Career

I have to admit that I am not sure I am a legacy in hospital medicine, and the term legacy throws me off a bit. I came to medical school after working at McKinsey & Co. consulting, and I chose pediatrics because of my love of working with children and families, as well as a vague notion that I wanted to work on “system” issues, and therefore, more generalist-type training seemed applicable.

I met Chris Landrigan, MD, MPH, and Vinny Chiang, MD, and learned what a hospitalist was, as an intern in 2002. We had a research elective and I was able to publish a couple of papers in Pediatrics on pediatric hospital medicine with Chris and Raj Srivastava, MD, MPH. In 2004, I went to my first Society of Hospital Medicine meeting and met Larry Wellikson, MD, MHM, and others. From there, I went to the Robert Wood Johnson Clinical Scholars Program, with Ron Keren, MD, MPH, and others, and along with faculty from the Cincinnati Children’s in hospital medicine.

In 2007, I applied for a White House Fellowship and told my wife that I didn’t think there was a chance that I would get it, so we should keep building our new home in Cincinnati. We were both surprised when I was selected. I served Michael Leavitt, the then-Secretary of the Department of Health & Human Services, as his White House fellow during the Bush administration, and then served as his chief medical officer. Exposure to health policy and leadership at that level was career shaping. Cincinnati Children’s was searching for a leader for the conversion of pediatric hospital medicine into a full division in 2009. So I returned to Cincinnati to take on leading pediatric hospital medicine, and a role leading quality measurement and improvement efforts for the entire health system. I loved the work and thought I would remain in that role, and our family would be in Cincinnati for a long time. Best laid plans …

In early 2011, Don Berwick, MD, who was then the administrator of the Centers for Medicare & Medicaid Services called and asked whether I “would come talk with him in D.C.” That talk quickly became a series of interviews, and he offered me the opportunity to be chief medical officer of CMS. He said “this platform is like no other to drive change.” He was right. I have been fortunate to have a few step-change opportunities in my life, and that was one.

On my first day at CMS, I looked around the table of senior executives reporting to me and realized they had more than 200 years of CMS experience. I was a bit scared. Together, we led the implementation of Hospital Value-Based Purchasing, the Compare websites, and numerous quality measurement and improvement programs. Partnership for Patients works on patient safety and was associated with preventing more than 3 million infections and adverse events, over 125,000 lives saved, and more than $26 billion in savings.

In early 2013, I was asked to lead the CMS Innovation Center (CMMI). The goal was to launch new payment and service delivery models to improve quality and lower costs. We launched Accountable Care Organizations, Bundled Payment programs, primary care medical homes, state-based innovation, and so much more. Medicare went from zero dollars in alternative payment models, where providers are accountable for quality and total cost of care, to more than 30% of Medicare payments, representing over $200 billion through agreements with more than 200,000 providers in these alternative payment models. It was the biggest shift in U.S. history in how CMS paid for care. Later, I became principal deputy administrator and acting administrator of CMS, leading an agency that spends over $1 trillion per year, or more than $2.5 billion per day and insures over 130 million Americans. We also improved from being bottom quintile in employee engagement and satisfaction across the federal government to No. 2.

I had assumed that, after working at CMS, I would return to a hospital/health system leadership role. But then, a recruiter called about the CEO role at Blue Cross Blue Shield of North Carolina. It is one of the largest not-for-profit health plans in the country and insures most of the people in North Carolina, many for most of their lives. I met a 75-year-old woman the other day that we have insured every day of her life. I am almost a year into the role and it is a mission-driven organization that drives positive change. I love it so far.

We are going to partner with providers, so that more than half of our payments will be in advanced alternative payment models. No payer in the United States has done that yet. This allows us to innovate and decrease friction in the system (e.g., turn off prior authorization) and be jointly accountable with providers for quality and total cost of care. We insure people through the ACA [Affordable Care Act], commercial, and Medicare markets, and are competing to serve Medicaid as well. We have invested more than $50 million to address social determinants of health across the state. We are making major investments in primary care, and mental and behavioral health. Our goal is to be a Model Blue – or a Model of Health Transformation for our state and nation – and achieve better health outcomes, lower costs, and best-in-class experience for all people we serve. I have learned that no physician leads a health plan of this size, and apparently, no practicing physician has ever led a health plan of this size.

What are some lessons learned over my career? I have had five criteria for all my career decisions: 1) family; 2) impact – better care and outcomes, lower costs, and exceptional experience for populations of patients; 3) people – mentors and colleagues; 4) learning; and 5) joy in work. If someone gives you a chance to lead people in your career as a physician, jump at the chance. We do a relatively poor job of providing this type of opportunity to those early in their careers in medicine, and learning how to manage people and money allows you to progress as a leader and manager.

Don’t listen to the people who say “you must do X before Y” or “you must take this path.” They are usually wrong. Take chances. I applied for many roles for which I was a long shot, and I didn’t always succeed. That’s life and learning. Hospital medicine is a great career. I worked in the hospital on a recent weekend and was able to help families through everything from palliative care decisions and new diagnoses, to recovering from illness. It is an honor to serve and help families in their time of need. Hospitalists have been – and should continue to be – primary drivers of the shift in our health system to value-based care.

As I look back on my career (and I hope I am only halfway done), I could not have predicted more than 90% of it. I was blessed with many opportunities, mentors, and teachers along the way. I try to pass this on by mentoring and teaching others. How did my career happen? I am not sure, but it has been a fun ride! And hopefully I have helped improve the health system some, along the way.
 

Dr. Conway is president and CEO of Blue Cross and Blue Shield of North Carolina. He is a hospitalist and former deputy administrator for innovation and quality at the Centers for Medicare and Medicaid Services.

I have to admit that I am not sure I am a legacy in hospital medicine, and the term legacy throws me off a bit. I came to medical school after working at McKinsey & Co. consulting, and I chose pediatrics because of my love of working with children and families, as well as a vague notion that I wanted to work on “system” issues, and therefore, more generalist-type training seemed applicable.

I met Chris Landrigan, MD, MPH, and Vinny Chiang, MD, and learned what a hospitalist was, as an intern in 2002. We had a research elective and I was able to publish a couple of papers in Pediatrics on pediatric hospital medicine with Chris and Raj Srivastava, MD, MPH. In 2004, I went to my first Society of Hospital Medicine meeting and met Larry Wellikson, MD, MHM, and others. From there, I went to the Robert Wood Johnson Clinical Scholars Program, with Ron Keren, MD, MPH, and others, and along with faculty from the Cincinnati Children’s in hospital medicine.

In 2007, I applied for a White House Fellowship and told my wife that I didn’t think there was a chance that I would get it, so we should keep building our new home in Cincinnati. We were both surprised when I was selected. I served Michael Leavitt, the then-Secretary of the Department of Health & Human Services, as his White House fellow during the Bush administration, and then served as his chief medical officer. Exposure to health policy and leadership at that level was career shaping. Cincinnati Children’s was searching for a leader for the conversion of pediatric hospital medicine into a full division in 2009. So I returned to Cincinnati to take on leading pediatric hospital medicine, and a role leading quality measurement and improvement efforts for the entire health system. I loved the work and thought I would remain in that role, and our family would be in Cincinnati for a long time. Best laid plans …

In early 2011, Don Berwick, MD, who was then the administrator of the Centers for Medicare & Medicaid Services called and asked whether I “would come talk with him in D.C.” That talk quickly became a series of interviews, and he offered me the opportunity to be chief medical officer of CMS. He said “this platform is like no other to drive change.” He was right. I have been fortunate to have a few step-change opportunities in my life, and that was one.

On my first day at CMS, I looked around the table of senior executives reporting to me and realized they had more than 200 years of CMS experience. I was a bit scared. Together, we led the implementation of Hospital Value-Based Purchasing, the Compare websites, and numerous quality measurement and improvement programs. Partnership for Patients works on patient safety and was associated with preventing more than 3 million infections and adverse events, over 125,000 lives saved, and more than $26 billion in savings.

In early 2013, I was asked to lead the CMS Innovation Center (CMMI). The goal was to launch new payment and service delivery models to improve quality and lower costs. We launched Accountable Care Organizations, Bundled Payment programs, primary care medical homes, state-based innovation, and so much more. Medicare went from zero dollars in alternative payment models, where providers are accountable for quality and total cost of care, to more than 30% of Medicare payments, representing over $200 billion through agreements with more than 200,000 providers in these alternative payment models. It was the biggest shift in U.S. history in how CMS paid for care. Later, I became principal deputy administrator and acting administrator of CMS, leading an agency that spends over $1 trillion per year, or more than $2.5 billion per day and insures over 130 million Americans. We also improved from being bottom quintile in employee engagement and satisfaction across the federal government to No. 2.

I had assumed that, after working at CMS, I would return to a hospital/health system leadership role. But then, a recruiter called about the CEO role at Blue Cross Blue Shield of North Carolina. It is one of the largest not-for-profit health plans in the country and insures most of the people in North Carolina, many for most of their lives. I met a 75-year-old woman the other day that we have insured every day of her life. I am almost a year into the role and it is a mission-driven organization that drives positive change. I love it so far.

We are going to partner with providers, so that more than half of our payments will be in advanced alternative payment models. No payer in the United States has done that yet. This allows us to innovate and decrease friction in the system (e.g., turn off prior authorization) and be jointly accountable with providers for quality and total cost of care. We insure people through the ACA [Affordable Care Act], commercial, and Medicare markets, and are competing to serve Medicaid as well. We have invested more than $50 million to address social determinants of health across the state. We are making major investments in primary care, and mental and behavioral health. Our goal is to be a Model Blue – or a Model of Health Transformation for our state and nation – and achieve better health outcomes, lower costs, and best-in-class experience for all people we serve. I have learned that no physician leads a health plan of this size, and apparently, no practicing physician has ever led a health plan of this size.

What are some lessons learned over my career? I have had five criteria for all my career decisions: 1) family; 2) impact – better care and outcomes, lower costs, and exceptional experience for populations of patients; 3) people – mentors and colleagues; 4) learning; and 5) joy in work. If someone gives you a chance to lead people in your career as a physician, jump at the chance. We do a relatively poor job of providing this type of opportunity to those early in their careers in medicine, and learning how to manage people and money allows you to progress as a leader and manager.

Don’t listen to the people who say “you must do X before Y” or “you must take this path.” They are usually wrong. Take chances. I applied for many roles for which I was a long shot, and I didn’t always succeed. That’s life and learning. Hospital medicine is a great career. I worked in the hospital on a recent weekend and was able to help families through everything from palliative care decisions and new diagnoses, to recovering from illness. It is an honor to serve and help families in their time of need. Hospitalists have been – and should continue to be – primary drivers of the shift in our health system to value-based care.

As I look back on my career (and I hope I am only halfway done), I could not have predicted more than 90% of it. I was blessed with many opportunities, mentors, and teachers along the way. I try to pass this on by mentoring and teaching others. How did my career happen? I am not sure, but it has been a fun ride! And hopefully I have helped improve the health system some, along the way.
 

Dr. Conway is president and CEO of Blue Cross and Blue Shield of North Carolina. He is a hospitalist and former deputy administrator for innovation and quality at the Centers for Medicare and Medicaid Services.

I have to admit that I am not sure I am a legacy in hospital medicine, and the term legacy throws me off a bit. I came to medical school after working at McKinsey & Co. consulting, and I chose pediatrics because of my love of working with children and families, as well as a vague notion that I wanted to work on “system” issues, and therefore, more generalist-type training seemed applicable.

I met Chris Landrigan, MD, MPH, and Vinny Chiang, MD, and learned what a hospitalist was, as an intern in 2002. We had a research elective and I was able to publish a couple of papers in Pediatrics on pediatric hospital medicine with Chris and Raj Srivastava, MD, MPH. In 2004, I went to my first Society of Hospital Medicine meeting and met Larry Wellikson, MD, MHM, and others. From there, I went to the Robert Wood Johnson Clinical Scholars Program, with Ron Keren, MD, MPH, and others, and along with faculty from the Cincinnati Children’s in hospital medicine.

In 2007, I applied for a White House Fellowship and told my wife that I didn’t think there was a chance that I would get it, so we should keep building our new home in Cincinnati. We were both surprised when I was selected. I served Michael Leavitt, the then-Secretary of the Department of Health & Human Services, as his White House fellow during the Bush administration, and then served as his chief medical officer. Exposure to health policy and leadership at that level was career shaping. Cincinnati Children’s was searching for a leader for the conversion of pediatric hospital medicine into a full division in 2009. So I returned to Cincinnati to take on leading pediatric hospital medicine, and a role leading quality measurement and improvement efforts for the entire health system. I loved the work and thought I would remain in that role, and our family would be in Cincinnati for a long time. Best laid plans …

In early 2011, Don Berwick, MD, who was then the administrator of the Centers for Medicare & Medicaid Services called and asked whether I “would come talk with him in D.C.” That talk quickly became a series of interviews, and he offered me the opportunity to be chief medical officer of CMS. He said “this platform is like no other to drive change.” He was right. I have been fortunate to have a few step-change opportunities in my life, and that was one.

On my first day at CMS, I looked around the table of senior executives reporting to me and realized they had more than 200 years of CMS experience. I was a bit scared. Together, we led the implementation of Hospital Value-Based Purchasing, the Compare websites, and numerous quality measurement and improvement programs. Partnership for Patients works on patient safety and was associated with preventing more than 3 million infections and adverse events, over 125,000 lives saved, and more than $26 billion in savings.

In early 2013, I was asked to lead the CMS Innovation Center (CMMI). The goal was to launch new payment and service delivery models to improve quality and lower costs. We launched Accountable Care Organizations, Bundled Payment programs, primary care medical homes, state-based innovation, and so much more. Medicare went from zero dollars in alternative payment models, where providers are accountable for quality and total cost of care, to more than 30% of Medicare payments, representing over $200 billion through agreements with more than 200,000 providers in these alternative payment models. It was the biggest shift in U.S. history in how CMS paid for care. Later, I became principal deputy administrator and acting administrator of CMS, leading an agency that spends over $1 trillion per year, or more than $2.5 billion per day and insures over 130 million Americans. We also improved from being bottom quintile in employee engagement and satisfaction across the federal government to No. 2.

I had assumed that, after working at CMS, I would return to a hospital/health system leadership role. But then, a recruiter called about the CEO role at Blue Cross Blue Shield of North Carolina. It is one of the largest not-for-profit health plans in the country and insures most of the people in North Carolina, many for most of their lives. I met a 75-year-old woman the other day that we have insured every day of her life. I am almost a year into the role and it is a mission-driven organization that drives positive change. I love it so far.

We are going to partner with providers, so that more than half of our payments will be in advanced alternative payment models. No payer in the United States has done that yet. This allows us to innovate and decrease friction in the system (e.g., turn off prior authorization) and be jointly accountable with providers for quality and total cost of care. We insure people through the ACA [Affordable Care Act], commercial, and Medicare markets, and are competing to serve Medicaid as well. We have invested more than $50 million to address social determinants of health across the state. We are making major investments in primary care, and mental and behavioral health. Our goal is to be a Model Blue – or a Model of Health Transformation for our state and nation – and achieve better health outcomes, lower costs, and best-in-class experience for all people we serve. I have learned that no physician leads a health plan of this size, and apparently, no practicing physician has ever led a health plan of this size.

What are some lessons learned over my career? I have had five criteria for all my career decisions: 1) family; 2) impact – better care and outcomes, lower costs, and exceptional experience for populations of patients; 3) people – mentors and colleagues; 4) learning; and 5) joy in work. If someone gives you a chance to lead people in your career as a physician, jump at the chance. We do a relatively poor job of providing this type of opportunity to those early in their careers in medicine, and learning how to manage people and money allows you to progress as a leader and manager.

Don’t listen to the people who say “you must do X before Y” or “you must take this path.” They are usually wrong. Take chances. I applied for many roles for which I was a long shot, and I didn’t always succeed. That’s life and learning. Hospital medicine is a great career. I worked in the hospital on a recent weekend and was able to help families through everything from palliative care decisions and new diagnoses, to recovering from illness. It is an honor to serve and help families in their time of need. Hospitalists have been – and should continue to be – primary drivers of the shift in our health system to value-based care.

As I look back on my career (and I hope I am only halfway done), I could not have predicted more than 90% of it. I was blessed with many opportunities, mentors, and teachers along the way. I try to pass this on by mentoring and teaching others. How did my career happen? I am not sure, but it has been a fun ride! And hopefully I have helped improve the health system some, along the way.
 

Dr. Conway is president and CEO of Blue Cross and Blue Shield of North Carolina. He is a hospitalist and former deputy administrator for innovation and quality at the Centers for Medicare and Medicaid Services.

LONDON – Female investigators are less likely to secure research funding than male investigators, not because their proposed project is of lesser scientific merit, but simply because they are women, according to research published in The Lancet.

Sara Freeman/MDedge News

Women had a 30% lower chance of success in getting funding for a project than did their male counterparts when the caliber of the principal investigator was considered as an explicit part of the grant application process, with an 8.8% probability of getting funded versus 12.7%, respectively. If the application was considered solely on a project basis, however, the gender bias was less (12.1% vs. 12.9%).

The overall success of grant applications was 15.8% in the analysis, which considered almost 24,000 grant applications from more than 7,000 principal investigators submitted to the Canadian Institutes of Health Research (CIHR) between 2011 and 2016.

“I see our study as basically one good thwack in a long game of whack-a-mole,” lead study author Holly O. Witteman, PhD, said during an event to launch a special edition of The Lancet focusing on advancing women in science, medicine, and global health.

Dr. Witteman’s research is one of three original articles included in the thematic issue that brings together female authors and commentators to look at gender equity and what needs to be done to address imbalances. The issue is the result of a call for papers that led to more than 300 submissions from more than 40 countries and, according to an editorial from The Lancet, highlights that gender equity in medicine “is not only a matter of justice and rights, it is crucial for producing the best research and providing the best care to patients.”

That there are discrepancies in research funding awarded to female and male investigators has been known for years, Dr. Witteman, associate professor of family and emergency medicine at Laval University, Quebec City, said at the London press conference. To learn how and why, a “quasiexperimental” approach was used to find out what factors might be influencing the gender gap.

“Women are scored lower for competence compared to men with the same publication record,” she said. It’s not that they publish less or do easier research, or that the quality is lower, they are just viewed less favorably overall throughout their careers. Even when you control for confounding factors, “they still don’t advance as quickly,” she said.

