Scott A. Flanders, MD, FHM

With the growth of HM has come a major change in the way healthcare is delivered in hospitals across the country: Hospitalists have become one of the major providers of care for hospitalized medical patients. Recent reports suggest that hospitalists care for more than 50% of Medicare patients admitted with a medical diagnosis. In addition to that staggering figure, hospitalists increasingly have assumed care for many surgical patients, have staffed observation units, created procedure services, assumed care of many subspecialty services, and have taken the lead on hospital-based IT and quality-improvement (QI) endeavors, among other key services.

It is hard to argue against the assertion that HM’s emergence over the past decade and a half is one of the most significant game-changers in all of healthcare. Despite this important impact on the structure of care delivery, HM to date has fallen short of the contributions made by many other disciplines over the years in one key area: the generation of new knowledge through research.

New Specialties’ Research Focus

Think for a minute of the contributions of the next two youngest specialties—critical-care medicine and emergency medicine. Both fields have transformed care delivery, as did HM, but in contrast, both critical-care and emergency medicine have well-established investigators and an impressive research agenda. They have had a major impact on the care of patients everywhere.

For example, the critical-care community developed new treatment paradigms for sepsis that grew out of basic science work exploring the roles of cytokines and the inflammatory cascade in infection. Its clinical-research networks have developed and tested new ventilator- and fluid-management strategies for acute respiratory distress syndrome.

Similarly, the emergency medicine community has developed new algorithms for the treatment of cardiac arrest, trauma, and many other common emergency diagnoses that are now implemented in EDs all over the country.

We, the HM community, should aspire to do the same.

By saying we need to do more, I do not mean to undermine the many important contributions we are making. Just pick up any issue of the Journal of Hospital Medicine, and you will find a wealth of literature describing the important work of hospitalists everywhere. But to have a lasting impact, we need to continue to expand on this work to advance the national health research agenda by having hospitalists pursue clinical and comparative-effectiveness research, quality and safety research, health system innovations work, and even basic science research.

Research Assistance

SHM has always prided itself in being at the forefront of training and networking opportunities for hospitalists. It should come as no surprise that SHM continues to lead in the creation of opportunities designed to enhance HM research.

To advance the research agenda, we need to advance researchers. HM researchers struggle to find funding for their work in a federal infrastructure that emphasizes disease- and organ-based investigation. A hospitalist investigator often explores areas that cross disease boundaries, or pursues work that falls into the realm of “quality and safety,” which tends to have fewer funding opportunities. Hospitalist investigators need a hand getting started, and SHM is going to lend that hand.

At HM10 this month in Washington, D.C., we will announce the recipients of the newly created SHM Junior Faculty Development Award. The award will provide two recipients with $25,000 per year for two consecutive years. This award is a mentored research award, which means it is intended to support junior hospitalist faculty as they apply for a research career development award. The goal in creating this award is to fulfill SHM’s mission of promoting excellence in the practice of HM through research, and to build a generation of effective hospitalist researchers who can define and explore questions pertinent to the general medical care of hospitalized patients.

We hope these awards, through funding and mentoring, boost successful hospitalist investigators, grow the number of hospitalist-initiated research projects, and show academic institutions that hospitalist research ideas have merit. It also is likely that, over time, the awards will create a network of SHM-funded investigators whose collaboration and interaction will further accelerate HM research.

Our hope is that this effort benefits not just the investigators receiving the money, but also all practicing hospitalists and their patients by further clarifying the best methods to care for hospitalized patients, by creating new treatment paradigms, and advancing the science of HM for the benefit of all.

Please join me in congratulating the recipients of this important and prestigious award. TH

Dr. Flanders is president of SHM.

With the growth of HM has come a major change in the way healthcare is delivered in hospitals across the country: Hospitalists have become one of the major providers of care for hospitalized medical patients. Recent reports suggest that hospitalists care for more than 50% of Medicare patients admitted with a medical diagnosis. In addition to that staggering figure, hospitalists increasingly have assumed care for many surgical patients, have staffed observation units, created procedure services, assumed care of many subspecialty services, and have taken the lead on hospital-based IT and quality-improvement (QI) endeavors, among other key services.

It is hard to argue against the assertion that HM’s emergence over the past decade and a half is one of the most significant game-changers in all of healthcare. Despite this important impact on the structure of care delivery, HM to date has fallen short of the contributions made by many other disciplines over the years in one key area: the generation of new knowledge through research.

New Specialties’ Research Focus

Think for a minute of the contributions of the next two youngest specialties—critical-care medicine and emergency medicine. Both fields have transformed care delivery, as did HM, but in contrast, both critical-care and emergency medicine have well-established investigators and an impressive research agenda. They have had a major impact on the care of patients everywhere.

For example, the critical-care community developed new treatment paradigms for sepsis that grew out of basic science work exploring the roles of cytokines and the inflammatory cascade in infection. Its clinical-research networks have developed and tested new ventilator- and fluid-management strategies for acute respiratory distress syndrome.

Similarly, the emergency medicine community has developed new algorithms for the treatment of cardiac arrest, trauma, and many other common emergency diagnoses that are now implemented in EDs all over the country.

We, the HM community, should aspire to do the same.

