Career

"“Your Song” became “Your Hospitalist Song”—the crowd gave him a standing ovation, perhaps as much for his chutzpah and piano playing as for his voice."

LAS VEGAS—Bob Wachter, MD, MHM, hyped the final six minutes of his annual meeting address as something hospitalists at HM14 conference wouldn’t forget. As usual, he was right.

The man who helped coin the term “hospitalist,” and whose penultimate pep talk has come to signal the unofficial end of SHM’s annual meeting, finished his plenary on the confab’s last day and returned minutes later in a white suit, yellowed wig, and sunglasses worthy of the man he was portraying: Elton John.

After enjoying Dr. Wachter’s retooled lyrics—in which “Your Song” became “Your Hospitalist Song”—the crowd gave him a standing ovation, perhaps as much for his chutzpah and piano playing as for his voice.

“That was just phenomenal,” said hospitalist Kevin Gilroy, MD, of Greenville, S.C. “What other conference does that? You find another society that is that down to Earth.”—RQ

"“Your Song” became “Your Hospitalist Song”—the crowd gave him a standing ovation, perhaps as much for his chutzpah and piano playing as for his voice."

LAS VEGAS—Bob Wachter, MD, MHM, hyped the final six minutes of his annual meeting address as something hospitalists at HM14 conference wouldn’t forget. As usual, he was right.

The man who helped coin the term “hospitalist,” and whose penultimate pep talk has come to signal the unofficial end of SHM’s annual meeting, finished his plenary on the confab’s last day and returned minutes later in a white suit, yellowed wig, and sunglasses worthy of the man he was portraying: Elton John.

After enjoying Dr. Wachter’s retooled lyrics—in which “Your Song” became “Your Hospitalist Song”—the crowd gave him a standing ovation, perhaps as much for his chutzpah and piano playing as for his voice.

“That was just phenomenal,” said hospitalist Kevin Gilroy, MD, of Greenville, S.C. “What other conference does that? You find another society that is that down to Earth.”—RQ

"“Your Song” became “Your Hospitalist Song”—the crowd gave him a standing ovation, perhaps as much for his chutzpah and piano playing as for his voice."

LAS VEGAS—Bob Wachter, MD, MHM, hyped the final six minutes of his annual meeting address as something hospitalists at HM14 conference wouldn’t forget. As usual, he was right.

The man who helped coin the term “hospitalist,” and whose penultimate pep talk has come to signal the unofficial end of SHM’s annual meeting, finished his plenary on the confab’s last day and returned minutes later in a white suit, yellowed wig, and sunglasses worthy of the man he was portraying: Elton John.

After enjoying Dr. Wachter’s retooled lyrics—in which “Your Song” became “Your Hospitalist Song”—the crowd gave him a standing ovation, perhaps as much for his chutzpah and piano playing as for his voice.

“That was just phenomenal,” said hospitalist Kevin Gilroy, MD, of Greenville, S.C. “What other conference does that? You find another society that is that down to Earth.”—RQ

New research has found that hospital-onset Clostridium difficile infections increase length of stay (LOS), risk of in-hospital mortality, and hospital costs for inpatients with sepsis.

Authors of a new study titled, "The Impact of Hospital-onset Clostridium difficile Infection on Outcomes of Hospitalized Patients with Sepsis," report that after multivariate adjustment, in-hospital mortality rate was 24% for patients with sepsis who develop C. diff infections, versus 15% of inpatient controls, according to the paper that was published online in the Journal of Hospital Medicine earlier this month. Adjusted LOS among cases with C. diff was 5.1 days longer than controls (95% confidence interval: 4.4–5.8), and the median-adjusted cost increase was $4,916 (P<0.001).

"Big numbers, but I'm actually not surprised," says lead author Tara Lagu, MD, MPH, a hospitalist at the Center for Quality of Care Research at Baystate Medical Center in Springfield, Mass. "I know that it happens, because I see it all the time."

Dr. Lagu says that when a patient is on day four of five of a stay for sepsis and develops diarrhea, precautions and treatment will last a minimum of three days, which drives up LOS and cost of care.

In the report, Dr. Lagu did not compare the cost-effectiveness of C. diff prevention programs aimed at sepsis patients, but she's hopeful that is how physicians will use the data.

"I'm just suggesting that if, as a hospital, you're trying to figure out if your program is worth it, think about these numbers in terms of prevention,” she says. "If it looks like the cost is worth it, then you should keep doing what you're doing. If not, then maybe you should do something different if you're not preventing enough cases."

Visit our website for more information on preventing, managing C. diff infections.

 

 

New research has found that hospital-onset Clostridium difficile infections increase length of stay (LOS), risk of in-hospital mortality, and hospital costs for inpatients with sepsis.

Authors of a new study titled, "The Impact of Hospital-onset Clostridium difficile Infection on Outcomes of Hospitalized Patients with Sepsis," report that after multivariate adjustment, in-hospital mortality rate was 24% for patients with sepsis who develop C. diff infections, versus 15% of inpatient controls, according to the paper that was published online in the Journal of Hospital Medicine earlier this month. Adjusted LOS among cases with C. diff was 5.1 days longer than controls (95% confidence interval: 4.4–5.8), and the median-adjusted cost increase was $4,916 (P<0.001).

"Big numbers, but I'm actually not surprised," says lead author Tara Lagu, MD, MPH, a hospitalist at the Center for Quality of Care Research at Baystate Medical Center in Springfield, Mass. "I know that it happens, because I see it all the time."

Dr. Lagu says that when a patient is on day four of five of a stay for sepsis and develops diarrhea, precautions and treatment will last a minimum of three days, which drives up LOS and cost of care.

In the report, Dr. Lagu did not compare the cost-effectiveness of C. diff prevention programs aimed at sepsis patients, but she's hopeful that is how physicians will use the data.

"I'm just suggesting that if, as a hospital, you're trying to figure out if your program is worth it, think about these numbers in terms of prevention,” she says. "If it looks like the cost is worth it, then you should keep doing what you're doing. If not, then maybe you should do something different if you're not preventing enough cases."

Visit our website for more information on preventing, managing C. diff infections.

 

 

New research has found that hospital-onset Clostridium difficile infections increase length of stay (LOS), risk of in-hospital mortality, and hospital costs for inpatients with sepsis.

Authors of a new study titled, "The Impact of Hospital-onset Clostridium difficile Infection on Outcomes of Hospitalized Patients with Sepsis," report that after multivariate adjustment, in-hospital mortality rate was 24% for patients with sepsis who develop C. diff infections, versus 15% of inpatient controls, according to the paper that was published online in the Journal of Hospital Medicine earlier this month. Adjusted LOS among cases with C. diff was 5.1 days longer than controls (95% confidence interval: 4.4–5.8), and the median-adjusted cost increase was $4,916 (P<0.001).

"Big numbers, but I'm actually not surprised," says lead author Tara Lagu, MD, MPH, a hospitalist at the Center for Quality of Care Research at Baystate Medical Center in Springfield, Mass. "I know that it happens, because I see it all the time."

Dr. Lagu says that when a patient is on day four of five of a stay for sepsis and develops diarrhea, precautions and treatment will last a minimum of three days, which drives up LOS and cost of care.

In the report, Dr. Lagu did not compare the cost-effectiveness of C. diff prevention programs aimed at sepsis patients, but she's hopeful that is how physicians will use the data.

"I'm just suggesting that if, as a hospital, you're trying to figure out if your program is worth it, think about these numbers in terms of prevention,” she says. "If it looks like the cost is worth it, then you should keep doing what you're doing. If not, then maybe you should do something different if you're not preventing enough cases."

Visit our website for more information on preventing, managing C. diff infections.

 

 

Clinical question: In patients with ischemic heart disease (IHD) undergoing non-cardiac surgery, do pre-operative beta blockers reduce post-operative major cardiovascular events (MACE) or mortality at 30 days?

Background: Pre-operative beta blocker use has become more restricted, as evidence about which patients derive benefit has become clearer. Opinions and practice vary regarding whether all patients with IHD, or only certain populations within this group, benefit from pre-operative beta blockers.

Study design: Retrospective, national registry-based cohort study.

Setting: Denmark, 2004-2009.

Synopsis: No benefit was found for the overall cohort of 28,263 patients. Patients with IHD and heart failure (n=7990) had lower risk of MACE (HR=0.75, 95% CI, 0.70-0.87) and mortality (HR=0.80, 95% CI, 0.70-0.92). Patients with IHD and myocardial infarction within two years (n=1664) had lower risk of MACE (HR=0.54, 95% CI, 0.37-0.78) but not mortality. Beta blocker dose and compliance were unknown. Whether patients had symptoms or inducible ischemia was not clear. This study supports the concept that higher-risk patients benefit more from pre-operative beta blockers, but it is not high-grade evidence.

