board of commissioners were ready to undertake initiatives, in addition to accreditation, in order to move the delivery system more rapidly toward higher levels of safety and quality. … It became clear to me they weren’t just willing to do it, but very enthusiastic about doing it.

Q: Can you give an example of one of those new initiatives?

A: I have watched and participated in the development of applications coming out of industry in the last 10 years or so, like Six Sigma and the Toyota Production System, that are highly promising in their ability to deliver much higher levels of excellence and sustain them. We’re in the middle of a very aggressive adoption of these tools, which we’re calling our Robust Process Improvement Initiative.

Q: What are the benefits of that initiative?

A: We are doing this to enhance our capacity to do process improvement, to simplify our processes, to focus on customer service. It does not mean it’s to make these surveys easy. It means understanding where our processes are too complicated, where we have too many bells and whistles that are not related to safety and quality, and where we can reduce our costs. At the same time, we’re exploring how we can work with organizations, hospitals, and health systems who have committed to learning these tools and methods to bring them to bear on safety and quality problems—medication reconciliation, infection control breakdown, pre-op verification to get rid of wrong site/wrong side surgery—that organizations struggle with but haven’t wrestled to the ground yet.

Q: Why is it so difficult?

A: In the last year, I’ve been challenging healthcare organizations with respect to exactly that question. I believe everyone—and I put the Joint Commission side by side with organizations that deliver the care—can’t settle for anything less than aiming to transform healthcare into a high-reliability industry. That means rates of adverse events and breakdowns and quality problems that are as low as the best high-reliability organizations in the world, like commercial air travel, nuclear power, and other organizations, that deal with risk and hazards every bit as difficult and dangerous as healthcare but do it a heck of a lot better than we do.

Q: What are the barriers that keep that from happening?

A: First, there’s no role model. There’s no example in healthcare of an organization of any size that is at that level of high reliability. We’re not really in a position to hand out a playbook or a set of blueprints and say, “If you follow these step-by-step set of processes, you’ll get there.”

Another issue is the imperfect creation of a uniform safety culture. One of the hallmarks of a true safety culture is every individual who works in a healthcare organization should be alert to the smallest deviation from safe practice and safe circumstance, and they should be expected and encouraged to report those problems. Is somebody not observing safe sterile techniques in the operating room? Is somebody giving an order for medication that is ambiguous or inaccurate? Just like the junior navigator in an airplane cockpit, everyone must feel his or her obligation to point out what he or she thinks the captain is doing wrong and bring that discrepancy to the surface.

Q: What are your thoughts on the tremendous growth of HM, as well as what the future holds for the field?

A: The growth provides challenges and opportunities. The biggest challenge is the risk the movement toward the delivery of more hospital care by hospitalists provides a discontinuity between the care that’s provided in the community on the front end and hospital care, and then a discontinuity on the back end when the patient goes back into the community. It puts a much larger burden on hospitalists and organizations to make sure they work together to develop really effective ways on both the front and back ends to minimize the unintended consequences of those potential discontinuities.

That said, the opportunity of having a group of physicians who are focused primarily on what happens in hospitals gives those of us who are in quality-oversight positions a natural constituency to work with on perfecting our safety and quality programs in hospitals. That’s an important opportunity, given how complicated it has become to deliver high-quality hospital care.

Q: When hospitalists head home from Chicago, what would you like them to know about the Joint Commission and its mission?

A: The legacy of what the Joint Commission used to be sometimes gets caricatured as a bunch of silly rules and hoops people have to jump through that have nothing to do with patient care. That caricature really is a thing of the past. The current programs we have—both in accreditation and some of these newer initiatives—really have the promise of delivering the capability of helping hospitals and other health organizations achieve the high reliability I know they want. And we need to work shoulder to shoulder on problems. That comes back to how we really need unvarnished feedback about our current programs, whether they’re working well and where we should be deploying more resources. TH

Mark Leiser is a freelance writer based in New Jersey.

Mark Chassin, MD, MPP, MPH, president of the Joint Commission, will deliver the keynote address at HM09 in Chicago. A board-certified internist who practiced emergency medicine for 12 years, Dr. Chassin is recognized as an expert in quality measurement and improvement.

He recently spoke to The Hospitalist about his views on the changing world of healthcare, the commission’s evolving role, and the importance of a stronger partnership between the accrediting body and hospital-based physicians.

Question: Why are you looking forward to speaking at HM09?

Answer: Hospitalists are an especially important group of physicians for [the Joint Commission] to connect with because of the close alignment between our mission and the way they practice medicine. Accreditation alone is not enough. We need active engagement of the HM practitioners in all of the quality and safety improvement initiatives the Joint Commission has set in motion. It’s also important for us to hear from the physicians on the front lines—and from those who have taken responsibility for oversight of quality programs in hospitals—about how our efforts are working and where we need to fill in gaps.

Q: Can you provide an overview of the topics you plan to talk about?

A: At the pace everything is changing, it’s hard to know exactly what I’ll want to talk about. I’ll probably say something about the major challenges we face across healthcare that are particularly magnified in hospitals. That’s where the most vulnerable patients are. That’s where the most dangerous procedures are done. That’s where the most dangerous drugs are used, and that’s where the most complicated devices are used. All these things have the potential for improving outcomes, but also increasing the potential for harm if they’re not used well.

The environment we’re in is going in one direction, and that is to demand more of all of us in healthcare with respect to the level of excellence at which care is provided and overseen. There’s a strong push on the part of public stakeholders for accountability in healthcare. I may talk about how we might respond to that demand and close the gap between what we know we could be providing in terms of safe, high-quality care, and what we are providing.

Q: You said accreditation by itself is not sufficient. What else is needed?

A: When I was exploring this job, I wanted to determine whether the Joint Commission and its board of commissioners were ready to undertake initiatives, in addition to accreditation, in order to move the delivery system more rapidly toward higher levels of safety and quality. … It became clear to me they weren’t just willing to do it, but very enthusiastic about doing it.

Q: Can you give an example of one of those new initiatives?

A: I have watched and participated in the development of applications coming out of industry in the last 10 years or so, like Six Sigma and the Toyota Production System, that are highly promising in their ability to deliver much higher levels of excellence and sustain them. We’re in the middle of a very aggressive adoption of these tools, which we’re calling our Robust Process Improvement Initiative.

Q: What are the benefits of that initiative?

A: We are doing this to enhance our capacity to do process improvement, to simplify our processes, to focus on customer service. It does not mean it’s to make these surveys easy. It means understanding where our processes are too complicated, where we have too many bells and whistles that are not related to safety and quality, and where we can reduce our costs. At the same time, we’re exploring how we can work with organizations, hospitals, and health systems who have committed to learning these tools and methods to bring them to bear on safety and quality problems—medication reconciliation, infection control breakdown, pre-op verification to get rid of wrong site/wrong side surgery—that organizations struggle with but haven’t wrestled to the ground yet.

Q: Why is it so difficult?

A: In the last year, I’ve been challenging healthcare organizations with respect to exactly that question. I believe everyone—and I put the Joint Commission side by side with organizations that deliver the care—can’t settle for anything less than aiming to transform healthcare into a high-reliability industry. That means rates of adverse events and breakdowns and quality problems that are as low as the best high-reliability organizations in the world, like commercial air travel, nuclear power, and other organizations, that deal with risk and hazards every bit as difficult and dangerous as healthcare but do it a heck of a lot better than we do.

Q: What are the barriers that keep that from happening?

A: First, there’s no role model. There’s no example in healthcare of an organization of any size that is at that level of high reliability. We’re not really in a position to hand out a playbook or a set of blueprints and say, “If you follow these step-by-step set of processes, you’ll get there.”

Another issue is the imperfect creation of a uniform safety culture. One of the hallmarks of a true safety culture is every individual who works in a healthcare organization should be alert to the smallest deviation from safe practice and safe circumstance, and they should be expected and encouraged to report those problems. Is somebody not observing safe sterile techniques in the operating room? Is somebody giving an order for medication that is ambiguous or inaccurate? Just like the junior navigator in an airplane cockpit, everyone must feel his or her obligation to point out what he or she thinks the captain is doing wrong and bring that discrepancy to the surface.

Q: What are your thoughts on the tremendous growth of HM, as well as what the future holds for the field?

A: The growth provides challenges and opportunities. The biggest challenge is the risk the movement toward the delivery of more hospital care by hospitalists provides a discontinuity between the care that’s provided in the community on the front end and hospital care, and then a discontinuity on the back end when the patient goes back into the community. It puts a much larger burden on hospitalists and organizations to make sure they work together to develop really effective ways on both the front and back ends to minimize the unintended consequences of those potential discontinuities.

That said, the opportunity of having a group of physicians who are focused primarily on what happens in hospitals gives those of us who are in quality-oversight positions a natural constituency to work with on perfecting our safety and quality programs in hospitals. That’s an important opportunity, given how complicated it has become to deliver high-quality hospital care.

Q: When hospitalists head home from Chicago, what would you like them to know about the Joint Commission and its mission?

A: The legacy of what the Joint Commission used to be sometimes gets caricatured as a bunch of silly rules and hoops people have to jump through that have nothing to do with patient care. That caricature really is a thing of the past. The current programs we have—both in accreditation and some of these newer initiatives—really have the promise of delivering the capability of helping hospitals and other health organizations achieve the high reliability I know they want. And we need to work shoulder to shoulder on problems. That comes back to how we really need unvarnished feedback about our current programs, whether they’re working well and where we should be deploying more resources. TH

Mark Leiser is a freelance writer based in New Jersey.

Mark Chassin, MD, MPP, MPH, president of the Joint Commission, will deliver the keynote address at HM09 in Chicago. A board-certified internist who practiced emergency medicine for 12 years, Dr. Chassin is recognized as an expert in quality measurement and improvement.

He recently spoke to The Hospitalist about his views on the changing world of healthcare, the commission’s evolving role, and the importance of a stronger partnership between the accrediting body and hospital-based physicians.

Question: Why are you looking forward to speaking at HM09?

Answer: Hospitalists are an especially important group of physicians for [the Joint Commission] to connect with because of the close alignment between our mission and the way they practice medicine. Accreditation alone is not enough. We need active engagement of the HM practitioners in all of the quality and safety improvement initiatives the Joint Commission has set in motion. It’s also important for us to hear from the physicians on the front lines—and from those who have taken responsibility for oversight of quality programs in hospitals—about how our efforts are working and where we need to fill in gaps.

Q: Can you provide an overview of the topics you plan to talk about?

A: At the pace everything is changing, it’s hard to know exactly what I’ll want to talk about. I’ll probably say something about the major challenges we face across healthcare that are particularly magnified in hospitals. That’s where the most vulnerable patients are. That’s where the most dangerous procedures are done. That’s where the most dangerous drugs are used, and that’s where the most complicated devices are used. All these things have the potential for improving outcomes, but also increasing the potential for harm if they’re not used well.

The environment we’re in is going in one direction, and that is to demand more of all of us in healthcare with respect to the level of excellence at which care is provided and overseen. There’s a strong push on the part of public stakeholders for accountability in healthcare. I may talk about how we might respond to that demand and close the gap between what we know we could be providing in terms of safe, high-quality care, and what we are providing.

Q: You said accreditation by itself is not sufficient. What else is needed?

A: When I was exploring this job, I wanted to determine whether the Joint Commission and its board of commissioners were ready to undertake initiatives, in addition to accreditation, in order to move the delivery system more rapidly toward higher levels of safety and quality. … It became clear to me they weren’t just willing to do it, but very enthusiastic about doing it.

Q: Can you give an example of one of those new initiatives?

A: I have watched and participated in the development of applications coming out of industry in the last 10 years or so, like Six Sigma and the Toyota Production System, that are highly promising in their ability to deliver much higher levels of excellence and sustain them. We’re in the middle of a very aggressive adoption of these tools, which we’re calling our Robust Process Improvement Initiative.