By saying we need to do more, I do not mean to undermine the many important contributions we are making. Just pick up any issue of the Journal of Hospital Medicine, and you will find a wealth of literature describing the important work of hospitalists everywhere. But to have a lasting impact, we need to continue to expand on this work to advance the national health research agenda by having hospitalists pursue clinical and comparative-effectiveness research, quality and safety research, health system innovations work, and even basic science research.

Research Assistance

SHM has always prided itself in being at the forefront of training and networking opportunities for hospitalists. It should come as no surprise that SHM continues to lead in the creation of opportunities designed to enhance HM research.

To advance the research agenda, we need to advance researchers. HM researchers struggle to find funding for their work in a federal infrastructure that emphasizes disease- and organ-based investigation. A hospitalist investigator often explores areas that cross disease boundaries, or pursues work that falls into the realm of “quality and safety,” which tends to have fewer funding opportunities. Hospitalist investigators need a hand getting started, and SHM is going to lend that hand.

At HM10 this month in Washington, D.C., we will announce the recipients of the newly created SHM Junior Faculty Development Award. The award will provide two recipients with $25,000 per year for two consecutive years. This award is a mentored research award, which means it is intended to support junior hospitalist faculty as they apply for a research career development award. The goal in creating this award is to fulfill SHM’s mission of promoting excellence in the practice of HM through research, and to build a generation of effective hospitalist researchers who can define and explore questions pertinent to the general medical care of hospitalized patients.

We hope these awards, through funding and mentoring, boost successful hospitalist investigators, grow the number of hospitalist-initiated research projects, and show academic institutions that hospitalist research ideas have merit. It also is likely that, over time, the awards will create a network of SHM-funded investigators whose collaboration and interaction will further accelerate HM research.

Our hope is that this effort benefits not just the investigators receiving the money, but also all practicing hospitalists and their patients by further clarifying the best methods to care for hospitalized patients, by creating new treatment paradigms, and advancing the science of HM for the benefit of all.

Please join me in congratulating the recipients of this important and prestigious award. TH

Dr. Flanders is president of SHM.

With the growth of HM has come a major change in the way healthcare is delivered in hospitals across the country: Hospitalists have become one of the major providers of care for hospitalized medical patients. Recent reports suggest that hospitalists care for more than 50% of Medicare patients admitted with a medical diagnosis. In addition to that staggering figure, hospitalists increasingly have assumed care for many surgical patients, have staffed observation units, created procedure services, assumed care of many subspecialty services, and have taken the lead on hospital-based IT and quality-improvement (QI) endeavors, among other key services.

It is hard to argue against the assertion that HM’s emergence over the past decade and a half is one of the most significant game-changers in all of healthcare. Despite this important impact on the structure of care delivery, HM to date has fallen short of the contributions made by many other disciplines over the years in one key area: the generation of new knowledge through research.

New Specialties’ Research Focus

Think for a minute of the contributions of the next two youngest specialties—critical-care medicine and emergency medicine. Both fields have transformed care delivery, as did HM, but in contrast, both critical-care and emergency medicine have well-established investigators and an impressive research agenda. They have had a major impact on the care of patients everywhere.

For example, the critical-care community developed new treatment paradigms for sepsis that grew out of basic science work exploring the roles of cytokines and the inflammatory cascade in infection. Its clinical-research networks have developed and tested new ventilator- and fluid-management strategies for acute respiratory distress syndrome.

Similarly, the emergency medicine community has developed new algorithms for the treatment of cardiac arrest, trauma, and many other common emergency diagnoses that are now implemented in EDs all over the country.

We, the HM community, should aspire to do the same.

By saying we need to do more, I do not mean to undermine the many important contributions we are making. Just pick up any issue of the Journal of Hospital Medicine, and you will find a wealth of literature describing the important work of hospitalists everywhere. But to have a lasting impact, we need to continue to expand on this work to advance the national health research agenda by having hospitalists pursue clinical and comparative-effectiveness research, quality and safety research, health system innovations work, and even basic science research.

Research Assistance

SHM has always prided itself in being at the forefront of training and networking opportunities for hospitalists. It should come as no surprise that SHM continues to lead in the creation of opportunities designed to enhance HM research.

To advance the research agenda, we need to advance researchers. HM researchers struggle to find funding for their work in a federal infrastructure that emphasizes disease- and organ-based investigation. A hospitalist investigator often explores areas that cross disease boundaries, or pursues work that falls into the realm of “quality and safety,” which tends to have fewer funding opportunities. Hospitalist investigators need a hand getting started, and SHM is going to lend that hand.

At HM10 this month in Washington, D.C., we will announce the recipients of the newly created SHM Junior Faculty Development Award. The award will provide two recipients with $25,000 per year for two consecutive years. This award is a mentored research award, which means it is intended to support junior hospitalist faculty as they apply for a research career development award. The goal in creating this award is to fulfill SHM’s mission of promoting excellence in the practice of HM through research, and to build a generation of effective hospitalist researchers who can define and explore questions pertinent to the general medical care of hospitalized patients.

We hope these awards, through funding and mentoring, boost successful hospitalist investigators, grow the number of hospitalist-initiated research projects, and show academic institutions that hospitalist research ideas have merit. It also is likely that, over time, the awards will create a network of SHM-funded investigators whose collaboration and interaction will further accelerate HM research.

