Career

Finding the right hospitalist position can help make the transition from resident to attending enjoyable as you adjust to a new level of responsibility. But the wrong job can leave you feeling overwhelmed and unsupported. So what is a busy senior resident to do? Here we offer selected pearls and pitfalls to help you find a great position.

Initial Steps and Things to Consider

Start applying in the fall of your PGY-3 year. The process of interviewing applicants, finalizing contracts, arranging for hospital privileges, and enrolling a new hire in insurance plans can take many months. Many employers start looking early.

Meet with your residency program director and your hospitalist group director to discuss your plans. They can help you clarify your goals, serving as coaches throughout the process, and they may know people at the places you are interested in. Recruiters can be helpful, but remember—many are incentivized to find you a position. Advertisements in the back of journals and professional society publications are useful resources.

Obtain your medical license as early as possible. Getting licensed in the state you will be working in can be much faster if you already have a license from another state. Applicants have lost positions because they didn’t have their medical license in time.

Don’t shop for a job based on schedule and salary alone. There are reasons some jobs pay better than most, and they aren’t always good (home call, for example). A seven-on, seven-off schedule affords a lot of free time, but while you are on service, family life often takes a back seat. Conversely, working every Monday to Friday offers less free time for travel or moonlighting.

Think about the care model you prefer. Do you want to work with residents, physician assistants, nurse practitioners, or in a “direct care” model where it’s just you and the nurses caring for patients? Salaries often are inversely related to the number of providers between you and the patients. Positions without resident support might require procedural competence. Demonstrating academic productivity, especially in the area of quality improvement or patient safety, can help you secure a position working with residents. Some programs first place new hires on the non-teaching service to earn the chance to work with residents and medical students.

Think about what type of career you want. Do you only want to see patients, or do you want a career that includes a non-clinical role for which you will be paid? Some hospitalists find that becoming a patient safety officer or residency program director, trying out a medical student clerkship, or growing into another administrative role is a great complement to their clinical time and prevents burnout.

How to Stand Out

Start off by getting the basics right. Make sure your e-mail address sounds professional. A well-formatted CV, with no spelling errors or unexplained time gaps, is a must. A cover letter that succinctly describes the type of position you are looking for, highlights your strengths, and does not wax on about why you wanted to become a doctor—that was your personal statement for med school—is helpful. Don’t correspond with employers using your smartphone if you’re prone to autocorrect or spelling errors, or if you tend to write too casually from a mobile device. Before you shoot off that immediate e-mail response, make sure you’re addressing people properly and not mixing up employers.

Join SHM (they have trainee rates!), and attend an SHM conference or local chapter meeting if you can (www.hospitalmedicine.org/events). SHM membership reflects your commitment to the specialty. Membership in other professional societies is a plus as well.

 

Quality improvement (QI), patient safety, and patient satisfaction are central to hospital medicine. Medication reconciliation, infection control, handoff, transitions of care, listening carefully to patients, and explaining things to them are likely things you’ve done throughout residency. Communicate to employers your experience in and appreciation of these areas. Completing a QI or patient safety project and participating on a hospital committee will help make you a competitive applicant.

Interview Do’s and Don’ts

The advice most were given when applying to residency still holds. Be on time, dress professionally, research the program, and be prepared to speak about why you want to work at a particular place. Speak to hospitalists in the group, and be very courteous to everyone.

Don’t start off by asking about salary—if you move along in the process, compensation will be discussed. Get a clear picture of the schedule and how time off/non-clinical time occurs, but don’t come off as inflexible or too needy.

Ask why hospitalists have left a group. Frequent turnover without good reason could be a red flag. If the hospitalist director and/or department chair are new or will be leaving, you should ask how that might affect the group. If the current leadership has been stable, ask what growth has occurred for the group overall and among individuals during their tenure.

Find out whether hospitalists have been promoted academically and if there are career growth opportunities in areas you are interested in. Try to determine if the group has a “voice” with administration by asking for examples of how hospitalist concerns have been positively addressed.

Having a clear picture of how much nursing, social work, case management, subspecialist, and intensivist support is available is critical. Whether billing is done electronically or on paper is important, as is the degree of instruction and support for billing.

Take the opportunity to meet the current hospitalists—and note that their input often is solicited as to whether or not to hire a candidate—and ask them questions away from the ears of the program leadership; most hospitalists like to meet potential colleagues.

Closing the Deal

If you make it past the interview stage, be sure additional deliverables, such as letters of recommendation, are on time. Now is the time to ask about salary. Don’t be afraid to inquire about relocation or sign-on bonuses. At this point, the employer likes you and has invested time in recruiting you. You can gently leverage this in your negotiations. Consult your program director or other mentors at this point—they can provide guidance.

If you are uncertain about accepting an offer, be open about this with the employer. Your honesty in the process is essential, will be viewed positively, and can trigger additional dialogue that may help you decide. Juggling multiple offers dishonestly is not ethical and can backfire, as many hospitalist directors know each other.

Have an attorney familiar with physician contracts review yours. Look at whether “tail coverage,” which insures legal actions brought against you after you have left, is provided. Take note of “non-compete” clauses; they may limit your ability to practice in the area if you leave a practice. Find out if moonlighting is allowed and if the hospital requires you to give them a percentage of your outside earnings.

If you secure a position, whether as a career hospitalist or just for a year or two before fellowship, you should be excited. HM is a wonderful field with tremendous and varied opportunities. Dive in, enjoy, and explore everything it has to offer!

---

 

Dr. Bryson is medical director of teaching services, associate program director of internal medicine residency, and assistant professor at Tufts University, and a hospitalist at Baystate Medical Center in Springfield, Mass. Dr. Steinberg is residency program director in the Department of Medicine at Beth Israel Medical Center, and associate professor of medicine at the Icahn School of Medicine at Mount Sinai in New York City. Both are members of SHM’s Physicians in Training Committee.

Finding the right hospitalist position can help make the transition from resident to attending enjoyable as you adjust to a new level of responsibility. But the wrong job can leave you feeling overwhelmed and unsupported. So what is a busy senior resident to do? Here we offer selected pearls and pitfalls to help you find a great position.

Initial Steps and Things to Consider

Start applying in the fall of your PGY-3 year. The process of interviewing applicants, finalizing contracts, arranging for hospital privileges, and enrolling a new hire in insurance plans can take many months. Many employers start looking early.

Meet with your residency program director and your hospitalist group director to discuss your plans. They can help you clarify your goals, serving as coaches throughout the process, and they may know people at the places you are interested in. Recruiters can be helpful, but remember—many are incentivized to find you a position. Advertisements in the back of journals and professional society publications are useful resources.

Obtain your medical license as early as possible. Getting licensed in the state you will be working in can be much faster if you already have a license from another state. Applicants have lost positions because they didn’t have their medical license in time.

Don’t shop for a job based on schedule and salary alone. There are reasons some jobs pay better than most, and they aren’t always good (home call, for example). A seven-on, seven-off schedule affords a lot of free time, but while you are on service, family life often takes a back seat. Conversely, working every Monday to Friday offers less free time for travel or moonlighting.

Think about the care model you prefer. Do you want to work with residents, physician assistants, nurse practitioners, or in a “direct care” model where it’s just you and the nurses caring for patients? Salaries often are inversely related to the number of providers between you and the patients. Positions without resident support might require procedural competence. Demonstrating academic productivity, especially in the area of quality improvement or patient safety, can help you secure a position working with residents. Some programs first place new hires on the non-teaching service to earn the chance to work with residents and medical students.

Think about what type of career you want. Do you only want to see patients, or do you want a career that includes a non-clinical role for which you will be paid? Some hospitalists find that becoming a patient safety officer or residency program director, trying out a medical student clerkship, or growing into another administrative role is a great complement to their clinical time and prevents burnout.

How to Stand Out

Start off by getting the basics right. Make sure your e-mail address sounds professional. A well-formatted CV, with no spelling errors or unexplained time gaps, is a must. A cover letter that succinctly describes the type of position you are looking for, highlights your strengths, and does not wax on about why you wanted to become a doctor—that was your personal statement for med school—is helpful. Don’t correspond with employers using your smartphone if you’re prone to autocorrect or spelling errors, or if you tend to write too casually from a mobile device. Before you shoot off that immediate e-mail response, make sure you’re addressing people properly and not mixing up employers.

Join SHM (they have trainee rates!), and attend an SHM conference or local chapter meeting if you can (www.hospitalmedicine.org/events). SHM membership reflects your commitment to the specialty. Membership in other professional societies is a plus as well.

 

Quality improvement (QI), patient safety, and patient satisfaction are central to hospital medicine. Medication reconciliation, infection control, handoff, transitions of care, listening carefully to patients, and explaining things to them are likely things you’ve done throughout residency. Communicate to employers your experience in and appreciation of these areas. Completing a QI or patient safety project and participating on a hospital committee will help make you a competitive applicant.

Interview Do’s and Don’ts

The advice most were given when applying to residency still holds. Be on time, dress professionally, research the program, and be prepared to speak about why you want to work at a particular place. Speak to hospitalists in the group, and be very courteous to everyone.

Don’t start off by asking about salary—if you move along in the process, compensation will be discussed. Get a clear picture of the schedule and how time off/non-clinical time occurs, but don’t come off as inflexible or too needy.

Ask why hospitalists have left a group. Frequent turnover without good reason could be a red flag. If the hospitalist director and/or department chair are new or will be leaving, you should ask how that might affect the group. If the current leadership has been stable, ask what growth has occurred for the group overall and among individuals during their tenure.

Find out whether hospitalists have been promoted academically and if there are career growth opportunities in areas you are interested in. Try to determine if the group has a “voice” with administration by asking for examples of how hospitalist concerns have been positively addressed.

Having a clear picture of how much nursing, social work, case management, subspecialist, and intensivist support is available is critical. Whether billing is done electronically or on paper is important, as is the degree of instruction and support for billing.

Take the opportunity to meet the current hospitalists—and note that their input often is solicited as to whether or not to hire a candidate—and ask them questions away from the ears of the program leadership; most hospitalists like to meet potential colleagues.