Q: What are the benefits of that initiative?

A: We are doing this to enhance our capacity to do process improvement, to simplify our processes, to focus on customer service. It does not mean it’s to make these surveys easy. It means understanding where our processes are too complicated, where we have too many bells and whistles that are not related to safety and quality, and where we can reduce our costs. At the same time, we’re exploring how we can work with organizations, hospitals, and health systems who have committed to learning these tools and methods to bring them to bear on safety and quality problems—medication reconciliation, infection control breakdown, pre-op verification to get rid of wrong site/wrong side surgery—that organizations struggle with but haven’t wrestled to the ground yet.

Q: Why is it so difficult?

A: In the last year, I’ve been challenging healthcare organizations with respect to exactly that question. I believe everyone—and I put the Joint Commission side by side with organizations that deliver the care—can’t settle for anything less than aiming to transform healthcare into a high-reliability industry. That means rates of adverse events and breakdowns and quality problems that are as low as the best high-reliability organizations in the world, like commercial air travel, nuclear power, and other organizations, that deal with risk and hazards every bit as difficult and dangerous as healthcare but do it a heck of a lot better than we do.

Q: What are the barriers that keep that from happening?

A: First, there’s no role model. There’s no example in healthcare of an organization of any size that is at that level of high reliability. We’re not really in a position to hand out a playbook or a set of blueprints and say, “If you follow these step-by-step set of processes, you’ll get there.”

Another issue is the imperfect creation of a uniform safety culture. One of the hallmarks of a true safety culture is every individual who works in a healthcare organization should be alert to the smallest deviation from safe practice and safe circumstance, and they should be expected and encouraged to report those problems. Is somebody not observing safe sterile techniques in the operating room? Is somebody giving an order for medication that is ambiguous or inaccurate? Just like the junior navigator in an airplane cockpit, everyone must feel his or her obligation to point out what he or she thinks the captain is doing wrong and bring that discrepancy to the surface.

Q: What are your thoughts on the tremendous growth of HM, as well as what the future holds for the field?

A: The growth provides challenges and opportunities. The biggest challenge is the risk the movement toward the delivery of more hospital care by hospitalists provides a discontinuity between the care that’s provided in the community on the front end and hospital care, and then a discontinuity on the back end when the patient goes back into the community. It puts a much larger burden on hospitalists and organizations to make sure they work together to develop really effective ways on both the front and back ends to minimize the unintended consequences of those potential discontinuities.

That said, the opportunity of having a group of physicians who are focused primarily on what happens in hospitals gives those of us who are in quality-oversight positions a natural constituency to work with on perfecting our safety and quality programs in hospitals. That’s an important opportunity, given how complicated it has become to deliver high-quality hospital care.

Q: When hospitalists head home from Chicago, what would you like them to know about the Joint Commission and its mission?

A: The legacy of what the Joint Commission used to be sometimes gets caricatured as a bunch of silly rules and hoops people have to jump through that have nothing to do with patient care. That caricature really is a thing of the past. The current programs we have—both in accreditation and some of these newer initiatives—really have the promise of delivering the capability of helping hospitals and other health organizations achieve the high reliability I know they want. And we need to work shoulder to shoulder on problems. That comes back to how we really need unvarnished feedback about our current programs, whether they’re working well and where we should be deploying more resources. TH

Mark Leiser is a freelance writer based in New Jersey.

Organizers of HM09 hope bigger means better.

SHM’s annual meeting—May 14-17 in Chicago—has been expanded to four days. A task force led by SHM board member and course director Joseph Ming-Wah Li, MD, FHM, recommended the change.

“The sense was, with a one-day pre-course and the annual meeting at two days, we didn’t really have enough time to put in all the content we wanted to put in,” says Dr. Li, an SHM board member and director of the hospital medicine program at Harvard Medical School, and associate chief of the division of general medicine and primary care at Beth Israel Deaconess Medical Center in Boston. “Unlike many other professional society meetings, we have several specialties. We have some physicians taking care of adults and others who take care of children. We also have nurse practitioners and physician assistants. The extra day really allows us to take a ‘big tent’ approach and make sure we have content of interest to a variety of different physicians.”

The longer meeting will allow for additional educational programming as well as two new tracks. The “second chance” track will give meeting participants an opportunity to attend sessions they missed earlier in the week. The research track is designed to give both novice and experienced researchers the chance to hone their skills.

“We’re a very young movement, and research lends credibility to any field,” Dr. Li says. “We wanted the SHM annual meeting to be a venue for HM research. In order to do that, we have to do that in a very public way.”

Also new this year is the American Board of Internal Medicine Maintenance of Certification learning session.

Continuing medical education sessions, typically offered in a block schedule, will be staggered this year. Course lengths will be tailored to specific topics, and the variations should create a better meeting experience by reducing lines in the dining area, exhibit halls, and other areas during breaks, Dr. Li says.

Based on early registration, HM09 will set attendance records this year. More than 2,000 physicians are expected to attend.

Mark Chassin, MD, MPP, MPH, president of the Joint Commission, will deliver the keynote address at 9 a.m. Friday. Dr. Chassin, whose organization accredits and certifies more than 15,000 healthcare organizations and programs, says the time has come for the commission to connect with physicians—specifically hospitalists—in a “better, more effective way.”

“The emergence of hospital medicine as a specialty is probably the most important structural change in medical practice in 20 or 25 years,” Dr. Chassin says. “Since many hospitalists are becoming more engaged in not just practicing medicine one patient at a time, but taking responsibility for oversight of quality programs in their hospitals, we certainly want to hear from them about how we can help them achieve their quality and safety goals.”

Robert Wachter, MD, FHM, professor and chief of the division of hospital medicine at the University of California at San Francisco, a former SHM president, and author of the blog Wachter’s World (www.wachtersworld.com), will speak at noon Sunday. His program is titled “Creating ‘Accountability’ in a ‘No-Blame’ Culture: The Yin and Yang of the Quality and Safety Revolutions.” TH

Mark Leiser is a freelance writer based in New Jersey.

Organizers of HM09 hope bigger means better.

SHM’s annual meeting—May 14-17 in Chicago—has been expanded to four days. A task force led by SHM board member and course director Joseph Ming-Wah Li, MD, FHM, recommended the change.

“The sense was, with a one-day pre-course and the annual meeting at two days, we didn’t really have enough time to put in all the content we wanted to put in,” says Dr. Li, an SHM board member and director of the hospital medicine program at Harvard Medical School, and associate chief of the division of general medicine and primary care at Beth Israel Deaconess Medical Center in Boston. “Unlike many other professional society meetings, we have several specialties. We have some physicians taking care of adults and others who take care of children. We also have nurse practitioners and physician assistants. The extra day really allows us to take a ‘big tent’ approach and make sure we have content of interest to a variety of different physicians.”

The longer meeting will allow for additional educational programming as well as two new tracks. The “second chance” track will give meeting participants an opportunity to attend sessions they missed earlier in the week. The research track is designed to give both novice and experienced researchers the chance to hone their skills.

“We’re a very young movement, and research lends credibility to any field,” Dr. Li says. “We wanted the SHM annual meeting to be a venue for HM research. In order to do that, we have to do that in a very public way.”

Also new this year is the American Board of Internal Medicine Maintenance of Certification learning session.

Continuing medical education sessions, typically offered in a block schedule, will be staggered this year. Course lengths will be tailored to specific topics, and the variations should create a better meeting experience by reducing lines in the dining area, exhibit halls, and other areas during breaks, Dr. Li says.

Based on early registration, HM09 will set attendance records this year. More than 2,000 physicians are expected to attend.

Mark Chassin, MD, MPP, MPH, president of the Joint Commission, will deliver the keynote address at 9 a.m. Friday. Dr. Chassin, whose organization accredits and certifies more than 15,000 healthcare organizations and programs, says the time has come for the commission to connect with physicians—specifically hospitalists—in a “better, more effective way.”

“The emergence of hospital medicine as a specialty is probably the most important structural change in medical practice in 20 or 25 years,” Dr. Chassin says. “Since many hospitalists are becoming more engaged in not just practicing medicine one patient at a time, but taking responsibility for oversight of quality programs in their hospitals, we certainly want to hear from them about how we can help them achieve their quality and safety goals.”

Robert Wachter, MD, FHM, professor and chief of the division of hospital medicine at the University of California at San Francisco, a former SHM president, and author of the blog Wachter’s World (www.wachtersworld.com), will speak at noon Sunday. His program is titled “Creating ‘Accountability’ in a ‘No-Blame’ Culture: The Yin and Yang of the Quality and Safety Revolutions.” TH

Mark Leiser is a freelance writer based in New Jersey.

Organizers of HM09 hope bigger means better.

SHM’s annual meeting—May 14-17 in Chicago—has been expanded to four days. A task force led by SHM board member and course director Joseph Ming-Wah Li, MD, FHM, recommended the change.

“The sense was, with a one-day pre-course and the annual meeting at two days, we didn’t really have enough time to put in all the content we wanted to put in,” says Dr. Li, an SHM board member and director of the hospital medicine program at Harvard Medical School, and associate chief of the division of general medicine and primary care at Beth Israel Deaconess Medical Center in Boston. “Unlike many other professional society meetings, we have several specialties. We have some physicians taking care of adults and others who take care of children. We also have nurse practitioners and physician assistants. The extra day really allows us to take a ‘big tent’ approach and make sure we have content of interest to a variety of different physicians.”

The longer meeting will allow for additional educational programming as well as two new tracks. The “second chance” track will give meeting participants an opportunity to attend sessions they missed earlier in the week. The research track is designed to give both novice and experienced researchers the chance to hone their skills.

“We’re a very young movement, and research lends credibility to any field,” Dr. Li says. “We wanted the SHM annual meeting to be a venue for HM research. In order to do that, we have to do that in a very public way.”

Also new this year is the American Board of Internal Medicine Maintenance of Certification learning session.

Continuing medical education sessions, typically offered in a block schedule, will be staggered this year. Course lengths will be tailored to specific topics, and the variations should create a better meeting experience by reducing lines in the dining area, exhibit halls, and other areas during breaks, Dr. Li says.

Based on early registration, HM09 will set attendance records this year. More than 2,000 physicians are expected to attend.

Mark Chassin, MD, MPP, MPH, president of the Joint Commission, will deliver the keynote address at 9 a.m. Friday. Dr. Chassin, whose organization accredits and certifies more than 15,000 healthcare organizations and programs, says the time has come for the commission to connect with physicians—specifically hospitalists—in a “better, more effective way.”

“The emergence of hospital medicine as a specialty is probably the most important structural change in medical practice in 20 or 25 years,” Dr. Chassin says. “Since many hospitalists are becoming more engaged in not just practicing medicine one patient at a time, but taking responsibility for oversight of quality programs in their hospitals, we certainly want to hear from them about how we can help them achieve their quality and safety goals.”

Robert Wachter, MD, FHM, professor and chief of the division of hospital medicine at the University of California at San Francisco, a former SHM president, and author of the blog Wachter’s World (www.wachtersworld.com), will speak at noon Sunday. His program is titled “Creating ‘Accountability’ in a ‘No-Blame’ Culture: The Yin and Yang of the Quality and Safety Revolutions.” TH

Mark Leiser is a freelance writer based in New Jersey.

William Ford, MD, FHM, was just three years removed from residency when he assumed his first HM leadership role. His qualifications were impressive, but because he was just in his early 30s, his soon-to-be bosses needed some convincing that he was right for the job.

But Dr. Ford—now medical director at Cogent Healthcare and director of the HM program at Temple University in Philadelphia—quickly proved that ability, attitude, and work ethic mean as much as, if not more than, a lengthy résumé. “I don’t think you need a title to lead or a position to lead,” Dr. Ford says. “You need the will to lead.”

Q: You spent a little more than a year in private practice before you became a hospitalist. What motivated you to make the switch?

