Career

Christina L. Andrew, DO, a medical director on the hospitalist team at McLeod Regional Medical Center in Florence, S.C., and Zeshan Anwar, MD, medical director of Evangelical Community Hospital’s hospitalist group in Lewisburg, Pa., recently were named Senior Fellows in Hospital Medicine (SFHM) by the Society of Hospital Medicine. SFHMs are dedicated to promoting excellence, innovation and improving the quality of patient care.

Dr. Andrew has been with McLeod since 2008. The board-certified internist received her medical degree from Des Moines (Iowa) University Osteopathic Medical Center and did her residency at the Cleveland Clinic. To earn SFHM status, physicians must have worked as a hospitalist for at least 5 years and be a member of SHM for 5 years, as well.

Dr. Anwar has been in his current position since 2015. He coordinates staff resources and inpatient care for the facility where he has worked since 2013. He has his medical degree from King Edward Medical University, Lahore, Pakistan, and did his residency at Bronx-Lebanon Hospital Center in New York.
 

Tiffany Egbe, MD, has been named to the board of directors of Refuge International, an organization that builds relationships in Guatemala that allow for medical services to be provided to an underserved population.

Dr. Egbe is a hospitalist in internal medicine at Christus Good Shepherd in Longview and Marshall, Tex. She also serves as program director of internal medicine residency for the University of Texas Health Science Center in Tyler, Tex.

Dr. Egbe earned her medical degree from the University of Alabama at Birmingham.
 

Il Jun Chon, MD, has been named vice president of medical affairs with WellSpan Ephrata (Pa.) Community Hospital. Dr. Chon, a hospitalist, had previously been the medical director of WellSpan Ephrata’s hospitalist services and president of the facility’s medical staff.

Dr. Chon earned his medical degree from the Medical College of Pennsylvania (now Drexel College of Medicine) and completed his residency at Thomas Jefferson University Hospital, both in Philadelphia.
 

Megan Hamreus, DO, recently was named chief of staff at Scripps Mercy Hospital in San Diego, Calif. Dr. Hamreus will oversee 1,000 doctors at two facilities.

Dr. Hamreus has been with Scripps Mercy for 10 years, serving as a hospitalist and a faculty member of the family medicine residence training program of Family Health Centers of San Diego.

Chief of staff is a 2-year, elected term. Among her duties, Dr. Hamreus will be Scripps Mercy’s liaison to the facilities’ administrative staff and Scripps Health’s board of trustees.
 

Jade Brice Roshell, MD, recently was named chief medical officer at Shelby Baptist Medical Center in Alabaster, Ala. Dr. Brice Roshell was promoted from director of the center’s hospitalist program.

In addition to her new position, Dr. Brice Roshell was named as one of 68 honorees on Becker’s 2019 list of African-American Leaders in Health.

Dr. Brice Roshell has been with Shelby Baptist since 2015. Previously, she was an internist at centers in Louisiana, Georgia, and Nebraska. Her medical degree is from Howard University in Washington, and she completed her residency at Tulane University in New Orleans.
 

Anju Manral, MD, recently was appointed as medical director for the University of New Mexico Student Health and Counseling Center in Albuquerque. The internist has experience as a hospitalist focused on palliative care and most recently has worked at UNM’s Family Health Clinic, providing care to patients of all ages and conditions.

Dr. Manral also serves as an assistant professor in the UNM General Internal Medicine Department and mentors UNM medical students in the health science learning community.


The Hiawatha (Kan.) Community Hospital unveiled its new hospitalist program on Feb. 12.

The program will be led by Dustin Williams, DNP. Dr. Williams will provide hospitalist and emergency medical services to patients every Tuesday through Friday, while an on-call specialist will serve as hospitalist on Saturday, Sunday, and Monday.

Christina L. Andrew, DO, a medical director on the hospitalist team at McLeod Regional Medical Center in Florence, S.C., and Zeshan Anwar, MD, medical director of Evangelical Community Hospital’s hospitalist group in Lewisburg, Pa., recently were named Senior Fellows in Hospital Medicine (SFHM) by the Society of Hospital Medicine. SFHMs are dedicated to promoting excellence, innovation and improving the quality of patient care.

Dr. Andrew has been with McLeod since 2008. The board-certified internist received her medical degree from Des Moines (Iowa) University Osteopathic Medical Center and did her residency at the Cleveland Clinic. To earn SFHM status, physicians must have worked as a hospitalist for at least 5 years and be a member of SHM for 5 years, as well.

Dr. Anwar has been in his current position since 2015. He coordinates staff resources and inpatient care for the facility where he has worked since 2013. He has his medical degree from King Edward Medical University, Lahore, Pakistan, and did his residency at Bronx-Lebanon Hospital Center in New York.
 

Tiffany Egbe, MD, has been named to the board of directors of Refuge International, an organization that builds relationships in Guatemala that allow for medical services to be provided to an underserved population.

Dr. Egbe is a hospitalist in internal medicine at Christus Good Shepherd in Longview and Marshall, Tex. She also serves as program director of internal medicine residency for the University of Texas Health Science Center in Tyler, Tex.

Dr. Egbe earned her medical degree from the University of Alabama at Birmingham.
 

Il Jun Chon, MD, has been named vice president of medical affairs with WellSpan Ephrata (Pa.) Community Hospital. Dr. Chon, a hospitalist, had previously been the medical director of WellSpan Ephrata’s hospitalist services and president of the facility’s medical staff.

Dr. Chon earned his medical degree from the Medical College of Pennsylvania (now Drexel College of Medicine) and completed his residency at Thomas Jefferson University Hospital, both in Philadelphia.
 

Megan Hamreus, DO, recently was named chief of staff at Scripps Mercy Hospital in San Diego, Calif. Dr. Hamreus will oversee 1,000 doctors at two facilities.

Dr. Hamreus has been with Scripps Mercy for 10 years, serving as a hospitalist and a faculty member of the family medicine residence training program of Family Health Centers of San Diego.

Chief of staff is a 2-year, elected term. Among her duties, Dr. Hamreus will be Scripps Mercy’s liaison to the facilities’ administrative staff and Scripps Health’s board of trustees.
 

Jade Brice Roshell, MD, recently was named chief medical officer at Shelby Baptist Medical Center in Alabaster, Ala. Dr. Brice Roshell was promoted from director of the center’s hospitalist program.

In addition to her new position, Dr. Brice Roshell was named as one of 68 honorees on Becker’s 2019 list of African-American Leaders in Health.

Dr. Brice Roshell has been with Shelby Baptist since 2015. Previously, she was an internist at centers in Louisiana, Georgia, and Nebraska. Her medical degree is from Howard University in Washington, and she completed her residency at Tulane University in New Orleans.
 

Anju Manral, MD, recently was appointed as medical director for the University of New Mexico Student Health and Counseling Center in Albuquerque. The internist has experience as a hospitalist focused on palliative care and most recently has worked at UNM’s Family Health Clinic, providing care to patients of all ages and conditions.

Dr. Manral also serves as an assistant professor in the UNM General Internal Medicine Department and mentors UNM medical students in the health science learning community.


The Hiawatha (Kan.) Community Hospital unveiled its new hospitalist program on Feb. 12.

The program will be led by Dustin Williams, DNP. Dr. Williams will provide hospitalist and emergency medical services to patients every Tuesday through Friday, while an on-call specialist will serve as hospitalist on Saturday, Sunday, and Monday.

Christina L. Andrew, DO, a medical director on the hospitalist team at McLeod Regional Medical Center in Florence, S.C., and Zeshan Anwar, MD, medical director of Evangelical Community Hospital’s hospitalist group in Lewisburg, Pa., recently were named Senior Fellows in Hospital Medicine (SFHM) by the Society of Hospital Medicine. SFHMs are dedicated to promoting excellence, innovation and improving the quality of patient care.

Dr. Andrew has been with McLeod since 2008. The board-certified internist received her medical degree from Des Moines (Iowa) University Osteopathic Medical Center and did her residency at the Cleveland Clinic. To earn SFHM status, physicians must have worked as a hospitalist for at least 5 years and be a member of SHM for 5 years, as well.

Dr. Anwar has been in his current position since 2015. He coordinates staff resources and inpatient care for the facility where he has worked since 2013. He has his medical degree from King Edward Medical University, Lahore, Pakistan, and did his residency at Bronx-Lebanon Hospital Center in New York.
 

Tiffany Egbe, MD, has been named to the board of directors of Refuge International, an organization that builds relationships in Guatemala that allow for medical services to be provided to an underserved population.

Dr. Egbe is a hospitalist in internal medicine at Christus Good Shepherd in Longview and Marshall, Tex. She also serves as program director of internal medicine residency for the University of Texas Health Science Center in Tyler, Tex.

Dr. Egbe earned her medical degree from the University of Alabama at Birmingham.
 

Il Jun Chon, MD, has been named vice president of medical affairs with WellSpan Ephrata (Pa.) Community Hospital. Dr. Chon, a hospitalist, had previously been the medical director of WellSpan Ephrata’s hospitalist services and president of the facility’s medical staff.

Dr. Chon earned his medical degree from the Medical College of Pennsylvania (now Drexel College of Medicine) and completed his residency at Thomas Jefferson University Hospital, both in Philadelphia.
 

Megan Hamreus, DO, recently was named chief of staff at Scripps Mercy Hospital in San Diego, Calif. Dr. Hamreus will oversee 1,000 doctors at two facilities.

Dr. Hamreus has been with Scripps Mercy for 10 years, serving as a hospitalist and a faculty member of the family medicine residence training program of Family Health Centers of San Diego.

Chief of staff is a 2-year, elected term. Among her duties, Dr. Hamreus will be Scripps Mercy’s liaison to the facilities’ administrative staff and Scripps Health’s board of trustees.
 

Jade Brice Roshell, MD, recently was named chief medical officer at Shelby Baptist Medical Center in Alabaster, Ala. Dr. Brice Roshell was promoted from director of the center’s hospitalist program.

In addition to her new position, Dr. Brice Roshell was named as one of 68 honorees on Becker’s 2019 list of African-American Leaders in Health.

Dr. Brice Roshell has been with Shelby Baptist since 2015. Previously, she was an internist at centers in Louisiana, Georgia, and Nebraska. Her medical degree is from Howard University in Washington, and she completed her residency at Tulane University in New Orleans.
 

Anju Manral, MD, recently was appointed as medical director for the University of New Mexico Student Health and Counseling Center in Albuquerque. The internist has experience as a hospitalist focused on palliative care and most recently has worked at UNM’s Family Health Clinic, providing care to patients of all ages and conditions.

Dr. Manral also serves as an assistant professor in the UNM General Internal Medicine Department and mentors UNM medical students in the health science learning community.


The Hiawatha (Kan.) Community Hospital unveiled its new hospitalist program on Feb. 12.

The program will be led by Dustin Williams, DNP. Dr. Williams will provide hospitalist and emergency medical services to patients every Tuesday through Friday, while an on-call specialist will serve as hospitalist on Saturday, Sunday, and Monday.

For the first time, employed physicians outnumber independent physicians, according to a survey from the American Medical Association.

The AMA’s annual Physician Practice Benchmark Survey, which queried 3,500 doctors, showed that 47% of all physicians in 2018 were employed, compared with 46% of doctors who were self-employed that year. The number of employed physicians has risen 6 percentage points since 2012, while the number of self-employed doctors has fallen by 7 percentage points over the same period, according to the study published May 6 on the AMA website.

Younger physicians and women doctors were more likely to be employed than their counterparts. Nearly 70% of physicians under age 40 years were employees in 2018, compared with 38% of physicians 55 years and older, the study found. About 35% of physicians worked either directly for a hospital or in a practice at least partly owned by a hospital in 2018, up from 29% in 2012.

More than half of physicians surveyed (54%) worked in physician-owned practices in 2018 either as an owner, employee, or contractor, a decrease from 60% in 2012. Male physicians were more likely to be practice owners than female physicians. Among female doctors, 58% were employees, compared with 34% who were practice owners, while 52% of men physicians were practice owners, compared with 42% who were employees.

Surgical subspecialists had the highest share of owners (65%) followed by obstetrician-gynecologists (54%) and internal medicine subspecialists (52%). Emergency physicians had the lowest share of owners (26%) and the highest share of independent contractors (27%). Family physicians, meanwhile, had the highest share of employed physicians (57%).

A majority of doctors still work in small practices, the analysis found. In 2018, 57% of physicians worked in practices with 10 or fewer physicians versus 61% in 2012. However, fewer physicians work in solo practice. Between 2012 and 2018 the percentage of physicians in solo practice fell from 18% in 2012 to 15% in 2018.

“Transformational change continues in the delivery of health care and physicians are responding by reevaluating their practice arrangements,” AMA President Barbara L. McAneny, MD, said in a statement. “Physicians must assess many factors and carefully determine for themselves what settings they find professionally rewarding when considering independence or employment.”

The AMA’s Physician Practice Benchmark Survey is a nationally representative survey of post-residency physicians who provide at least 20 hours of patient care per week, are not employed by the federal government, and practice in one of the 50 states or the District of Columbia. The 2018 survey was conducted in September 2018, and the final data included 3,500 physicians.

[email protected]

For the first time, employed physicians outnumber independent physicians, according to a survey from the American Medical Association.

The AMA’s annual Physician Practice Benchmark Survey, which queried 3,500 doctors, showed that 47% of all physicians in 2018 were employed, compared with 46% of doctors who were self-employed that year. The number of employed physicians has risen 6 percentage points since 2012, while the number of self-employed doctors has fallen by 7 percentage points over the same period, according to the study published May 6 on the AMA website.

