These days you’re just as likely to find Jeffrey Krebs, MD, FACP, in front of a camera as behind a stethoscope. And his patients are as likely to see him in a movie theater as they are by their hospital beds.

That’s because the San Diego hospitalist has a schedule that allows him to build an acting career without giving up the patient care he loves. But don’t expect to see him playing a physician. The youthful-looking 46-year-old doesn’t match Hollywood’s “Marcus Welby, MD” image. He’s usually only considered for resident or intern roles despite almost two decades of experience working in medicine. “I’ve been a physician for more than 17 years, and yet I don’t look like a doctor, casting directors tell me,” he says.

From Dabbling to Passion

Dr. Krebs has been dabbling in acting since he was a resident, but it wasn’t until he became a hospitalist last year that made his acting passion a priority. He first became interested in acting in 1989 while he interned at Cedars-Sinai Medical Center in Los Angeles. Frequent contact with celebrity patients led to the offer of a role as an extra in the movie “Heart Condition,” (1990) a comedy starring Denzel Washington and Bob Hoskins.

“I thought it would be fun,” Dr. Krebs says. “Because they were filming in a restaurant a couple of miles from the hospital, it was convenient.”

The day he spent on the set in his non-speaking role taught him how things are done in Hollywood. Even though his efforts ended up on the cutting-room floor, the experience sparked a passion for acting that has grown stronger every year.

After completing his internal medicine residency in Los Angeles in 1989, Dr. Krebs moved to San Diego to become a primary care physician at Kaiser Permanente San Diego Medical Center. He found an acting teacher who held classes in San Diego on Sundays and began developing his craft.

Despite the demands of his work as a busy primary care physician, Dr. Krebs has racked up an impressive list of film and TV credits through the years. He was cast as a softball attendant in the martial arts film “3 Ninjas: High Noon at Mega Mountain,” (1998) the last of the “tween” movie “3 Ninjas” series. He played Agent Hans in “The English Job” (2006), a food critic in “Single White Female 2: The Psycho” (2005), a computer programmer in “Form 3254-A” (2005), and a young doctor in “True Vinyl” (2000), a romantic musical movie.

He has also performed in local theater, appearing in “Intrusion,” “Hypocrisy,” “Prelude to a Kiss,” “Apres Opera,” and “Ignoto’s Farewell” in San Diego, where he was often recognized by patients and colleagues.

Time for a Change

But the last-minute demands of an actor have conflicted frequently with his responsibilities as a physician. “I would be cast in a film and then not hear from the casting director for months,” Dr. Krebs explains. “Then the travel department could call one day and tell me I had to be on the out-of-town set in three days. There were times when I had to turn down a role because I won’t put my patients’ health on hold to do a film. I began to realize that if I really wanted to make a go of my acting, I needed to make some changes in my life.”

An opportunity presented itself last year when Kaiser Permanente in San Diego created two nocturnist positions for hospitalists. When Dr. Krebs heard about the positions, he quickly applied. “I thought that was perfect because all the auditions and filming happen during the day, and I could attend them if I worked at night,” he explains.

Dr. Krebs and another physician work 12-hour shifts beginning at 6 p.m. three times a week. For Dr. Krebs it’s Sunday through Tuesday nights. When his shift ends Wednesday morning, he drives the 125 miles from San Diego to his apartment in Los Angeles, catches some sleep, then assumes the role of Hollywood actor.

From Wednesday through Saturday, you might find him auditioning, taking acting classes, filming on location, doing the behind-the-scenes business of an aspiring actor, or attending a Hollywood party to network. On Sunday afternoon, he returns to the hospital in San Diego to begin another round of night shifts.

“Sometimes I can put in a 31-hour day if I have an audition in Los Angeles on Wednesday afternoon after my shift in San Diego Tuesday night,” he says. “Then I’ll be running on adrenaline, but it’s worth it.”

Balanced from the Beginning

A Southern California native, Dr. Krebs grew up near Disneyland, where he played clarinet during the bicentennial parade there in 1976. He knew he wanted to be a doctor when he was 7 years old. His grandfather was an optometrist, and Dr. Krebs spent many of his school holidays talking happily to his grandfather’s office patients.

Dr. Krebs graduated with honors from the University of California at Davis and received a medical degree from the University of California, San Diego, School of Medicine. He has been honored by Kaiser Permanente Medical Group with its Distinguished Service Award, its Everyday Hero Award, and its Primary Care Leadership Recognition Award.

Dr. Krebs says being a physician and an actor creates the perfect balance between his right and left brains: “The analytical side of my brain is satisfied by medicine, and my creative side is satisfied by being able to immerse myself in acting on my days off. It’s a perfect balance for me.”

Patients benefit from this balance, Dr. Krebs believes, because he brings to his job the increased empathy he’s developed as an actor. “My acting has absolutely enhanced my relationships with patients,” he says. “Acting requires developing intense listening skills. I’ve become a much better listener. Acting also requires you to focus on what the other person is saying, and that has helped me really focus on what patients tell me.”

Conversely, being a physician has helped him with his acting.

“Physicians are trained observers. Medicine has helped me become a better observer of people’s mannerisms and what they say about their character,” he explains. “And that training in observation makes me better able to relate to other actors.”

Two different careers also fulfill two different aspects of his personality.

“I’m a bit of a ham, although I don’t ham it up in my acting,” admits Dr. Krebs. “I like being noticed. In acting, it’s all about me, so I’m on the receiving end. But when I’m a physician, it’s never about me; it’s about the patient. So I’m the giver. I like that because it balances my life.”

Dr. Krebs played Dolph Lundgren’s brother, Jeff, in “Missionary Man.”

Win-Win Situation

Dr. Krebs isn’t the only one satisfied with his nocturnist position. It’s also “a win, win, win situation for the hospital,” says Ted Geer, MD, chief of internal medicine at Kaiser Permanente San Diego Medical Center.

“Administratively it’s great because there aren’t as many shifts that have to be covered by other physicians,” Dr. Geer explains. “It’s win-win for patients and the emergency room because we have more physicians who are up all night to help.”

While many hospitalists use their off hours to pursue hobbies, it’s unusual for them to have another profession. “It’s a credit to him that he’s able to have a second career,” says Dr. Geer.

Dr. Krebs is a well-respected clinician and a good internist, according to Dr. Geer. “His skills as an internist make him fit into this role very well,” says Dr. Geer. “He takes very good care of his patients.”

Overlapping Worlds

Dr. Krebs says his medical colleagues get a kick out of his acting career. “Many of their children own the “3 Ninjas” movie. They tell me they have spotted me in the film while watching it with their kids,” he says.

Actors are surprised when they find out about his medical career. Although Dr. Krebs doesn’t volunteer the information that he’s a physician, he’ll tell others in the film industry when asked. “I want to keep my two worlds separate, but I am proud of who I am and what I do as a physician.”

Sometimes those two worlds overlap. When Dr. Krebs was cast in “True Vinyl,” “The casting director asked me what I did in my off hours and, when I said I was a physician, he said, ‘OK, so you’re the doctor in the film.’ ”

For that movie, Dr. Krebs also served as the medical consultant, ensuring the medical scenes were accurate.

Even though he enjoyed the experience, Dr. Krebs doesn’t want to pursue more medical consultant opportunities; acting is his passion. “When I’m on the set, I’m an actor and that’s what I want to be,” he says.

Can Do

It takes a focused, high-energy person to succeed as a physician and an actor. Dr. Krebs keeps his stamina high by making his health a priority. He exercises almost every day, eats right, and surrounds himself with positive people. “I have always been a high-energy person; I’m never depressed and always look at the positive side of any situation,” he says.

He credits his parents with instilling in him an optimistic view of life. “They told us we could be anybody and do anything we wanted,” he recalls. “When I was told that I couldn’t compete at a high level in figure skating and go to medical school, I thought, ‘My parents said I could do anything I wanted and I want to do this,’ so I did.”

It may have been his figure-skating background that gave Dr. Krebs the fearlessness required of a successful actor, according to his manager, Fritz Friedman.

“He’s willing to take chances,” notes Friedman. “It’s a fearsome thing to take those leaps in skating that seem so effortless. The risk he takes, as all actors do, is that he will look foolish. But actors don’t care. They try and hope their bodies will listen to their brains.”

Friedman says Dr. Krebs’ acting style is dramatic and intense: “I think he has capabilities of comedic roles but they haven’t been offered to him yet,” he says. “I think, given the right opportunity, he’d be terrific at that. Jeff has a very strong on-screen presence. When he’s on screen, people focus on him. He’s charismatic.”

