Career

Physicians experiencing burnout are twice as likely to be associated with patient safety issues and deliver a lower quality of care from low professionalism and are three times as likely to be rated poorly among patients because of depersonalization of care, according to recent research published in JAMA Internal Medicine.

olm26250/Thinkstock

“The primary conclusion of this review is that physician burnout might jeopardize patient care,” Maria Panagioti, PhD, from the National Institute for Health Research (NIHR) School for Primary Care Research and the NIHR Greater Manchester Patient Safety Translational Research Centre at the University of Manchester (United Kingdom) and her colleagues wrote in their study. “Physician wellness and quality of patient care are critical [as are] complementary dimensions of health care organization efficiency.”

Dr. Panagioti and her colleagues performed a search of the MEDLINE, EMBASE, CINAHL, and PsycInfo databases and found 47 eligible studies on the topics of physician burnout and patient care, which altogether included data from a pooled cohort of 42,473 physicians. The physicians were median 38 years old, with 44.7% of studies looking at physicians in residency or early career (up to 5 years post residency) and 55.3% of studies examining experienced physicians. The meta-analysis also evaluated physicians in a hospital setting (63.8%), primary care (13.8%), and across various different health care settings (8.5%).

The researchers found physicians with burnout were significantly associated with higher rates of patient safety issues (odds ratio, 1.96; 95% confidence interval, 1.59-2.40), reduced patient satisfaction (OR, 2.28; 95% CI, 1.42-3.68), and lower quality of care (OR, 2.31; 95% CI, 1.87-2.85). System-reported instances of patient safety issues and low professionalism were not statistically significant, but the subgroup differences did reach statistical significance (Cohen Q, 8.14; P = .007). Among residents and physicians in their early career, there was a greater association between burnout and low professionalism (OR, 3.39; 95% CI, 2.38-4.40), compared with physicians in the middle or later in their career (OR, 1.73; 95% CI, 1.46-2.01; Cohen Q, 7.27; P = .003).

“Investments in organizational strategies to jointly monitor and improve physician wellness and patient care outcomes are needed,” Dr. Panagioti and her colleagues wrote in the study. “Interventions aimed at improving the culture of health care organizations, as well as interventions focused on individual physicians but supported and funded by health care organizations, are beneficial.”

Researchers noted the study quality was low to moderate. Variation in outcomes across studies, heterogeneity among studies, potential selection bias by excluding gray literature, and the inability to establish causal links from findings because of the cross-sectional nature of the studies analyzed were potential limitations in the study, they reported.

The study was funded by the United Kingdom NIHR School for Primary Care Research and the NIHR Greater Manchester Patient Safety Translational Research Centre. The authors report no relevant conflicts of interest.

SOURCE: Panagioti M et al. JAMA Intern Med. 2018 Sept 4. doi: 10.1001/jamainternmed.2018.3713.

Physicians experiencing burnout are twice as likely to be associated with patient safety issues and deliver a lower quality of care from low professionalism and are three times as likely to be rated poorly among patients because of depersonalization of care, according to recent research published in JAMA Internal Medicine.

olm26250/Thinkstock

“The primary conclusion of this review is that physician burnout might jeopardize patient care,” Maria Panagioti, PhD, from the National Institute for Health Research (NIHR) School for Primary Care Research and the NIHR Greater Manchester Patient Safety Translational Research Centre at the University of Manchester (United Kingdom) and her colleagues wrote in their study. “Physician wellness and quality of patient care are critical [as are] complementary dimensions of health care organization efficiency.”

Dr. Panagioti and her colleagues performed a search of the MEDLINE, EMBASE, CINAHL, and PsycInfo databases and found 47 eligible studies on the topics of physician burnout and patient care, which altogether included data from a pooled cohort of 42,473 physicians. The physicians were median 38 years old, with 44.7% of studies looking at physicians in residency or early career (up to 5 years post residency) and 55.3% of studies examining experienced physicians. The meta-analysis also evaluated physicians in a hospital setting (63.8%), primary care (13.8%), and across various different health care settings (8.5%).

The researchers found physicians with burnout were significantly associated with higher rates of patient safety issues (odds ratio, 1.96; 95% confidence interval, 1.59-2.40), reduced patient satisfaction (OR, 2.28; 95% CI, 1.42-3.68), and lower quality of care (OR, 2.31; 95% CI, 1.87-2.85). System-reported instances of patient safety issues and low professionalism were not statistically significant, but the subgroup differences did reach statistical significance (Cohen Q, 8.14; P = .007). Among residents and physicians in their early career, there was a greater association between burnout and low professionalism (OR, 3.39; 95% CI, 2.38-4.40), compared with physicians in the middle or later in their career (OR, 1.73; 95% CI, 1.46-2.01; Cohen Q, 7.27; P = .003).

“Investments in organizational strategies to jointly monitor and improve physician wellness and patient care outcomes are needed,” Dr. Panagioti and her colleagues wrote in the study. “Interventions aimed at improving the culture of health care organizations, as well as interventions focused on individual physicians but supported and funded by health care organizations, are beneficial.”

Researchers noted the study quality was low to moderate. Variation in outcomes across studies, heterogeneity among studies, potential selection bias by excluding gray literature, and the inability to establish causal links from findings because of the cross-sectional nature of the studies analyzed were potential limitations in the study, they reported.

The study was funded by the United Kingdom NIHR School for Primary Care Research and the NIHR Greater Manchester Patient Safety Translational Research Centre. The authors report no relevant conflicts of interest.

SOURCE: Panagioti M et al. JAMA Intern Med. 2018 Sept 4. doi: 10.1001/jamainternmed.2018.3713.

Physicians experiencing burnout are twice as likely to be associated with patient safety issues and deliver a lower quality of care from low professionalism and are three times as likely to be rated poorly among patients because of depersonalization of care, according to recent research published in JAMA Internal Medicine.

olm26250/Thinkstock

“The primary conclusion of this review is that physician burnout might jeopardize patient care,” Maria Panagioti, PhD, from the National Institute for Health Research (NIHR) School for Primary Care Research and the NIHR Greater Manchester Patient Safety Translational Research Centre at the University of Manchester (United Kingdom) and her colleagues wrote in their study. “Physician wellness and quality of patient care are critical [as are] complementary dimensions of health care organization efficiency.”

Dr. Panagioti and her colleagues performed a search of the MEDLINE, EMBASE, CINAHL, and PsycInfo databases and found 47 eligible studies on the topics of physician burnout and patient care, which altogether included data from a pooled cohort of 42,473 physicians. The physicians were median 38 years old, with 44.7% of studies looking at physicians in residency or early career (up to 5 years post residency) and 55.3% of studies examining experienced physicians. The meta-analysis also evaluated physicians in a hospital setting (63.8%), primary care (13.8%), and across various different health care settings (8.5%).

The researchers found physicians with burnout were significantly associated with higher rates of patient safety issues (odds ratio, 1.96; 95% confidence interval, 1.59-2.40), reduced patient satisfaction (OR, 2.28; 95% CI, 1.42-3.68), and lower quality of care (OR, 2.31; 95% CI, 1.87-2.85). System-reported instances of patient safety issues and low professionalism were not statistically significant, but the subgroup differences did reach statistical significance (Cohen Q, 8.14; P = .007). Among residents and physicians in their early career, there was a greater association between burnout and low professionalism (OR, 3.39; 95% CI, 2.38-4.40), compared with physicians in the middle or later in their career (OR, 1.73; 95% CI, 1.46-2.01; Cohen Q, 7.27; P = .003).

“Investments in organizational strategies to jointly monitor and improve physician wellness and patient care outcomes are needed,” Dr. Panagioti and her colleagues wrote in the study. “Interventions aimed at improving the culture of health care organizations, as well as interventions focused on individual physicians but supported and funded by health care organizations, are beneficial.”

Researchers noted the study quality was low to moderate. Variation in outcomes across studies, heterogeneity among studies, potential selection bias by excluding gray literature, and the inability to establish causal links from findings because of the cross-sectional nature of the studies analyzed were potential limitations in the study, they reported.

The study was funded by the United Kingdom NIHR School for Primary Care Research and the NIHR Greater Manchester Patient Safety Translational Research Centre. The authors report no relevant conflicts of interest.

SOURCE: Panagioti M et al. JAMA Intern Med. 2018 Sept 4. doi: 10.1001/jamainternmed.2018.3713.

Unlike some children who wanted be firefighters or astronauts when they grew up, ever since Raj Sehgal, MD, FHM, was a boy, he dreamed of being a doctor.

Since earning his medical degree, Dr. Sehgal has kept himself involved in a wide variety of projects, driven by the desire to diversify his expertise.

Currently a clinical associate professor of medicine in the division of general and hospital medicine at the South Texas Veterans Health Care System, San Antonio, and University of Texas Health San Antonio, Dr. Sehgal has found his place as an educator as well as a clinician, earning the Division of Hospital Medicine Teaching Award in 2016.

As a member of the The Hospitalist’s volunteer editorial advisory board, Dr. Sehgal enjoys helping to educate and inform fellow hospitalists. He spoke with The Hospitalist to tell us more about himself.
 

How did you get into medicine?

I don’t know how old I was when I decided I was going to be a doctor, but it was at a very young age and I never really wavered in that desire. I guess I also would have wanted to be a baseball player or a musician, but I never had the talents for those, so it was doctor. That’s always what I was thinking of doing, straight through high school and college, and then after college I took a year off and joined AmeriCorps. I spent a year there and then went to medical school in Dallas at UT Southwestern. After medical school, I thought I should go somewhere as different from Dallas as possible, so I went to Portland, Ore., for my residency and then a fellowship in general internal medicine.

How did you end up in hospital medicine?

When I was doing my residency, I always enjoyed being a generalist. A lot of different areas of medicine interested me, but I like the breadth of things you encounter as a generalist, so I could never picture myself being a subspecialist, doing the same things every day, seeing the same things. I knew I wanted to keep practicing general internal medicine, so I took a fellowship where I was working both inpatient and outpatient, and when I was looking for a job, I sought out things that involved some inpatient and some outpatient work. It turned out hospital medicine was the best fit.

What would you say is your favorite part of hospital medicine?

My favorite part of the job is getting to teach, working with medical students and residents. I also like the variety of what I do as a hospitalist, so I’m about 50% clinical and the rest of the time I perform a variety of tasks, both administrative and educational.

What about your least favorite part of hospitalist work?

Sometimes, particularly if you’re doing clinical, educational, and administrative work, it can be a little overwhelming to try and do a little bit of everything. I think generally that’s a good thing, but sometimes it can feel like a little too much.

What is some of the best advice you have received regarding how to handle the stresses of hospital medicine?

Feel free to say no to things. When hospitalists are starting their careers, and particularly when they are new to a job and trying to express their desire to get involved, sometimes they can have too much thrown at them at once. People can get overloaded very quickly, so I think feeling like you’re able to say no to some requests, or to take some time to think before you accept an additional role. The other piece of advice I remember from my fellowship, is that, when you do something, make it count twice. For example, if you’re involved in a project, you get the practical clinical or educational benefits of whatever the project was. But also think about how you might write about your experience for research purposes, such as for a poster, article, or other presentation.

What is the worst advice you have been given?

I think it’s not necessarily bad advice, but I guess it’s advice that I haven’t really followed. Since I work in academic medicine, I’ve found that the people in academics fall into one of two categories: There are the people who find their niche and remain on that path, and they’re very clear about it and don’t really stray from it; and there are people who don’t find that niche right away. I think the advice I received when starting out was to try to find that niche, and if you’re building an academic career it is very helpful to have these things in which you have become the expert. But I’ve just tried to go where the job takes me. I don’t necessarily have a single academic niche or something that I spend all my time doing, but I do have my hand in a lot of different things. To me, that’s a lot more interesting because it adds to the variety of what you’re doing. Every day is a little different.

What else do you do professionally outside of hospital medicine?

I actually practice a little outpatient medicine. When I first started here, I wanted to keep some outpatient experience, and so I actually created my own clinic. It’s a procedure clinic where I do paracentesis on people who have cirrhosis. Then on the educational side, I sit on the admission committees for the medical school here, so I get to look through the applicants and choose who we interview, and then once we interview candidates, I help choose how we rank students for admission.

Where do you see yourself in the next 10 years?