Our hope is that this effort benefits not just the investigators receiving the money, but also all practicing hospitalists and their patients by further clarifying the best methods to care for hospitalized patients, by creating new treatment paradigms, and advancing the science of HM for the benefit of all.

Please join me in congratulating the recipients of this important and prestigious award. TH

Dr. Flanders is president of SHM.

The announcement was made Sept. 23, 2009. The American Board of Medical Specialties (ABMS) had approved a “pilot program” for Recognition of Focused Practice (RFP) in Hospital Medicine. ABMS-sanctioned board certification for hospitalists had finally arrived.

When the announcement came, I was at the University of California at San Francisco’s CME conference with 600 other hospitalists. Robert Wachter, MD, FHM, chief of the hospital medicine division, professor, and associate chair of the Department of Medicine at the University of California at San Francisco, a former SHM president, and author of the blog Wachter’s World, announced the RFP in HM to the audience—it received resounding applause. Dr. Wachter, the UCSF conference chair, then went on to recap the history behind RFP and how we got here. As he spoke, I realized that I had forgotten how long this process had taken and how much work had been done by so many people.

To practicing hospitalists, the creation of some sort of certification in HM seems like the proverbial no-brainer. But think about it from the American Board of Internal Medicine (ABIM) perspective: All “specialties” with board certification have training programs or fellowships that help define them. We do not have hospitalist residency programs or fellowships that are necessary for practicing as a hospitalist. Our expertise is acquired during practice.

So if the training path for hospitalists is not different—at least for now—from that of other general internists, how do we create board certification? When a group, such as hospitalists, “asks” to be recognized as a specialty with their own certification, the ABIM needs to consider the implications of creating such recognition. For hospitalists, the question was: If we do this for hospitalists, do we have to create a certificate for officists or outpatient physicians? For the broader questions around recognition of focused practice, the board needed to ask, “What if a group comes forward and asks for recognition of their focus and expertise in caring for diabetes or sepsis?”

ABIM thought very carefully about these questions. For the latter, ABIM says the field asking for recognition of focused practice must have a lot of physicians who only practice in this field while also having large numbers of physicians who never practice in the field. And they said, “Yes, if we do this for hospitalists, we will ultimately need to create a similar pathway for outpatient physicians.” Fortunately for us, they did not wait for RFP in outpatient medicine to be developed before proceeding with RFP for HM. (Figuring out how to do this on the outpatient side is even harder, and even though ABIM has been very supportive of RFP for hospitalists, the ABMS, which oversees all the specialty boards, still had to sign off on this approach. In September, they did.)

RFP Formula

So what will RFP in HM look like? The process is described on ABIM’s Web site (www.abim.org/news/news/focused-practice-hospital-medicine-qa.aspx), but to qualify, a hospitalist must:

• Be certified in internal medicine;
• Have practiced for a sufficient period of time to have achieved certain volume thresholds for patients with inpatient diagnoses;
• Participate in hospitalist-based practice improvement and self-assessment modules; and
• Pass a secure exam, which SHM president-elect Jeff Wiese, MD, FHM, and his committee have been hard at work in creating.

All told, the bar has been set high. And from what I hear, the exam has a strong QI focus—a discipline most residency programs skimp on when designing their curriculums.

SHM recognizes that we will have to ramp up our educational efforts to prepare hospitalists for RFP. We will need to develop QI assessment modules, continue developing and enhancing QI education at our annual meeting, and we’ll need to consider more regional efforts at providing the education hospitalists need to do this QI work in their hospitals.

A Bright Future

So what does this really mean for our field? Quite a bit, actually.

We have long tracked all the elements traditionally required to call HM a specialty, and one by one we have ticked them off: large numbers of physicians in the field, a separate body of knowledge (i.e., core competencies), textbooks, a journal, national meetings, training programs. But the one element that remained unchecked was a separate certification. Cross that one off the list. Granted, training programs remain few and underdeveloped, but I expect that, too, will change and grow over time.

There are additional questions raised by this new certification. One might ask: “Will hospitals or payors require RFP in HM in order to practice or be paid for what we do?” Maybe. I expect this will not happen rapidly, as many hospitalists are likely to wait until they need to recertify before choosing to pursue RFP in HM. But if all of our colleagues start getting certified, or programs hiring hospitalists begin to require this certification (e.g., advertise the fact that all of their physicians are “certified hospitalists”), the floodgates will open.

Questions also arise about what happens now for family practice or pediatrics. Well, I am pleased to say that the American Board of Family Medicine (ABFM) has announced its intent to collaborate with ABIM to establish a similar pilot program for RFP in HM for family-practice physicians. And the pediatric societies and board-certifying agencies are watching closely to see if they might consider the same approach for pediatric hospitalists. Stay tuned.

ABMS’ recent approval of the RFP pathway is what many have been working tirelessly toward for years. It is a testament to the maturity, breadth, and importance of our field. And it validates what many of us have known for years: Hospitalists have unique skill sets that are vital to the U.S. healthcare system, and, as a result, we have been integrated into the fabric of hospital care delivery in every state.

With the coming redesign of the healthcare system, hospitalists will be counted on to lead and facilitate the work required to deliver high-quality, efficient hospital care across the country. RFP provides both a means to get hospitalists up to speed to do this important work and recognizes those who are ready to go out and lead.

This truly is a watershed moment for HM. TH

Dr. Flanders is president of SHM.