And That’s Not All He Does …

In his free time, Dr. Krebs loves to cook, travel, and take photographs. He entertains his friends with a meal made from scratch at least once a month and has hired chefs from local restaurants to teach him advanced cooking techniques. In October, he’s going to Tuscany to indulge all three passions with Italian culinary classes, travel, and photography.

With two careers and many interests, Dr. Krebs sometimes finds it hard to get enough sleep. Although he would like to take singing lessons and French classes, that’s more than he can handle right now. “Sleep has to be a priority so I can continue to make good medical decisions,” he says. And he admits that getting his laundry done “is one of my biggest challenges in life.”

Dr. Krebs recently focused his acting career on film and television, giving up theater. “Acting in plays is harder—if not impossible—with my new life as a nocturnist,” he says. Theater requires months of rehearsals, held in the daytime during the week. But choosing film was an easy choice. “I like watching myself on film so that I can learn from it,” he says.

Dr. Krebs says his favorite roles have been “any in which I can learn something new or develop a new aspect of myself.” In a film to be released this spring, “Half Past Dead II: Justified,” he plays an inmate at a maximum-security prison. “That was a stretch because I had to tap into my inner serial killer. Sometimes the roles that I play are in conflict with who I am,” he explains. “You learn that everyone has every possibility inside of them, and you have to tap into that.”

He does this by developing the back story, which in this case meant creating a character who had done something bad enough to be in Alcatraz. The film’s director called Dr. Krebs recently to praise his efforts.

In March, Dr. Krebs was in Dallas filming “Missionary Man,” starring Dolph Lundgren. It is a Western-style movie involving “revenge and redemption at the end of a gun barrel.” In the film, Dr. Krebs plays Lundgren’s brother; the character’s name was changed to Jeff. “Imagine having a character named after me,” Dr. Krebs exclaims.

The Perfect Combination

What would happen if Dr. Krebs landed a major film role or a long-term television series? Would he give up medicine to become star of the next “ER” or “Grey’s Anatomy”? Not if it meant giving up his medical career, he says.

“It would be very difficult for me to give up medicine completely because I really love being a physician,” Dr. Krebs admits. “I might take a leave for a month or two if a big film opportunity came along. But right now I’m happy with the roles I’m getting that allow me to continue my medical career.”

Dr. Krebs says he could not have been the kind of actor he is and practice the kind of medicine he wants to practice without being a hospitalist, and he’s grateful for the opportunity.

“I’m so happy the hospitalist movement has taken off in the last several years,” he says. “My life is much, much better since I became a hospitalist. I feel like I have it all.” TH

Barbara Dillard is a medical journalist based in Chicago.

These days you’re just as likely to find Jeffrey Krebs, MD, FACP, in front of a camera as behind a stethoscope. And his patients are as likely to see him in a movie theater as they are by their hospital beds.

That’s because the San Diego hospitalist has a schedule that allows him to build an acting career without giving up the patient care he loves. But don’t expect to see him playing a physician. The youthful-looking 46-year-old doesn’t match Hollywood’s “Marcus Welby, MD” image. He’s usually only considered for resident or intern roles despite almost two decades of experience working in medicine. “I’ve been a physician for more than 17 years, and yet I don’t look like a doctor, casting directors tell me,” he says.

From Dabbling to Passion

Dr. Krebs has been dabbling in acting since he was a resident, but it wasn’t until he became a hospitalist last year that made his acting passion a priority. He first became interested in acting in 1989 while he interned at Cedars-Sinai Medical Center in Los Angeles. Frequent contact with celebrity patients led to the offer of a role as an extra in the movie “Heart Condition,” (1990) a comedy starring Denzel Washington and Bob Hoskins.

“I thought it would be fun,” Dr. Krebs says. “Because they were filming in a restaurant a couple of miles from the hospital, it was convenient.”

The day he spent on the set in his non-speaking role taught him how things are done in Hollywood. Even though his efforts ended up on the cutting-room floor, the experience sparked a passion for acting that has grown stronger every year.

After completing his internal medicine residency in Los Angeles in 1989, Dr. Krebs moved to San Diego to become a primary care physician at Kaiser Permanente San Diego Medical Center. He found an acting teacher who held classes in San Diego on Sundays and began developing his craft.

Despite the demands of his work as a busy primary care physician, Dr. Krebs has racked up an impressive list of film and TV credits through the years. He was cast as a softball attendant in the martial arts film “3 Ninjas: High Noon at Mega Mountain,” (1998) the last of the “tween” movie “3 Ninjas” series. He played Agent Hans in “The English Job” (2006), a food critic in “Single White Female 2: The Psycho” (2005), a computer programmer in “Form 3254-A” (2005), and a young doctor in “True Vinyl” (2000), a romantic musical movie.

He has also performed in local theater, appearing in “Intrusion,” “Hypocrisy,” “Prelude to a Kiss,” “Apres Opera,” and “Ignoto’s Farewell” in San Diego, where he was often recognized by patients and colleagues.

Time for a Change

But the last-minute demands of an actor have conflicted frequently with his responsibilities as a physician. “I would be cast in a film and then not hear from the casting director for months,” Dr. Krebs explains. “Then the travel department could call one day and tell me I had to be on the out-of-town set in three days. There were times when I had to turn down a role because I won’t put my patients’ health on hold to do a film. I began to realize that if I really wanted to make a go of my acting, I needed to make some changes in my life.”

An opportunity presented itself last year when Kaiser Permanente in San Diego created two nocturnist positions for hospitalists. When Dr. Krebs heard about the positions, he quickly applied. “I thought that was perfect because all the auditions and filming happen during the day, and I could attend them if I worked at night,” he explains.

Dr. Krebs and another physician work 12-hour shifts beginning at 6 p.m. three times a week. For Dr. Krebs it’s Sunday through Tuesday nights. When his shift ends Wednesday morning, he drives the 125 miles from San Diego to his apartment in Los Angeles, catches some sleep, then assumes the role of Hollywood actor.

From Wednesday through Saturday, you might find him auditioning, taking acting classes, filming on location, doing the behind-the-scenes business of an aspiring actor, or attending a Hollywood party to network. On Sunday afternoon, he returns to the hospital in San Diego to begin another round of night shifts.

“Sometimes I can put in a 31-hour day if I have an audition in Los Angeles on Wednesday afternoon after my shift in San Diego Tuesday night,” he says. “Then I’ll be running on adrenaline, but it’s worth it.”

Balanced from the Beginning

A Southern California native, Dr. Krebs grew up near Disneyland, where he played clarinet during the bicentennial parade there in 1976. He knew he wanted to be a doctor when he was 7 years old. His grandfather was an optometrist, and Dr. Krebs spent many of his school holidays talking happily to his grandfather’s office patients.

Dr. Krebs graduated with honors from the University of California at Davis and received a medical degree from the University of California, San Diego, School of Medicine. He has been honored by Kaiser Permanente Medical Group with its Distinguished Service Award, its Everyday Hero Award, and its Primary Care Leadership Recognition Award.

Dr. Krebs says being a physician and an actor creates the perfect balance between his right and left brains: “The analytical side of my brain is satisfied by medicine, and my creative side is satisfied by being able to immerse myself in acting on my days off. It’s a perfect balance for me.”

Patients benefit from this balance, Dr. Krebs believes, because he brings to his job the increased empathy he’s developed as an actor. “My acting has absolutely enhanced my relationships with patients,” he says. “Acting requires developing intense listening skills. I’ve become a much better listener. Acting also requires you to focus on what the other person is saying, and that has helped me really focus on what patients tell me.”

Conversely, being a physician has helped him with his acting.

“Physicians are trained observers. Medicine has helped me become a better observer of people’s mannerisms and what they say about their character,” he explains. “And that training in observation makes me better able to relate to other actors.”

Two different careers also fulfill two different aspects of his personality.

“I’m a bit of a ham, although I don’t ham it up in my acting,” admits Dr. Krebs. “I like being noticed. In acting, it’s all about me, so I’m on the receiving end. But when I’m a physician, it’s never about me; it’s about the patient. So I’m the giver. I like that because it balances my life.”

Dr. Krebs played Dolph Lundgren’s brother, Jeff, in “Missionary Man.”

Win-Win Situation

Dr. Krebs isn’t the only one satisfied with his nocturnist position. It’s also “a win, win, win situation for the hospital,” says Ted Geer, MD, chief of internal medicine at Kaiser Permanente San Diego Medical Center.

“Administratively it’s great because there aren’t as many shifts that have to be covered by other physicians,” Dr. Geer explains. “It’s win-win for patients and the emergency room because we have more physicians who are up all night to help.”