Bottom line: Not all patients with IHD benefit from pre-operative beta blockers; those with concomitant heart failure or recent MI have a lower risk of MACE and/or mortality at 30 days with beta blockers.

Citation: Andersson C, Merie C, Jorgensen M, et al. Association of ß-blocker therapy with risks of adverse cardiovascular events and deaths in patients with ischemic heart disease undergoing non-cardiac surgery: A Danish nationwide cohort study JAMA Intern Med. 2014;174(3):336-344.

Clinical question: In patients with ischemic heart disease (IHD) undergoing non-cardiac surgery, do pre-operative beta blockers reduce post-operative major cardiovascular events (MACE) or mortality at 30 days?

Background: Pre-operative beta blocker use has become more restricted, as evidence about which patients derive benefit has become clearer. Opinions and practice vary regarding whether all patients with IHD, or only certain populations within this group, benefit from pre-operative beta blockers.

Study design: Retrospective, national registry-based cohort study.

Setting: Denmark, 2004-2009.

Synopsis: No benefit was found for the overall cohort of 28,263 patients. Patients with IHD and heart failure (n=7990) had lower risk of MACE (HR=0.75, 95% CI, 0.70-0.87) and mortality (HR=0.80, 95% CI, 0.70-0.92). Patients with IHD and myocardial infarction within two years (n=1664) had lower risk of MACE (HR=0.54, 95% CI, 0.37-0.78) but not mortality. Beta blocker dose and compliance were unknown. Whether patients had symptoms or inducible ischemia was not clear. This study supports the concept that higher-risk patients benefit more from pre-operative beta blockers, but it is not high-grade evidence.

Bottom line: Not all patients with IHD benefit from pre-operative beta blockers; those with concomitant heart failure or recent MI have a lower risk of MACE and/or mortality at 30 days with beta blockers.

Citation: Andersson C, Merie C, Jorgensen M, et al. Association of ß-blocker therapy with risks of adverse cardiovascular events and deaths in patients with ischemic heart disease undergoing non-cardiac surgery: A Danish nationwide cohort study JAMA Intern Med. 2014;174(3):336-344.

Clinical question: In patients with ischemic heart disease (IHD) undergoing non-cardiac surgery, do pre-operative beta blockers reduce post-operative major cardiovascular events (MACE) or mortality at 30 days?

Background: Pre-operative beta blocker use has become more restricted, as evidence about which patients derive benefit has become clearer. Opinions and practice vary regarding whether all patients with IHD, or only certain populations within this group, benefit from pre-operative beta blockers.

Study design: Retrospective, national registry-based cohort study.

Setting: Denmark, 2004-2009.

Synopsis: No benefit was found for the overall cohort of 28,263 patients. Patients with IHD and heart failure (n=7990) had lower risk of MACE (HR=0.75, 95% CI, 0.70-0.87) and mortality (HR=0.80, 95% CI, 0.70-0.92). Patients with IHD and myocardial infarction within two years (n=1664) had lower risk of MACE (HR=0.54, 95% CI, 0.37-0.78) but not mortality. Beta blocker dose and compliance were unknown. Whether patients had symptoms or inducible ischemia was not clear. This study supports the concept that higher-risk patients benefit more from pre-operative beta blockers, but it is not high-grade evidence.

Bottom line: Not all patients with IHD benefit from pre-operative beta blockers; those with concomitant heart failure or recent MI have a lower risk of MACE and/or mortality at 30 days with beta blockers.

Citation: Andersson C, Merie C, Jorgensen M, et al. Association of ß-blocker therapy with risks of adverse cardiovascular events and deaths in patients with ischemic heart disease undergoing non-cardiac surgery: A Danish nationwide cohort study JAMA Intern Med. 2014;174(3):336-344.

Congress has once again delayed implementation of draconian Medicare cuts tied to the sustainable growth rate (SGR) formula, but this time, the vote by lawmakers to patch the ailing physician reimbursement program rather than scrap it also pushes back the pending debut of ICD-10.

And that's frustrating some hospitalists.

"For about 12 hours, I felt relief about the ICD-10 and then I just realized, it's still coming, presumably," says John Nelson, MD, MHM, a co-founder and past president of SHM and medical director of the hospitalist practice at Overlake Hospital in Bellevue, Wash. "[It's] like a patient who needs surgery and finds out it's canceled for the day and he'll have it tomorrow. Well, that's good for right now, but [he] still has to face this eventually."

The SGR extension through year's end means that physicians do not face a 24% cut to physician payments under Medicare. The delay in transitioning healthcare providers from the ICD-9 medical coding classification system to the more complicated ICD-10 could mean the upgraded system may not go into effect until at least Oct. 1, 2015. This comes after the Centers for Medicare & Medicaid Services already pushed back the original implementation date for ICD-10 by one year.

SHM Public Policy Committee member Joshua Lenchus, DO, RPh, SFHM, says he expects the majority of doctors to be content with the delay, particularly in light of some estimates that show only 20% or so of physicians "have actually initiated the ICD-10 transition," but that it's unfair to those health systems that have prepared.

"ICD-9 has a little more than 14,000 diagnostic codes and nearly 4,000 procedural codes. That is to be contrasted to ICD-10, which has more than 68,000 diagnostic codes...and over 72,000 procedural codes," Dr. Lenchus writes in an e-mail to The Hospitalist's eWire. "So, it is not surprising that many take solace in the delay."

"It's distressing and frustrating for hospitalists, but less disruptive than it might be for hospitals," Dr. Nelson says. "And, of course in some places, hospitalists may be the physician leads on ICD-10 efforts, so [they are] very much wrapped up in the problem of 'What do we do now?'"

 

Visit our website for more information about ICD-10.

 

 

Congress has once again delayed implementation of draconian Medicare cuts tied to the sustainable growth rate (SGR) formula, but this time, the vote by lawmakers to patch the ailing physician reimbursement program rather than scrap it also pushes back the pending debut of ICD-10.

And that's frustrating some hospitalists.

"For about 12 hours, I felt relief about the ICD-10 and then I just realized, it's still coming, presumably," says John Nelson, MD, MHM, a co-founder and past president of SHM and medical director of the hospitalist practice at Overlake Hospital in Bellevue, Wash. "[It's] like a patient who needs surgery and finds out it's canceled for the day and he'll have it tomorrow. Well, that's good for right now, but [he] still has to face this eventually."

The SGR extension through year's end means that physicians do not face a 24% cut to physician payments under Medicare. The delay in transitioning healthcare providers from the ICD-9 medical coding classification system to the more complicated ICD-10 could mean the upgraded system may not go into effect until at least Oct. 1, 2015. This comes after the Centers for Medicare & Medicaid Services already pushed back the original implementation date for ICD-10 by one year.

SHM Public Policy Committee member Joshua Lenchus, DO, RPh, SFHM, says he expects the majority of doctors to be content with the delay, particularly in light of some estimates that show only 20% or so of physicians "have actually initiated the ICD-10 transition," but that it's unfair to those health systems that have prepared.

"ICD-9 has a little more than 14,000 diagnostic codes and nearly 4,000 procedural codes. That is to be contrasted to ICD-10, which has more than 68,000 diagnostic codes...and over 72,000 procedural codes," Dr. Lenchus writes in an e-mail to The Hospitalist's eWire. "So, it is not surprising that many take solace in the delay."

"It's distressing and frustrating for hospitalists, but less disruptive than it might be for hospitals," Dr. Nelson says. "And, of course in some places, hospitalists may be the physician leads on ICD-10 efforts, so [they are] very much wrapped up in the problem of 'What do we do now?'"

 

Visit our website for more information about ICD-10.

 

 

Congress has once again delayed implementation of draconian Medicare cuts tied to the sustainable growth rate (SGR) formula, but this time, the vote by lawmakers to patch the ailing physician reimbursement program rather than scrap it also pushes back the pending debut of ICD-10.

And that's frustrating some hospitalists.

"For about 12 hours, I felt relief about the ICD-10 and then I just realized, it's still coming, presumably," says John Nelson, MD, MHM, a co-founder and past president of SHM and medical director of the hospitalist practice at Overlake Hospital in Bellevue, Wash. "[It's] like a patient who needs surgery and finds out it's canceled for the day and he'll have it tomorrow. Well, that's good for right now, but [he] still has to face this eventually."