A: I really enjoy the mix of responsibilities. There’s a lot more to HM than just treating the patient. You’re actually treating the hospital. And, ultimately, it’s more fast-paced. I like the ability to be on the cutting edge of medicine, and just being in a hospital keeps you on your toes from a medical perspective.

Q: Your first two clinical sites—Lehigh Valley Hospital in Allentown, Pa., and Union Hospital in Elkton, Md.—are more suburban settings. What made Temple the right fit?

A: I trained at Drexel University (also in Philadelphia), and I wanted to get back to the urban setting. I find that environment to be very challenging.

Q: How so?

A: The biggest challenge is the socioeconomic problems. Eighty percent of our patients are on Medicare or Medicaid. … In a nutshell, the challenge comes down to basic access to care.

Q: How frustrating is that for you?

A: It’s very frustrating, and it angers me. If I write a prescription for a patient, there’s a good chance the person won’t take it. If I tell them they need follow-up treatment, there’s a good chance they won’t get it. It’s not that they don’t want to. Maybe they can’t afford the co-pay, or maybe, if they haven’t been monitored by a primary-care physician (PCP), they can’t get an appointment for three months. I know we, as a group, can care for patients much better if they would follow up with our instructions. But because of the hoops they have to go through, whether for economic reasons or access reasons, many of them are coming back to the ED.

Q: What keeps you going in spite of those challenges?

A: The patients. They are a very grateful population. They know they are underserved, and they are appreciative of the care.

Q: Temple partnered with Cogent Healthcare in 2006 to manage its hospitalist program. Were you excited about being able to put your stamp on a program and really help it develop?

A: That was enormously appealing. If you’re a true leader, you’re never satisfied with the way your boss is running the program. If you really have the qualities to lead a group, you always think you can do better. … I was intrigued by the opportunity to start a group in a major teaching center that, for the first time, was outsourcing its hospitalist program and trying to solidify its teaching mission.

Q: How quickly has the program grown?

A: We’ve grown from four physicians to 27, and we treat about 15,000 inpatients annually.

Q: What advice would you give to the director of a program experiencing similar growth?

A: Be very stringent on the doctors you choose. For a lot of groups, retention/recruitment is the No. 1, No. 2, and No. 3 problem. We’ve been fortunate we haven’t made many bad hires. But the time and effort it takes to get rid of a bad hire can really end up bogging you down. I’d rather have everyone pull up their bootstraps and work a bit harder and take an extra few months to find the right person than go ahead with a bad hire simply to have another body.

Q: Were there other keys behind the program’s success?

A: There are several. I owe a great deal of the success of the program to the great doctors I work with. I received tremendous support from the department of internal medicine when I arrived, and that ensured a smooth transition. Another big component is good communication.

Q: What role has communication played?

A: Hospitals are very siloed. One group doesn’t speak to another. We’re taught to stick our head in the sand, fix the problem, and move on to the next problem. That gets you crucified in the world of HM. As hospitalists, we have to be the glue that brings all these silos together. In our profession, to be a good leader, you don’t have to be the smartest or best clinician. But you do have to have the attributes of communication and teambuilding. The key is to meet people and talk to them. Try to get to know every key hospital administrator. Don’t just write an order and go away; talk to the nurse. If you forge relationships and try to get the group more fully implemented, it will be more likely to reach its full potential.

Q: At 35, you are slightly younger than the average U.S. hospitalist, yet you’re nearly three years into your first true leadership role. Has your age ever been an issue?

A: Initially, it was a hindrance. It took four months for Temple to interview me. The biggest negative they gave to Cogent was, “He’s so young.” In any other field, 35 would not be considered a child. We’d be in the workforce for 13 years, and we’d be considered middle or senior management. Medicine in general is steeped in, “If you don’t have gray hair, you’re not able to sit at the table.” In our specialty, you can. … It doesn’t have to hinder you, but you have to be willing and able to do the right things. If you are, you will be noticed.

Q: You consider HM program marketing and branding one of your specialties. Why are those efforts necessary?

A: If you don’t market yourself, you’ll die, particularly in a competitive market. Whether you are at an academic center or a small community hospital or even a larger hospital, you could have two or three hospitalist groups all vying for the same patient volume. You need to give yourself a differential advantage.

Q: How do you do that?

A: You have to get out and meet people and shake some hands. You have to meet all of your customers, and you have to find out if they are happy or displeased. You have to communicate with them. You have to think about your customers, and they’re not just the patients in the bed. Your customers also are your administration, your PCPs, your subspecialists. … It’s no different than a vendor selling fax machines. We are a business, and if doctors don’t think that, they’re very naive.

Q: You’re also a big proponent of team-building within groups.

A: Definitely. That’s the foundation. Groups are going to coalesce differently. In my group at Lehigh Valley, we all had a Fourth of July party. We were never so close as after that one experience when we shared dinner together. It may be as simple as that. At Temple, I had all 25 of us meet and go over a teambuilding exercise to understand what values people have and why they come to work. I asked them to tell me something I didn’t know about them. I heard everything from “I changed my name when I was 5” to “I played basketball in college.”

You’re more willing to cover for a colleague if he or she is sick if you get to know them on a personal level. And if that happens, you’re less likely to leave, and that decreases turnover. On top of everything else, you become a group. You see group buy-in and goal recognition, and you start to see those goals attained.

Q: On top of your administrative duties and teaching responsibilities, you’re still doing 10 clinical shifts per month. Why?

A: It’s hugely important for two reasons. No. 1 is respect among members of your team. No. 2 is knowledge of your service. It’s not until you get your hands dirty that you can really understand what physicians in your group are going through and figure out ways to make life better. And at the end of the day, we’re all still physicians. TH

Mark Leiser is a freelance writer in New Jersey.

William Ford, MD, FHM, was just three years removed from residency when he assumed his first HM leadership role. His qualifications were impressive, but because he was just in his early 30s, his soon-to-be bosses needed some convincing that he was right for the job.

But Dr. Ford—now medical director at Cogent Healthcare and director of the HM program at Temple University in Philadelphia—quickly proved that ability, attitude, and work ethic mean as much as, if not more than, a lengthy résumé. “I don’t think you need a title to lead or a position to lead,” Dr. Ford says. “You need the will to lead.”

Q: You spent a little more than a year in private practice before you became a hospitalist. What motivated you to make the switch?

A: I really enjoy the mix of responsibilities. There’s a lot more to HM than just treating the patient. You’re actually treating the hospital. And, ultimately, it’s more fast-paced. I like the ability to be on the cutting edge of medicine, and just being in a hospital keeps you on your toes from a medical perspective.

Q: Your first two clinical sites—Lehigh Valley Hospital in Allentown, Pa., and Union Hospital in Elkton, Md.—are more suburban settings. What made Temple the right fit?

A: I trained at Drexel University (also in Philadelphia), and I wanted to get back to the urban setting. I find that environment to be very challenging.

Q: How so?

A: The biggest challenge is the socioeconomic problems. Eighty percent of our patients are on Medicare or Medicaid. … In a nutshell, the challenge comes down to basic access to care.

Q: How frustrating is that for you?

A: It’s very frustrating, and it angers me. If I write a prescription for a patient, there’s a good chance the person won’t take it. If I tell them they need follow-up treatment, there’s a good chance they won’t get it. It’s not that they don’t want to. Maybe they can’t afford the co-pay, or maybe, if they haven’t been monitored by a primary-care physician (PCP), they can’t get an appointment for three months. I know we, as a group, can care for patients much better if they would follow up with our instructions. But because of the hoops they have to go through, whether for economic reasons or access reasons, many of them are coming back to the ED.

Q: What keeps you going in spite of those challenges?

A: The patients. They are a very grateful population. They know they are underserved, and they are appreciative of the care.

Q: Temple partnered with Cogent Healthcare in 2006 to manage its hospitalist program. Were you excited about being able to put your stamp on a program and really help it develop?

A: That was enormously appealing. If you’re a true leader, you’re never satisfied with the way your boss is running the program. If you really have the qualities to lead a group, you always think you can do better. … I was intrigued by the opportunity to start a group in a major teaching center that, for the first time, was outsourcing its hospitalist program and trying to solidify its teaching mission.

Q: How quickly has the program grown?

A: We’ve grown from four physicians to 27, and we treat about 15,000 inpatients annually.

Q: What advice would you give to the director of a program experiencing similar growth?

A: Be very stringent on the doctors you choose. For a lot of groups, retention/recruitment is the No. 1, No. 2, and No. 3 problem. We’ve been fortunate we haven’t made many bad hires. But the time and effort it takes to get rid of a bad hire can really end up bogging you down. I’d rather have everyone pull up their bootstraps and work a bit harder and take an extra few months to find the right person than go ahead with a bad hire simply to have another body.

Q: Were there other keys behind the program’s success?

A: There are several. I owe a great deal of the success of the program to the great doctors I work with. I received tremendous support from the department of internal medicine when I arrived, and that ensured a smooth transition. Another big component is good communication.

Q: What role has communication played?

A: Hospitals are very siloed. One group doesn’t speak to another. We’re taught to stick our head in the sand, fix the problem, and move on to the next problem. That gets you crucified in the world of HM. As hospitalists, we have to be the glue that brings all these silos together. In our profession, to be a good leader, you don’t have to be the smartest or best clinician. But you do have to have the attributes of communication and teambuilding. The key is to meet people and talk to them. Try to get to know every key hospital administrator. Don’t just write an order and go away; talk to the nurse. If you forge relationships and try to get the group more fully implemented, it will be more likely to reach its full potential.

Q: At 35, you are slightly younger than the average U.S. hospitalist, yet you’re nearly three years into your first true leadership role. Has your age ever been an issue?

A: Initially, it was a hindrance. It took four months for Temple to interview me. The biggest negative they gave to Cogent was, “He’s so young.” In any other field, 35 would not be considered a child. We’d be in the workforce for 13 years, and we’d be considered middle or senior management. Medicine in general is steeped in, “If you don’t have gray hair, you’re not able to sit at the table.” In our specialty, you can. … It doesn’t have to hinder you, but you have to be willing and able to do the right things. If you are, you will be noticed.

Q: You consider HM program marketing and branding one of your specialties. Why are those efforts necessary?

A: If you don’t market yourself, you’ll die, particularly in a competitive market. Whether you are at an academic center or a small community hospital or even a larger hospital, you could have two or three hospitalist groups all vying for the same patient volume. You need to give yourself a differential advantage.

Q: How do you do that?

A: You have to get out and meet people and shake some hands. You have to meet all of your customers, and you have to find out if they are happy or displeased. You have to communicate with them. You have to think about your customers, and they’re not just the patients in the bed. Your customers also are your administration, your PCPs, your subspecialists. … It’s no different than a vendor selling fax machines. We are a business, and if doctors don’t think that, they’re very naive.

Q: You’re also a big proponent of team-building within groups.

A: Definitely. That’s the foundation. Groups are going to coalesce differently. In my group at Lehigh Valley, we all had a Fourth of July party. We were never so close as after that one experience when we shared dinner together. It may be as simple as that. At Temple, I had all 25 of us meet and go over a teambuilding exercise to understand what values people have and why they come to work. I asked them to tell me something I didn’t know about them. I heard everything from “I changed my name when I was 5” to “I played basketball in college.”

You’re more willing to cover for a colleague if he or she is sick if you get to know them on a personal level. And if that happens, you’re less likely to leave, and that decreases turnover. On top of everything else, you become a group. You see group buy-in and goal recognition, and you start to see those goals attained.

Q: On top of your administrative duties and teaching responsibilities, you’re still doing 10 clinical shifts per month. Why?

A: It’s hugely important for two reasons. No. 1 is respect among members of your team. No. 2 is knowledge of your service. It’s not until you get your hands dirty that you can really understand what physicians in your group are going through and figure out ways to make life better. And at the end of the day, we’re all still physicians. TH

Mark Leiser is a freelance writer in New Jersey.