While many hospitalists use their off hours to pursue hobbies, it’s unusual for them to have another profession. “It’s a credit to him that he’s able to have a second career,” says Dr. Geer.

Dr. Krebs is a well-respected clinician and a good internist, according to Dr. Geer. “His skills as an internist make him fit into this role very well,” says Dr. Geer. “He takes very good care of his patients.”

Overlapping Worlds

Dr. Krebs says his medical colleagues get a kick out of his acting career. “Many of their children own the “3 Ninjas” movie. They tell me they have spotted me in the film while watching it with their kids,” he says.

Actors are surprised when they find out about his medical career. Although Dr. Krebs doesn’t volunteer the information that he’s a physician, he’ll tell others in the film industry when asked. “I want to keep my two worlds separate, but I am proud of who I am and what I do as a physician.”

Sometimes those two worlds overlap. When Dr. Krebs was cast in “True Vinyl,” “The casting director asked me what I did in my off hours and, when I said I was a physician, he said, ‘OK, so you’re the doctor in the film.’ ”

For that movie, Dr. Krebs also served as the medical consultant, ensuring the medical scenes were accurate.

Even though he enjoyed the experience, Dr. Krebs doesn’t want to pursue more medical consultant opportunities; acting is his passion. “When I’m on the set, I’m an actor and that’s what I want to be,” he says.

Can Do

It takes a focused, high-energy person to succeed as a physician and an actor. Dr. Krebs keeps his stamina high by making his health a priority. He exercises almost every day, eats right, and surrounds himself with positive people. “I have always been a high-energy person; I’m never depressed and always look at the positive side of any situation,” he says.

He credits his parents with instilling in him an optimistic view of life. “They told us we could be anybody and do anything we wanted,” he recalls. “When I was told that I couldn’t compete at a high level in figure skating and go to medical school, I thought, ‘My parents said I could do anything I wanted and I want to do this,’ so I did.”

It may have been his figure-skating background that gave Dr. Krebs the fearlessness required of a successful actor, according to his manager, Fritz Friedman.

“He’s willing to take chances,” notes Friedman. “It’s a fearsome thing to take those leaps in skating that seem so effortless. The risk he takes, as all actors do, is that he will look foolish. But actors don’t care. They try and hope their bodies will listen to their brains.”

Friedman says Dr. Krebs’ acting style is dramatic and intense: “I think he has capabilities of comedic roles but they haven’t been offered to him yet,” he says. “I think, given the right opportunity, he’d be terrific at that. Jeff has a very strong on-screen presence. When he’s on screen, people focus on him. He’s charismatic.”

And That’s Not All He Does …

In his free time, Dr. Krebs loves to cook, travel, and take photographs. He entertains his friends with a meal made from scratch at least once a month and has hired chefs from local restaurants to teach him advanced cooking techniques. In October, he’s going to Tuscany to indulge all three passions with Italian culinary classes, travel, and photography.

With two careers and many interests, Dr. Krebs sometimes finds it hard to get enough sleep. Although he would like to take singing lessons and French classes, that’s more than he can handle right now. “Sleep has to be a priority so I can continue to make good medical decisions,” he says. And he admits that getting his laundry done “is one of my biggest challenges in life.”

Dr. Krebs recently focused his acting career on film and television, giving up theater. “Acting in plays is harder—if not impossible—with my new life as a nocturnist,” he says. Theater requires months of rehearsals, held in the daytime during the week. But choosing film was an easy choice. “I like watching myself on film so that I can learn from it,” he says.

Dr. Krebs says his favorite roles have been “any in which I can learn something new or develop a new aspect of myself.” In a film to be released this spring, “Half Past Dead II: Justified,” he plays an inmate at a maximum-security prison. “That was a stretch because I had to tap into my inner serial killer. Sometimes the roles that I play are in conflict with who I am,” he explains. “You learn that everyone has every possibility inside of them, and you have to tap into that.”

He does this by developing the back story, which in this case meant creating a character who had done something bad enough to be in Alcatraz. The film’s director called Dr. Krebs recently to praise his efforts.

In March, Dr. Krebs was in Dallas filming “Missionary Man,” starring Dolph Lundgren. It is a Western-style movie involving “revenge and redemption at the end of a gun barrel.” In the film, Dr. Krebs plays Lundgren’s brother; the character’s name was changed to Jeff. “Imagine having a character named after me,” Dr. Krebs exclaims.

The Perfect Combination

What would happen if Dr. Krebs landed a major film role or a long-term television series? Would he give up medicine to become star of the next “ER” or “Grey’s Anatomy”? Not if it meant giving up his medical career, he says.

“It would be very difficult for me to give up medicine completely because I really love being a physician,” Dr. Krebs admits. “I might take a leave for a month or two if a big film opportunity came along. But right now I’m happy with the roles I’m getting that allow me to continue my medical career.”

Dr. Krebs says he could not have been the kind of actor he is and practice the kind of medicine he wants to practice without being a hospitalist, and he’s grateful for the opportunity.

“I’m so happy the hospitalist movement has taken off in the last several years,” he says. “My life is much, much better since I became a hospitalist. I feel like I have it all.” TH

Barbara Dillard is a medical journalist based in Chicago.

These days you’re just as likely to find Jeffrey Krebs, MD, FACP, in front of a camera as behind a stethoscope. And his patients are as likely to see him in a movie theater as they are by their hospital beds.

That’s because the San Diego hospitalist has a schedule that allows him to build an acting career without giving up the patient care he loves. But don’t expect to see him playing a physician. The youthful-looking 46-year-old doesn’t match Hollywood’s “Marcus Welby, MD” image. He’s usually only considered for resident or intern roles despite almost two decades of experience working in medicine. “I’ve been a physician for more than 17 years, and yet I don’t look like a doctor, casting directors tell me,” he says.

From Dabbling to Passion

Dr. Krebs has been dabbling in acting since he was a resident, but it wasn’t until he became a hospitalist last year that made his acting passion a priority. He first became interested in acting in 1989 while he interned at Cedars-Sinai Medical Center in Los Angeles. Frequent contact with celebrity patients led to the offer of a role as an extra in the movie “Heart Condition,” (1990) a comedy starring Denzel Washington and Bob Hoskins.

“I thought it would be fun,” Dr. Krebs says. “Because they were filming in a restaurant a couple of miles from the hospital, it was convenient.”

The day he spent on the set in his non-speaking role taught him how things are done in Hollywood. Even though his efforts ended up on the cutting-room floor, the experience sparked a passion for acting that has grown stronger every year.

After completing his internal medicine residency in Los Angeles in 1989, Dr. Krebs moved to San Diego to become a primary care physician at Kaiser Permanente San Diego Medical Center. He found an acting teacher who held classes in San Diego on Sundays and began developing his craft.

Despite the demands of his work as a busy primary care physician, Dr. Krebs has racked up an impressive list of film and TV credits through the years. He was cast as a softball attendant in the martial arts film “3 Ninjas: High Noon at Mega Mountain,” (1998) the last of the “tween” movie “3 Ninjas” series. He played Agent Hans in “The English Job” (2006), a food critic in “Single White Female 2: The Psycho” (2005), a computer programmer in “Form 3254-A” (2005), and a young doctor in “True Vinyl” (2000), a romantic musical movie.

He has also performed in local theater, appearing in “Intrusion,” “Hypocrisy,” “Prelude to a Kiss,” “Apres Opera,” and “Ignoto’s Farewell” in San Diego, where he was often recognized by patients and colleagues.

Time for a Change

But the last-minute demands of an actor have conflicted frequently with his responsibilities as a physician. “I would be cast in a film and then not hear from the casting director for months,” Dr. Krebs explains. “Then the travel department could call one day and tell me I had to be on the out-of-town set in three days. There were times when I had to turn down a role because I won’t put my patients’ health on hold to do a film. I began to realize that if I really wanted to make a go of my acting, I needed to make some changes in my life.”

An opportunity presented itself last year when Kaiser Permanente in San Diego created two nocturnist positions for hospitalists. When Dr. Krebs heard about the positions, he quickly applied. “I thought that was perfect because all the auditions and filming happen during the day, and I could attend them if I worked at night,” he explains.

Dr. Krebs and another physician work 12-hour shifts beginning at 6 p.m. three times a week. For Dr. Krebs it’s Sunday through Tuesday nights. When his shift ends Wednesday morning, he drives the 125 miles from San Diego to his apartment in Los Angeles, catches some sleep, then assumes the role of Hollywood actor.