The SGR extension through year's end means that physicians do not face a 24% cut to physician payments under Medicare. The delay in transitioning healthcare providers from the ICD-9 medical coding classification system to the more complicated ICD-10 could mean the upgraded system may not go into effect until at least Oct. 1, 2015. This comes after the Centers for Medicare & Medicaid Services already pushed back the original implementation date for ICD-10 by one year.

SHM Public Policy Committee member Joshua Lenchus, DO, RPh, SFHM, says he expects the majority of doctors to be content with the delay, particularly in light of some estimates that show only 20% or so of physicians "have actually initiated the ICD-10 transition," but that it's unfair to those health systems that have prepared.

"ICD-9 has a little more than 14,000 diagnostic codes and nearly 4,000 procedural codes. That is to be contrasted to ICD-10, which has more than 68,000 diagnostic codes...and over 72,000 procedural codes," Dr. Lenchus writes in an e-mail to The Hospitalist's eWire. "So, it is not surprising that many take solace in the delay."

"It's distressing and frustrating for hospitalists, but less disruptive than it might be for hospitals," Dr. Nelson says. "And, of course in some places, hospitalists may be the physician leads on ICD-10 efforts, so [they are] very much wrapped up in the problem of 'What do we do now?'"

 

Visit our website for more information about ICD-10.

 

 

Danielle Scheurer, MD, MSCR, SFHM, has her sights set on quality improvement when it comes to serving on SHM's Board of Directors over the next three years. As a representative of a society she considers well managed and efficient, Dr. Scheurer plans to continue fulfilling the goals she set for herself when she began her career in hospital medicine.

"I realized very quickly that I was not going to be satisfied being a good doctor with individual patients because of the barriers to good care and became compelled to attack the issues at the system level," says Dr. Scheurer, who also serves as physician editor of The Hospitalist.

After earning a medical degree from the University of Tennessee in Knoxville and completing a dual residency in internal medicine and pediatrics at Duke University in Durham, N.C., Dr. Scheurer immersed herself in patient-centered care practices as a hospitalist at Brigham and Women's Hospital in Boston from 2005 to 2010. She continues to stress the importance of quality in her current role as chief quality officer at the Medical University of South Carolina in Charleston.

Since becoming involved with SHM in 2003, Dr. Scheurer has spent time educating hospitalists on tactics to make hospital systems more effective and she blogs about clinical and practice issues. Dr. Scheurer also serves on SHM’s Education Committee, a role that she plans to continue in tandem with her work on the board.

Dr. Scheurer's hard work for the society not gone unnoticed. SHM President Burke T. Kealey, MD, SFHM, notes, "I'm very pleased to have Danielle on the board with us. I think she is going to add a great voice. Danielle has already been a great contributor to SHM. She has done a great job of getting out the message about SHM to our members and to others."

One of Dr. Scheurer's biggest accomplishments has been her role developing medical knowledge modules on quality and patient safety for the American Board of Internal Medicine's Recognition in Focused Practice in Hospital Medicine maintenance of certification (MOC) program. She has presented numerous MOC pre-courses at SHM's annual meetings. She says her involvement with fledgling hospitalists has made her optimistic about the future of the specialty.

"People in hospital medicine are already very focused on quality," she says. "We are getting better at understanding that it's not just about being a good doctor, its about creating systems that can effectively and reliably deliver high-quality care."

 

Danielle Scheurer, MD, MSCR, SFHM, has her sights set on quality improvement when it comes to serving on SHM's Board of Directors over the next three years. As a representative of a society she considers well managed and efficient, Dr. Scheurer plans to continue fulfilling the goals she set for herself when she began her career in hospital medicine.

"I realized very quickly that I was not going to be satisfied being a good doctor with individual patients because of the barriers to good care and became compelled to attack the issues at the system level," says Dr. Scheurer, who also serves as physician editor of The Hospitalist.

After earning a medical degree from the University of Tennessee in Knoxville and completing a dual residency in internal medicine and pediatrics at Duke University in Durham, N.C., Dr. Scheurer immersed herself in patient-centered care practices as a hospitalist at Brigham and Women's Hospital in Boston from 2005 to 2010. She continues to stress the importance of quality in her current role as chief quality officer at the Medical University of South Carolina in Charleston.

Since becoming involved with SHM in 2003, Dr. Scheurer has spent time educating hospitalists on tactics to make hospital systems more effective and she blogs about clinical and practice issues. Dr. Scheurer also serves on SHM’s Education Committee, a role that she plans to continue in tandem with her work on the board.

Dr. Scheurer's hard work for the society not gone unnoticed. SHM President Burke T. Kealey, MD, SFHM, notes, "I'm very pleased to have Danielle on the board with us. I think she is going to add a great voice. Danielle has already been a great contributor to SHM. She has done a great job of getting out the message about SHM to our members and to others."

One of Dr. Scheurer's biggest accomplishments has been her role developing medical knowledge modules on quality and patient safety for the American Board of Internal Medicine's Recognition in Focused Practice in Hospital Medicine maintenance of certification (MOC) program. She has presented numerous MOC pre-courses at SHM's annual meetings. She says her involvement with fledgling hospitalists has made her optimistic about the future of the specialty.

"People in hospital medicine are already very focused on quality," she says. "We are getting better at understanding that it's not just about being a good doctor, its about creating systems that can effectively and reliably deliver high-quality care."

 

Danielle Scheurer, MD, MSCR, SFHM, has her sights set on quality improvement when it comes to serving on SHM's Board of Directors over the next three years. As a representative of a society she considers well managed and efficient, Dr. Scheurer plans to continue fulfilling the goals she set for herself when she began her career in hospital medicine.

"I realized very quickly that I was not going to be satisfied being a good doctor with individual patients because of the barriers to good care and became compelled to attack the issues at the system level," says Dr. Scheurer, who also serves as physician editor of The Hospitalist.

After earning a medical degree from the University of Tennessee in Knoxville and completing a dual residency in internal medicine and pediatrics at Duke University in Durham, N.C., Dr. Scheurer immersed herself in patient-centered care practices as a hospitalist at Brigham and Women's Hospital in Boston from 2005 to 2010. She continues to stress the importance of quality in her current role as chief quality officer at the Medical University of South Carolina in Charleston.

Since becoming involved with SHM in 2003, Dr. Scheurer has spent time educating hospitalists on tactics to make hospital systems more effective and she blogs about clinical and practice issues. Dr. Scheurer also serves on SHM’s Education Committee, a role that she plans to continue in tandem with her work on the board.

Dr. Scheurer's hard work for the society not gone unnoticed. SHM President Burke T. Kealey, MD, SFHM, notes, "I'm very pleased to have Danielle on the board with us. I think she is going to add a great voice. Danielle has already been a great contributor to SHM. She has done a great job of getting out the message about SHM to our members and to others."

One of Dr. Scheurer's biggest accomplishments has been her role developing medical knowledge modules on quality and patient safety for the American Board of Internal Medicine's Recognition in Focused Practice in Hospital Medicine maintenance of certification (MOC) program. She has presented numerous MOC pre-courses at SHM's annual meetings. She says her involvement with fledgling hospitalists has made her optimistic about the future of the specialty.

"People in hospital medicine are already very focused on quality," she says. "We are getting better at understanding that it's not just about being a good doctor, its about creating systems that can effectively and reliably deliver high-quality care."

 

Which are the best internal medicine residency programs in the U.S.? Now prospective hospitalists—about a third of whom will complete their residency training in internal medicine—have an answer.

Although a formal ranking system for postgraduate medical training programs doesn't exist, a new survey commissioned by U.S. News & World Report gives some idea about what programs are most popular among physicians.

The survey asked physicians who completed their internal medicine residency in the U.S. to name up to five programs they believe offer the best clinical training.

Four programs: Massachusetts General Hospital in Boston, Johns Hopkins University in Baltimore, Boston’s Brigham and Women’s Hospital, and the University of California San Francisco Medical Center (UCSF) each received almost twice as many nominations as any other program.

Out of more than 9,000 submitted nominations, the top three hospital-based apprenticeship programs each received at least 600 nods: Massachusetts General Hospital (732), Johns Hopkins (696), and Brigham and Women’s (600). UCSF received 579 nominations. Likewise, 20 other internal medicine programs each received between 100 to 300 nominations.

In a separate analysis that looked at the survey responses of general internists as a subgroup—as opposed to subspecialists who completed an internal medicine residency—UCSF received the most nominations (201) of any program.