I’ve never been one who looks at a particular job and says ‘Okay, I want to be the dean or have this position.’ I guess I just hope I’m better at the things I’m currently doing. I hope in 10 years that I’m a better teacher, that I’ll have learned more strategies to help more people, and that I have a better handle on the administrative side of the work. I hope I’ve progressed to a point in my career where I’m doing an even better job than I am now.

What are your goals as a member of the editorial board?

I have an interest not only in medicine but also in writing; I’ve gotten to do some writing both medical and nonmedical in the past. I’ve published a few articles in The Hospitalist, and hopefully, I can do more of that because writing is just another part of education.

Unlike some children who wanted be firefighters or astronauts when they grew up, ever since Raj Sehgal, MD, FHM, was a boy, he dreamed of being a doctor.

Since earning his medical degree, Dr. Sehgal has kept himself involved in a wide variety of projects, driven by the desire to diversify his expertise.

Currently a clinical associate professor of medicine in the division of general and hospital medicine at the South Texas Veterans Health Care System, San Antonio, and University of Texas Health San Antonio, Dr. Sehgal has found his place as an educator as well as a clinician, earning the Division of Hospital Medicine Teaching Award in 2016.

As a member of the The Hospitalist’s volunteer editorial advisory board, Dr. Sehgal enjoys helping to educate and inform fellow hospitalists. He spoke with The Hospitalist to tell us more about himself.
 

How did you get into medicine?

I don’t know how old I was when I decided I was going to be a doctor, but it was at a very young age and I never really wavered in that desire. I guess I also would have wanted to be a baseball player or a musician, but I never had the talents for those, so it was doctor. That’s always what I was thinking of doing, straight through high school and college, and then after college I took a year off and joined AmeriCorps. I spent a year there and then went to medical school in Dallas at UT Southwestern. After medical school, I thought I should go somewhere as different from Dallas as possible, so I went to Portland, Ore., for my residency and then a fellowship in general internal medicine.

How did you end up in hospital medicine?

When I was doing my residency, I always enjoyed being a generalist. A lot of different areas of medicine interested me, but I like the breadth of things you encounter as a generalist, so I could never picture myself being a subspecialist, doing the same things every day, seeing the same things. I knew I wanted to keep practicing general internal medicine, so I took a fellowship where I was working both inpatient and outpatient, and when I was looking for a job, I sought out things that involved some inpatient and some outpatient work. It turned out hospital medicine was the best fit.

What would you say is your favorite part of hospital medicine?

My favorite part of the job is getting to teach, working with medical students and residents. I also like the variety of what I do as a hospitalist, so I’m about 50% clinical and the rest of the time I perform a variety of tasks, both administrative and educational.

What about your least favorite part of hospitalist work?

Sometimes, particularly if you’re doing clinical, educational, and administrative work, it can be a little overwhelming to try and do a little bit of everything. I think generally that’s a good thing, but sometimes it can feel like a little too much.

What is some of the best advice you have received regarding how to handle the stresses of hospital medicine?

Feel free to say no to things. When hospitalists are starting their careers, and particularly when they are new to a job and trying to express their desire to get involved, sometimes they can have too much thrown at them at once. People can get overloaded very quickly, so I think feeling like you’re able to say no to some requests, or to take some time to think before you accept an additional role. The other piece of advice I remember from my fellowship, is that, when you do something, make it count twice. For example, if you’re involved in a project, you get the practical clinical or educational benefits of whatever the project was. But also think about how you might write about your experience for research purposes, such as for a poster, article, or other presentation.

What is the worst advice you have been given?

I think it’s not necessarily bad advice, but I guess it’s advice that I haven’t really followed. Since I work in academic medicine, I’ve found that the people in academics fall into one of two categories: There are the people who find their niche and remain on that path, and they’re very clear about it and don’t really stray from it; and there are people who don’t find that niche right away. I think the advice I received when starting out was to try to find that niche, and if you’re building an academic career it is very helpful to have these things in which you have become the expert. But I’ve just tried to go where the job takes me. I don’t necessarily have a single academic niche or something that I spend all my time doing, but I do have my hand in a lot of different things. To me, that’s a lot more interesting because it adds to the variety of what you’re doing. Every day is a little different.

What else do you do professionally outside of hospital medicine?

I actually practice a little outpatient medicine. When I first started here, I wanted to keep some outpatient experience, and so I actually created my own clinic. It’s a procedure clinic where I do paracentesis on people who have cirrhosis. Then on the educational side, I sit on the admission committees for the medical school here, so I get to look through the applicants and choose who we interview, and then once we interview candidates, I help choose how we rank students for admission.

Where do you see yourself in the next 10 years?

I’ve never been one who looks at a particular job and says ‘Okay, I want to be the dean or have this position.’ I guess I just hope I’m better at the things I’m currently doing. I hope in 10 years that I’m a better teacher, that I’ll have learned more strategies to help more people, and that I have a better handle on the administrative side of the work. I hope I’ve progressed to a point in my career where I’m doing an even better job than I am now.

What are your goals as a member of the editorial board?

I have an interest not only in medicine but also in writing; I’ve gotten to do some writing both medical and nonmedical in the past. I’ve published a few articles in The Hospitalist, and hopefully, I can do more of that because writing is just another part of education.

Unlike some children who wanted be firefighters or astronauts when they grew up, ever since Raj Sehgal, MD, FHM, was a boy, he dreamed of being a doctor.

Since earning his medical degree, Dr. Sehgal has kept himself involved in a wide variety of projects, driven by the desire to diversify his expertise.

Currently a clinical associate professor of medicine in the division of general and hospital medicine at the South Texas Veterans Health Care System, San Antonio, and University of Texas Health San Antonio, Dr. Sehgal has found his place as an educator as well as a clinician, earning the Division of Hospital Medicine Teaching Award in 2016.

As a member of the The Hospitalist’s volunteer editorial advisory board, Dr. Sehgal enjoys helping to educate and inform fellow hospitalists. He spoke with The Hospitalist to tell us more about himself.
 

How did you get into medicine?

I don’t know how old I was when I decided I was going to be a doctor, but it was at a very young age and I never really wavered in that desire. I guess I also would have wanted to be a baseball player or a musician, but I never had the talents for those, so it was doctor. That’s always what I was thinking of doing, straight through high school and college, and then after college I took a year off and joined AmeriCorps. I spent a year there and then went to medical school in Dallas at UT Southwestern. After medical school, I thought I should go somewhere as different from Dallas as possible, so I went to Portland, Ore., for my residency and then a fellowship in general internal medicine.

How did you end up in hospital medicine?

When I was doing my residency, I always enjoyed being a generalist. A lot of different areas of medicine interested me, but I like the breadth of things you encounter as a generalist, so I could never picture myself being a subspecialist, doing the same things every day, seeing the same things. I knew I wanted to keep practicing general internal medicine, so I took a fellowship where I was working both inpatient and outpatient, and when I was looking for a job, I sought out things that involved some inpatient and some outpatient work. It turned out hospital medicine was the best fit.

What would you say is your favorite part of hospital medicine?

My favorite part of the job is getting to teach, working with medical students and residents. I also like the variety of what I do as a hospitalist, so I’m about 50% clinical and the rest of the time I perform a variety of tasks, both administrative and educational.

What about your least favorite part of hospitalist work?

Sometimes, particularly if you’re doing clinical, educational, and administrative work, it can be a little overwhelming to try and do a little bit of everything. I think generally that’s a good thing, but sometimes it can feel like a little too much.

What is some of the best advice you have received regarding how to handle the stresses of hospital medicine?

Feel free to say no to things. When hospitalists are starting their careers, and particularly when they are new to a job and trying to express their desire to get involved, sometimes they can have too much thrown at them at once. People can get overloaded very quickly, so I think feeling like you’re able to say no to some requests, or to take some time to think before you accept an additional role. The other piece of advice I remember from my fellowship, is that, when you do something, make it count twice. For example, if you’re involved in a project, you get the practical clinical or educational benefits of whatever the project was. But also think about how you might write about your experience for research purposes, such as for a poster, article, or other presentation.

What is the worst advice you have been given?

I think it’s not necessarily bad advice, but I guess it’s advice that I haven’t really followed. Since I work in academic medicine, I’ve found that the people in academics fall into one of two categories: There are the people who find their niche and remain on that path, and they’re very clear about it and don’t really stray from it; and there are people who don’t find that niche right away. I think the advice I received when starting out was to try to find that niche, and if you’re building an academic career it is very helpful to have these things in which you have become the expert. But I’ve just tried to go where the job takes me. I don’t necessarily have a single academic niche or something that I spend all my time doing, but I do have my hand in a lot of different things. To me, that’s a lot more interesting because it adds to the variety of what you’re doing. Every day is a little different.

What else do you do professionally outside of hospital medicine?

I actually practice a little outpatient medicine. When I first started here, I wanted to keep some outpatient experience, and so I actually created my own clinic. It’s a procedure clinic where I do paracentesis on people who have cirrhosis. Then on the educational side, I sit on the admission committees for the medical school here, so I get to look through the applicants and choose who we interview, and then once we interview candidates, I help choose how we rank students for admission.

Where do you see yourself in the next 10 years?

I’ve never been one who looks at a particular job and says ‘Okay, I want to be the dean or have this position.’ I guess I just hope I’m better at the things I’m currently doing. I hope in 10 years that I’m a better teacher, that I’ll have learned more strategies to help more people, and that I have a better handle on the administrative side of the work. I hope I’ve progressed to a point in my career where I’m doing an even better job than I am now.

What are your goals as a member of the editorial board?

I have an interest not only in medicine but also in writing; I’ve gotten to do some writing both medical and nonmedical in the past. I’ve published a few articles in The Hospitalist, and hopefully, I can do more of that because writing is just another part of education.

“You can teach a canary in a coal mine to meditate, but it is still going to die.”

I have seen the canary sentiment above – used as a metaphor for health care and burnout – pop up a few times on Twitter, attributed to a few different thoughtful doctors, including Jenny Ramsey, MD, of the Cleveland Clinic (at Hospital Medicine 2018); Lucy Kalanithi, MD, a clinical assistant professor of medicine at Stanford (Calif.) University and widow of Paul Kalanithi, MD, of “When Breath Becomes Air” fame; and Stuart Slavin, MD, associate dean for curriculum and a professor of pediatrics at Saint Louis University.

To be honest, I am rather burned out on reading about physician burnout at this point. Nevertheless, I love the canary idea; it is such a perfect visual of the current problem facing physicians.

I was thinking about the meditating canary when I read the new “Charter on Physician Well-Being,” published in JAMA and already endorsed by most major medical organizations/acronyms, including SHM, ACP, SGIM, AMA, AAMC, AAIM, ABIM, ACCME, APA, and the IHI. This physician well-being charter was created by the Collaborative for Healing and Renewal in Medicine, a group that includes leading medical centers and organizations.

What makes this different from previous attempts at addressing burnout? The charter takes a systems-based approach to physician well-being. Aha, of course! As the patient safety movement realized more than 2 decades ago, real progress would only be made when we stopped focusing our attention, blame, and interventions on individuals and instead looked at systems; now, the physician well-being movement has officially made the same bold proclamation.

It is not the fault of the burned-out physician who apparently just needs to be hammered over the head with better coping skills – just as the majority of medical errors would not be fixed by continuing to tell physicians that they screwed up and should figure out how not to do that again!

We need to make real changes to the system. For example, one of the charter’s authors, Colin P. West, MD, PhD, highlighted why it is important that organizations commit to optimizing highly functioning interprofessional teams: “Can you imagine @KingJames [LeBron James] or @Oprah applying their unique skills AND personally seating the crowd, collecting stats, assessing satisfaction, etc.? So why do we?”

The authors also call for organizations to commit to reducing time spent on documentation and administration. Hallelujah!

Now the question is whether this charter will actually have any teeth or whether it will have the same fate as our canary, slowly fading away, never to be heard from again?

Read the full post at hospitalleader.org.

Dr. Moriates is the assistant dean for health care value and an associate professor of internal medicine at the University of Texas, Austin.
 