The announcement was made Sept. 23, 2009. The American Board of Medical Specialties (ABMS) had approved a “pilot program” for Recognition of Focused Practice (RFP) in Hospital Medicine. ABMS-sanctioned board certification for hospitalists had finally arrived.

When the announcement came, I was at the University of California at San Francisco’s CME conference with 600 other hospitalists. Robert Wachter, MD, FHM, chief of the hospital medicine division, professor, and associate chair of the Department of Medicine at the University of California at San Francisco, a former SHM president, and author of the blog Wachter’s World, announced the RFP in HM to the audience—it received resounding applause. Dr. Wachter, the UCSF conference chair, then went on to recap the history behind RFP and how we got here. As he spoke, I realized that I had forgotten how long this process had taken and how much work had been done by so many people.

To practicing hospitalists, the creation of some sort of certification in HM seems like the proverbial no-brainer. But think about it from the American Board of Internal Medicine (ABIM) perspective: All “specialties” with board certification have training programs or fellowships that help define them. We do not have hospitalist residency programs or fellowships that are necessary for practicing as a hospitalist. Our expertise is acquired during practice.

So if the training path for hospitalists is not different—at least for now—from that of other general internists, how do we create board certification? When a group, such as hospitalists, “asks” to be recognized as a specialty with their own certification, the ABIM needs to consider the implications of creating such recognition. For hospitalists, the question was: If we do this for hospitalists, do we have to create a certificate for officists or outpatient physicians? For the broader questions around recognition of focused practice, the board needed to ask, “What if a group comes forward and asks for recognition of their focus and expertise in caring for diabetes or sepsis?”

ABIM thought very carefully about these questions. For the latter, ABIM says the field asking for recognition of focused practice must have a lot of physicians who only practice in this field while also having large numbers of physicians who never practice in the field. And they said, “Yes, if we do this for hospitalists, we will ultimately need to create a similar pathway for outpatient physicians.” Fortunately for us, they did not wait for RFP in outpatient medicine to be developed before proceeding with RFP for HM. (Figuring out how to do this on the outpatient side is even harder, and even though ABIM has been very supportive of RFP for hospitalists, the ABMS, which oversees all the specialty boards, still had to sign off on this approach. In September, they did.)

RFP Formula

So what will RFP in HM look like? The process is described on ABIM’s Web site (www.abim.org/news/news/focused-practice-hospital-medicine-qa.aspx), but to qualify, a hospitalist must:

• Be certified in internal medicine;
• Have practiced for a sufficient period of time to have achieved certain volume thresholds for patients with inpatient diagnoses;
• Participate in hospitalist-based practice improvement and self-assessment modules; and
• Pass a secure exam, which SHM president-elect Jeff Wiese, MD, FHM, and his committee have been hard at work in creating.

All told, the bar has been set high. And from what I hear, the exam has a strong QI focus—a discipline most residency programs skimp on when designing their curriculums.

SHM recognizes that we will have to ramp up our educational efforts to prepare hospitalists for RFP. We will need to develop QI assessment modules, continue developing and enhancing QI education at our annual meeting, and we’ll need to consider more regional efforts at providing the education hospitalists need to do this QI work in their hospitals.

A Bright Future

So what does this really mean for our field? Quite a bit, actually.

We have long tracked all the elements traditionally required to call HM a specialty, and one by one we have ticked them off: large numbers of physicians in the field, a separate body of knowledge (i.e., core competencies), textbooks, a journal, national meetings, training programs. But the one element that remained unchecked was a separate certification. Cross that one off the list. Granted, training programs remain few and underdeveloped, but I expect that, too, will change and grow over time.

There are additional questions raised by this new certification. One might ask: “Will hospitals or payors require RFP in HM in order to practice or be paid for what we do?” Maybe. I expect this will not happen rapidly, as many hospitalists are likely to wait until they need to recertify before choosing to pursue RFP in HM. But if all of our colleagues start getting certified, or programs hiring hospitalists begin to require this certification (e.g., advertise the fact that all of their physicians are “certified hospitalists”), the floodgates will open.

Questions also arise about what happens now for family practice or pediatrics. Well, I am pleased to say that the American Board of Family Medicine (ABFM) has announced its intent to collaborate with ABIM to establish a similar pilot program for RFP in HM for family-practice physicians. And the pediatric societies and board-certifying agencies are watching closely to see if they might consider the same approach for pediatric hospitalists. Stay tuned.

ABMS’ recent approval of the RFP pathway is what many have been working tirelessly toward for years. It is a testament to the maturity, breadth, and importance of our field. And it validates what many of us have known for years: Hospitalists have unique skill sets that are vital to the U.S. healthcare system, and, as a result, we have been integrated into the fabric of hospital care delivery in every state.

With the coming redesign of the healthcare system, hospitalists will be counted on to lead and facilitate the work required to deliver high-quality, efficient hospital care across the country. RFP provides both a means to get hospitalists up to speed to do this important work and recognizes those who are ready to go out and lead.

This truly is a watershed moment for HM. TH

Dr. Flanders is president of SHM.

The announcement was made Sept. 23, 2009. The American Board of Medical Specialties (ABMS) had approved a “pilot program” for Recognition of Focused Practice (RFP) in Hospital Medicine. ABMS-sanctioned board certification for hospitalists had finally arrived.