“It had been documented for a while that, overall, women tend to get less grant funding and there hasn’t been any evidence to show either way if maybe women’s grant applications weren’t as good,” Dr. Witteman explained.

In 2014, the CIHR changed the way it funded research projects, creating a “natural experiment.” Two new grant application programs were put in place which largely differed by whether or not an explicit review of the principal investigator and their ability to conduct the research was included.

Adjusting for age and type of research, Dr. Witteman and her coauthors found that there was little difference in the success of women in securing research funding when their grant applications were judged solely on a scientific basis; however, when the focus was placed on the principal investigator, women were disadvantaged.

Dr. Witteman said that “this provides robust evidence in support of the idea that women write equally good grant applications but aren’t evaluated as being equally good scientists.”

So how to redress the balance? Dr. Witteman suggested that one way was for funders to collect robust evidence on the success of grant applications and be transparent who is getting funded and how much funding is being awarded. Institutions should invest in and support young investigators, distributing power and flattening traditionally male-led hierarchies. Salaries should be aligned and research support evened out, she said.

SOURCE: Witteman HO et al. Lancet. 2019. doi: 10.1016/S0140-6736(18)32611-4

LONDON – Female investigators are less likely to secure research funding than male investigators, not because their proposed project is of lesser scientific merit, but simply because they are women, according to research published in The Lancet.

Sara Freeman/MDedge News

Women had a 30% lower chance of success in getting funding for a project than did their male counterparts when the caliber of the principal investigator was considered as an explicit part of the grant application process, with an 8.8% probability of getting funded versus 12.7%, respectively. If the application was considered solely on a project basis, however, the gender bias was less (12.1% vs. 12.9%).

The overall success of grant applications was 15.8% in the analysis, which considered almost 24,000 grant applications from more than 7,000 principal investigators submitted to the Canadian Institutes of Health Research (CIHR) between 2011 and 2016.

“I see our study as basically one good thwack in a long game of whack-a-mole,” lead study author Holly O. Witteman, PhD, said during an event to launch a special edition of The Lancet focusing on advancing women in science, medicine, and global health.

Dr. Witteman’s research is one of three original articles included in the thematic issue that brings together female authors and commentators to look at gender equity and what needs to be done to address imbalances. The issue is the result of a call for papers that led to more than 300 submissions from more than 40 countries and, according to an editorial from The Lancet, highlights that gender equity in medicine “is not only a matter of justice and rights, it is crucial for producing the best research and providing the best care to patients.”

That there are discrepancies in research funding awarded to female and male investigators has been known for years, Dr. Witteman, associate professor of family and emergency medicine at Laval University, Quebec City, said at the London press conference. To learn how and why, a “quasiexperimental” approach was used to find out what factors might be influencing the gender gap.

“Women are scored lower for competence compared to men with the same publication record,” she said. It’s not that they publish less or do easier research, or that the quality is lower, they are just viewed less favorably overall throughout their careers. Even when you control for confounding factors, “they still don’t advance as quickly,” she said.

“It had been documented for a while that, overall, women tend to get less grant funding and there hasn’t been any evidence to show either way if maybe women’s grant applications weren’t as good,” Dr. Witteman explained.

In 2014, the CIHR changed the way it funded research projects, creating a “natural experiment.” Two new grant application programs were put in place which largely differed by whether or not an explicit review of the principal investigator and their ability to conduct the research was included.

Adjusting for age and type of research, Dr. Witteman and her coauthors found that there was little difference in the success of women in securing research funding when their grant applications were judged solely on a scientific basis; however, when the focus was placed on the principal investigator, women were disadvantaged.

Dr. Witteman said that “this provides robust evidence in support of the idea that women write equally good grant applications but aren’t evaluated as being equally good scientists.”

So how to redress the balance? Dr. Witteman suggested that one way was for funders to collect robust evidence on the success of grant applications and be transparent who is getting funded and how much funding is being awarded. Institutions should invest in and support young investigators, distributing power and flattening traditionally male-led hierarchies. Salaries should be aligned and research support evened out, she said.

SOURCE: Witteman HO et al. Lancet. 2019. doi: 10.1016/S0140-6736(18)32611-4

LONDON – Female investigators are less likely to secure research funding than male investigators, not because their proposed project is of lesser scientific merit, but simply because they are women, according to research published in The Lancet.

Sara Freeman/MDedge News

Women had a 30% lower chance of success in getting funding for a project than did their male counterparts when the caliber of the principal investigator was considered as an explicit part of the grant application process, with an 8.8% probability of getting funded versus 12.7%, respectively. If the application was considered solely on a project basis, however, the gender bias was less (12.1% vs. 12.9%).

The overall success of grant applications was 15.8% in the analysis, which considered almost 24,000 grant applications from more than 7,000 principal investigators submitted to the Canadian Institutes of Health Research (CIHR) between 2011 and 2016.

“I see our study as basically one good thwack in a long game of whack-a-mole,” lead study author Holly O. Witteman, PhD, said during an event to launch a special edition of The Lancet focusing on advancing women in science, medicine, and global health.

Dr. Witteman’s research is one of three original articles included in the thematic issue that brings together female authors and commentators to look at gender equity and what needs to be done to address imbalances. The issue is the result of a call for papers that led to more than 300 submissions from more than 40 countries and, according to an editorial from The Lancet, highlights that gender equity in medicine “is not only a matter of justice and rights, it is crucial for producing the best research and providing the best care to patients.”

That there are discrepancies in research funding awarded to female and male investigators has been known for years, Dr. Witteman, associate professor of family and emergency medicine at Laval University, Quebec City, said at the London press conference. To learn how and why, a “quasiexperimental” approach was used to find out what factors might be influencing the gender gap.

“Women are scored lower for competence compared to men with the same publication record,” she said. It’s not that they publish less or do easier research, or that the quality is lower, they are just viewed less favorably overall throughout their careers. Even when you control for confounding factors, “they still don’t advance as quickly,” she said.

“It had been documented for a while that, overall, women tend to get less grant funding and there hasn’t been any evidence to show either way if maybe women’s grant applications weren’t as good,” Dr. Witteman explained.

In 2014, the CIHR changed the way it funded research projects, creating a “natural experiment.” Two new grant application programs were put in place which largely differed by whether or not an explicit review of the principal investigator and their ability to conduct the research was included.

Adjusting for age and type of research, Dr. Witteman and her coauthors found that there was little difference in the success of women in securing research funding when their grant applications were judged solely on a scientific basis; however, when the focus was placed on the principal investigator, women were disadvantaged.

Dr. Witteman said that “this provides robust evidence in support of the idea that women write equally good grant applications but aren’t evaluated as being equally good scientists.”

So how to redress the balance? Dr. Witteman suggested that one way was for funders to collect robust evidence on the success of grant applications and be transparent who is getting funded and how much funding is being awarded. Institutions should invest in and support young investigators, distributing power and flattening traditionally male-led hierarchies. Salaries should be aligned and research support evened out, she said.

SOURCE: Witteman HO et al. Lancet. 2019. doi: 10.1016/S0140-6736(18)32611-4

Are residents generally prepared for fellowship interviews? Applications to the Fellowship Match through the National Residency Matching Program (NRMP) Specialties Matching Service (SMS) are at an all-time high, but there is limited data regarding the preparedness of residents who go through the fellowship interview process, said Kelvin Wong, MD, a coauthor of research describing a new approach to fellowship interview preparation, which may be generalizable to hospitalists in applying for other positions.

“Applicants receive little to no feedback after their interviews and are thus likely to repeat the same mistakes throughout the process. Verbal feedback from our own fellowship directors indicated that residents as a whole are unprepared to interview,” according to an abstract written by Dr. Wong and his colleagues.

Dr. Wong wanted to investigate the effects of a standardized fellowship interview preparation course on resident preparedness. He and his coauthors developed a formal preparation course for the applicants in the summer of 2017.

Precourse surveys showed that only 17.65% of residents felt prepared to go on interviews; postcourse surveys showed a rise in this number to 82.35%. Immediately after their mock interview, only 27.78% of residents rated their overall interview skills as “very good” or “excellent,” whereas 87.5% of interviewers and 70.59% of observers rated their skills to be “very good” or “excellent.”

A final survey will be given to the applicants and the fellowship program directors once the applicants have completed all of their actual interviews.

“This demonstrates the potential positive impact that mock interviews and standardized interview preparation courses can have, which may be generalizable to hospitalists applying for other positions,” Dr. Wong said. “Specifically for teaching hospitalists in teaching hospitals, the institution of such fellowship interview preparation courses may improve resident preparedness for the fellowship application process.”
 

Reference

1. Wong K et al. A novel approach to improve fellowship interview skills [abstract]. https://www.shmabstracts.com/abstract/a-novel-approach-to-improve-fellowship-interview-skills/.

Are residents generally prepared for fellowship interviews? Applications to the Fellowship Match through the National Residency Matching Program (NRMP) Specialties Matching Service (SMS) are at an all-time high, but there is limited data regarding the preparedness of residents who go through the fellowship interview process, said Kelvin Wong, MD, a coauthor of research describing a new approach to fellowship interview preparation, which may be generalizable to hospitalists in applying for other positions.

“Applicants receive little to no feedback after their interviews and are thus likely to repeat the same mistakes throughout the process. Verbal feedback from our own fellowship directors indicated that residents as a whole are unprepared to interview,” according to an abstract written by Dr. Wong and his colleagues.

Dr. Wong wanted to investigate the effects of a standardized fellowship interview preparation course on resident preparedness. He and his coauthors developed a formal preparation course for the applicants in the summer of 2017.

Precourse surveys showed that only 17.65% of residents felt prepared to go on interviews; postcourse surveys showed a rise in this number to 82.35%. Immediately after their mock interview, only 27.78% of residents rated their overall interview skills as “very good” or “excellent,” whereas 87.5% of interviewers and 70.59% of observers rated their skills to be “very good” or “excellent.”

A final survey will be given to the applicants and the fellowship program directors once the applicants have completed all of their actual interviews.

“This demonstrates the potential positive impact that mock interviews and standardized interview preparation courses can have, which may be generalizable to hospitalists applying for other positions,” Dr. Wong said. “Specifically for teaching hospitalists in teaching hospitals, the institution of such fellowship interview preparation courses may improve resident preparedness for the fellowship application process.”
 

Reference

1. Wong K et al. A novel approach to improve fellowship interview skills [abstract]. https://www.shmabstracts.com/abstract/a-novel-approach-to-improve-fellowship-interview-skills/.

Are residents generally prepared for fellowship interviews? Applications to the Fellowship Match through the National Residency Matching Program (NRMP) Specialties Matching Service (SMS) are at an all-time high, but there is limited data regarding the preparedness of residents who go through the fellowship interview process, said Kelvin Wong, MD, a coauthor of research describing a new approach to fellowship interview preparation, which may be generalizable to hospitalists in applying for other positions.

“Applicants receive little to no feedback after their interviews and are thus likely to repeat the same mistakes throughout the process. Verbal feedback from our own fellowship directors indicated that residents as a whole are unprepared to interview,” according to an abstract written by Dr. Wong and his colleagues.

Dr. Wong wanted to investigate the effects of a standardized fellowship interview preparation course on resident preparedness. He and his coauthors developed a formal preparation course for the applicants in the summer of 2017.

Precourse surveys showed that only 17.65% of residents felt prepared to go on interviews; postcourse surveys showed a rise in this number to 82.35%. Immediately after their mock interview, only 27.78% of residents rated their overall interview skills as “very good” or “excellent,” whereas 87.5% of interviewers and 70.59% of observers rated their skills to be “very good” or “excellent.”

A final survey will be given to the applicants and the fellowship program directors once the applicants have completed all of their actual interviews.

“This demonstrates the potential positive impact that mock interviews and standardized interview preparation courses can have, which may be generalizable to hospitalists applying for other positions,” Dr. Wong said. “Specifically for teaching hospitalists in teaching hospitals, the institution of such fellowship interview preparation courses may improve resident preparedness for the fellowship application process.”
 

Reference

1. Wong K et al. A novel approach to improve fellowship interview skills [abstract]. https://www.shmabstracts.com/abstract/a-novel-approach-to-improve-fellowship-interview-skills/.

Emilie Thornhill Davis, PA-C, is the assistant vice president for advanced practice providers at Ochsner Health System in New Orleans. She is the former chair of SHM’s Nurse Practitioner and Physician Assistant (NP/PA) Committee, and has spoken multiple times at the SHM Annual Conference.

In honor of the inaugural National Hospitalist Day, to be held on Thursday, March 7, 2019, The Hospitalist spoke with Ms. Davis about the unique contributions of NP and PA hospitalists to the specialty of hospital medicine.
 

Where did you get your education?

I got my undergraduate degree from Mercer University and then went on to get my prerequisites for PA school, and worked clinically for a year prior to starting graduate school in Savannah, Georgia, at South University.

Was your intention always to be a PA?

During my sophomore year of college, Mercer was starting a PA program. Having been taken care of by PAs for most of my life, I realized that this was a profession I was very interested in. I shadowed a lot of PAs and found that they had extremely high levels of satisfaction. I saw the versatility to do so many types of medicine as a PA.

How did you become interested in hospital medicine?

When I was in PA school, we had small groups that were led by a PA who practiced clinically. The PA who was my small group leader was a hospitalist and was a fantastic role model. I did a clinical rotation with her team, and then went on to do my elective with her team in hospital medicine. When I graduated, I got my first job with the hospital medicine group that I had done those clinical rotations with in Savannah. And then in 2013, after about a year and a half, life brought me to New Orleans and I started working at Ochsner in the department of hospital medicine. I was one of the first two PAs that this group had employed.

What is your current role and title at Ochsner?

From 2013 to 2018, I worked in the department of hospital medicine, and for the last 2 years I functioned as the system lead for advanced practice providers in the department of hospital medicine. In September of 2018, I accepted the role of assistant vice president of advanced practice providers for Ochsner Health System.

What are your areas of interest or research?

I’ve had the opportunity to speak at the annual Society of Hospital Medicine Conference for 3 years in a row on innovative models of care, and nurse practitioner and PA utilization in hospital medicine. I was the chair for the NP/PA committee, and during that time we developed a toolkit aimed at providing a resource to hospital medicine groups around nurse practitioner and PA integration to practice in full utilization.

What has your experience taught you about how NPs and PAs can best fit into hospital medicine groups?

Nurse practitioners and PAs are perfectly set up to integrate into practice in hospital medicine. Training for PAs specifically is based on the medicine model, where you have a year of didactic and a year of clinical work in all the major disciplines of medicine. And so in a clinical year as a PA, I would rotate through primary care, internal medicine, general surgery, ob.gyn., psychiatry, emergency medicine, pediatrics. When I come out of school, I’m generalist trained, and depending on where your emphasis was during clinical rotations, that could include a lot of inpatient experience.

I transitioned very smoothly into my first role in hospital medicine as a PA, because I had gained that experience while I was a student on clinical rotations. PAs and nurse practitioners are – when they’re utilized appropriately and at the top of their experience and training – able to provide services to patients that can improve quality outcomes, enhance throughput, decrease length of stay, and improve all the different areas that we focus on as hospitalists.

What roles can a PA occupy in relation to physicians and nurse practitioners in hospital medicine?

When you’re looking at a PA versus a nurse practitioner in hospital medicine, you’ll notice that there are differences in the way that PAs and nurse practitioners are trained. All PAs are trained on a medical model and have a very similar kind of generalist background, whereas a nurse practitioner is typically schooled with nursing training that includes bedside experience that you can’t always guarantee with PAs. But once we enter into practice, our scope and the way that we take care of patients over time becomes very similar. So a PA and a nurse practitioner for the most part can function in very similar capacities in hospital medicine.

The only thing that creates a difference for PAs and NPs are federal and state rules and regulations, as well as hospital policies that might create “scope of practice” barriers. For instance, when I first moved to Louisiana, PAs were not able to prescribe Schedule II medications. That created a barrier whenever I was discharging patients who needed prescriptions for Schedule II. That has since changed in the state of Louisiana; now both PAs and NPs have full prescriptive authority in the state.

I would compare the work of PAs and NPs to that of physicians like this: Once you have NPs or PAs who are trained and have experience in the specialty that they are working in, they are able to provide services that would otherwise be provided by physicians.

How does a hospitalist PA work differently from a PA in other care settings?

The scope of practice for a PA is defined by the physician they’re working with. So my day-to-day work as a PA in hospital medicine looked very similar to a physician’s day-to-day work in hospital medicine. In cardiology, for example, the same would likely hold true, but with tasks unique to that specialty.

How does SHM support hospitalist PAs?

SHM is the home where you have physicians, nurse practitioners, and PAs all represented by one society, which I think is really important whenever we’re talking about a membership organization that reflects what things truly look like in practice. When I am a member of SHM, and the physician I work with is a member of SHM, we are getting the same journals and are both familiar with the changes that occur nationally in our specialty; this really helps us to align ourselves clinically, and to understand what’s going on across the country.

What kind of resources do hospitalist PAs need to succeed, either from SHM or from their own institutions?

I think the first thing we have to do is make sure that we’re getting the nomenclature right, that we’re referring to nurse practitioners and physician assistants by their appropriate names and recognizing their role in hospital medicine. Every year that I spoke at the SHM Annual Conference, I had many hospital medicine leaders come up to me and say they needed help with incorporating NPs and PAs, not only clinically, but also making sure they were represented within their hospital system. That’s why we developed the toolkit, which provides resources for integrating NPs and PAs into practice.

There is an investment early on when you bring PAs into your group to train them. We often use the SHM core competencies when we are referring to a training guide for PAs or NPs as a way to categorize the different materials that they would need to know to practice efficiently, but I do think those could be expanded upon.

What’s on the horizon for NPs and PAs in hospital medicine?

One national trend I see is an increase in the number of NPs and PAs entering hospital medicine. The other big trend is the formal development of postgraduate fellowships for PAs in hospital medicine. As the complexity of our health systems continues to grow, the feeling is that to get a nurse practitioner and PA the training they need, there are benefits to having a protected postgrad year to learn.

One unique thing about nurse practitioners and PAs is their versatility and their ability to move among the various medical specialties. As a PA or a nurse practitioner, if I’m working in hospital medicine and I have a really strong foundation, there’s nothing to say that I couldn’t then accept a job in CV surgery or cardiology and bring those skills with me from hospital medicine.