Closing the Deal

If you make it past the interview stage, be sure additional deliverables, such as letters of recommendation, are on time. Now is the time to ask about salary. Don’t be afraid to inquire about relocation or sign-on bonuses. At this point, the employer likes you and has invested time in recruiting you. You can gently leverage this in your negotiations. Consult your program director or other mentors at this point—they can provide guidance.

If you are uncertain about accepting an offer, be open about this with the employer. Your honesty in the process is essential, will be viewed positively, and can trigger additional dialogue that may help you decide. Juggling multiple offers dishonestly is not ethical and can backfire, as many hospitalist directors know each other.

Have an attorney familiar with physician contracts review yours. Look at whether “tail coverage,” which insures legal actions brought against you after you have left, is provided. Take note of “non-compete” clauses; they may limit your ability to practice in the area if you leave a practice. Find out if moonlighting is allowed and if the hospital requires you to give them a percentage of your outside earnings.

If you secure a position, whether as a career hospitalist or just for a year or two before fellowship, you should be excited. HM is a wonderful field with tremendous and varied opportunities. Dive in, enjoy, and explore everything it has to offer!

---

 

Dr. Bryson is medical director of teaching services, associate program director of internal medicine residency, and assistant professor at Tufts University, and a hospitalist at Baystate Medical Center in Springfield, Mass. Dr. Steinberg is residency program director in the Department of Medicine at Beth Israel Medical Center, and associate professor of medicine at the Icahn School of Medicine at Mount Sinai in New York City. Both are members of SHM’s Physicians in Training Committee.

Finding the right hospitalist position can help make the transition from resident to attending enjoyable as you adjust to a new level of responsibility. But the wrong job can leave you feeling overwhelmed and unsupported. So what is a busy senior resident to do? Here we offer selected pearls and pitfalls to help you find a great position.

Initial Steps and Things to Consider

Start applying in the fall of your PGY-3 year. The process of interviewing applicants, finalizing contracts, arranging for hospital privileges, and enrolling a new hire in insurance plans can take many months. Many employers start looking early.

Meet with your residency program director and your hospitalist group director to discuss your plans. They can help you clarify your goals, serving as coaches throughout the process, and they may know people at the places you are interested in. Recruiters can be helpful, but remember—many are incentivized to find you a position. Advertisements in the back of journals and professional society publications are useful resources.

Obtain your medical license as early as possible. Getting licensed in the state you will be working in can be much faster if you already have a license from another state. Applicants have lost positions because they didn’t have their medical license in time.

Don’t shop for a job based on schedule and salary alone. There are reasons some jobs pay better than most, and they aren’t always good (home call, for example). A seven-on, seven-off schedule affords a lot of free time, but while you are on service, family life often takes a back seat. Conversely, working every Monday to Friday offers less free time for travel or moonlighting.

Think about the care model you prefer. Do you want to work with residents, physician assistants, nurse practitioners, or in a “direct care” model where it’s just you and the nurses caring for patients? Salaries often are inversely related to the number of providers between you and the patients. Positions without resident support might require procedural competence. Demonstrating academic productivity, especially in the area of quality improvement or patient safety, can help you secure a position working with residents. Some programs first place new hires on the non-teaching service to earn the chance to work with residents and medical students.

Think about what type of career you want. Do you only want to see patients, or do you want a career that includes a non-clinical role for which you will be paid? Some hospitalists find that becoming a patient safety officer or residency program director, trying out a medical student clerkship, or growing into another administrative role is a great complement to their clinical time and prevents burnout.

How to Stand Out

Start off by getting the basics right. Make sure your e-mail address sounds professional. A well-formatted CV, with no spelling errors or unexplained time gaps, is a must. A cover letter that succinctly describes the type of position you are looking for, highlights your strengths, and does not wax on about why you wanted to become a doctor—that was your personal statement for med school—is helpful. Don’t correspond with employers using your smartphone if you’re prone to autocorrect or spelling errors, or if you tend to write too casually from a mobile device. Before you shoot off that immediate e-mail response, make sure you’re addressing people properly and not mixing up employers.

Join SHM (they have trainee rates!), and attend an SHM conference or local chapter meeting if you can (www.hospitalmedicine.org/events). SHM membership reflects your commitment to the specialty. Membership in other professional societies is a plus as well.

 

Quality improvement (QI), patient safety, and patient satisfaction are central to hospital medicine. Medication reconciliation, infection control, handoff, transitions of care, listening carefully to patients, and explaining things to them are likely things you’ve done throughout residency. Communicate to employers your experience in and appreciation of these areas. Completing a QI or patient safety project and participating on a hospital committee will help make you a competitive applicant.

Interview Do’s and Don’ts

The advice most were given when applying to residency still holds. Be on time, dress professionally, research the program, and be prepared to speak about why you want to work at a particular place. Speak to hospitalists in the group, and be very courteous to everyone.

Don’t start off by asking about salary—if you move along in the process, compensation will be discussed. Get a clear picture of the schedule and how time off/non-clinical time occurs, but don’t come off as inflexible or too needy.

Ask why hospitalists have left a group. Frequent turnover without good reason could be a red flag. If the hospitalist director and/or department chair are new or will be leaving, you should ask how that might affect the group. If the current leadership has been stable, ask what growth has occurred for the group overall and among individuals during their tenure.

Find out whether hospitalists have been promoted academically and if there are career growth opportunities in areas you are interested in. Try to determine if the group has a “voice” with administration by asking for examples of how hospitalist concerns have been positively addressed.

Having a clear picture of how much nursing, social work, case management, subspecialist, and intensivist support is available is critical. Whether billing is done electronically or on paper is important, as is the degree of instruction and support for billing.

Take the opportunity to meet the current hospitalists—and note that their input often is solicited as to whether or not to hire a candidate—and ask them questions away from the ears of the program leadership; most hospitalists like to meet potential colleagues.

Closing the Deal

If you make it past the interview stage, be sure additional deliverables, such as letters of recommendation, are on time. Now is the time to ask about salary. Don’t be afraid to inquire about relocation or sign-on bonuses. At this point, the employer likes you and has invested time in recruiting you. You can gently leverage this in your negotiations. Consult your program director or other mentors at this point—they can provide guidance.

If you are uncertain about accepting an offer, be open about this with the employer. Your honesty in the process is essential, will be viewed positively, and can trigger additional dialogue that may help you decide. Juggling multiple offers dishonestly is not ethical and can backfire, as many hospitalist directors know each other.

Have an attorney familiar with physician contracts review yours. Look at whether “tail coverage,” which insures legal actions brought against you after you have left, is provided. Take note of “non-compete” clauses; they may limit your ability to practice in the area if you leave a practice. Find out if moonlighting is allowed and if the hospital requires you to give them a percentage of your outside earnings.

If you secure a position, whether as a career hospitalist or just for a year or two before fellowship, you should be excited. HM is a wonderful field with tremendous and varied opportunities. Dive in, enjoy, and explore everything it has to offer!

---

 

Dr. Bryson is medical director of teaching services, associate program director of internal medicine residency, and assistant professor at Tufts University, and a hospitalist at Baystate Medical Center in Springfield, Mass. Dr. Steinberg is residency program director in the Department of Medicine at Beth Israel Medical Center, and associate professor of medicine at the Icahn School of Medicine at Mount Sinai in New York City. Both are members of SHM’s Physicians in Training Committee.

Study Suggests Medical Trainees Need More Manners

Researchers at Johns Hopkins Hospital and the University of Maryland Medical Center, both in Baltimore, identified an overall lack of “common courtesy” shown by internal medicine trainees in their interactions with patients.³ Such behavior can lead to lower patient satisfaction and worse medical outcomes, note the authors of the study, which included hospitalist Leonard Feldman, MD, FACP, FAAP, SFHM, an assistant professor of medicine at Hopkins.

The study, published in the November issue of the Journal of Hospital Medicine, followed 29 interns on rounds for three weeks and looked for five key strategies of etiquette-based communication. Researchers found that while the interns asked open-ended questions 75% of the time, they explained their role to the patient only 37% of the time and sat down to talk eye to eye during an encounter only 9% of the time.

The interns performed all five recommended behaviors only 4% of the time.

“These are things that matter to patients and are relatively easy to do,” Dr. Feldman said in a prepared statement. “They’re not being done to the extent they should be.”

---

Larry Beresford is a freelance writer in Alameda, Calif.

References

1. Rizk D, Calabrese R, Page C, Bookbinder M, Flores S, Portenoy R. A unique hospitalist/pain management collaboration to improve pain outcomes [abstract]. Available at: http://www.shmabstracts.com/abstract.asp?MeetingID=793&id=104310. Accessed November 29, 2013.
2. American Society for Parenteral and Enteral Nutrition. A.S.P.E.N. supports major medical device changes for improved patient safety. Available at: http://www.nutritioncare.org/Press_Room/Press_Releases/A_S_P_E_N__Supports_Major_Medical_Device_Changes_for_Improved_Patient_Safety/. Accessed November 29, 2013.
3. Block LB, Hutzler L, Habicht R, Wu AW, et al. Do internal medicine interns practice etiquette-based communication? A critical look at the inpatient encounter. J Hosp Med. 2013;8(11):631-634.
4. Mirkinson LJ, Section on Hospital Medicine. Guiding principles for pediatric hospital medicine programs. Pediatrics. 2013;132(4):782-786.

Study Suggests Medical Trainees Need More Manners

Researchers at Johns Hopkins Hospital and the University of Maryland Medical Center, both in Baltimore, identified an overall lack of “common courtesy” shown by internal medicine trainees in their interactions with patients.³ Such behavior can lead to lower patient satisfaction and worse medical outcomes, note the authors of the study, which included hospitalist Leonard Feldman, MD, FACP, FAAP, SFHM, an assistant professor of medicine at Hopkins.

The study, published in the November issue of the Journal of Hospital Medicine, followed 29 interns on rounds for three weeks and looked for five key strategies of etiquette-based communication. Researchers found that while the interns asked open-ended questions 75% of the time, they explained their role to the patient only 37% of the time and sat down to talk eye to eye during an encounter only 9% of the time.