When the announcement came, I was at the University of California at San Francisco’s CME conference with 600 other hospitalists. Robert Wachter, MD, FHM, chief of the hospital medicine division, professor, and associate chair of the Department of Medicine at the University of California at San Francisco, a former SHM president, and author of the blog Wachter’s World, announced the RFP in HM to the audience—it received resounding applause. Dr. Wachter, the UCSF conference chair, then went on to recap the history behind RFP and how we got here. As he spoke, I realized that I had forgotten how long this process had taken and how much work had been done by so many people.

To practicing hospitalists, the creation of some sort of certification in HM seems like the proverbial no-brainer. But think about it from the American Board of Internal Medicine (ABIM) perspective: All “specialties” with board certification have training programs or fellowships that help define them. We do not have hospitalist residency programs or fellowships that are necessary for practicing as a hospitalist. Our expertise is acquired during practice.

So if the training path for hospitalists is not different—at least for now—from that of other general internists, how do we create board certification? When a group, such as hospitalists, “asks” to be recognized as a specialty with their own certification, the ABIM needs to consider the implications of creating such recognition. For hospitalists, the question was: If we do this for hospitalists, do we have to create a certificate for officists or outpatient physicians? For the broader questions around recognition of focused practice, the board needed to ask, “What if a group comes forward and asks for recognition of their focus and expertise in caring for diabetes or sepsis?”

ABIM thought very carefully about these questions. For the latter, ABIM says the field asking for recognition of focused practice must have a lot of physicians who only practice in this field while also having large numbers of physicians who never practice in the field. And they said, “Yes, if we do this for hospitalists, we will ultimately need to create a similar pathway for outpatient physicians.” Fortunately for us, they did not wait for RFP in outpatient medicine to be developed before proceeding with RFP for HM. (Figuring out how to do this on the outpatient side is even harder, and even though ABIM has been very supportive of RFP for hospitalists, the ABMS, which oversees all the specialty boards, still had to sign off on this approach. In September, they did.)

RFP Formula

So what will RFP in HM look like? The process is described on ABIM’s Web site (www.abim.org/news/news/focused-practice-hospital-medicine-qa.aspx), but to qualify, a hospitalist must:

• Be certified in internal medicine;
• Have practiced for a sufficient period of time to have achieved certain volume thresholds for patients with inpatient diagnoses;
• Participate in hospitalist-based practice improvement and self-assessment modules; and
• Pass a secure exam, which SHM president-elect Jeff Wiese, MD, FHM, and his committee have been hard at work in creating.

All told, the bar has been set high. And from what I hear, the exam has a strong QI focus—a discipline most residency programs skimp on when designing their curriculums.

SHM recognizes that we will have to ramp up our educational efforts to prepare hospitalists for RFP. We will need to develop QI assessment modules, continue developing and enhancing QI education at our annual meeting, and we’ll need to consider more regional efforts at providing the education hospitalists need to do this QI work in their hospitals.

A Bright Future

So what does this really mean for our field? Quite a bit, actually.

We have long tracked all the elements traditionally required to call HM a specialty, and one by one we have ticked them off: large numbers of physicians in the field, a separate body of knowledge (i.e., core competencies), textbooks, a journal, national meetings, training programs. But the one element that remained unchecked was a separate certification. Cross that one off the list. Granted, training programs remain few and underdeveloped, but I expect that, too, will change and grow over time.

There are additional questions raised by this new certification. One might ask: “Will hospitals or payors require RFP in HM in order to practice or be paid for what we do?” Maybe. I expect this will not happen rapidly, as many hospitalists are likely to wait until they need to recertify before choosing to pursue RFP in HM. But if all of our colleagues start getting certified, or programs hiring hospitalists begin to require this certification (e.g., advertise the fact that all of their physicians are “certified hospitalists”), the floodgates will open.

Questions also arise about what happens now for family practice or pediatrics. Well, I am pleased to say that the American Board of Family Medicine (ABFM) has announced its intent to collaborate with ABIM to establish a similar pilot program for RFP in HM for family-practice physicians. And the pediatric societies and board-certifying agencies are watching closely to see if they might consider the same approach for pediatric hospitalists. Stay tuned.

ABMS’ recent approval of the RFP pathway is what many have been working tirelessly toward for years. It is a testament to the maturity, breadth, and importance of our field. And it validates what many of us have known for years: Hospitalists have unique skill sets that are vital to the U.S. healthcare system, and, as a result, we have been integrated into the fabric of hospital care delivery in every state.

With the coming redesign of the healthcare system, hospitalists will be counted on to lead and facilitate the work required to deliver high-quality, efficient hospital care across the country. RFP provides both a means to get hospitalists up to speed to do this important work and recognizes those who are ready to go out and lead.

This truly is a watershed moment for HM. TH

Dr. Flanders is president of SHM.

Let me start my first column as SHM president by introducing myself. I am an associate professor of medicine and the director of the hospital medicine program at the University of Michigan in Ann Arbor. I live in Ann Arbor with my family, which includes my wife, Juliet, and three young children. I also have a “professional family” at U of M, which includes 40 hospitalists and all the staff who facilitate the great work they do every day.