Younger physicians and women doctors were more likely to be employed than their counterparts. Nearly 70% of physicians under age 40 years were employees in 2018, compared with 38% of physicians 55 years and older, the study found. About 35% of physicians worked either directly for a hospital or in a practice at least partly owned by a hospital in 2018, up from 29% in 2012.

More than half of physicians surveyed (54%) worked in physician-owned practices in 2018 either as an owner, employee, or contractor, a decrease from 60% in 2012. Male physicians were more likely to be practice owners than female physicians. Among female doctors, 58% were employees, compared with 34% who were practice owners, while 52% of men physicians were practice owners, compared with 42% who were employees.

Surgical subspecialists had the highest share of owners (65%) followed by obstetrician-gynecologists (54%) and internal medicine subspecialists (52%). Emergency physicians had the lowest share of owners (26%) and the highest share of independent contractors (27%). Family physicians, meanwhile, had the highest share of employed physicians (57%).

A majority of doctors still work in small practices, the analysis found. In 2018, 57% of physicians worked in practices with 10 or fewer physicians versus 61% in 2012. However, fewer physicians work in solo practice. Between 2012 and 2018 the percentage of physicians in solo practice fell from 18% in 2012 to 15% in 2018.

“Transformational change continues in the delivery of health care and physicians are responding by reevaluating their practice arrangements,” AMA President Barbara L. McAneny, MD, said in a statement. “Physicians must assess many factors and carefully determine for themselves what settings they find professionally rewarding when considering independence or employment.”

The AMA’s Physician Practice Benchmark Survey is a nationally representative survey of post-residency physicians who provide at least 20 hours of patient care per week, are not employed by the federal government, and practice in one of the 50 states or the District of Columbia. The 2018 survey was conducted in September 2018, and the final data included 3,500 physicians.

[email protected]

For the first time, employed physicians outnumber independent physicians, according to a survey from the American Medical Association.

The AMA’s annual Physician Practice Benchmark Survey, which queried 3,500 doctors, showed that 47% of all physicians in 2018 were employed, compared with 46% of doctors who were self-employed that year. The number of employed physicians has risen 6 percentage points since 2012, while the number of self-employed doctors has fallen by 7 percentage points over the same period, according to the study published May 6 on the AMA website.

Younger physicians and women doctors were more likely to be employed than their counterparts. Nearly 70% of physicians under age 40 years were employees in 2018, compared with 38% of physicians 55 years and older, the study found. About 35% of physicians worked either directly for a hospital or in a practice at least partly owned by a hospital in 2018, up from 29% in 2012.

More than half of physicians surveyed (54%) worked in physician-owned practices in 2018 either as an owner, employee, or contractor, a decrease from 60% in 2012. Male physicians were more likely to be practice owners than female physicians. Among female doctors, 58% were employees, compared with 34% who were practice owners, while 52% of men physicians were practice owners, compared with 42% who were employees.

Surgical subspecialists had the highest share of owners (65%) followed by obstetrician-gynecologists (54%) and internal medicine subspecialists (52%). Emergency physicians had the lowest share of owners (26%) and the highest share of independent contractors (27%). Family physicians, meanwhile, had the highest share of employed physicians (57%).

A majority of doctors still work in small practices, the analysis found. In 2018, 57% of physicians worked in practices with 10 or fewer physicians versus 61% in 2012. However, fewer physicians work in solo practice. Between 2012 and 2018 the percentage of physicians in solo practice fell from 18% in 2012 to 15% in 2018.

“Transformational change continues in the delivery of health care and physicians are responding by reevaluating their practice arrangements,” AMA President Barbara L. McAneny, MD, said in a statement. “Physicians must assess many factors and carefully determine for themselves what settings they find professionally rewarding when considering independence or employment.”

The AMA’s Physician Practice Benchmark Survey is a nationally representative survey of post-residency physicians who provide at least 20 hours of patient care per week, are not employed by the federal government, and practice in one of the 50 states or the District of Columbia. The 2018 survey was conducted in September 2018, and the final data included 3,500 physicians.

[email protected]

Residents and junior faculty have frequently asked me how they can attain a position similar to mine, focused on quality and leadership in a health care system. When I was first asked to offer advice on this topic, my response was generally something like, “Heck if I know! I just had a series of lucky accidents to get here!”

Back then, I would recount my career history. I established myself as a clinician educator and associate program director soon after Chief Residency. After that, I would explain, a series of fortunate events and health care trends shaped my career. Evidence-based medicine (EBM), the patient safety movement, a shift to incorporate value (as well as volume) into reimbursement models, and the hospital medicine movement all emerged in interesting and often synergistic ways.

A young SHM organization (then known as NAIP) grew rapidly even while the hospitalist programs I led in Phoenix, then at University of California, San Diego, grew in size and influence. Inevitably, it seemed, I was increasingly involved in quality improvement (QI) efforts, and began to publish and speak about them. Collaborative work with SHM and a number of hospital systems broadened my visibility regionally and nationally. Finally, in 2015, I was recruited away from UC San Diego into a new position, as chief quality officer at UC Davis.

On hearing this history, those seeking my sage advice would look a little confused, and then say something like, “So your advice is that I should get lucky??? Gee, thanks a lot! Really helpful!” (Insert sarcasm here).

The honor of being asked to contribute to the “Legacies” series in The Hospitalist gave me an opportunity to think about this a little differently. No one really wanted to know about how past changes in the health care environment led to my career success. They wanted advice on tools and strategies that will allow them to thrive in an environment of ongoing, disruptive change that is likely only going to accelerate. I now present my upgraded points of advice, intertwined with examples of how SHM positively influenced my career (and could assist yours):
 

Learn how your hospital works. Hospitalists obviously have an inside track on many aspects of hospital operations, but sometimes remain oblivious to the organizational and committee structure, priorities of hospital leadership, and the mechanism for implementing standardized care. Knowing where to go with new ideas, and the process of implementing protocols, will keep you from hitting political land mines and unintentionally encroaching on someone else’s turf, while aligning your efforts with institutional priorities improves the buy-in and resources available to do the work.

Start small, but think big. Don’t bite off more than you can chew, and make sure your ideas for change work on a small scale before trying to sell the world on them. On the other hand, think big! The care you and others provide is dependent on systems that go far beyond your immediate control. Policies, protocols, standardized order sets, checklists, and an array of other tools can be leveraged to influence care across an entire health system, and in the SHM Mentored Implementation programs, can impact hundreds of hospitals.

Broaden your skills. Commit to learning new skills that can increase your impact and career diversity. Procedural skills; information technology; and EMR, EBM, research, public health, QI, business, leadership, public speaking, advocacy, and telehealth, can all open up a whole world of possibilities when combined with a medical degree. These skills can move you into areas that keep you engaged and excited to go to work.

Engage in mentor/mentee relationships. As an associate program director and clinician-educator, I had a lot of opportunity to mentor residents and fellows. It is so rewarding to watch the mentee grow in experience and skills, and to eventually see many of them assume leadership and mentoring roles themselves. You don’t have to be in a teaching position to act as a mentor (my experience mentoring hospitalists and others in leadership and quality improvement now far surpasses my experience with house staff).

The mentor often benefits as much as the mentee from this relationship. I have been inspired by their passion and dedication, educated by their ideas and innovation, and frequently find I am learning more from them, than they are from me. I have had great experiences in the SHM Mentored Implementation program in the role of mentee and mentor.
 

Participate in a community. When I first joined NAIP, I was amazed that the giants (Wachter, Nelson, Whitcomb, Holman, Williams, Greeno, Howell, Huddleston, Wellikson, and on and on) were not only approachable, they were warm, friendly, interesting, and extraordinarily welcoming. The ever-expanding and evolving community at SHM continues that tradition and offers a forum to share innovative work, discuss common problems and solutions, contact world experts, or just find an empathetic ear. Working on toolkits and collaborative efforts with this community remains a real highlight of my career, and the source of several lasting friendships. So don’t be shy; step right up; and introduce yourself!

Avoid my past mistakes (this might be a long list). Random things you should try to avoid.

• Tribalism – It is natural to be protective of your hospitalist group, and to focus on the injustices heaped upon you from (insert favorite punching bag here, e.g., ED, orthopedists, cardiologists, nursing staff, evil administration penny pinchers, etc). While some of those injustices might be real, tribalism, defensiveness, and circling the wagons generally only makes things worse. Sit down face to face, learn a little bit about the opposing tribe (both about their work, and about them as people), and see how much more fun and productive work can be.
• Storming out of a meeting with the CMO and CEO, slamming the door, etc. – not productive. Administrative leaders are doing their own juggling act and are generally well intentioned and doing the best they can. Respect that, argue your case, but if things don’t pan out, shake their hand, and live to fight another day.
• Using e-mail (evil-mail) to resolve conflict – And if you’re a young whippersnapper, don’t use Twitter, Facebook, Snapchat, or other social media to address conflict either!
• Forgetting to put patients first – Frame decisions for your group around what best serves your patients, not your doctors. Long term, this gives your group credibility and will serve the hospitalists better as well. SHM does this on a large scale with their advocacy efforts, resulting in more credibility and influence on Capitol Hill.

Make time for friends, family, fitness, fun, and reflection. A sense of humor and an occasional laugh when dealing with ill patients, hospital medicine politics, and the EMR all day provides resilience, as does taking the time to foster self-awareness and insight into your own weaknesses, strengths, and how you react to different stressors. A little bit of exercise and time with family and friends can go a long way towards improving your outlook, work, and life in general, while reducing burnout. Oh yeah, it’s also a good idea to choose a great life partner as well. Thanks Michelle!

Dr. Maynard is chief quality officer, University of California Davis Medical Center, Sacramento, Calif.

Residents and junior faculty have frequently asked me how they can attain a position similar to mine, focused on quality and leadership in a health care system. When I was first asked to offer advice on this topic, my response was generally something like, “Heck if I know! I just had a series of lucky accidents to get here!”

Back then, I would recount my career history. I established myself as a clinician educator and associate program director soon after Chief Residency. After that, I would explain, a series of fortunate events and health care trends shaped my career. Evidence-based medicine (EBM), the patient safety movement, a shift to incorporate value (as well as volume) into reimbursement models, and the hospital medicine movement all emerged in interesting and often synergistic ways.

A young SHM organization (then known as NAIP) grew rapidly even while the hospitalist programs I led in Phoenix, then at University of California, San Diego, grew in size and influence. Inevitably, it seemed, I was increasingly involved in quality improvement (QI) efforts, and began to publish and speak about them. Collaborative work with SHM and a number of hospital systems broadened my visibility regionally and nationally. Finally, in 2015, I was recruited away from UC San Diego into a new position, as chief quality officer at UC Davis.

On hearing this history, those seeking my sage advice would look a little confused, and then say something like, “So your advice is that I should get lucky??? Gee, thanks a lot! Really helpful!” (Insert sarcasm here).

The honor of being asked to contribute to the “Legacies” series in The Hospitalist gave me an opportunity to think about this a little differently. No one really wanted to know about how past changes in the health care environment led to my career success. They wanted advice on tools and strategies that will allow them to thrive in an environment of ongoing, disruptive change that is likely only going to accelerate. I now present my upgraded points of advice, intertwined with examples of how SHM positively influenced my career (and could assist yours):
 

Learn how your hospital works. Hospitalists obviously have an inside track on many aspects of hospital operations, but sometimes remain oblivious to the organizational and committee structure, priorities of hospital leadership, and the mechanism for implementing standardized care. Knowing where to go with new ideas, and the process of implementing protocols, will keep you from hitting political land mines and unintentionally encroaching on someone else’s turf, while aligning your efforts with institutional priorities improves the buy-in and resources available to do the work.

Start small, but think big. Don’t bite off more than you can chew, and make sure your ideas for change work on a small scale before trying to sell the world on them. On the other hand, think big! The care you and others provide is dependent on systems that go far beyond your immediate control. Policies, protocols, standardized order sets, checklists, and an array of other tools can be leveraged to influence care across an entire health system, and in the SHM Mentored Implementation programs, can impact hundreds of hospitals.

Broaden your skills. Commit to learning new skills that can increase your impact and career diversity. Procedural skills; information technology; and EMR, EBM, research, public health, QI, business, leadership, public speaking, advocacy, and telehealth, can all open up a whole world of possibilities when combined with a medical degree. These skills can move you into areas that keep you engaged and excited to go to work.

Engage in mentor/mentee relationships. As an associate program director and clinician-educator, I had a lot of opportunity to mentor residents and fellows. It is so rewarding to watch the mentee grow in experience and skills, and to eventually see many of them assume leadership and mentoring roles themselves. You don’t have to be in a teaching position to act as a mentor (my experience mentoring hospitalists and others in leadership and quality improvement now far surpasses my experience with house staff).

The mentor often benefits as much as the mentee from this relationship. I have been inspired by their passion and dedication, educated by their ideas and innovation, and frequently find I am learning more from them, than they are from me. I have had great experiences in the SHM Mentored Implementation program in the role of mentee and mentor.
 

Participate in a community. When I first joined NAIP, I was amazed that the giants (Wachter, Nelson, Whitcomb, Holman, Williams, Greeno, Howell, Huddleston, Wellikson, and on and on) were not only approachable, they were warm, friendly, interesting, and extraordinarily welcoming. The ever-expanding and evolving community at SHM continues that tradition and offers a forum to share innovative work, discuss common problems and solutions, contact world experts, or just find an empathetic ear. Working on toolkits and collaborative efforts with this community remains a real highlight of my career, and the source of several lasting friendships. So don’t be shy; step right up; and introduce yourself!