The interns performed all five recommended behaviors only 4% of the time.

“These are things that matter to patients and are relatively easy to do,” Dr. Feldman said in a prepared statement. “They’re not being done to the extent they should be.”

---

Larry Beresford is a freelance writer in Alameda, Calif.

References

1. Rizk D, Calabrese R, Page C, Bookbinder M, Flores S, Portenoy R. A unique hospitalist/pain management collaboration to improve pain outcomes [abstract]. Available at: http://www.shmabstracts.com/abstract.asp?MeetingID=793&id=104310. Accessed November 29, 2013.
2. American Society for Parenteral and Enteral Nutrition. A.S.P.E.N. supports major medical device changes for improved patient safety. Available at: http://www.nutritioncare.org/Press_Room/Press_Releases/A_S_P_E_N__Supports_Major_Medical_Device_Changes_for_Improved_Patient_Safety/. Accessed November 29, 2013.
3. Block LB, Hutzler L, Habicht R, Wu AW, et al. Do internal medicine interns practice etiquette-based communication? A critical look at the inpatient encounter. J Hosp Med. 2013;8(11):631-634.
4. Mirkinson LJ, Section on Hospital Medicine. Guiding principles for pediatric hospital medicine programs. Pediatrics. 2013;132(4):782-786.

Study Suggests Medical Trainees Need More Manners

Researchers at Johns Hopkins Hospital and the University of Maryland Medical Center, both in Baltimore, identified an overall lack of “common courtesy” shown by internal medicine trainees in their interactions with patients.³ Such behavior can lead to lower patient satisfaction and worse medical outcomes, note the authors of the study, which included hospitalist Leonard Feldman, MD, FACP, FAAP, SFHM, an assistant professor of medicine at Hopkins.

The study, published in the November issue of the Journal of Hospital Medicine, followed 29 interns on rounds for three weeks and looked for five key strategies of etiquette-based communication. Researchers found that while the interns asked open-ended questions 75% of the time, they explained their role to the patient only 37% of the time and sat down to talk eye to eye during an encounter only 9% of the time.

The interns performed all five recommended behaviors only 4% of the time.

“These are things that matter to patients and are relatively easy to do,” Dr. Feldman said in a prepared statement. “They’re not being done to the extent they should be.”

---

Larry Beresford is a freelance writer in Alameda, Calif.

References

1. Rizk D, Calabrese R, Page C, Bookbinder M, Flores S, Portenoy R. A unique hospitalist/pain management collaboration to improve pain outcomes [abstract]. Available at: http://www.shmabstracts.com/abstract.asp?MeetingID=793&id=104310. Accessed November 29, 2013.
2. American Society for Parenteral and Enteral Nutrition. A.S.P.E.N. supports major medical device changes for improved patient safety. Available at: http://www.nutritioncare.org/Press_Room/Press_Releases/A_S_P_E_N__Supports_Major_Medical_Device_Changes_for_Improved_Patient_Safety/. Accessed November 29, 2013.
3. Block LB, Hutzler L, Habicht R, Wu AW, et al. Do internal medicine interns practice etiquette-based communication? A critical look at the inpatient encounter. J Hosp Med. 2013;8(11):631-634.
4. Mirkinson LJ, Section on Hospital Medicine. Guiding principles for pediatric hospital medicine programs. Pediatrics. 2013;132(4):782-786.

A collaboration between hospitalists and the pain department at Beth Israel Medical Center in New York City is helping hospitalists address moderate to severe pain and complicating factors in their patients.

“The idea was to impart knowledge from a small group of experts to the hospitalists who manage pain in the majority of hospitalized patients,” says Dahlia Rizk, DO, chief of hospital medicine at Beth Israel and lead author on a poster that described the program and was presented at HM13 in Washington, D.C.¹

Dr. Rizk first approached Russell Portenoy, MD, internationally recognized chair of the Department of Pain Management and Palliative Care at Beth Israel, to draw upon his specialized knowledge. Grant funding supported protected time for two hospitalist champions and a nurse practitioner; they reviewed charts on participating units and conducted focus groups with hospitalists to identify barriers to effective pain management. Barriers were compiled into a 56-item menu and shaped the curriculum for weekly training sessions presented by the pain service.

Dr. Portenoy and the project team also established a metric for “high sustained pain,” patients reporting three or more days of three or more episodes of moderate to severe pain, according to the hospital’s standardized pain assessment scale. The information was captured in a computerized, tablet-based “Live View” tool that shows all of the patients on a unit and their incidences of high sustained pain over a week. The tool is used for rounding on patients and identifying those needing an immediate interdisciplinary focus.

Project results, Dr. Rizk reported, include improvements in high sustained pain scores on six of seven participating units and average reductions in the number of identified barriers to pain. Hospitalists reported increased comfort with adjusting pain therapies, while patient satisfaction scores with pain management also increased.

“Not everyone has access to an expert like Dr. Portenoy, but we’ve now done the root cause analysis and barriers list,” Dr. Rizk says. “I also think this approach could be applied more widely to other problem areas. We plan to try something similar with geriatrics.”

For more information about the collaborative and its pain problem list, contact Dr. Rizk at [email protected].

A collaboration between hospitalists and the pain department at Beth Israel Medical Center in New York City is helping hospitalists address moderate to severe pain and complicating factors in their patients.

“The idea was to impart knowledge from a small group of experts to the hospitalists who manage pain in the majority of hospitalized patients,” says Dahlia Rizk, DO, chief of hospital medicine at Beth Israel and lead author on a poster that described the program and was presented at HM13 in Washington, D.C.¹

Dr. Rizk first approached Russell Portenoy, MD, internationally recognized chair of the Department of Pain Management and Palliative Care at Beth Israel, to draw upon his specialized knowledge. Grant funding supported protected time for two hospitalist champions and a nurse practitioner; they reviewed charts on participating units and conducted focus groups with hospitalists to identify barriers to effective pain management. Barriers were compiled into a 56-item menu and shaped the curriculum for weekly training sessions presented by the pain service.

Dr. Portenoy and the project team also established a metric for “high sustained pain,” patients reporting three or more days of three or more episodes of moderate to severe pain, according to the hospital’s standardized pain assessment scale. The information was captured in a computerized, tablet-based “Live View” tool that shows all of the patients on a unit and their incidences of high sustained pain over a week. The tool is used for rounding on patients and identifying those needing an immediate interdisciplinary focus.

Project results, Dr. Rizk reported, include improvements in high sustained pain scores on six of seven participating units and average reductions in the number of identified barriers to pain. Hospitalists reported increased comfort with adjusting pain therapies, while patient satisfaction scores with pain management also increased.

“Not everyone has access to an expert like Dr. Portenoy, but we’ve now done the root cause analysis and barriers list,” Dr. Rizk says. “I also think this approach could be applied more widely to other problem areas. We plan to try something similar with geriatrics.”

For more information about the collaborative and its pain problem list, contact Dr. Rizk at [email protected].

A collaboration between hospitalists and the pain department at Beth Israel Medical Center in New York City is helping hospitalists address moderate to severe pain and complicating factors in their patients.

“The idea was to impart knowledge from a small group of experts to the hospitalists who manage pain in the majority of hospitalized patients,” says Dahlia Rizk, DO, chief of hospital medicine at Beth Israel and lead author on a poster that described the program and was presented at HM13 in Washington, D.C.¹

Dr. Rizk first approached Russell Portenoy, MD, internationally recognized chair of the Department of Pain Management and Palliative Care at Beth Israel, to draw upon his specialized knowledge. Grant funding supported protected time for two hospitalist champions and a nurse practitioner; they reviewed charts on participating units and conducted focus groups with hospitalists to identify barriers to effective pain management. Barriers were compiled into a 56-item menu and shaped the curriculum for weekly training sessions presented by the pain service.

Dr. Portenoy and the project team also established a metric for “high sustained pain,” patients reporting three or more days of three or more episodes of moderate to severe pain, according to the hospital’s standardized pain assessment scale. The information was captured in a computerized, tablet-based “Live View” tool that shows all of the patients on a unit and their incidences of high sustained pain over a week. The tool is used for rounding on patients and identifying those needing an immediate interdisciplinary focus.

Project results, Dr. Rizk reported, include improvements in high sustained pain scores on six of seven participating units and average reductions in the number of identified barriers to pain. Hospitalists reported increased comfort with adjusting pain therapies, while patient satisfaction scores with pain management also increased.

“Not everyone has access to an expert like Dr. Portenoy, but we’ve now done the root cause analysis and barriers list,” Dr. Rizk says. “I also think this approach could be applied more widely to other problem areas. We plan to try something similar with geriatrics.”

For more information about the collaborative and its pain problem list, contact Dr. Rizk at [email protected].

HM MOVERS AND SHAKERS

Sereen Sharp, MD, has been named director of the hospital medicine program at Fairview Range Medical Center (FRMC) in Hibbing, Minn. Dr. Sharp has been a practicing hospitalist at FRMC since the program launched in 2010.

James Matsuda, MD, PhD, has been hired as a pediatric hospitalist and director of pediatrics at Mercy Medical Center in Cedar Rapids, Iowa. Dr. Matsuda comes to Mercy from St. Luke’s Hospital in Cedar Rapids, where he served as director of the pediatric hospitalist program and pediatric intensive care unit.

 

 

Robert Maloney, MD, chief hospitalist at Sault Area Hospital (SAH) in Sault Ste. Marie, Ontario, Canada, was awarded the Canadian Society of Hospital Medicine’s 2013 clinical excellence award. Dr. Maloney was recognized for his excellent patient care, professionalism, and leadership. He is credited with helping to launch SAH’s hospitalist program, which has improved inpatient healthcare for the community since its 2004 introduction. Dr. Maloney is also an assistant professor of family medicine at the Northern Ontario School of Medicine.

 

Sanin Syed, MD, has been named medical director of the newly founded hospitalist program at Lawrence Hospital Center in Bronxville, N.Y. Dr. Syed previously served as a hospitalist at Mt. Sinai Hospital in New York City.