William Ford, MD, FHM, was just three years removed from residency when he assumed his first HM leadership role. His qualifications were impressive, but because he was just in his early 30s, his soon-to-be bosses needed some convincing that he was right for the job.

But Dr. Ford—now medical director at Cogent Healthcare and director of the HM program at Temple University in Philadelphia—quickly proved that ability, attitude, and work ethic mean as much as, if not more than, a lengthy résumé. “I don’t think you need a title to lead or a position to lead,” Dr. Ford says. “You need the will to lead.”

Q: You spent a little more than a year in private practice before you became a hospitalist. What motivated you to make the switch?

A: I really enjoy the mix of responsibilities. There’s a lot more to HM than just treating the patient. You’re actually treating the hospital. And, ultimately, it’s more fast-paced. I like the ability to be on the cutting edge of medicine, and just being in a hospital keeps you on your toes from a medical perspective.

Q: Your first two clinical sites—Lehigh Valley Hospital in Allentown, Pa., and Union Hospital in Elkton, Md.—are more suburban settings. What made Temple the right fit?

A: I trained at Drexel University (also in Philadelphia), and I wanted to get back to the urban setting. I find that environment to be very challenging.

Q: How so?

A: The biggest challenge is the socioeconomic problems. Eighty percent of our patients are on Medicare or Medicaid. … In a nutshell, the challenge comes down to basic access to care.

Q: How frustrating is that for you?

A: It’s very frustrating, and it angers me. If I write a prescription for a patient, there’s a good chance the person won’t take it. If I tell them they need follow-up treatment, there’s a good chance they won’t get it. It’s not that they don’t want to. Maybe they can’t afford the co-pay, or maybe, if they haven’t been monitored by a primary-care physician (PCP), they can’t get an appointment for three months. I know we, as a group, can care for patients much better if they would follow up with our instructions. But because of the hoops they have to go through, whether for economic reasons or access reasons, many of them are coming back to the ED.

Q: What keeps you going in spite of those challenges?

A: The patients. They are a very grateful population. They know they are underserved, and they are appreciative of the care.

Q: Temple partnered with Cogent Healthcare in 2006 to manage its hospitalist program. Were you excited about being able to put your stamp on a program and really help it develop?

A: That was enormously appealing. If you’re a true leader, you’re never satisfied with the way your boss is running the program. If you really have the qualities to lead a group, you always think you can do better. … I was intrigued by the opportunity to start a group in a major teaching center that, for the first time, was outsourcing its hospitalist program and trying to solidify its teaching mission.

Q: How quickly has the program grown?

A: We’ve grown from four physicians to 27, and we treat about 15,000 inpatients annually.

Q: What advice would you give to the director of a program experiencing similar growth?

A: Be very stringent on the doctors you choose. For a lot of groups, retention/recruitment is the No. 1, No. 2, and No. 3 problem. We’ve been fortunate we haven’t made many bad hires. But the time and effort it takes to get rid of a bad hire can really end up bogging you down. I’d rather have everyone pull up their bootstraps and work a bit harder and take an extra few months to find the right person than go ahead with a bad hire simply to have another body.

Q: Were there other keys behind the program’s success?

A: There are several. I owe a great deal of the success of the program to the great doctors I work with. I received tremendous support from the department of internal medicine when I arrived, and that ensured a smooth transition. Another big component is good communication.

Q: What role has communication played?

A: Hospitals are very siloed. One group doesn’t speak to another. We’re taught to stick our head in the sand, fix the problem, and move on to the next problem. That gets you crucified in the world of HM. As hospitalists, we have to be the glue that brings all these silos together. In our profession, to be a good leader, you don’t have to be the smartest or best clinician. But you do have to have the attributes of communication and teambuilding. The key is to meet people and talk to them. Try to get to know every key hospital administrator. Don’t just write an order and go away; talk to the nurse. If you forge relationships and try to get the group more fully implemented, it will be more likely to reach its full potential.

Q: At 35, you are slightly younger than the average U.S. hospitalist, yet you’re nearly three years into your first true leadership role. Has your age ever been an issue?

A: Initially, it was a hindrance. It took four months for Temple to interview me. The biggest negative they gave to Cogent was, “He’s so young.” In any other field, 35 would not be considered a child. We’d be in the workforce for 13 years, and we’d be considered middle or senior management. Medicine in general is steeped in, “If you don’t have gray hair, you’re not able to sit at the table.” In our specialty, you can. … It doesn’t have to hinder you, but you have to be willing and able to do the right things. If you are, you will be noticed.

Q: You consider HM program marketing and branding one of your specialties. Why are those efforts necessary?

A: If you don’t market yourself, you’ll die, particularly in a competitive market. Whether you are at an academic center or a small community hospital or even a larger hospital, you could have two or three hospitalist groups all vying for the same patient volume. You need to give yourself a differential advantage.

Q: How do you do that?

A: You have to get out and meet people and shake some hands. You have to meet all of your customers, and you have to find out if they are happy or displeased. You have to communicate with them. You have to think about your customers, and they’re not just the patients in the bed. Your customers also are your administration, your PCPs, your subspecialists. … It’s no different than a vendor selling fax machines. We are a business, and if doctors don’t think that, they’re very naive.

Q: You’re also a big proponent of team-building within groups.

A: Definitely. That’s the foundation. Groups are going to coalesce differently. In my group at Lehigh Valley, we all had a Fourth of July party. We were never so close as after that one experience when we shared dinner together. It may be as simple as that. At Temple, I had all 25 of us meet and go over a teambuilding exercise to understand what values people have and why they come to work. I asked them to tell me something I didn’t know about them. I heard everything from “I changed my name when I was 5” to “I played basketball in college.”

You’re more willing to cover for a colleague if he or she is sick if you get to know them on a personal level. And if that happens, you’re less likely to leave, and that decreases turnover. On top of everything else, you become a group. You see group buy-in and goal recognition, and you start to see those goals attained.

Q: On top of your administrative duties and teaching responsibilities, you’re still doing 10 clinical shifts per month. Why?

A: It’s hugely important for two reasons. No. 1 is respect among members of your team. No. 2 is knowledge of your service. It’s not until you get your hands dirty that you can really understand what physicians in your group are going through and figure out ways to make life better. And at the end of the day, we’re all still physicians. TH

Mark Leiser is a freelance writer in New Jersey.

David Yu, MD, learned early on the value of being flexible. While attending Washington University in St. Louis, he found his calling when he changed his major from economics to biology. When the malpractice insurance crisis forced him to close his private practice, he embraced an opportunity to launch a program devoted to the “newfangled concept” of hospital medicine.

“I’m kind of like the accidental tourist,” says Dr. Yu, medical director of hospitalist services at the 372-bed Decatur Memorial Hospital in Decatur, Ill., and clinical assistant professor of family and community medicine at Southern Illinois University School of Medicine in Carbondale. “I didn’t really go to college with the mind-set of being a doctor, and when I became a doctor, there was no such thing as a hospitalist. … I went where the current took me and, fortunately, here I am.”

Question: What prompted the switch from economics to pre-med/biology?

Answer: When I got to the upper-level econ classes, I realized why the economy is the way it is: because nobody can understand how it works. My sister was in medical school. She really liked it and she talked me into it.

Q: You spent nine years in traditional practice. Why did you become a hospitalist?

A: In 2004, my malpractice insurance rate shot up 400% without any active lawsuits, so I had to close my practice. I had the choice of joining another traditional group, or Decatur (Memorial Hospital) was starting a new hospitalist program. To quote “The Godfather,” they made me an offer I couldn’t refuse.

Q: How did your experience in traditional practice prepare you for your role as a hospitalist?

A: I had been surrounded by incredible specialists. I saw how they interacted with me and how they treated my patients. As hospitalists, we are serving our patients, but really our clientele is the physicians we admit for. When I made the switch, I really had an idea of how a hospitalist should serve traditional practice.

Q: What is that service model?

A: It comes down to what I call the three A’s: You have to be available, you have to be able, and you have to be amicable. One of the problems in our field is a lot of hospitalists complain they’re treated like residents. They say they don’t get respect. They feel mistreated. That’s the wrong attitude. You can’t just ask for respect or demand it. You have to develop relationships.

Q: When Decatur’s hospitalist program started, you were on your own. Now there are seven physicians, two physician assistants, and a practice manager. How rewarding has it been to see it grow?

A: It’s been very rewarding. I’m honored to have been chosen as a member of Team Hospitalist, and I’m honored to be a committee member for SHM’s Non-Physician Provider Committee. Those are personal honors, but they are reflections on the success of the program. It’s an honor for the entire Decatur Memorial Hospital, and the administration, that a program started four and a half years ago, indirectly, has received national recognition.

Q: You implemented a one-week-on, one-week-off schedule for your hospitalists as a way to decrease signouts. How did that come about?

A: Signouts have been the bane of medical mistakes. Instead of having signouts twice a day, we have one physician on call for that entire week for his or her patients. It’s patient-centric versus schedule-centric. Physicians leave the hospital when their work is done, instead of looking at the clock and waiting to sign out at a certain time like a factory worker. It treats hospitalists not as shift workers but as attending physicians. It gives them due respect that they can manage their own patients responsibly.

Q: Do you think the schedule improves the quality of patient care?

A: The continuity of care is incredible. If you are admitted and discharged between Mondays, you have one hospitalist in charge of your entire case, instead of multiple physicians being on call for you. That increases patient satisfaction, reduces medical errors, and eliminates the need for unnecessary tests when new physicians take over. I’m also a huge believer that scheduling brings out the best and worst in hospitalists.

Q: How does it bring out the best in them?

A: As medical directors, we have to find ways to help hospitalists take more ownership in their patients and their program. If they’re thinking, “My shift is ending and I’m going to be off and I can hand this issue off to the next doctor,” that can have a tremendous effect on the quality of care and the way a hospitalist delivers medicine. With our schedule, you can’t pawn off your responsibility to the nocturnist or the weekend guy. … If something goes wrong or if the ball gets dropped, there’s no one else to blame it on.

Q: You developed a system at Decatur through which patient discharge summaries are sent electronically to primary-care physicians, often before the patient leaves the hospital. Have the primaries been receptive?

A: Absolutely. Communication is the mother’s milk of hospitalists. Some hospitalist programs are very large, they’re very busy, or there’s no incentive for them to do this because they’re the only game in town. But I practice in a mid-size community and I know all of these doctors. My reputation is my bond. I have to provide good service.

Q: What do you enjoy most about your role as a hospitalist?

A: I love solving problems for a patient. I also love how the relationship builds. You introduce yourself to a patient and their family as a hospitalist and they’re thinking, “Who the heck are you?” For a few seconds, it’s like meeting someone on a blind date. And when they’re discharged, they tell you they had a pleasant experience and they appreciate your help. It’s a courtship at a rapid pace.

Q: What do you consider to be your biggest challenge?

A: Recruitment; the administration asking us to take on more responsibilities; burnout. … We’re a typical hospitalist program; I think the problems are pretty universal.

Q: How do you address those challenges?

A: As medical director, you’re always navigating political and personal minefields. It comes back to developing relationships. The only way to earn goodwill is to give and provide service. That’s a problem some hospitalist programs run into. They want to instantly demand respect. You can’t demand it; you have to earn it. Sometimes hospitalists feel dumped on. Those are opportunities … to provide service in a willing and positive way instead of complaining. I’m not saying you have to be a whipping boy, but there are times when you have to give a little to get a little. That’s where the wisdom of the medical director comes in and sets the whole tone.

Q: What’s ahead for the academic side of your career?

A: We’re considering the possibility of starting a family practice fellowship program for attending residents who finish but want to go into the field of hospital medicine and want additional training. It’s not a done deal, but it’s an exciting possibility.

Q: How so?