Avoid my past mistakes (this might be a long list). Random things you should try to avoid.

• Tribalism – It is natural to be protective of your hospitalist group, and to focus on the injustices heaped upon you from (insert favorite punching bag here, e.g., ED, orthopedists, cardiologists, nursing staff, evil administration penny pinchers, etc). While some of those injustices might be real, tribalism, defensiveness, and circling the wagons generally only makes things worse. Sit down face to face, learn a little bit about the opposing tribe (both about their work, and about them as people), and see how much more fun and productive work can be.
• Storming out of a meeting with the CMO and CEO, slamming the door, etc. – not productive. Administrative leaders are doing their own juggling act and are generally well intentioned and doing the best they can. Respect that, argue your case, but if things don’t pan out, shake their hand, and live to fight another day.
• Using e-mail (evil-mail) to resolve conflict – And if you’re a young whippersnapper, don’t use Twitter, Facebook, Snapchat, or other social media to address conflict either!
• Forgetting to put patients first – Frame decisions for your group around what best serves your patients, not your doctors. Long term, this gives your group credibility and will serve the hospitalists better as well. SHM does this on a large scale with their advocacy efforts, resulting in more credibility and influence on Capitol Hill.

Make time for friends, family, fitness, fun, and reflection. A sense of humor and an occasional laugh when dealing with ill patients, hospital medicine politics, and the EMR all day provides resilience, as does taking the time to foster self-awareness and insight into your own weaknesses, strengths, and how you react to different stressors. A little bit of exercise and time with family and friends can go a long way towards improving your outlook, work, and life in general, while reducing burnout. Oh yeah, it’s also a good idea to choose a great life partner as well. Thanks Michelle!

Dr. Maynard is chief quality officer, University of California Davis Medical Center, Sacramento, Calif.

Residents and junior faculty have frequently asked me how they can attain a position similar to mine, focused on quality and leadership in a health care system. When I was first asked to offer advice on this topic, my response was generally something like, “Heck if I know! I just had a series of lucky accidents to get here!”

Back then, I would recount my career history. I established myself as a clinician educator and associate program director soon after Chief Residency. After that, I would explain, a series of fortunate events and health care trends shaped my career. Evidence-based medicine (EBM), the patient safety movement, a shift to incorporate value (as well as volume) into reimbursement models, and the hospital medicine movement all emerged in interesting and often synergistic ways.

A young SHM organization (then known as NAIP) grew rapidly even while the hospitalist programs I led in Phoenix, then at University of California, San Diego, grew in size and influence. Inevitably, it seemed, I was increasingly involved in quality improvement (QI) efforts, and began to publish and speak about them. Collaborative work with SHM and a number of hospital systems broadened my visibility regionally and nationally. Finally, in 2015, I was recruited away from UC San Diego into a new position, as chief quality officer at UC Davis.

On hearing this history, those seeking my sage advice would look a little confused, and then say something like, “So your advice is that I should get lucky??? Gee, thanks a lot! Really helpful!” (Insert sarcasm here).

The honor of being asked to contribute to the “Legacies” series in The Hospitalist gave me an opportunity to think about this a little differently. No one really wanted to know about how past changes in the health care environment led to my career success. They wanted advice on tools and strategies that will allow them to thrive in an environment of ongoing, disruptive change that is likely only going to accelerate. I now present my upgraded points of advice, intertwined with examples of how SHM positively influenced my career (and could assist yours):
 

Learn how your hospital works. Hospitalists obviously have an inside track on many aspects of hospital operations, but sometimes remain oblivious to the organizational and committee structure, priorities of hospital leadership, and the mechanism for implementing standardized care. Knowing where to go with new ideas, and the process of implementing protocols, will keep you from hitting political land mines and unintentionally encroaching on someone else’s turf, while aligning your efforts with institutional priorities improves the buy-in and resources available to do the work.

Start small, but think big. Don’t bite off more than you can chew, and make sure your ideas for change work on a small scale before trying to sell the world on them. On the other hand, think big! The care you and others provide is dependent on systems that go far beyond your immediate control. Policies, protocols, standardized order sets, checklists, and an array of other tools can be leveraged to influence care across an entire health system, and in the SHM Mentored Implementation programs, can impact hundreds of hospitals.

Broaden your skills. Commit to learning new skills that can increase your impact and career diversity. Procedural skills; information technology; and EMR, EBM, research, public health, QI, business, leadership, public speaking, advocacy, and telehealth, can all open up a whole world of possibilities when combined with a medical degree. These skills can move you into areas that keep you engaged and excited to go to work.

Engage in mentor/mentee relationships. As an associate program director and clinician-educator, I had a lot of opportunity to mentor residents and fellows. It is so rewarding to watch the mentee grow in experience and skills, and to eventually see many of them assume leadership and mentoring roles themselves. You don’t have to be in a teaching position to act as a mentor (my experience mentoring hospitalists and others in leadership and quality improvement now far surpasses my experience with house staff).

The mentor often benefits as much as the mentee from this relationship. I have been inspired by their passion and dedication, educated by their ideas and innovation, and frequently find I am learning more from them, than they are from me. I have had great experiences in the SHM Mentored Implementation program in the role of mentee and mentor.
 

Participate in a community. When I first joined NAIP, I was amazed that the giants (Wachter, Nelson, Whitcomb, Holman, Williams, Greeno, Howell, Huddleston, Wellikson, and on and on) were not only approachable, they were warm, friendly, interesting, and extraordinarily welcoming. The ever-expanding and evolving community at SHM continues that tradition and offers a forum to share innovative work, discuss common problems and solutions, contact world experts, or just find an empathetic ear. Working on toolkits and collaborative efforts with this community remains a real highlight of my career, and the source of several lasting friendships. So don’t be shy; step right up; and introduce yourself!

Avoid my past mistakes (this might be a long list). Random things you should try to avoid.

• Tribalism – It is natural to be protective of your hospitalist group, and to focus on the injustices heaped upon you from (insert favorite punching bag here, e.g., ED, orthopedists, cardiologists, nursing staff, evil administration penny pinchers, etc). While some of those injustices might be real, tribalism, defensiveness, and circling the wagons generally only makes things worse. Sit down face to face, learn a little bit about the opposing tribe (both about their work, and about them as people), and see how much more fun and productive work can be.
• Storming out of a meeting with the CMO and CEO, slamming the door, etc. – not productive. Administrative leaders are doing their own juggling act and are generally well intentioned and doing the best they can. Respect that, argue your case, but if things don’t pan out, shake their hand, and live to fight another day.
• Using e-mail (evil-mail) to resolve conflict – And if you’re a young whippersnapper, don’t use Twitter, Facebook, Snapchat, or other social media to address conflict either!
• Forgetting to put patients first – Frame decisions for your group around what best serves your patients, not your doctors. Long term, this gives your group credibility and will serve the hospitalists better as well. SHM does this on a large scale with their advocacy efforts, resulting in more credibility and influence on Capitol Hill.

Make time for friends, family, fitness, fun, and reflection. A sense of humor and an occasional laugh when dealing with ill patients, hospital medicine politics, and the EMR all day provides resilience, as does taking the time to foster self-awareness and insight into your own weaknesses, strengths, and how you react to different stressors. A little bit of exercise and time with family and friends can go a long way towards improving your outlook, work, and life in general, while reducing burnout. Oh yeah, it’s also a good idea to choose a great life partner as well. Thanks Michelle!

Dr. Maynard is chief quality officer, University of California Davis Medical Center, Sacramento, Calif.

Achieving equity in leadership in academic medicine and the health care industry doesn’t have to be a pipe dream. There are clear, actionable steps that will lead us there.

The benefits of diversity are numerous and well documented. Diversity brings competitive advantage to organizations and strength to teams. With academic health centers (AHCs) facing continual stressors while at the same time being significant financial contributors to – and anchors in – their communities, ensuring their high performance is critical to society as a whole. To grow, thrive, and be ethical examples to their communities, health centers need the strongest and most innovative leaders who are reflective of the communities that they serve. This means more diversity in leadership positions.

When we look at the facts of the gender makeup of academic medicine and the health care industry, we can clearly see inequity – only 22% of medical school full professors, 18% of medical school department chairs, and 17% of medical school deans are women. Note that it has taken 50 years to get from 0 women deans to the 25 women deans who are now in this role. Only 28% of full and associate professors and 21% of department chairs are nonwhite. In the health care industry, only 13% of CEOs are women. The pace toward equity has been excruciatingly slow, and it’s not only women and underrepresented minorities who lose, but also the AHCs and their communities.

So how do we reach equity? Mentorship is a key pathway to this goal. In a session at Hospital Medicine 2019 (HM19), “What Mentorship Has Meant To Me (And What It Can Do For You): High Impact Stories from Leaders in Hospital Medicine,” fellow panelists and I outlined how mentorship can positively affect your career, define the qualities of effective mentors and mentees, describe the difference between mentorship and sponsorship, and explained how to navigate common pitfalls in mentor-mentee relationships.

We spoke about the responsibility the mentee has in the relationship and the need to “manage up,” a term borrowed from the corporate world, where the mentee takes responsibility for his or her part in the relationship and takes a leadership role in the relationship. The mentee must be an “active participant” in the relationship for the relationship to be successful. We hope that attendees at the session took some key points back to their institutions to open dialogue on strategies to achieve equity through building mentoring relationships.

When I look back on my time in residency and fellowship, I recognize that I was surrounded by people who offered guidance and advice. But once I became a faculty member, that guidance was less apparent, and I struggled in the first few years. It wasn’t until I attended a conference on peer mentoring that I recognized that I didn’t just need a didactic mentor, but that I needed a portfolio of mentors and that I had to take the initiative to actively engage mentorship. So I did, and its effects on my career have been powerful and numerous.

The evidence is there that mentorship can play a major role in advancing careers. Now it is up to the leadership of academic and nonacademic health centers to take the initiative and establish formalized programs in their institutions. We all benefit when we have diversity in leadership – so let’s get there together.

Dr. Spector is executive director, Executive Leadership in Academic Medicine, associate dean of faculty development, Drexel University, Philadelphia.

Achieving equity in leadership in academic medicine and the health care industry doesn’t have to be a pipe dream. There are clear, actionable steps that will lead us there.

The benefits of diversity are numerous and well documented. Diversity brings competitive advantage to organizations and strength to teams. With academic health centers (AHCs) facing continual stressors while at the same time being significant financial contributors to – and anchors in – their communities, ensuring their high performance is critical to society as a whole. To grow, thrive, and be ethical examples to their communities, health centers need the strongest and most innovative leaders who are reflective of the communities that they serve. This means more diversity in leadership positions.

When we look at the facts of the gender makeup of academic medicine and the health care industry, we can clearly see inequity – only 22% of medical school full professors, 18% of medical school department chairs, and 17% of medical school deans are women. Note that it has taken 50 years to get from 0 women deans to the 25 women deans who are now in this role. Only 28% of full and associate professors and 21% of department chairs are nonwhite. In the health care industry, only 13% of CEOs are women. The pace toward equity has been excruciatingly slow, and it’s not only women and underrepresented minorities who lose, but also the AHCs and their communities.

So how do we reach equity? Mentorship is a key pathway to this goal. In a session at Hospital Medicine 2019 (HM19), “What Mentorship Has Meant To Me (And What It Can Do For You): High Impact Stories from Leaders in Hospital Medicine,” fellow panelists and I outlined how mentorship can positively affect your career, define the qualities of effective mentors and mentees, describe the difference between mentorship and sponsorship, and explained how to navigate common pitfalls in mentor-mentee relationships.

We spoke about the responsibility the mentee has in the relationship and the need to “manage up,” a term borrowed from the corporate world, where the mentee takes responsibility for his or her part in the relationship and takes a leadership role in the relationship. The mentee must be an “active participant” in the relationship for the relationship to be successful. We hope that attendees at the session took some key points back to their institutions to open dialogue on strategies to achieve equity through building mentoring relationships.

When I look back on my time in residency and fellowship, I recognize that I was surrounded by people who offered guidance and advice. But once I became a faculty member, that guidance was less apparent, and I struggled in the first few years. It wasn’t until I attended a conference on peer mentoring that I recognized that I didn’t just need a didactic mentor, but that I needed a portfolio of mentors and that I had to take the initiative to actively engage mentorship. So I did, and its effects on my career have been powerful and numerous.

The evidence is there that mentorship can play a major role in advancing careers. Now it is up to the leadership of academic and nonacademic health centers to take the initiative and establish formalized programs in their institutions. We all benefit when we have diversity in leadership – so let’s get there together.

Dr. Spector is executive director, Executive Leadership in Academic Medicine, associate dean of faculty development, Drexel University, Philadelphia.

Achieving equity in leadership in academic medicine and the health care industry doesn’t have to be a pipe dream. There are clear, actionable steps that will lead us there.

The benefits of diversity are numerous and well documented. Diversity brings competitive advantage to organizations and strength to teams. With academic health centers (AHCs) facing continual stressors while at the same time being significant financial contributors to – and anchors in – their communities, ensuring their high performance is critical to society as a whole. To grow, thrive, and be ethical examples to their communities, health centers need the strongest and most innovative leaders who are reflective of the communities that they serve. This means more diversity in leadership positions.

When we look at the facts of the gender makeup of academic medicine and the health care industry, we can clearly see inequity – only 22% of medical school full professors, 18% of medical school department chairs, and 17% of medical school deans are women. Note that it has taken 50 years to get from 0 women deans to the 25 women deans who are now in this role. Only 28% of full and associate professors and 21% of department chairs are nonwhite. In the health care industry, only 13% of CEOs are women. The pace toward equity has been excruciatingly slow, and it’s not only women and underrepresented minorities who lose, but also the AHCs and their communities.