Business Moves

Tacoma, Wash.-based Sound Physicians has agreed to provide hospitalist services at Wyckoff Heights Medical Center in Brooklyn, N.Y., and Covenant Medical Center in Lubbock, Texas. Sound also has acquired hospitalist-related assets of Inpatient Care United, Inc., a private hospitalist staffing company in northeast Ohio, which already provides hospitalist services to Akron General Medical Center and Summa Akron City Hospital in Akron, Ohio.

Ob Hospitalist Group (OBHG), based in Mauldin, S.C., has been named one of the best places to work in South Carolina by the South Carolina Chamber of Commerce, the Best Companies Group, and the publishers of SCBIZ News. The private OB-GYN hospitalist staffing company was ranked 5th among South Carolina companies in the same size category. Additionally, OBHG was recognized as one of Inc.’s 500/5000 list of fastest-growing private companies, as well as one of South Carolina’s 25 fastest-growing companies. OBHG has been staffing private OB hospitalists at hospitals throughout the country since 2006.

North Hollywood, Calif.-based IPC The Hospitalist Company recently acquired the following hospitalist practices:

Greater Orlando Hospitalists (GOH), P.A., in Orlando, Fla.

The Hospitalist Group (THG) in Mission, Texas, consisting of three affiliated hospitalist practices: THG The Hospitalist Group, LP; The Hospitalist Management Group, LLC; and MD @ Home Ltd., all serving the greater Rio Grande Valley area of Southwest Texas.

Naples, Fla.-based Neapolitan Inpatient Care, LLC , and Venetian Hospitalist Services, LLC, headquartered in Venice, Fla.

Hospitalist-related assets of Metropolitan Pulmonary and Hospital Medicine, P.C., based in Kansas City, Mo.

IPC has signed definitive agreements to acquire Park Avenue Health Care Management, LLC; Park Avenue Medical Associates, P.C.; Park Avenue Medical Associates, LLC; and Geriatric Services, P.C., collectively known as Park Avenue and headquartered in White Plains, N.Y.

TeamHealth Hospital Medicine has acquired Marshall Physician Services, LLC, also known as MESA Medical Group, in Lexington, Ky. MESA already oversees hospitalist and emergency medicine services at 24 different hospitals throughout Indiana, Ohio, West Virginia, and Kentucky. TeamHealth now operates specialty hospital medicine programs in more than 850 acute and post-acute care centers throughout the U.S.

The Children’s Hospital of San Antonio and Baylor College of Medicine have collaborated to initiate a pediatric hospitalist program at the facility in San Antonio, Texas. The new program will staff 10 pediatric hospitalists and will be led by professor Ricardo Quiñonez, who comes to San Antonio from Texas Children’s Hospital in Houston, Texas.

 

Methodist Hospital in Henderson, Ky.,has partnered with the Dallas, Texas-based Eagle Hospital Physicians to provide hospitalist services at the privately owned facility. Eagle provides hospitalist and emergency medicine services to hospitals in 17 states.

HM MOVERS AND SHAKERS

Sereen Sharp, MD, has been named director of the hospital medicine program at Fairview Range Medical Center (FRMC) in Hibbing, Minn. Dr. Sharp has been a practicing hospitalist at FRMC since the program launched in 2010.

James Matsuda, MD, PhD, has been hired as a pediatric hospitalist and director of pediatrics at Mercy Medical Center in Cedar Rapids, Iowa. Dr. Matsuda comes to Mercy from St. Luke’s Hospital in Cedar Rapids, where he served as director of the pediatric hospitalist program and pediatric intensive care unit.

 

 

Robert Maloney, MD, chief hospitalist at Sault Area Hospital (SAH) in Sault Ste. Marie, Ontario, Canada, was awarded the Canadian Society of Hospital Medicine’s 2013 clinical excellence award. Dr. Maloney was recognized for his excellent patient care, professionalism, and leadership. He is credited with helping to launch SAH’s hospitalist program, which has improved inpatient healthcare for the community since its 2004 introduction. Dr. Maloney is also an assistant professor of family medicine at the Northern Ontario School of Medicine.

 

Sanin Syed, MD, has been named medical director of the newly founded hospitalist program at Lawrence Hospital Center in Bronxville, N.Y. Dr. Syed previously served as a hospitalist at Mt. Sinai Hospital in New York City.

Business Moves

Tacoma, Wash.-based Sound Physicians has agreed to provide hospitalist services at Wyckoff Heights Medical Center in Brooklyn, N.Y., and Covenant Medical Center in Lubbock, Texas. Sound also has acquired hospitalist-related assets of Inpatient Care United, Inc., a private hospitalist staffing company in northeast Ohio, which already provides hospitalist services to Akron General Medical Center and Summa Akron City Hospital in Akron, Ohio.

Ob Hospitalist Group (OBHG), based in Mauldin, S.C., has been named one of the best places to work in South Carolina by the South Carolina Chamber of Commerce, the Best Companies Group, and the publishers of SCBIZ News. The private OB-GYN hospitalist staffing company was ranked 5th among South Carolina companies in the same size category. Additionally, OBHG was recognized as one of Inc.’s 500/5000 list of fastest-growing private companies, as well as one of South Carolina’s 25 fastest-growing companies. OBHG has been staffing private OB hospitalists at hospitals throughout the country since 2006.

North Hollywood, Calif.-based IPC The Hospitalist Company recently acquired the following hospitalist practices:

Greater Orlando Hospitalists (GOH), P.A., in Orlando, Fla.

The Hospitalist Group (THG) in Mission, Texas, consisting of three affiliated hospitalist practices: THG The Hospitalist Group, LP; The Hospitalist Management Group, LLC; and MD @ Home Ltd., all serving the greater Rio Grande Valley area of Southwest Texas.

Naples, Fla.-based Neapolitan Inpatient Care, LLC , and Venetian Hospitalist Services, LLC, headquartered in Venice, Fla.

Hospitalist-related assets of Metropolitan Pulmonary and Hospital Medicine, P.C., based in Kansas City, Mo.

IPC has signed definitive agreements to acquire Park Avenue Health Care Management, LLC; Park Avenue Medical Associates, P.C.; Park Avenue Medical Associates, LLC; and Geriatric Services, P.C., collectively known as Park Avenue and headquartered in White Plains, N.Y.

TeamHealth Hospital Medicine has acquired Marshall Physician Services, LLC, also known as MESA Medical Group, in Lexington, Ky. MESA already oversees hospitalist and emergency medicine services at 24 different hospitals throughout Indiana, Ohio, West Virginia, and Kentucky. TeamHealth now operates specialty hospital medicine programs in more than 850 acute and post-acute care centers throughout the U.S.

The Children’s Hospital of San Antonio and Baylor College of Medicine have collaborated to initiate a pediatric hospitalist program at the facility in San Antonio, Texas. The new program will staff 10 pediatric hospitalists and will be led by professor Ricardo Quiñonez, who comes to San Antonio from Texas Children’s Hospital in Houston, Texas.

 

Methodist Hospital in Henderson, Ky.,has partnered with the Dallas, Texas-based Eagle Hospital Physicians to provide hospitalist services at the privately owned facility. Eagle provides hospitalist and emergency medicine services to hospitals in 17 states.

HM MOVERS AND SHAKERS

Sereen Sharp, MD, has been named director of the hospital medicine program at Fairview Range Medical Center (FRMC) in Hibbing, Minn. Dr. Sharp has been a practicing hospitalist at FRMC since the program launched in 2010.

James Matsuda, MD, PhD, has been hired as a pediatric hospitalist and director of pediatrics at Mercy Medical Center in Cedar Rapids, Iowa. Dr. Matsuda comes to Mercy from St. Luke’s Hospital in Cedar Rapids, where he served as director of the pediatric hospitalist program and pediatric intensive care unit.

 

 

Robert Maloney, MD, chief hospitalist at Sault Area Hospital (SAH) in Sault Ste. Marie, Ontario, Canada, was awarded the Canadian Society of Hospital Medicine’s 2013 clinical excellence award. Dr. Maloney was recognized for his excellent patient care, professionalism, and leadership. He is credited with helping to launch SAH’s hospitalist program, which has improved inpatient healthcare for the community since its 2004 introduction. Dr. Maloney is also an assistant professor of family medicine at the Northern Ontario School of Medicine.

 

Sanin Syed, MD, has been named medical director of the newly founded hospitalist program at Lawrence Hospital Center in Bronxville, N.Y. Dr. Syed previously served as a hospitalist at Mt. Sinai Hospital in New York City.

Business Moves

Tacoma, Wash.-based Sound Physicians has agreed to provide hospitalist services at Wyckoff Heights Medical Center in Brooklyn, N.Y., and Covenant Medical Center in Lubbock, Texas. Sound also has acquired hospitalist-related assets of Inpatient Care United, Inc., a private hospitalist staffing company in northeast Ohio, which already provides hospitalist services to Akron General Medical Center and Summa Akron City Hospital in Akron, Ohio.

Ob Hospitalist Group (OBHG), based in Mauldin, S.C., has been named one of the best places to work in South Carolina by the South Carolina Chamber of Commerce, the Best Companies Group, and the publishers of SCBIZ News. The private OB-GYN hospitalist staffing company was ranked 5th among South Carolina companies in the same size category. Additionally, OBHG was recognized as one of Inc.’s 500/5000 list of fastest-growing private companies, as well as one of South Carolina’s 25 fastest-growing companies. OBHG has been staffing private OB hospitalists at hospitals throughout the country since 2006.

North Hollywood, Calif.-based IPC The Hospitalist Company recently acquired the following hospitalist practices:

Greater Orlando Hospitalists (GOH), P.A., in Orlando, Fla.

The Hospitalist Group (THG) in Mission, Texas, consisting of three affiliated hospitalist practices: THG The Hospitalist Group, LP; The Hospitalist Management Group, LLC; and MD @ Home Ltd., all serving the greater Rio Grande Valley area of Southwest Texas.

Naples, Fla.-based Neapolitan Inpatient Care, LLC , and Venetian Hospitalist Services, LLC, headquartered in Venice, Fla.