From Wednesday through Saturday, you might find him auditioning, taking acting classes, filming on location, doing the behind-the-scenes business of an aspiring actor, or attending a Hollywood party to network. On Sunday afternoon, he returns to the hospital in San Diego to begin another round of night shifts.

“Sometimes I can put in a 31-hour day if I have an audition in Los Angeles on Wednesday afternoon after my shift in San Diego Tuesday night,” he says. “Then I’ll be running on adrenaline, but it’s worth it.”

Balanced from the Beginning

A Southern California native, Dr. Krebs grew up near Disneyland, where he played clarinet during the bicentennial parade there in 1976. He knew he wanted to be a doctor when he was 7 years old. His grandfather was an optometrist, and Dr. Krebs spent many of his school holidays talking happily to his grandfather’s office patients.

Dr. Krebs graduated with honors from the University of California at Davis and received a medical degree from the University of California, San Diego, School of Medicine. He has been honored by Kaiser Permanente Medical Group with its Distinguished Service Award, its Everyday Hero Award, and its Primary Care Leadership Recognition Award.

Dr. Krebs says being a physician and an actor creates the perfect balance between his right and left brains: “The analytical side of my brain is satisfied by medicine, and my creative side is satisfied by being able to immerse myself in acting on my days off. It’s a perfect balance for me.”

Patients benefit from this balance, Dr. Krebs believes, because he brings to his job the increased empathy he’s developed as an actor. “My acting has absolutely enhanced my relationships with patients,” he says. “Acting requires developing intense listening skills. I’ve become a much better listener. Acting also requires you to focus on what the other person is saying, and that has helped me really focus on what patients tell me.”

Conversely, being a physician has helped him with his acting.

“Physicians are trained observers. Medicine has helped me become a better observer of people’s mannerisms and what they say about their character,” he explains. “And that training in observation makes me better able to relate to other actors.”

Two different careers also fulfill two different aspects of his personality.

“I’m a bit of a ham, although I don’t ham it up in my acting,” admits Dr. Krebs. “I like being noticed. In acting, it’s all about me, so I’m on the receiving end. But when I’m a physician, it’s never about me; it’s about the patient. So I’m the giver. I like that because it balances my life.”

Dr. Krebs played Dolph Lundgren’s brother, Jeff, in “Missionary Man.”

Win-Win Situation

Dr. Krebs isn’t the only one satisfied with his nocturnist position. It’s also “a win, win, win situation for the hospital,” says Ted Geer, MD, chief of internal medicine at Kaiser Permanente San Diego Medical Center.

“Administratively it’s great because there aren’t as many shifts that have to be covered by other physicians,” Dr. Geer explains. “It’s win-win for patients and the emergency room because we have more physicians who are up all night to help.”

While many hospitalists use their off hours to pursue hobbies, it’s unusual for them to have another profession. “It’s a credit to him that he’s able to have a second career,” says Dr. Geer.

Dr. Krebs is a well-respected clinician and a good internist, according to Dr. Geer. “His skills as an internist make him fit into this role very well,” says Dr. Geer. “He takes very good care of his patients.”

Overlapping Worlds

Dr. Krebs says his medical colleagues get a kick out of his acting career. “Many of their children own the “3 Ninjas” movie. They tell me they have spotted me in the film while watching it with their kids,” he says.

Actors are surprised when they find out about his medical career. Although Dr. Krebs doesn’t volunteer the information that he’s a physician, he’ll tell others in the film industry when asked. “I want to keep my two worlds separate, but I am proud of who I am and what I do as a physician.”

Sometimes those two worlds overlap. When Dr. Krebs was cast in “True Vinyl,” “The casting director asked me what I did in my off hours and, when I said I was a physician, he said, ‘OK, so you’re the doctor in the film.’ ”

For that movie, Dr. Krebs also served as the medical consultant, ensuring the medical scenes were accurate.

Even though he enjoyed the experience, Dr. Krebs doesn’t want to pursue more medical consultant opportunities; acting is his passion. “When I’m on the set, I’m an actor and that’s what I want to be,” he says.

Can Do

It takes a focused, high-energy person to succeed as a physician and an actor. Dr. Krebs keeps his stamina high by making his health a priority. He exercises almost every day, eats right, and surrounds himself with positive people. “I have always been a high-energy person; I’m never depressed and always look at the positive side of any situation,” he says.

He credits his parents with instilling in him an optimistic view of life. “They told us we could be anybody and do anything we wanted,” he recalls. “When I was told that I couldn’t compete at a high level in figure skating and go to medical school, I thought, ‘My parents said I could do anything I wanted and I want to do this,’ so I did.”

It may have been his figure-skating background that gave Dr. Krebs the fearlessness required of a successful actor, according to his manager, Fritz Friedman.

“He’s willing to take chances,” notes Friedman. “It’s a fearsome thing to take those leaps in skating that seem so effortless. The risk he takes, as all actors do, is that he will look foolish. But actors don’t care. They try and hope their bodies will listen to their brains.”

Friedman says Dr. Krebs’ acting style is dramatic and intense: “I think he has capabilities of comedic roles but they haven’t been offered to him yet,” he says. “I think, given the right opportunity, he’d be terrific at that. Jeff has a very strong on-screen presence. When he’s on screen, people focus on him. He’s charismatic.”

And That’s Not All He Does …

In his free time, Dr. Krebs loves to cook, travel, and take photographs. He entertains his friends with a meal made from scratch at least once a month and has hired chefs from local restaurants to teach him advanced cooking techniques. In October, he’s going to Tuscany to indulge all three passions with Italian culinary classes, travel, and photography.

With two careers and many interests, Dr. Krebs sometimes finds it hard to get enough sleep. Although he would like to take singing lessons and French classes, that’s more than he can handle right now. “Sleep has to be a priority so I can continue to make good medical decisions,” he says. And he admits that getting his laundry done “is one of my biggest challenges in life.”

Dr. Krebs recently focused his acting career on film and television, giving up theater. “Acting in plays is harder—if not impossible—with my new life as a nocturnist,” he says. Theater requires months of rehearsals, held in the daytime during the week. But choosing film was an easy choice. “I like watching myself on film so that I can learn from it,” he says.

Dr. Krebs says his favorite roles have been “any in which I can learn something new or develop a new aspect of myself.” In a film to be released this spring, “Half Past Dead II: Justified,” he plays an inmate at a maximum-security prison. “That was a stretch because I had to tap into my inner serial killer. Sometimes the roles that I play are in conflict with who I am,” he explains. “You learn that everyone has every possibility inside of them, and you have to tap into that.”

He does this by developing the back story, which in this case meant creating a character who had done something bad enough to be in Alcatraz. The film’s director called Dr. Krebs recently to praise his efforts.

In March, Dr. Krebs was in Dallas filming “Missionary Man,” starring Dolph Lundgren. It is a Western-style movie involving “revenge and redemption at the end of a gun barrel.” In the film, Dr. Krebs plays Lundgren’s brother; the character’s name was changed to Jeff. “Imagine having a character named after me,” Dr. Krebs exclaims.

The Perfect Combination

What would happen if Dr. Krebs landed a major film role or a long-term television series? Would he give up medicine to become star of the next “ER” or “Grey’s Anatomy”? Not if it meant giving up his medical career, he says.

“It would be very difficult for me to give up medicine completely because I really love being a physician,” Dr. Krebs admits. “I might take a leave for a month or two if a big film opportunity came along. But right now I’m happy with the roles I’m getting that allow me to continue my medical career.”

Dr. Krebs says he could not have been the kind of actor he is and practice the kind of medicine he wants to practice without being a hospitalist, and he’s grateful for the opportunity.

“I’m so happy the hospitalist movement has taken off in the last several years,” he says. “My life is much, much better since I became a hospitalist. I feel like I have it all.” TH

Barbara Dillard is a medical journalist based in Chicago.

Whether obligatory or voluntary, service on committees is a reality for most hospitalists. “The 2005-2006 SHM Survey: State of the Hospital Medicine Movement” found that, for 92% of respondents, committee participation topped the list of non-clinical activities.1 Hospital medicine group leaders, consultants, and administrators interviewed for this article say time-pressed hospitalists must become more effective committee participants.

Civic Duty or Career Advancement?

Because of growing presence at the hospital and their knowledge of hospital operations, hospitalists are a logical choice for committee assignments. These can range from committees dedicated to care delivery (e.g., pharmacy and therapeutics) to the hospital board’s governance committees.