So how do we reach equity? Mentorship is a key pathway to this goal. In a session at Hospital Medicine 2019 (HM19), “What Mentorship Has Meant To Me (And What It Can Do For You): High Impact Stories from Leaders in Hospital Medicine,” fellow panelists and I outlined how mentorship can positively affect your career, define the qualities of effective mentors and mentees, describe the difference between mentorship and sponsorship, and explained how to navigate common pitfalls in mentor-mentee relationships.

We spoke about the responsibility the mentee has in the relationship and the need to “manage up,” a term borrowed from the corporate world, where the mentee takes responsibility for his or her part in the relationship and takes a leadership role in the relationship. The mentee must be an “active participant” in the relationship for the relationship to be successful. We hope that attendees at the session took some key points back to their institutions to open dialogue on strategies to achieve equity through building mentoring relationships.

When I look back on my time in residency and fellowship, I recognize that I was surrounded by people who offered guidance and advice. But once I became a faculty member, that guidance was less apparent, and I struggled in the first few years. It wasn’t until I attended a conference on peer mentoring that I recognized that I didn’t just need a didactic mentor, but that I needed a portfolio of mentors and that I had to take the initiative to actively engage mentorship. So I did, and its effects on my career have been powerful and numerous.

The evidence is there that mentorship can play a major role in advancing careers. Now it is up to the leadership of academic and nonacademic health centers to take the initiative and establish formalized programs in their institutions. We all benefit when we have diversity in leadership – so let’s get there together.

Dr. Spector is executive director, Executive Leadership in Academic Medicine, associate dean of faculty development, Drexel University, Philadelphia.

Recently, I was asked to present my top public speaking tips for a group of women leaders. This is a topic near and dear to my heart, and one that I teach a number of groups, from medical students to faculty.

I also benefited from just returning from the Harvard Macy Educators Course, where Victoria Brazil, MD, an experienced emergency medicine physician from Australia, provided her top tips. Here is a mash-up of the top tips to think about for any of the speakers out there among us – with a few shout-outs for the ladies out there. Please add your own!

The Dos

• Do project power: Stand tall with a relaxed stance and shoulders back – posture is everything. This is especially important for women, who may tend to shrink their bodies, or anyone who is short. A powerful messenger is just as important as the power of the message. The same also applies to sitting down, especially if you are on a panel. Do not look like you are falling into the table.
• Do look up: Think about addressing the people in the back, not in the front row. This looks better in photos as well since you are appealing to the large audience and not the front row. Dr. Brazil’s tip came from Cate Blanchett who said that before she gives talks, she literally and physically advises “picking up your crown and put it on your head.” Not only will you feel better, you will look it too.
• Do pause strategically: The human brain needs rest to process what you are about to say. You can ask people to “think of a time” and take a pause. Or “I want you to all think about what I just said for one moment.” And TAKE a moment. But think about Emma’s pause during the March For Your Lives. Pauses are powerful and serve as a way to cement what you are saying for even the most critical crowd. Think about when anyone on their phone pauses, even if you’re on a boring conference call others will wake up and wonder what is going on and are now engaged in the talk.
• Do strategically summarize: Before you end, or in between important sections, say the following: “There are three main things you can do.” Even if someone fell asleep, they will wake up to take note. It’s a way to get folks’ attention back. There is nothing like challenging others to do something.

The Don’ts

• Don’t start with an apology for “not being an expert”: Or whatever you are thinking about apologizing for. The voice in your head does not need to be broadcast to others. Just say thank you after you are introduced, and launch in. Someone has asked you to talk, so bring your own unique expertise and don’t start with undermining yourself!
• Don’t use your slides as a crutch: Make your audience look at you and not your slides. That means at times, you may be talking and your slides will not be moving. Other times, if you are starting with a story, maybe there is no slide behind you and the screen is blacked out. Some of the most powerful moments in a talk are when slides are not being used.
• Don’t stand behind the podium if you can help it. This means ask for a wireless microphone. Most podiums will overwhelm you. If you have to use a podium, go back to the posture in the “dos.” One year, I had a leg injury and definitely used the podium, so obviously there may be times you need to use a podium; even then, try as hard as possible to make sure you are seen.
• Don’t engage grandstanders during Q&A: Invariably, you will get someone who stands up and goes into a long comment that is not a question to hear themselves speak. Insert yourself, say “thank you” and take the next question. If there is not a next question, you can add, “Before I forget, I want to share another question I am often asked which may be of help to you.” Then, answer your own question. You get the final word this way!

Happy speaking! I look forward to seeing you in warmer weather during the spring conference season.

For more posts from the Hospital Leader blog, visit hospitalleader.org.

Recently, I was asked to present my top public speaking tips for a group of women leaders. This is a topic near and dear to my heart, and one that I teach a number of groups, from medical students to faculty.

I also benefited from just returning from the Harvard Macy Educators Course, where Victoria Brazil, MD, an experienced emergency medicine physician from Australia, provided her top tips. Here is a mash-up of the top tips to think about for any of the speakers out there among us – with a few shout-outs for the ladies out there. Please add your own!

The Dos

• Do project power: Stand tall with a relaxed stance and shoulders back – posture is everything. This is especially important for women, who may tend to shrink their bodies, or anyone who is short. A powerful messenger is just as important as the power of the message. The same also applies to sitting down, especially if you are on a panel. Do not look like you are falling into the table.
• Do look up: Think about addressing the people in the back, not in the front row. This looks better in photos as well since you are appealing to the large audience and not the front row. Dr. Brazil’s tip came from Cate Blanchett who said that before she gives talks, she literally and physically advises “picking up your crown and put it on your head.” Not only will you feel better, you will look it too.
• Do pause strategically: The human brain needs rest to process what you are about to say. You can ask people to “think of a time” and take a pause. Or “I want you to all think about what I just said for one moment.” And TAKE a moment. But think about Emma’s pause during the March For Your Lives. Pauses are powerful and serve as a way to cement what you are saying for even the most critical crowd. Think about when anyone on their phone pauses, even if you’re on a boring conference call others will wake up and wonder what is going on and are now engaged in the talk.
• Do strategically summarize: Before you end, or in between important sections, say the following: “There are three main things you can do.” Even if someone fell asleep, they will wake up to take note. It’s a way to get folks’ attention back. There is nothing like challenging others to do something.

The Don’ts

• Don’t start with an apology for “not being an expert”: Or whatever you are thinking about apologizing for. The voice in your head does not need to be broadcast to others. Just say thank you after you are introduced, and launch in. Someone has asked you to talk, so bring your own unique expertise and don’t start with undermining yourself!
• Don’t use your slides as a crutch: Make your audience look at you and not your slides. That means at times, you may be talking and your slides will not be moving. Other times, if you are starting with a story, maybe there is no slide behind you and the screen is blacked out. Some of the most powerful moments in a talk are when slides are not being used.
• Don’t stand behind the podium if you can help it. This means ask for a wireless microphone. Most podiums will overwhelm you. If you have to use a podium, go back to the posture in the “dos.” One year, I had a leg injury and definitely used the podium, so obviously there may be times you need to use a podium; even then, try as hard as possible to make sure you are seen.
• Don’t engage grandstanders during Q&A: Invariably, you will get someone who stands up and goes into a long comment that is not a question to hear themselves speak. Insert yourself, say “thank you” and take the next question. If there is not a next question, you can add, “Before I forget, I want to share another question I am often asked which may be of help to you.” Then, answer your own question. You get the final word this way!

Happy speaking! I look forward to seeing you in warmer weather during the spring conference season.

For more posts from the Hospital Leader blog, visit hospitalleader.org.

Recently, I was asked to present my top public speaking tips for a group of women leaders. This is a topic near and dear to my heart, and one that I teach a number of groups, from medical students to faculty.

I also benefited from just returning from the Harvard Macy Educators Course, where Victoria Brazil, MD, an experienced emergency medicine physician from Australia, provided her top tips. Here is a mash-up of the top tips to think about for any of the speakers out there among us – with a few shout-outs for the ladies out there. Please add your own!

The Dos

• Do project power: Stand tall with a relaxed stance and shoulders back – posture is everything. This is especially important for women, who may tend to shrink their bodies, or anyone who is short. A powerful messenger is just as important as the power of the message. The same also applies to sitting down, especially if you are on a panel. Do not look like you are falling into the table.
• Do look up: Think about addressing the people in the back, not in the front row. This looks better in photos as well since you are appealing to the large audience and not the front row. Dr. Brazil’s tip came from Cate Blanchett who said that before she gives talks, she literally and physically advises “picking up your crown and put it on your head.” Not only will you feel better, you will look it too.
• Do pause strategically: The human brain needs rest to process what you are about to say. You can ask people to “think of a time” and take a pause. Or “I want you to all think about what I just said for one moment.” And TAKE a moment. But think about Emma’s pause during the March For Your Lives. Pauses are powerful and serve as a way to cement what you are saying for even the most critical crowd. Think about when anyone on their phone pauses, even if you’re on a boring conference call others will wake up and wonder what is going on and are now engaged in the talk.
• Do strategically summarize: Before you end, or in between important sections, say the following: “There are three main things you can do.” Even if someone fell asleep, they will wake up to take note. It’s a way to get folks’ attention back. There is nothing like challenging others to do something.

The Don’ts

• Don’t start with an apology for “not being an expert”: Or whatever you are thinking about apologizing for. The voice in your head does not need to be broadcast to others. Just say thank you after you are introduced, and launch in. Someone has asked you to talk, so bring your own unique expertise and don’t start with undermining yourself!
• Don’t use your slides as a crutch: Make your audience look at you and not your slides. That means at times, you may be talking and your slides will not be moving. Other times, if you are starting with a story, maybe there is no slide behind you and the screen is blacked out. Some of the most powerful moments in a talk are when slides are not being used.
• Don’t stand behind the podium if you can help it. This means ask for a wireless microphone. Most podiums will overwhelm you. If you have to use a podium, go back to the posture in the “dos.” One year, I had a leg injury and definitely used the podium, so obviously there may be times you need to use a podium; even then, try as hard as possible to make sure you are seen.
• Don’t engage grandstanders during Q&A: Invariably, you will get someone who stands up and goes into a long comment that is not a question to hear themselves speak. Insert yourself, say “thank you” and take the next question. If there is not a next question, you can add, “Before I forget, I want to share another question I am often asked which may be of help to you.” Then, answer your own question. You get the final word this way!

Happy speaking! I look forward to seeing you in warmer weather during the spring conference season.

For more posts from the Hospital Leader blog, visit hospitalleader.org.

PHILADELPHIA – Women physicians face a potential additional challenge in their contract negotiations that they need to account for: the gender wage gap.

Gregory Twachtman/MDedge News

“Find a lawyer ... that will support your fight for pay equity,” Michael Sinha, MD, advised in a presentation at the annual meeting of the American College of Physicians.

“Definitely interview them,” said Dr. Sinha of Harvard Medical School, Boston. “Get a sense of how committed they are to that cause. Seek recommendations from other women in medicine. Maybe they will point you to the person who really is committed to this cause and wants to help you.”

He also cautioned that physicians might have to help their lawyer fill in the knowledge gap. “Sometimes you need to provide that lawyer with data. There are a lot of reports that have been published from various organizations [including the ACP]. Don’t assume that the lawyer has the evidence.”

Armed with evidence, he said there is opportunity to address gender pay gaps in the contract. “You can put a lot of things into your contract, why not some of these things? If there is institutional evidence of a pay gap or a leaky promotional pipeline, you are telling them you have a problem with salary discrepancies between male and female physicians and I need to protect my own self-worth.”

Dr. Sinha recommended prospective employees develop strategies with their lawyers, which could mean letting the lawyer take the lead in the negotiations.

“Maybe that reduces stress or emotion in the process. That will preserve a good relationship with the employer,” he said. “A confident, knowledgeable lawyer may help mitigate gender differences in negotiation strategy.”

In order to help close the gender gap, Dr. Sinha said he advises his male colleagues to help female physicians by being open about their compensation, especially if compensation is not public information. “I have been encouraging male physician colleagues of mine to share that information when you are asked. Don’t make it impossible for someone to figure out.”

He noted that it is not likely that closing the gender gap by raising women’s compensation is going to result in male physicians losing money, but rather in the long run it will mean better compensation for everyone.

Dr. Sinha also had this advice for employers: “Before you do anything else, level your pay gap. ... For every physician that works in your organization, level your pay gap. Offer equitable salary packages up front to men and women. Understand your responsibilities under federal and state equal pay laws.”

When it comes to equitable compensation packages, all offerings, including salary and fringe benefits, should be offered to both male and female physicians or to neither.

“Don’t make something nonnegotiable for women but engage men in negotiations,” he said. “I think that is obvious but I have seen that happen.”

Dr. Sinha also said it is important to check your gender biases at the door before entering negotiations. Don’t view a woman asking for something as demanding or harsh when a male asking for the same exact thing is viewed as assertive and self-confident.

“Don’t fall into those traps. And if you have people that can call out your biases and help you see that, that’s important,” Dr. Sinha noted.

He also stated that hiring committees need to show diversity in terms of gender, race, and ethnicity, adding that it is “hugely important” that you do that.

The bottom line is to not force women to negotiate for equal pay, Dr. Sinha noted. “The gender gap is well documented in medicine, and you really have to do your part.”

[email protected]

PHILADELPHIA – Women physicians face a potential additional challenge in their contract negotiations that they need to account for: the gender wage gap.