But this is kind of a double-edged sword, because it also means that you may have a PA or NP leave your HM group after 1-2 years. That kind of turnover is a difficult thing to address, because it means dealing with issues such as workplace culture and compensation. But that shows why training and engagement is important early on in that first year – to make sure that NPs and PAs feel fully supported to meet the demands that hospital medicine requires. All of those things really factor into whether an NP or PA will choose to continue in the field.

Emilie Thornhill Davis, PA-C, is the assistant vice president for advanced practice providers at Ochsner Health System in New Orleans. She is the former chair of SHM’s Nurse Practitioner and Physician Assistant (NP/PA) Committee, and has spoken multiple times at the SHM Annual Conference.

In honor of the inaugural National Hospitalist Day, to be held on Thursday, March 7, 2019, The Hospitalist spoke with Ms. Davis about the unique contributions of NP and PA hospitalists to the specialty of hospital medicine.
 

Where did you get your education?

I got my undergraduate degree from Mercer University and then went on to get my prerequisites for PA school, and worked clinically for a year prior to starting graduate school in Savannah, Georgia, at South University.

Was your intention always to be a PA?

During my sophomore year of college, Mercer was starting a PA program. Having been taken care of by PAs for most of my life, I realized that this was a profession I was very interested in. I shadowed a lot of PAs and found that they had extremely high levels of satisfaction. I saw the versatility to do so many types of medicine as a PA.

How did you become interested in hospital medicine?

When I was in PA school, we had small groups that were led by a PA who practiced clinically. The PA who was my small group leader was a hospitalist and was a fantastic role model. I did a clinical rotation with her team, and then went on to do my elective with her team in hospital medicine. When I graduated, I got my first job with the hospital medicine group that I had done those clinical rotations with in Savannah. And then in 2013, after about a year and a half, life brought me to New Orleans and I started working at Ochsner in the department of hospital medicine. I was one of the first two PAs that this group had employed.

What is your current role and title at Ochsner?

From 2013 to 2018, I worked in the department of hospital medicine, and for the last 2 years I functioned as the system lead for advanced practice providers in the department of hospital medicine. In September of 2018, I accepted the role of assistant vice president of advanced practice providers for Ochsner Health System.

What are your areas of interest or research?

I’ve had the opportunity to speak at the annual Society of Hospital Medicine Conference for 3 years in a row on innovative models of care, and nurse practitioner and PA utilization in hospital medicine. I was the chair for the NP/PA committee, and during that time we developed a toolkit aimed at providing a resource to hospital medicine groups around nurse practitioner and PA integration to practice in full utilization.

What has your experience taught you about how NPs and PAs can best fit into hospital medicine groups?

Nurse practitioners and PAs are perfectly set up to integrate into practice in hospital medicine. Training for PAs specifically is based on the medicine model, where you have a year of didactic and a year of clinical work in all the major disciplines of medicine. And so in a clinical year as a PA, I would rotate through primary care, internal medicine, general surgery, ob.gyn., psychiatry, emergency medicine, pediatrics. When I come out of school, I’m generalist trained, and depending on where your emphasis was during clinical rotations, that could include a lot of inpatient experience.

I transitioned very smoothly into my first role in hospital medicine as a PA, because I had gained that experience while I was a student on clinical rotations. PAs and nurse practitioners are – when they’re utilized appropriately and at the top of their experience and training – able to provide services to patients that can improve quality outcomes, enhance throughput, decrease length of stay, and improve all the different areas that we focus on as hospitalists.

What roles can a PA occupy in relation to physicians and nurse practitioners in hospital medicine?

When you’re looking at a PA versus a nurse practitioner in hospital medicine, you’ll notice that there are differences in the way that PAs and nurse practitioners are trained. All PAs are trained on a medical model and have a very similar kind of generalist background, whereas a nurse practitioner is typically schooled with nursing training that includes bedside experience that you can’t always guarantee with PAs. But once we enter into practice, our scope and the way that we take care of patients over time becomes very similar. So a PA and a nurse practitioner for the most part can function in very similar capacities in hospital medicine.

The only thing that creates a difference for PAs and NPs are federal and state rules and regulations, as well as hospital policies that might create “scope of practice” barriers. For instance, when I first moved to Louisiana, PAs were not able to prescribe Schedule II medications. That created a barrier whenever I was discharging patients who needed prescriptions for Schedule II. That has since changed in the state of Louisiana; now both PAs and NPs have full prescriptive authority in the state.

I would compare the work of PAs and NPs to that of physicians like this: Once you have NPs or PAs who are trained and have experience in the specialty that they are working in, they are able to provide services that would otherwise be provided by physicians.

How does a hospitalist PA work differently from a PA in other care settings?

The scope of practice for a PA is defined by the physician they’re working with. So my day-to-day work as a PA in hospital medicine looked very similar to a physician’s day-to-day work in hospital medicine. In cardiology, for example, the same would likely hold true, but with tasks unique to that specialty.

How does SHM support hospitalist PAs?

SHM is the home where you have physicians, nurse practitioners, and PAs all represented by one society, which I think is really important whenever we’re talking about a membership organization that reflects what things truly look like in practice. When I am a member of SHM, and the physician I work with is a member of SHM, we are getting the same journals and are both familiar with the changes that occur nationally in our specialty; this really helps us to align ourselves clinically, and to understand what’s going on across the country.

What kind of resources do hospitalist PAs need to succeed, either from SHM or from their own institutions?

I think the first thing we have to do is make sure that we’re getting the nomenclature right, that we’re referring to nurse practitioners and physician assistants by their appropriate names and recognizing their role in hospital medicine. Every year that I spoke at the SHM Annual Conference, I had many hospital medicine leaders come up to me and say they needed help with incorporating NPs and PAs, not only clinically, but also making sure they were represented within their hospital system. That’s why we developed the toolkit, which provides resources for integrating NPs and PAs into practice.

There is an investment early on when you bring PAs into your group to train them. We often use the SHM core competencies when we are referring to a training guide for PAs or NPs as a way to categorize the different materials that they would need to know to practice efficiently, but I do think those could be expanded upon.

What’s on the horizon for NPs and PAs in hospital medicine?

One national trend I see is an increase in the number of NPs and PAs entering hospital medicine. The other big trend is the formal development of postgraduate fellowships for PAs in hospital medicine. As the complexity of our health systems continues to grow, the feeling is that to get a nurse practitioner and PA the training they need, there are benefits to having a protected postgrad year to learn.

One unique thing about nurse practitioners and PAs is their versatility and their ability to move among the various medical specialties. As a PA or a nurse practitioner, if I’m working in hospital medicine and I have a really strong foundation, there’s nothing to say that I couldn’t then accept a job in CV surgery or cardiology and bring those skills with me from hospital medicine.

But this is kind of a double-edged sword, because it also means that you may have a PA or NP leave your HM group after 1-2 years. That kind of turnover is a difficult thing to address, because it means dealing with issues such as workplace culture and compensation. But that shows why training and engagement is important early on in that first year – to make sure that NPs and PAs feel fully supported to meet the demands that hospital medicine requires. All of those things really factor into whether an NP or PA will choose to continue in the field.

Emilie Thornhill Davis, PA-C, is the assistant vice president for advanced practice providers at Ochsner Health System in New Orleans. She is the former chair of SHM’s Nurse Practitioner and Physician Assistant (NP/PA) Committee, and has spoken multiple times at the SHM Annual Conference.

In honor of the inaugural National Hospitalist Day, to be held on Thursday, March 7, 2019, The Hospitalist spoke with Ms. Davis about the unique contributions of NP and PA hospitalists to the specialty of hospital medicine.
 

Where did you get your education?

I got my undergraduate degree from Mercer University and then went on to get my prerequisites for PA school, and worked clinically for a year prior to starting graduate school in Savannah, Georgia, at South University.

Was your intention always to be a PA?

During my sophomore year of college, Mercer was starting a PA program. Having been taken care of by PAs for most of my life, I realized that this was a profession I was very interested in. I shadowed a lot of PAs and found that they had extremely high levels of satisfaction. I saw the versatility to do so many types of medicine as a PA.

How did you become interested in hospital medicine?

When I was in PA school, we had small groups that were led by a PA who practiced clinically. The PA who was my small group leader was a hospitalist and was a fantastic role model. I did a clinical rotation with her team, and then went on to do my elective with her team in hospital medicine. When I graduated, I got my first job with the hospital medicine group that I had done those clinical rotations with in Savannah. And then in 2013, after about a year and a half, life brought me to New Orleans and I started working at Ochsner in the department of hospital medicine. I was one of the first two PAs that this group had employed.

What is your current role and title at Ochsner?

From 2013 to 2018, I worked in the department of hospital medicine, and for the last 2 years I functioned as the system lead for advanced practice providers in the department of hospital medicine. In September of 2018, I accepted the role of assistant vice president of advanced practice providers for Ochsner Health System.

What are your areas of interest or research?

I’ve had the opportunity to speak at the annual Society of Hospital Medicine Conference for 3 years in a row on innovative models of care, and nurse practitioner and PA utilization in hospital medicine. I was the chair for the NP/PA committee, and during that time we developed a toolkit aimed at providing a resource to hospital medicine groups around nurse practitioner and PA integration to practice in full utilization.

What has your experience taught you about how NPs and PAs can best fit into hospital medicine groups?

Nurse practitioners and PAs are perfectly set up to integrate into practice in hospital medicine. Training for PAs specifically is based on the medicine model, where you have a year of didactic and a year of clinical work in all the major disciplines of medicine. And so in a clinical year as a PA, I would rotate through primary care, internal medicine, general surgery, ob.gyn., psychiatry, emergency medicine, pediatrics. When I come out of school, I’m generalist trained, and depending on where your emphasis was during clinical rotations, that could include a lot of inpatient experience.

I transitioned very smoothly into my first role in hospital medicine as a PA, because I had gained that experience while I was a student on clinical rotations. PAs and nurse practitioners are – when they’re utilized appropriately and at the top of their experience and training – able to provide services to patients that can improve quality outcomes, enhance throughput, decrease length of stay, and improve all the different areas that we focus on as hospitalists.

What roles can a PA occupy in relation to physicians and nurse practitioners in hospital medicine?

When you’re looking at a PA versus a nurse practitioner in hospital medicine, you’ll notice that there are differences in the way that PAs and nurse practitioners are trained. All PAs are trained on a medical model and have a very similar kind of generalist background, whereas a nurse practitioner is typically schooled with nursing training that includes bedside experience that you can’t always guarantee with PAs. But once we enter into practice, our scope and the way that we take care of patients over time becomes very similar. So a PA and a nurse practitioner for the most part can function in very similar capacities in hospital medicine.

The only thing that creates a difference for PAs and NPs are federal and state rules and regulations, as well as hospital policies that might create “scope of practice” barriers. For instance, when I first moved to Louisiana, PAs were not able to prescribe Schedule II medications. That created a barrier whenever I was discharging patients who needed prescriptions for Schedule II. That has since changed in the state of Louisiana; now both PAs and NPs have full prescriptive authority in the state.

I would compare the work of PAs and NPs to that of physicians like this: Once you have NPs or PAs who are trained and have experience in the specialty that they are working in, they are able to provide services that would otherwise be provided by physicians.

How does a hospitalist PA work differently from a PA in other care settings?

The scope of practice for a PA is defined by the physician they’re working with. So my day-to-day work as a PA in hospital medicine looked very similar to a physician’s day-to-day work in hospital medicine. In cardiology, for example, the same would likely hold true, but with tasks unique to that specialty.

How does SHM support hospitalist PAs?

SHM is the home where you have physicians, nurse practitioners, and PAs all represented by one society, which I think is really important whenever we’re talking about a membership organization that reflects what things truly look like in practice. When I am a member of SHM, and the physician I work with is a member of SHM, we are getting the same journals and are both familiar with the changes that occur nationally in our specialty; this really helps us to align ourselves clinically, and to understand what’s going on across the country.

What kind of resources do hospitalist PAs need to succeed, either from SHM or from their own institutions?

I think the first thing we have to do is make sure that we’re getting the nomenclature right, that we’re referring to nurse practitioners and physician assistants by their appropriate names and recognizing their role in hospital medicine. Every year that I spoke at the SHM Annual Conference, I had many hospital medicine leaders come up to me and say they needed help with incorporating NPs and PAs, not only clinically, but also making sure they were represented within their hospital system. That’s why we developed the toolkit, which provides resources for integrating NPs and PAs into practice.

There is an investment early on when you bring PAs into your group to train them. We often use the SHM core competencies when we are referring to a training guide for PAs or NPs as a way to categorize the different materials that they would need to know to practice efficiently, but I do think those could be expanded upon.

What’s on the horizon for NPs and PAs in hospital medicine?

One national trend I see is an increase in the number of NPs and PAs entering hospital medicine. The other big trend is the formal development of postgraduate fellowships for PAs in hospital medicine. As the complexity of our health systems continues to grow, the feeling is that to get a nurse practitioner and PA the training they need, there are benefits to having a protected postgrad year to learn.

One unique thing about nurse practitioners and PAs is their versatility and their ability to move among the various medical specialties. As a PA or a nurse practitioner, if I’m working in hospital medicine and I have a really strong foundation, there’s nothing to say that I couldn’t then accept a job in CV surgery or cardiology and bring those skills with me from hospital medicine.

But this is kind of a double-edged sword, because it also means that you may have a PA or NP leave your HM group after 1-2 years. That kind of turnover is a difficult thing to address, because it means dealing with issues such as workplace culture and compensation. But that shows why training and engagement is important early on in that first year – to make sure that NPs and PAs feel fully supported to meet the demands that hospital medicine requires. All of those things really factor into whether an NP or PA will choose to continue in the field.

Samir S. Shah, MD, MSCE, director of the division of hospital medicine at Cincinnati Children’s Hospital Medical Center, believes that pediatric and adult hospitalists have much to learn from each other. And he aims to promote that mutual education in his new role as editor in chief of the Journal of Hospital Medicine.

Dr. Shah is the first pediatric hospitalist to hold this position for JHM, the official journal of the Society of Hospital Medicine. He says his new position, which became effective Jan. 1, is primed for fostering interaction between pediatric and adult hospitalists. “Pediatric hospital medicine is such a vibrant community of its own. There are many opportunities for partnership and collaboration between adult and pediatric hospitalists,” he said.

The field of pediatric hospital medicine has started down the path toward becoming recognized as a board-certified subspecialty.¹ “That will place a greater emphasis on our role in fellowship training, which is important to ensure that pediatric hospitalists have a clearly defined skill set,” Dr. Shah said. “So much of what we learn in medical school is oriented to the medical care of adults. If you go into pediatrics, you’ve already had a fair amount of grounding in the healthy physiology and common diseases of adults. Pediatric hospital medicine fellowships offer an opportunity to refine clinical skill sets, as well as develop new skills in domains such as research and leadership.”
 

An emphasis on diversity

Although he has praised the innovative work of his predecessors, Mark Williams, MD, MHM, and Andrew Auerbach, MD, MPH, MHM, in shepherding the journal to its current strong position, Dr. Shah brings ideas for new features and directions.

“We as a field really benefit from a diversity of skill sets and perspectives. I’m excited to create processes to ensure equity and diversity in everything we do, starting with adding more women and more pediatric hospitalists to the journal’s leadership team, as well as purposefully developing a diverse leadership pipeline for the journal and for the field,” he said.

“We are intentionally reaching out to pediatricians to emphasize the extent to which JHM is invested in their field. For example, we have increased by seven the number of pediatricians as part of the JHM leadership team.” But pediatric hospitalists have always seen JHM as a home for their work, and Dr. Shah himself has published a couple dozen research papers in the journal. “It has always felt to me like a welcoming place,” he said.

“The great thing for me is that I’m not doing this alone. We have a marvelous crew of senior deputy editors, deputy editors, associate editors, and advisors. The opportunity I have is to leverage the phenomenal expertise and enthusiasm of this exceptional team.”

The journal under Dr. Auerbach’s lead created an editorial fellowship program offering opportunities for 1-year mentored exposure to the publication of academic scholarship and to different aspects of how a medical journal works. “We’re excited to continue investing in this program and included an editorial about it and an application form in the January 2019 issue of the Journal,” Dr. Shah said. He encourages editorial fellowship applications from physicians who historically have been underrepresented in academic medicine leadership.

“We’re also creating a column on leadership and professional development so that leaders in different fields can share their perspective and wisdom with our readers. We’ll be presenting a new, shorter review format; distilling clinical practice guidelines; and working on redesigning the journal’s web presence. We believe that our readers interact with the journal differently than they did five years ago, and increasingly are leveraging social media,” he said.

“I’m eager to broaden the scope of the journal. In the past, we focused on quality, value in health care and transitions of care in and out of the hospital, which are important topics. But I’m also excited about the adoption of new technologies, how to evaluate them and incorporate them into medical practice – things like Apple Watch for measuring heart rhythm,” Dr. Shah.

He wants to explore other technology-related topics like alarm fatigue and the use of monitors. Another big subject is the management of health of populations under new, emerging, risk-based payment models, with their pressures on health systems to take greater responsibility for risk. JHM is a medical journal and an official society journal, Dr. Shah said. “But our readership and submitters are not limited to hospitalists. As editor in chief, I’m here to make sure the journal is relevant to our members and to our other constituencies.”

Dr. Shah joined JHM’s editorial leadership team in 2009, then he became its deputy editor in 2012 and its senior deputy editor in 2015. A founding associate editor of the Journal of the Pediatric Infectious Diseases Society, he has also served on the editorial board of JAMA Pediatrics. He is editor or coeditor of 12 books in the fields of pediatrics and infectious diseases, including coauthoring “The Philadelphia Guide: Inpatient Pediatrics for McGraw-Hill Education” while still a fellow in academic general pediatrics and pediatric infectious diseases at Children’s Hospital of Philadelphia (CHOP) and, more recently, “Pediatric Infectious Diseases: Essentials for Practice,” a textbook for the pediatric generalist.
 

Broad scope of activities

Dr. Shah started practicing pediatric hospital medicine in 2001 during his fellowship training. He joined the faculty at CHOP and the University of Pennsylvania, also in Philadelphia, in 2005. In 2011 he arrived at Cincinnati Children’s Hospital, a facility with more than 600 beds that’s affiliated with the University of Cincinnati, where he is professor in the department of pediatrics and holds the James M. Ewell Endowed Chair, to lead a newly created division of hospital medicine. That division now includes more than 55 physician faculty members, 10 nurse practitioners, and nine 3-year fellows.