Also in The Hospital Leader

“What’s a Cost, Charge, and Price?” by Brad Flansbaum, DO, MPH, MHM

“There Is a ‘You’ in Team,” by Tracy Cardin, ACNP-BC, SFHM

“‘Harper’s Index’ of Hospital Medicine 2018,” by Jordan Messler, MD, SFHM

“You can teach a canary in a coal mine to meditate, but it is still going to die.”

I have seen the canary sentiment above – used as a metaphor for health care and burnout – pop up a few times on Twitter, attributed to a few different thoughtful doctors, including Jenny Ramsey, MD, of the Cleveland Clinic (at Hospital Medicine 2018); Lucy Kalanithi, MD, a clinical assistant professor of medicine at Stanford (Calif.) University and widow of Paul Kalanithi, MD, of “When Breath Becomes Air” fame; and Stuart Slavin, MD, associate dean for curriculum and a professor of pediatrics at Saint Louis University.

To be honest, I am rather burned out on reading about physician burnout at this point. Nevertheless, I love the canary idea; it is such a perfect visual of the current problem facing physicians.

I was thinking about the meditating canary when I read the new “Charter on Physician Well-Being,” published in JAMA and already endorsed by most major medical organizations/acronyms, including SHM, ACP, SGIM, AMA, AAMC, AAIM, ABIM, ACCME, APA, and the IHI. This physician well-being charter was created by the Collaborative for Healing and Renewal in Medicine, a group that includes leading medical centers and organizations.

What makes this different from previous attempts at addressing burnout? The charter takes a systems-based approach to physician well-being. Aha, of course! As the patient safety movement realized more than 2 decades ago, real progress would only be made when we stopped focusing our attention, blame, and interventions on individuals and instead looked at systems; now, the physician well-being movement has officially made the same bold proclamation.

It is not the fault of the burned-out physician who apparently just needs to be hammered over the head with better coping skills – just as the majority of medical errors would not be fixed by continuing to tell physicians that they screwed up and should figure out how not to do that again!

We need to make real changes to the system. For example, one of the charter’s authors, Colin P. West, MD, PhD, highlighted why it is important that organizations commit to optimizing highly functioning interprofessional teams: “Can you imagine @KingJames [LeBron James] or @Oprah applying their unique skills AND personally seating the crowd, collecting stats, assessing satisfaction, etc.? So why do we?”

The authors also call for organizations to commit to reducing time spent on documentation and administration. Hallelujah!

Now the question is whether this charter will actually have any teeth or whether it will have the same fate as our canary, slowly fading away, never to be heard from again?

Read the full post at hospitalleader.org.

Dr. Moriates is the assistant dean for health care value and an associate professor of internal medicine at the University of Texas, Austin.
 

Also in The Hospital Leader

“What’s a Cost, Charge, and Price?” by Brad Flansbaum, DO, MPH, MHM

“There Is a ‘You’ in Team,” by Tracy Cardin, ACNP-BC, SFHM

“‘Harper’s Index’ of Hospital Medicine 2018,” by Jordan Messler, MD, SFHM

“You can teach a canary in a coal mine to meditate, but it is still going to die.”

I have seen the canary sentiment above – used as a metaphor for health care and burnout – pop up a few times on Twitter, attributed to a few different thoughtful doctors, including Jenny Ramsey, MD, of the Cleveland Clinic (at Hospital Medicine 2018); Lucy Kalanithi, MD, a clinical assistant professor of medicine at Stanford (Calif.) University and widow of Paul Kalanithi, MD, of “When Breath Becomes Air” fame; and Stuart Slavin, MD, associate dean for curriculum and a professor of pediatrics at Saint Louis University.

To be honest, I am rather burned out on reading about physician burnout at this point. Nevertheless, I love the canary idea; it is such a perfect visual of the current problem facing physicians.

I was thinking about the meditating canary when I read the new “Charter on Physician Well-Being,” published in JAMA and already endorsed by most major medical organizations/acronyms, including SHM, ACP, SGIM, AMA, AAMC, AAIM, ABIM, ACCME, APA, and the IHI. This physician well-being charter was created by the Collaborative for Healing and Renewal in Medicine, a group that includes leading medical centers and organizations.

What makes this different from previous attempts at addressing burnout? The charter takes a systems-based approach to physician well-being. Aha, of course! As the patient safety movement realized more than 2 decades ago, real progress would only be made when we stopped focusing our attention, blame, and interventions on individuals and instead looked at systems; now, the physician well-being movement has officially made the same bold proclamation.

It is not the fault of the burned-out physician who apparently just needs to be hammered over the head with better coping skills – just as the majority of medical errors would not be fixed by continuing to tell physicians that they screwed up and should figure out how not to do that again!

We need to make real changes to the system. For example, one of the charter’s authors, Colin P. West, MD, PhD, highlighted why it is important that organizations commit to optimizing highly functioning interprofessional teams: “Can you imagine @KingJames [LeBron James] or @Oprah applying their unique skills AND personally seating the crowd, collecting stats, assessing satisfaction, etc.? So why do we?”

The authors also call for organizations to commit to reducing time spent on documentation and administration. Hallelujah!

Now the question is whether this charter will actually have any teeth or whether it will have the same fate as our canary, slowly fading away, never to be heard from again?

Read the full post at hospitalleader.org.

Dr. Moriates is the assistant dean for health care value and an associate professor of internal medicine at the University of Texas, Austin.
 

Also in The Hospital Leader

“What’s a Cost, Charge, and Price?” by Brad Flansbaum, DO, MPH, MHM

“There Is a ‘You’ in Team,” by Tracy Cardin, ACNP-BC, SFHM

“‘Harper’s Index’ of Hospital Medicine 2018,” by Jordan Messler, MD, SFHM

Society of Hospital Medicine committee participation is an exciting opportunity available to all medical students and resident physicians. Whether you are hoping to explore new facets of hospital medicine, or take the next step in shaping your career, committee involvement creates opportunities for individuals to share their insight and work collaboratively on key SHM priorities to shape the future of hospital medicine.

If you are interested, the application is short and straightforward. Requisite SHM membership is free for students and discounted for resident members. And the benefits of committee participation are far reaching.

SHM committee opportunities will cater to most interests and career paths. Our personal interest in academic hospital medicine and medical education led us to the Physicians-In-Training (PIT) committee, but seventeen committees are available (see the complete list below). Review the committee descriptions online and select the one that best aligns with your individual interests. A mentor’s insight may be valuable in determining which committee is the best opportunity.

SHM Committee Opportunities:

• Academic Hospitalist Committee
• Annual Meeting Committee
• Awards Committee
• Chapter Support Committee
• Communications Strategy Committee
• Digital Learning Committee
• Education Committee
• Hospital Quality and Patient Safety Committee
• Membership Committee
• Patient Experience Committee
• Performance Measurement & Reporting Committee
• Physicians in Training Committee
• Practice Analysis Committee
• Practice Management Committee
• Public Policy Committee
• Research Committee
• Special Interest Group Support Committee

Dr. Bartlett is a hospitalist at the University of New Mexico Hospital, Albuquerque. Mr. Namavar is a medical student at Stritch School of Medicine, Loyola University Chicago.

Society of Hospital Medicine committee participation is an exciting opportunity available to all medical students and resident physicians. Whether you are hoping to explore new facets of hospital medicine, or take the next step in shaping your career, committee involvement creates opportunities for individuals to share their insight and work collaboratively on key SHM priorities to shape the future of hospital medicine.

If you are interested, the application is short and straightforward. Requisite SHM membership is free for students and discounted for resident members. And the benefits of committee participation are far reaching.

SHM committee opportunities will cater to most interests and career paths. Our personal interest in academic hospital medicine and medical education led us to the Physicians-In-Training (PIT) committee, but seventeen committees are available (see the complete list below). Review the committee descriptions online and select the one that best aligns with your individual interests. A mentor’s insight may be valuable in determining which committee is the best opportunity.

SHM Committee Opportunities:

• Academic Hospitalist Committee
• Annual Meeting Committee
• Awards Committee
• Chapter Support Committee
• Communications Strategy Committee
• Digital Learning Committee
• Education Committee
• Hospital Quality and Patient Safety Committee
• Membership Committee
• Patient Experience Committee
• Performance Measurement & Reporting Committee
• Physicians in Training Committee
• Practice Analysis Committee
• Practice Management Committee
• Public Policy Committee
• Research Committee
• Special Interest Group Support Committee

Dr. Bartlett is a hospitalist at the University of New Mexico Hospital, Albuquerque. Mr. Namavar is a medical student at Stritch School of Medicine, Loyola University Chicago.

Society of Hospital Medicine committee participation is an exciting opportunity available to all medical students and resident physicians. Whether you are hoping to explore new facets of hospital medicine, or take the next step in shaping your career, committee involvement creates opportunities for individuals to share their insight and work collaboratively on key SHM priorities to shape the future of hospital medicine.

If you are interested, the application is short and straightforward. Requisite SHM membership is free for students and discounted for resident members. And the benefits of committee participation are far reaching.

SHM committee opportunities will cater to most interests and career paths. Our personal interest in academic hospital medicine and medical education led us to the Physicians-In-Training (PIT) committee, but seventeen committees are available (see the complete list below). Review the committee descriptions online and select the one that best aligns with your individual interests. A mentor’s insight may be valuable in determining which committee is the best opportunity.

SHM Committee Opportunities:

• Academic Hospitalist Committee
• Annual Meeting Committee
• Awards Committee
• Chapter Support Committee
• Communications Strategy Committee
• Digital Learning Committee
• Education Committee
• Hospital Quality and Patient Safety Committee
• Membership Committee
• Patient Experience Committee
• Performance Measurement & Reporting Committee
• Physicians in Training Committee
• Practice Analysis Committee
• Practice Management Committee
• Public Policy Committee
• Research Committee
• Special Interest Group Support Committee

Dr. Bartlett is a hospitalist at the University of New Mexico Hospital, Albuquerque. Mr. Namavar is a medical student at Stritch School of Medicine, Loyola University Chicago.

Editor’s note: SHM occasionally puts the spotlight on our most active members who are making substantial contributions to hospital medicine. Visit www.hospitalmedicine.org for more information on how you can lend your expertise to help improve the care of hospitalized patients.

This month, The Hospitalist spotlights Ramin Yazdanfar, MD, hospitalist and Harrisburg (Pa.) site medical director at UPMC Pinnacle. Dr. Ramin has been a member of SHM since 2016, has attended two annual conferences as well as Leadership Academy, and together with his team received SHM’s Award of Excellence in Teamwork.
 

How did you learn about SHM and why did you become a member?

I first heard about SHM during my initial job out of residency. At that time, our medical director encouraged engagement in the field of hospital medicine, and he was quite involved in local meetings and national conferences. I became a member because I felt it would be a good way to connect with other hospitalists who might have been going through similar experiences and struggles, and in the hopes of gaining something I could take back to use in my daily practice.

Which SHM conferences have you attended and why?

I have attended two national conferences thus far. The first was the 2016 SHM Annual Conference in San Diego, where our hospitalist team won the Excellence in Teamwork and Quality Improvement Award for our active bed management program under Mary Ellen Pfeiffer, MD, and William “Tex” Landis, MD, among others. I also attended the 2017 Leadership Academy in Scottsdale, Ariz. As a new site director for a new hospitalist group, I thought it would be a valuable learning experience, with the goal of improving my communication as a leader. I also will be attending the 2018 SHM Leadership Academy in Vancouver. I am excited to reconnect with peers I met last year and to advance my leadership skills further.

What were the main takeaways from Leadership: Mastering Teamwork, and how have you applied them in your practice?

My most vivid and actionable memory of Leadership: Mastering Teamwork was the initial session around the five dysfunctions of a team and how to build a cohesive leadership team. Allowing ourselves to be vulnerable and open creates the foundation of trust, on which we can build everything else, such as handling conflict and creating commitment, accountability, and results. I have tried to use these principles in our own practice, at UPMC Pinnacle Health in Harrisburg, Pa. We have an ever-growing health system with an expanding regional leadership team. We base our foundation on trust in one another, and in our vision, so the rest follows suit.

As a separate takeaway, I really enjoyed sessions with Leonard Marcus, PhD, on SWARM Intelligence and Meta-Leadership. He is a very engaging speaker whom I would recommend to anyone considering the Mastering Teamwork session.
 

What advice do you have for early-career hospitalists looking to advance their career in hospital medicine?