A: Every medical director says they have a hard time recruiting. One way we can help solve the problem is by producing more hospitalists. We can’t just complain. We have to increase the pool of professionals interested in our model, train them, and get them integrated into our system.

Q: What advice would you give a student who is considering going that route?

A: You have to be a good communicator, you have to enjoy taking care of very sick people, and you have to enjoy solving very complex problems. You can’t just do it for the lifestyle. If you do, you won’t be happy in the long run. If I ask a medical student or resident why they want to be a hospitalist and they say, “I like the one-week-on, one-week-off schedule,” I tell them, “If that’s the reason you’re considering it, you really should reconsider.” TH

Mark Leiser is a freelance writer in New Jersey.

David Yu, MD, learned early on the value of being flexible. While attending Washington University in St. Louis, he found his calling when he changed his major from economics to biology. When the malpractice insurance crisis forced him to close his private practice, he embraced an opportunity to launch a program devoted to the “newfangled concept” of hospital medicine.

“I’m kind of like the accidental tourist,” says Dr. Yu, medical director of hospitalist services at the 372-bed Decatur Memorial Hospital in Decatur, Ill., and clinical assistant professor of family and community medicine at Southern Illinois University School of Medicine in Carbondale. “I didn’t really go to college with the mind-set of being a doctor, and when I became a doctor, there was no such thing as a hospitalist. … I went where the current took me and, fortunately, here I am.”

Question: What prompted the switch from economics to pre-med/biology?

Answer: When I got to the upper-level econ classes, I realized why the economy is the way it is: because nobody can understand how it works. My sister was in medical school. She really liked it and she talked me into it.

Q: You spent nine years in traditional practice. Why did you become a hospitalist?

A: In 2004, my malpractice insurance rate shot up 400% without any active lawsuits, so I had to close my practice. I had the choice of joining another traditional group, or Decatur (Memorial Hospital) was starting a new hospitalist program. To quote “The Godfather,” they made me an offer I couldn’t refuse.

Q: How did your experience in traditional practice prepare you for your role as a hospitalist?

A: I had been surrounded by incredible specialists. I saw how they interacted with me and how they treated my patients. As hospitalists, we are serving our patients, but really our clientele is the physicians we admit for. When I made the switch, I really had an idea of how a hospitalist should serve traditional practice.

Q: What is that service model?

A: It comes down to what I call the three A’s: You have to be available, you have to be able, and you have to be amicable. One of the problems in our field is a lot of hospitalists complain they’re treated like residents. They say they don’t get respect. They feel mistreated. That’s the wrong attitude. You can’t just ask for respect or demand it. You have to develop relationships.

Q: When Decatur’s hospitalist program started, you were on your own. Now there are seven physicians, two physician assistants, and a practice manager. How rewarding has it been to see it grow?

A: It’s been very rewarding. I’m honored to have been chosen as a member of Team Hospitalist, and I’m honored to be a committee member for SHM’s Non-Physician Provider Committee. Those are personal honors, but they are reflections on the success of the program. It’s an honor for the entire Decatur Memorial Hospital, and the administration, that a program started four and a half years ago, indirectly, has received national recognition.

Q: You implemented a one-week-on, one-week-off schedule for your hospitalists as a way to decrease signouts. How did that come about?

A: Signouts have been the bane of medical mistakes. Instead of having signouts twice a day, we have one physician on call for that entire week for his or her patients. It’s patient-centric versus schedule-centric. Physicians leave the hospital when their work is done, instead of looking at the clock and waiting to sign out at a certain time like a factory worker. It treats hospitalists not as shift workers but as attending physicians. It gives them due respect that they can manage their own patients responsibly.

Q: Do you think the schedule improves the quality of patient care?

A: The continuity of care is incredible. If you are admitted and discharged between Mondays, you have one hospitalist in charge of your entire case, instead of multiple physicians being on call for you. That increases patient satisfaction, reduces medical errors, and eliminates the need for unnecessary tests when new physicians take over. I’m also a huge believer that scheduling brings out the best and worst in hospitalists.

Q: How does it bring out the best in them?

A: As medical directors, we have to find ways to help hospitalists take more ownership in their patients and their program. If they’re thinking, “My shift is ending and I’m going to be off and I can hand this issue off to the next doctor,” that can have a tremendous effect on the quality of care and the way a hospitalist delivers medicine. With our schedule, you can’t pawn off your responsibility to the nocturnist or the weekend guy. … If something goes wrong or if the ball gets dropped, there’s no one else to blame it on.

Q: You developed a system at Decatur through which patient discharge summaries are sent electronically to primary-care physicians, often before the patient leaves the hospital. Have the primaries been receptive?

A: Absolutely. Communication is the mother’s milk of hospitalists. Some hospitalist programs are very large, they’re very busy, or there’s no incentive for them to do this because they’re the only game in town. But I practice in a mid-size community and I know all of these doctors. My reputation is my bond. I have to provide good service.

Q: What do you enjoy most about your role as a hospitalist?

A: I love solving problems for a patient. I also love how the relationship builds. You introduce yourself to a patient and their family as a hospitalist and they’re thinking, “Who the heck are you?” For a few seconds, it’s like meeting someone on a blind date. And when they’re discharged, they tell you they had a pleasant experience and they appreciate your help. It’s a courtship at a rapid pace.

Q: What do you consider to be your biggest challenge?

A: Recruitment; the administration asking us to take on more responsibilities; burnout. … We’re a typical hospitalist program; I think the problems are pretty universal.

Q: How do you address those challenges?

A: As medical director, you’re always navigating political and personal minefields. It comes back to developing relationships. The only way to earn goodwill is to give and provide service. That’s a problem some hospitalist programs run into. They want to instantly demand respect. You can’t demand it; you have to earn it. Sometimes hospitalists feel dumped on. Those are opportunities … to provide service in a willing and positive way instead of complaining. I’m not saying you have to be a whipping boy, but there are times when you have to give a little to get a little. That’s where the wisdom of the medical director comes in and sets the whole tone.

Q: What’s ahead for the academic side of your career?

A: We’re considering the possibility of starting a family practice fellowship program for attending residents who finish but want to go into the field of hospital medicine and want additional training. It’s not a done deal, but it’s an exciting possibility.

Q: How so?

A: Every medical director says they have a hard time recruiting. One way we can help solve the problem is by producing more hospitalists. We can’t just complain. We have to increase the pool of professionals interested in our model, train them, and get them integrated into our system.

Q: What advice would you give a student who is considering going that route?

A: You have to be a good communicator, you have to enjoy taking care of very sick people, and you have to enjoy solving very complex problems. You can’t just do it for the lifestyle. If you do, you won’t be happy in the long run. If I ask a medical student or resident why they want to be a hospitalist and they say, “I like the one-week-on, one-week-off schedule,” I tell them, “If that’s the reason you’re considering it, you really should reconsider.” TH

Mark Leiser is a freelance writer in New Jersey.

David Yu, MD, learned early on the value of being flexible. While attending Washington University in St. Louis, he found his calling when he changed his major from economics to biology. When the malpractice insurance crisis forced him to close his private practice, he embraced an opportunity to launch a program devoted to the “newfangled concept” of hospital medicine.

“I’m kind of like the accidental tourist,” says Dr. Yu, medical director of hospitalist services at the 372-bed Decatur Memorial Hospital in Decatur, Ill., and clinical assistant professor of family and community medicine at Southern Illinois University School of Medicine in Carbondale. “I didn’t really go to college with the mind-set of being a doctor, and when I became a doctor, there was no such thing as a hospitalist. … I went where the current took me and, fortunately, here I am.”

Question: What prompted the switch from economics to pre-med/biology?

Answer: When I got to the upper-level econ classes, I realized why the economy is the way it is: because nobody can understand how it works. My sister was in medical school. She really liked it and she talked me into it.

Q: You spent nine years in traditional practice. Why did you become a hospitalist?

A: In 2004, my malpractice insurance rate shot up 400% without any active lawsuits, so I had to close my practice. I had the choice of joining another traditional group, or Decatur (Memorial Hospital) was starting a new hospitalist program. To quote “The Godfather,” they made me an offer I couldn’t refuse.

Q: How did your experience in traditional practice prepare you for your role as a hospitalist?

A: I had been surrounded by incredible specialists. I saw how they interacted with me and how they treated my patients. As hospitalists, we are serving our patients, but really our clientele is the physicians we admit for. When I made the switch, I really had an idea of how a hospitalist should serve traditional practice.

Q: What is that service model?

A: It comes down to what I call the three A’s: You have to be available, you have to be able, and you have to be amicable. One of the problems in our field is a lot of hospitalists complain they’re treated like residents. They say they don’t get respect. They feel mistreated. That’s the wrong attitude. You can’t just ask for respect or demand it. You have to develop relationships.

Q: When Decatur’s hospitalist program started, you were on your own. Now there are seven physicians, two physician assistants, and a practice manager. How rewarding has it been to see it grow?

A: It’s been very rewarding. I’m honored to have been chosen as a member of Team Hospitalist, and I’m honored to be a committee member for SHM’s Non-Physician Provider Committee. Those are personal honors, but they are reflections on the success of the program. It’s an honor for the entire Decatur Memorial Hospital, and the administration, that a program started four and a half years ago, indirectly, has received national recognition.

Q: You implemented a one-week-on, one-week-off schedule for your hospitalists as a way to decrease signouts. How did that come about?

A: Signouts have been the bane of medical mistakes. Instead of having signouts twice a day, we have one physician on call for that entire week for his or her patients. It’s patient-centric versus schedule-centric. Physicians leave the hospital when their work is done, instead of looking at the clock and waiting to sign out at a certain time like a factory worker. It treats hospitalists not as shift workers but as attending physicians. It gives them due respect that they can manage their own patients responsibly.

Q: Do you think the schedule improves the quality of patient care?

A: The continuity of care is incredible. If you are admitted and discharged between Mondays, you have one hospitalist in charge of your entire case, instead of multiple physicians being on call for you. That increases patient satisfaction, reduces medical errors, and eliminates the need for unnecessary tests when new physicians take over. I’m also a huge believer that scheduling brings out the best and worst in hospitalists.

Q: How does it bring out the best in them?

A: As medical directors, we have to find ways to help hospitalists take more ownership in their patients and their program. If they’re thinking, “My shift is ending and I’m going to be off and I can hand this issue off to the next doctor,” that can have a tremendous effect on the quality of care and the way a hospitalist delivers medicine. With our schedule, you can’t pawn off your responsibility to the nocturnist or the weekend guy. … If something goes wrong or if the ball gets dropped, there’s no one else to blame it on.

Q: You developed a system at Decatur through which patient discharge summaries are sent electronically to primary-care physicians, often before the patient leaves the hospital. Have the primaries been receptive?

A: Absolutely. Communication is the mother’s milk of hospitalists. Some hospitalist programs are very large, they’re very busy, or there’s no incentive for them to do this because they’re the only game in town. But I practice in a mid-size community and I know all of these doctors. My reputation is my bond. I have to provide good service.

Q: What do you enjoy most about your role as a hospitalist?

A: I love solving problems for a patient. I also love how the relationship builds. You introduce yourself to a patient and their family as a hospitalist and they’re thinking, “Who the heck are you?” For a few seconds, it’s like meeting someone on a blind date. And when they’re discharged, they tell you they had a pleasant experience and they appreciate your help. It’s a courtship at a rapid pace.

Q: What do you consider to be your biggest challenge?

A: Recruitment; the administration asking us to take on more responsibilities; burnout. … We’re a typical hospitalist program; I think the problems are pretty universal.

Q: How do you address those challenges?

A: As medical director, you’re always navigating political and personal minefields. It comes back to developing relationships. The only way to earn goodwill is to give and provide service. That’s a problem some hospitalist programs run into. They want to instantly demand respect. You can’t demand it; you have to earn it. Sometimes hospitalists feel dumped on. Those are opportunities … to provide service in a willing and positive way instead of complaining. I’m not saying you have to be a whipping boy, but there are times when you have to give a little to get a little. That’s where the wisdom of the medical director comes in and sets the whole tone.