Collectively the staff represent a broad scope of clinical and research activities along with consulting and surgical comanagement roles and a unique service staffed by med/peds hospitalists for adult patients who have been followed at the hospital since they were children. “Years ago, those patients would not have survived beyond childhood, but with medical advances, they have. Although they continue to benefit from pediatric expertise, these adults also require internal medicine expertise for their adult health needs,” he explained. Examples include patients with neurologic impairments, dependence on medical technology, or congenital heart defects.

Dr. Shah’s own schedule is 28% clinical. He also serves as the hospital’s chief metrics officer, and his research interests include serious infectious diseases, such as pneumonia and meningitis. He is studying the comparative effectiveness of different antibiotic treatments for community-acquired pneumonia and how to improve outcomes for hospital-acquired pneumonia.

Dr. Shah has tried to be deliberate in leading efforts to grow researchers within the field, both nationally and locally. He serves as the chair of the National Childhood Pneumonia Guidelines Committee of the Infectious Diseases Society of America and the Pediatric Infectious Diseases Society, and he also is vice chair of the Pediatric Research in Inpatient Settings (PRIS) Network, which facilitates multicenter cost-effectiveness studies among its 120 hospital members. For example, a series of studies funded by the Patient- Centered Outcomes Research Institute has demonstrated the comparable effectiveness of oral and intravenous antibiotics for osteomyelitis and complicated pneumonia.
 

Sustainable positions

When he was asked whether he felt pediatric hospitalists face particular challenges in trying to take their place in the burgeoning field of hospital medicine, Dr. Shah said he and his colleagues don’t really think of it in those terms. “Hospital medicine is such a dynamic field. For example, pediatric hospital medicine has charted its own course by pursuing subspecialty certification and fellowship training. Yet support from the field broadly has been quite strong, and SHM has embraced pediatricians, who serve on its board of directors and on numerous committees.”

SHM’s commitment to supporting pediatric hospital medicine practice and research includes its cosponsorship, with the Academic Pediatric Association and the American Academy of Pediatrics, an annual pediatric hospital medicine educational and research conference, which will next be held July 25-28, 2019, in Seattle. “In my recent meetings with society leaders I have seen exceptional enthusiasm for increasing the presence of pediatric hospitalists in the society’s work. Many pediatric hospitalists already attend SHM’s annual meeting and submit their research, but we all recognize that a strong pediatric presence is important for the society.”

Dr. Shah credits Cincinnati Children’s Hospital for supporting a sustainable work schedule for its hospitalists and for a team-oriented culture that emphasizes both professional and personal development and encourages a diversity of skill sets and perspectives, skills development, and additional training. “Individuals are recognized for their achievements within and beyond the confines of the hospital. The mentorship structure we set up here is incredible. Each faculty member has a primary mentor, a peer mentor, and access to a career development committee. Additionally, there is broad participation in clinical operations, educational scholarship, research, and quality improvement.”

Dr. Shah’s professional interests in academics, research, and infectious diseases trace back in part to a thesis project he did on neonatal infections while in medical school at Yale University, New Haven, Conn. “I was working with basic sciences in a hematology lab under the direction of the neonatologist Dr. Patrick Gallagher, whose research focused on pediatric blood cell membrane disorders.” Dr. Gallagher, who directs the Yale Center for Blood Disorders, had a keen interest in infections in infants, Dr. Shah recalled.

“He would share with me interesting cases from his practice. What particularly captured my attention was realizing how the research I could do might have a direct impact on patients and families.” Thus inspired to do an additional year of medical school training at Yale before graduating in 1998, Dr. Shah used that year to focus on research, including a placement at the Centers for Disease Control and Prevention to investigate infectious disease outbreaks, which offered real-world mysteries to solve.

“When I was a resident, pediatric hospital medicine had not yet been recognized as a specialty. But during my fellowships, most of my work was focused on the inpatient side of medicine,” he said. That made hospital medicine a natural career path.

Dr. Shah describes himself as a devoted soccer fan with season tickets for himself, his wife, and their three children to the Major League Soccer team FC Cincinnati. He’s also a movie buff and a former avid bicyclist who’s now trying to get back into cycling. He encourages readers of The Hospitalist to contact him with input on any aspect of the Journal of Hospital Medicine. Email him at [email protected] and follow him on Twitter: @samirshahmd.

Reference

1. Barrett DJ et al. Pediatric hospital medicine: A proposed new subspecialty. Pediatrics. 2017 March;139(3):e20161823.

Samir S. Shah, MD, MSCE, director of the division of hospital medicine at Cincinnati Children’s Hospital Medical Center, believes that pediatric and adult hospitalists have much to learn from each other. And he aims to promote that mutual education in his new role as editor in chief of the Journal of Hospital Medicine.

Dr. Shah is the first pediatric hospitalist to hold this position for JHM, the official journal of the Society of Hospital Medicine. He says his new position, which became effective Jan. 1, is primed for fostering interaction between pediatric and adult hospitalists. “Pediatric hospital medicine is such a vibrant community of its own. There are many opportunities for partnership and collaboration between adult and pediatric hospitalists,” he said.

The field of pediatric hospital medicine has started down the path toward becoming recognized as a board-certified subspecialty.¹ “That will place a greater emphasis on our role in fellowship training, which is important to ensure that pediatric hospitalists have a clearly defined skill set,” Dr. Shah said. “So much of what we learn in medical school is oriented to the medical care of adults. If you go into pediatrics, you’ve already had a fair amount of grounding in the healthy physiology and common diseases of adults. Pediatric hospital medicine fellowships offer an opportunity to refine clinical skill sets, as well as develop new skills in domains such as research and leadership.”
 

An emphasis on diversity

Although he has praised the innovative work of his predecessors, Mark Williams, MD, MHM, and Andrew Auerbach, MD, MPH, MHM, in shepherding the journal to its current strong position, Dr. Shah brings ideas for new features and directions.

“We as a field really benefit from a diversity of skill sets and perspectives. I’m excited to create processes to ensure equity and diversity in everything we do, starting with adding more women and more pediatric hospitalists to the journal’s leadership team, as well as purposefully developing a diverse leadership pipeline for the journal and for the field,” he said.

“We are intentionally reaching out to pediatricians to emphasize the extent to which JHM is invested in their field. For example, we have increased by seven the number of pediatricians as part of the JHM leadership team.” But pediatric hospitalists have always seen JHM as a home for their work, and Dr. Shah himself has published a couple dozen research papers in the journal. “It has always felt to me like a welcoming place,” he said.

“The great thing for me is that I’m not doing this alone. We have a marvelous crew of senior deputy editors, deputy editors, associate editors, and advisors. The opportunity I have is to leverage the phenomenal expertise and enthusiasm of this exceptional team.”

The journal under Dr. Auerbach’s lead created an editorial fellowship program offering opportunities for 1-year mentored exposure to the publication of academic scholarship and to different aspects of how a medical journal works. “We’re excited to continue investing in this program and included an editorial about it and an application form in the January 2019 issue of the Journal,” Dr. Shah said. He encourages editorial fellowship applications from physicians who historically have been underrepresented in academic medicine leadership.

“We’re also creating a column on leadership and professional development so that leaders in different fields can share their perspective and wisdom with our readers. We’ll be presenting a new, shorter review format; distilling clinical practice guidelines; and working on redesigning the journal’s web presence. We believe that our readers interact with the journal differently than they did five years ago, and increasingly are leveraging social media,” he said.

“I’m eager to broaden the scope of the journal. In the past, we focused on quality, value in health care and transitions of care in and out of the hospital, which are important topics. But I’m also excited about the adoption of new technologies, how to evaluate them and incorporate them into medical practice – things like Apple Watch for measuring heart rhythm,” Dr. Shah.

He wants to explore other technology-related topics like alarm fatigue and the use of monitors. Another big subject is the management of health of populations under new, emerging, risk-based payment models, with their pressures on health systems to take greater responsibility for risk. JHM is a medical journal and an official society journal, Dr. Shah said. “But our readership and submitters are not limited to hospitalists. As editor in chief, I’m here to make sure the journal is relevant to our members and to our other constituencies.”

Dr. Shah joined JHM’s editorial leadership team in 2009, then he became its deputy editor in 2012 and its senior deputy editor in 2015. A founding associate editor of the Journal of the Pediatric Infectious Diseases Society, he has also served on the editorial board of JAMA Pediatrics. He is editor or coeditor of 12 books in the fields of pediatrics and infectious diseases, including coauthoring “The Philadelphia Guide: Inpatient Pediatrics for McGraw-Hill Education” while still a fellow in academic general pediatrics and pediatric infectious diseases at Children’s Hospital of Philadelphia (CHOP) and, more recently, “Pediatric Infectious Diseases: Essentials for Practice,” a textbook for the pediatric generalist.
 

Broad scope of activities

Dr. Shah started practicing pediatric hospital medicine in 2001 during his fellowship training. He joined the faculty at CHOP and the University of Pennsylvania, also in Philadelphia, in 2005. In 2011 he arrived at Cincinnati Children’s Hospital, a facility with more than 600 beds that’s affiliated with the University of Cincinnati, where he is professor in the department of pediatrics and holds the James M. Ewell Endowed Chair, to lead a newly created division of hospital medicine. That division now includes more than 55 physician faculty members, 10 nurse practitioners, and nine 3-year fellows.

Collectively the staff represent a broad scope of clinical and research activities along with consulting and surgical comanagement roles and a unique service staffed by med/peds hospitalists for adult patients who have been followed at the hospital since they were children. “Years ago, those patients would not have survived beyond childhood, but with medical advances, they have. Although they continue to benefit from pediatric expertise, these adults also require internal medicine expertise for their adult health needs,” he explained. Examples include patients with neurologic impairments, dependence on medical technology, or congenital heart defects.

Dr. Shah’s own schedule is 28% clinical. He also serves as the hospital’s chief metrics officer, and his research interests include serious infectious diseases, such as pneumonia and meningitis. He is studying the comparative effectiveness of different antibiotic treatments for community-acquired pneumonia and how to improve outcomes for hospital-acquired pneumonia.

Dr. Shah has tried to be deliberate in leading efforts to grow researchers within the field, both nationally and locally. He serves as the chair of the National Childhood Pneumonia Guidelines Committee of the Infectious Diseases Society of America and the Pediatric Infectious Diseases Society, and he also is vice chair of the Pediatric Research in Inpatient Settings (PRIS) Network, which facilitates multicenter cost-effectiveness studies among its 120 hospital members. For example, a series of studies funded by the Patient- Centered Outcomes Research Institute has demonstrated the comparable effectiveness of oral and intravenous antibiotics for osteomyelitis and complicated pneumonia.
 

Sustainable positions

When he was asked whether he felt pediatric hospitalists face particular challenges in trying to take their place in the burgeoning field of hospital medicine, Dr. Shah said he and his colleagues don’t really think of it in those terms. “Hospital medicine is such a dynamic field. For example, pediatric hospital medicine has charted its own course by pursuing subspecialty certification and fellowship training. Yet support from the field broadly has been quite strong, and SHM has embraced pediatricians, who serve on its board of directors and on numerous committees.”

SHM’s commitment to supporting pediatric hospital medicine practice and research includes its cosponsorship, with the Academic Pediatric Association and the American Academy of Pediatrics, an annual pediatric hospital medicine educational and research conference, which will next be held July 25-28, 2019, in Seattle. “In my recent meetings with society leaders I have seen exceptional enthusiasm for increasing the presence of pediatric hospitalists in the society’s work. Many pediatric hospitalists already attend SHM’s annual meeting and submit their research, but we all recognize that a strong pediatric presence is important for the society.”

Dr. Shah credits Cincinnati Children’s Hospital for supporting a sustainable work schedule for its hospitalists and for a team-oriented culture that emphasizes both professional and personal development and encourages a diversity of skill sets and perspectives, skills development, and additional training. “Individuals are recognized for their achievements within and beyond the confines of the hospital. The mentorship structure we set up here is incredible. Each faculty member has a primary mentor, a peer mentor, and access to a career development committee. Additionally, there is broad participation in clinical operations, educational scholarship, research, and quality improvement.”

Dr. Shah’s professional interests in academics, research, and infectious diseases trace back in part to a thesis project he did on neonatal infections while in medical school at Yale University, New Haven, Conn. “I was working with basic sciences in a hematology lab under the direction of the neonatologist Dr. Patrick Gallagher, whose research focused on pediatric blood cell membrane disorders.” Dr. Gallagher, who directs the Yale Center for Blood Disorders, had a keen interest in infections in infants, Dr. Shah recalled.

“He would share with me interesting cases from his practice. What particularly captured my attention was realizing how the research I could do might have a direct impact on patients and families.” Thus inspired to do an additional year of medical school training at Yale before graduating in 1998, Dr. Shah used that year to focus on research, including a placement at the Centers for Disease Control and Prevention to investigate infectious disease outbreaks, which offered real-world mysteries to solve.

“When I was a resident, pediatric hospital medicine had not yet been recognized as a specialty. But during my fellowships, most of my work was focused on the inpatient side of medicine,” he said. That made hospital medicine a natural career path.

Dr. Shah describes himself as a devoted soccer fan with season tickets for himself, his wife, and their three children to the Major League Soccer team FC Cincinnati. He’s also a movie buff and a former avid bicyclist who’s now trying to get back into cycling. He encourages readers of The Hospitalist to contact him with input on any aspect of the Journal of Hospital Medicine. Email him at [email protected] and follow him on Twitter: @samirshahmd.

Reference

1. Barrett DJ et al. Pediatric hospital medicine: A proposed new subspecialty. Pediatrics. 2017 March;139(3):e20161823.

Samir S. Shah, MD, MSCE, director of the division of hospital medicine at Cincinnati Children’s Hospital Medical Center, believes that pediatric and adult hospitalists have much to learn from each other. And he aims to promote that mutual education in his new role as editor in chief of the Journal of Hospital Medicine.

Dr. Shah is the first pediatric hospitalist to hold this position for JHM, the official journal of the Society of Hospital Medicine. He says his new position, which became effective Jan. 1, is primed for fostering interaction between pediatric and adult hospitalists. “Pediatric hospital medicine is such a vibrant community of its own. There are many opportunities for partnership and collaboration between adult and pediatric hospitalists,” he said.

The field of pediatric hospital medicine has started down the path toward becoming recognized as a board-certified subspecialty.¹ “That will place a greater emphasis on our role in fellowship training, which is important to ensure that pediatric hospitalists have a clearly defined skill set,” Dr. Shah said. “So much of what we learn in medical school is oriented to the medical care of adults. If you go into pediatrics, you’ve already had a fair amount of grounding in the healthy physiology and common diseases of adults. Pediatric hospital medicine fellowships offer an opportunity to refine clinical skill sets, as well as develop new skills in domains such as research and leadership.”
 

An emphasis on diversity

Although he has praised the innovative work of his predecessors, Mark Williams, MD, MHM, and Andrew Auerbach, MD, MPH, MHM, in shepherding the journal to its current strong position, Dr. Shah brings ideas for new features and directions.

“We as a field really benefit from a diversity of skill sets and perspectives. I’m excited to create processes to ensure equity and diversity in everything we do, starting with adding more women and more pediatric hospitalists to the journal’s leadership team, as well as purposefully developing a diverse leadership pipeline for the journal and for the field,” he said.

“We are intentionally reaching out to pediatricians to emphasize the extent to which JHM is invested in their field. For example, we have increased by seven the number of pediatricians as part of the JHM leadership team.” But pediatric hospitalists have always seen JHM as a home for their work, and Dr. Shah himself has published a couple dozen research papers in the journal. “It has always felt to me like a welcoming place,” he said.

“The great thing for me is that I’m not doing this alone. We have a marvelous crew of senior deputy editors, deputy editors, associate editors, and advisors. The opportunity I have is to leverage the phenomenal expertise and enthusiasm of this exceptional team.”

The journal under Dr. Auerbach’s lead created an editorial fellowship program offering opportunities for 1-year mentored exposure to the publication of academic scholarship and to different aspects of how a medical journal works. “We’re excited to continue investing in this program and included an editorial about it and an application form in the January 2019 issue of the Journal,” Dr. Shah said. He encourages editorial fellowship applications from physicians who historically have been underrepresented in academic medicine leadership.

“We’re also creating a column on leadership and professional development so that leaders in different fields can share their perspective and wisdom with our readers. We’ll be presenting a new, shorter review format; distilling clinical practice guidelines; and working on redesigning the journal’s web presence. We believe that our readers interact with the journal differently than they did five years ago, and increasingly are leveraging social media,” he said.

“I’m eager to broaden the scope of the journal. In the past, we focused on quality, value in health care and transitions of care in and out of the hospital, which are important topics. But I’m also excited about the adoption of new technologies, how to evaluate them and incorporate them into medical practice – things like Apple Watch for measuring heart rhythm,” Dr. Shah.

He wants to explore other technology-related topics like alarm fatigue and the use of monitors. Another big subject is the management of health of populations under new, emerging, risk-based payment models, with their pressures on health systems to take greater responsibility for risk. JHM is a medical journal and an official society journal, Dr. Shah said. “But our readership and submitters are not limited to hospitalists. As editor in chief, I’m here to make sure the journal is relevant to our members and to our other constituencies.”

Dr. Shah joined JHM’s editorial leadership team in 2009, then he became its deputy editor in 2012 and its senior deputy editor in 2015. A founding associate editor of the Journal of the Pediatric Infectious Diseases Society, he has also served on the editorial board of JAMA Pediatrics. He is editor or coeditor of 12 books in the fields of pediatrics and infectious diseases, including coauthoring “The Philadelphia Guide: Inpatient Pediatrics for McGraw-Hill Education” while still a fellow in academic general pediatrics and pediatric infectious diseases at Children’s Hospital of Philadelphia (CHOP) and, more recently, “Pediatric Infectious Diseases: Essentials for Practice,” a textbook for the pediatric generalist.
 