SHM, of course, is another big part of my extended family. I have been involved with SHM since 1997—when it was formed as the National Association of Inpatient Physi-cians (NAIP)—and have watched in awe its meteoric rise. What started as an organization with a handful of members and one staffer fully supported by the American College of Physicians (ACP) has grown into a fully independent society with more than 9,400 members and 50 employees. The growth in scope of SHM’s activities is no less impressive. In the mid-1990s, the society was focused on justifying the existence of a new breed of doctors called hospitalists.

Today, SHM is involved in multiple projects and programs designed to cement HM as the center of a healthcare system being redesigned to deliver high-quality, safe, efficient, and patient-centered healthcare.

Challenges Ahead

As exciting and ambitious as SHM’s goals are, there are innumerable challenges facing the field of HM that stand in its way. Let me touch on just a few.

The first and most obvious is the economy. This country is experiencing the worst recession it has seen in decades, and it is certainly affecting our hospitals. Here in Michigan, the plight of the auto industry graces the front pages of our newspapers daily (at least the papers that still exist). Hospitals that used to gloat about their high percentage of privately insured patients as a result of lucrative auto union contracts now see marked increases in public insurance—or no insurance at all.

Unfortunately, this is not just Michigan’s problem. Recent data suggest that more than 65% of the nation’s hospitals have seen increases in nonpaying patients and, as a result, marked declines in elective procedures and a bleak financial outlook. Many hospitalist programs are tied to the financial viability of their hospitals.

The decline in hospital resources also comes at a time when hospitals are being asked to invest more to promote safety and quality concurrent with growth in pay-for-performance programs and “no-pay” events, which make it clear that the financial picture could get even worse if these investments are not made.

The challenge in positioning hospitalists and HM at quality improvement (QI) ground zero—as we are doing—is that many of the systems and processes that require change extend beyond our usual range of control. The attention that has been given to reducing hospital readmissions by improving care transitions is a good example. It is not news that many bad things can—and often do—happen to patients after discharge. And many of the patients who suffer a post-discharge adverse event get readmitted.

It seems logical to have hospitalists fix the problem. But hospital readmissions are complex. As has been recently argued, some readmissions may even be a reflection of good quality—for example, if we capture a post-discharge problem and “save the patient” by readmitting them before they died at home.1 And to address preventable readmissions, systems must be developed to manage patients after they leave our hospitals, primary-care physicians need to be engaged to create effective ways to “receive” the post-discharge patient, and, finally, the decision to readmit—which often is made by the ED doctor or the PCP—needs to be addressed. This is not easy work.

Additionally, there are some challenges unique to academic hospitalists, a subset of our membership. Academic HM programs have been forced to grow at a dizzying speed in the past several years to keep up with increases in hospital discharges in an era of increased restrictions on the work hours of medical residents. These programs have grown by hiring many junior faculty with no advanced training in research, teaching, QI, or patient safety, let alone all the skills they need to bill, lead large teams, or manage complex hospital processes.

Of those problems, the most challenging, and arguably the most important to fix, is research training. To make lasting contributions to the practice of HM, rather than just implementing the practices, new treatments, and new care processes developed by other fields, HM needs to generate the new knowledge we use. That takes growing research, researchers, and sustainable academic programs. That, too, is not easy work.

HM Can Meet the Challenges

I am optimistic we can meet these myriad challenges, and I believe SHM is positioned to lead the charge. There is nothing we can do about the recession; hospitalists will have to weather the storm. Fortunately, HM has spent the last decade advocating not only its effectiveness, but also its cost-effectiveness. As a key hospital ally in the quality and safety wars, we are entrenched, and most hospital CEOs looking at ways to control costs should look beyond the core aspects of the local HM program. (They can take back my water cooler.)

It has not been lost on many at SHM that improving quality and safety at the hospital level requires engaging those outside our field. SHM is indeed tackling the daunting task of improving care transitions with its Project BOOST (Better Outcomes for Older Adults through Safe Transitions) program, but this comes after years of working with national quality organizations, policymakers, and other professional societies—including those that represent ED physicians and PCPs—in recognizing that fixing poor care transitions cannot be done by hospitalists alone.

Academic HM also is on SHM’s radar. The society, along with the Society of General Internal Medicine and the Association of Chiefs of General Internal Medicine, organized a summit to delineate and address the problems faced by academic HM. That meeting led to increased attention on the problems the field faces, enhanced advocacy at the federal level for research support, a “boot camp” designed for academic hospitalists to develop the skills they need to excel in an academic environment, and the beginnings of an SHM-funded faculty development research award.

All told, while there may be dark clouds on the horizon and rain in the forecast, SHM has spent years building a watertight organization and has foreseen many of the problems we now face. If we keep up the hard work, I am confident we, our patients, and the next generation of hospitalists will have brighter days ahead.

I look forward to the next year at the helm of SHM and am honored to represent SHM and its members, whose hard work and accomplishments never cease to amaze me.

Dr. Flanders is president of SHM.

Reference

1. Epstein AM. Revisiting readmissions—changing the incentives for shared accountability. N Engl J Med. 2009;360(14):1457-1459.

Let me start my first column as SHM president by introducing myself. I am an associate professor of medicine and the director of the hospital medicine program at the University of Michigan in Ann Arbor. I live in Ann Arbor with my family, which includes my wife, Juliet, and three young children. I also have a “professional family” at U of M, which includes 40 hospitalists and all the staff who facilitate the great work they do every day.