Harry Hollander, MD, director of UCSF’s internal medicine residency program, says the positive feedback likely “reflects the strong tradition of general internal medicine training here, the prominence of both outstanding ambulatory internists and hospitalists on our faculty, and the accomplishments and reputation of our graduates who have pursued either generalist or subspecialty careers in internal medicine.”

Dr. Hollander noted that the Accreditation Council for Graduate Medical Education plans to introduce a new accreditation system that would, in theory, make the comparison of residency program metrics more transparent.

“However, no matter how much objective data exist, gut feeling and intuition about the place, the people, and the culture will always remain a key part of students choosing the right residency program for them,” he says.

Doximity, an online social network for physicians, conducted the survey through a combination of web notifications and emails sent to 18,695 members. A total of 3,410 physicians responded to the survey, which ran from last December through February 10.

Visit our website for more on internal medicine residency training programs.

 

Which are the best internal medicine residency programs in the U.S.? Now prospective hospitalists—about a third of whom will complete their residency training in internal medicine—have an answer.

Although a formal ranking system for postgraduate medical training programs doesn't exist, a new survey commissioned by U.S. News & World Report gives some idea about what programs are most popular among physicians.

The survey asked physicians who completed their internal medicine residency in the U.S. to name up to five programs they believe offer the best clinical training.

Four programs: Massachusetts General Hospital in Boston, Johns Hopkins University in Baltimore, Boston’s Brigham and Women’s Hospital, and the University of California San Francisco Medical Center (UCSF) each received almost twice as many nominations as any other program.

Out of more than 9,000 submitted nominations, the top three hospital-based apprenticeship programs each received at least 600 nods: Massachusetts General Hospital (732), Johns Hopkins (696), and Brigham and Women’s (600). UCSF received 579 nominations. Likewise, 20 other internal medicine programs each received between 100 to 300 nominations.

In a separate analysis that looked at the survey responses of general internists as a subgroup—as opposed to subspecialists who completed an internal medicine residency—UCSF received the most nominations (201) of any program.

Harry Hollander, MD, director of UCSF’s internal medicine residency program, says the positive feedback likely “reflects the strong tradition of general internal medicine training here, the prominence of both outstanding ambulatory internists and hospitalists on our faculty, and the accomplishments and reputation of our graduates who have pursued either generalist or subspecialty careers in internal medicine.”

Dr. Hollander noted that the Accreditation Council for Graduate Medical Education plans to introduce a new accreditation system that would, in theory, make the comparison of residency program metrics more transparent.

“However, no matter how much objective data exist, gut feeling and intuition about the place, the people, and the culture will always remain a key part of students choosing the right residency program for them,” he says.

Doximity, an online social network for physicians, conducted the survey through a combination of web notifications and emails sent to 18,695 members. A total of 3,410 physicians responded to the survey, which ran from last December through February 10.

Visit our website for more on internal medicine residency training programs.

 

Which are the best internal medicine residency programs in the U.S.? Now prospective hospitalists—about a third of whom will complete their residency training in internal medicine—have an answer.

Although a formal ranking system for postgraduate medical training programs doesn't exist, a new survey commissioned by U.S. News & World Report gives some idea about what programs are most popular among physicians.

The survey asked physicians who completed their internal medicine residency in the U.S. to name up to five programs they believe offer the best clinical training.

Four programs: Massachusetts General Hospital in Boston, Johns Hopkins University in Baltimore, Boston’s Brigham and Women’s Hospital, and the University of California San Francisco Medical Center (UCSF) each received almost twice as many nominations as any other program.

Out of more than 9,000 submitted nominations, the top three hospital-based apprenticeship programs each received at least 600 nods: Massachusetts General Hospital (732), Johns Hopkins (696), and Brigham and Women’s (600). UCSF received 579 nominations. Likewise, 20 other internal medicine programs each received between 100 to 300 nominations.

In a separate analysis that looked at the survey responses of general internists as a subgroup—as opposed to subspecialists who completed an internal medicine residency—UCSF received the most nominations (201) of any program.

Harry Hollander, MD, director of UCSF’s internal medicine residency program, says the positive feedback likely “reflects the strong tradition of general internal medicine training here, the prominence of both outstanding ambulatory internists and hospitalists on our faculty, and the accomplishments and reputation of our graduates who have pursued either generalist or subspecialty careers in internal medicine.”

Dr. Hollander noted that the Accreditation Council for Graduate Medical Education plans to introduce a new accreditation system that would, in theory, make the comparison of residency program metrics more transparent.

“However, no matter how much objective data exist, gut feeling and intuition about the place, the people, and the culture will always remain a key part of students choosing the right residency program for them,” he says.

Doximity, an online social network for physicians, conducted the survey through a combination of web notifications and emails sent to 18,695 members. A total of 3,410 physicians responded to the survey, which ran from last December through February 10.

Visit our website for more on internal medicine residency training programs.

 

Clinical question: Do thrombin and factor Xa inhibitors increase the risk of gastrointestinal (GI) bleeding when compared to vitamin K antagonists and heparins?

Background: New oral anticoagulants (thrombin and factor Xa inhibitors) are available and being used with increased frequency due to equal efficacy and ease of administration. Some studies indicate a higher risk of GI bleeding with these agents. Further evaluation is needed, because no reversal therapy is available.

Study design: Systematic review and meta-analysis.

Setting: Data from MEDLINE, Embase, and the Cochrane Library.

Synopsis: More than 150,000 patients from 43 randomized controlled trials were evaluated for risk of GI bleed when treated with new anticoagulants versus traditional therapy. Patients were treated for one of the following: embolism prevention from atrial fibrillation, venous thromboembolism (VTE) prophylaxis post orthopedic surgery, VTE prophylaxis of medical patients, acute VTE, and acute coronary syndrome (ACS). Use of aspirin or NSAIDs was discouraged but not documented. The odds ratio for GI bleeding with use of the new anticoagulants was 1.45, with a number needed to harm of 500. Evaluation of subgroups revealed increased GI bleed risk in patients treated for ACS and acute thrombosis versus prophylaxis. Postsurgical patients had the lowest risk. This study was limited by the heterogeneity and differing primary outcomes (mostly efficacy rather than safety) of the included trials. Studies excluded high-risk patients, which the authors estimate to be 25%–40% of actual patients. More studies need to be done that include high-risk patients and focus on GI bleed as a primary outcome.

Bottom line: The new anticoagulants tend to have a higher incidence of GI bleed than traditional therapy, but this varies based on indication of therapy and needs further evaluation to clarify risk.

Citation: Holster IL, Valkhoff VE, Kuipers EJ, Tjwa ET. New oral anticoagulants increase risk for gastrointestinal bleeding: A systematic review and meta-analysis. Gastroenterology. 2013;145(1):105–112.

 

Clinical question: Do thrombin and factor Xa inhibitors increase the risk of gastrointestinal (GI) bleeding when compared to vitamin K antagonists and heparins?

Background: New oral anticoagulants (thrombin and factor Xa inhibitors) are available and being used with increased frequency due to equal efficacy and ease of administration. Some studies indicate a higher risk of GI bleeding with these agents. Further evaluation is needed, because no reversal therapy is available.

Study design: Systematic review and meta-analysis.

Setting: Data from MEDLINE, Embase, and the Cochrane Library.

Synopsis: More than 150,000 patients from 43 randomized controlled trials were evaluated for risk of GI bleed when treated with new anticoagulants versus traditional therapy. Patients were treated for one of the following: embolism prevention from atrial fibrillation, venous thromboembolism (VTE) prophylaxis post orthopedic surgery, VTE prophylaxis of medical patients, acute VTE, and acute coronary syndrome (ACS). Use of aspirin or NSAIDs was discouraged but not documented. The odds ratio for GI bleeding with use of the new anticoagulants was 1.45, with a number needed to harm of 500. Evaluation of subgroups revealed increased GI bleed risk in patients treated for ACS and acute thrombosis versus prophylaxis. Postsurgical patients had the lowest risk. This study was limited by the heterogeneity and differing primary outcomes (mostly efficacy rather than safety) of the included trials. Studies excluded high-risk patients, which the authors estimate to be 25%–40% of actual patients. More studies need to be done that include high-risk patients and focus on GI bleed as a primary outcome.

Bottom line: The new anticoagulants tend to have a higher incidence of GI bleed than traditional therapy, but this varies based on indication of therapy and needs further evaluation to clarify risk.