Broad scope of activities

Dr. Shah started practicing pediatric hospital medicine in 2001 during his fellowship training. He joined the faculty at CHOP and the University of Pennsylvania, also in Philadelphia, in 2005. In 2011 he arrived at Cincinnati Children’s Hospital, a facility with more than 600 beds that’s affiliated with the University of Cincinnati, where he is professor in the department of pediatrics and holds the James M. Ewell Endowed Chair, to lead a newly created division of hospital medicine. That division now includes more than 55 physician faculty members, 10 nurse practitioners, and nine 3-year fellows.

Collectively the staff represent a broad scope of clinical and research activities along with consulting and surgical comanagement roles and a unique service staffed by med/peds hospitalists for adult patients who have been followed at the hospital since they were children. “Years ago, those patients would not have survived beyond childhood, but with medical advances, they have. Although they continue to benefit from pediatric expertise, these adults also require internal medicine expertise for their adult health needs,” he explained. Examples include patients with neurologic impairments, dependence on medical technology, or congenital heart defects.

Dr. Shah’s own schedule is 28% clinical. He also serves as the hospital’s chief metrics officer, and his research interests include serious infectious diseases, such as pneumonia and meningitis. He is studying the comparative effectiveness of different antibiotic treatments for community-acquired pneumonia and how to improve outcomes for hospital-acquired pneumonia.

Dr. Shah has tried to be deliberate in leading efforts to grow researchers within the field, both nationally and locally. He serves as the chair of the National Childhood Pneumonia Guidelines Committee of the Infectious Diseases Society of America and the Pediatric Infectious Diseases Society, and he also is vice chair of the Pediatric Research in Inpatient Settings (PRIS) Network, which facilitates multicenter cost-effectiveness studies among its 120 hospital members. For example, a series of studies funded by the Patient- Centered Outcomes Research Institute has demonstrated the comparable effectiveness of oral and intravenous antibiotics for osteomyelitis and complicated pneumonia.
 

Sustainable positions

When he was asked whether he felt pediatric hospitalists face particular challenges in trying to take their place in the burgeoning field of hospital medicine, Dr. Shah said he and his colleagues don’t really think of it in those terms. “Hospital medicine is such a dynamic field. For example, pediatric hospital medicine has charted its own course by pursuing subspecialty certification and fellowship training. Yet support from the field broadly has been quite strong, and SHM has embraced pediatricians, who serve on its board of directors and on numerous committees.”

SHM’s commitment to supporting pediatric hospital medicine practice and research includes its cosponsorship, with the Academic Pediatric Association and the American Academy of Pediatrics, an annual pediatric hospital medicine educational and research conference, which will next be held July 25-28, 2019, in Seattle. “In my recent meetings with society leaders I have seen exceptional enthusiasm for increasing the presence of pediatric hospitalists in the society’s work. Many pediatric hospitalists already attend SHM’s annual meeting and submit their research, but we all recognize that a strong pediatric presence is important for the society.”

Dr. Shah credits Cincinnati Children’s Hospital for supporting a sustainable work schedule for its hospitalists and for a team-oriented culture that emphasizes both professional and personal development and encourages a diversity of skill sets and perspectives, skills development, and additional training. “Individuals are recognized for their achievements within and beyond the confines of the hospital. The mentorship structure we set up here is incredible. Each faculty member has a primary mentor, a peer mentor, and access to a career development committee. Additionally, there is broad participation in clinical operations, educational scholarship, research, and quality improvement.”

Dr. Shah’s professional interests in academics, research, and infectious diseases trace back in part to a thesis project he did on neonatal infections while in medical school at Yale University, New Haven, Conn. “I was working with basic sciences in a hematology lab under the direction of the neonatologist Dr. Patrick Gallagher, whose research focused on pediatric blood cell membrane disorders.” Dr. Gallagher, who directs the Yale Center for Blood Disorders, had a keen interest in infections in infants, Dr. Shah recalled.

“He would share with me interesting cases from his practice. What particularly captured my attention was realizing how the research I could do might have a direct impact on patients and families.” Thus inspired to do an additional year of medical school training at Yale before graduating in 1998, Dr. Shah used that year to focus on research, including a placement at the Centers for Disease Control and Prevention to investigate infectious disease outbreaks, which offered real-world mysteries to solve.

“When I was a resident, pediatric hospital medicine had not yet been recognized as a specialty. But during my fellowships, most of my work was focused on the inpatient side of medicine,” he said. That made hospital medicine a natural career path.

Dr. Shah describes himself as a devoted soccer fan with season tickets for himself, his wife, and their three children to the Major League Soccer team FC Cincinnati. He’s also a movie buff and a former avid bicyclist who’s now trying to get back into cycling. He encourages readers of The Hospitalist to contact him with input on any aspect of the Journal of Hospital Medicine. Email him at [email protected] and follow him on Twitter: @samirshahmd.

Reference

1. Barrett DJ et al. Pediatric hospital medicine: A proposed new subspecialty. Pediatrics. 2017 March;139(3):e20161823.

The Michigan chapter of the Society of Hospital Medicine has named Peter Watson, MD, SFHM, as state Hospitalist of the Year. Dr. Watson is the vice president of care management and outcomes for Health Alliance Plan (HAP) in Detroit. The Michigan chapter cited Dr. Watson’s leadership in hospital medicine and “generosity of spirit” as reasons for his selection.

Dr. Watson oversees nurses, social workers, and support staff while also serving as HAP Midwest Health Plan’s medical director. He’s a founding member of the Michigan SHM chapter, which he formerly represented as president.

Dr. Watson spent 11 years overseeing the Henry Ford Medical Group’s hospitalist program prior to joining HAP, and still works as an attending hospitalist for Henry Ford.

Hyung (Harry) Cho, MD, was named the inaugural chief value officer for NYC Health + Hospitals, which includes 11 hospitals in New York and is the largest public health system in the United States. He will oversee systemwide initiatives in value improvement and the reduction of unnecessary testing and treatment.

Prior to this appointment, Dr. Cho served as an academic hospitalist at Mount Sinai Hospital for 7 years, leading high-value care initiatives. Currently, he is a senior fellow with the Lown Institute in Brookline, Mass., and director of quality improvement implementation for the High Value Practice Academic Alliance.

Nick Fitterman, MD, SFHM, has been promoted to executive director at Huntington (N.Y.) Hospital. Dr. Fitterman has been a long-time physician and administrator at Huntington, serving previously as vice chair of medicine as well as head of hospitalists.

Dr. Fitterman has served as president of SHM’s Long Island chapter.

Previously, Dr. Fitterman was chief resident at the State University of New York at Stony Brook, and he remains an associate professor at Hofstra University, Hempstead, N.Y.

Allen Kachalia, MD, was named director of the Armstrong Institute for Patient Safety and Quality and senior vice president of patient safety and quality for Johns Hopkins Medicine in Baltimore. Dr. Kachalia is a general internist who has been an active academic hospitalist at Brigham and Women’s Hospital in Boston.

Dr. Kachalia will oversee patient safety and quality across all of Hopkins Medicine, with a focus on ending preventable harm, improving outcomes and patient experience, and reducing waste in the system’s delivery of care. He also will guide academic efforts for the Armstrong Institute, formed recently thanks to a $10 million gift.

In addition to his hospitalist work, Dr. Kachalia comes to Hopkins after serving as chief quality officer and vice president of quality and safety at Brigham Health.

Riane Dodge, PA, has been elevated to director of clinical education in physician assistant studies at Clarkson University, Potsdam, N.Y. The veteran physician assistant previously worked as a hospitalist in the Claxton Hepburn Medical Center in Ogdensburg, N.Y. There, she cared for patients in acute rehab, mental health, and on regular medical floors.

Dodge also has a background in urgent care and family medicine, and has experience as an emergency department technician.

BUSINESS MOVES

Surgical Affiliates of Sacramento, a surgical hospitalist provider with expertise in trauma, orthopedic, neurosurgery, and general surgery for hospital systems, has added partnerships with Christus Spohn Hospital South and Christus Spohn Hospital Shoreline in Corpus Christi, Texas.

Surgical Affiliates’ hospitalist system will provide round-the-clock emergency orthopedic surgery service to adult and pediatric patients in the two hospitals. With Surgical Affiliates’ help, Christus Spohn facilities will be able to cover its own patients, as well as those requiring transfer from regional hospitals.

Hospitalist surgeons will handle emergency surgeries and patient surgery consultations. Clinics will be provided at each facility to care for patients after they are discharged.

The Michigan chapter of the Society of Hospital Medicine has named Peter Watson, MD, SFHM, as state Hospitalist of the Year. Dr. Watson is the vice president of care management and outcomes for Health Alliance Plan (HAP) in Detroit. The Michigan chapter cited Dr. Watson’s leadership in hospital medicine and “generosity of spirit” as reasons for his selection.

Dr. Watson oversees nurses, social workers, and support staff while also serving as HAP Midwest Health Plan’s medical director. He’s a founding member of the Michigan SHM chapter, which he formerly represented as president.

Dr. Watson spent 11 years overseeing the Henry Ford Medical Group’s hospitalist program prior to joining HAP, and still works as an attending hospitalist for Henry Ford.

Hyung (Harry) Cho, MD, was named the inaugural chief value officer for NYC Health + Hospitals, which includes 11 hospitals in New York and is the largest public health system in the United States. He will oversee systemwide initiatives in value improvement and the reduction of unnecessary testing and treatment.

Prior to this appointment, Dr. Cho served as an academic hospitalist at Mount Sinai Hospital for 7 years, leading high-value care initiatives. Currently, he is a senior fellow with the Lown Institute in Brookline, Mass., and director of quality improvement implementation for the High Value Practice Academic Alliance.

Nick Fitterman, MD, SFHM, has been promoted to executive director at Huntington (N.Y.) Hospital. Dr. Fitterman has been a long-time physician and administrator at Huntington, serving previously as vice chair of medicine as well as head of hospitalists.

Dr. Fitterman has served as president of SHM’s Long Island chapter.

Previously, Dr. Fitterman was chief resident at the State University of New York at Stony Brook, and he remains an associate professor at Hofstra University, Hempstead, N.Y.

Allen Kachalia, MD, was named director of the Armstrong Institute for Patient Safety and Quality and senior vice president of patient safety and quality for Johns Hopkins Medicine in Baltimore. Dr. Kachalia is a general internist who has been an active academic hospitalist at Brigham and Women’s Hospital in Boston.

Dr. Kachalia will oversee patient safety and quality across all of Hopkins Medicine, with a focus on ending preventable harm, improving outcomes and patient experience, and reducing waste in the system’s delivery of care. He also will guide academic efforts for the Armstrong Institute, formed recently thanks to a $10 million gift.

In addition to his hospitalist work, Dr. Kachalia comes to Hopkins after serving as chief quality officer and vice president of quality and safety at Brigham Health.

Riane Dodge, PA, has been elevated to director of clinical education in physician assistant studies at Clarkson University, Potsdam, N.Y. The veteran physician assistant previously worked as a hospitalist in the Claxton Hepburn Medical Center in Ogdensburg, N.Y. There, she cared for patients in acute rehab, mental health, and on regular medical floors.

Dodge also has a background in urgent care and family medicine, and has experience as an emergency department technician.

BUSINESS MOVES

Surgical Affiliates of Sacramento, a surgical hospitalist provider with expertise in trauma, orthopedic, neurosurgery, and general surgery for hospital systems, has added partnerships with Christus Spohn Hospital South and Christus Spohn Hospital Shoreline in Corpus Christi, Texas.

Surgical Affiliates’ hospitalist system will provide round-the-clock emergency orthopedic surgery service to adult and pediatric patients in the two hospitals. With Surgical Affiliates’ help, Christus Spohn facilities will be able to cover its own patients, as well as those requiring transfer from regional hospitals.

Hospitalist surgeons will handle emergency surgeries and patient surgery consultations. Clinics will be provided at each facility to care for patients after they are discharged.

The Michigan chapter of the Society of Hospital Medicine has named Peter Watson, MD, SFHM, as state Hospitalist of the Year. Dr. Watson is the vice president of care management and outcomes for Health Alliance Plan (HAP) in Detroit. The Michigan chapter cited Dr. Watson’s leadership in hospital medicine and “generosity of spirit” as reasons for his selection.

Dr. Watson oversees nurses, social workers, and support staff while also serving as HAP Midwest Health Plan’s medical director. He’s a founding member of the Michigan SHM chapter, which he formerly represented as president.

Dr. Watson spent 11 years overseeing the Henry Ford Medical Group’s hospitalist program prior to joining HAP, and still works as an attending hospitalist for Henry Ford.

Hyung (Harry) Cho, MD, was named the inaugural chief value officer for NYC Health + Hospitals, which includes 11 hospitals in New York and is the largest public health system in the United States. He will oversee systemwide initiatives in value improvement and the reduction of unnecessary testing and treatment.

Prior to this appointment, Dr. Cho served as an academic hospitalist at Mount Sinai Hospital for 7 years, leading high-value care initiatives. Currently, he is a senior fellow with the Lown Institute in Brookline, Mass., and director of quality improvement implementation for the High Value Practice Academic Alliance.

Nick Fitterman, MD, SFHM, has been promoted to executive director at Huntington (N.Y.) Hospital. Dr. Fitterman has been a long-time physician and administrator at Huntington, serving previously as vice chair of medicine as well as head of hospitalists.

Dr. Fitterman has served as president of SHM’s Long Island chapter.

Previously, Dr. Fitterman was chief resident at the State University of New York at Stony Brook, and he remains an associate professor at Hofstra University, Hempstead, N.Y.

Allen Kachalia, MD, was named director of the Armstrong Institute for Patient Safety and Quality and senior vice president of patient safety and quality for Johns Hopkins Medicine in Baltimore. Dr. Kachalia is a general internist who has been an active academic hospitalist at Brigham and Women’s Hospital in Boston.

Dr. Kachalia will oversee patient safety and quality across all of Hopkins Medicine, with a focus on ending preventable harm, improving outcomes and patient experience, and reducing waste in the system’s delivery of care. He also will guide academic efforts for the Armstrong Institute, formed recently thanks to a $10 million gift.

In addition to his hospitalist work, Dr. Kachalia comes to Hopkins after serving as chief quality officer and vice president of quality and safety at Brigham Health.

Riane Dodge, PA, has been elevated to director of clinical education in physician assistant studies at Clarkson University, Potsdam, N.Y. The veteran physician assistant previously worked as a hospitalist in the Claxton Hepburn Medical Center in Ogdensburg, N.Y. There, she cared for patients in acute rehab, mental health, and on regular medical floors.

Dodge also has a background in urgent care and family medicine, and has experience as an emergency department technician.

BUSINESS MOVES

Surgical Affiliates of Sacramento, a surgical hospitalist provider with expertise in trauma, orthopedic, neurosurgery, and general surgery for hospital systems, has added partnerships with Christus Spohn Hospital South and Christus Spohn Hospital Shoreline in Corpus Christi, Texas.

Surgical Affiliates’ hospitalist system will provide round-the-clock emergency orthopedic surgery service to adult and pediatric patients in the two hospitals. With Surgical Affiliates’ help, Christus Spohn facilities will be able to cover its own patients, as well as those requiring transfer from regional hospitals.

Hospitalist surgeons will handle emergency surgeries and patient surgery consultations. Clinics will be provided at each facility to care for patients after they are discharged.

As Dr. Melanie Schaffer neared the end of her family medicine residency in the spring of 2015, she found herself considering a hospital medicine fellowship. Unsure if she could get a hospitalist job in an urban market given the outpatient focus of her training, Dr. Schaffer began searching for fellowships on the Society of Hospital Medicine website.¹

Likewise, in 2014 Dr. Micah Prochaska was seriously contemplating a hospital medicine fellowship. He was about to graduate from internal medicine residency at the University of Chicago and was eager to gain skills and experience in clinical research.

In 2006, there were a total of 16 HM fellowship programs in the United States, catering to graduates of internal medicine, family medicine, and pediatric residencies.² Since that time, the number of hospital medicine fellowships has grown considerably, paralleling the explosive growth of hospital medicine as a specialty. For example, at one point in the summer of 2018, the SHM website listed 13 clinical family practice fellowships, 29 internal medicine fellowships, and 26 pediatric fellowships. Each fellowship emphasized different aspects of hospital medicine including clinical practice, research, quality improvement, and leadership.

Now more than ever, residents interested in hospital medicine may get overwhelmed by the multitude of options for fellowship training. And the question remains: why pursue fellowship training in the first place?

“I learned that as a family physician it is harder to get a job as a hospitalist outside of smaller communities, and I wanted to have extra training and credentials,” Dr. Schaffer said. “I pursued a fellowship in hospital medicine to hone my inpatient skills, obtain more ICU exposure, and work on procedures.”

Dr. Schaffer’s online search eventually led her to the Advanced Hospital Medicine Fellowship at Swedish Medical Center in Seattle. This 1-year hospital medicine fellowship started in 2008 with an intentional clinical focus, aiming to provide additional training opportunities in hospital medicine primarily to family medicine residency graduates.

“The goal of our program is to bridge the gap between the training of family medicine and internal medicine so our trainees can refine and develop their inpatient skills,” said Dr. David Wilson, program director of the Swedish Hospitalist Fellowship.

During her fellowship year, Dr. Schaffer was caring for hospitalized adult patients on a general medical ward, with supervision from a dedicated group of teaching hospitalists. She also completed rotations in the ICU, on subspecialty services, and received advanced training in point-of-care ultrasound.

Now in her second year of practice as a full time adult hospitalist at Swedish Medical Center, Dr. Schaffer believes her year of hospital medicine fellowship prepared her well for her current position.

“I am constantly using the tools and knowledge I acquired during my fellowship year,” she said. “I would encourage anyone who has an interest in working on procedural skills and gaining more ICU exposure to pursue a similar fellowship.”

In contrast to Dr. Schaffer, Dr. Prochaska was satisfied with his clinical training but chose to pursue a hospital medicine fellowship to develop research skills. Prior to starting the 2-year Hospitalist Scholars Training Program at the University of Chicago in 2014, Dr. Prochaska had a clear vision of becoming a hospital medicine health outcomes investigator, and believed this career would not be possible without the additional training offered by a research-focused fellowship program.

The Hospitalist Scholars Program at the University of Chicago, one of the first programs of its kind, offers a built-in master’s degree to all participants. At the conclusion of his fellowship training in 2016, Dr. Prochaska completed his Master’s in Health Sciences, which gives considerable attention to biostatistics and epidemiology. According to Dr. Prochaska, the key to becoming a successful academic researcher lies in one’s ability to write grants and receive funding, a skill he honed during this fellowship.