“Hospitalists, with their perspective of hospital operations and clinical care, could be a great part of broadening the perspective of the board, informing their decision-making and helping them to formulate policies,” says John Combes, MD, president of the Center for Healthcare Governance in Chicago, a subsidiary committee of the American Hospital Association.

Mark V. Williams, MD, professor of medicine and director, Emory Hospital Medicine Unit in Atlanta, and editor in chief of the Journal of Hospital Medicine, does not consider committee participation optional.

“I strongly encourage—if not almost require—all of the hospitalists in our group to be involved in at least one committee,” says Dr. Williams. “My belief is that hospitalists are integral to the functioning of the hospital, and as part of their responsibility, they need to be actively involved in committee work to move projects forward.”

Leslie Flores, MHA, co-principal of Nelson/Flores Associates, LLC, agrees. “It’s in the hospitalists’ best interest to be involved in committees,” she says. “Hospitalists are often in the best position to see what needs to be fixed, and they have the potential to have a significant impact on how effectively their hospital operates, which can make their own jobs easier.”

Further, she points out, “If the hospital, which is financially supporting them, is more successful and effective, there’s likely to be less financial pressure on their practice.”

Hospitalists’ perceptions about committee participation can be influenced by each hospitalist’s employment model. If one is working directly for the hospital and giving 110% to that employer, being asked to volunteer additional time to serve on a committee might be viewed as a burden. On the other hand, an independent hospital medicine group (HMG) contracting with the hospital to deliver services may view committee participation as an avenue for ensuring the group’s success. Whatever the employment model, and whatever the career goals of individual hospitalists, it often pays to target one’s participation in committees.

Make Participation Count

Hospitalists will be playing more key roles in medical staff leadership, according to William D. Atchley Jr., MD, medical director of the Division of Hospital Medicine for Sentara Medical Group in Hampton, Va. His concern is that hospitalists will be asked to serve on more than one or two committees. He advises younger hospitalists to notify the president of the medical staff of which committees they would be interested in working on. Dr. Atchley is also a member of the SHM Board of Directors.

“It could be peer review, performance improvement, or ad hoc committees focused on developing evidence-based order sets, improving through-put or disaster preparedness,” says Dr. Atchley. Whatever the pick, “it should be something that they’re going to find enjoyable and that they feel will advance their stature within the hospital.”

To be an effective member of a hospital board committee, a hospitalist must represent the greater interests of all stakeholders—not just his or her own self-interest, cautions Dr. Combes. However, “as physicians become more stressed and production-oriented, giving up clinical time to participate in governance activities becomes more and more difficult,” he concedes. Hospitalists should choose committee assignments based on their interests and expertise.

Dr. Williams encourages hospitalists in his group to pick one committee—preferably one focused on care delivery (quality improvement, pharmacy and therapeutics, utilization review) and take an active role. “Then, over time, I encourage them to try to chair committees to obtain leadership experience,” he says.

Taking on too many extracurricular committee tasks can be counterproductive. To avoid this, Flores advises younger hospitalists to ask themselves the following:

• What will my committee participation do to support the goals of the committee and the organization?
• By participating in this committee, can I expand my own knowledge or understanding of the culture and politics of the organization?
• Can I become more comfortable interacting on an organizational level?
• Can I network and get to know people I wouldn’t otherwise encounter, who can be helpful to me personally?

In addition, Dr. Atchley believes rotating committee assignments is also beneficial, especially for the younger hospitalist. In his tenure as a hospitalist, Dr. Atchley has served as chairman of the Department of Medicine’s credentials and quality assurance committees, and as vice president of the medical staff. Each committee furnishes hospitalists with a different perspective about how the hospital functions.

“I think hospitalists should understand the medical staff bylaws and procedures,” says Dr. Atchley. “Each hospital medicine staff has this governance structure, and I have found it beneficial in resolving conflicts about patient care and interaction between physicians.”

Mary A. Dallas, MD, has seen the committee situation from both sides of the fence. She is medical information officer for Presbyterian Healthcare Services, an integrated healthcare delivery network in Albuquerque, N.M., but served as medical director of Presbyterian’s hospitalist group for five years before that.

“Hospitalists have a vested interest in making sure their work area is protected, so they need to plant some people in strategic places for the governance and medical staff,” says Dr. Dallas. “In order to be effective in the governance of the hospital, you have to be part of that medical substructure and get involved.”

For instance, as medical director, she sat on the hospital’s credential committee and found it allowed her to keep tabs on new HMG hires going through the credentialing process. “This [the hospital] is your work environment,” she explains. “You are here day in and day out, and you should shape that environment, have a say in policies and rules, so that you can make your job more successful and make patient care better.”

The Quandary over Compensation

Many hospitalists feel frustrated when committee obligations impinge on clinical duties. Is compensation the answer for filling committee slots? Opinions are mixed.

Dr. Williams says he is “a little uncomfortable with the concept of people getting paid every time they attend a committee meeting. For hospitalists who receive funding from the hospital to support their programs, it’s important for the leader [of the HMG] to ensure that they’re collaborating with hospital administration. The hospital has the expectation that, as part of our salary structure, we will be members of committees. That needs to be part of the job.”

Dr. Dallas agrees: “Regardless of whether you’re getting paid or not, this is your work environment. I think it’s very important to be involved, so that your voice is heard and so that you can help make the [hospital] structure better.”

Compensating physicians for their time does communicate that their time is valued and respected, says Dr. Combes, but payment does not necessarily guarantee a high level of committee members’ engagement. In addition, he says, if physicians are being compensated directly by the hospital for serving on committees, “this can threaten the perception of their objectivity, in terms of bringing an independent perspective to the board.” A better solution might be for the hospital medicine group to build its own compensation structure for non-clinical work so members retain independence when voicing opinions to the hospital board.

Dr. Atchley admits it’s sometimes a struggle to find people willing to serve on medical staff committees. He advocates compensation for those duties on a per-meeting or hourly basis. His hospital meets attendance requirements by giving credit to doctors who participate on selected medical staff committees.

Through her consulting assignments, Flores has observed that in some organizations where hospitalists are paid based on productivity, committee participation can be assigned a relative value unit so hospitalists are compensated on the same basis as for clinical work.

Flores concurs with Drs. Dallas and Williams: “In most organizations, a certain minimum level of participation in medical staff activities is expected of all staff members. I think that hospitalists should expect to do that to the same degree as other medical staff members, on a voluntary basis.

“If hospitalists truly want to impact how the medical staff and the hospital operate, and to be considered for high-level leadership positions, then their best way of becoming known and respected in the medical community is by participating on committees.” TH

Gretchen Henkel writes frequently for The Hospitalist.

Reference

1. SHM’s “2005-2006 Survey: State of the Hospital Medicine Movement, 2006.” Available online at www.hospitalmedicine.org Last accessed April 5, 2007.

Whether obligatory or voluntary, service on committees is a reality for most hospitalists. “The 2005-2006 SHM Survey: State of the Hospital Medicine Movement” found that, for 92% of respondents, committee participation topped the list of non-clinical activities.1 Hospital medicine group leaders, consultants, and administrators interviewed for this article say time-pressed hospitalists must become more effective committee participants.

Civic Duty or Career Advancement?

Because of growing presence at the hospital and their knowledge of hospital operations, hospitalists are a logical choice for committee assignments. These can range from committees dedicated to care delivery (e.g., pharmacy and therapeutics) to the hospital board’s governance committees.

“Hospitalists, with their perspective of hospital operations and clinical care, could be a great part of broadening the perspective of the board, informing their decision-making and helping them to formulate policies,” says John Combes, MD, president of the Center for Healthcare Governance in Chicago, a subsidiary committee of the American Hospital Association.

Mark V. Williams, MD, professor of medicine and director, Emory Hospital Medicine Unit in Atlanta, and editor in chief of the Journal of Hospital Medicine, does not consider committee participation optional.

“I strongly encourage—if not almost require—all of the hospitalists in our group to be involved in at least one committee,” says Dr. Williams. “My belief is that hospitalists are integral to the functioning of the hospital, and as part of their responsibility, they need to be actively involved in committee work to move projects forward.”

Leslie Flores, MHA, co-principal of Nelson/Flores Associates, LLC, agrees. “It’s in the hospitalists’ best interest to be involved in committees,” she says. “Hospitalists are often in the best position to see what needs to be fixed, and they have the potential to have a significant impact on how effectively their hospital operates, which can make their own jobs easier.”

Further, she points out, “If the hospital, which is financially supporting them, is more successful and effective, there’s likely to be less financial pressure on their practice.”