Gregory Twachtman/MDedge News

“Find a lawyer ... that will support your fight for pay equity,” Michael Sinha, MD, advised in a presentation at the annual meeting of the American College of Physicians.

“Definitely interview them,” said Dr. Sinha of Harvard Medical School, Boston. “Get a sense of how committed they are to that cause. Seek recommendations from other women in medicine. Maybe they will point you to the person who really is committed to this cause and wants to help you.”

He also cautioned that physicians might have to help their lawyer fill in the knowledge gap. “Sometimes you need to provide that lawyer with data. There are a lot of reports that have been published from various organizations [including the ACP]. Don’t assume that the lawyer has the evidence.”

Armed with evidence, he said there is opportunity to address gender pay gaps in the contract. “You can put a lot of things into your contract, why not some of these things? If there is institutional evidence of a pay gap or a leaky promotional pipeline, you are telling them you have a problem with salary discrepancies between male and female physicians and I need to protect my own self-worth.”

Dr. Sinha recommended prospective employees develop strategies with their lawyers, which could mean letting the lawyer take the lead in the negotiations.

“Maybe that reduces stress or emotion in the process. That will preserve a good relationship with the employer,” he said. “A confident, knowledgeable lawyer may help mitigate gender differences in negotiation strategy.”

In order to help close the gender gap, Dr. Sinha said he advises his male colleagues to help female physicians by being open about their compensation, especially if compensation is not public information. “I have been encouraging male physician colleagues of mine to share that information when you are asked. Don’t make it impossible for someone to figure out.”

He noted that it is not likely that closing the gender gap by raising women’s compensation is going to result in male physicians losing money, but rather in the long run it will mean better compensation for everyone.

Dr. Sinha also had this advice for employers: “Before you do anything else, level your pay gap. ... For every physician that works in your organization, level your pay gap. Offer equitable salary packages up front to men and women. Understand your responsibilities under federal and state equal pay laws.”

When it comes to equitable compensation packages, all offerings, including salary and fringe benefits, should be offered to both male and female physicians or to neither.

“Don’t make something nonnegotiable for women but engage men in negotiations,” he said. “I think that is obvious but I have seen that happen.”

Dr. Sinha also said it is important to check your gender biases at the door before entering negotiations. Don’t view a woman asking for something as demanding or harsh when a male asking for the same exact thing is viewed as assertive and self-confident.

“Don’t fall into those traps. And if you have people that can call out your biases and help you see that, that’s important,” Dr. Sinha noted.

He also stated that hiring committees need to show diversity in terms of gender, race, and ethnicity, adding that it is “hugely important” that you do that.

The bottom line is to not force women to negotiate for equal pay, Dr. Sinha noted. “The gender gap is well documented in medicine, and you really have to do your part.”

[email protected]

PHILADELPHIA – Women physicians face a potential additional challenge in their contract negotiations that they need to account for: the gender wage gap.

Gregory Twachtman/MDedge News

“Find a lawyer ... that will support your fight for pay equity,” Michael Sinha, MD, advised in a presentation at the annual meeting of the American College of Physicians.

“Definitely interview them,” said Dr. Sinha of Harvard Medical School, Boston. “Get a sense of how committed they are to that cause. Seek recommendations from other women in medicine. Maybe they will point you to the person who really is committed to this cause and wants to help you.”

He also cautioned that physicians might have to help their lawyer fill in the knowledge gap. “Sometimes you need to provide that lawyer with data. There are a lot of reports that have been published from various organizations [including the ACP]. Don’t assume that the lawyer has the evidence.”

Armed with evidence, he said there is opportunity to address gender pay gaps in the contract. “You can put a lot of things into your contract, why not some of these things? If there is institutional evidence of a pay gap or a leaky promotional pipeline, you are telling them you have a problem with salary discrepancies between male and female physicians and I need to protect my own self-worth.”

Dr. Sinha recommended prospective employees develop strategies with their lawyers, which could mean letting the lawyer take the lead in the negotiations.

“Maybe that reduces stress or emotion in the process. That will preserve a good relationship with the employer,” he said. “A confident, knowledgeable lawyer may help mitigate gender differences in negotiation strategy.”

In order to help close the gender gap, Dr. Sinha said he advises his male colleagues to help female physicians by being open about their compensation, especially if compensation is not public information. “I have been encouraging male physician colleagues of mine to share that information when you are asked. Don’t make it impossible for someone to figure out.”

He noted that it is not likely that closing the gender gap by raising women’s compensation is going to result in male physicians losing money, but rather in the long run it will mean better compensation for everyone.

Dr. Sinha also had this advice for employers: “Before you do anything else, level your pay gap. ... For every physician that works in your organization, level your pay gap. Offer equitable salary packages up front to men and women. Understand your responsibilities under federal and state equal pay laws.”

When it comes to equitable compensation packages, all offerings, including salary and fringe benefits, should be offered to both male and female physicians or to neither.

“Don’t make something nonnegotiable for women but engage men in negotiations,” he said. “I think that is obvious but I have seen that happen.”

Dr. Sinha also said it is important to check your gender biases at the door before entering negotiations. Don’t view a woman asking for something as demanding or harsh when a male asking for the same exact thing is viewed as assertive and self-confident.

“Don’t fall into those traps. And if you have people that can call out your biases and help you see that, that’s important,” Dr. Sinha noted.

He also stated that hiring committees need to show diversity in terms of gender, race, and ethnicity, adding that it is “hugely important” that you do that.

The bottom line is to not force women to negotiate for equal pay, Dr. Sinha noted. “The gender gap is well documented in medicine, and you really have to do your part.”

[email protected]

In the March 2019 issue of The Hospitalist, I wrote about some key findings from a 2018 survey of U.S. physicians by The Physicians Foundation. It’s no surprise to anyone working in health care today that the survey found alarming levels of professional dissatisfaction, burnout, and pessimism about the future of medicine among respondent physicians. Sadly, it appears that much of that pessimism is directed toward hospitals and their leaders: 46% of survey respondents viewed the relationships between physicians and hospitals as somewhat or mostly negative and adversarial.

Several physicians posted comments online, and they deeply saddened me. My heart hurt for those doctors who wrote, “I loved medicine. It was good for my soul, but medicine left me. Doctors gave up most of their power and large corporations without an ethical foundation and no god, but money took over.” Or “They are waiting so all the senior physicians will retire. Nurses will become leaders who will follow administration’s lead and control physicians. Money and cost cutting is the major driver. Physicians are not valuable anymore because they have different opinions which cost a lot. There is a lot of window dressing, but they actually don’t care. They just want to run a business.” I also read “I was tossed out like dirty laundry water at age 59.” And “On a personal basis, I will try to reason with management exactly once before I bail.” Sigh.

These commenters are well-meaning physicians who had bad experiences with hospital leaders they saw as uncaring and unresponsive to their concerns as clinicians. Their experiences left them demoralized and embittered. I’m truly sorry for that.

I’m a recovering hospital administrator myself. My business partner John Nelson, MD, MHM, likes to tell people that he has successfully deprogrammed me from the way most administrators think about doctors, but he’s mostly joking (at least I think he is). I can tell you that most of the hospital leaders I have met – both when I was still an administrator and now in my consulting work – are well-intentioned people who care deeply about patients and their fellow health care professionals and are trying hard to do the right thing. Many of them could have earned more and had better career opportunities doing similar work in a field other than health care, but they chose health care out of a sincere desire to do good and help people.

A big part of the problem is that doctors and administrators come to health care from very different starting points, and so have very different perspectives. They generally function in separate silos, each paying attention to their own comfortable little part of that monster we call a health care delivery system. Often, neither administrators nor doctors have made enough effort to cross over and understand the issues and perspectives of people in other silos. As a result, it’s easy for assumptions and biases to creep in and poison our interactions.

When we interpret the behavior of others, we humans tend to overemphasize dispositional factors, such as personality or motives, and to discount situational factors, such as external stressors. Psychologists call this the fundamental attribution error or correspondence bias, and the result is usually heightened conflict as a result of presumed negative intentions on the part of others (“All she cares about is making a profit”) and discounting circumstantial factors that might be influencing others’ behavior (“She is facing reduced market share and a funding shortfall, and she’s fearful for the future of the institution”).

Add in another phenomenon known as the actor-observer bias, in which we tend to attribute others’ behavior to their dispositions but attribute our own behavior to the circumstances (“That administrator lost his temper because he’s a demanding jerk, but I only lost my temper because he pushed me over the edge”).

Is it possible that hospital leaders and doctors are reading each other inaccurately and that they’re making assumptions about each other’s intentions that get in the way of having constructive dialogue? How can we get to a place of greater trust? I don’t know the whole answer, of course, but I have a few ideas to offer.

Read the full post at hospitalleader.org.

In the March 2019 issue of The Hospitalist, I wrote about some key findings from a 2018 survey of U.S. physicians by The Physicians Foundation. It’s no surprise to anyone working in health care today that the survey found alarming levels of professional dissatisfaction, burnout, and pessimism about the future of medicine among respondent physicians. Sadly, it appears that much of that pessimism is directed toward hospitals and their leaders: 46% of survey respondents viewed the relationships between physicians and hospitals as somewhat or mostly negative and adversarial.

Several physicians posted comments online, and they deeply saddened me. My heart hurt for those doctors who wrote, “I loved medicine. It was good for my soul, but medicine left me. Doctors gave up most of their power and large corporations without an ethical foundation and no god, but money took over.” Or “They are waiting so all the senior physicians will retire. Nurses will become leaders who will follow administration’s lead and control physicians. Money and cost cutting is the major driver. Physicians are not valuable anymore because they have different opinions which cost a lot. There is a lot of window dressing, but they actually don’t care. They just want to run a business.” I also read “I was tossed out like dirty laundry water at age 59.” And “On a personal basis, I will try to reason with management exactly once before I bail.” Sigh.

These commenters are well-meaning physicians who had bad experiences with hospital leaders they saw as uncaring and unresponsive to their concerns as clinicians. Their experiences left them demoralized and embittered. I’m truly sorry for that.

I’m a recovering hospital administrator myself. My business partner John Nelson, MD, MHM, likes to tell people that he has successfully deprogrammed me from the way most administrators think about doctors, but he’s mostly joking (at least I think he is). I can tell you that most of the hospital leaders I have met – both when I was still an administrator and now in my consulting work – are well-intentioned people who care deeply about patients and their fellow health care professionals and are trying hard to do the right thing. Many of them could have earned more and had better career opportunities doing similar work in a field other than health care, but they chose health care out of a sincere desire to do good and help people.

A big part of the problem is that doctors and administrators come to health care from very different starting points, and so have very different perspectives. They generally function in separate silos, each paying attention to their own comfortable little part of that monster we call a health care delivery system. Often, neither administrators nor doctors have made enough effort to cross over and understand the issues and perspectives of people in other silos. As a result, it’s easy for assumptions and biases to creep in and poison our interactions.

When we interpret the behavior of others, we humans tend to overemphasize dispositional factors, such as personality or motives, and to discount situational factors, such as external stressors. Psychologists call this the fundamental attribution error or correspondence bias, and the result is usually heightened conflict as a result of presumed negative intentions on the part of others (“All she cares about is making a profit”) and discounting circumstantial factors that might be influencing others’ behavior (“She is facing reduced market share and a funding shortfall, and she’s fearful for the future of the institution”).

Add in another phenomenon known as the actor-observer bias, in which we tend to attribute others’ behavior to their dispositions but attribute our own behavior to the circumstances (“That administrator lost his temper because he’s a demanding jerk, but I only lost my temper because he pushed me over the edge”).

Is it possible that hospital leaders and doctors are reading each other inaccurately and that they’re making assumptions about each other’s intentions that get in the way of having constructive dialogue? How can we get to a place of greater trust? I don’t know the whole answer, of course, but I have a few ideas to offer.

Read the full post at hospitalleader.org.

In the March 2019 issue of The Hospitalist, I wrote about some key findings from a 2018 survey of U.S. physicians by The Physicians Foundation. It’s no surprise to anyone working in health care today that the survey found alarming levels of professional dissatisfaction, burnout, and pessimism about the future of medicine among respondent physicians. Sadly, it appears that much of that pessimism is directed toward hospitals and their leaders: 46% of survey respondents viewed the relationships between physicians and hospitals as somewhat or mostly negative and adversarial.

Several physicians posted comments online, and they deeply saddened me. My heart hurt for those doctors who wrote, “I loved medicine. It was good for my soul, but medicine left me. Doctors gave up most of their power and large corporations without an ethical foundation and no god, but money took over.” Or “They are waiting so all the senior physicians will retire. Nurses will become leaders who will follow administration’s lead and control physicians. Money and cost cutting is the major driver. Physicians are not valuable anymore because they have different opinions which cost a lot. There is a lot of window dressing, but they actually don’t care. They just want to run a business.” I also read “I was tossed out like dirty laundry water at age 59.” And “On a personal basis, I will try to reason with management exactly once before I bail.” Sigh.

These commenters are well-meaning physicians who had bad experiences with hospital leaders they saw as uncaring and unresponsive to their concerns as clinicians. Their experiences left them demoralized and embittered. I’m truly sorry for that.

I’m a recovering hospital administrator myself. My business partner John Nelson, MD, MHM, likes to tell people that he has successfully deprogrammed me from the way most administrators think about doctors, but he’s mostly joking (at least I think he is). I can tell you that most of the hospital leaders I have met – both when I was still an administrator and now in my consulting work – are well-intentioned people who care deeply about patients and their fellow health care professionals and are trying hard to do the right thing. Many of them could have earned more and had better career opportunities doing similar work in a field other than health care, but they chose health care out of a sincere desire to do good and help people.