Citation: Holster IL, Valkhoff VE, Kuipers EJ, Tjwa ET. New oral anticoagulants increase risk for gastrointestinal bleeding: A systematic review and meta-analysis. Gastroenterology. 2013;145(1):105–112.

 

Clinical question: Do thrombin and factor Xa inhibitors increase the risk of gastrointestinal (GI) bleeding when compared to vitamin K antagonists and heparins?

Background: New oral anticoagulants (thrombin and factor Xa inhibitors) are available and being used with increased frequency due to equal efficacy and ease of administration. Some studies indicate a higher risk of GI bleeding with these agents. Further evaluation is needed, because no reversal therapy is available.

Study design: Systematic review and meta-analysis.

Setting: Data from MEDLINE, Embase, and the Cochrane Library.

Synopsis: More than 150,000 patients from 43 randomized controlled trials were evaluated for risk of GI bleed when treated with new anticoagulants versus traditional therapy. Patients were treated for one of the following: embolism prevention from atrial fibrillation, venous thromboembolism (VTE) prophylaxis post orthopedic surgery, VTE prophylaxis of medical patients, acute VTE, and acute coronary syndrome (ACS). Use of aspirin or NSAIDs was discouraged but not documented. The odds ratio for GI bleeding with use of the new anticoagulants was 1.45, with a number needed to harm of 500. Evaluation of subgroups revealed increased GI bleed risk in patients treated for ACS and acute thrombosis versus prophylaxis. Postsurgical patients had the lowest risk. This study was limited by the heterogeneity and differing primary outcomes (mostly efficacy rather than safety) of the included trials. Studies excluded high-risk patients, which the authors estimate to be 25%–40% of actual patients. More studies need to be done that include high-risk patients and focus on GI bleed as a primary outcome.

Bottom line: The new anticoagulants tend to have a higher incidence of GI bleed than traditional therapy, but this varies based on indication of therapy and needs further evaluation to clarify risk.

Citation: Holster IL, Valkhoff VE, Kuipers EJ, Tjwa ET. New oral anticoagulants increase risk for gastrointestinal bleeding: A systematic review and meta-analysis. Gastroenterology. 2013;145(1):105–112.

 

Dr. Steve Narang

CEO, Banner Health’s Good Samaritan Medical Center, Phoenix

Path to the C-suite: Medical school at Northwestern University; residency at Johns Hopkins; pediatric hospitalist at Children’s Hospital of New Orleans; medical director of Pediatric Hospitalists of Louisiana; master’s in healthcare management from Harvard; chief medical officer at Banner Health’s Cardon Children’s Medical Center

As a resident at Johns Hopkins in pediatrics, Dr. Narang wasn’t always pleased by what he saw—too many process errors and patient safety gaps, and too much waste. Healthcare resources were not being spent in the right way, he discovered.

“I was struck by [the fact] that we spent a lot of our resources in publishing more articles about what’s new, and what the coolest drug is,” he says. “I saw very little of that [relating to] what does this mean in terms of value?”

He became a hospitalist because he saw it as a role in which he could “really touch everything” if he chose to do so and work within the system to improve it.

“The hospital could use a partner,” he says. “One of the biggest challenges we have in healthcare is hospitals and physicians are often not working together to add value, and they’re subtracting from value, and they’re competing with each other.”

If doctors make the effort to learn the management aspects of working in a hospital, they can put themselves in a great position to take on big leadership roles, Dr. Narang says. He says hospitals are seeing the value in having physicians in those roles.

“If you can find the right leader and it happens to be a physician, if it happens to be a physician who can speak that language—and find a sweet spot for independent physicians, employed physicians, and hospitalists to deliver value, which we have to now I think it’s the best way to go,” he says. “I think you’re going to see a trend moving forward to this as more physicians become more interested in this track.” —TC

Being a hospitalist was a key strength of my background. Hospitalists are so well-positioned…to get truly at the intersection of operations and find value in a complex puzzle. Hospitalists are able to do that.

—Steve Narang, MD, a pediatrician, hospitalist, and the then-CMO at Banner Health’s Cardon Children’s Medical Center in Phoenix

---

Dr. Brian Harte

President, South Pointe Hospital, Warrenville Heights, Ohio

Path to the C-suite: Resident at University of California San Francisco; private practice hospitalist in Marin County, near San Francisco; hospitalist at Cleveland Clinic; program director of hospital medicine at Cleveland Clinic’s Euclid Hospital; chief operating officer at Cleveland Clinic’s Hillcrest Hospital For about two hours a day, Dr. Harte makes his way through South Pointe Hospital—to see and to be seen. Before he started doing this as president of the hospital, he underestimated how important it was to stay visible to everyone—nurses, doctors, housekeeping, and so on.

“The impression that makes surprised me,” he says.

He’ll ask what people need to do their jobs better. He’ll also pop into patients’ rooms, introduce himself, and ask how their experiences have been. Then he takes that feedback and incorporates it into his planning.

Dr. Harte says he likes to have an “open and transparent” relationship with physicians and lists his credibility, both as a physician and a person, as a top attribute for a leader. For those embarking on leadership roles in a hospital, he says it’s a must to have a “strong mentor that you can go to.”

 

He also says a supportive environment is critical.

“You must work in an organization that is a resource to help you succeed, because when you move out of the purely clinical or clinical administrative jobs like division chair, department chair, program director, even CMO or VPMA [vice president of medical affairs], those are doctor jobs,” he says. “When you really become a doctor doing administrative work, unless it’s in your background and in your skill set, I think it’s important to work in an organization that is going to support you in your continued growth.

“Because these are jobs that I think you grow into.” —TC

I think one of the things that makes hospitalists fairly natural fits for the hospital leadership positions is that a hospital is a very complicated environment. You have pockets of enormous expertise that sometimes function like silos. Being a hospitalist actually trains you well for those things.

—Brian Harte, MD, SFHM, president, South Pointe Hospital, Warrenville Heights, Ohio, SHM board member

---

Dr. Nasim Afsar

Associate Chief Medical Officer, UCLA Hospitals, Los Angeles

Path to the C-suite: Residency at UCLA; advanced training program in quality improvement at Intermountain Healthcare Dr. Afsar wasn’t aiming for a top administrative job in a hospital. But, during her time spent working as a hospitalist, she started noticing trouble within the system. Eventually, she wanted to try to solve problems in a way that would have a ripple effect. Inspired, she ventured into quality improvement.

“I’m very passionate about helping the patient in front of me, whether it’s helping them get better or helping them during a really challenging time of their life,” she says. “But there’s something about feeling that the improvements that you make will not just impact the person in front of you, but the thousands of patients that come after them.”

Part of her job is instilling in other healthcare providers the sense that they themselves are agents of change. One big difference in her administrative job and clinical work is how to gauge success.

“The job is a lot harder than it seems. In our clinical world, I know what constitutes a good job. I know that when I’m on service, I get up early in the morning, I come in, I pre-round on my patients extensively, I read up on a couple of different things, I go out onto the wards with my team,” she explains. “This type of leadership role, I think, is more challenging. Initiatives that you do to improve care in one area could have detrimental or challenging impacts on another set of stakeholders or care area. You’re constantly navigating the system.” —TC

By nature when you’re a hospitalist, you are a problem solver. You don’t shy away from problems that you don’t understand.

—Nasim Afsar, MD, SFHM, associate chief medical officer, UCLA Hospitals, Los Angeles, SHM board member

---

Dr. Patrick Torcson

Chief Integration Officer, St. Tammany Parish Hospital, Covington, La.

Path to the C-Suite: Residency at Ochsner Clinic in New Orleans; private internist; director of hospital medicine at St. Tammany Parish Hospital Dr. Torcson recently became his hospital’s first chief integration officer, a job in which he promotes clinical quality and service quality using information technology.

But it was never about a promotion, he says.

“It’s really been more about just trying to provide quality care and make contributions to fixing a broken healthcare system,” he says. “Staying focused on that personal journey has really brought me to where I am.”

 

A good leader within a hospital is a “systems-level thinker,” not one focusing on a specific agenda. And, prioritizing important items is crucial to success, he notes.

“We all have a limited amount of energy. If you can pick three to five things that are really important and prioritize them and they turn out to be important, that’s going to facilitate your success,” he says.

He can’t emphasize “clinical credibility” enough. That’s where it all begins, he says.

“Your leadership is facilitated if you’re seen as someone that takes good care of your patients,” being the doctor that other doctors would want themselves and their families to go to. “That’s huge.”

Also, he says, running out and getting a master’s degree in business management and then applying for positions around the country is probably not the best approach to seeking out leadership positions, he says.