Hospitalist-related assets of Metropolitan Pulmonary and Hospital Medicine, P.C., based in Kansas City, Mo.

IPC has signed definitive agreements to acquire Park Avenue Health Care Management, LLC; Park Avenue Medical Associates, P.C.; Park Avenue Medical Associates, LLC; and Geriatric Services, P.C., collectively known as Park Avenue and headquartered in White Plains, N.Y.

TeamHealth Hospital Medicine has acquired Marshall Physician Services, LLC, also known as MESA Medical Group, in Lexington, Ky. MESA already oversees hospitalist and emergency medicine services at 24 different hospitals throughout Indiana, Ohio, West Virginia, and Kentucky. TeamHealth now operates specialty hospital medicine programs in more than 850 acute and post-acute care centers throughout the U.S.

The Children’s Hospital of San Antonio and Baylor College of Medicine have collaborated to initiate a pediatric hospitalist program at the facility in San Antonio, Texas. The new program will staff 10 pediatric hospitalists and will be led by professor Ricardo Quiñonez, who comes to San Antonio from Texas Children’s Hospital in Houston, Texas.

 

Methodist Hospital in Henderson, Ky.,has partnered with the Dallas, Texas-based Eagle Hospital Physicians to provide hospitalist services at the privately owned facility. Eagle provides hospitalist and emergency medicine services to hospitals in 17 states.

Academic Hospitalists and Program Directors: There Is Still Time to Register for the Quality and Safety Educators Academy

Make sure your hospital is ready to meet the ACGME’s requirements that residency programs integrate quality and safety into their curriculum. The Quality and Safety Educators Academy (QSEA) is May 1-3 at the Tempe Mission Palms in Arizona.

For more info, visit www.hospitalmedicine.org/qsea.

Use SHM’s CODE-H Interactive to Avoid Coding Issues

Coding is a part of every hospitalist’s life, but tips from the experts can make that life easier, more efficient, and more compliant. That’s why SHM’s CODE-H program teaches hospitalists and hospitalist group managers and administrators how to stay up to date with the latest in the best practices of coding and documentation.

On March 20, coding expert Barbara Pierce, CCS-P, ACS-EM, will present an online session on some of the most important coding topics for hospitalists, including:

• Critical care;
• Prolonged services;
• Documentation when working with NPs and PAs;
• Teaching physician rules; and
• Tips to avoid billing issues and potential denials.

This session is the third in a series of seven that cover the full range of coding topics, from developing a compliance plan and internal auditing process to ICD-10, PQRS, and Medicare’s Physician Value-Based Payment Modifier.

CME credits are offered through post-tests following each webinar, and each participant is eligible for up to seven credits throughout the series. Up to 10 individuals in a group can sign up through a single registration.

For more information, visit www.hospitalmedicine.org/codeh.

BOOST Makes a Difference

Want to make a real difference in your hospital’s readmission rates? Now is the time to start compiling applications for SHM’s Project BOOST. Applications are due Aug. 30.

For more info, visit www.hospitalmedicine.org/boost.

Academic Hospitalists and Program Directors: There Is Still Time to Register for the Quality and Safety Educators Academy

Make sure your hospital is ready to meet the ACGME’s requirements that residency programs integrate quality and safety into their curriculum. The Quality and Safety Educators Academy (QSEA) is May 1-3 at the Tempe Mission Palms in Arizona.

For more info, visit www.hospitalmedicine.org/qsea.

Use SHM’s CODE-H Interactive to Avoid Coding Issues

Coding is a part of every hospitalist’s life, but tips from the experts can make that life easier, more efficient, and more compliant. That’s why SHM’s CODE-H program teaches hospitalists and hospitalist group managers and administrators how to stay up to date with the latest in the best practices of coding and documentation.

On March 20, coding expert Barbara Pierce, CCS-P, ACS-EM, will present an online session on some of the most important coding topics for hospitalists, including:

• Critical care;
• Prolonged services;
• Documentation when working with NPs and PAs;
• Teaching physician rules; and
• Tips to avoid billing issues and potential denials.

This session is the third in a series of seven that cover the full range of coding topics, from developing a compliance plan and internal auditing process to ICD-10, PQRS, and Medicare’s Physician Value-Based Payment Modifier.

CME credits are offered through post-tests following each webinar, and each participant is eligible for up to seven credits throughout the series. Up to 10 individuals in a group can sign up through a single registration.

For more information, visit www.hospitalmedicine.org/codeh.

BOOST Makes a Difference

Want to make a real difference in your hospital’s readmission rates? Now is the time to start compiling applications for SHM’s Project BOOST. Applications are due Aug. 30.

For more info, visit www.hospitalmedicine.org/boost.

Academic Hospitalists and Program Directors: There Is Still Time to Register for the Quality and Safety Educators Academy

Make sure your hospital is ready to meet the ACGME’s requirements that residency programs integrate quality and safety into their curriculum. The Quality and Safety Educators Academy (QSEA) is May 1-3 at the Tempe Mission Palms in Arizona.

For more info, visit www.hospitalmedicine.org/qsea.

Use SHM’s CODE-H Interactive to Avoid Coding Issues

Coding is a part of every hospitalist’s life, but tips from the experts can make that life easier, more efficient, and more compliant. That’s why SHM’s CODE-H program teaches hospitalists and hospitalist group managers and administrators how to stay up to date with the latest in the best practices of coding and documentation.

On March 20, coding expert Barbara Pierce, CCS-P, ACS-EM, will present an online session on some of the most important coding topics for hospitalists, including:

• Critical care;
• Prolonged services;
• Documentation when working with NPs and PAs;
• Teaching physician rules; and
• Tips to avoid billing issues and potential denials.

This session is the third in a series of seven that cover the full range of coding topics, from developing a compliance plan and internal auditing process to ICD-10, PQRS, and Medicare’s Physician Value-Based Payment Modifier.

CME credits are offered through post-tests following each webinar, and each participant is eligible for up to seven credits throughout the series. Up to 10 individuals in a group can sign up through a single registration.

For more information, visit www.hospitalmedicine.org/codeh.

BOOST Makes a Difference

Want to make a real difference in your hospital’s readmission rates? Now is the time to start compiling applications for SHM’s Project BOOST. Applications are due Aug. 30.

For more info, visit www.hospitalmedicine.org/boost.

Dr. Howell

If only there were a place where young hospitalists, mid-career hospitalists, and veteran hospitalists in a new position could go to proverbially pick the brains of those who came before them in an informal setting that practically begs for crowd-sourced learning.

Wait, there is.

Sure, the roughly 3,000 hospitalists who descend upon SHM’s annual meeting at Mandalay Bay Resort and Casino will be there for HM14’s slate of educational offerings, keynote addresses, and clinical updates. But for guys like Darren Swenson, MD, a regional medical advisor for IPC The Hospitalist Co. in Las Vegas, it’s also a chance to catch up with long-lost colleagues and med-school buddies while making new friends and gleaning tips from a who’s who of industry leaders.

“Whether you’re early in your career, or eight, 10, 12 years into your career, healthcare is changing so rapidly now, getting access to leadership skills is essential,” he says.

HM14 course director Daniel Brotman, MD, FACP, SFHM, says it’s impossible to overstate the value of networking at the annual meeting.

“Many of these folks I see once a year, and I look forward to seeing them,” says Dr. Brotman, who practices at John Hopkins Hospital in Baltimore, Md. “For me, as a director of a hospitalist program, to network with other people who direct programs and are trying to navigate very similar challenges is great, because it gives me ideas for how I might do something different, and I can return the favor.”

There’s the flipside, too, where commiseration helps soothe the soul. But mostly, conversations with other physicians who struggle the same issues that you see can be the meeting’s most important takeaway.

“There’s so much commonality in what we’re dealing with on a day-to-day basis to run a hospitalist program successfully,” Dr. Brotman adds. “Ultimately, good ideas are good ideas.

“There is so much innovation going on in this field that’s it’s almost impossible not to attend this meeting and come away with so many new ideas.”

In particular, Dr. Brotman sees great opportunities for early-career hospitalists to meet, greet, and build relationships.

“One of the things that marks our specialty is recognizing that the future of hospital medicine is the young hospitalists who are attending these meetings and getting fired up about it,” he adds.

SHM President Eric Howell, MD, SFHM, chief of hospital medicine at Johns Hopkins Bayview Medical Center in Baltimore, sees another, less heralded benefit to networking: pride.

“You can really brag about your program’s success and your individual successes,” he says. “That can’t be underestimated in terms of value.”

Dr. Howell encourages junior faculty to attend in order to meet and interact with as many people as possible, through the poster contests or impromptu post-meeting beverages. Such discussion, whether it involves bragging or the aforementioned commiserating, tends to invigorate and energize staffers, he says.

“It’s therapeutic to be able to discuss these things,” Dr. Howell adds. “Networking is also peer-to-peer mentoring. You can tell them things you can’t tell your boss or the people you oversee. It allows you a fairly open conversation with a peer on how to advance your program and your career.”

 

---

Richard Quinn is a freelance writer in New Jersey.

Dr. Howell

If only there were a place where young hospitalists, mid-career hospitalists, and veteran hospitalists in a new position could go to proverbially pick the brains of those who came before them in an informal setting that practically begs for crowd-sourced learning.

Wait, there is.

Sure, the roughly 3,000 hospitalists who descend upon SHM’s annual meeting at Mandalay Bay Resort and Casino will be there for HM14’s slate of educational offerings, keynote addresses, and clinical updates. But for guys like Darren Swenson, MD, a regional medical advisor for IPC The Hospitalist Co. in Las Vegas, it’s also a chance to catch up with long-lost colleagues and med-school buddies while making new friends and gleaning tips from a who’s who of industry leaders.

“Whether you’re early in your career, or eight, 10, 12 years into your career, healthcare is changing so rapidly now, getting access to leadership skills is essential,” he says.

HM14 course director Daniel Brotman, MD, FACP, SFHM, says it’s impossible to overstate the value of networking at the annual meeting.