A big part of the problem is that doctors and administrators come to health care from very different starting points, and so have very different perspectives. They generally function in separate silos, each paying attention to their own comfortable little part of that monster we call a health care delivery system. Often, neither administrators nor doctors have made enough effort to cross over and understand the issues and perspectives of people in other silos. As a result, it’s easy for assumptions and biases to creep in and poison our interactions.

When we interpret the behavior of others, we humans tend to overemphasize dispositional factors, such as personality or motives, and to discount situational factors, such as external stressors. Psychologists call this the fundamental attribution error or correspondence bias, and the result is usually heightened conflict as a result of presumed negative intentions on the part of others (“All she cares about is making a profit”) and discounting circumstantial factors that might be influencing others’ behavior (“She is facing reduced market share and a funding shortfall, and she’s fearful for the future of the institution”).

Add in another phenomenon known as the actor-observer bias, in which we tend to attribute others’ behavior to their dispositions but attribute our own behavior to the circumstances (“That administrator lost his temper because he’s a demanding jerk, but I only lost my temper because he pushed me over the edge”).

Is it possible that hospital leaders and doctors are reading each other inaccurately and that they’re making assumptions about each other’s intentions that get in the way of having constructive dialogue? How can we get to a place of greater trust? I don’t know the whole answer, of course, but I have a few ideas to offer.

Read the full post at hospitalleader.org.

Bryce Gartland, MD, was working as a full-time hospitalist at Emory University Hospital in Atlanta when hospital administrators first started asking him to take on administrative roles, such as clinical site director or medical director of care coordination.

Today, Dr. Gartland is hospital group president and cochief of clinical operations for Emory Healthcare, with responsibility for overall performance and achievement across all 11 Emory hospitals. In that role, he keeps his eyes open for similar talent and leadership potential in younger physicians.

Following internal medicine residency at Cedars-Sinai Medical Center in Los Angeles, Dr. Gartland moved into a traditional private practice setting in Beverly Hills. “Two years later, my wife and I decided to move back to my home town of Atlanta. This was 2005 and hospital medicine was a nascent movement in health care. I was intrigued, and Emory had a strong hospitalist program based in a major academic medical setting, which has since grown from approximately 20 physicians to over 120 across seven hospitals,” he said.

Senior leaders at Emory recognized something in Dr. Gartland and more administrative offers were forthcoming.

“After a year of practicing at Emory, the system’s chief financial officer knocked on my door to ask if I would be interested in becoming medical director for care coordination. This role afforded me tremendous opportunities to get involved in clinical/administrative activities at Emory – utilization review, hospice and palliative care, transitions of care, interface with managed care organizations. The role was very rewarding. In some ways, I became a kind of chief translator at the hospital for anything clinical that also had financial implications,” he recalled.

“Then we went through a reorganization and I was offered the opportunity to step into the chief operating officer position at Emory University Hospital. Shortly thereafter, there was leadership turnover within the division of hospital medicine and I was asked by the CEO of Emory Healthcare and chair of the department of medicine to serve as section head for hospital medicine.” Dr. Gartland wore both of those hats for about 2 years, later becoming the CEO of Emory University Hospital and two other facilities within the system. He was appointed to his current position as hospital group president and cochief of clinical operations for Emory Healthcare in 2018.

Consumed with administrative responsibilities, he largely had to step away from patient care, although with mixed emotions.

“Over the years, I worked hard to maintain a strong clinical role, but the reality is that if you are not delivering patient care routinely, it’s difficult to practice at the highest level of current medical practice,” he said. Nonetheless, Dr. Gartland tries to keep a hand in patient care by routinely rounding with hospitalist teams and attending care conferences.

Fixing the larger health care system

“I am a huge supporter of more physicians becoming actively engaged in administrative positions in health care. They are key to helping us best fix the larger health care system,” Dr. Gartland said. “However, we’ve all seen clinicians drafted into administrative positions who were not great administrators. One needs to be bilingual in both medicine and business. While some skills, such as strong communication, may cross over, it’s important to recognize that clinical strength and success do not necessarily equate to administrative achievement.”

Dr. Gartland also believes in the importance of mentorship in developing future leaders and in seeking and engaging mentors from other disciplines outside of one’s own specialty. “I’ve been fortunate to have a number of mentors who saw something in me and supported investment in my personal and professional development. I am now fortunate to be in the position to give back by mentoring a number of younger hospitalists who are interested in growing their nonclinical roles.”

“One bit of advice from a mentor that really resonated with me was: Don’t let the urgent get in the way of the important,” Dr. Gartland said. “Life is busy and full of urgent day-to-day fires. It’s important to take the time to pause and consider where you are going and what you are doing to enhance your career development. Are you getting the right kinds of feedback?” He explained that a coach or mentor who can provide constructive feedback is important and is something he has relied upon throughout his own professional development.

Different paths to learning business

Dr. Gartland did not pursue formal business training before the administrative opportunities started to multiply for him at Emory, although in college he had a strong interest in both business and medicine and at one time contemplated going into either.

“Over the years, my mentors have given me a lot of advice, one of which was that a medical degree can be a passport to a lot of different career paths, with real opportunities for merging business and medicine,” he said.

He has since intentionally pursued business training opportunities wherever they came up, such as courses offered by the American College of Physician Executives (now the American Association for Physician Leadership). “At one point, I considered going back to college in an MBA program, but that’s when John Fox – then Emory Healthcare’s CEO – called and said he wanted to send me to the Harvard Business School’s Managing Health Care Delivery executive education program, with an Emory team comprising the chief nurse executive, chief of human resources, and CEO for one of our hospitals.” Harvard’s roughly 9-month program involves 3 weeks on campus with assignments between the on-campus visits.

“In my current role as hospital group president, I have direct responsibility for our hospitals’ and system’s clinically essential services such as radiology, laboratory, pharmacy, and perioperative medicine. I also still serve as CEO for Emory University Hospital while we recruit my replacement,” Dr. Gartland said. “Overall, my work time breaks down roughly into thirds. One-third is spent on strategy and strategic initiatives – such as organizational and program design. Our system recently acquired a large community health system whose strategic and operational integration I am actively leading.”

Another third of his time is focused on operations, and the final third is focused on talent management and development. “People are truly the most valuable asset any organization has, particularly in health care,” he noted. “Being intentional about organizational design, coaching, and supporting the development and deployment of talent at all levels of the organization helps everyone achieve their full potential. It is one of the most important roles a leader can play.”

Dr. Gartland said that Emory is committed to Lean-based management systems, using both horizontal and vertical strategies for process improvement and waste reduction, with implementation beginning in urology, transplant, and heart and vascular services. Experts say Lean success starts at the very top, and Emory and Dr. Gartland are all in.

“These types of changes are measured in 5- to 7-year increments or more, not in months. We believe this is key to creating the best workplace to support the highest quality, experience, and value in health care delivery. It creates and supports the right culture within an organization, and we have made the commitment to following that path,” he said.

Recognizing leadership potential

What does Dr. Gartland look for in physicians with leadership potential?

“Are you someone who collaborates well?” he asked. “Someone who raises your hand at meetings or gets engaged with the issues? Do you volunteer to take on assignments? Are you someone with a balanced perspective, system minded in thinking and inquisitive, with a positive approach to problem solving?”

A lot of physicians might come to a meeting with the hospital or their boss and complain about all the things that aren’t working, he said, but “it’s rarer for them to come in and say: ‘I see these problems, and here’s where I think we can make improvements. How can I help?’ ” Dr. Gartland looks for evidence of emotional intelligence and the ability to effect change management across disciplines. Another skill with ever-greater importance is comfort with data and data-driven decision making.

“When our national health care system is experiencing so much change and upheaval, much of which is captured in newspaper headlines, it can sound scary,” he said. “I encourage people to see that complex, dynamic times like these, filled with so much change, are also a tremendous opportunity. Run towards and embrace the opportunity for change. Hospitalists, by nature, bring with them a tremendous background and experience set that is invaluable to help lead positive change in these dynamic times.”

The SHM has offerings for hospitalists wanting to advance in leadership positions, Dr. Gartland said, including its annual Leadership Academy. The next one is scheduled to be held in Nashville, Tenn., Nov. 4-7, 2019.

“The Leadership Academy is a great initial step for physicians, especially those early in their careers. Also, try to gain exposure to a variety of perspectives outside of hospital medicine,” he said. “I’d love to see further advances in leadership for our specialty – growing the number of hospitalists who serve as hospital CEOs or CMOs and in other leadership roles. We have more to learn collectively about leadership as a specialty, and I’d love to see us grow that capacity by offering further learning opportunities and bringing together hospitalists who have an interest in advancing leadership.”

Bryce Gartland, MD, was working as a full-time hospitalist at Emory University Hospital in Atlanta when hospital administrators first started asking him to take on administrative roles, such as clinical site director or medical director of care coordination.

Today, Dr. Gartland is hospital group president and cochief of clinical operations for Emory Healthcare, with responsibility for overall performance and achievement across all 11 Emory hospitals. In that role, he keeps his eyes open for similar talent and leadership potential in younger physicians.

Following internal medicine residency at Cedars-Sinai Medical Center in Los Angeles, Dr. Gartland moved into a traditional private practice setting in Beverly Hills. “Two years later, my wife and I decided to move back to my home town of Atlanta. This was 2005 and hospital medicine was a nascent movement in health care. I was intrigued, and Emory had a strong hospitalist program based in a major academic medical setting, which has since grown from approximately 20 physicians to over 120 across seven hospitals,” he said.

Senior leaders at Emory recognized something in Dr. Gartland and more administrative offers were forthcoming.

“After a year of practicing at Emory, the system’s chief financial officer knocked on my door to ask if I would be interested in becoming medical director for care coordination. This role afforded me tremendous opportunities to get involved in clinical/administrative activities at Emory – utilization review, hospice and palliative care, transitions of care, interface with managed care organizations. The role was very rewarding. In some ways, I became a kind of chief translator at the hospital for anything clinical that also had financial implications,” he recalled.

“Then we went through a reorganization and I was offered the opportunity to step into the chief operating officer position at Emory University Hospital. Shortly thereafter, there was leadership turnover within the division of hospital medicine and I was asked by the CEO of Emory Healthcare and chair of the department of medicine to serve as section head for hospital medicine.” Dr. Gartland wore both of those hats for about 2 years, later becoming the CEO of Emory University Hospital and two other facilities within the system. He was appointed to his current position as hospital group president and cochief of clinical operations for Emory Healthcare in 2018.

Consumed with administrative responsibilities, he largely had to step away from patient care, although with mixed emotions.

“Over the years, I worked hard to maintain a strong clinical role, but the reality is that if you are not delivering patient care routinely, it’s difficult to practice at the highest level of current medical practice,” he said. Nonetheless, Dr. Gartland tries to keep a hand in patient care by routinely rounding with hospitalist teams and attending care conferences.

Fixing the larger health care system

“I am a huge supporter of more physicians becoming actively engaged in administrative positions in health care. They are key to helping us best fix the larger health care system,” Dr. Gartland said. “However, we’ve all seen clinicians drafted into administrative positions who were not great administrators. One needs to be bilingual in both medicine and business. While some skills, such as strong communication, may cross over, it’s important to recognize that clinical strength and success do not necessarily equate to administrative achievement.”

Dr. Gartland also believes in the importance of mentorship in developing future leaders and in seeking and engaging mentors from other disciplines outside of one’s own specialty. “I’ve been fortunate to have a number of mentors who saw something in me and supported investment in my personal and professional development. I am now fortunate to be in the position to give back by mentoring a number of younger hospitalists who are interested in growing their nonclinical roles.”

“One bit of advice from a mentor that really resonated with me was: Don’t let the urgent get in the way of the important,” Dr. Gartland said. “Life is busy and full of urgent day-to-day fires. It’s important to take the time to pause and consider where you are going and what you are doing to enhance your career development. Are you getting the right kinds of feedback?” He explained that a coach or mentor who can provide constructive feedback is important and is something he has relied upon throughout his own professional development.

Different paths to learning business

Dr. Gartland did not pursue formal business training before the administrative opportunities started to multiply for him at Emory, although in college he had a strong interest in both business and medicine and at one time contemplated going into either.

“Over the years, my mentors have given me a lot of advice, one of which was that a medical degree can be a passport to a lot of different career paths, with real opportunities for merging business and medicine,” he said.

He has since intentionally pursued business training opportunities wherever they came up, such as courses offered by the American College of Physician Executives (now the American Association for Physician Leadership). “At one point, I considered going back to college in an MBA program, but that’s when John Fox – then Emory Healthcare’s CEO – called and said he wanted to send me to the Harvard Business School’s Managing Health Care Delivery executive education program, with an Emory team comprising the chief nurse executive, chief of human resources, and CEO for one of our hospitals.” Harvard’s roughly 9-month program involves 3 weeks on campus with assignments between the on-campus visits.

“In my current role as hospital group president, I have direct responsibility for our hospitals’ and system’s clinically essential services such as radiology, laboratory, pharmacy, and perioperative medicine. I also still serve as CEO for Emory University Hospital while we recruit my replacement,” Dr. Gartland said. “Overall, my work time breaks down roughly into thirds. One-third is spent on strategy and strategic initiatives – such as organizational and program design. Our system recently acquired a large community health system whose strategic and operational integration I am actively leading.”

Another third of his time is focused on operations, and the final third is focused on talent management and development. “People are truly the most valuable asset any organization has, particularly in health care,” he noted. “Being intentional about organizational design, coaching, and supporting the development and deployment of talent at all levels of the organization helps everyone achieve their full potential. It is one of the most important roles a leader can play.”