“I don’t think many people are put in a position where you’re just asked to pull a sword out of a stone and you’re suddenly chief of something,” he points out. “Leadership is home-grown, and you work your way up.” —TC

I don’t think many people are put in a position where you’re just asked to pull a sword out of a stone and you’re suddenly chief of something. Leadership is home-grown, and you work your way up.

—Patrick Torcson, MD, MMM, FACP, SFHM, vice president and chief integration officer, St. Tammany Parish Hospital, Covington, La., SHM board member

Dr. Steve Narang

CEO, Banner Health’s Good Samaritan Medical Center, Phoenix

Path to the C-suite: Medical school at Northwestern University; residency at Johns Hopkins; pediatric hospitalist at Children’s Hospital of New Orleans; medical director of Pediatric Hospitalists of Louisiana; master’s in healthcare management from Harvard; chief medical officer at Banner Health’s Cardon Children’s Medical Center

As a resident at Johns Hopkins in pediatrics, Dr. Narang wasn’t always pleased by what he saw—too many process errors and patient safety gaps, and too much waste. Healthcare resources were not being spent in the right way, he discovered.

“I was struck by [the fact] that we spent a lot of our resources in publishing more articles about what’s new, and what the coolest drug is,” he says. “I saw very little of that [relating to] what does this mean in terms of value?”

He became a hospitalist because he saw it as a role in which he could “really touch everything” if he chose to do so and work within the system to improve it.

“The hospital could use a partner,” he says. “One of the biggest challenges we have in healthcare is hospitals and physicians are often not working together to add value, and they’re subtracting from value, and they’re competing with each other.”

If doctors make the effort to learn the management aspects of working in a hospital, they can put themselves in a great position to take on big leadership roles, Dr. Narang says. He says hospitals are seeing the value in having physicians in those roles.

“If you can find the right leader and it happens to be a physician, if it happens to be a physician who can speak that language—and find a sweet spot for independent physicians, employed physicians, and hospitalists to deliver value, which we have to now I think it’s the best way to go,” he says. “I think you’re going to see a trend moving forward to this as more physicians become more interested in this track.” —TC

Being a hospitalist was a key strength of my background. Hospitalists are so well-positioned…to get truly at the intersection of operations and find value in a complex puzzle. Hospitalists are able to do that.

—Steve Narang, MD, a pediatrician, hospitalist, and the then-CMO at Banner Health’s Cardon Children’s Medical Center in Phoenix

---

Dr. Brian Harte

President, South Pointe Hospital, Warrenville Heights, Ohio

Path to the C-suite: Resident at University of California San Francisco; private practice hospitalist in Marin County, near San Francisco; hospitalist at Cleveland Clinic; program director of hospital medicine at Cleveland Clinic’s Euclid Hospital; chief operating officer at Cleveland Clinic’s Hillcrest Hospital For about two hours a day, Dr. Harte makes his way through South Pointe Hospital—to see and to be seen. Before he started doing this as president of the hospital, he underestimated how important it was to stay visible to everyone—nurses, doctors, housekeeping, and so on.

“The impression that makes surprised me,” he says.

He’ll ask what people need to do their jobs better. He’ll also pop into patients’ rooms, introduce himself, and ask how their experiences have been. Then he takes that feedback and incorporates it into his planning.

Dr. Harte says he likes to have an “open and transparent” relationship with physicians and lists his credibility, both as a physician and a person, as a top attribute for a leader. For those embarking on leadership roles in a hospital, he says it’s a must to have a “strong mentor that you can go to.”

 

He also says a supportive environment is critical.

“You must work in an organization that is a resource to help you succeed, because when you move out of the purely clinical or clinical administrative jobs like division chair, department chair, program director, even CMO or VPMA [vice president of medical affairs], those are doctor jobs,” he says. “When you really become a doctor doing administrative work, unless it’s in your background and in your skill set, I think it’s important to work in an organization that is going to support you in your continued growth.

“Because these are jobs that I think you grow into.” —TC

I think one of the things that makes hospitalists fairly natural fits for the hospital leadership positions is that a hospital is a very complicated environment. You have pockets of enormous expertise that sometimes function like silos. Being a hospitalist actually trains you well for those things.

—Brian Harte, MD, SFHM, president, South Pointe Hospital, Warrenville Heights, Ohio, SHM board member

---

Dr. Nasim Afsar

Associate Chief Medical Officer, UCLA Hospitals, Los Angeles

Path to the C-suite: Residency at UCLA; advanced training program in quality improvement at Intermountain Healthcare Dr. Afsar wasn’t aiming for a top administrative job in a hospital. But, during her time spent working as a hospitalist, she started noticing trouble within the system. Eventually, she wanted to try to solve problems in a way that would have a ripple effect. Inspired, she ventured into quality improvement.

“I’m very passionate about helping the patient in front of me, whether it’s helping them get better or helping them during a really challenging time of their life,” she says. “But there’s something about feeling that the improvements that you make will not just impact the person in front of you, but the thousands of patients that come after them.”

Part of her job is instilling in other healthcare providers the sense that they themselves are agents of change. One big difference in her administrative job and clinical work is how to gauge success.

“The job is a lot harder than it seems. In our clinical world, I know what constitutes a good job. I know that when I’m on service, I get up early in the morning, I come in, I pre-round on my patients extensively, I read up on a couple of different things, I go out onto the wards with my team,” she explains. “This type of leadership role, I think, is more challenging. Initiatives that you do to improve care in one area could have detrimental or challenging impacts on another set of stakeholders or care area. You’re constantly navigating the system.” —TC

By nature when you’re a hospitalist, you are a problem solver. You don’t shy away from problems that you don’t understand.

—Nasim Afsar, MD, SFHM, associate chief medical officer, UCLA Hospitals, Los Angeles, SHM board member

---

Dr. Patrick Torcson

Chief Integration Officer, St. Tammany Parish Hospital, Covington, La.

Path to the C-Suite: Residency at Ochsner Clinic in New Orleans; private internist; director of hospital medicine at St. Tammany Parish Hospital Dr. Torcson recently became his hospital’s first chief integration officer, a job in which he promotes clinical quality and service quality using information technology.

But it was never about a promotion, he says.

“It’s really been more about just trying to provide quality care and make contributions to fixing a broken healthcare system,” he says. “Staying focused on that personal journey has really brought me to where I am.”

 

A good leader within a hospital is a “systems-level thinker,” not one focusing on a specific agenda. And, prioritizing important items is crucial to success, he notes.

“We all have a limited amount of energy. If you can pick three to five things that are really important and prioritize them and they turn out to be important, that’s going to facilitate your success,” he says.

He can’t emphasize “clinical credibility” enough. That’s where it all begins, he says.

“Your leadership is facilitated if you’re seen as someone that takes good care of your patients,” being the doctor that other doctors would want themselves and their families to go to. “That’s huge.”

Also, he says, running out and getting a master’s degree in business management and then applying for positions around the country is probably not the best approach to seeking out leadership positions, he says.

“I don’t think many people are put in a position where you’re just asked to pull a sword out of a stone and you’re suddenly chief of something,” he points out. “Leadership is home-grown, and you work your way up.” —TC

I don’t think many people are put in a position where you’re just asked to pull a sword out of a stone and you’re suddenly chief of something. Leadership is home-grown, and you work your way up.

—Patrick Torcson, MD, MMM, FACP, SFHM, vice president and chief integration officer, St. Tammany Parish Hospital, Covington, La., SHM board member

Dr. Steve Narang

CEO, Banner Health’s Good Samaritan Medical Center, Phoenix

Path to the C-suite: Medical school at Northwestern University; residency at Johns Hopkins; pediatric hospitalist at Children’s Hospital of New Orleans; medical director of Pediatric Hospitalists of Louisiana; master’s in healthcare management from Harvard; chief medical officer at Banner Health’s Cardon Children’s Medical Center

As a resident at Johns Hopkins in pediatrics, Dr. Narang wasn’t always pleased by what he saw—too many process errors and patient safety gaps, and too much waste. Healthcare resources were not being spent in the right way, he discovered.

“I was struck by [the fact] that we spent a lot of our resources in publishing more articles about what’s new, and what the coolest drug is,” he says. “I saw very little of that [relating to] what does this mean in terms of value?”

He became a hospitalist because he saw it as a role in which he could “really touch everything” if he chose to do so and work within the system to improve it.

“The hospital could use a partner,” he says. “One of the biggest challenges we have in healthcare is hospitals and physicians are often not working together to add value, and they’re subtracting from value, and they’re competing with each other.”