SHM, of course, is another big part of my extended family. I have been involved with SHM since 1997—when it was formed as the National Association of Inpatient Physi-cians (NAIP)—and have watched in awe its meteoric rise. What started as an organization with a handful of members and one staffer fully supported by the American College of Physicians (ACP) has grown into a fully independent society with more than 9,400 members and 50 employees. The growth in scope of SHM’s activities is no less impressive. In the mid-1990s, the society was focused on justifying the existence of a new breed of doctors called hospitalists.

Today, SHM is involved in multiple projects and programs designed to cement HM as the center of a healthcare system being redesigned to deliver high-quality, safe, efficient, and patient-centered healthcare.

Challenges Ahead

As exciting and ambitious as SHM’s goals are, there are innumerable challenges facing the field of HM that stand in its way. Let me touch on just a few.

The first and most obvious is the economy. This country is experiencing the worst recession it has seen in decades, and it is certainly affecting our hospitals. Here in Michigan, the plight of the auto industry graces the front pages of our newspapers daily (at least the papers that still exist). Hospitals that used to gloat about their high percentage of privately insured patients as a result of lucrative auto union contracts now see marked increases in public insurance—or no insurance at all.

Unfortunately, this is not just Michigan’s problem. Recent data suggest that more than 65% of the nation’s hospitals have seen increases in nonpaying patients and, as a result, marked declines in elective procedures and a bleak financial outlook. Many hospitalist programs are tied to the financial viability of their hospitals.

The decline in hospital resources also comes at a time when hospitals are being asked to invest more to promote safety and quality concurrent with growth in pay-for-performance programs and “no-pay” events, which make it clear that the financial picture could get even worse if these investments are not made.

The challenge in positioning hospitalists and HM at quality improvement (QI) ground zero—as we are doing—is that many of the systems and processes that require change extend beyond our usual range of control. The attention that has been given to reducing hospital readmissions by improving care transitions is a good example. It is not news that many bad things can—and often do—happen to patients after discharge. And many of the patients who suffer a post-discharge adverse event get readmitted.

It seems logical to have hospitalists fix the problem. But hospital readmissions are complex. As has been recently argued, some readmissions may even be a reflection of good quality—for example, if we capture a post-discharge problem and “save the patient” by readmitting them before they died at home.1 And to address preventable readmissions, systems must be developed to manage patients after they leave our hospitals, primary-care physicians need to be engaged to create effective ways to “receive” the post-discharge patient, and, finally, the decision to readmit—which often is made by the ED doctor or the PCP—needs to be addressed. This is not easy work.

Additionally, there are some challenges unique to academic hospitalists, a subset of our membership. Academic HM programs have been forced to grow at a dizzying speed in the past several years to keep up with increases in hospital discharges in an era of increased restrictions on the work hours of medical residents. These programs have grown by hiring many junior faculty with no advanced training in research, teaching, QI, or patient safety, let alone all the skills they need to bill, lead large teams, or manage complex hospital processes.

Of those problems, the most challenging, and arguably the most important to fix, is research training. To make lasting contributions to the practice of HM, rather than just implementing the practices, new treatments, and new care processes developed by other fields, HM needs to generate the new knowledge we use. That takes growing research, researchers, and sustainable academic programs. That, too, is not easy work.

HM Can Meet the Challenges

I am optimistic we can meet these myriad challenges, and I believe SHM is positioned to lead the charge. There is nothing we can do about the recession; hospitalists will have to weather the storm. Fortunately, HM has spent the last decade advocating not only its effectiveness, but also its cost-effectiveness. As a key hospital ally in the quality and safety wars, we are entrenched, and most hospital CEOs looking at ways to control costs should look beyond the core aspects of the local HM program. (They can take back my water cooler.)

It has not been lost on many at SHM that improving quality and safety at the hospital level requires engaging those outside our field. SHM is indeed tackling the daunting task of improving care transitions with its Project BOOST (Better Outcomes for Older Adults through Safe Transitions) program, but this comes after years of working with national quality organizations, policymakers, and other professional societies—including those that represent ED physicians and PCPs—in recognizing that fixing poor care transitions cannot be done by hospitalists alone.

Academic HM also is on SHM’s radar. The society, along with the Society of General Internal Medicine and the Association of Chiefs of General Internal Medicine, organized a summit to delineate and address the problems faced by academic HM. That meeting led to increased attention on the problems the field faces, enhanced advocacy at the federal level for research support, a “boot camp” designed for academic hospitalists to develop the skills they need to excel in an academic environment, and the beginnings of an SHM-funded faculty development research award.

All told, while there may be dark clouds on the horizon and rain in the forecast, SHM has spent years building a watertight organization and has foreseen many of the problems we now face. If we keep up the hard work, I am confident we, our patients, and the next generation of hospitalists will have brighter days ahead.

I look forward to the next year at the helm of SHM and am honored to represent SHM and its members, whose hard work and accomplishments never cease to amaze me.

Dr. Flanders is president of SHM.

Reference

1. Epstein AM. Revisiting readmissions—changing the incentives for shared accountability. N Engl J Med. 2009;360(14):1457-1459.