Q: What’s ahead for the academic side of your career?

A: We’re considering the possibility of starting a family practice fellowship program for attending residents who finish but want to go into the field of hospital medicine and want additional training. It’s not a done deal, but it’s an exciting possibility.

Q: How so?

A: Every medical director says they have a hard time recruiting. One way we can help solve the problem is by producing more hospitalists. We can’t just complain. We have to increase the pool of professionals interested in our model, train them, and get them integrated into our system.

Q: What advice would you give a student who is considering going that route?

A: You have to be a good communicator, you have to enjoy taking care of very sick people, and you have to enjoy solving very complex problems. You can’t just do it for the lifestyle. If you do, you won’t be happy in the long run. If I ask a medical student or resident why they want to be a hospitalist and they say, “I like the one-week-on, one-week-off schedule,” I tell them, “If that’s the reason you’re considering it, you really should reconsider.” TH

Mark Leiser is a freelance writer in New Jersey.

Many physicians use traditional practice as their stepping stone to a hospitalist career. David M. Grace, MD, took a far more unconventional path.

He served as a combat medic in the Army National Guard, joined a disaster medical assistance team at the Federal Emergency Management Agency (FEMA), and volunteered to help the American Red Cross in times of crisis—all before entering medical school.

Dr. Grace became a hospitalist in 2002, and now serves as hospitalist division area medical officer for The Schumacher Group, a staffing and consulting firm in Lafayette, La., that hires physicians as independent contractors to work in hospitals across the country.

But 21 years into his healthcare career, he continues to seek opportunities that offer the same two rewards: “I want to be filled with Adrenalin,” he says, “but I still want to use my brains.”

Question: Given your varied background, how did you wind up becoming a hospitalist?

Answer: My predoctoring resume reads like a fast track of becoming an emergency physician. In residency, I had heard the term “hospitalist.” I knew I liked dealing with sick patients. Emergency departments act as a fairly good filter, and anyone who gets through and upstairs truly is a sick patient. I figured if I were a hospitalist, all my patients would be sick, as opposed to just some. That really drove me to hospital medicine.

Q: You founded your own hospitalist company in 2005, but within two years, you joined The Schumacher Group. Why did you make the switch?

A: With the speed with which hospital medicine is growing, I thought if I could tap into their resources and infrastructure … I’d be able to do things I couldn’t do in my own group for years, if not decades. I really thought I would be able to impact a far larger portion of patient lives with them than I could in my own smaller, somewhat homemade group.

Q: When The Schumacher Group formed, it focused on emergency departments. In 2007, it launched a hospitalist service. What’s the benefit?

A: If you put good hospitalist systems under the same umbrella as good emergency department systems, you can do things to boost the synergy between the two disciplines and improve patient care. In the facilities where we’re managing both the ED and the hospitalists, we can effect patient care from the moment the patient swings through the ambulance bay doors until the moment they are discharged.

Q: How successful has the HM effort been?

A: The hospitalist side, by the end of the year, will have about 20 to 25 practices up and running, with growth in the neighborhood of 10 to 15 practices a year expected to come on line.

Q: What are the advantages to a private corporation setup?

A: At the end of the day, doctors need to be patient-care advocates. But if you are employed by a hospital, they sign your check. When push comes to shove on a quality issue, I think there’s a tendency not to shove as hard when the person you’re shoving is the person employing you.

Q: Could this approach be the wave of the future?

A: I think so. It goes back to the idea of focusing all of your resources into one small area, such as hospital medicine or inpatient medicine, so there’s far fewer distractions than for a hospital that runs its own hospitalist program. We saw that in the 1970s, when hospitals were buying primary-care practices left and right. They realized they didn’t have the skills or the resources to make that effective, and they rapidly divested.

Q: Most doctors at the executive level of The Schumacher Group—including yourself—still practice medicine. Why is that so integral to the mission?

A: When I served in the military, the best officers I served under were officers who had been enlisted men earlier in their career. The same follows suit in hospital medicine. When I make an administrative decision, it can affect thousands of patient lives tomorrow. I can mentally track the effects of my decision all the way back to how it will affect the patient laying in the bed. If you’re not having that constantly reinforced by seeing patients, it’s very easy to lose track of it, and that has such a profound effect on patient care.

Q: SHM recently designated you one of the inaugural “Fellows in Hospital Medicine.” What is the biggest reward of a HM career?

A: For me, there are two. One is the ability to see the fruits of your labor much more rapidly than in the outpatient world. I can have a patient in bed in front of me actively dying and watch them a week later walk out of hospital in good condition. That’s a very different timetable than the outpatient world, when you may put a patient on all the right medicines to reduce the risk of a heart attack and, over 60 years, watch them not have a heart attack. The other thing I find very rewarding is the amount of measurements and data collected on what we do. We get feedback ranging from patient satisfaction scores to referring physician scores to readmission rates to data that shows if we are able to get patients better outcomes at lower costs. You just don’t get that type of feedback in many other fields.

Q: What is the greatest challenge facing the profession?

A: One of the biggest is the supply and demand mismatch. Right now, one of the hardest jobs is a hospitalist recruiter. With every physician having five to 10 open job offers …recruiting is difficult, and recruiting the right physician is extremely difficult.

Q: How can that be addressed?

A: One way is to be efficient. Can we see more patients in the same amount of time with no decrease in quality? For us, it involves the use of what we call a practice coordinator. It’s an employee of The Schumacher Group who is located in the individual hospital who does everything from assisting with managing the practice to answering telephone calls. This really allows us to help us organize our time better, so we don’t get bogged down in nonclinical work. Every minute spent on the phone with an insurance company or home health agency is a minute not spent at the bedside. Another way is expanding the use of midlevel providers. The key is not to use them as a replacement for a physician, but as an assistant to the physician—again, to boost capacity.

Q: How did your background with the military, FEMA, and the Red Cross prepare you for what you’re doing now?

A: Business as usual is very difficult to do in a chaotic environment, so I began to appreciate the importance of systems. If you’re relying on an individual and that individual leaves, your entity is in trouble. If you put good systems into place, you’re not so reliant on any one individual. Systems can function long after any individual doctor has come and gone. In the world of hospitalists—where there’s still fairly high turnover, being a young field and there are many opportunities—it’s imperative the systems approach is taken. TH

Mark Leiser is a freelance writer in New Jersey.

Many physicians use traditional practice as their stepping stone to a hospitalist career. David M. Grace, MD, took a far more unconventional path.

He served as a combat medic in the Army National Guard, joined a disaster medical assistance team at the Federal Emergency Management Agency (FEMA), and volunteered to help the American Red Cross in times of crisis—all before entering medical school.

Dr. Grace became a hospitalist in 2002, and now serves as hospitalist division area medical officer for The Schumacher Group, a staffing and consulting firm in Lafayette, La., that hires physicians as independent contractors to work in hospitals across the country.

But 21 years into his healthcare career, he continues to seek opportunities that offer the same two rewards: “I want to be filled with Adrenalin,” he says, “but I still want to use my brains.”

Question: Given your varied background, how did you wind up becoming a hospitalist?

Answer: My predoctoring resume reads like a fast track of becoming an emergency physician. In residency, I had heard the term “hospitalist.” I knew I liked dealing with sick patients. Emergency departments act as a fairly good filter, and anyone who gets through and upstairs truly is a sick patient. I figured if I were a hospitalist, all my patients would be sick, as opposed to just some. That really drove me to hospital medicine.

Q: You founded your own hospitalist company in 2005, but within two years, you joined The Schumacher Group. Why did you make the switch?

A: With the speed with which hospital medicine is growing, I thought if I could tap into their resources and infrastructure … I’d be able to do things I couldn’t do in my own group for years, if not decades. I really thought I would be able to impact a far larger portion of patient lives with them than I could in my own smaller, somewhat homemade group.

Q: When The Schumacher Group formed, it focused on emergency departments. In 2007, it launched a hospitalist service. What’s the benefit?

A: If you put good hospitalist systems under the same umbrella as good emergency department systems, you can do things to boost the synergy between the two disciplines and improve patient care. In the facilities where we’re managing both the ED and the hospitalists, we can effect patient care from the moment the patient swings through the ambulance bay doors until the moment they are discharged.

Q: How successful has the HM effort been?

A: The hospitalist side, by the end of the year, will have about 20 to 25 practices up and running, with growth in the neighborhood of 10 to 15 practices a year expected to come on line.

Q: What are the advantages to a private corporation setup?

A: At the end of the day, doctors need to be patient-care advocates. But if you are employed by a hospital, they sign your check. When push comes to shove on a quality issue, I think there’s a tendency not to shove as hard when the person you’re shoving is the person employing you.

Q: Could this approach be the wave of the future?

A: I think so. It goes back to the idea of focusing all of your resources into one small area, such as hospital medicine or inpatient medicine, so there’s far fewer distractions than for a hospital that runs its own hospitalist program. We saw that in the 1970s, when hospitals were buying primary-care practices left and right. They realized they didn’t have the skills or the resources to make that effective, and they rapidly divested.

Q: Most doctors at the executive level of The Schumacher Group—including yourself—still practice medicine. Why is that so integral to the mission?

A: When I served in the military, the best officers I served under were officers who had been enlisted men earlier in their career. The same follows suit in hospital medicine. When I make an administrative decision, it can affect thousands of patient lives tomorrow. I can mentally track the effects of my decision all the way back to how it will affect the patient laying in the bed. If you’re not having that constantly reinforced by seeing patients, it’s very easy to lose track of it, and that has such a profound effect on patient care.

Q: SHM recently designated you one of the inaugural “Fellows in Hospital Medicine.” What is the biggest reward of a HM career?

A: For me, there are two. One is the ability to see the fruits of your labor much more rapidly than in the outpatient world. I can have a patient in bed in front of me actively dying and watch them a week later walk out of hospital in good condition. That’s a very different timetable than the outpatient world, when you may put a patient on all the right medicines to reduce the risk of a heart attack and, over 60 years, watch them not have a heart attack. The other thing I find very rewarding is the amount of measurements and data collected on what we do. We get feedback ranging from patient satisfaction scores to referring physician scores to readmission rates to data that shows if we are able to get patients better outcomes at lower costs. You just don’t get that type of feedback in many other fields.

Q: What is the greatest challenge facing the profession?

A: One of the biggest is the supply and demand mismatch. Right now, one of the hardest jobs is a hospitalist recruiter. With every physician having five to 10 open job offers …recruiting is difficult, and recruiting the right physician is extremely difficult.

Q: How can that be addressed?

A: One way is to be efficient. Can we see more patients in the same amount of time with no decrease in quality? For us, it involves the use of what we call a practice coordinator. It’s an employee of The Schumacher Group who is located in the individual hospital who does everything from assisting with managing the practice to answering telephone calls. This really allows us to help us organize our time better, so we don’t get bogged down in nonclinical work. Every minute spent on the phone with an insurance company or home health agency is a minute not spent at the bedside. Another way is expanding the use of midlevel providers. The key is not to use them as a replacement for a physician, but as an assistant to the physician—again, to boost capacity.

Q: How did your background with the military, FEMA, and the Red Cross prepare you for what you’re doing now?

A: Business as usual is very difficult to do in a chaotic environment, so I began to appreciate the importance of systems. If you’re relying on an individual and that individual leaves, your entity is in trouble. If you put good systems into place, you’re not so reliant on any one individual. Systems can function long after any individual doctor has come and gone. In the world of hospitalists—where there’s still fairly high turnover, being a young field and there are many opportunities—it’s imperative the systems approach is taken. TH

Mark Leiser is a freelance writer in New Jersey.

Many physicians use traditional practice as their stepping stone to a hospitalist career. David M. Grace, MD, took a far more unconventional path.