“Many of these folks I see once a year, and I look forward to seeing them,” says Dr. Brotman, who practices at John Hopkins Hospital in Baltimore, Md. “For me, as a director of a hospitalist program, to network with other people who direct programs and are trying to navigate very similar challenges is great, because it gives me ideas for how I might do something different, and I can return the favor.”

There’s the flipside, too, where commiseration helps soothe the soul. But mostly, conversations with other physicians who struggle the same issues that you see can be the meeting’s most important takeaway.

“There’s so much commonality in what we’re dealing with on a day-to-day basis to run a hospitalist program successfully,” Dr. Brotman adds. “Ultimately, good ideas are good ideas.

“There is so much innovation going on in this field that’s it’s almost impossible not to attend this meeting and come away with so many new ideas.”

In particular, Dr. Brotman sees great opportunities for early-career hospitalists to meet, greet, and build relationships.

“One of the things that marks our specialty is recognizing that the future of hospital medicine is the young hospitalists who are attending these meetings and getting fired up about it,” he adds.

SHM President Eric Howell, MD, SFHM, chief of hospital medicine at Johns Hopkins Bayview Medical Center in Baltimore, sees another, less heralded benefit to networking: pride.

“You can really brag about your program’s success and your individual successes,” he says. “That can’t be underestimated in terms of value.”

Dr. Howell encourages junior faculty to attend in order to meet and interact with as many people as possible, through the poster contests or impromptu post-meeting beverages. Such discussion, whether it involves bragging or the aforementioned commiserating, tends to invigorate and energize staffers, he says.

“It’s therapeutic to be able to discuss these things,” Dr. Howell adds. “Networking is also peer-to-peer mentoring. You can tell them things you can’t tell your boss or the people you oversee. It allows you a fairly open conversation with a peer on how to advance your program and your career.”

 

---

Richard Quinn is a freelance writer in New Jersey.

Dr. Howell

If only there were a place where young hospitalists, mid-career hospitalists, and veteran hospitalists in a new position could go to proverbially pick the brains of those who came before them in an informal setting that practically begs for crowd-sourced learning.

Wait, there is.

Sure, the roughly 3,000 hospitalists who descend upon SHM’s annual meeting at Mandalay Bay Resort and Casino will be there for HM14’s slate of educational offerings, keynote addresses, and clinical updates. But for guys like Darren Swenson, MD, a regional medical advisor for IPC The Hospitalist Co. in Las Vegas, it’s also a chance to catch up with long-lost colleagues and med-school buddies while making new friends and gleaning tips from a who’s who of industry leaders.

“Whether you’re early in your career, or eight, 10, 12 years into your career, healthcare is changing so rapidly now, getting access to leadership skills is essential,” he says.

HM14 course director Daniel Brotman, MD, FACP, SFHM, says it’s impossible to overstate the value of networking at the annual meeting.

“Many of these folks I see once a year, and I look forward to seeing them,” says Dr. Brotman, who practices at John Hopkins Hospital in Baltimore, Md. “For me, as a director of a hospitalist program, to network with other people who direct programs and are trying to navigate very similar challenges is great, because it gives me ideas for how I might do something different, and I can return the favor.”

There’s the flipside, too, where commiseration helps soothe the soul. But mostly, conversations with other physicians who struggle the same issues that you see can be the meeting’s most important takeaway.

“There’s so much commonality in what we’re dealing with on a day-to-day basis to run a hospitalist program successfully,” Dr. Brotman adds. “Ultimately, good ideas are good ideas.

“There is so much innovation going on in this field that’s it’s almost impossible not to attend this meeting and come away with so many new ideas.”

In particular, Dr. Brotman sees great opportunities for early-career hospitalists to meet, greet, and build relationships.

“One of the things that marks our specialty is recognizing that the future of hospital medicine is the young hospitalists who are attending these meetings and getting fired up about it,” he adds.

SHM President Eric Howell, MD, SFHM, chief of hospital medicine at Johns Hopkins Bayview Medical Center in Baltimore, sees another, less heralded benefit to networking: pride.

“You can really brag about your program’s success and your individual successes,” he says. “That can’t be underestimated in terms of value.”

Dr. Howell encourages junior faculty to attend in order to meet and interact with as many people as possible, through the poster contests or impromptu post-meeting beverages. Such discussion, whether it involves bragging or the aforementioned commiserating, tends to invigorate and energize staffers, he says.

“It’s therapeutic to be able to discuss these things,” Dr. Howell adds. “Networking is also peer-to-peer mentoring. You can tell them things you can’t tell your boss or the people you oversee. It allows you a fairly open conversation with a peer on how to advance your program and your career.”

 

---

Richard Quinn is a freelance writer in New Jersey.

HM14 offers something for every hospitalist, from procedures training to special interest forums to practice management pearls. The four-day annual meeting, coming up March 24-27 at the Mandalay Bay in Las Vegas, caters to young, old, and every doctor in between.

So how will you get the most value out of the conference?

“The highest-yield content is going to depend on what your background is and how to spend that time in a way that augments your knowledge, your perspective, or your exposure to like-minded colleagues in a very individual way,” says HM14 course director Daniel Brotman, MD, FACP, SFHM, director of the hospitalist program at Johns Hopkins Hospital in Baltimore. “One of the things that’s so cool about hospital medicine is its diversity.”

But don’t take Dr. Brotman’s well-educated word for it. Here’s a list of recommendations from Team Hospitalist, the only reader-involvement group of its kind in HM, on events they would not miss this year.

Team Hospitalist contributors: Danielle Scheurer, MD, MSCR, SFHM, hospitalist, chief quality officer, Medical University of South Carolina; Edward Ma, MD, hospitalist, Coatesville (Pa.) VA Medical Center; Nick Fitterman, MD, FACP, SFHM, vice chair of hospital medicine, Hofstra North Shore-LIJ School of Medicine, Manhasset, N.Y.; James O’Callaghan, MD, FHM, clinical assistant professor of pediatrics, Seattle Children’s Hospital, University of Washington, and EvergreenHealth, Kirkland, Wash.; Klaus Suehler, MD, FHM, Mercy Hospital, Allina Health, Minneapolis, Minn.

1 “When Time is Brain (or Cord): Neurological Emergencies for the Hospitalist”

Tuesday, March 25

10:35-11:15 am

Dr. Suehler: As hospitalists, we often are the first ones to see patients with such neurological emergencies, and it is crucial to know when to get the neurologist or neurosurgeon involved. These are opportunities with a brief window of time to save or restore a patient’s neurological function.

2 “The ACA at 4: Impact on Costs, Quality, Lifestyle, and Payment”

Tuesday, March 25

10:35-11:50 am

Dr. Scheurer: This will be a packed session and will discuss all angles of the Affordable Care Act: how it will play out in hospitals around the country and, particularly, what it will mean to hospitalists. The complexity of the ACA is dizzying, so it will be time well spent to hear from several leaders in the field on how the major components of the ACA can and will impact us.

Dr. Ma: The ACA is nearly four years old, so I’m looking forward to a review on what precisely has been accomplished in medicine thus far and what can we anticipate down the road. The lawyers bantered about the constitutionality of the policy for the first two years. Politicians have been ranting about death panels, repeals, and amendments [for] the past four years. The public endured the latter part of 2013 reading about (or experiencing firsthand) the disastrous rollout of the healthcare.gov website. I want a clearer idea, beyond the fear and loathing, beyond the inane rhetoric, of the real impact that ACA has had and will have on the two most important components of healthcare: physicians and patients.

3 “Rate, Rhythm, Rivaroxaban, Ablation: Update in Atrial Fibrillation”

Tuesday, March 25

11:20 am-Noon

Dr. Suehler: This is a standard situation for hospitalists. We often admit patients with atrial fibrillation or get consulted when patients who are hospitalized for other reasons develop atrial fibrillation. It is very important for hospitalists to provide optimal care and counseling to patients with this arrhythmia, whether or not cardiologists get involved down the road.

4 “How ICD-10 Will Affect Hospitalists”

 

Tuesday, March 25

1:10-2:25 pm

Dr. Scheurer: Whether we like it or not, ICD-10 is right around the corner. This session will give an overview of what impact ICD-10 will have on our medical record documentation and coding, including how it can and will affect reimbursement. The more you know now, the better off you will be when your hospital implements it.

5 “Controversies in Perioperative Medicine”

Wednesday, March 26

11 am-Noon

Dr. Scheurer: We all know how much our surgeons depend on us to give them sound and evidence-based advice on how to manage surgical patients in the perioperative period. This session will review some controversial topics, from [the perspective of] two of the leaders in the field of perioperative medicine.

6 “Is It OK if I Sit Down?: Improving Patient Communication and Satisfaction at the Bedside”

Wednesday, March 26

11:45 am-12:25 pm

Dr. Fitterman: Any hospitalist or HM program leader struggling to raise patient satisfaction scores must attend this session. Recognizing that 30% of the value-based incentive pool for hospitals is directly linked to these scores, we all have “skin in the game.” Most hospitalists have part of their salary tied to patient satisfaction; however, many still lack the desired improvement in rankings despite multiple initiatives to address this issue. Four of the top five drivers of the patient experience are related to nursing, making our responsibility to impact this quite challenging. There is a correlation between the hospitals with the best satisfaction scores and lower patient mortality, so this is not just about the “chocolate on the pillow” but about filling gaps in care. I anticipate the discussion leaders will help us navigate this challenge with tips to bring back to our programs.

7 “Ending the Benevolent Dictatorship: Shared Decision-Making in the Hospital”

Wednesday, March 26

2:50-3:30 pm

Dr. Fitterman: This is a must attend for anyone interested in the “next blockbuster drug.” That is how patient activation and shared decision-making are being referred to (Health Affairs, February 2013). Where this has been implemented, patients have recognized better health outcomes, and there has been less decisional conflict (which likely equates to better satisfaction)—and all at lower costs. Sounds like a blockbuster drug, doesn’t it? The challenges I hope to see answered in this breakout session: First, most evidence wrapped around this topic is in the outpatient arena. Second, how do we overcome a lack of training in this field? Finally, how can we fit this into our busy workflows? Save me a seat.