My advice to early-career hospitalists is to be open to opportunity. There is so much change and development in the field of hospital medicine. While the foundation of our job is in the patient care realm, many of us find a niche that interests us. My advice is pursue it and be open to what follows, without forgetting that we do this for our patients and community.

Ms. Steele is a marketing communications specialist at the Society of Hospital Medicine.

Editor’s note: SHM occasionally puts the spotlight on our most active members who are making substantial contributions to hospital medicine. Visit www.hospitalmedicine.org for more information on how you can lend your expertise to help improve the care of hospitalized patients.

This month, The Hospitalist spotlights Ramin Yazdanfar, MD, hospitalist and Harrisburg (Pa.) site medical director at UPMC Pinnacle. Dr. Ramin has been a member of SHM since 2016, has attended two annual conferences as well as Leadership Academy, and together with his team received SHM’s Award of Excellence in Teamwork.
 

How did you learn about SHM and why did you become a member?

I first heard about SHM during my initial job out of residency. At that time, our medical director encouraged engagement in the field of hospital medicine, and he was quite involved in local meetings and national conferences. I became a member because I felt it would be a good way to connect with other hospitalists who might have been going through similar experiences and struggles, and in the hopes of gaining something I could take back to use in my daily practice.

Which SHM conferences have you attended and why?

I have attended two national conferences thus far. The first was the 2016 SHM Annual Conference in San Diego, where our hospitalist team won the Excellence in Teamwork and Quality Improvement Award for our active bed management program under Mary Ellen Pfeiffer, MD, and William “Tex” Landis, MD, among others. I also attended the 2017 Leadership Academy in Scottsdale, Ariz. As a new site director for a new hospitalist group, I thought it would be a valuable learning experience, with the goal of improving my communication as a leader. I also will be attending the 2018 SHM Leadership Academy in Vancouver. I am excited to reconnect with peers I met last year and to advance my leadership skills further.

What were the main takeaways from Leadership: Mastering Teamwork, and how have you applied them in your practice?

My most vivid and actionable memory of Leadership: Mastering Teamwork was the initial session around the five dysfunctions of a team and how to build a cohesive leadership team. Allowing ourselves to be vulnerable and open creates the foundation of trust, on which we can build everything else, such as handling conflict and creating commitment, accountability, and results. I have tried to use these principles in our own practice, at UPMC Pinnacle Health in Harrisburg, Pa. We have an ever-growing health system with an expanding regional leadership team. We base our foundation on trust in one another, and in our vision, so the rest follows suit.

As a separate takeaway, I really enjoyed sessions with Leonard Marcus, PhD, on SWARM Intelligence and Meta-Leadership. He is a very engaging speaker whom I would recommend to anyone considering the Mastering Teamwork session.
 

What advice do you have for early-career hospitalists looking to advance their career in hospital medicine?

My advice to early-career hospitalists is to be open to opportunity. There is so much change and development in the field of hospital medicine. While the foundation of our job is in the patient care realm, many of us find a niche that interests us. My advice is pursue it and be open to what follows, without forgetting that we do this for our patients and community.

Ms. Steele is a marketing communications specialist at the Society of Hospital Medicine.

Editor’s note: SHM occasionally puts the spotlight on our most active members who are making substantial contributions to hospital medicine. Visit www.hospitalmedicine.org for more information on how you can lend your expertise to help improve the care of hospitalized patients.

This month, The Hospitalist spotlights Ramin Yazdanfar, MD, hospitalist and Harrisburg (Pa.) site medical director at UPMC Pinnacle. Dr. Ramin has been a member of SHM since 2016, has attended two annual conferences as well as Leadership Academy, and together with his team received SHM’s Award of Excellence in Teamwork.
 

How did you learn about SHM and why did you become a member?

I first heard about SHM during my initial job out of residency. At that time, our medical director encouraged engagement in the field of hospital medicine, and he was quite involved in local meetings and national conferences. I became a member because I felt it would be a good way to connect with other hospitalists who might have been going through similar experiences and struggles, and in the hopes of gaining something I could take back to use in my daily practice.

Which SHM conferences have you attended and why?

I have attended two national conferences thus far. The first was the 2016 SHM Annual Conference in San Diego, where our hospitalist team won the Excellence in Teamwork and Quality Improvement Award for our active bed management program under Mary Ellen Pfeiffer, MD, and William “Tex” Landis, MD, among others. I also attended the 2017 Leadership Academy in Scottsdale, Ariz. As a new site director for a new hospitalist group, I thought it would be a valuable learning experience, with the goal of improving my communication as a leader. I also will be attending the 2018 SHM Leadership Academy in Vancouver. I am excited to reconnect with peers I met last year and to advance my leadership skills further.

What were the main takeaways from Leadership: Mastering Teamwork, and how have you applied them in your practice?

My most vivid and actionable memory of Leadership: Mastering Teamwork was the initial session around the five dysfunctions of a team and how to build a cohesive leadership team. Allowing ourselves to be vulnerable and open creates the foundation of trust, on which we can build everything else, such as handling conflict and creating commitment, accountability, and results. I have tried to use these principles in our own practice, at UPMC Pinnacle Health in Harrisburg, Pa. We have an ever-growing health system with an expanding regional leadership team. We base our foundation on trust in one another, and in our vision, so the rest follows suit.

As a separate takeaway, I really enjoyed sessions with Leonard Marcus, PhD, on SWARM Intelligence and Meta-Leadership. He is a very engaging speaker whom I would recommend to anyone considering the Mastering Teamwork session.
 

What advice do you have for early-career hospitalists looking to advance their career in hospital medicine?

My advice to early-career hospitalists is to be open to opportunity. There is so much change and development in the field of hospital medicine. While the foundation of our job is in the patient care realm, many of us find a niche that interests us. My advice is pursue it and be open to what follows, without forgetting that we do this for our patients and community.

Ms. Steele is a marketing communications specialist at the Society of Hospital Medicine.

Steven Pantilat, MD, MHM, has been named the first chief of the newly established division of palliative medicine at University of California, San Francisco Health. Dr. Pantilat’s new role commenced on May 1st, with the division launch anticipated for July 1st.

Gary J. Carver, MD, recently was named the chief medical officer at Coshocton (Ohio) Regional Medical Center. Dr. Carver has been the hospital’s director of hospital medicine since 2013 and will continue in that role in addition to his duties as CMO.

In his new position, Dr. Carver joins Coshocton Medical Center’s senior leadership team, providing medical oversight, as well as clinical direction and leadership as the facility seeks accreditation, quality improvement, and service line development.
 

Lisa Shah, MD, has been hired by Sound Physicians as the group’s chief innovation officer. Dr. Shah had been working as senior vice president of Evolent Health’s clinical operations and network. With Sound Physicians, Dr. Shah will lead clinical innovation and transformation for the nationwide organization of physicians providing emergency medical, critical care, and hospital medicine services at more than 180 hospitals.

Dr. Shah will be tasked with developing innovative care models, tech-centered clinical workflows, and telemedicine strategies. She brings a robust hospital medicine background, having served in a 2-year Hospitalist Scholars Fellowship at the University of Chicago, while simultaneously earning a master’s degree in public health.
 

BUSINESS MOVES

The University of Mississippi Medical Center Children’s of Mississippi, Hattiesburg, branch is joining forces with Memorial Hospital at Gulfport (Miss.) to provide care throughout southern Mississippi.

The highlight of the merger is the acquisition of six pediatric clinics into the UMMC family, with UMMC assuming control of the pediatric hospitalist program at each of the locations. The acquired clinics all have been branded as Children’s of Mississippi as of March 26th.
 

Sound Physicians’ parent company Fresenius Medical Care, which has held a controlling interest in Sound since 2014, has sold that interest to Germany-based Summit Partners for a reported $2.15 billion. The acquisition is expected to be finalized later this calendar year.

Sound, which reported revenues of approximately $1.5 billion in 2017, is optimistic that it can tap into new markets while under the Summit umbrella.
 

The Ob Hospitalist Group, Greenville, S.C., the nation’s largest Ob/Gyn hospitalist organization, recently announced the rollout of its CARE (Clinician Assistance, Recovery, and Encourage) program. CARE uses peer support to assist clinicians facing psychological and emotional impacts from adverse Ob events.

CARE peer counseling focuses on confidentiality, empathy, trust, and respect for colleagues suffering from a negative patient-care event. The program is available to more than 600 Ob hospitalist clinicians at more than 120 hospitals nationwide.

Steven Pantilat, MD, MHM, has been named the first chief of the newly established division of palliative medicine at University of California, San Francisco Health. Dr. Pantilat’s new role commenced on May 1st, with the division launch anticipated for July 1st.

Gary J. Carver, MD, recently was named the chief medical officer at Coshocton (Ohio) Regional Medical Center. Dr. Carver has been the hospital’s director of hospital medicine since 2013 and will continue in that role in addition to his duties as CMO.

In his new position, Dr. Carver joins Coshocton Medical Center’s senior leadership team, providing medical oversight, as well as clinical direction and leadership as the facility seeks accreditation, quality improvement, and service line development.
 

Lisa Shah, MD, has been hired by Sound Physicians as the group’s chief innovation officer. Dr. Shah had been working as senior vice president of Evolent Health’s clinical operations and network. With Sound Physicians, Dr. Shah will lead clinical innovation and transformation for the nationwide organization of physicians providing emergency medical, critical care, and hospital medicine services at more than 180 hospitals.

Dr. Shah will be tasked with developing innovative care models, tech-centered clinical workflows, and telemedicine strategies. She brings a robust hospital medicine background, having served in a 2-year Hospitalist Scholars Fellowship at the University of Chicago, while simultaneously earning a master’s degree in public health.
 

BUSINESS MOVES

The University of Mississippi Medical Center Children’s of Mississippi, Hattiesburg, branch is joining forces with Memorial Hospital at Gulfport (Miss.) to provide care throughout southern Mississippi.

The highlight of the merger is the acquisition of six pediatric clinics into the UMMC family, with UMMC assuming control of the pediatric hospitalist program at each of the locations. The acquired clinics all have been branded as Children’s of Mississippi as of March 26th.
 

Sound Physicians’ parent company Fresenius Medical Care, which has held a controlling interest in Sound since 2014, has sold that interest to Germany-based Summit Partners for a reported $2.15 billion. The acquisition is expected to be finalized later this calendar year.

Sound, which reported revenues of approximately $1.5 billion in 2017, is optimistic that it can tap into new markets while under the Summit umbrella.
 

The Ob Hospitalist Group, Greenville, S.C., the nation’s largest Ob/Gyn hospitalist organization, recently announced the rollout of its CARE (Clinician Assistance, Recovery, and Encourage) program. CARE uses peer support to assist clinicians facing psychological and emotional impacts from adverse Ob events.

CARE peer counseling focuses on confidentiality, empathy, trust, and respect for colleagues suffering from a negative patient-care event. The program is available to more than 600 Ob hospitalist clinicians at more than 120 hospitals nationwide.

Steven Pantilat, MD, MHM, has been named the first chief of the newly established division of palliative medicine at University of California, San Francisco Health. Dr. Pantilat’s new role commenced on May 1st, with the division launch anticipated for July 1st.

Gary J. Carver, MD, recently was named the chief medical officer at Coshocton (Ohio) Regional Medical Center. Dr. Carver has been the hospital’s director of hospital medicine since 2013 and will continue in that role in addition to his duties as CMO.

In his new position, Dr. Carver joins Coshocton Medical Center’s senior leadership team, providing medical oversight, as well as clinical direction and leadership as the facility seeks accreditation, quality improvement, and service line development.
 

Lisa Shah, MD, has been hired by Sound Physicians as the group’s chief innovation officer. Dr. Shah had been working as senior vice president of Evolent Health’s clinical operations and network. With Sound Physicians, Dr. Shah will lead clinical innovation and transformation for the nationwide organization of physicians providing emergency medical, critical care, and hospital medicine services at more than 180 hospitals.

Dr. Shah will be tasked with developing innovative care models, tech-centered clinical workflows, and telemedicine strategies. She brings a robust hospital medicine background, having served in a 2-year Hospitalist Scholars Fellowship at the University of Chicago, while simultaneously earning a master’s degree in public health.
 