He served as a combat medic in the Army National Guard, joined a disaster medical assistance team at the Federal Emergency Management Agency (FEMA), and volunteered to help the American Red Cross in times of crisis—all before entering medical school.

Dr. Grace became a hospitalist in 2002, and now serves as hospitalist division area medical officer for The Schumacher Group, a staffing and consulting firm in Lafayette, La., that hires physicians as independent contractors to work in hospitals across the country.

But 21 years into his healthcare career, he continues to seek opportunities that offer the same two rewards: “I want to be filled with Adrenalin,” he says, “but I still want to use my brains.”

Question: Given your varied background, how did you wind up becoming a hospitalist?

Answer: My predoctoring resume reads like a fast track of becoming an emergency physician. In residency, I had heard the term “hospitalist.” I knew I liked dealing with sick patients. Emergency departments act as a fairly good filter, and anyone who gets through and upstairs truly is a sick patient. I figured if I were a hospitalist, all my patients would be sick, as opposed to just some. That really drove me to hospital medicine.

Q: You founded your own hospitalist company in 2005, but within two years, you joined The Schumacher Group. Why did you make the switch?

A: With the speed with which hospital medicine is growing, I thought if I could tap into their resources and infrastructure … I’d be able to do things I couldn’t do in my own group for years, if not decades. I really thought I would be able to impact a far larger portion of patient lives with them than I could in my own smaller, somewhat homemade group.

Q: When The Schumacher Group formed, it focused on emergency departments. In 2007, it launched a hospitalist service. What’s the benefit?

A: If you put good hospitalist systems under the same umbrella as good emergency department systems, you can do things to boost the synergy between the two disciplines and improve patient care. In the facilities where we’re managing both the ED and the hospitalists, we can effect patient care from the moment the patient swings through the ambulance bay doors until the moment they are discharged.

Q: How successful has the HM effort been?

A: The hospitalist side, by the end of the year, will have about 20 to 25 practices up and running, with growth in the neighborhood of 10 to 15 practices a year expected to come on line.

Q: What are the advantages to a private corporation setup?

A: At the end of the day, doctors need to be patient-care advocates. But if you are employed by a hospital, they sign your check. When push comes to shove on a quality issue, I think there’s a tendency not to shove as hard when the person you’re shoving is the person employing you.

Q: Could this approach be the wave of the future?

A: I think so. It goes back to the idea of focusing all of your resources into one small area, such as hospital medicine or inpatient medicine, so there’s far fewer distractions than for a hospital that runs its own hospitalist program. We saw that in the 1970s, when hospitals were buying primary-care practices left and right. They realized they didn’t have the skills or the resources to make that effective, and they rapidly divested.

Q: Most doctors at the executive level of The Schumacher Group—including yourself—still practice medicine. Why is that so integral to the mission?

A: When I served in the military, the best officers I served under were officers who had been enlisted men earlier in their career. The same follows suit in hospital medicine. When I make an administrative decision, it can affect thousands of patient lives tomorrow. I can mentally track the effects of my decision all the way back to how it will affect the patient laying in the bed. If you’re not having that constantly reinforced by seeing patients, it’s very easy to lose track of it, and that has such a profound effect on patient care.

Q: SHM recently designated you one of the inaugural “Fellows in Hospital Medicine.” What is the biggest reward of a HM career?

A: For me, there are two. One is the ability to see the fruits of your labor much more rapidly than in the outpatient world. I can have a patient in bed in front of me actively dying and watch them a week later walk out of hospital in good condition. That’s a very different timetable than the outpatient world, when you may put a patient on all the right medicines to reduce the risk of a heart attack and, over 60 years, watch them not have a heart attack. The other thing I find very rewarding is the amount of measurements and data collected on what we do. We get feedback ranging from patient satisfaction scores to referring physician scores to readmission rates to data that shows if we are able to get patients better outcomes at lower costs. You just don’t get that type of feedback in many other fields.

Q: What is the greatest challenge facing the profession?

A: One of the biggest is the supply and demand mismatch. Right now, one of the hardest jobs is a hospitalist recruiter. With every physician having five to 10 open job offers …recruiting is difficult, and recruiting the right physician is extremely difficult.

Q: How can that be addressed?

A: One way is to be efficient. Can we see more patients in the same amount of time with no decrease in quality? For us, it involves the use of what we call a practice coordinator. It’s an employee of The Schumacher Group who is located in the individual hospital who does everything from assisting with managing the practice to answering telephone calls. This really allows us to help us organize our time better, so we don’t get bogged down in nonclinical work. Every minute spent on the phone with an insurance company or home health agency is a minute not spent at the bedside. Another way is expanding the use of midlevel providers. The key is not to use them as a replacement for a physician, but as an assistant to the physician—again, to boost capacity.

Q: How did your background with the military, FEMA, and the Red Cross prepare you for what you’re doing now?

A: Business as usual is very difficult to do in a chaotic environment, so I began to appreciate the importance of systems. If you’re relying on an individual and that individual leaves, your entity is in trouble. If you put good systems into place, you’re not so reliant on any one individual. Systems can function long after any individual doctor has come and gone. In the world of hospitalists—where there’s still fairly high turnover, being a young field and there are many opportunities—it’s imperative the systems approach is taken. TH

Mark Leiser is a freelance writer in New Jersey.

Julia S. Wright, MD, spent 10 years in traditional practice before joining the University of Wisconsin School of Medicine and Public Health in Madison. Now a clinical associate professor and section head of hospital medicine, the title has changed and the professional demands have intensified. The mission, however, remains the same.

Every decision she’s made in her career—whether it be medical, managerial, financial, or even her seemingly curious choice of college majors—has been guided by one basic question: What will this mean for the quality of patient care? “It may sound cliché, but that’s always the bottom line,” Dr. Wright says. “It’s why I do what I do.”

You spent 10 years in traditional practice before becoming a hospitalist. How did that prepare you for what you’re doing now?

Answer: That experience is a tremendous asset. I made the switch to inpatient medicine because that was the arena I enjoyed the most. But having had experience in the outpatient setting gives me a better understanding of the continuum of care, and my clinical skills have been honed by that experience. I also have an understanding of the strengths of the primary care physicians (PCP), as well as the breadth of the problems they are able to take on.

How does that help you?

A: It really helps in the patient transition, especially on the return side, when patients go back to their PCP after hospitalization. Having an understanding of what resources are available to PCPs helps to determine an appropriate time to discharge a patient. Someone without that experience may have a tendency to think every loose end has to be tied up, or they may make changes that wind up making things more difficult for PCP. But if you have an understanding of a PCP’s capabilities, maybe the patient can be discharged a little earlier.

The University of Wisconsin’s hospitalist program started in 2005. You were named director in 2006. How exciting is it to guide a new program and help it develop?

A: It’s been a tremendous experience. When I joined, we had six hospitalists. Now we have 19. But it was strategic growth; it wasn’t haphazard.

What do you mean by strategic growth?

A: We didn’t simply say, ‘We need more people.’ Every time we brought somebody on, we really made sure it was going to be someone who would add value to the program and be beneficial to the hospital. We were worried, as we got bigger, that it’d be hard to keep the same cohesiveness and that same espirit de corps. During the interviews and the search process, we’re not just asking, ‘Are they qualified?’ We’re asking, ‘Are they a really good fit?’ And everybody has different areas of interest within the group. Some are more research-inclined; one developed a curriculum; some are more clinically oriented. That allows each hospitalist to have an identity in the group. That translated into a good expansion, and it’s been a win-win for us.

What makes someone a good fit for your program?

A: It sounds cliché, but I think the key to a strong developing program is to have a strong sense of what the group values. For us, we value the academic experience. For people going into academic medicine, the struggle is to be able to provide value to the hospital and yet stay academic. Our hospitalists are very clear—that’s our vision. With the support of the hospital and the department, we were able to do both at the same time.

Can you pinpoint one experience that you’ve had that made you realize you’re doing what you’re meant to do?

A: The biggest reward is always patient care. I enjoy the direct patient experience as much as I always have, and that’s what keeps me in the game.

What have you enjoyed most about your transition to a leadership role?

A: I really enjoy the position, not because of the hierarchy, but because of the opportunities afforded by it. I get to interact with hospital medicine staff and the department of medicine chair, and the vice chairs. I’ve been able to interact with others in hospital medicine across the country, and that has been a great experience.

Some hospitalists enjoy what they do because they don’t have to handle the business side of operations or deal with the administrative hassles that private physicians face. In your role, though, you do have to face those challenges. Is that a drawback?

A: I do have to pay attention to the numbers. That’s the bottom line. But it’s something I actually really enjoy. When it comes to awareness of the balance sheet, there’s a division between the leadership level and the clinician level. It’s hard to bridge that chasm of, ‘I’m here for patient care and I don’t necessarily focus on the numbers.’

How do you bridge the chasm?

A: It’s something we should be emphasizing more in hospital medicine. Some people may think it’s distasteful to think about, but it’s something hospitals do need to care about. There’s not enough of that trickling down. This is a huge area for potential growth. It’s important to have an understanding of the importance of the bottom line without feeling too much like it’s threatening the quality of the practice or getting in the way of what we want to be doing.

What other changes are in store for hospital medicine?

A: If you look at the traditional role of a hospitalist, you do a few things on the side of quality, but basically you’re seeing patients. The theory is there could be market saturation, because there are only a certain number of patients you can see in a hospital. But now hospitalists are seen as a physician resource that didn’t exist before. You have a group of doctors that understand patient care very well and are available to make changes and implement initiatives within a hospital. That’s going to lead to more roles besides direct patient care role. Hospitalists are going to be in charge of a number of administrative duties or assume administrative positions within hospitals. Because we’re branching out into other areas of hospital-based care, we’ll see more growth and still see high demand.

One of your primary medical interests is healthcare for Spanish-speaking families. Why is that so important to you?

A: My interest in working with the Latino population comes from my own background. I was a Spanish literature major at Northwestern University, and I’ve had a lot of opportunities to travel. When I started practicing, a large number of the patients were Latino. It became clear how important it is for us to understand what’s happening in our communities. We need to know what patients are coming in, what their demographics are, what their experiences have been, and what their needs are. Everything we do in a hospital translates to what’s happening outside the hospital.

Hospital medicine is quite a switch from Spanish literature. How’d that come about?

A: Actually, it was planned. I always knew I was going to medical school, but I really enjoy linguistics and language. I kept that balance. I didn’t want to be too science-oriented. It was one of those left brain-right brain things.

What is the biggest challenge facing hospital medicine?

A: The challenge is going to be retaining hospitalists and trying to avoid burnout.

How do you address the retention issue?

A: A big part of retention is making people feel happy in their field. It’s about allowing them to feel like they’re contributing in their particular area of physician interest, making them feel like their contributions are valued, making them feel like they can effect change, and making them feel like they’re really part of a team. We’ve been able to keep those as priorities.

How about the risk of burnout?

A: We have to find ways to balance our professions with our personal lives. Everybody’s looking for that balance. I have a husband and three children, so I want it, too. We really have to be reasonable. An important part of being good doctors is being good human beings.

What’s next for you personally?

A: Expanding research and developing a fellowship are two of the primary areas of focus. We also want to focus on triage and flow, and improving the throughput. Beyond that, it’s going to be program expansion, just like it’s been. That’s going to keep me busy. TH

Mark Leiser is a freelance writer in New Jersey.

Julia S. Wright, MD, spent 10 years in traditional practice before joining the University of Wisconsin School of Medicine and Public Health in Madison. Now a clinical associate professor and section head of hospital medicine, the title has changed and the professional demands have intensified. The mission, however, remains the same.

Every decision she’s made in her career—whether it be medical, managerial, financial, or even her seemingly curious choice of college majors—has been guided by one basic question: What will this mean for the quality of patient care? “It may sound cliché, but that’s always the bottom line,” Dr. Wright says. “It’s why I do what I do.”