8 “What Keeps Your CFO Awake at Night”

Wednesday, March 26

2:50-4:05 pm

Dr. Scheurer: The complexity of hospital finances can confuse even the brightest of hospitalists. This session will focus on the basics of what hospitalists should know and care about, as it relates to hospital finances. You won’t want to miss the concise opportunity to get informed.

9 “Different Generation/Different Concerns: Managing Boomers, Gen-Xers, and Gen Ys”

Thursday, March 27

8:45-9:40 am

Dr. Ma: This will likely be a contentious yet humorous session. The generational differences in attitude toward the practice of medicine can be very pronounced at times and certainly can lead to conflict in the workplace between the older and younger physicians. It’s important to recognize these differences without passing judgment and understand how they impact a practice.

10 “Effective, Efficient, and Prudent Syncope Evaluation”

Thursday, March 27

10:30-11:10 am

Dr. Suehler: Syncope is a frequent admission diagnosis for hospitalists. There is a wide spectrum of how hospitalists manage such patients (how long to monitor on telemetry, what additional tests to order). Hospitalists need to know how to provide a rational and cost-effective evaluation of patients with syncope and be able to identify patients who have a serious or life-threatening cause for their syncope.

 

11 “The Leadership Imperative: Building a Culture of Engagement and Ownership”

Thursday, March 27

10:55-11:50 am

Dr. O’Callaghan: Hospital practices, and the systems to which they belong, are complex organizations with their own culture. Producing long-term, sustainable change and improvement usually means changing this culture. Practices and their leaders need to develop hospitalists who think about improving the system of care, not just the patients in front of them. Successful practices are able to provide physicians with the freedom and responsibility to develop an ownership-mindset toward the practice. This lecture will help leaders develop the skills needed to support the development and maintenance of a culture of ownership.

12 “HFNC in Bronchiolitis: Best Thing Since Sliced Bread?”

Thursday, March 25

1:10-2:25 pm

Dr. O’Callaghan: Shawn Ralston, MD, is well known in pediatric hospital medicine for having both expertise and passion around the diagnosis of bronchiolitis. In the past year, she was lead author of a multi-site voluntary QI collaborative study that demonstrated that benchmarking decreased utilization of bronchodilators and chest physiotherapy in bronchiolitis (J Hosp Med. 2013;8:25-30). In addition, she was one of the authors of SHM’s Choosing Wisely Pediatric Hospital Medicine Recommendations (J Hosp Med. 2013;8(9):479-485). Dr. Ralston is a strong proponent of “doing more by doing less,” with regard to bronchiolitis, which is a self-limiting disease in pediatrics; however, along comes a potential new therapy—high flow nasal cannula therapy. I am very excited to see Dr. Ralston explore this new treatment. Will she have a debate with herself, and if so, which Ralston wins—doing-less Ralston or doing-more Ralston? I anticipate this session to be both highly informative and highly entertaining.

---

Richard Quinn is a freelance writer in New Jersey.

HM14 offers something for every hospitalist, from procedures training to special interest forums to practice management pearls. The four-day annual meeting, coming up March 24-27 at the Mandalay Bay in Las Vegas, caters to young, old, and every doctor in between.

So how will you get the most value out of the conference?

“The highest-yield content is going to depend on what your background is and how to spend that time in a way that augments your knowledge, your perspective, or your exposure to like-minded colleagues in a very individual way,” says HM14 course director Daniel Brotman, MD, FACP, SFHM, director of the hospitalist program at Johns Hopkins Hospital in Baltimore. “One of the things that’s so cool about hospital medicine is its diversity.”

But don’t take Dr. Brotman’s well-educated word for it. Here’s a list of recommendations from Team Hospitalist, the only reader-involvement group of its kind in HM, on events they would not miss this year.

Team Hospitalist contributors: Danielle Scheurer, MD, MSCR, SFHM, hospitalist, chief quality officer, Medical University of South Carolina; Edward Ma, MD, hospitalist, Coatesville (Pa.) VA Medical Center; Nick Fitterman, MD, FACP, SFHM, vice chair of hospital medicine, Hofstra North Shore-LIJ School of Medicine, Manhasset, N.Y.; James O’Callaghan, MD, FHM, clinical assistant professor of pediatrics, Seattle Children’s Hospital, University of Washington, and EvergreenHealth, Kirkland, Wash.; Klaus Suehler, MD, FHM, Mercy Hospital, Allina Health, Minneapolis, Minn.

1 “When Time is Brain (or Cord): Neurological Emergencies for the Hospitalist”

Tuesday, March 25

10:35-11:15 am

Dr. Suehler: As hospitalists, we often are the first ones to see patients with such neurological emergencies, and it is crucial to know when to get the neurologist or neurosurgeon involved. These are opportunities with a brief window of time to save or restore a patient’s neurological function.

2 “The ACA at 4: Impact on Costs, Quality, Lifestyle, and Payment”

Tuesday, March 25

10:35-11:50 am

Dr. Scheurer: This will be a packed session and will discuss all angles of the Affordable Care Act: how it will play out in hospitals around the country and, particularly, what it will mean to hospitalists. The complexity of the ACA is dizzying, so it will be time well spent to hear from several leaders in the field on how the major components of the ACA can and will impact us.

Dr. Ma: The ACA is nearly four years old, so I’m looking forward to a review on what precisely has been accomplished in medicine thus far and what can we anticipate down the road. The lawyers bantered about the constitutionality of the policy for the first two years. Politicians have been ranting about death panels, repeals, and amendments [for] the past four years. The public endured the latter part of 2013 reading about (or experiencing firsthand) the disastrous rollout of the healthcare.gov website. I want a clearer idea, beyond the fear and loathing, beyond the inane rhetoric, of the real impact that ACA has had and will have on the two most important components of healthcare: physicians and patients.

3 “Rate, Rhythm, Rivaroxaban, Ablation: Update in Atrial Fibrillation”

Tuesday, March 25

11:20 am-Noon

Dr. Suehler: This is a standard situation for hospitalists. We often admit patients with atrial fibrillation or get consulted when patients who are hospitalized for other reasons develop atrial fibrillation. It is very important for hospitalists to provide optimal care and counseling to patients with this arrhythmia, whether or not cardiologists get involved down the road.

4 “How ICD-10 Will Affect Hospitalists”

 

Tuesday, March 25

1:10-2:25 pm

Dr. Scheurer: Whether we like it or not, ICD-10 is right around the corner. This session will give an overview of what impact ICD-10 will have on our medical record documentation and coding, including how it can and will affect reimbursement. The more you know now, the better off you will be when your hospital implements it.

5 “Controversies in Perioperative Medicine”

Wednesday, March 26

11 am-Noon

Dr. Scheurer: We all know how much our surgeons depend on us to give them sound and evidence-based advice on how to manage surgical patients in the perioperative period. This session will review some controversial topics, from [the perspective of] two of the leaders in the field of perioperative medicine.

6 “Is It OK if I Sit Down?: Improving Patient Communication and Satisfaction at the Bedside”

Wednesday, March 26

11:45 am-12:25 pm

Dr. Fitterman: Any hospitalist or HM program leader struggling to raise patient satisfaction scores must attend this session. Recognizing that 30% of the value-based incentive pool for hospitals is directly linked to these scores, we all have “skin in the game.” Most hospitalists have part of their salary tied to patient satisfaction; however, many still lack the desired improvement in rankings despite multiple initiatives to address this issue. Four of the top five drivers of the patient experience are related to nursing, making our responsibility to impact this quite challenging. There is a correlation between the hospitals with the best satisfaction scores and lower patient mortality, so this is not just about the “chocolate on the pillow” but about filling gaps in care. I anticipate the discussion leaders will help us navigate this challenge with tips to bring back to our programs.

7 “Ending the Benevolent Dictatorship: Shared Decision-Making in the Hospital”

Wednesday, March 26

2:50-3:30 pm

Dr. Fitterman: This is a must attend for anyone interested in the “next blockbuster drug.” That is how patient activation and shared decision-making are being referred to (Health Affairs, February 2013). Where this has been implemented, patients have recognized better health outcomes, and there has been less decisional conflict (which likely equates to better satisfaction)—and all at lower costs. Sounds like a blockbuster drug, doesn’t it? The challenges I hope to see answered in this breakout session: First, most evidence wrapped around this topic is in the outpatient arena. Second, how do we overcome a lack of training in this field? Finally, how can we fit this into our busy workflows? Save me a seat.

8 “What Keeps Your CFO Awake at Night”

Wednesday, March 26

2:50-4:05 pm

Dr. Scheurer: The complexity of hospital finances can confuse even the brightest of hospitalists. This session will focus on the basics of what hospitalists should know and care about, as it relates to hospital finances. You won’t want to miss the concise opportunity to get informed.

9 “Different Generation/Different Concerns: Managing Boomers, Gen-Xers, and Gen Ys”

Thursday, March 27

8:45-9:40 am

Dr. Ma: This will likely be a contentious yet humorous session. The generational differences in attitude toward the practice of medicine can be very pronounced at times and certainly can lead to conflict in the workplace between the older and younger physicians. It’s important to recognize these differences without passing judgment and understand how they impact a practice.

10 “Effective, Efficient, and Prudent Syncope Evaluation”

Thursday, March 27

10:30-11:10 am

Dr. Suehler: Syncope is a frequent admission diagnosis for hospitalists. There is a wide spectrum of how hospitalists manage such patients (how long to monitor on telemetry, what additional tests to order). Hospitalists need to know how to provide a rational and cost-effective evaluation of patients with syncope and be able to identify patients who have a serious or life-threatening cause for their syncope.

 

11 “The Leadership Imperative: Building a Culture of Engagement and Ownership”

Thursday, March 27

10:55-11:50 am

Dr. O’Callaghan: Hospital practices, and the systems to which they belong, are complex organizations with their own culture. Producing long-term, sustainable change and improvement usually means changing this culture. Practices and their leaders need to develop hospitalists who think about improving the system of care, not just the patients in front of them. Successful practices are able to provide physicians with the freedom and responsibility to develop an ownership-mindset toward the practice. This lecture will help leaders develop the skills needed to support the development and maintenance of a culture of ownership.