If doctors make the effort to learn the management aspects of working in a hospital, they can put themselves in a great position to take on big leadership roles, Dr. Narang says. He says hospitals are seeing the value in having physicians in those roles.

“If you can find the right leader and it happens to be a physician, if it happens to be a physician who can speak that language—and find a sweet spot for independent physicians, employed physicians, and hospitalists to deliver value, which we have to now I think it’s the best way to go,” he says. “I think you’re going to see a trend moving forward to this as more physicians become more interested in this track.” —TC

Being a hospitalist was a key strength of my background. Hospitalists are so well-positioned…to get truly at the intersection of operations and find value in a complex puzzle. Hospitalists are able to do that.

—Steve Narang, MD, a pediatrician, hospitalist, and the then-CMO at Banner Health’s Cardon Children’s Medical Center in Phoenix

---

Dr. Brian Harte

President, South Pointe Hospital, Warrenville Heights, Ohio

Path to the C-suite: Resident at University of California San Francisco; private practice hospitalist in Marin County, near San Francisco; hospitalist at Cleveland Clinic; program director of hospital medicine at Cleveland Clinic’s Euclid Hospital; chief operating officer at Cleveland Clinic’s Hillcrest Hospital For about two hours a day, Dr. Harte makes his way through South Pointe Hospital—to see and to be seen. Before he started doing this as president of the hospital, he underestimated how important it was to stay visible to everyone—nurses, doctors, housekeeping, and so on.

“The impression that makes surprised me,” he says.

He’ll ask what people need to do their jobs better. He’ll also pop into patients’ rooms, introduce himself, and ask how their experiences have been. Then he takes that feedback and incorporates it into his planning.

Dr. Harte says he likes to have an “open and transparent” relationship with physicians and lists his credibility, both as a physician and a person, as a top attribute for a leader. For those embarking on leadership roles in a hospital, he says it’s a must to have a “strong mentor that you can go to.”

 

He also says a supportive environment is critical.

“You must work in an organization that is a resource to help you succeed, because when you move out of the purely clinical or clinical administrative jobs like division chair, department chair, program director, even CMO or VPMA [vice president of medical affairs], those are doctor jobs,” he says. “When you really become a doctor doing administrative work, unless it’s in your background and in your skill set, I think it’s important to work in an organization that is going to support you in your continued growth.

“Because these are jobs that I think you grow into.” —TC

I think one of the things that makes hospitalists fairly natural fits for the hospital leadership positions is that a hospital is a very complicated environment. You have pockets of enormous expertise that sometimes function like silos. Being a hospitalist actually trains you well for those things.

—Brian Harte, MD, SFHM, president, South Pointe Hospital, Warrenville Heights, Ohio, SHM board member

---

Dr. Nasim Afsar

Associate Chief Medical Officer, UCLA Hospitals, Los Angeles

Path to the C-suite: Residency at UCLA; advanced training program in quality improvement at Intermountain Healthcare Dr. Afsar wasn’t aiming for a top administrative job in a hospital. But, during her time spent working as a hospitalist, she started noticing trouble within the system. Eventually, she wanted to try to solve problems in a way that would have a ripple effect. Inspired, she ventured into quality improvement.

“I’m very passionate about helping the patient in front of me, whether it’s helping them get better or helping them during a really challenging time of their life,” she says. “But there’s something about feeling that the improvements that you make will not just impact the person in front of you, but the thousands of patients that come after them.”

Part of her job is instilling in other healthcare providers the sense that they themselves are agents of change. One big difference in her administrative job and clinical work is how to gauge success.

“The job is a lot harder than it seems. In our clinical world, I know what constitutes a good job. I know that when I’m on service, I get up early in the morning, I come in, I pre-round on my patients extensively, I read up on a couple of different things, I go out onto the wards with my team,” she explains. “This type of leadership role, I think, is more challenging. Initiatives that you do to improve care in one area could have detrimental or challenging impacts on another set of stakeholders or care area. You’re constantly navigating the system.” —TC

By nature when you’re a hospitalist, you are a problem solver. You don’t shy away from problems that you don’t understand.

—Nasim Afsar, MD, SFHM, associate chief medical officer, UCLA Hospitals, Los Angeles, SHM board member

---

Dr. Patrick Torcson

Chief Integration Officer, St. Tammany Parish Hospital, Covington, La.

Path to the C-Suite: Residency at Ochsner Clinic in New Orleans; private internist; director of hospital medicine at St. Tammany Parish Hospital Dr. Torcson recently became his hospital’s first chief integration officer, a job in which he promotes clinical quality and service quality using information technology.

But it was never about a promotion, he says.

“It’s really been more about just trying to provide quality care and make contributions to fixing a broken healthcare system,” he says. “Staying focused on that personal journey has really brought me to where I am.”

 

A good leader within a hospital is a “systems-level thinker,” not one focusing on a specific agenda. And, prioritizing important items is crucial to success, he notes.

“We all have a limited amount of energy. If you can pick three to five things that are really important and prioritize them and they turn out to be important, that’s going to facilitate your success,” he says.

He can’t emphasize “clinical credibility” enough. That’s where it all begins, he says.

“Your leadership is facilitated if you’re seen as someone that takes good care of your patients,” being the doctor that other doctors would want themselves and their families to go to. “That’s huge.”

Also, he says, running out and getting a master’s degree in business management and then applying for positions around the country is probably not the best approach to seeking out leadership positions, he says.

“I don’t think many people are put in a position where you’re just asked to pull a sword out of a stone and you’re suddenly chief of something,” he points out. “Leadership is home-grown, and you work your way up.” —TC

I don’t think many people are put in a position where you’re just asked to pull a sword out of a stone and you’re suddenly chief of something. Leadership is home-grown, and you work your way up.

—Patrick Torcson, MD, MMM, FACP, SFHM, vice president and chief integration officer, St. Tammany Parish Hospital, Covington, La., SHM board member

Quality improvement education is no longer just an elective for trainees, which is why medical educators need the best possible knowledge and tools for teaching quality and safety. SHM and the Alliance for Academic Internal Medicine (AAIM) have teamed up to present the Quality and Safety Educators Academy, to be held May 1-3 in Tempe, Ariz.

There is still time to register. For more information, visit www.hospitalmedicine.org/qsea.

Quality improvement education is no longer just an elective for trainees, which is why medical educators need the best possible knowledge and tools for teaching quality and safety. SHM and the Alliance for Academic Internal Medicine (AAIM) have teamed up to present the Quality and Safety Educators Academy, to be held May 1-3 in Tempe, Ariz.

There is still time to register. For more information, visit www.hospitalmedicine.org/qsea.

Quality improvement education is no longer just an elective for trainees, which is why medical educators need the best possible knowledge and tools for teaching quality and safety. SHM and the Alliance for Academic Internal Medicine (AAIM) have teamed up to present the Quality and Safety Educators Academy, to be held May 1-3 in Tempe, Ariz.

There is still time to register. For more information, visit www.hospitalmedicine.org/qsea.

Lakshmi Halasyamani, MD, SFHM, is the new chief medical officer (CMO) for Cogent Healthcare, which is based in Brentwood, Tenn. A former SHM board member, Dr. Halasyamani comes to Cogent from her role as CMO at St. Joseph Mercy Health System in Ypsilanti, Mich. She has assumed the role left vacant by Ron Greeno, MD, MHM, after Cogent appointed him executive vice president of strategy and innovation.

 

Dalibor Hradek, MD, has been named the 2013 physician of the year by the Greenville, S.C.-based OB Hospitalist Group (OBHG). Dr. Hradek is an OB/GYN hospitalist at Lakeland Regional Medical Center in Lakeland, Fla. Dr. Hradek received praise for his clinical expertise and dedication to his patients. OBHG staffs more than 250 OB/GYN hospitalists in over 55 programs nationwide.

 

Abdul Ftesi, MD, has been named the new hospitalist medical director at the University of Oklahoma Medical Center (OUMC) in Oklahoma City, Okla., by the Dallas, Texas-based provider Questcare Hospitalists. In his new role, Dr. Ftesi will lead and coordinate a team of 12 hospitalists.

 

 

Alan Dulit, MD, is the new chief medical officer for St. Anthony Summit Medical Center in Frisco, Colo. Dr. Dulit comes to St. Anthony from his role as OB Hospitalist Group’s vice president of medical affairs at St. Mark’s Hospital in Salt Lake City.