Let me start my first column as SHM president by introducing myself. I am an associate professor of medicine and the director of the hospital medicine program at the University of Michigan in Ann Arbor. I live in Ann Arbor with my family, which includes my wife, Juliet, and three young children. I also have a “professional family” at U of M, which includes 40 hospitalists and all the staff who facilitate the great work they do every day.

SHM, of course, is another big part of my extended family. I have been involved with SHM since 1997—when it was formed as the National Association of Inpatient Physi-cians (NAIP)—and have watched in awe its meteoric rise. What started as an organization with a handful of members and one staffer fully supported by the American College of Physicians (ACP) has grown into a fully independent society with more than 9,400 members and 50 employees. The growth in scope of SHM’s activities is no less impressive. In the mid-1990s, the society was focused on justifying the existence of a new breed of doctors called hospitalists.

Today, SHM is involved in multiple projects and programs designed to cement HM as the center of a healthcare system being redesigned to deliver high-quality, safe, efficient, and patient-centered healthcare.

Challenges Ahead

As exciting and ambitious as SHM’s goals are, there are innumerable challenges facing the field of HM that stand in its way. Let me touch on just a few.

The first and most obvious is the economy. This country is experiencing the worst recession it has seen in decades, and it is certainly affecting our hospitals. Here in Michigan, the plight of the auto industry graces the front pages of our newspapers daily (at least the papers that still exist). Hospitals that used to gloat about their high percentage of privately insured patients as a result of lucrative auto union contracts now see marked increases in public insurance—or no insurance at all.

Unfortunately, this is not just Michigan’s problem. Recent data suggest that more than 65% of the nation’s hospitals have seen increases in nonpaying patients and, as a result, marked declines in elective procedures and a bleak financial outlook. Many hospitalist programs are tied to the financial viability of their hospitals.

The decline in hospital resources also comes at a time when hospitals are being asked to invest more to promote safety and quality concurrent with growth in pay-for-performance programs and “no-pay” events, which make it clear that the financial picture could get even worse if these investments are not made.

The challenge in positioning hospitalists and HM at quality improvement (QI) ground zero—as we are doing—is that many of the systems and processes that require change extend beyond our usual range of control. The attention that has been given to reducing hospital readmissions by improving care transitions is a good example. It is not news that many bad things can—and often do—happen to patients after discharge. And many of the patients who suffer a post-discharge adverse event get readmitted.

It seems logical to have hospitalists fix the problem. But hospital readmissions are complex. As has been recently argued, some readmissions may even be a reflection of good quality—for example, if we capture a post-discharge problem and “save the patient” by readmitting them before they died at home.1 And to address preventable readmissions, systems must be developed to manage patients after they leave our hospitals, primary-care physicians need to be engaged to create effective ways to “receive” the post-discharge patient, and, finally, the decision to readmit—which often is made by the ED doctor or the PCP—needs to be addressed. This is not easy work.

Additionally, there are some challenges unique to academic hospitalists, a subset of our membership. Academic HM programs have been forced to grow at a dizzying speed in the past several years to keep up with increases in hospital discharges in an era of increased restrictions on the work hours of medical residents. These programs have grown by hiring many junior faculty with no advanced training in research, teaching, QI, or patient safety, let alone all the skills they need to bill, lead large teams, or manage complex hospital processes.

Of those problems, the most challenging, and arguably the most important to fix, is research training. To make lasting contributions to the practice of HM, rather than just implementing the practices, new treatments, and new care processes developed by other fields, HM needs to generate the new knowledge we use. That takes growing research, researchers, and sustainable academic programs. That, too, is not easy work.

HM Can Meet the Challenges

I am optimistic we can meet these myriad challenges, and I believe SHM is positioned to lead the charge. There is nothing we can do about the recession; hospitalists will have to weather the storm. Fortunately, HM has spent the last decade advocating not only its effectiveness, but also its cost-effectiveness. As a key hospital ally in the quality and safety wars, we are entrenched, and most hospital CEOs looking at ways to control costs should look beyond the core aspects of the local HM program. (They can take back my water cooler.)

It has not been lost on many at SHM that improving quality and safety at the hospital level requires engaging those outside our field. SHM is indeed tackling the daunting task of improving care transitions with its Project BOOST (Better Outcomes for Older Adults through Safe Transitions) program, but this comes after years of working with national quality organizations, policymakers, and other professional societies—including those that represent ED physicians and PCPs—in recognizing that fixing poor care transitions cannot be done by hospitalists alone.

Academic HM also is on SHM’s radar. The society, along with the Society of General Internal Medicine and the Association of Chiefs of General Internal Medicine, organized a summit to delineate and address the problems faced by academic HM. That meeting led to increased attention on the problems the field faces, enhanced advocacy at the federal level for research support, a “boot camp” designed for academic hospitalists to develop the skills they need to excel in an academic environment, and the beginnings of an SHM-funded faculty development research award.

All told, while there may be dark clouds on the horizon and rain in the forecast, SHM has spent years building a watertight organization and has foreseen many of the problems we now face. If we keep up the hard work, I am confident we, our patients, and the next generation of hospitalists will have brighter days ahead.

I look forward to the next year at the helm of SHM and am honored to represent SHM and its members, whose hard work and accomplishments never cease to amaze me.

Dr. Flanders is president of SHM.

Reference

1. Epstein AM. Revisiting readmissions—changing the incentives for shared accountability. N Engl J Med. 2009;360(14):1457-1459.