Now on faculty at the University of Chicago in the Section of Hospital Medicine, Dr. Prochaska devotes approximately 75% of his time to research and 25% to patient care.

Beyond the research training and experience he gained during his hospital medicine fellowship, Dr. Prochaska said he values the mentorship afforded to him. He noted that one of the most meaningful experiences during his 2 years of fellowship was having the opportunity to sit down with his program directors, Dr. Vineet Arora and Dr. David Meltzer, to discuss the trajectory of his career in academic medicine.

“It is hard to find senior mentors in hospital medicine,” Dr. Prochaska said. “You could get a master’s degree on your own, but with the fellowship program, your mentors can help you think about the next steps in your career.”

For Dr. Schaffer and Dr. Prochaska, fellowship provided training and experience well-matched to their individual goals and helped foster their careers in hospital medicine. For some, however, a fellowship may not be a necessary step on the path to becoming a hospitalist. Many leaders in the field of hospital medicine have advanced in their careers without further training. In addition, receiving little more than a resident’s salary for an additional year or more during fellowship may not be financially tenable for some. Given the ongoing demand for hospitalists across the country, the lack of a fellowship on your resume may not significantly diminish your chances of securing a position, especially in the community setting.

In the end, the decision of whether to pursue a hospital medicine fellowship is a personal one, and the programs available are as varied as the individuals completing them. “Any hospitalist interested in more than simply patient care – potentially QI, medical education, policy, or administration – should consider a fellowship,” Dr. Prochaska said. “Hospitalists have a unique opportunity to be involved in all these areas, but there are absolutely critical skills you need to develop beyond your clinical skills to succeed.” Fellowships are one way to enhance these nonclinical skills.

The best advice to those considering a hospital medicine fellowship? Dedicate some time to engage in self-assessment and goal setting, before jumping to SHM’s online list of programs.

Ask yourself: “Where do I see myself in 10 years? What do I wish to accomplish in my career as a hospitalist? What additional training (clinical, research, quality improvement, leadership) might I need to achieve these goals? Will completion of a hospital medicine fellowship help me make this vision a reality?”

For Dr. Schaffer, a clinical practice–focused hospital medicine fellowship served as a necessary bridge between her family medicine residency and her current position as an adult hospitalist. While for Dr. Prochaska, a research-intensive hospital medicine fellowship was a key step in launching his academic career.

Of course, for many trainees at the end of residency, your self-assessment may lead you in the opposite direction. In that case it is time to find your first “real job” as an attending physician. But if you feel you need more training to meet your personal goals you should rest assured – whether now or in the future, there is almost certainly a hospital medicine fellowship that is right for you.

Dr. Schouten is a hospitalist at Mayo Clinic in Rochester, Minn., and serves on the Society of Hospital Medicine Physicians in Training Committee. Dr. Sundar is a hospitalist at Emory Saint Joseph’s Hospital in Sandy Springs, Ga., and serves as the Site Assistant Director for Education.

References


1. www.hospitalmedicine.org/membership/hospitalist-fellowships/

2. Ranji et al. “Hospital medicine fellowships: Works in progress.” American J Med. 2006 Jan;119(1):72.e1-7. doi: 10.1016/j.amjmed.2005.07.061.
 

As Dr. Melanie Schaffer neared the end of her family medicine residency in the spring of 2015, she found herself considering a hospital medicine fellowship. Unsure if she could get a hospitalist job in an urban market given the outpatient focus of her training, Dr. Schaffer began searching for fellowships on the Society of Hospital Medicine website.¹

Likewise, in 2014 Dr. Micah Prochaska was seriously contemplating a hospital medicine fellowship. He was about to graduate from internal medicine residency at the University of Chicago and was eager to gain skills and experience in clinical research.

In 2006, there were a total of 16 HM fellowship programs in the United States, catering to graduates of internal medicine, family medicine, and pediatric residencies.² Since that time, the number of hospital medicine fellowships has grown considerably, paralleling the explosive growth of hospital medicine as a specialty. For example, at one point in the summer of 2018, the SHM website listed 13 clinical family practice fellowships, 29 internal medicine fellowships, and 26 pediatric fellowships. Each fellowship emphasized different aspects of hospital medicine including clinical practice, research, quality improvement, and leadership.

Now more than ever, residents interested in hospital medicine may get overwhelmed by the multitude of options for fellowship training. And the question remains: why pursue fellowship training in the first place?

“I learned that as a family physician it is harder to get a job as a hospitalist outside of smaller communities, and I wanted to have extra training and credentials,” Dr. Schaffer said. “I pursued a fellowship in hospital medicine to hone my inpatient skills, obtain more ICU exposure, and work on procedures.”

Dr. Schaffer’s online search eventually led her to the Advanced Hospital Medicine Fellowship at Swedish Medical Center in Seattle. This 1-year hospital medicine fellowship started in 2008 with an intentional clinical focus, aiming to provide additional training opportunities in hospital medicine primarily to family medicine residency graduates.

“The goal of our program is to bridge the gap between the training of family medicine and internal medicine so our trainees can refine and develop their inpatient skills,” said Dr. David Wilson, program director of the Swedish Hospitalist Fellowship.

During her fellowship year, Dr. Schaffer was caring for hospitalized adult patients on a general medical ward, with supervision from a dedicated group of teaching hospitalists. She also completed rotations in the ICU, on subspecialty services, and received advanced training in point-of-care ultrasound.

Now in her second year of practice as a full time adult hospitalist at Swedish Medical Center, Dr. Schaffer believes her year of hospital medicine fellowship prepared her well for her current position.

“I am constantly using the tools and knowledge I acquired during my fellowship year,” she said. “I would encourage anyone who has an interest in working on procedural skills and gaining more ICU exposure to pursue a similar fellowship.”

In contrast to Dr. Schaffer, Dr. Prochaska was satisfied with his clinical training but chose to pursue a hospital medicine fellowship to develop research skills. Prior to starting the 2-year Hospitalist Scholars Training Program at the University of Chicago in 2014, Dr. Prochaska had a clear vision of becoming a hospital medicine health outcomes investigator, and believed this career would not be possible without the additional training offered by a research-focused fellowship program.

The Hospitalist Scholars Program at the University of Chicago, one of the first programs of its kind, offers a built-in master’s degree to all participants. At the conclusion of his fellowship training in 2016, Dr. Prochaska completed his Master’s in Health Sciences, which gives considerable attention to biostatistics and epidemiology. According to Dr. Prochaska, the key to becoming a successful academic researcher lies in one’s ability to write grants and receive funding, a skill he honed during this fellowship.

Now on faculty at the University of Chicago in the Section of Hospital Medicine, Dr. Prochaska devotes approximately 75% of his time to research and 25% to patient care.

Beyond the research training and experience he gained during his hospital medicine fellowship, Dr. Prochaska said he values the mentorship afforded to him. He noted that one of the most meaningful experiences during his 2 years of fellowship was having the opportunity to sit down with his program directors, Dr. Vineet Arora and Dr. David Meltzer, to discuss the trajectory of his career in academic medicine.

“It is hard to find senior mentors in hospital medicine,” Dr. Prochaska said. “You could get a master’s degree on your own, but with the fellowship program, your mentors can help you think about the next steps in your career.”

For Dr. Schaffer and Dr. Prochaska, fellowship provided training and experience well-matched to their individual goals and helped foster their careers in hospital medicine. For some, however, a fellowship may not be a necessary step on the path to becoming a hospitalist. Many leaders in the field of hospital medicine have advanced in their careers without further training. In addition, receiving little more than a resident’s salary for an additional year or more during fellowship may not be financially tenable for some. Given the ongoing demand for hospitalists across the country, the lack of a fellowship on your resume may not significantly diminish your chances of securing a position, especially in the community setting.

In the end, the decision of whether to pursue a hospital medicine fellowship is a personal one, and the programs available are as varied as the individuals completing them. “Any hospitalist interested in more than simply patient care – potentially QI, medical education, policy, or administration – should consider a fellowship,” Dr. Prochaska said. “Hospitalists have a unique opportunity to be involved in all these areas, but there are absolutely critical skills you need to develop beyond your clinical skills to succeed.” Fellowships are one way to enhance these nonclinical skills.

The best advice to those considering a hospital medicine fellowship? Dedicate some time to engage in self-assessment and goal setting, before jumping to SHM’s online list of programs.

Ask yourself: “Where do I see myself in 10 years? What do I wish to accomplish in my career as a hospitalist? What additional training (clinical, research, quality improvement, leadership) might I need to achieve these goals? Will completion of a hospital medicine fellowship help me make this vision a reality?”

For Dr. Schaffer, a clinical practice–focused hospital medicine fellowship served as a necessary bridge between her family medicine residency and her current position as an adult hospitalist. While for Dr. Prochaska, a research-intensive hospital medicine fellowship was a key step in launching his academic career.

Of course, for many trainees at the end of residency, your self-assessment may lead you in the opposite direction. In that case it is time to find your first “real job” as an attending physician. But if you feel you need more training to meet your personal goals you should rest assured – whether now or in the future, there is almost certainly a hospital medicine fellowship that is right for you.

Dr. Schouten is a hospitalist at Mayo Clinic in Rochester, Minn., and serves on the Society of Hospital Medicine Physicians in Training Committee. Dr. Sundar is a hospitalist at Emory Saint Joseph’s Hospital in Sandy Springs, Ga., and serves as the Site Assistant Director for Education.

References


1. www.hospitalmedicine.org/membership/hospitalist-fellowships/

2. Ranji et al. “Hospital medicine fellowships: Works in progress.” American J Med. 2006 Jan;119(1):72.e1-7. doi: 10.1016/j.amjmed.2005.07.061.
 

As Dr. Melanie Schaffer neared the end of her family medicine residency in the spring of 2015, she found herself considering a hospital medicine fellowship. Unsure if she could get a hospitalist job in an urban market given the outpatient focus of her training, Dr. Schaffer began searching for fellowships on the Society of Hospital Medicine website.¹

Likewise, in 2014 Dr. Micah Prochaska was seriously contemplating a hospital medicine fellowship. He was about to graduate from internal medicine residency at the University of Chicago and was eager to gain skills and experience in clinical research.

In 2006, there were a total of 16 HM fellowship programs in the United States, catering to graduates of internal medicine, family medicine, and pediatric residencies.² Since that time, the number of hospital medicine fellowships has grown considerably, paralleling the explosive growth of hospital medicine as a specialty. For example, at one point in the summer of 2018, the SHM website listed 13 clinical family practice fellowships, 29 internal medicine fellowships, and 26 pediatric fellowships. Each fellowship emphasized different aspects of hospital medicine including clinical practice, research, quality improvement, and leadership.

Now more than ever, residents interested in hospital medicine may get overwhelmed by the multitude of options for fellowship training. And the question remains: why pursue fellowship training in the first place?

“I learned that as a family physician it is harder to get a job as a hospitalist outside of smaller communities, and I wanted to have extra training and credentials,” Dr. Schaffer said. “I pursued a fellowship in hospital medicine to hone my inpatient skills, obtain more ICU exposure, and work on procedures.”

Dr. Schaffer’s online search eventually led her to the Advanced Hospital Medicine Fellowship at Swedish Medical Center in Seattle. This 1-year hospital medicine fellowship started in 2008 with an intentional clinical focus, aiming to provide additional training opportunities in hospital medicine primarily to family medicine residency graduates.

“The goal of our program is to bridge the gap between the training of family medicine and internal medicine so our trainees can refine and develop their inpatient skills,” said Dr. David Wilson, program director of the Swedish Hospitalist Fellowship.

During her fellowship year, Dr. Schaffer was caring for hospitalized adult patients on a general medical ward, with supervision from a dedicated group of teaching hospitalists. She also completed rotations in the ICU, on subspecialty services, and received advanced training in point-of-care ultrasound.

Now in her second year of practice as a full time adult hospitalist at Swedish Medical Center, Dr. Schaffer believes her year of hospital medicine fellowship prepared her well for her current position.

“I am constantly using the tools and knowledge I acquired during my fellowship year,” she said. “I would encourage anyone who has an interest in working on procedural skills and gaining more ICU exposure to pursue a similar fellowship.”

In contrast to Dr. Schaffer, Dr. Prochaska was satisfied with his clinical training but chose to pursue a hospital medicine fellowship to develop research skills. Prior to starting the 2-year Hospitalist Scholars Training Program at the University of Chicago in 2014, Dr. Prochaska had a clear vision of becoming a hospital medicine health outcomes investigator, and believed this career would not be possible without the additional training offered by a research-focused fellowship program.

The Hospitalist Scholars Program at the University of Chicago, one of the first programs of its kind, offers a built-in master’s degree to all participants. At the conclusion of his fellowship training in 2016, Dr. Prochaska completed his Master’s in Health Sciences, which gives considerable attention to biostatistics and epidemiology. According to Dr. Prochaska, the key to becoming a successful academic researcher lies in one’s ability to write grants and receive funding, a skill he honed during this fellowship.

Now on faculty at the University of Chicago in the Section of Hospital Medicine, Dr. Prochaska devotes approximately 75% of his time to research and 25% to patient care.

Beyond the research training and experience he gained during his hospital medicine fellowship, Dr. Prochaska said he values the mentorship afforded to him. He noted that one of the most meaningful experiences during his 2 years of fellowship was having the opportunity to sit down with his program directors, Dr. Vineet Arora and Dr. David Meltzer, to discuss the trajectory of his career in academic medicine.

“It is hard to find senior mentors in hospital medicine,” Dr. Prochaska said. “You could get a master’s degree on your own, but with the fellowship program, your mentors can help you think about the next steps in your career.”

For Dr. Schaffer and Dr. Prochaska, fellowship provided training and experience well-matched to their individual goals and helped foster their careers in hospital medicine. For some, however, a fellowship may not be a necessary step on the path to becoming a hospitalist. Many leaders in the field of hospital medicine have advanced in their careers without further training. In addition, receiving little more than a resident’s salary for an additional year or more during fellowship may not be financially tenable for some. Given the ongoing demand for hospitalists across the country, the lack of a fellowship on your resume may not significantly diminish your chances of securing a position, especially in the community setting.

In the end, the decision of whether to pursue a hospital medicine fellowship is a personal one, and the programs available are as varied as the individuals completing them. “Any hospitalist interested in more than simply patient care – potentially QI, medical education, policy, or administration – should consider a fellowship,” Dr. Prochaska said. “Hospitalists have a unique opportunity to be involved in all these areas, but there are absolutely critical skills you need to develop beyond your clinical skills to succeed.” Fellowships are one way to enhance these nonclinical skills.

The best advice to those considering a hospital medicine fellowship? Dedicate some time to engage in self-assessment and goal setting, before jumping to SHM’s online list of programs.

Ask yourself: “Where do I see myself in 10 years? What do I wish to accomplish in my career as a hospitalist? What additional training (clinical, research, quality improvement, leadership) might I need to achieve these goals? Will completion of a hospital medicine fellowship help me make this vision a reality?”

For Dr. Schaffer, a clinical practice–focused hospital medicine fellowship served as a necessary bridge between her family medicine residency and her current position as an adult hospitalist. While for Dr. Prochaska, a research-intensive hospital medicine fellowship was a key step in launching his academic career.

Of course, for many trainees at the end of residency, your self-assessment may lead you in the opposite direction. In that case it is time to find your first “real job” as an attending physician. But if you feel you need more training to meet your personal goals you should rest assured – whether now or in the future, there is almost certainly a hospital medicine fellowship that is right for you.

Dr. Schouten is a hospitalist at Mayo Clinic in Rochester, Minn., and serves on the Society of Hospital Medicine Physicians in Training Committee. Dr. Sundar is a hospitalist at Emory Saint Joseph’s Hospital in Sandy Springs, Ga., and serves as the Site Assistant Director for Education.

References


1. www.hospitalmedicine.org/membership/hospitalist-fellowships/

2. Ranji et al. “Hospital medicine fellowships: Works in progress.” American J Med. 2006 Jan;119(1):72.e1-7. doi: 10.1016/j.amjmed.2005.07.061.
 

The symptoms of burnout include emotional exhaustion, depersonalization, and reduced personal efficacy, and burnout is a widespread problem among hospitalists; recent data suggest that half of physicians are experiencing at least one such symptom.

Health care leaders are increasingly concerned that these levels of physician burnout pose a threat to patient quality and safety. “As a result, some health care systems are shifting emphasis from the Triple Aim – population health, reduced costs, and patient satisfaction – to the Quadruple Aim, which incorporates health care provider wellness,” according to a recent abstract.

The authors began their own attempt to address the problem when Penn State Health in Dauphin County, Pa., built a stand-alone children’s hospital and experienced bed demands that exceeded bed availability, creating decreased organizational efficiency, high stress, and elevated physician burnout.

The LEAN principles offer a process-focused, customer-centered methodology that improves efficiency and quality. “We redesigned our service line using LEAN principles, such as ‘staff to demand’ and ‘standardize work,’ ” the authors wrote. “To ‘staff to demand,’ we hired three additional FTE [full-time equivalent employees]. This allowed creation of two rounding teams ([up] from one) and reduced our patient-to-attending ratio from 15:1 to 8:1. Workflow was resequenced and standardized, which enabled teams to see discharges at the start of rounds. We also provided in-house evening and overnight resident supervision. Our model permitted flexibility in physicians’ schedules, deemphasized reliance on RVUs, and heightened purpose and efficiency in work as determinants of providers’ value-adding capacity.”

As a result, both service line and hospital efficiency improved and faculty stress decreased in their hospital. “Mean stress scores decreased from 23 (preintervention) to 15 over the first 2 years, and has remained steady for a period of 3 years. Our divisional work-life balance measurement 2 years after the intervention was 85%, well above the reported average of 41%. We have maintained a low physician turnover rate at 3.5% over the last 3 years.”
 

Reference

Keefer L et al. LEAN in: Our secrets to decreasing provider stress, maximizing efficiency on a pediatric hospitalist service [abstract]. Accessed April 6, 2018.


 

The symptoms of burnout include emotional exhaustion, depersonalization, and reduced personal efficacy, and burnout is a widespread problem among hospitalists; recent data suggest that half of physicians are experiencing at least one such symptom.

Health care leaders are increasingly concerned that these levels of physician burnout pose a threat to patient quality and safety. “As a result, some health care systems are shifting emphasis from the Triple Aim – population health, reduced costs, and patient satisfaction – to the Quadruple Aim, which incorporates health care provider wellness,” according to a recent abstract.