Hospitalists’ perceptions about committee participation can be influenced by each hospitalist’s employment model. If one is working directly for the hospital and giving 110% to that employer, being asked to volunteer additional time to serve on a committee might be viewed as a burden. On the other hand, an independent hospital medicine group (HMG) contracting with the hospital to deliver services may view committee participation as an avenue for ensuring the group’s success. Whatever the employment model, and whatever the career goals of individual hospitalists, it often pays to target one’s participation in committees.

Make Participation Count

Hospitalists will be playing more key roles in medical staff leadership, according to William D. Atchley Jr., MD, medical director of the Division of Hospital Medicine for Sentara Medical Group in Hampton, Va. His concern is that hospitalists will be asked to serve on more than one or two committees. He advises younger hospitalists to notify the president of the medical staff of which committees they would be interested in working on. Dr. Atchley is also a member of the SHM Board of Directors.

“It could be peer review, performance improvement, or ad hoc committees focused on developing evidence-based order sets, improving through-put or disaster preparedness,” says Dr. Atchley. Whatever the pick, “it should be something that they’re going to find enjoyable and that they feel will advance their stature within the hospital.”

To be an effective member of a hospital board committee, a hospitalist must represent the greater interests of all stakeholders—not just his or her own self-interest, cautions Dr. Combes. However, “as physicians become more stressed and production-oriented, giving up clinical time to participate in governance activities becomes more and more difficult,” he concedes. Hospitalists should choose committee assignments based on their interests and expertise.

Dr. Williams encourages hospitalists in his group to pick one committee—preferably one focused on care delivery (quality improvement, pharmacy and therapeutics, utilization review) and take an active role. “Then, over time, I encourage them to try to chair committees to obtain leadership experience,” he says.

Taking on too many extracurricular committee tasks can be counterproductive. To avoid this, Flores advises younger hospitalists to ask themselves the following:

• What will my committee participation do to support the goals of the committee and the organization?
• By participating in this committee, can I expand my own knowledge or understanding of the culture and politics of the organization?
• Can I become more comfortable interacting on an organizational level?
• Can I network and get to know people I wouldn’t otherwise encounter, who can be helpful to me personally?

In addition, Dr. Atchley believes rotating committee assignments is also beneficial, especially for the younger hospitalist. In his tenure as a hospitalist, Dr. Atchley has served as chairman of the Department of Medicine’s credentials and quality assurance committees, and as vice president of the medical staff. Each committee furnishes hospitalists with a different perspective about how the hospital functions.

“I think hospitalists should understand the medical staff bylaws and procedures,” says Dr. Atchley. “Each hospital medicine staff has this governance structure, and I have found it beneficial in resolving conflicts about patient care and interaction between physicians.”

Mary A. Dallas, MD, has seen the committee situation from both sides of the fence. She is medical information officer for Presbyterian Healthcare Services, an integrated healthcare delivery network in Albuquerque, N.M., but served as medical director of Presbyterian’s hospitalist group for five years before that.

“Hospitalists have a vested interest in making sure their work area is protected, so they need to plant some people in strategic places for the governance and medical staff,” says Dr. Dallas. “In order to be effective in the governance of the hospital, you have to be part of that medical substructure and get involved.”

For instance, as medical director, she sat on the hospital’s credential committee and found it allowed her to keep tabs on new HMG hires going through the credentialing process. “This [the hospital] is your work environment,” she explains. “You are here day in and day out, and you should shape that environment, have a say in policies and rules, so that you can make your job more successful and make patient care better.”

The Quandary over Compensation

Many hospitalists feel frustrated when committee obligations impinge on clinical duties. Is compensation the answer for filling committee slots? Opinions are mixed.

Dr. Williams says he is “a little uncomfortable with the concept of people getting paid every time they attend a committee meeting. For hospitalists who receive funding from the hospital to support their programs, it’s important for the leader [of the HMG] to ensure that they’re collaborating with hospital administration. The hospital has the expectation that, as part of our salary structure, we will be members of committees. That needs to be part of the job.”

Dr. Dallas agrees: “Regardless of whether you’re getting paid or not, this is your work environment. I think it’s very important to be involved, so that your voice is heard and so that you can help make the [hospital] structure better.”

Compensating physicians for their time does communicate that their time is valued and respected, says Dr. Combes, but payment does not necessarily guarantee a high level of committee members’ engagement. In addition, he says, if physicians are being compensated directly by the hospital for serving on committees, “this can threaten the perception of their objectivity, in terms of bringing an independent perspective to the board.” A better solution might be for the hospital medicine group to build its own compensation structure for non-clinical work so members retain independence when voicing opinions to the hospital board.

Dr. Atchley admits it’s sometimes a struggle to find people willing to serve on medical staff committees. He advocates compensation for those duties on a per-meeting or hourly basis. His hospital meets attendance requirements by giving credit to doctors who participate on selected medical staff committees.

Through her consulting assignments, Flores has observed that in some organizations where hospitalists are paid based on productivity, committee participation can be assigned a relative value unit so hospitalists are compensated on the same basis as for clinical work.

Flores concurs with Drs. Dallas and Williams: “In most organizations, a certain minimum level of participation in medical staff activities is expected of all staff members. I think that hospitalists should expect to do that to the same degree as other medical staff members, on a voluntary basis.

“If hospitalists truly want to impact how the medical staff and the hospital operate, and to be considered for high-level leadership positions, then their best way of becoming known and respected in the medical community is by participating on committees.” TH

Gretchen Henkel writes frequently for The Hospitalist.

Reference

1. SHM’s “2005-2006 Survey: State of the Hospital Medicine Movement, 2006.” Available online at www.hospitalmedicine.org Last accessed April 5, 2007.

Whether obligatory or voluntary, service on committees is a reality for most hospitalists. “The 2005-2006 SHM Survey: State of the Hospital Medicine Movement” found that, for 92% of respondents, committee participation topped the list of non-clinical activities.1 Hospital medicine group leaders, consultants, and administrators interviewed for this article say time-pressed hospitalists must become more effective committee participants.

Civic Duty or Career Advancement?

Because of growing presence at the hospital and their knowledge of hospital operations, hospitalists are a logical choice for committee assignments. These can range from committees dedicated to care delivery (e.g., pharmacy and therapeutics) to the hospital board’s governance committees.

“Hospitalists, with their perspective of hospital operations and clinical care, could be a great part of broadening the perspective of the board, informing their decision-making and helping them to formulate policies,” says John Combes, MD, president of the Center for Healthcare Governance in Chicago, a subsidiary committee of the American Hospital Association.

Mark V. Williams, MD, professor of medicine and director, Emory Hospital Medicine Unit in Atlanta, and editor in chief of the Journal of Hospital Medicine, does not consider committee participation optional.

“I strongly encourage—if not almost require—all of the hospitalists in our group to be involved in at least one committee,” says Dr. Williams. “My belief is that hospitalists are integral to the functioning of the hospital, and as part of their responsibility, they need to be actively involved in committee work to move projects forward.”

Leslie Flores, MHA, co-principal of Nelson/Flores Associates, LLC, agrees. “It’s in the hospitalists’ best interest to be involved in committees,” she says. “Hospitalists are often in the best position to see what needs to be fixed, and they have the potential to have a significant impact on how effectively their hospital operates, which can make their own jobs easier.”

Further, she points out, “If the hospital, which is financially supporting them, is more successful and effective, there’s likely to be less financial pressure on their practice.”

Hospitalists’ perceptions about committee participation can be influenced by each hospitalist’s employment model. If one is working directly for the hospital and giving 110% to that employer, being asked to volunteer additional time to serve on a committee might be viewed as a burden. On the other hand, an independent hospital medicine group (HMG) contracting with the hospital to deliver services may view committee participation as an avenue for ensuring the group’s success. Whatever the employment model, and whatever the career goals of individual hospitalists, it often pays to target one’s participation in committees.

Make Participation Count

Hospitalists will be playing more key roles in medical staff leadership, according to William D. Atchley Jr., MD, medical director of the Division of Hospital Medicine for Sentara Medical Group in Hampton, Va. His concern is that hospitalists will be asked to serve on more than one or two committees. He advises younger hospitalists to notify the president of the medical staff of which committees they would be interested in working on. Dr. Atchley is also a member of the SHM Board of Directors.

“It could be peer review, performance improvement, or ad hoc committees focused on developing evidence-based order sets, improving through-put or disaster preparedness,” says Dr. Atchley. Whatever the pick, “it should be something that they’re going to find enjoyable and that they feel will advance their stature within the hospital.”