Dr. Gartland said that Emory is committed to Lean-based management systems, using both horizontal and vertical strategies for process improvement and waste reduction, with implementation beginning in urology, transplant, and heart and vascular services. Experts say Lean success starts at the very top, and Emory and Dr. Gartland are all in.

“These types of changes are measured in 5- to 7-year increments or more, not in months. We believe this is key to creating the best workplace to support the highest quality, experience, and value in health care delivery. It creates and supports the right culture within an organization, and we have made the commitment to following that path,” he said.

Recognizing leadership potential

What does Dr. Gartland look for in physicians with leadership potential?

“Are you someone who collaborates well?” he asked. “Someone who raises your hand at meetings or gets engaged with the issues? Do you volunteer to take on assignments? Are you someone with a balanced perspective, system minded in thinking and inquisitive, with a positive approach to problem solving?”

A lot of physicians might come to a meeting with the hospital or their boss and complain about all the things that aren’t working, he said, but “it’s rarer for them to come in and say: ‘I see these problems, and here’s where I think we can make improvements. How can I help?’ ” Dr. Gartland looks for evidence of emotional intelligence and the ability to effect change management across disciplines. Another skill with ever-greater importance is comfort with data and data-driven decision making.

“When our national health care system is experiencing so much change and upheaval, much of which is captured in newspaper headlines, it can sound scary,” he said. “I encourage people to see that complex, dynamic times like these, filled with so much change, are also a tremendous opportunity. Run towards and embrace the opportunity for change. Hospitalists, by nature, bring with them a tremendous background and experience set that is invaluable to help lead positive change in these dynamic times.”

The SHM has offerings for hospitalists wanting to advance in leadership positions, Dr. Gartland said, including its annual Leadership Academy. The next one is scheduled to be held in Nashville, Tenn., Nov. 4-7, 2019.

“The Leadership Academy is a great initial step for physicians, especially those early in their careers. Also, try to gain exposure to a variety of perspectives outside of hospital medicine,” he said. “I’d love to see further advances in leadership for our specialty – growing the number of hospitalists who serve as hospital CEOs or CMOs and in other leadership roles. We have more to learn collectively about leadership as a specialty, and I’d love to see us grow that capacity by offering further learning opportunities and bringing together hospitalists who have an interest in advancing leadership.”

Bryce Gartland, MD, was working as a full-time hospitalist at Emory University Hospital in Atlanta when hospital administrators first started asking him to take on administrative roles, such as clinical site director or medical director of care coordination.

Today, Dr. Gartland is hospital group president and cochief of clinical operations for Emory Healthcare, with responsibility for overall performance and achievement across all 11 Emory hospitals. In that role, he keeps his eyes open for similar talent and leadership potential in younger physicians.

Following internal medicine residency at Cedars-Sinai Medical Center in Los Angeles, Dr. Gartland moved into a traditional private practice setting in Beverly Hills. “Two years later, my wife and I decided to move back to my home town of Atlanta. This was 2005 and hospital medicine was a nascent movement in health care. I was intrigued, and Emory had a strong hospitalist program based in a major academic medical setting, which has since grown from approximately 20 physicians to over 120 across seven hospitals,” he said.

Senior leaders at Emory recognized something in Dr. Gartland and more administrative offers were forthcoming.

“After a year of practicing at Emory, the system’s chief financial officer knocked on my door to ask if I would be interested in becoming medical director for care coordination. This role afforded me tremendous opportunities to get involved in clinical/administrative activities at Emory – utilization review, hospice and palliative care, transitions of care, interface with managed care organizations. The role was very rewarding. In some ways, I became a kind of chief translator at the hospital for anything clinical that also had financial implications,” he recalled.

“Then we went through a reorganization and I was offered the opportunity to step into the chief operating officer position at Emory University Hospital. Shortly thereafter, there was leadership turnover within the division of hospital medicine and I was asked by the CEO of Emory Healthcare and chair of the department of medicine to serve as section head for hospital medicine.” Dr. Gartland wore both of those hats for about 2 years, later becoming the CEO of Emory University Hospital and two other facilities within the system. He was appointed to his current position as hospital group president and cochief of clinical operations for Emory Healthcare in 2018.

Consumed with administrative responsibilities, he largely had to step away from patient care, although with mixed emotions.

“Over the years, I worked hard to maintain a strong clinical role, but the reality is that if you are not delivering patient care routinely, it’s difficult to practice at the highest level of current medical practice,” he said. Nonetheless, Dr. Gartland tries to keep a hand in patient care by routinely rounding with hospitalist teams and attending care conferences.

Fixing the larger health care system

“I am a huge supporter of more physicians becoming actively engaged in administrative positions in health care. They are key to helping us best fix the larger health care system,” Dr. Gartland said. “However, we’ve all seen clinicians drafted into administrative positions who were not great administrators. One needs to be bilingual in both medicine and business. While some skills, such as strong communication, may cross over, it’s important to recognize that clinical strength and success do not necessarily equate to administrative achievement.”

Dr. Gartland also believes in the importance of mentorship in developing future leaders and in seeking and engaging mentors from other disciplines outside of one’s own specialty. “I’ve been fortunate to have a number of mentors who saw something in me and supported investment in my personal and professional development. I am now fortunate to be in the position to give back by mentoring a number of younger hospitalists who are interested in growing their nonclinical roles.”

“One bit of advice from a mentor that really resonated with me was: Don’t let the urgent get in the way of the important,” Dr. Gartland said. “Life is busy and full of urgent day-to-day fires. It’s important to take the time to pause and consider where you are going and what you are doing to enhance your career development. Are you getting the right kinds of feedback?” He explained that a coach or mentor who can provide constructive feedback is important and is something he has relied upon throughout his own professional development.

Different paths to learning business

Dr. Gartland did not pursue formal business training before the administrative opportunities started to multiply for him at Emory, although in college he had a strong interest in both business and medicine and at one time contemplated going into either.

“Over the years, my mentors have given me a lot of advice, one of which was that a medical degree can be a passport to a lot of different career paths, with real opportunities for merging business and medicine,” he said.

He has since intentionally pursued business training opportunities wherever they came up, such as courses offered by the American College of Physician Executives (now the American Association for Physician Leadership). “At one point, I considered going back to college in an MBA program, but that’s when John Fox – then Emory Healthcare’s CEO – called and said he wanted to send me to the Harvard Business School’s Managing Health Care Delivery executive education program, with an Emory team comprising the chief nurse executive, chief of human resources, and CEO for one of our hospitals.” Harvard’s roughly 9-month program involves 3 weeks on campus with assignments between the on-campus visits.

“In my current role as hospital group president, I have direct responsibility for our hospitals’ and system’s clinically essential services such as radiology, laboratory, pharmacy, and perioperative medicine. I also still serve as CEO for Emory University Hospital while we recruit my replacement,” Dr. Gartland said. “Overall, my work time breaks down roughly into thirds. One-third is spent on strategy and strategic initiatives – such as organizational and program design. Our system recently acquired a large community health system whose strategic and operational integration I am actively leading.”

Another third of his time is focused on operations, and the final third is focused on talent management and development. “People are truly the most valuable asset any organization has, particularly in health care,” he noted. “Being intentional about organizational design, coaching, and supporting the development and deployment of talent at all levels of the organization helps everyone achieve their full potential. It is one of the most important roles a leader can play.”

Dr. Gartland said that Emory is committed to Lean-based management systems, using both horizontal and vertical strategies for process improvement and waste reduction, with implementation beginning in urology, transplant, and heart and vascular services. Experts say Lean success starts at the very top, and Emory and Dr. Gartland are all in.

“These types of changes are measured in 5- to 7-year increments or more, not in months. We believe this is key to creating the best workplace to support the highest quality, experience, and value in health care delivery. It creates and supports the right culture within an organization, and we have made the commitment to following that path,” he said.

Recognizing leadership potential

What does Dr. Gartland look for in physicians with leadership potential?

“Are you someone who collaborates well?” he asked. “Someone who raises your hand at meetings or gets engaged with the issues? Do you volunteer to take on assignments? Are you someone with a balanced perspective, system minded in thinking and inquisitive, with a positive approach to problem solving?”

A lot of physicians might come to a meeting with the hospital or their boss and complain about all the things that aren’t working, he said, but “it’s rarer for them to come in and say: ‘I see these problems, and here’s where I think we can make improvements. How can I help?’ ” Dr. Gartland looks for evidence of emotional intelligence and the ability to effect change management across disciplines. Another skill with ever-greater importance is comfort with data and data-driven decision making.

“When our national health care system is experiencing so much change and upheaval, much of which is captured in newspaper headlines, it can sound scary,” he said. “I encourage people to see that complex, dynamic times like these, filled with so much change, are also a tremendous opportunity. Run towards and embrace the opportunity for change. Hospitalists, by nature, bring with them a tremendous background and experience set that is invaluable to help lead positive change in these dynamic times.”

The SHM has offerings for hospitalists wanting to advance in leadership positions, Dr. Gartland said, including its annual Leadership Academy. The next one is scheduled to be held in Nashville, Tenn., Nov. 4-7, 2019.

“The Leadership Academy is a great initial step for physicians, especially those early in their careers. Also, try to gain exposure to a variety of perspectives outside of hospital medicine,” he said. “I’d love to see further advances in leadership for our specialty – growing the number of hospitalists who serve as hospital CEOs or CMOs and in other leadership roles. We have more to learn collectively about leadership as a specialty, and I’d love to see us grow that capacity by offering further learning opportunities and bringing together hospitalists who have an interest in advancing leadership.”

Our profession continues to experience steady growth, and demand for hospitalist physicians exceeds supply. In a recent article in The Hospitalist, Andrew White, MD, SFHM, highlighted the fact that most hospital medicine groups (HMGs) are constantly recruiting and open positions are not uncommon.

When we think about recruitment and staffing, I bet many of us think principally of physicians trained in the general medicine specialties of internal medicine, family medicine, and pediatrics. Yet, to help meet demand for hospital-based clinicians, HMGs sometimes turn to physicians certified in emergency medicine, critical care, geriatric medicine, palliative care, and other fields.

To gain a better understanding of the diversity within our profession, the Society of Hospital Medicine’s State of Hospital Medicine survey asked HMGs whether they employ at least one physician in these various specialties. Results published in the recently released 2018 State of Hospital Medicine (SoHM) Report show significant differences among groups, affected by location, group size, and type of employer.

At the core of our profession are physicians trained in internal medicine, present in 99.2% of adult medicine HMGs throughout the United States. No surprise given that our field was founded by internists and remains a popular career choice for IM residency graduates. Family physicians follow, with the highest percentage of groups employing at least one FP located in the southern United States at 70.3% and lowest in the west at 54.7%. Small-sized groups – fewer than 10 full-time equivalents (FTEs) – were also more likely to employ FPs.

This speaks to the challenge – often faced by smaller hospitals – of covering both adult and pediatric patient populations and limited workforce availability. Pediatrics- and internal medicine/pediatrics–trained physicians help meet this need and were prevalent within small-sized groups. Another distinction found in the report is that, while 92.1% of multistate hospitalist management companies employed family physicians, only 28.8% of academic university settings did so. Partly because of Accreditation Council for Graduate Medical Education requirements for IM-certified teaching attending for internal medicine residents, FP and other specialties are filling some non–teaching hospitalist positions within our academic programs.

What may be surprising is that emergency medicine and critical care had the largest increase in representation in hospital medicine. The two specialties showed similar growth trends, with a larger presence in the South and Midwest states and 56% of multistate hospitalist management companies employing them. Small- to medium-sized groups of up to 20 FTEs were also more likely to have physicians from these fields, with up to 44% of groups doing so. This is a significant change from 2016, when less than 3.4% of all HMGs overall had a physician certified in emergency or critical care medicine.

This finding seems to coincide with the growth in hospital medicine groups who are covering both ED and inpatient services. For small and rural hospitals, it has become necessary and beneficial to have physicians capable of covering both clinical settings.

Contrast this with geriatric medicine and palliative care. Here, we saw these two specialties to be present in our academic institutions at 26.8% and 22.5%, respectively. Large-sized HMGs were more likely to employ them, whereas their presence in multistate management groups or private multispecialty/primary care groups was quite low. Compared with our last survey in 2016, their overall prevalence in HMGs hasn’t changed significantly. Whether this will be different in the future with our aging population will be interesting to follow.

Published biannually, the SoHM report provides insight into these and other market-based dynamics that shape hospital medicine. The demand for hospital-based clinicians and the demands of acute inpatient care are leading to the broad and inclusive nature of hospital medicine. Our staffing will continue to be met not only by internal medicine and family medicine physicians but also through these other specialties joining our ranks and adding diversity to our profession.

Dr. Sites is the executive medical director of acute medicine at Providence St. Joseph Health, Oregon, and a member of SHM’s Practice Analysis Committee. She leads the hospital medicine programs and is involved in strategy development and alignment of acute inpatient medicine services at eight member hospitals. She has been a practicing hospitalist for 20 years and volunteers on medical mission trips to Guatemala annually.

Our profession continues to experience steady growth, and demand for hospitalist physicians exceeds supply. In a recent article in The Hospitalist, Andrew White, MD, SFHM, highlighted the fact that most hospital medicine groups (HMGs) are constantly recruiting and open positions are not uncommon.

When we think about recruitment and staffing, I bet many of us think principally of physicians trained in the general medicine specialties of internal medicine, family medicine, and pediatrics. Yet, to help meet demand for hospital-based clinicians, HMGs sometimes turn to physicians certified in emergency medicine, critical care, geriatric medicine, palliative care, and other fields.