You spent 10 years in traditional practice before becoming a hospitalist. How did that prepare you for what you’re doing now?

Answer: That experience is a tremendous asset. I made the switch to inpatient medicine because that was the arena I enjoyed the most. But having had experience in the outpatient setting gives me a better understanding of the continuum of care, and my clinical skills have been honed by that experience. I also have an understanding of the strengths of the primary care physicians (PCP), as well as the breadth of the problems they are able to take on.

How does that help you?

A: It really helps in the patient transition, especially on the return side, when patients go back to their PCP after hospitalization. Having an understanding of what resources are available to PCPs helps to determine an appropriate time to discharge a patient. Someone without that experience may have a tendency to think every loose end has to be tied up, or they may make changes that wind up making things more difficult for PCP. But if you have an understanding of a PCP’s capabilities, maybe the patient can be discharged a little earlier.

The University of Wisconsin’s hospitalist program started in 2005. You were named director in 2006. How exciting is it to guide a new program and help it develop?

A: It’s been a tremendous experience. When I joined, we had six hospitalists. Now we have 19. But it was strategic growth; it wasn’t haphazard.

What do you mean by strategic growth?

A: We didn’t simply say, ‘We need more people.’ Every time we brought somebody on, we really made sure it was going to be someone who would add value to the program and be beneficial to the hospital. We were worried, as we got bigger, that it’d be hard to keep the same cohesiveness and that same espirit de corps. During the interviews and the search process, we’re not just asking, ‘Are they qualified?’ We’re asking, ‘Are they a really good fit?’ And everybody has different areas of interest within the group. Some are more research-inclined; one developed a curriculum; some are more clinically oriented. That allows each hospitalist to have an identity in the group. That translated into a good expansion, and it’s been a win-win for us.

What makes someone a good fit for your program?

A: It sounds cliché, but I think the key to a strong developing program is to have a strong sense of what the group values. For us, we value the academic experience. For people going into academic medicine, the struggle is to be able to provide value to the hospital and yet stay academic. Our hospitalists are very clear—that’s our vision. With the support of the hospital and the department, we were able to do both at the same time.

Can you pinpoint one experience that you’ve had that made you realize you’re doing what you’re meant to do?

A: The biggest reward is always patient care. I enjoy the direct patient experience as much as I always have, and that’s what keeps me in the game.

What have you enjoyed most about your transition to a leadership role?

A: I really enjoy the position, not because of the hierarchy, but because of the opportunities afforded by it. I get to interact with hospital medicine staff and the department of medicine chair, and the vice chairs. I’ve been able to interact with others in hospital medicine across the country, and that has been a great experience.

Some hospitalists enjoy what they do because they don’t have to handle the business side of operations or deal with the administrative hassles that private physicians face. In your role, though, you do have to face those challenges. Is that a drawback?

A: I do have to pay attention to the numbers. That’s the bottom line. But it’s something I actually really enjoy. When it comes to awareness of the balance sheet, there’s a division between the leadership level and the clinician level. It’s hard to bridge that chasm of, ‘I’m here for patient care and I don’t necessarily focus on the numbers.’

How do you bridge the chasm?

A: It’s something we should be emphasizing more in hospital medicine. Some people may think it’s distasteful to think about, but it’s something hospitals do need to care about. There’s not enough of that trickling down. This is a huge area for potential growth. It’s important to have an understanding of the importance of the bottom line without feeling too much like it’s threatening the quality of the practice or getting in the way of what we want to be doing.

What other changes are in store for hospital medicine?

A: If you look at the traditional role of a hospitalist, you do a few things on the side of quality, but basically you’re seeing patients. The theory is there could be market saturation, because there are only a certain number of patients you can see in a hospital. But now hospitalists are seen as a physician resource that didn’t exist before. You have a group of doctors that understand patient care very well and are available to make changes and implement initiatives within a hospital. That’s going to lead to more roles besides direct patient care role. Hospitalists are going to be in charge of a number of administrative duties or assume administrative positions within hospitals. Because we’re branching out into other areas of hospital-based care, we’ll see more growth and still see high demand.

One of your primary medical interests is healthcare for Spanish-speaking families. Why is that so important to you?

A: My interest in working with the Latino population comes from my own background. I was a Spanish literature major at Northwestern University, and I’ve had a lot of opportunities to travel. When I started practicing, a large number of the patients were Latino. It became clear how important it is for us to understand what’s happening in our communities. We need to know what patients are coming in, what their demographics are, what their experiences have been, and what their needs are. Everything we do in a hospital translates to what’s happening outside the hospital.

Hospital medicine is quite a switch from Spanish literature. How’d that come about?

A: Actually, it was planned. I always knew I was going to medical school, but I really enjoy linguistics and language. I kept that balance. I didn’t want to be too science-oriented. It was one of those left brain-right brain things.

What is the biggest challenge facing hospital medicine?

A: The challenge is going to be retaining hospitalists and trying to avoid burnout.

How do you address the retention issue?

A: A big part of retention is making people feel happy in their field. It’s about allowing them to feel like they’re contributing in their particular area of physician interest, making them feel like their contributions are valued, making them feel like they can effect change, and making them feel like they’re really part of a team. We’ve been able to keep those as priorities.

How about the risk of burnout?

A: We have to find ways to balance our professions with our personal lives. Everybody’s looking for that balance. I have a husband and three children, so I want it, too. We really have to be reasonable. An important part of being good doctors is being good human beings.

What’s next for you personally?

A: Expanding research and developing a fellowship are two of the primary areas of focus. We also want to focus on triage and flow, and improving the throughput. Beyond that, it’s going to be program expansion, just like it’s been. That’s going to keep me busy. TH

Mark Leiser is a freelance writer in New Jersey.

Julia S. Wright, MD, spent 10 years in traditional practice before joining the University of Wisconsin School of Medicine and Public Health in Madison. Now a clinical associate professor and section head of hospital medicine, the title has changed and the professional demands have intensified. The mission, however, remains the same.

Every decision she’s made in her career—whether it be medical, managerial, financial, or even her seemingly curious choice of college majors—has been guided by one basic question: What will this mean for the quality of patient care? “It may sound cliché, but that’s always the bottom line,” Dr. Wright says. “It’s why I do what I do.”

You spent 10 years in traditional practice before becoming a hospitalist. How did that prepare you for what you’re doing now?

Answer: That experience is a tremendous asset. I made the switch to inpatient medicine because that was the arena I enjoyed the most. But having had experience in the outpatient setting gives me a better understanding of the continuum of care, and my clinical skills have been honed by that experience. I also have an understanding of the strengths of the primary care physicians (PCP), as well as the breadth of the problems they are able to take on.

How does that help you?

A: It really helps in the patient transition, especially on the return side, when patients go back to their PCP after hospitalization. Having an understanding of what resources are available to PCPs helps to determine an appropriate time to discharge a patient. Someone without that experience may have a tendency to think every loose end has to be tied up, or they may make changes that wind up making things more difficult for PCP. But if you have an understanding of a PCP’s capabilities, maybe the patient can be discharged a little earlier.

The University of Wisconsin’s hospitalist program started in 2005. You were named director in 2006. How exciting is it to guide a new program and help it develop?

A: It’s been a tremendous experience. When I joined, we had six hospitalists. Now we have 19. But it was strategic growth; it wasn’t haphazard.

What do you mean by strategic growth?

A: We didn’t simply say, ‘We need more people.’ Every time we brought somebody on, we really made sure it was going to be someone who would add value to the program and be beneficial to the hospital. We were worried, as we got bigger, that it’d be hard to keep the same cohesiveness and that same espirit de corps. During the interviews and the search process, we’re not just asking, ‘Are they qualified?’ We’re asking, ‘Are they a really good fit?’ And everybody has different areas of interest within the group. Some are more research-inclined; one developed a curriculum; some are more clinically oriented. That allows each hospitalist to have an identity in the group. That translated into a good expansion, and it’s been a win-win for us.

What makes someone a good fit for your program?

A: It sounds cliché, but I think the key to a strong developing program is to have a strong sense of what the group values. For us, we value the academic experience. For people going into academic medicine, the struggle is to be able to provide value to the hospital and yet stay academic. Our hospitalists are very clear—that’s our vision. With the support of the hospital and the department, we were able to do both at the same time.

Can you pinpoint one experience that you’ve had that made you realize you’re doing what you’re meant to do?

A: The biggest reward is always patient care. I enjoy the direct patient experience as much as I always have, and that’s what keeps me in the game.

What have you enjoyed most about your transition to a leadership role?

A: I really enjoy the position, not because of the hierarchy, but because of the opportunities afforded by it. I get to interact with hospital medicine staff and the department of medicine chair, and the vice chairs. I’ve been able to interact with others in hospital medicine across the country, and that has been a great experience.

Some hospitalists enjoy what they do because they don’t have to handle the business side of operations or deal with the administrative hassles that private physicians face. In your role, though, you do have to face those challenges. Is that a drawback?

A: I do have to pay attention to the numbers. That’s the bottom line. But it’s something I actually really enjoy. When it comes to awareness of the balance sheet, there’s a division between the leadership level and the clinician level. It’s hard to bridge that chasm of, ‘I’m here for patient care and I don’t necessarily focus on the numbers.’

How do you bridge the chasm?

A: It’s something we should be emphasizing more in hospital medicine. Some people may think it’s distasteful to think about, but it’s something hospitals do need to care about. There’s not enough of that trickling down. This is a huge area for potential growth. It’s important to have an understanding of the importance of the bottom line without feeling too much like it’s threatening the quality of the practice or getting in the way of what we want to be doing.

What other changes are in store for hospital medicine?

A: If you look at the traditional role of a hospitalist, you do a few things on the side of quality, but basically you’re seeing patients. The theory is there could be market saturation, because there are only a certain number of patients you can see in a hospital. But now hospitalists are seen as a physician resource that didn’t exist before. You have a group of doctors that understand patient care very well and are available to make changes and implement initiatives within a hospital. That’s going to lead to more roles besides direct patient care role. Hospitalists are going to be in charge of a number of administrative duties or assume administrative positions within hospitals. Because we’re branching out into other areas of hospital-based care, we’ll see more growth and still see high demand.

One of your primary medical interests is healthcare for Spanish-speaking families. Why is that so important to you?

A: My interest in working with the Latino population comes from my own background. I was a Spanish literature major at Northwestern University, and I’ve had a lot of opportunities to travel. When I started practicing, a large number of the patients were Latino. It became clear how important it is for us to understand what’s happening in our communities. We need to know what patients are coming in, what their demographics are, what their experiences have been, and what their needs are. Everything we do in a hospital translates to what’s happening outside the hospital.

Hospital medicine is quite a switch from Spanish literature. How’d that come about?

A: Actually, it was planned. I always knew I was going to medical school, but I really enjoy linguistics and language. I kept that balance. I didn’t want to be too science-oriented. It was one of those left brain-right brain things.

What is the biggest challenge facing hospital medicine?

A: The challenge is going to be retaining hospitalists and trying to avoid burnout.

How do you address the retention issue?

A: A big part of retention is making people feel happy in their field. It’s about allowing them to feel like they’re contributing in their particular area of physician interest, making them feel like their contributions are valued, making them feel like they can effect change, and making them feel like they’re really part of a team. We’ve been able to keep those as priorities.

How about the risk of burnout?

A: We have to find ways to balance our professions with our personal lives. Everybody’s looking for that balance. I have a husband and three children, so I want it, too. We really have to be reasonable. An important part of being good doctors is being good human beings.

What’s next for you personally?

A: Expanding research and developing a fellowship are two of the primary areas of focus. We also want to focus on triage and flow, and improving the throughput. Beyond that, it’s going to be program expansion, just like it’s been. That’s going to keep me busy. TH

Mark Leiser is a freelance writer in New Jersey.