To be an effective member of a hospital board committee, a hospitalist must represent the greater interests of all stakeholders—not just his or her own self-interest, cautions Dr. Combes. However, “as physicians become more stressed and production-oriented, giving up clinical time to participate in governance activities becomes more and more difficult,” he concedes. Hospitalists should choose committee assignments based on their interests and expertise.

Dr. Williams encourages hospitalists in his group to pick one committee—preferably one focused on care delivery (quality improvement, pharmacy and therapeutics, utilization review) and take an active role. “Then, over time, I encourage them to try to chair committees to obtain leadership experience,” he says.

Taking on too many extracurricular committee tasks can be counterproductive. To avoid this, Flores advises younger hospitalists to ask themselves the following:

• What will my committee participation do to support the goals of the committee and the organization?
• By participating in this committee, can I expand my own knowledge or understanding of the culture and politics of the organization?
• Can I become more comfortable interacting on an organizational level?
• Can I network and get to know people I wouldn’t otherwise encounter, who can be helpful to me personally?

In addition, Dr. Atchley believes rotating committee assignments is also beneficial, especially for the younger hospitalist. In his tenure as a hospitalist, Dr. Atchley has served as chairman of the Department of Medicine’s credentials and quality assurance committees, and as vice president of the medical staff. Each committee furnishes hospitalists with a different perspective about how the hospital functions.

“I think hospitalists should understand the medical staff bylaws and procedures,” says Dr. Atchley. “Each hospital medicine staff has this governance structure, and I have found it beneficial in resolving conflicts about patient care and interaction between physicians.”

Mary A. Dallas, MD, has seen the committee situation from both sides of the fence. She is medical information officer for Presbyterian Healthcare Services, an integrated healthcare delivery network in Albuquerque, N.M., but served as medical director of Presbyterian’s hospitalist group for five years before that.

“Hospitalists have a vested interest in making sure their work area is protected, so they need to plant some people in strategic places for the governance and medical staff,” says Dr. Dallas. “In order to be effective in the governance of the hospital, you have to be part of that medical substructure and get involved.”

For instance, as medical director, she sat on the hospital’s credential committee and found it allowed her to keep tabs on new HMG hires going through the credentialing process. “This [the hospital] is your work environment,” she explains. “You are here day in and day out, and you should shape that environment, have a say in policies and rules, so that you can make your job more successful and make patient care better.”

The Quandary over Compensation

Many hospitalists feel frustrated when committee obligations impinge on clinical duties. Is compensation the answer for filling committee slots? Opinions are mixed.

Dr. Williams says he is “a little uncomfortable with the concept of people getting paid every time they attend a committee meeting. For hospitalists who receive funding from the hospital to support their programs, it’s important for the leader [of the HMG] to ensure that they’re collaborating with hospital administration. The hospital has the expectation that, as part of our salary structure, we will be members of committees. That needs to be part of the job.”

Dr. Dallas agrees: “Regardless of whether you’re getting paid or not, this is your work environment. I think it’s very important to be involved, so that your voice is heard and so that you can help make the [hospital] structure better.”

Compensating physicians for their time does communicate that their time is valued and respected, says Dr. Combes, but payment does not necessarily guarantee a high level of committee members’ engagement. In addition, he says, if physicians are being compensated directly by the hospital for serving on committees, “this can threaten the perception of their objectivity, in terms of bringing an independent perspective to the board.” A better solution might be for the hospital medicine group to build its own compensation structure for non-clinical work so members retain independence when voicing opinions to the hospital board.

Dr. Atchley admits it’s sometimes a struggle to find people willing to serve on medical staff committees. He advocates compensation for those duties on a per-meeting or hourly basis. His hospital meets attendance requirements by giving credit to doctors who participate on selected medical staff committees.

Through her consulting assignments, Flores has observed that in some organizations where hospitalists are paid based on productivity, committee participation can be assigned a relative value unit so hospitalists are compensated on the same basis as for clinical work.

Flores concurs with Drs. Dallas and Williams: “In most organizations, a certain minimum level of participation in medical staff activities is expected of all staff members. I think that hospitalists should expect to do that to the same degree as other medical staff members, on a voluntary basis.

“If hospitalists truly want to impact how the medical staff and the hospital operate, and to be considered for high-level leadership positions, then their best way of becoming known and respected in the medical community is by participating on committees.” TH

Gretchen Henkel writes frequently for The Hospitalist.

Reference

1. SHM’s “2005-2006 Survey: State of the Hospital Medicine Movement, 2006.” Available online at www.hospitalmedicine.org Last accessed April 5, 2007.

This is the second in a series on the four pillars of career satisfaction. Part 1 appeared on p. 14 in the June issue of The Hospitalist.

How can hospitalists work long days often packed from beginning to end and still remain happy with their jobs? One answer can be found in “A Challenge for a New Specialty: A White Paper on Hospitalist Career Satisfaction” (available online at www.hospitalmedicine.org), a comprehensive document by SHM’s Career Satisfaction Task Force (CSTF). This white paper can be used by hospitalists and hospital medicine practices as a toolkit for improving job satisfaction. It outlines the four pillars of career satisfaction.

The Second Pillar: Workload/Schedule

The workload/schedule pillar refers to the type, volume, and intensity of a hospitalist’s work as well as time pressures, variability of work, and number of interruptions. A hospitalist schedule must take all these factors into consideration.

CSTF Co-Chairperson Winthrop Whitcomb, MD, Mercy Medical Center, Springfield, Mass., maintains that this pillar is supported by the other three—autonomy/control, reward/recognition, and community/environment—but most closely with reward/recognition.

“There needs to be a reward system in place no matter what the workload,” says Dr. Whitcomb. “You can’t really talk about workload without addressing rewards. It’s human nature that in order to work hard, you need to be rewarded in some meaningful way.”

But many people—not just physicians but workers from all fields—may have separate concerns about heavy workload and just rewards.

An Example of Workload Issues

You probably know from your own experience as a hospitalist how workload can affect career satisfaction. Here is a fictional example of a hospitalist struggling with an increased patient load:

The director of my community-based hospital medicine program has mandated that each hospitalist see 15 to 20 patients each weekday, and 20 to 30 patients a day over weekends. I know this workload is too heavy to allow good quality of care. Under the pressure of seeing my quota of patients, I’m afraid I might make a mistake or miss something.

“There are physicians out there who can and do handle this type of workload, and they do it happily and well,” Dr. Whitcomb points out. “But this is only true if there is an appropriate reward system in place, and there clearly needs to be a good support system in order to provide quality of care” under this example.

CSTF says this individual should take the following steps:

Step 1: Go on a fact-finding mission. Find out whether hospitalist workload, responsibilities, and schedule at this facility are the norm. “[The hospitalist] should get an idea of what’s happening at other hospital medicine groups; he should understand the national picture,” says Dr. Whitcomb. “He might then realize that hospitalists in his group are only working 187 days a year, and that over a course of a year they’re not really working any harder than others who work more days,” says Dr. Whitcomb. “This might get him thinking a little bit differently about the workload.”

Step 2: Undertake organizational strategies. A hospitalist can find out how he or she has a voice in workload issues.“Figure out how hospitalists are represented in the structure of the group,” advises Dr. Whitcomb. “If a director is mandating how much [hospitalists] work, there has to be some mechanism for the physicians to be able to provide feedback. This often takes the shape of a compensation committee; this group is not just about compensation but about budget and sustainability for both the hospital and the hospitalists.” Physician representation—having a say in workload and schedule—is important to maintain a good balance within a hospital medicine program.

Step 3: Consider recommendations to ease workload. “You can try to change the workload through justifying adding staff or through putting systems in place that allow you to see more patients,” says Dr. Whitcomb. But what if the hospitalist considers or takes these steps and still finds his patient load to be unsustainable long term? “In terms of feeling like you’re not able to provide safe care,” says Dr. Whitcomb, “once you’ve suggested changes to the leadership and no changes are made, this may become a deal-breaker.”

Workload Leans on Other Pillars

The interesting thing about the workload/schedule pillar of job satisfaction is that, if you are unhappy with your workload, the other three pillars can sustain you and make you generally satisfied.

Dr. Whitcomb points to a 2002 article published in the Journal of Health and Social Behavior.1 The study examined a national survey of hospitalists and found that job burnout and intent to remain in the career are more meaningfully associated with favorable “community” relations than with negative experiences such as reduced autonomy.

“Workload is not a predictor of burnout as long as the other three pillars are intact,” summarizes Dr. Whitcomb.

Jane Jerrard has written for The Hospitalist since 2005.