BUSINESS MOVES

The University of Mississippi Medical Center Children’s of Mississippi, Hattiesburg, branch is joining forces with Memorial Hospital at Gulfport (Miss.) to provide care throughout southern Mississippi.

The highlight of the merger is the acquisition of six pediatric clinics into the UMMC family, with UMMC assuming control of the pediatric hospitalist program at each of the locations. The acquired clinics all have been branded as Children’s of Mississippi as of March 26th.
 

Sound Physicians’ parent company Fresenius Medical Care, which has held a controlling interest in Sound since 2014, has sold that interest to Germany-based Summit Partners for a reported $2.15 billion. The acquisition is expected to be finalized later this calendar year.

Sound, which reported revenues of approximately $1.5 billion in 2017, is optimistic that it can tap into new markets while under the Summit umbrella.
 

The Ob Hospitalist Group, Greenville, S.C., the nation’s largest Ob/Gyn hospitalist organization, recently announced the rollout of its CARE (Clinician Assistance, Recovery, and Encourage) program. CARE uses peer support to assist clinicians facing psychological and emotional impacts from adverse Ob events.

CARE peer counseling focuses on confidentiality, empathy, trust, and respect for colleagues suffering from a negative patient-care event. The program is available to more than 600 Ob hospitalist clinicians at more than 120 hospitals nationwide.

If you are in the business of health care – whether as a direct care provider who is doing their best in an increasingly complex system with an increasingly complex panel of patients; a hospital medicine group leader who is trying to keep a group afloat and lead people through this rocky terrain; or a hospital system leader or chief medical officer dealing with the arcane and ever-changing landscape – there is one universal truth: This business is hard.

You can call it “challenging.” You can say there are “opportunities for improvement.” You can put all kinds of sugar on top, but at times, it is a bitter drink to swallow.

So why, as hospitalists, do we keep doing this?

I always joke that I’m going to open a “fro-yo” stand on the beach, but of course, I never do. And that constancy is one huge reason why I love hospitalists. We are always trying to decode, unlock, and solve some of these seemingly unsolvable problems. But at the same time, this plethora of constant change and instability at all kinds of levels can be a bit, well, impossible.

How do we do it every day? You can change jobs, change patient panels, and change medical systems, but no matter what, you will be confronted on some level with a gap of clearly defined solutions to your “challenges.”

One thing in my arsenal of coping, beyond my fro-yo fantasy, is simply this: compassion. When one of your providers comes to you and is complaining about their workload, don’t tell them about how you used to see three times as many patients at your last job. Instead, put your hand on their shoulder, look them in the eye, and say “It is hard. It is.”

When the CEO of your hospital tells you that the already tiny margin of the hospital is shrinking, and she has to cut a service you feel is indispensable, reflect her pain. Believe me – she feels it.

To practice compassion in hospital medicine is to accept that medicine is hard on everyone. It’s not “us” versus “them.” It’s not just “us” that hurts and “them” that are immune. We all struggle.

We need – I need – to acknowledge the pain this profession often elicits. It can be burnout, resentment, overarching grief, or incredible frustration with broken systems and sometimes broken people. When we deny it, when we try to shove those feelings deep down, then people – good people who feel these things – perceive they are flawed or somehow not cut out for this profession. So they end up leaving. Or imploding.

Instead, if we practice compassion for ourselves and each other, we may find strength and restoration in these relationships with others. We will normalize these very normal responses to the challenges we face every day. And we may then survive all these “opportunities for improvement.”

I challenge everyone to practice this simple compassionate meditation. It will take less than five minutes. As you lay in bed at night, your mind racing, concentrate on feeling compassion for four different people. Start with the person you don’t know well, such as the person who works at the dry cleaner. Breathe deeply. Pick a sentence – a gift to give. I always think, “I wish you happy and healthy, wealthy and wise.” Do this for three or four deep breaths.

Next, using this same technique, choose someone that is hard to feel compassion for – perhaps that difficult family member, or the co-worker that gets under your skin.

Then feel that compassion. Breathe deeply – for yourself, with all your human frailties. You don’t have to be perfect to be loved or lovable. Feel that.

Finally, take a deep breath, feel your chest opening, expanding. Feel that compassion for the whole world – the whole crummy mixed-up world that’s just doing its best. The world needs our compassion, too.

While you were at HM18, I hope you were able to look into the eyes of the others you see. These are your fellow hospitalists. People who feel your joys, your frustrations. Some of those eyes will be bright and excited; others will be worn and tired. But revel in this shared and universal knowledge.

It is hard. But with compassion and understanding, we can make it a bit better. For all of us.

Read the full post at hospitalleader.org.

Ms. Cardin, ACNP-BC, SFHM is vice president, Advanced Practice Providers, at Sound Physicians, and also serves on SHM’s Board of Directors.

Also in The Hospital Leader

• How Can Hospitalists Improve Their HCAHPS Scores? by Leslie Flores, MHA, SFHM
• “Harper’s Index” of Hospital Medicine 2018 by Jordan Messler, MD, SFHM
• What’s a Cost, Charge, and Price? by Brad Flansbaum, DO, MPH, MHM

If you are in the business of health care – whether as a direct care provider who is doing their best in an increasingly complex system with an increasingly complex panel of patients; a hospital medicine group leader who is trying to keep a group afloat and lead people through this rocky terrain; or a hospital system leader or chief medical officer dealing with the arcane and ever-changing landscape – there is one universal truth: This business is hard.

You can call it “challenging.” You can say there are “opportunities for improvement.” You can put all kinds of sugar on top, but at times, it is a bitter drink to swallow.

So why, as hospitalists, do we keep doing this?

I always joke that I’m going to open a “fro-yo” stand on the beach, but of course, I never do. And that constancy is one huge reason why I love hospitalists. We are always trying to decode, unlock, and solve some of these seemingly unsolvable problems. But at the same time, this plethora of constant change and instability at all kinds of levels can be a bit, well, impossible.

How do we do it every day? You can change jobs, change patient panels, and change medical systems, but no matter what, you will be confronted on some level with a gap of clearly defined solutions to your “challenges.”

One thing in my arsenal of coping, beyond my fro-yo fantasy, is simply this: compassion. When one of your providers comes to you and is complaining about their workload, don’t tell them about how you used to see three times as many patients at your last job. Instead, put your hand on their shoulder, look them in the eye, and say “It is hard. It is.”

When the CEO of your hospital tells you that the already tiny margin of the hospital is shrinking, and she has to cut a service you feel is indispensable, reflect her pain. Believe me – she feels it.

To practice compassion in hospital medicine is to accept that medicine is hard on everyone. It’s not “us” versus “them.” It’s not just “us” that hurts and “them” that are immune. We all struggle.

We need – I need – to acknowledge the pain this profession often elicits. It can be burnout, resentment, overarching grief, or incredible frustration with broken systems and sometimes broken people. When we deny it, when we try to shove those feelings deep down, then people – good people who feel these things – perceive they are flawed or somehow not cut out for this profession. So they end up leaving. Or imploding.

Instead, if we practice compassion for ourselves and each other, we may find strength and restoration in these relationships with others. We will normalize these very normal responses to the challenges we face every day. And we may then survive all these “opportunities for improvement.”

I challenge everyone to practice this simple compassionate meditation. It will take less than five minutes. As you lay in bed at night, your mind racing, concentrate on feeling compassion for four different people. Start with the person you don’t know well, such as the person who works at the dry cleaner. Breathe deeply. Pick a sentence – a gift to give. I always think, “I wish you happy and healthy, wealthy and wise.” Do this for three or four deep breaths.

Next, using this same technique, choose someone that is hard to feel compassion for – perhaps that difficult family member, or the co-worker that gets under your skin.

Then feel that compassion. Breathe deeply – for yourself, with all your human frailties. You don’t have to be perfect to be loved or lovable. Feel that.

Finally, take a deep breath, feel your chest opening, expanding. Feel that compassion for the whole world – the whole crummy mixed-up world that’s just doing its best. The world needs our compassion, too.

While you were at HM18, I hope you were able to look into the eyes of the others you see. These are your fellow hospitalists. People who feel your joys, your frustrations. Some of those eyes will be bright and excited; others will be worn and tired. But revel in this shared and universal knowledge.

It is hard. But with compassion and understanding, we can make it a bit better. For all of us.

Read the full post at hospitalleader.org.

Ms. Cardin, ACNP-BC, SFHM is vice president, Advanced Practice Providers, at Sound Physicians, and also serves on SHM’s Board of Directors.

Also in The Hospital Leader

• How Can Hospitalists Improve Their HCAHPS Scores? by Leslie Flores, MHA, SFHM
• “Harper’s Index” of Hospital Medicine 2018 by Jordan Messler, MD, SFHM
• What’s a Cost, Charge, and Price? by Brad Flansbaum, DO, MPH, MHM

If you are in the business of health care – whether as a direct care provider who is doing their best in an increasingly complex system with an increasingly complex panel of patients; a hospital medicine group leader who is trying to keep a group afloat and lead people through this rocky terrain; or a hospital system leader or chief medical officer dealing with the arcane and ever-changing landscape – there is one universal truth: This business is hard.

You can call it “challenging.” You can say there are “opportunities for improvement.” You can put all kinds of sugar on top, but at times, it is a bitter drink to swallow.

So why, as hospitalists, do we keep doing this?

I always joke that I’m going to open a “fro-yo” stand on the beach, but of course, I never do. And that constancy is one huge reason why I love hospitalists. We are always trying to decode, unlock, and solve some of these seemingly unsolvable problems. But at the same time, this plethora of constant change and instability at all kinds of levels can be a bit, well, impossible.

How do we do it every day? You can change jobs, change patient panels, and change medical systems, but no matter what, you will be confronted on some level with a gap of clearly defined solutions to your “challenges.”

One thing in my arsenal of coping, beyond my fro-yo fantasy, is simply this: compassion. When one of your providers comes to you and is complaining about their workload, don’t tell them about how you used to see three times as many patients at your last job. Instead, put your hand on their shoulder, look them in the eye, and say “It is hard. It is.”

When the CEO of your hospital tells you that the already tiny margin of the hospital is shrinking, and she has to cut a service you feel is indispensable, reflect her pain. Believe me – she feels it.

To practice compassion in hospital medicine is to accept that medicine is hard on everyone. It’s not “us” versus “them.” It’s not just “us” that hurts and “them” that are immune. We all struggle.

We need – I need – to acknowledge the pain this profession often elicits. It can be burnout, resentment, overarching grief, or incredible frustration with broken systems and sometimes broken people. When we deny it, when we try to shove those feelings deep down, then people – good people who feel these things – perceive they are flawed or somehow not cut out for this profession. So they end up leaving. Or imploding.

Instead, if we practice compassion for ourselves and each other, we may find strength and restoration in these relationships with others. We will normalize these very normal responses to the challenges we face every day. And we may then survive all these “opportunities for improvement.”

I challenge everyone to practice this simple compassionate meditation. It will take less than five minutes. As you lay in bed at night, your mind racing, concentrate on feeling compassion for four different people. Start with the person you don’t know well, such as the person who works at the dry cleaner. Breathe deeply. Pick a sentence – a gift to give. I always think, “I wish you happy and healthy, wealthy and wise.” Do this for three or four deep breaths.

Next, using this same technique, choose someone that is hard to feel compassion for – perhaps that difficult family member, or the co-worker that gets under your skin.

Then feel that compassion. Breathe deeply – for yourself, with all your human frailties. You don’t have to be perfect to be loved or lovable. Feel that.

Finally, take a deep breath, feel your chest opening, expanding. Feel that compassion for the whole world – the whole crummy mixed-up world that’s just doing its best. The world needs our compassion, too.

While you were at HM18, I hope you were able to look into the eyes of the others you see. These are your fellow hospitalists. People who feel your joys, your frustrations. Some of those eyes will be bright and excited; others will be worn and tired. But revel in this shared and universal knowledge.

It is hard. But with compassion and understanding, we can make it a bit better. For all of us.

Read the full post at hospitalleader.org.

Ms. Cardin, ACNP-BC, SFHM is vice president, Advanced Practice Providers, at Sound Physicians, and also serves on SHM’s Board of Directors.