The authors began their own attempt to address the problem when Penn State Health in Dauphin County, Pa., built a stand-alone children’s hospital and experienced bed demands that exceeded bed availability, creating decreased organizational efficiency, high stress, and elevated physician burnout.

The LEAN principles offer a process-focused, customer-centered methodology that improves efficiency and quality. “We redesigned our service line using LEAN principles, such as ‘staff to demand’ and ‘standardize work,’ ” the authors wrote. “To ‘staff to demand,’ we hired three additional FTE [full-time equivalent employees]. This allowed creation of two rounding teams ([up] from one) and reduced our patient-to-attending ratio from 15:1 to 8:1. Workflow was resequenced and standardized, which enabled teams to see discharges at the start of rounds. We also provided in-house evening and overnight resident supervision. Our model permitted flexibility in physicians’ schedules, deemphasized reliance on RVUs, and heightened purpose and efficiency in work as determinants of providers’ value-adding capacity.”

As a result, both service line and hospital efficiency improved and faculty stress decreased in their hospital. “Mean stress scores decreased from 23 (preintervention) to 15 over the first 2 years, and has remained steady for a period of 3 years. Our divisional work-life balance measurement 2 years after the intervention was 85%, well above the reported average of 41%. We have maintained a low physician turnover rate at 3.5% over the last 3 years.”
 

Reference

Keefer L et al. LEAN in: Our secrets to decreasing provider stress, maximizing efficiency on a pediatric hospitalist service [abstract]. Accessed April 6, 2018.


 

The symptoms of burnout include emotional exhaustion, depersonalization, and reduced personal efficacy, and burnout is a widespread problem among hospitalists; recent data suggest that half of physicians are experiencing at least one such symptom.

Health care leaders are increasingly concerned that these levels of physician burnout pose a threat to patient quality and safety. “As a result, some health care systems are shifting emphasis from the Triple Aim – population health, reduced costs, and patient satisfaction – to the Quadruple Aim, which incorporates health care provider wellness,” according to a recent abstract.

The authors began their own attempt to address the problem when Penn State Health in Dauphin County, Pa., built a stand-alone children’s hospital and experienced bed demands that exceeded bed availability, creating decreased organizational efficiency, high stress, and elevated physician burnout.

The LEAN principles offer a process-focused, customer-centered methodology that improves efficiency and quality. “We redesigned our service line using LEAN principles, such as ‘staff to demand’ and ‘standardize work,’ ” the authors wrote. “To ‘staff to demand,’ we hired three additional FTE [full-time equivalent employees]. This allowed creation of two rounding teams ([up] from one) and reduced our patient-to-attending ratio from 15:1 to 8:1. Workflow was resequenced and standardized, which enabled teams to see discharges at the start of rounds. We also provided in-house evening and overnight resident supervision. Our model permitted flexibility in physicians’ schedules, deemphasized reliance on RVUs, and heightened purpose and efficiency in work as determinants of providers’ value-adding capacity.”

As a result, both service line and hospital efficiency improved and faculty stress decreased in their hospital. “Mean stress scores decreased from 23 (preintervention) to 15 over the first 2 years, and has remained steady for a period of 3 years. Our divisional work-life balance measurement 2 years after the intervention was 85%, well above the reported average of 41%. We have maintained a low physician turnover rate at 3.5% over the last 3 years.”
 

Reference

Keefer L et al. LEAN in: Our secrets to decreasing provider stress, maximizing efficiency on a pediatric hospitalist service [abstract]. Accessed April 6, 2018.


 

This fall I attended the 2018 Society of Hospital Medicine Leadership Academy, held in Vancouver. Once again, this conference sold out weeks ahead of time, and 300 hospitalists took time out of their busy schedules for learning and fun. There have been about 18 Leadership Academies over the years, with approximately 3,000 total participants, but this one may have been the best to date.

Why was it so good? Here are my top four reasons that Leadership Academy 2018 was the best ever:

Setting: Vancouver is just beautiful. My family has a strong maritime background, and I am a water person with saltwater in my veins. My inner sailor was overjoyed with the hotel’s views of False Creek and Vancouver Harbor, and I loved the mix of yachts and working boats. I even saw a seaplane! The hotel was a great match for the 300 hospitalists who traveled to the JW Marriott for 4 days of learning and relaxing. It was the perfect blend, whether for work or play; the hotel and city did not disappoint.

Networking: What’s more fun than getting to know 300 like-minded, leadership-oriented hospitalists for a few days? I am always energized by seeing old friends and making new ones. I really enjoy hearing about the professional adventures hospitalists at all career points are going through. Plus, I get really good advice on my own career! I also appreciate that a number of hospital medicine leaders (and even giants) come to SHM’s Leadership Academy. Over half of the SHM Board of Directors were there, as were a number of current and previous SHM presidents (Mark Williams, Jeff Wiese, Burke Kealey, Bob Harrington, Nasim Afsar, Rusty Holman, Ron Greeno, Chris Frost, and John Nelson), as well as Larry Wellikson, the CEO who has led our society through its many successes. All of these hospitalist leaders are there, having fun and networking, alongside everyone else.

Faculty: The faculty for all four courses (yes, Leadership Academy junkies, we’ve added a fourth course!) are absolutely phenomenal. I think the faculty are just the right blend of expert hospitalists (Jeff Glasheen, Rusty Holman, Jeff Wiese, Mark Williams, John Nelson) and national experts outside of hospital medicine. For example, Lenny Marcus of Harvard T.H. Chan School of Public Health, Boston, brings his experience coaching the Department of Defense, the White House, the Department of Homeland Security, and many others to the Influential Management and Mastering Teamwork courses. Lenny’s experience working with national leaders through disasters like the Boston Marathon bombing, Hurricane Katrina, and the Ebola outbreak make for more than riveting stories; there are real, tangible lessons for hospitalist leaders trying to improve clinical care. Nancy Spector is a pediatrician, nationally recognized for her work in mentoring, and is the executive director of Drexel University’s Executive Leadership in Academic Medicine. We have been fortunate to have her join the Academies, and Nancy successfully led the first group of hospitalists through the launch of SHM’s fourth leadership course, which I will describe in more detail below.

High energy & continued growth: There continues to be an enormous amount of energy around the Leadership Academy. The Vancouver courses sold out months ahead of the actual meeting! Hospitalists across the country continue to take on leadership roles and have told us that they value the skills they have learned from the courses.
 

Hospitalist leaders want more

In addition to the current 4-day courses (Strategic Essentials, Influential Management, and Mastering Teamwork), hospitalists are looking for a course that continues skill building once they return home.

That’s why SHM has developed a fourth Leadership Academy course. This course, called the Capstone Course, was launched in Vancouver and consists of 2 days of on-site skill development and team building (during the first 2 days of the traditional Leadership Academy) and 6 months of a longitudinal learning collaborative. The six-month learning collaborative component consists of a learning “pod” of five or six fellow hospitalists and monthly virtual meetings around crucial leadership topics. They are facilitated by an experienced Leadership Academy facilitator.

Dr. Spector is the lead faculty; her expertise made the Capstone launch a huge success. She will work with SHM and the Capstone participants throughout the entire 6 months to ensure the Capstone course is as high-quality as the previous three Academy courses.

If you haven’t been, I invite you to attend our next Leadership Academy. Over the years, despite being course director, I have learned many take-home skills from colleagues and leaders in the field that I use often. Just to name a few:

• Flexing my communications style: Tim Keogh’s lecture opened my eyes to the fact that not everyone is a data-driven introvert. I now know that some people need a social warm up, while others just want the facts, and that there are “huggers and shakers.” (In summary, it’s fine to shake hands with a hugger, but be wary of hugging a shaker.)
• I send birthday emails after I heard Jeff Wiese’s talk.
• Lenny Marcus taught me to be aware when I am “in the basement” emotionally. I now know to wait to send emails or confront others until I can get out of the basement.

And that’s just scratching the surface!

In closing, the Vancouver Leadership Academy was fantastic. Good friends, great professional development, a setting that was amazing, and an Academy that remains relevant and dynamic to our specialty. I can’t wait to see how the 2019 Leadership Academy shapes up for its debut in Nashville. My inner sailor may have to give way to my inner musician! I hope to see you and 300 of my closest friends there.

Learn more about SHM’s Leadership Academy at shmleadershipacademy.org.
 

Dr. Howell is a professor of medicine at Johns Hopkins University, Baltimore, and chief of the division of hospital medicine at Johns Hopkins Bayview Medical Center. He is also chief operating officer at the Society of Hospital Medicine and course director of the SHM Leadership Academy.

This fall I attended the 2018 Society of Hospital Medicine Leadership Academy, held in Vancouver. Once again, this conference sold out weeks ahead of time, and 300 hospitalists took time out of their busy schedules for learning and fun. There have been about 18 Leadership Academies over the years, with approximately 3,000 total participants, but this one may have been the best to date.

Why was it so good? Here are my top four reasons that Leadership Academy 2018 was the best ever:

Setting: Vancouver is just beautiful. My family has a strong maritime background, and I am a water person with saltwater in my veins. My inner sailor was overjoyed with the hotel’s views of False Creek and Vancouver Harbor, and I loved the mix of yachts and working boats. I even saw a seaplane! The hotel was a great match for the 300 hospitalists who traveled to the JW Marriott for 4 days of learning and relaxing. It was the perfect blend, whether for work or play; the hotel and city did not disappoint.

Networking: What’s more fun than getting to know 300 like-minded, leadership-oriented hospitalists for a few days? I am always energized by seeing old friends and making new ones. I really enjoy hearing about the professional adventures hospitalists at all career points are going through. Plus, I get really good advice on my own career! I also appreciate that a number of hospital medicine leaders (and even giants) come to SHM’s Leadership Academy. Over half of the SHM Board of Directors were there, as were a number of current and previous SHM presidents (Mark Williams, Jeff Wiese, Burke Kealey, Bob Harrington, Nasim Afsar, Rusty Holman, Ron Greeno, Chris Frost, and John Nelson), as well as Larry Wellikson, the CEO who has led our society through its many successes. All of these hospitalist leaders are there, having fun and networking, alongside everyone else.

Faculty: The faculty for all four courses (yes, Leadership Academy junkies, we’ve added a fourth course!) are absolutely phenomenal. I think the faculty are just the right blend of expert hospitalists (Jeff Glasheen, Rusty Holman, Jeff Wiese, Mark Williams, John Nelson) and national experts outside of hospital medicine. For example, Lenny Marcus of Harvard T.H. Chan School of Public Health, Boston, brings his experience coaching the Department of Defense, the White House, the Department of Homeland Security, and many others to the Influential Management and Mastering Teamwork courses. Lenny’s experience working with national leaders through disasters like the Boston Marathon bombing, Hurricane Katrina, and the Ebola outbreak make for more than riveting stories; there are real, tangible lessons for hospitalist leaders trying to improve clinical care. Nancy Spector is a pediatrician, nationally recognized for her work in mentoring, and is the executive director of Drexel University’s Executive Leadership in Academic Medicine. We have been fortunate to have her join the Academies, and Nancy successfully led the first group of hospitalists through the launch of SHM’s fourth leadership course, which I will describe in more detail below.

High energy & continued growth: There continues to be an enormous amount of energy around the Leadership Academy. The Vancouver courses sold out months ahead of the actual meeting! Hospitalists across the country continue to take on leadership roles and have told us that they value the skills they have learned from the courses.
 

Hospitalist leaders want more

In addition to the current 4-day courses (Strategic Essentials, Influential Management, and Mastering Teamwork), hospitalists are looking for a course that continues skill building once they return home.

That’s why SHM has developed a fourth Leadership Academy course. This course, called the Capstone Course, was launched in Vancouver and consists of 2 days of on-site skill development and team building (during the first 2 days of the traditional Leadership Academy) and 6 months of a longitudinal learning collaborative. The six-month learning collaborative component consists of a learning “pod” of five or six fellow hospitalists and monthly virtual meetings around crucial leadership topics. They are facilitated by an experienced Leadership Academy facilitator.

Dr. Spector is the lead faculty; her expertise made the Capstone launch a huge success. She will work with SHM and the Capstone participants throughout the entire 6 months to ensure the Capstone course is as high-quality as the previous three Academy courses.

If you haven’t been, I invite you to attend our next Leadership Academy. Over the years, despite being course director, I have learned many take-home skills from colleagues and leaders in the field that I use often. Just to name a few:

• Flexing my communications style: Tim Keogh’s lecture opened my eyes to the fact that not everyone is a data-driven introvert. I now know that some people need a social warm up, while others just want the facts, and that there are “huggers and shakers.” (In summary, it’s fine to shake hands with a hugger, but be wary of hugging a shaker.)
• I send birthday emails after I heard Jeff Wiese’s talk.
• Lenny Marcus taught me to be aware when I am “in the basement” emotionally. I now know to wait to send emails or confront others until I can get out of the basement.

And that’s just scratching the surface!

In closing, the Vancouver Leadership Academy was fantastic. Good friends, great professional development, a setting that was amazing, and an Academy that remains relevant and dynamic to our specialty. I can’t wait to see how the 2019 Leadership Academy shapes up for its debut in Nashville. My inner sailor may have to give way to my inner musician! I hope to see you and 300 of my closest friends there.

Learn more about SHM’s Leadership Academy at shmleadershipacademy.org.
 

Dr. Howell is a professor of medicine at Johns Hopkins University, Baltimore, and chief of the division of hospital medicine at Johns Hopkins Bayview Medical Center. He is also chief operating officer at the Society of Hospital Medicine and course director of the SHM Leadership Academy.

This fall I attended the 2018 Society of Hospital Medicine Leadership Academy, held in Vancouver. Once again, this conference sold out weeks ahead of time, and 300 hospitalists took time out of their busy schedules for learning and fun. There have been about 18 Leadership Academies over the years, with approximately 3,000 total participants, but this one may have been the best to date.

Why was it so good? Here are my top four reasons that Leadership Academy 2018 was the best ever:

Setting: Vancouver is just beautiful. My family has a strong maritime background, and I am a water person with saltwater in my veins. My inner sailor was overjoyed with the hotel’s views of False Creek and Vancouver Harbor, and I loved the mix of yachts and working boats. I even saw a seaplane! The hotel was a great match for the 300 hospitalists who traveled to the JW Marriott for 4 days of learning and relaxing. It was the perfect blend, whether for work or play; the hotel and city did not disappoint.

Networking: What’s more fun than getting to know 300 like-minded, leadership-oriented hospitalists for a few days? I am always energized by seeing old friends and making new ones. I really enjoy hearing about the professional adventures hospitalists at all career points are going through. Plus, I get really good advice on my own career! I also appreciate that a number of hospital medicine leaders (and even giants) come to SHM’s Leadership Academy. Over half of the SHM Board of Directors were there, as were a number of current and previous SHM presidents (Mark Williams, Jeff Wiese, Burke Kealey, Bob Harrington, Nasim Afsar, Rusty Holman, Ron Greeno, Chris Frost, and John Nelson), as well as Larry Wellikson, the CEO who has led our society through its many successes. All of these hospitalist leaders are there, having fun and networking, alongside everyone else.

Faculty: The faculty for all four courses (yes, Leadership Academy junkies, we’ve added a fourth course!) are absolutely phenomenal. I think the faculty are just the right blend of expert hospitalists (Jeff Glasheen, Rusty Holman, Jeff Wiese, Mark Williams, John Nelson) and national experts outside of hospital medicine. For example, Lenny Marcus of Harvard T.H. Chan School of Public Health, Boston, brings his experience coaching the Department of Defense, the White House, the Department of Homeland Security, and many others to the Influential Management and Mastering Teamwork courses. Lenny’s experience working with national leaders through disasters like the Boston Marathon bombing, Hurricane Katrina, and the Ebola outbreak make for more than riveting stories; there are real, tangible lessons for hospitalist leaders trying to improve clinical care. Nancy Spector is a pediatrician, nationally recognized for her work in mentoring, and is the executive director of Drexel University’s Executive Leadership in Academic Medicine. We have been fortunate to have her join the Academies, and Nancy successfully led the first group of hospitalists through the launch of SHM’s fourth leadership course, which I will describe in more detail below.

High energy & continued growth: There continues to be an enormous amount of energy around the Leadership Academy. The Vancouver courses sold out months ahead of the actual meeting! Hospitalists across the country continue to take on leadership roles and have told us that they value the skills they have learned from the courses.
 

Hospitalist leaders want more

In addition to the current 4-day courses (Strategic Essentials, Influential Management, and Mastering Teamwork), hospitalists are looking for a course that continues skill building once they return home.

That’s why SHM has developed a fourth Leadership Academy course. This course, called the Capstone Course, was launched in Vancouver and consists of 2 days of on-site skill development and team building (during the first 2 days of the traditional Leadership Academy) and 6 months of a longitudinal learning collaborative. The six-month learning collaborative component consists of a learning “pod” of five or six fellow hospitalists and monthly virtual meetings around crucial leadership topics. They are facilitated by an experienced Leadership Academy facilitator.

Dr. Spector is the lead faculty; her expertise made the Capstone launch a huge success. She will work with SHM and the Capstone participants throughout the entire 6 months to ensure the Capstone course is as high-quality as the previous three Academy courses.

If you haven’t been, I invite you to attend our next Leadership Academy. Over the years, despite being course director, I have learned many take-home skills from colleagues and leaders in the field that I use often. Just to name a few:

• Flexing my communications style: Tim Keogh’s lecture opened my eyes to the fact that not everyone is a data-driven introvert. I now know that some people need a social warm up, while others just want the facts, and that there are “huggers and shakers.” (In summary, it’s fine to shake hands with a hugger, but be wary of hugging a shaker.)
• I send birthday emails after I heard Jeff Wiese’s talk.
• Lenny Marcus taught me to be aware when I am “in the basement” emotionally. I now know to wait to send emails or confront others until I can get out of the basement.

And that’s just scratching the surface!

In closing, the Vancouver Leadership Academy was fantastic. Good friends, great professional development, a setting that was amazing, and an Academy that remains relevant and dynamic to our specialty. I can’t wait to see how the 2019 Leadership Academy shapes up for its debut in Nashville. My inner sailor may have to give way to my inner musician! I hope to see you and 300 of my closest friends there.