To gain a better understanding of the diversity within our profession, the Society of Hospital Medicine’s State of Hospital Medicine survey asked HMGs whether they employ at least one physician in these various specialties. Results published in the recently released 2018 State of Hospital Medicine (SoHM) Report show significant differences among groups, affected by location, group size, and type of employer.

At the core of our profession are physicians trained in internal medicine, present in 99.2% of adult medicine HMGs throughout the United States. No surprise given that our field was founded by internists and remains a popular career choice for IM residency graduates. Family physicians follow, with the highest percentage of groups employing at least one FP located in the southern United States at 70.3% and lowest in the west at 54.7%. Small-sized groups – fewer than 10 full-time equivalents (FTEs) – were also more likely to employ FPs.

This speaks to the challenge – often faced by smaller hospitals – of covering both adult and pediatric patient populations and limited workforce availability. Pediatrics- and internal medicine/pediatrics–trained physicians help meet this need and were prevalent within small-sized groups. Another distinction found in the report is that, while 92.1% of multistate hospitalist management companies employed family physicians, only 28.8% of academic university settings did so. Partly because of Accreditation Council for Graduate Medical Education requirements for IM-certified teaching attending for internal medicine residents, FP and other specialties are filling some non–teaching hospitalist positions within our academic programs.

What may be surprising is that emergency medicine and critical care had the largest increase in representation in hospital medicine. The two specialties showed similar growth trends, with a larger presence in the South and Midwest states and 56% of multistate hospitalist management companies employing them. Small- to medium-sized groups of up to 20 FTEs were also more likely to have physicians from these fields, with up to 44% of groups doing so. This is a significant change from 2016, when less than 3.4% of all HMGs overall had a physician certified in emergency or critical care medicine.

This finding seems to coincide with the growth in hospital medicine groups who are covering both ED and inpatient services. For small and rural hospitals, it has become necessary and beneficial to have physicians capable of covering both clinical settings.

Contrast this with geriatric medicine and palliative care. Here, we saw these two specialties to be present in our academic institutions at 26.8% and 22.5%, respectively. Large-sized HMGs were more likely to employ them, whereas their presence in multistate management groups or private multispecialty/primary care groups was quite low. Compared with our last survey in 2016, their overall prevalence in HMGs hasn’t changed significantly. Whether this will be different in the future with our aging population will be interesting to follow.

Published biannually, the SoHM report provides insight into these and other market-based dynamics that shape hospital medicine. The demand for hospital-based clinicians and the demands of acute inpatient care are leading to the broad and inclusive nature of hospital medicine. Our staffing will continue to be met not only by internal medicine and family medicine physicians but also through these other specialties joining our ranks and adding diversity to our profession.

Dr. Sites is the executive medical director of acute medicine at Providence St. Joseph Health, Oregon, and a member of SHM’s Practice Analysis Committee. She leads the hospital medicine programs and is involved in strategy development and alignment of acute inpatient medicine services at eight member hospitals. She has been a practicing hospitalist for 20 years and volunteers on medical mission trips to Guatemala annually.

Our profession continues to experience steady growth, and demand for hospitalist physicians exceeds supply. In a recent article in The Hospitalist, Andrew White, MD, SFHM, highlighted the fact that most hospital medicine groups (HMGs) are constantly recruiting and open positions are not uncommon.

When we think about recruitment and staffing, I bet many of us think principally of physicians trained in the general medicine specialties of internal medicine, family medicine, and pediatrics. Yet, to help meet demand for hospital-based clinicians, HMGs sometimes turn to physicians certified in emergency medicine, critical care, geriatric medicine, palliative care, and other fields.

To gain a better understanding of the diversity within our profession, the Society of Hospital Medicine’s State of Hospital Medicine survey asked HMGs whether they employ at least one physician in these various specialties. Results published in the recently released 2018 State of Hospital Medicine (SoHM) Report show significant differences among groups, affected by location, group size, and type of employer.

At the core of our profession are physicians trained in internal medicine, present in 99.2% of adult medicine HMGs throughout the United States. No surprise given that our field was founded by internists and remains a popular career choice for IM residency graduates. Family physicians follow, with the highest percentage of groups employing at least one FP located in the southern United States at 70.3% and lowest in the west at 54.7%. Small-sized groups – fewer than 10 full-time equivalents (FTEs) – were also more likely to employ FPs.

This speaks to the challenge – often faced by smaller hospitals – of covering both adult and pediatric patient populations and limited workforce availability. Pediatrics- and internal medicine/pediatrics–trained physicians help meet this need and were prevalent within small-sized groups. Another distinction found in the report is that, while 92.1% of multistate hospitalist management companies employed family physicians, only 28.8% of academic university settings did so. Partly because of Accreditation Council for Graduate Medical Education requirements for IM-certified teaching attending for internal medicine residents, FP and other specialties are filling some non–teaching hospitalist positions within our academic programs.

What may be surprising is that emergency medicine and critical care had the largest increase in representation in hospital medicine. The two specialties showed similar growth trends, with a larger presence in the South and Midwest states and 56% of multistate hospitalist management companies employing them. Small- to medium-sized groups of up to 20 FTEs were also more likely to have physicians from these fields, with up to 44% of groups doing so. This is a significant change from 2016, when less than 3.4% of all HMGs overall had a physician certified in emergency or critical care medicine.

This finding seems to coincide with the growth in hospital medicine groups who are covering both ED and inpatient services. For small and rural hospitals, it has become necessary and beneficial to have physicians capable of covering both clinical settings.

Contrast this with geriatric medicine and palliative care. Here, we saw these two specialties to be present in our academic institutions at 26.8% and 22.5%, respectively. Large-sized HMGs were more likely to employ them, whereas their presence in multistate management groups or private multispecialty/primary care groups was quite low. Compared with our last survey in 2016, their overall prevalence in HMGs hasn’t changed significantly. Whether this will be different in the future with our aging population will be interesting to follow.

Published biannually, the SoHM report provides insight into these and other market-based dynamics that shape hospital medicine. The demand for hospital-based clinicians and the demands of acute inpatient care are leading to the broad and inclusive nature of hospital medicine. Our staffing will continue to be met not only by internal medicine and family medicine physicians but also through these other specialties joining our ranks and adding diversity to our profession.

Dr. Sites is the executive medical director of acute medicine at Providence St. Joseph Health, Oregon, and a member of SHM’s Practice Analysis Committee. She leads the hospital medicine programs and is involved in strategy development and alignment of acute inpatient medicine services at eight member hospitals. She has been a practicing hospitalist for 20 years and volunteers on medical mission trips to Guatemala annually.

The proportion of women speaking at medical conferences in the United States and Canada increased significantly between 2007 and 2017, while the proportion at surgical specialty conferences lagged noticeably behind, according to new research.

“Although female representation at academic meetings has been identified as an important gender equity issue, the proportion of conference speakers who are women has not yet been systematically measured across different medical subspecialties,” wrote Shannon M. Ruzycki, MD, and her colleagues from the University of Calgary (Alta.). The report is in JAMA Network Open.

Using the Web of Science Conference database, the investigators identified 181 conferences and 701 unique meetings (40 in 2007, 104 in 2013, 115 in 2014, 124 in 2015, 137 in 2016, and 181 in 2017). The list of names from each meeting program was analyzed by the Gender Balance Assessment Tool to identify the likely proportion of female speakers by assigning a probability of each name belonging to a gender, based on social media data.

In 2007, the proportion of female speakers was 24.6% , which increased to 34.1% by 2017, an average increase of 0.97% per year. The range of female speakers at each meeting ranged from 0% to 82.6%, with 82 (12%) of the 701 meetings having more than 50% female speakers. The proportion of female speakers was slightly less than the proportion of female doctors in the United States and Canada in 2007 (26.1%), but was slightly greater than the proportion of female doctors in 2015 (32.4%).

During the study period, the proportion of female speakers at surgical specialty conferences was significantly lower than that for medical specialty conferences (20.1% in 2007 and 28.4% in 2017 vs. 29.9% in 2007 and 38.8% in 2017). While the number of speakers at medical meetings in 2015 matched the proportion of doctors in the United States and Canada in that year, the proportion of speakers at surgical meetings was noticeably higher than the number of female surgeons.

“We hypothesize that the low proportion of female speakers at medical conferences reflects broader gender inequity within the medical profession, particularly in subspecialties where the majority of physicians are men. It has been shown that the presence of female role models in male-dominated career streams can increase engagement of young women,” the investigators wrote. “Exposure to female speakers at medical conferences may be a means of encouraging female medical students and residents to choose specialties that have historically been male dominated. Strategies to promote inclusivity of female speakers at academic conferences may therefore represent an important opportunity to influence gender equity within medicine,” they concluded.

The University of Calgary funded the study. The authors reported no conflicts of interest.

[email protected]

SOURCE: Ruzycki SM et al. JAMA Netw Open. 2019 Apr 12. doi: 10.1001/jamanetworkopen.2019.2103.

The proportion of women speaking at medical conferences in the United States and Canada increased significantly between 2007 and 2017, while the proportion at surgical specialty conferences lagged noticeably behind, according to new research.

“Although female representation at academic meetings has been identified as an important gender equity issue, the proportion of conference speakers who are women has not yet been systematically measured across different medical subspecialties,” wrote Shannon M. Ruzycki, MD, and her colleagues from the University of Calgary (Alta.). The report is in JAMA Network Open.

Using the Web of Science Conference database, the investigators identified 181 conferences and 701 unique meetings (40 in 2007, 104 in 2013, 115 in 2014, 124 in 2015, 137 in 2016, and 181 in 2017). The list of names from each meeting program was analyzed by the Gender Balance Assessment Tool to identify the likely proportion of female speakers by assigning a probability of each name belonging to a gender, based on social media data.

In 2007, the proportion of female speakers was 24.6% , which increased to 34.1% by 2017, an average increase of 0.97% per year. The range of female speakers at each meeting ranged from 0% to 82.6%, with 82 (12%) of the 701 meetings having more than 50% female speakers. The proportion of female speakers was slightly less than the proportion of female doctors in the United States and Canada in 2007 (26.1%), but was slightly greater than the proportion of female doctors in 2015 (32.4%).

During the study period, the proportion of female speakers at surgical specialty conferences was significantly lower than that for medical specialty conferences (20.1% in 2007 and 28.4% in 2017 vs. 29.9% in 2007 and 38.8% in 2017). While the number of speakers at medical meetings in 2015 matched the proportion of doctors in the United States and Canada in that year, the proportion of speakers at surgical meetings was noticeably higher than the number of female surgeons.

“We hypothesize that the low proportion of female speakers at medical conferences reflects broader gender inequity within the medical profession, particularly in subspecialties where the majority of physicians are men. It has been shown that the presence of female role models in male-dominated career streams can increase engagement of young women,” the investigators wrote. “Exposure to female speakers at medical conferences may be a means of encouraging female medical students and residents to choose specialties that have historically been male dominated. Strategies to promote inclusivity of female speakers at academic conferences may therefore represent an important opportunity to influence gender equity within medicine,” they concluded.

The University of Calgary funded the study. The authors reported no conflicts of interest.

[email protected]

SOURCE: Ruzycki SM et al. JAMA Netw Open. 2019 Apr 12. doi: 10.1001/jamanetworkopen.2019.2103.

The proportion of women speaking at medical conferences in the United States and Canada increased significantly between 2007 and 2017, while the proportion at surgical specialty conferences lagged noticeably behind, according to new research.

“Although female representation at academic meetings has been identified as an important gender equity issue, the proportion of conference speakers who are women has not yet been systematically measured across different medical subspecialties,” wrote Shannon M. Ruzycki, MD, and her colleagues from the University of Calgary (Alta.). The report is in JAMA Network Open.

Using the Web of Science Conference database, the investigators identified 181 conferences and 701 unique meetings (40 in 2007, 104 in 2013, 115 in 2014, 124 in 2015, 137 in 2016, and 181 in 2017). The list of names from each meeting program was analyzed by the Gender Balance Assessment Tool to identify the likely proportion of female speakers by assigning a probability of each name belonging to a gender, based on social media data.

In 2007, the proportion of female speakers was 24.6% , which increased to 34.1% by 2017, an average increase of 0.97% per year. The range of female speakers at each meeting ranged from 0% to 82.6%, with 82 (12%) of the 701 meetings having more than 50% female speakers. The proportion of female speakers was slightly less than the proportion of female doctors in the United States and Canada in 2007 (26.1%), but was slightly greater than the proportion of female doctors in 2015 (32.4%).

During the study period, the proportion of female speakers at surgical specialty conferences was significantly lower than that for medical specialty conferences (20.1% in 2007 and 28.4% in 2017 vs. 29.9% in 2007 and 38.8% in 2017). While the number of speakers at medical meetings in 2015 matched the proportion of doctors in the United States and Canada in that year, the proportion of speakers at surgical meetings was noticeably higher than the number of female surgeons.

“We hypothesize that the low proportion of female speakers at medical conferences reflects broader gender inequity within the medical profession, particularly in subspecialties where the majority of physicians are men. It has been shown that the presence of female role models in male-dominated career streams can increase engagement of young women,” the investigators wrote. “Exposure to female speakers at medical conferences may be a means of encouraging female medical students and residents to choose specialties that have historically been male dominated. Strategies to promote inclusivity of female speakers at academic conferences may therefore represent an important opportunity to influence gender equity within medicine,” they concluded.

The University of Calgary funded the study. The authors reported no conflicts of interest.

[email protected]

SOURCE: Ruzycki SM et al. JAMA Netw Open. 2019 Apr 12. doi: 10.1001/jamanetworkopen.2019.2103.