Reference

1. Hoff T, Whitcomb WF, Nelson JR. Thriving and surviving in a new medical career: the case of hospitalist physicians. J Health Social Behav. 2002 Mar;43(1):72-91

This is the second in a series on the four pillars of career satisfaction. Part 1 appeared on p. 14 in the June issue of The Hospitalist.

How can hospitalists work long days often packed from beginning to end and still remain happy with their jobs? One answer can be found in “A Challenge for a New Specialty: A White Paper on Hospitalist Career Satisfaction” (available online at www.hospitalmedicine.org), a comprehensive document by SHM’s Career Satisfaction Task Force (CSTF). This white paper can be used by hospitalists and hospital medicine practices as a toolkit for improving job satisfaction. It outlines the four pillars of career satisfaction.

The Second Pillar: Workload/Schedule

The workload/schedule pillar refers to the type, volume, and intensity of a hospitalist’s work as well as time pressures, variability of work, and number of interruptions. A hospitalist schedule must take all these factors into consideration.

CSTF Co-Chairperson Winthrop Whitcomb, MD, Mercy Medical Center, Springfield, Mass., maintains that this pillar is supported by the other three—autonomy/control, reward/recognition, and community/environment—but most closely with reward/recognition.

“There needs to be a reward system in place no matter what the workload,” says Dr. Whitcomb. “You can’t really talk about workload without addressing rewards. It’s human nature that in order to work hard, you need to be rewarded in some meaningful way.”

But many people—not just physicians but workers from all fields—may have separate concerns about heavy workload and just rewards.

An Example of Workload Issues

You probably know from your own experience as a hospitalist how workload can affect career satisfaction. Here is a fictional example of a hospitalist struggling with an increased patient load:

The director of my community-based hospital medicine program has mandated that each hospitalist see 15 to 20 patients each weekday, and 20 to 30 patients a day over weekends. I know this workload is too heavy to allow good quality of care. Under the pressure of seeing my quota of patients, I’m afraid I might make a mistake or miss something.

“There are physicians out there who can and do handle this type of workload, and they do it happily and well,” Dr. Whitcomb points out. “But this is only true if there is an appropriate reward system in place, and there clearly needs to be a good support system in order to provide quality of care” under this example.

CSTF says this individual should take the following steps:

Step 1: Go on a fact-finding mission. Find out whether hospitalist workload, responsibilities, and schedule at this facility are the norm. “[The hospitalist] should get an idea of what’s happening at other hospital medicine groups; he should understand the national picture,” says Dr. Whitcomb. “He might then realize that hospitalists in his group are only working 187 days a year, and that over a course of a year they’re not really working any harder than others who work more days,” says Dr. Whitcomb. “This might get him thinking a little bit differently about the workload.”

Step 2: Undertake organizational strategies. A hospitalist can find out how he or she has a voice in workload issues.“Figure out how hospitalists are represented in the structure of the group,” advises Dr. Whitcomb. “If a director is mandating how much [hospitalists] work, there has to be some mechanism for the physicians to be able to provide feedback. This often takes the shape of a compensation committee; this group is not just about compensation but about budget and sustainability for both the hospital and the hospitalists.” Physician representation—having a say in workload and schedule—is important to maintain a good balance within a hospital medicine program.

Step 3: Consider recommendations to ease workload. “You can try to change the workload through justifying adding staff or through putting systems in place that allow you to see more patients,” says Dr. Whitcomb. But what if the hospitalist considers or takes these steps and still finds his patient load to be unsustainable long term? “In terms of feeling like you’re not able to provide safe care,” says Dr. Whitcomb, “once you’ve suggested changes to the leadership and no changes are made, this may become a deal-breaker.”

Workload Leans on Other Pillars

The interesting thing about the workload/schedule pillar of job satisfaction is that, if you are unhappy with your workload, the other three pillars can sustain you and make you generally satisfied.

Dr. Whitcomb points to a 2002 article published in the Journal of Health and Social Behavior.1 The study examined a national survey of hospitalists and found that job burnout and intent to remain in the career are more meaningfully associated with favorable “community” relations than with negative experiences such as reduced autonomy.

“Workload is not a predictor of burnout as long as the other three pillars are intact,” summarizes Dr. Whitcomb.

Jane Jerrard has written for The Hospitalist since 2005.

Reference

1. Hoff T, Whitcomb WF, Nelson JR. Thriving and surviving in a new medical career: the case of hospitalist physicians. J Health Social Behav. 2002 Mar;43(1):72-91

This is the second in a series on the four pillars of career satisfaction. Part 1 appeared on p. 14 in the June issue of The Hospitalist.

How can hospitalists work long days often packed from beginning to end and still remain happy with their jobs? One answer can be found in “A Challenge for a New Specialty: A White Paper on Hospitalist Career Satisfaction” (available online at www.hospitalmedicine.org), a comprehensive document by SHM’s Career Satisfaction Task Force (CSTF). This white paper can be used by hospitalists and hospital medicine practices as a toolkit for improving job satisfaction. It outlines the four pillars of career satisfaction.

The Second Pillar: Workload/Schedule

The workload/schedule pillar refers to the type, volume, and intensity of a hospitalist’s work as well as time pressures, variability of work, and number of interruptions. A hospitalist schedule must take all these factors into consideration.

CSTF Co-Chairperson Winthrop Whitcomb, MD, Mercy Medical Center, Springfield, Mass., maintains that this pillar is supported by the other three—autonomy/control, reward/recognition, and community/environment—but most closely with reward/recognition.

“There needs to be a reward system in place no matter what the workload,” says Dr. Whitcomb. “You can’t really talk about workload without addressing rewards. It’s human nature that in order to work hard, you need to be rewarded in some meaningful way.”

But many people—not just physicians but workers from all fields—may have separate concerns about heavy workload and just rewards.

An Example of Workload Issues

You probably know from your own experience as a hospitalist how workload can affect career satisfaction. Here is a fictional example of a hospitalist struggling with an increased patient load:

The director of my community-based hospital medicine program has mandated that each hospitalist see 15 to 20 patients each weekday, and 20 to 30 patients a day over weekends. I know this workload is too heavy to allow good quality of care. Under the pressure of seeing my quota of patients, I’m afraid I might make a mistake or miss something.

“There are physicians out there who can and do handle this type of workload, and they do it happily and well,” Dr. Whitcomb points out. “But this is only true if there is an appropriate reward system in place, and there clearly needs to be a good support system in order to provide quality of care” under this example.

CSTF says this individual should take the following steps:

Step 1: Go on a fact-finding mission. Find out whether hospitalist workload, responsibilities, and schedule at this facility are the norm. “[The hospitalist] should get an idea of what’s happening at other hospital medicine groups; he should understand the national picture,” says Dr. Whitcomb. “He might then realize that hospitalists in his group are only working 187 days a year, and that over a course of a year they’re not really working any harder than others who work more days,” says Dr. Whitcomb. “This might get him thinking a little bit differently about the workload.”

Step 2: Undertake organizational strategies. A hospitalist can find out how he or she has a voice in workload issues.“Figure out how hospitalists are represented in the structure of the group,” advises Dr. Whitcomb. “If a director is mandating how much [hospitalists] work, there has to be some mechanism for the physicians to be able to provide feedback. This often takes the shape of a compensation committee; this group is not just about compensation but about budget and sustainability for both the hospital and the hospitalists.” Physician representation—having a say in workload and schedule—is important to maintain a good balance within a hospital medicine program.

Step 3: Consider recommendations to ease workload. “You can try to change the workload through justifying adding staff or through putting systems in place that allow you to see more patients,” says Dr. Whitcomb. But what if the hospitalist considers or takes these steps and still finds his patient load to be unsustainable long term? “In terms of feeling like you’re not able to provide safe care,” says Dr. Whitcomb, “once you’ve suggested changes to the leadership and no changes are made, this may become a deal-breaker.”

Workload Leans on Other Pillars

The interesting thing about the workload/schedule pillar of job satisfaction is that, if you are unhappy with your workload, the other three pillars can sustain you and make you generally satisfied.

Dr. Whitcomb points to a 2002 article published in the Journal of Health and Social Behavior.1 The study examined a national survey of hospitalists and found that job burnout and intent to remain in the career are more meaningfully associated with favorable “community” relations than with negative experiences such as reduced autonomy.

“Workload is not a predictor of burnout as long as the other three pillars are intact,” summarizes Dr. Whitcomb.

Jane Jerrard has written for The Hospitalist since 2005.

Reference

1. Hoff T, Whitcomb WF, Nelson JR. Thriving and surviving in a new medical career: the case of hospitalist physicians. J Health Social Behav. 2002 Mar;43(1):72-91