Learn more about SHM’s Leadership Academy at shmleadershipacademy.org.
 

Dr. Howell is a professor of medicine at Johns Hopkins University, Baltimore, and chief of the division of hospital medicine at Johns Hopkins Bayview Medical Center. He is also chief operating officer at the Society of Hospital Medicine and course director of the SHM Leadership Academy.

Nidhi Goel, MD, MHS, is a Med-Peds hospitalist and assistant professor of internal medicine and pediatrics at the University of Maryland, Baltimore. Since August 2017, she has been the president of the Maryland chapter of SHM.

Can you talk about your background and how you became interested in hospital medicine?

I grew up in the Baltimore area, and I went to medical school at the University of Maryland in Baltimore. I trained in internal medicine and pediatrics, also at the University of Maryland. Then I joined the faculty after I finished residency in 2014. I practiced as a hospitalist in internal medicine and pediatrics and was also a teaching hospitalist.

Early in my residency, I worked with teaching hospitalists. I rotated on the hospitalist teams, and I was inspired by their perspective on taking care of patients through a lens of quality and safety. I gained a greater appreciation for the risks associated with taking care of a patient in the hospital setting, and the opportunities to mitigate those risks and provide really high quality patient care. It made me realize that was what I wanted to do – and also to teach residents and students how to do the same.
 

So it was a philosophical attraction to the hospitalist approach?

Yes, and intellectually I’d say that I liked taking care of really complicated, very sick patients. I found that to be interesting – and rewarding when they got better.

Tell us more about what kind of research you do.

I work primarily on projects centered on quality and safety; they involve both adult internal medicine and pediatric patients. Currently on the adult medicine side, we have a project looking at improving outcomes for sepsis in the hospital setting. On the pediatric side, I’ve done a lot of work related to throughput – trying to increase the efficiency of our admissions – and especially our discharge process. Moving patients through the system efficiently has become a significant quality issue, especially during the winter months when our volumes pick up.

How long have you been involved in the Maryland SHM chapter, and what are the rewards of participation?

Early in my residency, I got involved in the chapter because some of the hospitalist faculty I worked with were chapter officers. They believed that the chapter was a good place for residents to be exposed to research and to other hospitalists for networking and camaraderie. So they began inviting us to Maryland chapter meetings, and I found those meetings to be very enlightening – from the practical and research content related to hospital medicine, and to networking with other hospitalists.

I was invited to be part of the Maryland chapter advisory board when I was still a resident, so that I might present trainee perspectives on how the chapter could continue to grow and target some of their activities for the benefit of residents. I stayed involved with the chapter after I finished residency, and when the opportunity presented itself to become an officer, and I decided to take it. I thought serving as a chapter officer would be a really interesting chance to meet more people in the field and to continue to innovate within the chapter setting.
 

Tell us more about the Maryland chapter.

We are a large chapter and we’re very, very active. Around 7 or 8 years ago, the Maryland chapter reached a significant turning point because the officers that were in place at that time had a vision for building the chapter. That was a major inflexion point in how active the chapter became, leading to the kinds of activities that we do now, and the variety of memberships.

One thing that I’m super proud of our chapter for is that we’ve really tried to continue building on the diversity that is represented in our membership. We have members stretching geographically all through the Baltimore and the Washington corridor, as well as out to western Maryland and the Eastern shore. The Maryland chapter has been able to attract members from different organizations throughout the state and from a diversity of practice settings. We have active members who are not just physicians, but also a nurse practitioners, physician assistants, and clinical pharmacists. We have members from throughout the health care delivery process, which really enriches the discussion and the value of the chapter as a whole.
 

What kind of initiatives and programs is the chapter working on?

Every year we have an abstracts competition at our fall meeting. Whoever wins that competition is allowed to present at the national SHM conference, which is a great opportunity. We’re really pushing that competition to make it an even more robust experience.

One thing that we had heard from some of our members, and that we recognized as a need as well, was to make our career guidance a little bit more robust. To that end, we’re creating a separate job fair that is almost like an employment workshop – to help people to buff up their CVs, to talk about interviewing skills, contracts, salary negotiations, as well as exposing job candidates to various hospital groups from throughout the area. That’s something that we’re really excited about. It’s going to take a lot of work, but I think it could be a really high-yield event for our members.

We’re also encouraging our nonphysician members to take more active leadership roles in the chapter; several of our nonphysician members on our chapter advisory board, including pharmacists and physician assistants, and we are trying to make sure that we’re also liaising with some of the professional organizations that represent our nonphysician members. So, for example, the clinical pharmacist who’s on our advisory board also is president of the Maryland chapter of the Society for Hospital Pharmacists. She brings a lot of really great ideas and interesting perspectives, and she’s brought a lot of exposure of our SHM chapter to the clinical pharmacy community as well.
 

What about more long-term goals for your chapter? What’s on the horizon?

We’re targeting early-career hospitalists and helping them to develop their career goals in whatever fashion they see as appropriate.

So, as someone who’s in academics, obviously research and publications are very important for me, but they’re not necessarily as important for other hospitalists. I think our early-career hospitalists are increasingly looking to incorporate things into their practice aside from direct patient care. Our members have interests in various elements of hospital medicine, including patient safety and quality improvement initiatives, clinical informatics, advocacy (especially related to the myriad aspects of health care reform), and strategies surrounding billing and denials. I think having our chapter help our members to realize some of those opportunities and develop their skills in a way that’s personally meaningful to them, as well as good for their marketability as they build their careers, would be a really positive step.

The ultimate goal of the chapter is to service members, so whatever long-term goals we have right now could definitely be fluid as time goes on.
 

What are some concerns of the chapter?

One area of significant discussion among hospitalists in Maryland has been global budgets. Our system of reimbursement is unique in the nation. It’s a system that aims to emphasize high-value care: the idea is to prioritize quality over quantity.

This system requires that hospitals rethink how we provide care in the inpatient setting, and how we create a continuum of care to the post-acute setting. It poses a lot of challenges, but also a lot of opportunities. Hospitalists are positioned perfectly to play a substantial role in implementing solutions.
 

Why might readers want to consider getting involved in their local SHM chapters?

I think it’s really beneficial to have the exposure that being involved with an SHM chapter brings – to people, to perspectives, to knowledge. There’s not really a downside to being involved with a chapter. You can take as little or as much as you want out of it, but I think most of our members find it to be a very enriching experience. Being involved in a chapter means you can have a voice, so that the chapter ends up serving you and your needs as well.

Nidhi Goel, MD, MHS, is a Med-Peds hospitalist and assistant professor of internal medicine and pediatrics at the University of Maryland, Baltimore. Since August 2017, she has been the president of the Maryland chapter of SHM.

Can you talk about your background and how you became interested in hospital medicine?

I grew up in the Baltimore area, and I went to medical school at the University of Maryland in Baltimore. I trained in internal medicine and pediatrics, also at the University of Maryland. Then I joined the faculty after I finished residency in 2014. I practiced as a hospitalist in internal medicine and pediatrics and was also a teaching hospitalist.

Early in my residency, I worked with teaching hospitalists. I rotated on the hospitalist teams, and I was inspired by their perspective on taking care of patients through a lens of quality and safety. I gained a greater appreciation for the risks associated with taking care of a patient in the hospital setting, and the opportunities to mitigate those risks and provide really high quality patient care. It made me realize that was what I wanted to do – and also to teach residents and students how to do the same.
 

So it was a philosophical attraction to the hospitalist approach?

Yes, and intellectually I’d say that I liked taking care of really complicated, very sick patients. I found that to be interesting – and rewarding when they got better.

Tell us more about what kind of research you do.

I work primarily on projects centered on quality and safety; they involve both adult internal medicine and pediatric patients. Currently on the adult medicine side, we have a project looking at improving outcomes for sepsis in the hospital setting. On the pediatric side, I’ve done a lot of work related to throughput – trying to increase the efficiency of our admissions – and especially our discharge process. Moving patients through the system efficiently has become a significant quality issue, especially during the winter months when our volumes pick up.

How long have you been involved in the Maryland SHM chapter, and what are the rewards of participation?

Early in my residency, I got involved in the chapter because some of the hospitalist faculty I worked with were chapter officers. They believed that the chapter was a good place for residents to be exposed to research and to other hospitalists for networking and camaraderie. So they began inviting us to Maryland chapter meetings, and I found those meetings to be very enlightening – from the practical and research content related to hospital medicine, and to networking with other hospitalists.

I was invited to be part of the Maryland chapter advisory board when I was still a resident, so that I might present trainee perspectives on how the chapter could continue to grow and target some of their activities for the benefit of residents. I stayed involved with the chapter after I finished residency, and when the opportunity presented itself to become an officer, and I decided to take it. I thought serving as a chapter officer would be a really interesting chance to meet more people in the field and to continue to innovate within the chapter setting.
 

Tell us more about the Maryland chapter.

We are a large chapter and we’re very, very active. Around 7 or 8 years ago, the Maryland chapter reached a significant turning point because the officers that were in place at that time had a vision for building the chapter. That was a major inflexion point in how active the chapter became, leading to the kinds of activities that we do now, and the variety of memberships.

One thing that I’m super proud of our chapter for is that we’ve really tried to continue building on the diversity that is represented in our membership. We have members stretching geographically all through the Baltimore and the Washington corridor, as well as out to western Maryland and the Eastern shore. The Maryland chapter has been able to attract members from different organizations throughout the state and from a diversity of practice settings. We have active members who are not just physicians, but also a nurse practitioners, physician assistants, and clinical pharmacists. We have members from throughout the health care delivery process, which really enriches the discussion and the value of the chapter as a whole.
 

What kind of initiatives and programs is the chapter working on?

Every year we have an abstracts competition at our fall meeting. Whoever wins that competition is allowed to present at the national SHM conference, which is a great opportunity. We’re really pushing that competition to make it an even more robust experience.

One thing that we had heard from some of our members, and that we recognized as a need as well, was to make our career guidance a little bit more robust. To that end, we’re creating a separate job fair that is almost like an employment workshop – to help people to buff up their CVs, to talk about interviewing skills, contracts, salary negotiations, as well as exposing job candidates to various hospital groups from throughout the area. That’s something that we’re really excited about. It’s going to take a lot of work, but I think it could be a really high-yield event for our members.

We’re also encouraging our nonphysician members to take more active leadership roles in the chapter; several of our nonphysician members on our chapter advisory board, including pharmacists and physician assistants, and we are trying to make sure that we’re also liaising with some of the professional organizations that represent our nonphysician members. So, for example, the clinical pharmacist who’s on our advisory board also is president of the Maryland chapter of the Society for Hospital Pharmacists. She brings a lot of really great ideas and interesting perspectives, and she’s brought a lot of exposure of our SHM chapter to the clinical pharmacy community as well.
 

What about more long-term goals for your chapter? What’s on the horizon?

We’re targeting early-career hospitalists and helping them to develop their career goals in whatever fashion they see as appropriate.

So, as someone who’s in academics, obviously research and publications are very important for me, but they’re not necessarily as important for other hospitalists. I think our early-career hospitalists are increasingly looking to incorporate things into their practice aside from direct patient care. Our members have interests in various elements of hospital medicine, including patient safety and quality improvement initiatives, clinical informatics, advocacy (especially related to the myriad aspects of health care reform), and strategies surrounding billing and denials. I think having our chapter help our members to realize some of those opportunities and develop their skills in a way that’s personally meaningful to them, as well as good for their marketability as they build their careers, would be a really positive step.

The ultimate goal of the chapter is to service members, so whatever long-term goals we have right now could definitely be fluid as time goes on.
 

What are some concerns of the chapter?

One area of significant discussion among hospitalists in Maryland has been global budgets. Our system of reimbursement is unique in the nation. It’s a system that aims to emphasize high-value care: the idea is to prioritize quality over quantity.

This system requires that hospitals rethink how we provide care in the inpatient setting, and how we create a continuum of care to the post-acute setting. It poses a lot of challenges, but also a lot of opportunities. Hospitalists are positioned perfectly to play a substantial role in implementing solutions.
 

Why might readers want to consider getting involved in their local SHM chapters?

I think it’s really beneficial to have the exposure that being involved with an SHM chapter brings – to people, to perspectives, to knowledge. There’s not really a downside to being involved with a chapter. You can take as little or as much as you want out of it, but I think most of our members find it to be a very enriching experience. Being involved in a chapter means you can have a voice, so that the chapter ends up serving you and your needs as well.

Nidhi Goel, MD, MHS, is a Med-Peds hospitalist and assistant professor of internal medicine and pediatrics at the University of Maryland, Baltimore. Since August 2017, she has been the president of the Maryland chapter of SHM.

Can you talk about your background and how you became interested in hospital medicine?

I grew up in the Baltimore area, and I went to medical school at the University of Maryland in Baltimore. I trained in internal medicine and pediatrics, also at the University of Maryland. Then I joined the faculty after I finished residency in 2014. I practiced as a hospitalist in internal medicine and pediatrics and was also a teaching hospitalist.

Early in my residency, I worked with teaching hospitalists. I rotated on the hospitalist teams, and I was inspired by their perspective on taking care of patients through a lens of quality and safety. I gained a greater appreciation for the risks associated with taking care of a patient in the hospital setting, and the opportunities to mitigate those risks and provide really high quality patient care. It made me realize that was what I wanted to do – and also to teach residents and students how to do the same.
 

So it was a philosophical attraction to the hospitalist approach?

Yes, and intellectually I’d say that I liked taking care of really complicated, very sick patients. I found that to be interesting – and rewarding when they got better.

Tell us more about what kind of research you do.

I work primarily on projects centered on quality and safety; they involve both adult internal medicine and pediatric patients. Currently on the adult medicine side, we have a project looking at improving outcomes for sepsis in the hospital setting. On the pediatric side, I’ve done a lot of work related to throughput – trying to increase the efficiency of our admissions – and especially our discharge process. Moving patients through the system efficiently has become a significant quality issue, especially during the winter months when our volumes pick up.

How long have you been involved in the Maryland SHM chapter, and what are the rewards of participation?

Early in my residency, I got involved in the chapter because some of the hospitalist faculty I worked with were chapter officers. They believed that the chapter was a good place for residents to be exposed to research and to other hospitalists for networking and camaraderie. So they began inviting us to Maryland chapter meetings, and I found those meetings to be very enlightening – from the practical and research content related to hospital medicine, and to networking with other hospitalists.

I was invited to be part of the Maryland chapter advisory board when I was still a resident, so that I might present trainee perspectives on how the chapter could continue to grow and target some of their activities for the benefit of residents. I stayed involved with the chapter after I finished residency, and when the opportunity presented itself to become an officer, and I decided to take it. I thought serving as a chapter officer would be a really interesting chance to meet more people in the field and to continue to innovate within the chapter setting.
 

Tell us more about the Maryland chapter.

We are a large chapter and we’re very, very active. Around 7 or 8 years ago, the Maryland chapter reached a significant turning point because the officers that were in place at that time had a vision for building the chapter. That was a major inflexion point in how active the chapter became, leading to the kinds of activities that we do now, and the variety of memberships.

One thing that I’m super proud of our chapter for is that we’ve really tried to continue building on the diversity that is represented in our membership. We have members stretching geographically all through the Baltimore and the Washington corridor, as well as out to western Maryland and the Eastern shore. The Maryland chapter has been able to attract members from different organizations throughout the state and from a diversity of practice settings. We have active members who are not just physicians, but also a nurse practitioners, physician assistants, and clinical pharmacists. We have members from throughout the health care delivery process, which really enriches the discussion and the value of the chapter as a whole.
 

What kind of initiatives and programs is the chapter working on?

Every year we have an abstracts competition at our fall meeting. Whoever wins that competition is allowed to present at the national SHM conference, which is a great opportunity. We’re really pushing that competition to make it an even more robust experience.

One thing that we had heard from some of our members, and that we recognized as a need as well, was to make our career guidance a little bit more robust. To that end, we’re creating a separate job fair that is almost like an employment workshop – to help people to buff up their CVs, to talk about interviewing skills, contracts, salary negotiations, as well as exposing job candidates to various hospital groups from throughout the area. That’s something that we’re really excited about. It’s going to take a lot of work, but I think it could be a really high-yield event for our members.

We’re also encouraging our nonphysician members to take more active leadership roles in the chapter; several of our nonphysician members on our chapter advisory board, including pharmacists and physician assistants, and we are trying to make sure that we’re also liaising with some of the professional organizations that represent our nonphysician members. So, for example, the clinical pharmacist who’s on our advisory board also is president of the Maryland chapter of the Society for Hospital Pharmacists. She brings a lot of really great ideas and interesting perspectives, and she’s brought a lot of exposure of our SHM chapter to the clinical pharmacy community as well.
 

What about more long-term goals for your chapter? What’s on the horizon?

We’re targeting early-career hospitalists and helping them to develop their career goals in whatever fashion they see as appropriate.

So, as someone who’s in academics, obviously research and publications are very important for me, but they’re not necessarily as important for other hospitalists. I think our early-career hospitalists are increasingly looking to incorporate things into their practice aside from direct patient care. Our members have interests in various elements of hospital medicine, including patient safety and quality improvement initiatives, clinical informatics, advocacy (especially related to the myriad aspects of health care reform), and strategies surrounding billing and denials. I think having our chapter help our members to realize some of those opportunities and develop their skills in a way that’s personally meaningful to them, as well as good for their marketability as they build their careers, would be a really positive step.

The ultimate goal of the chapter is to service members, so whatever long-term goals we have right now could definitely be fluid as time goes on.
 

What are some concerns of the chapter?

One area of significant discussion among hospitalists in Maryland has been global budgets. Our system of reimbursement is unique in the nation. It’s a system that aims to emphasize high-value care: the idea is to prioritize quality over quantity.

This system requires that hospitals rethink how we provide care in the inpatient setting, and how we create a continuum of care to the post-acute setting. It poses a lot of challenges, but also a lot of opportunities. Hospitalists are positioned perfectly to play a substantial role in implementing solutions.
 

Why might readers want to consider getting involved in their local SHM chapters?

I think it’s really beneficial to have the exposure that being involved with an SHM chapter brings – to people, to perspectives, to knowledge. There’s not really a downside to being involved with a chapter. You can take as little or as much as you want out of it, but I think most of our members find it to be a very enriching experience. Being involved in a chapter means you can have a voice, so that the chapter ends up serving you and your needs as well.