Also in The Hospital Leader

• How Can Hospitalists Improve Their HCAHPS Scores? by Leslie Flores, MHA, SFHM
• “Harper’s Index” of Hospital Medicine 2018 by Jordan Messler, MD, SFHM
• What’s a Cost, Charge, and Price? by Brad Flansbaum, DO, MPH, MHM

As vice chair of the hospital medicine service at Northwell Health, Nick Fitterman, MD, FACP, SFHM, oversees 16 HM groups at 15 hospitals in New York. He says the duties of his hospitalist staff, like those of most U.S. hospitalists, are similar to what they have traditionally been – clinical care on the wards, teaching, comanagement of surgery, quality improvement, committee work, and research. But he has noticed a trend of late: rapid expansion of the hospitalist’s role.

Speaking at an education session at HM18 in Orlando, Dr. Fitterman said the role of the hospitalist is growing to include tasks that might not be as common, but are becoming more familiar all the time: working at infusion centers, caring for patients in skilled nursing facilities, specializing in electronic health record use, colocating in psychiatric hospitals, even being deployed to natural disasters. His list went on, and it was much longer than the list of traditional hospitalist responsibilities.

“Where do we draw the line and say, ‘Wait a minute, our primary site is going to suffer if we continue to get spread this thin. Can we really do it all?” Dr. Fitterman said. As the number of hats hospitalists wear grows ever bigger, he said more thought must be placed into how expansion happens.
 

The preop clinic

Efren Manjarrez, MD, SFHM, former chief of hospital medicine at the University of Miami, told a cautionary tale about a preoperative clinic staffed by hospitalists that appeared to provide a financial benefit to a hospital – helping to avoid costly last-minute cancellations of surgeries – but that ultimately was shuttered. The hospital, he said, loses $8,000-$10,000 for each case that gets canceled on the same day.

“Think about that just for a minute,” Dr. Manjarrez said. “If 100 cases are canceled during the year at the last minute, that’s a lot of money.”

A preoperative clinic seemed like a worthwhile role for hospitalists – the program was started in Miami by the same doctor who initiated a similar program at Cleveland Clinic. “Surgical cases are what support the hospital [financially], and we’re here to help them along,” Dr. Manjarrez said. “The purpose of hospitalists is to make sure that patients are medically optimized.”

The preop program concept, used in U.S. medicine since the 1990s, was originally started by anesthesiologists, but they may not always be the best fit to staff such programs.

“Anesthesiologists do not manage all beta blockers,” Dr. Manjarrez said. “They don’t manage ACE inhibitors by mouth. They don’t manage all oral diabetes agents, and they sure as heck don’t manage pills that are anticoagulants. That’s the domain of internal medicine. And as patients have become more complex, that’s where hospitalists who [work in] preop clinics have stepped in.”

Studies have found that hospitalists staffing preop clinics have improved quality metrics and some clinical outcomes, including lowering cancellation rates and more appropriate use of beta blockers, he said.

In the Miami program described by Dr. Manjarrez, hospitalists in the preop clinic at first saw only patients who’d been financially cleared as able to pay. But ultimately, a tiered system was developed, and hospitalists saw only patients who were higher risk – those with COPD or stroke patients, for example – without regard to ability to pay.

“The hospital would have to make up any financial deficit at the very end,” Dr. Manjarrez said. This meant there were no longer efficient 5-minute encounters with patients. Instead, visits lasted about 45 minutes, so fewer patients were seen.

The program was successful, in that the same-day cancellation rate for surgeries dropped to less than 0.1% – fewer than 1 in 1,000 – with the preop clinic up and running, Dr. Manjarrez. Still, the hospital decided to end the program. “The hospital no longer wanted to reimburse us,” he said.

A takeaway from this experience for Dr. Manjarrez was that hospitalists need to do a better job of showing the financial benefits in their expanding roles, if they want them to endure.

“At the end of the day, hospitalists do provide value in preoperative clinics,” he said. “But unfortunately, we’re not doing a great job of publishing our data and showing our value.”
 

At-home care

At Brigham and Women’s Hospital in Boston, hospitalists have demonstrated good results with a program to provide care at home rather than in the hospital.

David Levine, MD, MPH, MA, clinician and investigator at Brigham and Women’s and an instructor in medicine at Harvard Medical School, said that the structure of inpatient care has generally not changed much over decades, despite advances in technology.

Postdischarge clinics

Lauren Doctoroff, MD, FHM – a hospitalist at Beth Israel Deaconness Medical Center in Boston and assistant professor of medicine at Harvard Medical School – explained another hospitalist-staffed project meant to improve access to care: her center’s postdischarge clinic, which was started in 2009 but is no longer operating.

As vice chair of the hospital medicine service at Northwell Health, Nick Fitterman, MD, FACP, SFHM, oversees 16 HM groups at 15 hospitals in New York. He says the duties of his hospitalist staff, like those of most U.S. hospitalists, are similar to what they have traditionally been – clinical care on the wards, teaching, comanagement of surgery, quality improvement, committee work, and research. But he has noticed a trend of late: rapid expansion of the hospitalist’s role.

Speaking at an education session at HM18 in Orlando, Dr. Fitterman said the role of the hospitalist is growing to include tasks that might not be as common, but are becoming more familiar all the time: working at infusion centers, caring for patients in skilled nursing facilities, specializing in electronic health record use, colocating in psychiatric hospitals, even being deployed to natural disasters. His list went on, and it was much longer than the list of traditional hospitalist responsibilities.

“Where do we draw the line and say, ‘Wait a minute, our primary site is going to suffer if we continue to get spread this thin. Can we really do it all?” Dr. Fitterman said. As the number of hats hospitalists wear grows ever bigger, he said more thought must be placed into how expansion happens.
 

The preop clinic

Efren Manjarrez, MD, SFHM, former chief of hospital medicine at the University of Miami, told a cautionary tale about a preoperative clinic staffed by hospitalists that appeared to provide a financial benefit to a hospital – helping to avoid costly last-minute cancellations of surgeries – but that ultimately was shuttered. The hospital, he said, loses $8,000-$10,000 for each case that gets canceled on the same day.

“Think about that just for a minute,” Dr. Manjarrez said. “If 100 cases are canceled during the year at the last minute, that’s a lot of money.”

A preoperative clinic seemed like a worthwhile role for hospitalists – the program was started in Miami by the same doctor who initiated a similar program at Cleveland Clinic. “Surgical cases are what support the hospital [financially], and we’re here to help them along,” Dr. Manjarrez said. “The purpose of hospitalists is to make sure that patients are medically optimized.”

The preop program concept, used in U.S. medicine since the 1990s, was originally started by anesthesiologists, but they may not always be the best fit to staff such programs.

“Anesthesiologists do not manage all beta blockers,” Dr. Manjarrez said. “They don’t manage ACE inhibitors by mouth. They don’t manage all oral diabetes agents, and they sure as heck don’t manage pills that are anticoagulants. That’s the domain of internal medicine. And as patients have become more complex, that’s where hospitalists who [work in] preop clinics have stepped in.”

Studies have found that hospitalists staffing preop clinics have improved quality metrics and some clinical outcomes, including lowering cancellation rates and more appropriate use of beta blockers, he said.

In the Miami program described by Dr. Manjarrez, hospitalists in the preop clinic at first saw only patients who’d been financially cleared as able to pay. But ultimately, a tiered system was developed, and hospitalists saw only patients who were higher risk – those with COPD or stroke patients, for example – without regard to ability to pay.

“The hospital would have to make up any financial deficit at the very end,” Dr. Manjarrez said. This meant there were no longer efficient 5-minute encounters with patients. Instead, visits lasted about 45 minutes, so fewer patients were seen.

The program was successful, in that the same-day cancellation rate for surgeries dropped to less than 0.1% – fewer than 1 in 1,000 – with the preop clinic up and running, Dr. Manjarrez. Still, the hospital decided to end the program. “The hospital no longer wanted to reimburse us,” he said.

A takeaway from this experience for Dr. Manjarrez was that hospitalists need to do a better job of showing the financial benefits in their expanding roles, if they want them to endure.

“At the end of the day, hospitalists do provide value in preoperative clinics,” he said. “But unfortunately, we’re not doing a great job of publishing our data and showing our value.”
 

At-home care

At Brigham and Women’s Hospital in Boston, hospitalists have demonstrated good results with a program to provide care at home rather than in the hospital.

David Levine, MD, MPH, MA, clinician and investigator at Brigham and Women’s and an instructor in medicine at Harvard Medical School, said that the structure of inpatient care has generally not changed much over decades, despite advances in technology.

Postdischarge clinics

Lauren Doctoroff, MD, FHM – a hospitalist at Beth Israel Deaconness Medical Center in Boston and assistant professor of medicine at Harvard Medical School – explained another hospitalist-staffed project meant to improve access to care: her center’s postdischarge clinic, which was started in 2009 but is no longer operating.

As vice chair of the hospital medicine service at Northwell Health, Nick Fitterman, MD, FACP, SFHM, oversees 16 HM groups at 15 hospitals in New York. He says the duties of his hospitalist staff, like those of most U.S. hospitalists, are similar to what they have traditionally been – clinical care on the wards, teaching, comanagement of surgery, quality improvement, committee work, and research. But he has noticed a trend of late: rapid expansion of the hospitalist’s role.

Speaking at an education session at HM18 in Orlando, Dr. Fitterman said the role of the hospitalist is growing to include tasks that might not be as common, but are becoming more familiar all the time: working at infusion centers, caring for patients in skilled nursing facilities, specializing in electronic health record use, colocating in psychiatric hospitals, even being deployed to natural disasters. His list went on, and it was much longer than the list of traditional hospitalist responsibilities.

“Where do we draw the line and say, ‘Wait a minute, our primary site is going to suffer if we continue to get spread this thin. Can we really do it all?” Dr. Fitterman said. As the number of hats hospitalists wear grows ever bigger, he said more thought must be placed into how expansion happens.
 

The preop clinic

Efren Manjarrez, MD, SFHM, former chief of hospital medicine at the University of Miami, told a cautionary tale about a preoperative clinic staffed by hospitalists that appeared to provide a financial benefit to a hospital – helping to avoid costly last-minute cancellations of surgeries – but that ultimately was shuttered. The hospital, he said, loses $8,000-$10,000 for each case that gets canceled on the same day.

“Think about that just for a minute,” Dr. Manjarrez said. “If 100 cases are canceled during the year at the last minute, that’s a lot of money.”

A preoperative clinic seemed like a worthwhile role for hospitalists – the program was started in Miami by the same doctor who initiated a similar program at Cleveland Clinic. “Surgical cases are what support the hospital [financially], and we’re here to help them along,” Dr. Manjarrez said. “The purpose of hospitalists is to make sure that patients are medically optimized.”

The preop program concept, used in U.S. medicine since the 1990s, was originally started by anesthesiologists, but they may not always be the best fit to staff such programs.

“Anesthesiologists do not manage all beta blockers,” Dr. Manjarrez said. “They don’t manage ACE inhibitors by mouth. They don’t manage all oral diabetes agents, and they sure as heck don’t manage pills that are anticoagulants. That’s the domain of internal medicine. And as patients have become more complex, that’s where hospitalists who [work in] preop clinics have stepped in.”

Studies have found that hospitalists staffing preop clinics have improved quality metrics and some clinical outcomes, including lowering cancellation rates and more appropriate use of beta blockers, he said.

In the Miami program described by Dr. Manjarrez, hospitalists in the preop clinic at first saw only patients who’d been financially cleared as able to pay. But ultimately, a tiered system was developed, and hospitalists saw only patients who were higher risk – those with COPD or stroke patients, for example – without regard to ability to pay.

“The hospital would have to make up any financial deficit at the very end,” Dr. Manjarrez said. This meant there were no longer efficient 5-minute encounters with patients. Instead, visits lasted about 45 minutes, so fewer patients were seen.

The program was successful, in that the same-day cancellation rate for surgeries dropped to less than 0.1% – fewer than 1 in 1,000 – with the preop clinic up and running, Dr. Manjarrez. Still, the hospital decided to end the program. “The hospital no longer wanted to reimburse us,” he said.

A takeaway from this experience for Dr. Manjarrez was that hospitalists need to do a better job of showing the financial benefits in their expanding roles, if they want them to endure.

“At the end of the day, hospitalists do provide value in preoperative clinics,” he said. “But unfortunately, we’re not doing a great job of publishing our data and showing our value.”
 