Sujesh Pillai, MD, has been named the 2013 Physician of the Year by Huntsville (Texas) Memorial Hospital (HMH). Dr. Pillai currently serves as hospitalist medical director at HMH. Dr. Pillai is noted for his professionalism and his compassion for his patients and their families.

Christine Meagher, RN, is the first to receive the Hospitalist Nursing Service Award from the Physician Hospitalist group at Heywood Hospital in Gardner, Mass. Meagher serves as a nurse in the ICU at the 134-bed acute care facility.

John Larson, MD, has been named Family Physician of the Year for 2013 by the Wisconsin Academy of Family Physicians. Dr. Larson serves as regional assistant medical director for Mayo Clinic Health System and often plays the role of a hospitalist, among many others, as part of his job.

Charles Clair, MD, recently received a service and gratitude award from the Pocatello (Idaho) Free Clinic. Dr. Clair serves as a hospitalist at Portneuf Medical Center in Pocatello, Idaho, and regularly volunteers at the Free Clinic with his wife, who offers her time maintaining the clinic’s website. The Pocatello Free Clinic has been serving patients in the area since 1971.

Felix Cabrera, MD, is the new director of clinical informatics and medical education for Guam Regional Medical City (GRMC) in Dededo, Guam. Dr. Cabrera was previously a hospitalist and associate medical director at Guam Memorial Hospital. GRMC is a brand new, 130-bed acute care facility privately owned by Philippine healthcare firm The Medical City.

Scott Sears, MD, FACP, has been named the new chief clinical officer for the Tacoma, Wash.-based Sound Physicians. Dr. Sears assumes his new role after serving as Sound’s regional chief medical officer for the Northwest Region.

 

Talbot “Mac” McCormick, MD, has assumed the role of chief executive officer of the Dallas, Texas-based Eagle Hospital Physicians. Dr. McCormick previously served as Eagle’s president and chief operating officer and has been with Eagle in various roles since 2003.

 

 

 

 

Lakshmi Halasyamani, MD, SFHM, is the new chief medical officer (CMO) for Cogent Healthcare, which is based in Brentwood, Tenn. A former SHM board member, Dr. Halasyamani comes to Cogent from her role as CMO at St. Joseph Mercy Health System in Ypsilanti, Mich. She has assumed the role left vacant by Ron Greeno, MD, MHM, after Cogent appointed him executive vice president of strategy and innovation.

 

Dalibor Hradek, MD, has been named the 2013 physician of the year by the Greenville, S.C.-based OB Hospitalist Group (OBHG). Dr. Hradek is an OB/GYN hospitalist at Lakeland Regional Medical Center in Lakeland, Fla. Dr. Hradek received praise for his clinical expertise and dedication to his patients. OBHG staffs more than 250 OB/GYN hospitalists in over 55 programs nationwide.

 

Abdul Ftesi, MD, has been named the new hospitalist medical director at the University of Oklahoma Medical Center (OUMC) in Oklahoma City, Okla., by the Dallas, Texas-based provider Questcare Hospitalists. In his new role, Dr. Ftesi will lead and coordinate a team of 12 hospitalists.

 

 

Alan Dulit, MD, is the new chief medical officer for St. Anthony Summit Medical Center in Frisco, Colo. Dr. Dulit comes to St. Anthony from his role as OB Hospitalist Group’s vice president of medical affairs at St. Mark’s Hospital in Salt Lake City.

Sujesh Pillai, MD, has been named the 2013 Physician of the Year by Huntsville (Texas) Memorial Hospital (HMH). Dr. Pillai currently serves as hospitalist medical director at HMH. Dr. Pillai is noted for his professionalism and his compassion for his patients and their families.

Christine Meagher, RN, is the first to receive the Hospitalist Nursing Service Award from the Physician Hospitalist group at Heywood Hospital in Gardner, Mass. Meagher serves as a nurse in the ICU at the 134-bed acute care facility.

John Larson, MD, has been named Family Physician of the Year for 2013 by the Wisconsin Academy of Family Physicians. Dr. Larson serves as regional assistant medical director for Mayo Clinic Health System and often plays the role of a hospitalist, among many others, as part of his job.

Charles Clair, MD, recently received a service and gratitude award from the Pocatello (Idaho) Free Clinic. Dr. Clair serves as a hospitalist at Portneuf Medical Center in Pocatello, Idaho, and regularly volunteers at the Free Clinic with his wife, who offers her time maintaining the clinic’s website. The Pocatello Free Clinic has been serving patients in the area since 1971.

Felix Cabrera, MD, is the new director of clinical informatics and medical education for Guam Regional Medical City (GRMC) in Dededo, Guam. Dr. Cabrera was previously a hospitalist and associate medical director at Guam Memorial Hospital. GRMC is a brand new, 130-bed acute care facility privately owned by Philippine healthcare firm The Medical City.

Scott Sears, MD, FACP, has been named the new chief clinical officer for the Tacoma, Wash.-based Sound Physicians. Dr. Sears assumes his new role after serving as Sound’s regional chief medical officer for the Northwest Region.

 

Talbot “Mac” McCormick, MD, has assumed the role of chief executive officer of the Dallas, Texas-based Eagle Hospital Physicians. Dr. McCormick previously served as Eagle’s president and chief operating officer and has been with Eagle in various roles since 2003.

 

 

 

 

Lakshmi Halasyamani, MD, SFHM, is the new chief medical officer (CMO) for Cogent Healthcare, which is based in Brentwood, Tenn. A former SHM board member, Dr. Halasyamani comes to Cogent from her role as CMO at St. Joseph Mercy Health System in Ypsilanti, Mich. She has assumed the role left vacant by Ron Greeno, MD, MHM, after Cogent appointed him executive vice president of strategy and innovation.

 

Dalibor Hradek, MD, has been named the 2013 physician of the year by the Greenville, S.C.-based OB Hospitalist Group (OBHG). Dr. Hradek is an OB/GYN hospitalist at Lakeland Regional Medical Center in Lakeland, Fla. Dr. Hradek received praise for his clinical expertise and dedication to his patients. OBHG staffs more than 250 OB/GYN hospitalists in over 55 programs nationwide.

 

Abdul Ftesi, MD, has been named the new hospitalist medical director at the University of Oklahoma Medical Center (OUMC) in Oklahoma City, Okla., by the Dallas, Texas-based provider Questcare Hospitalists. In his new role, Dr. Ftesi will lead and coordinate a team of 12 hospitalists.

 

 

Alan Dulit, MD, is the new chief medical officer for St. Anthony Summit Medical Center in Frisco, Colo. Dr. Dulit comes to St. Anthony from his role as OB Hospitalist Group’s vice president of medical affairs at St. Mark’s Hospital in Salt Lake City.

Sujesh Pillai, MD, has been named the 2013 Physician of the Year by Huntsville (Texas) Memorial Hospital (HMH). Dr. Pillai currently serves as hospitalist medical director at HMH. Dr. Pillai is noted for his professionalism and his compassion for his patients and their families.

Christine Meagher, RN, is the first to receive the Hospitalist Nursing Service Award from the Physician Hospitalist group at Heywood Hospital in Gardner, Mass. Meagher serves as a nurse in the ICU at the 134-bed acute care facility.

John Larson, MD, has been named Family Physician of the Year for 2013 by the Wisconsin Academy of Family Physicians. Dr. Larson serves as regional assistant medical director for Mayo Clinic Health System and often plays the role of a hospitalist, among many others, as part of his job.

Charles Clair, MD, recently received a service and gratitude award from the Pocatello (Idaho) Free Clinic. Dr. Clair serves as a hospitalist at Portneuf Medical Center in Pocatello, Idaho, and regularly volunteers at the Free Clinic with his wife, who offers her time maintaining the clinic’s website. The Pocatello Free Clinic has been serving patients in the area since 1971.

Felix Cabrera, MD, is the new director of clinical informatics and medical education for Guam Regional Medical City (GRMC) in Dededo, Guam. Dr. Cabrera was previously a hospitalist and associate medical director at Guam Memorial Hospital. GRMC is a brand new, 130-bed acute care facility privately owned by Philippine healthcare firm The Medical City.

Scott Sears, MD, FACP, has been named the new chief clinical officer for the Tacoma, Wash.-based Sound Physicians. Dr. Sears assumes his new role after serving as Sound’s regional chief medical officer for the Northwest Region.

 

Talbot “Mac” McCormick, MD, has assumed the role of chief executive officer of the Dallas, Texas-based Eagle Hospital Physicians. Dr. McCormick previously served as Eagle’s president and chief operating officer and has been with Eagle in various roles since 2003.