At-home care

At Brigham and Women’s Hospital in Boston, hospitalists have demonstrated good results with a program to provide care at home rather than in the hospital.

David Levine, MD, MPH, MA, clinician and investigator at Brigham and Women’s and an instructor in medicine at Harvard Medical School, said that the structure of inpatient care has generally not changed much over decades, despite advances in technology.

Postdischarge clinics

Lauren Doctoroff, MD, FHM – a hospitalist at Beth Israel Deaconness Medical Center in Boston and assistant professor of medicine at Harvard Medical School – explained another hospitalist-staffed project meant to improve access to care: her center’s postdischarge clinic, which was started in 2009 but is no longer operating.

As I began my career in pediatric hospital medicine at the Monroe Carell Jr. Children’s Hospital at Vanderbilt in Nashville, Tenn., I knew that I wanted a way to continue my education and to network with other hospitalists with interests in academics and pediatrics.

In 2010, I decided to attend a pre-course to the Society of Hospital Medicine’s annual conference that focused on academic hospital medicine, and my career has never been the same! I am thrilled to say I have found my professional home in SHM.

Here’s a quick list of the reasons SHM has been such a warm, welcoming home for me. I’ve highlighted the few options that stood out to me, but rest assured there is so much more from which to choose:

• Leadership opportunities in our Pediatrics Special Interest Group.
• Representation on the Annual Conference Committee to select pediatric-specific content as well as workshops on leadership, education, patient experience, and quality improvement.
• The Academic Hospitalist Academy, first as a pre-course before the SHM annual conference, and now as its own amazing meeting for academic pediatric hospital medicine providers.
• SHM’s Leadership Academy, a wonderful opportunity to learn leadership skills and network with other leaders. This year, it is in Vancouver!
• Participation in quality improvement initiatives like Pedi-BOOST, a care transitions program that specializes in pediatric patients.
• Traveling to Abu Dhabi and the Middle East Update in Hospital Medicine this March – being able to spread the latest trends in hospital medicine in the USA is one of the best experiences I have had with SHM!

Another reason SHM truly made me feel welcomed was the opportunity to attend the Pediatric Hospital Medicine (PHM) meeting. Each July, SHM helps to put on the largest gathering of pediatric hospital medicine providers. This year, it will be held in Atlanta from July 19-22.

This meeting is organized and supported by SHM, the American Academy of Pediatrics (AAP), and the Academic Pediatric Association (APA), and offers spectacular content in many tracks, including quality improvement, education, research, and the incredibly popular “Top Articles” presentation at lunch on Saturday. This session provides teaching materials that can span the year for Journal Clubs and resident and student education. The abstracts and poster sessions are top-notch and provide an opportunity for young and experienced providers to share their work.

The fourth annual Knowledge Café will be a highlight for me as well, as it allows collaboration and networking experiences in hot topics for early career hospitalists. How to strive for work/life balance, how to get the most out of your first meeting, and techniques for talking with your boss about difficult issues are some of the topics we plan to cover this year.

On top of this, networking and participation on various committees and work groups afforded me the opportunity to join the SHM Board of Directors in May of 2017. Having completed my first year on the Board, I have an even deeper appreciation for the progressive thinking of our leadership team and the amazing work that the staff of SHM does behind the scenes to help us maximize our memberships. I love the continuous process improvement that is happening with every Board meeting.

As a member of the Board, it’s important to keep tabs on the pulse of SHM members and their evolving needs. One way I have really enjoyed getting to learn about our membership is by attending local chapter meetings. I recently traveled to West Virginia and Connecticut, both of which have active, engaged chapters working to improve care in their local communities – it was so inspiring to have the opportunity to represent the organization, and I look forward to more meetings just like this. For our local chapter in Nashville, I have the honor of picking the venue for our meetings, which keeps me on my toes as I look for the latest hot spots in an incredibly happening city!

Last summer, the benefits of membership in SHM and my career choice of hospital medicine took on a whole new meaning. In July, just before PHM 2017, a meeting that I was lucky enough to chair, my husband started to feel the pain of a recurrent kidney stone as he was traveling with our four sons and their three friends. Can you imagine being on an airplane with seven elementary school–age boys when the worst pain EVER strikes?

I was home in Nashville thinking, “Who can I call to help him in Minneapolis?” My first thought was of fellow members of SHM with whom I’ve developed friendships over the years – other hospitalists like you and me. Many people came to mind, all of whom practice hospital medicine! A huge thank-you to our friend Dr. Shaun Frost, who rescued my husband, drove him to a local ED, AND took the seven boys out for lunch. I truly have never been so grateful!

My task for you is simple: Engage with the Society of Hospital Medicine! Come to a meeting, join a special interest group, connect with your local chapter, and make friends who can support you through your career – and, as evidenced by my husband’s experience – even in your personal life. It’s truly a special organization, and I can’t wait to share some experiences just like these with you.


Dr. Rehm is associate professor, pediatrics, and director, division of pediatric outreach medicine at Vanderbilt University and Monroe Carell Jr. Children’s Hospital at Vanderbilt, both in Nashville, Tenn. She is also a member of the SHM board of directors.

As I began my career in pediatric hospital medicine at the Monroe Carell Jr. Children’s Hospital at Vanderbilt in Nashville, Tenn., I knew that I wanted a way to continue my education and to network with other hospitalists with interests in academics and pediatrics.

In 2010, I decided to attend a pre-course to the Society of Hospital Medicine’s annual conference that focused on academic hospital medicine, and my career has never been the same! I am thrilled to say I have found my professional home in SHM.

Here’s a quick list of the reasons SHM has been such a warm, welcoming home for me. I’ve highlighted the few options that stood out to me, but rest assured there is so much more from which to choose:

• Leadership opportunities in our Pediatrics Special Interest Group.
• Representation on the Annual Conference Committee to select pediatric-specific content as well as workshops on leadership, education, patient experience, and quality improvement.
• The Academic Hospitalist Academy, first as a pre-course before the SHM annual conference, and now as its own amazing meeting for academic pediatric hospital medicine providers.
• SHM’s Leadership Academy, a wonderful opportunity to learn leadership skills and network with other leaders. This year, it is in Vancouver!
• Participation in quality improvement initiatives like Pedi-BOOST, a care transitions program that specializes in pediatric patients.
• Traveling to Abu Dhabi and the Middle East Update in Hospital Medicine this March – being able to spread the latest trends in hospital medicine in the USA is one of the best experiences I have had with SHM!

Another reason SHM truly made me feel welcomed was the opportunity to attend the Pediatric Hospital Medicine (PHM) meeting. Each July, SHM helps to put on the largest gathering of pediatric hospital medicine providers. This year, it will be held in Atlanta from July 19-22.

This meeting is organized and supported by SHM, the American Academy of Pediatrics (AAP), and the Academic Pediatric Association (APA), and offers spectacular content in many tracks, including quality improvement, education, research, and the incredibly popular “Top Articles” presentation at lunch on Saturday. This session provides teaching materials that can span the year for Journal Clubs and resident and student education. The abstracts and poster sessions are top-notch and provide an opportunity for young and experienced providers to share their work.

The fourth annual Knowledge Café will be a highlight for me as well, as it allows collaboration and networking experiences in hot topics for early career hospitalists. How to strive for work/life balance, how to get the most out of your first meeting, and techniques for talking with your boss about difficult issues are some of the topics we plan to cover this year.

On top of this, networking and participation on various committees and work groups afforded me the opportunity to join the SHM Board of Directors in May of 2017. Having completed my first year on the Board, I have an even deeper appreciation for the progressive thinking of our leadership team and the amazing work that the staff of SHM does behind the scenes to help us maximize our memberships. I love the continuous process improvement that is happening with every Board meeting.

As a member of the Board, it’s important to keep tabs on the pulse of SHM members and their evolving needs. One way I have really enjoyed getting to learn about our membership is by attending local chapter meetings. I recently traveled to West Virginia and Connecticut, both of which have active, engaged chapters working to improve care in their local communities – it was so inspiring to have the opportunity to represent the organization, and I look forward to more meetings just like this. For our local chapter in Nashville, I have the honor of picking the venue for our meetings, which keeps me on my toes as I look for the latest hot spots in an incredibly happening city!

Last summer, the benefits of membership in SHM and my career choice of hospital medicine took on a whole new meaning. In July, just before PHM 2017, a meeting that I was lucky enough to chair, my husband started to feel the pain of a recurrent kidney stone as he was traveling with our four sons and their three friends. Can you imagine being on an airplane with seven elementary school–age boys when the worst pain EVER strikes?

I was home in Nashville thinking, “Who can I call to help him in Minneapolis?” My first thought was of fellow members of SHM with whom I’ve developed friendships over the years – other hospitalists like you and me. Many people came to mind, all of whom practice hospital medicine! A huge thank-you to our friend Dr. Shaun Frost, who rescued my husband, drove him to a local ED, AND took the seven boys out for lunch. I truly have never been so grateful!

My task for you is simple: Engage with the Society of Hospital Medicine! Come to a meeting, join a special interest group, connect with your local chapter, and make friends who can support you through your career – and, as evidenced by my husband’s experience – even in your personal life. It’s truly a special organization, and I can’t wait to share some experiences just like these with you.


Dr. Rehm is associate professor, pediatrics, and director, division of pediatric outreach medicine at Vanderbilt University and Monroe Carell Jr. Children’s Hospital at Vanderbilt, both in Nashville, Tenn. She is also a member of the SHM board of directors.

As I began my career in pediatric hospital medicine at the Monroe Carell Jr. Children’s Hospital at Vanderbilt in Nashville, Tenn., I knew that I wanted a way to continue my education and to network with other hospitalists with interests in academics and pediatrics.

In 2010, I decided to attend a pre-course to the Society of Hospital Medicine’s annual conference that focused on academic hospital medicine, and my career has never been the same! I am thrilled to say I have found my professional home in SHM.

Here’s a quick list of the reasons SHM has been such a warm, welcoming home for me. I’ve highlighted the few options that stood out to me, but rest assured there is so much more from which to choose:

• Leadership opportunities in our Pediatrics Special Interest Group.
• Representation on the Annual Conference Committee to select pediatric-specific content as well as workshops on leadership, education, patient experience, and quality improvement.
• The Academic Hospitalist Academy, first as a pre-course before the SHM annual conference, and now as its own amazing meeting for academic pediatric hospital medicine providers.
• SHM’s Leadership Academy, a wonderful opportunity to learn leadership skills and network with other leaders. This year, it is in Vancouver!
• Participation in quality improvement initiatives like Pedi-BOOST, a care transitions program that specializes in pediatric patients.
• Traveling to Abu Dhabi and the Middle East Update in Hospital Medicine this March – being able to spread the latest trends in hospital medicine in the USA is one of the best experiences I have had with SHM!

Another reason SHM truly made me feel welcomed was the opportunity to attend the Pediatric Hospital Medicine (PHM) meeting. Each July, SHM helps to put on the largest gathering of pediatric hospital medicine providers. This year, it will be held in Atlanta from July 19-22.

This meeting is organized and supported by SHM, the American Academy of Pediatrics (AAP), and the Academic Pediatric Association (APA), and offers spectacular content in many tracks, including quality improvement, education, research, and the incredibly popular “Top Articles” presentation at lunch on Saturday. This session provides teaching materials that can span the year for Journal Clubs and resident and student education. The abstracts and poster sessions are top-notch and provide an opportunity for young and experienced providers to share their work.

The fourth annual Knowledge Café will be a highlight for me as well, as it allows collaboration and networking experiences in hot topics for early career hospitalists. How to strive for work/life balance, how to get the most out of your first meeting, and techniques for talking with your boss about difficult issues are some of the topics we plan to cover this year.

On top of this, networking and participation on various committees and work groups afforded me the opportunity to join the SHM Board of Directors in May of 2017. Having completed my first year on the Board, I have an even deeper appreciation for the progressive thinking of our leadership team and the amazing work that the staff of SHM does behind the scenes to help us maximize our memberships. I love the continuous process improvement that is happening with every Board meeting.

As a member of the Board, it’s important to keep tabs on the pulse of SHM members and their evolving needs. One way I have really enjoyed getting to learn about our membership is by attending local chapter meetings. I recently traveled to West Virginia and Connecticut, both of which have active, engaged chapters working to improve care in their local communities – it was so inspiring to have the opportunity to represent the organization, and I look forward to more meetings just like this. For our local chapter in Nashville, I have the honor of picking the venue for our meetings, which keeps me on my toes as I look for the latest hot spots in an incredibly happening city!

Last summer, the benefits of membership in SHM and my career choice of hospital medicine took on a whole new meaning. In July, just before PHM 2017, a meeting that I was lucky enough to chair, my husband started to feel the pain of a recurrent kidney stone as he was traveling with our four sons and their three friends. Can you imagine being on an airplane with seven elementary school–age boys when the worst pain EVER strikes?

I was home in Nashville thinking, “Who can I call to help him in Minneapolis?” My first thought was of fellow members of SHM with whom I’ve developed friendships over the years – other hospitalists like you and me. Many people came to mind, all of whom practice hospital medicine! A huge thank-you to our friend Dr. Shaun Frost, who rescued my husband, drove him to a local ED, AND took the seven boys out for lunch. I truly have never been so grateful!

My task for you is simple: Engage with the Society of Hospital Medicine! Come to a meeting, join a special interest group, connect with your local chapter, and make friends who can support you through your career – and, as evidenced by my husband’s experience – even in your personal life. It’s truly a special organization, and I can’t wait to share some experiences just like these with you.


Dr. Rehm is associate professor, pediatrics, and director, division of pediatric outreach medicine at Vanderbilt University and Monroe Carell Jr. Children’s Hospital at Vanderbilt, both in Nashville, Tenn. She is also a member of the SHM board of directors.

Burnout is influenced by a seemingly infinite combination of variables. An optimal schedule alone isn’t the key to preventing it, but maybe a good schedule can reduce your risk you’ll suffer from it.

Smart people who have spent years as hospitalists, working multiple different schedules, have formed a variety of conclusions about which work schedules best reduce the risk of burnout. There’s no meaningful research to settle the question, so everyone will have to reach their own conclusions, as I’ve done here.
 

Scheduling flexibility: Often overlooked?

Someone who typically works the same number of consecutive day shifts, each of which is the same duration, might suffer from the monotony and inexorable predictability. Schedules that vary the number of consecutive day shifts, the intensity or length of shifts, and the number of consecutive days off might result in lower rates of burnout. This is especially likely to be the case if each provider has some flexibility to control how her schedule varies over time.

shutteratakan/Thinkstock

Personal time goes on the calendar first

Those who have a regularly repeating work schedule tend to work hard arranging such important things as family vacations on days the schedule dictates. In other words, the first thing that goes on the personal calendar are the weeks of work; they’re “X-ed” out and personal events filled into the remaining days.

That’s fine for many personal activities, but it means the hospitalist might tend to set a pretty high bar for activities that are worth negotiating alterations to the usual schedule. For example, you might want to see U2 but decide to skip their concert in your town since it falls in the middle of your regularly scheduled week of work. Maybe that’s not a big deal (Isn’t U2 overplayed and out of date anyway?), but an accumulation of small sacrifices like this might increase resentment of work.

It’s possible to organize a hospitalist group schedule in which each provider’s personally requested days off, like the U2 concert, go on the work calendar first, and the clinical schedule is built around them. It can get pretty time consuming to manage, but might be a worthwhile investment to reduce burnout risk.

A paradox: Fewer shifts could increase burnout risk

I’m convinced many hospitalists make the mistake of seeking to maximize their number of days off with the idea that it will be good for happiness, career longevity, burnout, etc. While having more days off provides more time for nonwork activities and rest/recovery from work, it usually means the average workday is busier and more stressful to maintain expected levels of productivity. The net effect for some seems to be increased burnout.

Consider someone who has been working 182 hospitalist shifts and generating a total of 2,114 billed encounters annually (both are the most recent national medians available from surveys). This hospitalist successfully negotiates a reduction to 161 annual shifts. This would probably feel good to anyone at first, but keep in mind that it means the average number of daily encounters to maintain median annual productivity would increase 13% (from 11.6 to 13.1 in this example). That is, each day of work just got 13% busier.

I regularly encounter career hospitalists with more than 10 years of experience who say they still appreciate – or even are addicted to – having lots of days off. But the worked days often are so busy they don’t know how long they can keep doing it. It is possible some of them might be happier and less burned out if they work more shifts annually, and the average shift is meaningfully less busy.

The “right” number of shifts depends on a combination of personal and economic factors. Rather than focusing almost exclusively on the number of shifts worked annually, it may be better to think about the total amount of annual work measured in billed encounters, or wRVUs [work relative value units], and how it is titrated out on the calendar.

Other scheduling attributes and burnout

I think it’s really important to ensure the hospitalist group always has the target number of providers working each day. Many groups have experienced staffing deficits for so long that they’ve essentially given up on this goal, and staffing levels vary day to day. This means each provider has uncertainty regarding how often he will be scheduled on days with fewer than the targeted numbers of providers working.

Dr. Nelson has had a career in clinical practice as a hospitalist starting in 1988. He is cofounder and past president of SHM, and principal in Nelson Flores Hospital Medicine Consultants. He is codirector for SHM’s practice management courses. Contact him at [email protected].

Burnout is influenced by a seemingly infinite combination of variables. An optimal schedule alone isn’t the key to preventing it, but maybe a good schedule can reduce your risk you’ll suffer from it.

Smart people who have spent years as hospitalists, working multiple different schedules, have formed a variety of conclusions about which work schedules best reduce the risk of burnout. There’s no meaningful research to settle the question, so everyone will have to reach their own conclusions, as I’ve done here.
 

Scheduling flexibility: Often overlooked?

Someone who typically works the same number of consecutive day shifts, each of which is the same duration, might suffer from the monotony and inexorable predictability. Schedules that vary the number of consecutive day shifts, the intensity or length of shifts, and the number of consecutive days off might result in lower rates of burnout. This is especially likely to be the case if each provider has some flexibility to control how her schedule varies over time.

shutteratakan/Thinkstock

Personal time goes on the calendar first

Those who have a regularly repeating work schedule tend to work hard arranging such important things as family vacations on days the schedule dictates. In other words, the first thing that goes on the personal calendar are the weeks of work; they’re “X-ed” out and personal events filled into the remaining days.

That’s fine for many personal activities, but it means the hospitalist might tend to set a pretty high bar for activities that are worth negotiating alterations to the usual schedule. For example, you might want to see U2 but decide to skip their concert in your town since it falls in the middle of your regularly scheduled week of work. Maybe that’s not a big deal (Isn’t U2 overplayed and out of date anyway?), but an accumulation of small sacrifices like this might increase resentment of work.

It’s possible to organize a hospitalist group schedule in which each provider’s personally requested days off, like the U2 concert, go on the work calendar first, and the clinical schedule is built around them. It can get pretty time consuming to manage, but might be a worthwhile investment to reduce burnout risk.

A paradox: Fewer shifts could increase burnout risk

I’m convinced many hospitalists make the mistake of seeking to maximize their number of days off with the idea that it will be good for happiness, career longevity, burnout, etc. While having more days off provides more time for nonwork activities and rest/recovery from work, it usually means the average workday is busier and more stressful to maintain expected levels of productivity. The net effect for some seems to be increased burnout.

Consider someone who has been working 182 hospitalist shifts and generating a total of 2,114 billed encounters annually (both are the most recent national medians available from surveys). This hospitalist successfully negotiates a reduction to 161 annual shifts. This would probably feel good to anyone at first, but keep in mind that it means the average number of daily encounters to maintain median annual productivity would increase 13% (from 11.6 to 13.1 in this example). That is, each day of work just got 13% busier.

I regularly encounter career hospitalists with more than 10 years of experience who say they still appreciate – or even are addicted to – having lots of days off. But the worked days often are so busy they don’t know how long they can keep doing it. It is possible some of them might be happier and less burned out if they work more shifts annually, and the average shift is meaningfully less busy.

The “right” number of shifts depends on a combination of personal and economic factors. Rather than focusing almost exclusively on the number of shifts worked annually, it may be better to think about the total amount of annual work measured in billed encounters, or wRVUs [work relative value units], and how it is titrated out on the calendar.

Other scheduling attributes and burnout

I think it’s really important to ensure the hospitalist group always has the target number of providers working each day. Many groups have experienced staffing deficits for so long that they’ve essentially given up on this goal, and staffing levels vary day to day. This means each provider has uncertainty regarding how often he will be scheduled on days with fewer than the targeted numbers of providers working.

Dr. Nelson has had a career in clinical practice as a hospitalist starting in 1988. He is cofounder and past president of SHM, and principal in Nelson Flores Hospital Medicine Consultants. He is codirector for SHM’s practice management courses. Contact him at [email protected].

Burnout is influenced by a seemingly infinite combination of variables. An optimal schedule alone isn’t the key to preventing it, but maybe a good schedule can reduce your risk you’ll suffer from it.

Smart people who have spent years as hospitalists, working multiple different schedules, have formed a variety of conclusions about which work schedules best reduce the risk of burnout. There’s no meaningful research to settle the question, so everyone will have to reach their own conclusions, as I’ve done here.
 

Scheduling flexibility: Often overlooked?

Someone who typically works the same number of consecutive day shifts, each of which is the same duration, might suffer from the monotony and inexorable predictability. Schedules that vary the number of consecutive day shifts, the intensity or length of shifts, and the number of consecutive days off might result in lower rates of burnout. This is especially likely to be the case if each provider has some flexibility to control how her schedule varies over time.

shutteratakan/Thinkstock

Personal time goes on the calendar first

Those who have a regularly repeating work schedule tend to work hard arranging such important things as family vacations on days the schedule dictates. In other words, the first thing that goes on the personal calendar are the weeks of work; they’re “X-ed” out and personal events filled into the remaining days.

That’s fine for many personal activities, but it means the hospitalist might tend to set a pretty high bar for activities that are worth negotiating alterations to the usual schedule. For example, you might want to see U2 but decide to skip their concert in your town since it falls in the middle of your regularly scheduled week of work. Maybe that’s not a big deal (Isn’t U2 overplayed and out of date anyway?), but an accumulation of small sacrifices like this might increase resentment of work.

It’s possible to organize a hospitalist group schedule in which each provider’s personally requested days off, like the U2 concert, go on the work calendar first, and the clinical schedule is built around them. It can get pretty time consuming to manage, but might be a worthwhile investment to reduce burnout risk.

A paradox: Fewer shifts could increase burnout risk

I’m convinced many hospitalists make the mistake of seeking to maximize their number of days off with the idea that it will be good for happiness, career longevity, burnout, etc. While having more days off provides more time for nonwork activities and rest/recovery from work, it usually means the average workday is busier and more stressful to maintain expected levels of productivity. The net effect for some seems to be increased burnout.

Consider someone who has been working 182 hospitalist shifts and generating a total of 2,114 billed encounters annually (both are the most recent national medians available from surveys). This hospitalist successfully negotiates a reduction to 161 annual shifts. This would probably feel good to anyone at first, but keep in mind that it means the average number of daily encounters to maintain median annual productivity would increase 13% (from 11.6 to 13.1 in this example). That is, each day of work just got 13% busier.

I regularly encounter career hospitalists with more than 10 years of experience who say they still appreciate – or even are addicted to – having lots of days off. But the worked days often are so busy they don’t know how long they can keep doing it. It is possible some of them might be happier and less burned out if they work more shifts annually, and the average shift is meaningfully less busy.

The “right” number of shifts depends on a combination of personal and economic factors. Rather than focusing almost exclusively on the number of shifts worked annually, it may be better to think about the total amount of annual work measured in billed encounters, or wRVUs [work relative value units], and how it is titrated out on the calendar.

Other scheduling attributes and burnout

I think it’s really important to ensure the hospitalist group always has the target number of providers working each day. Many groups have experienced staffing deficits for so long that they’ve essentially given up on this goal, and staffing levels vary day to day. This means each provider has uncertainty regarding how often he will be scheduled on days with fewer than the targeted numbers of providers working.

Dr. Nelson has had a career in clinical practice as a hospitalist starting in 1988. He is cofounder and past president of SHM, and principal in Nelson Flores Hospital Medicine Consultants. He is codirector for SHM’s practice management courses. Contact him at [email protected].