12 “HFNC in Bronchiolitis: Best Thing Since Sliced Bread?”

Thursday, March 25

1:10-2:25 pm

Dr. O’Callaghan: Shawn Ralston, MD, is well known in pediatric hospital medicine for having both expertise and passion around the diagnosis of bronchiolitis. In the past year, she was lead author of a multi-site voluntary QI collaborative study that demonstrated that benchmarking decreased utilization of bronchodilators and chest physiotherapy in bronchiolitis (J Hosp Med. 2013;8:25-30). In addition, she was one of the authors of SHM’s Choosing Wisely Pediatric Hospital Medicine Recommendations (J Hosp Med. 2013;8(9):479-485). Dr. Ralston is a strong proponent of “doing more by doing less,” with regard to bronchiolitis, which is a self-limiting disease in pediatrics; however, along comes a potential new therapy—high flow nasal cannula therapy. I am very excited to see Dr. Ralston explore this new treatment. Will she have a debate with herself, and if so, which Ralston wins—doing-less Ralston or doing-more Ralston? I anticipate this session to be both highly informative and highly entertaining.

---

Richard Quinn is a freelance writer in New Jersey.

HM14 offers something for every hospitalist, from procedures training to special interest forums to practice management pearls. The four-day annual meeting, coming up March 24-27 at the Mandalay Bay in Las Vegas, caters to young, old, and every doctor in between.

So how will you get the most value out of the conference?

“The highest-yield content is going to depend on what your background is and how to spend that time in a way that augments your knowledge, your perspective, or your exposure to like-minded colleagues in a very individual way,” says HM14 course director Daniel Brotman, MD, FACP, SFHM, director of the hospitalist program at Johns Hopkins Hospital in Baltimore. “One of the things that’s so cool about hospital medicine is its diversity.”

But don’t take Dr. Brotman’s well-educated word for it. Here’s a list of recommendations from Team Hospitalist, the only reader-involvement group of its kind in HM, on events they would not miss this year.

Team Hospitalist contributors: Danielle Scheurer, MD, MSCR, SFHM, hospitalist, chief quality officer, Medical University of South Carolina; Edward Ma, MD, hospitalist, Coatesville (Pa.) VA Medical Center; Nick Fitterman, MD, FACP, SFHM, vice chair of hospital medicine, Hofstra North Shore-LIJ School of Medicine, Manhasset, N.Y.; James O’Callaghan, MD, FHM, clinical assistant professor of pediatrics, Seattle Children’s Hospital, University of Washington, and EvergreenHealth, Kirkland, Wash.; Klaus Suehler, MD, FHM, Mercy Hospital, Allina Health, Minneapolis, Minn.

1 “When Time is Brain (or Cord): Neurological Emergencies for the Hospitalist”

Tuesday, March 25

10:35-11:15 am

Dr. Suehler: As hospitalists, we often are the first ones to see patients with such neurological emergencies, and it is crucial to know when to get the neurologist or neurosurgeon involved. These are opportunities with a brief window of time to save or restore a patient’s neurological function.

2 “The ACA at 4: Impact on Costs, Quality, Lifestyle, and Payment”

Tuesday, March 25

10:35-11:50 am

Dr. Scheurer: This will be a packed session and will discuss all angles of the Affordable Care Act: how it will play out in hospitals around the country and, particularly, what it will mean to hospitalists. The complexity of the ACA is dizzying, so it will be time well spent to hear from several leaders in the field on how the major components of the ACA can and will impact us.

Dr. Ma: The ACA is nearly four years old, so I’m looking forward to a review on what precisely has been accomplished in medicine thus far and what can we anticipate down the road. The lawyers bantered about the constitutionality of the policy for the first two years. Politicians have been ranting about death panels, repeals, and amendments [for] the past four years. The public endured the latter part of 2013 reading about (or experiencing firsthand) the disastrous rollout of the healthcare.gov website. I want a clearer idea, beyond the fear and loathing, beyond the inane rhetoric, of the real impact that ACA has had and will have on the two most important components of healthcare: physicians and patients.

3 “Rate, Rhythm, Rivaroxaban, Ablation: Update in Atrial Fibrillation”

Tuesday, March 25

11:20 am-Noon

Dr. Suehler: This is a standard situation for hospitalists. We often admit patients with atrial fibrillation or get consulted when patients who are hospitalized for other reasons develop atrial fibrillation. It is very important for hospitalists to provide optimal care and counseling to patients with this arrhythmia, whether or not cardiologists get involved down the road.

4 “How ICD-10 Will Affect Hospitalists”

 

Tuesday, March 25

1:10-2:25 pm

Dr. Scheurer: Whether we like it or not, ICD-10 is right around the corner. This session will give an overview of what impact ICD-10 will have on our medical record documentation and coding, including how it can and will affect reimbursement. The more you know now, the better off you will be when your hospital implements it.

5 “Controversies in Perioperative Medicine”

Wednesday, March 26

11 am-Noon

Dr. Scheurer: We all know how much our surgeons depend on us to give them sound and evidence-based advice on how to manage surgical patients in the perioperative period. This session will review some controversial topics, from [the perspective of] two of the leaders in the field of perioperative medicine.

6 “Is It OK if I Sit Down?: Improving Patient Communication and Satisfaction at the Bedside”

Wednesday, March 26

11:45 am-12:25 pm

Dr. Fitterman: Any hospitalist or HM program leader struggling to raise patient satisfaction scores must attend this session. Recognizing that 30% of the value-based incentive pool for hospitals is directly linked to these scores, we all have “skin in the game.” Most hospitalists have part of their salary tied to patient satisfaction; however, many still lack the desired improvement in rankings despite multiple initiatives to address this issue. Four of the top five drivers of the patient experience are related to nursing, making our responsibility to impact this quite challenging. There is a correlation between the hospitals with the best satisfaction scores and lower patient mortality, so this is not just about the “chocolate on the pillow” but about filling gaps in care. I anticipate the discussion leaders will help us navigate this challenge with tips to bring back to our programs.

7 “Ending the Benevolent Dictatorship: Shared Decision-Making in the Hospital”

Wednesday, March 26

2:50-3:30 pm

Dr. Fitterman: This is a must attend for anyone interested in the “next blockbuster drug.” That is how patient activation and shared decision-making are being referred to (Health Affairs, February 2013). Where this has been implemented, patients have recognized better health outcomes, and there has been less decisional conflict (which likely equates to better satisfaction)—and all at lower costs. Sounds like a blockbuster drug, doesn’t it? The challenges I hope to see answered in this breakout session: First, most evidence wrapped around this topic is in the outpatient arena. Second, how do we overcome a lack of training in this field? Finally, how can we fit this into our busy workflows? Save me a seat.

8 “What Keeps Your CFO Awake at Night”

Wednesday, March 26

2:50-4:05 pm

Dr. Scheurer: The complexity of hospital finances can confuse even the brightest of hospitalists. This session will focus on the basics of what hospitalists should know and care about, as it relates to hospital finances. You won’t want to miss the concise opportunity to get informed.

9 “Different Generation/Different Concerns: Managing Boomers, Gen-Xers, and Gen Ys”

Thursday, March 27

8:45-9:40 am

Dr. Ma: This will likely be a contentious yet humorous session. The generational differences in attitude toward the practice of medicine can be very pronounced at times and certainly can lead to conflict in the workplace between the older and younger physicians. It’s important to recognize these differences without passing judgment and understand how they impact a practice.

10 “Effective, Efficient, and Prudent Syncope Evaluation”

Thursday, March 27

10:30-11:10 am

Dr. Suehler: Syncope is a frequent admission diagnosis for hospitalists. There is a wide spectrum of how hospitalists manage such patients (how long to monitor on telemetry, what additional tests to order). Hospitalists need to know how to provide a rational and cost-effective evaluation of patients with syncope and be able to identify patients who have a serious or life-threatening cause for their syncope.

 

11 “The Leadership Imperative: Building a Culture of Engagement and Ownership”

Thursday, March 27

10:55-11:50 am

Dr. O’Callaghan: Hospital practices, and the systems to which they belong, are complex organizations with their own culture. Producing long-term, sustainable change and improvement usually means changing this culture. Practices and their leaders need to develop hospitalists who think about improving the system of care, not just the patients in front of them. Successful practices are able to provide physicians with the freedom and responsibility to develop an ownership-mindset toward the practice. This lecture will help leaders develop the skills needed to support the development and maintenance of a culture of ownership.

12 “HFNC in Bronchiolitis: Best Thing Since Sliced Bread?”

Thursday, March 25

1:10-2:25 pm

Dr. O’Callaghan: Shawn Ralston, MD, is well known in pediatric hospital medicine for having both expertise and passion around the diagnosis of bronchiolitis. In the past year, she was lead author of a multi-site voluntary QI collaborative study that demonstrated that benchmarking decreased utilization of bronchodilators and chest physiotherapy in bronchiolitis (J Hosp Med. 2013;8:25-30). In addition, she was one of the authors of SHM’s Choosing Wisely Pediatric Hospital Medicine Recommendations (J Hosp Med. 2013;8(9):479-485). Dr. Ralston is a strong proponent of “doing more by doing less,” with regard to bronchiolitis, which is a self-limiting disease in pediatrics; however, along comes a potential new therapy—high flow nasal cannula therapy. I am very excited to see Dr. Ralston explore this new treatment. Will she have a debate with herself, and if so, which Ralston wins—doing-less Ralston or doing-more Ralston? I anticipate this session to be both highly informative and highly entertaining.

---

Richard Quinn is a freelance writer in New Jersey.

SHM’s annual meeting offers something new each year. For HM14, a timely new track dubbed “Bending the Cost Curve” will focus on hospitalists’ role in improving cost effectiveness for the healthcare system as a whole.

“The value equation has always been something that’s near and dear to us,” says HM14 course director Daniel Brotman, MD, SFHM. “What’s different now is that cost shifting to the outpatient setting is something that is now being recognized as a potential unintended consequence of rushing through hospitalizations. And as we’re moving into the accountable-care world, making sure that the cost shifting does not occur…is really important.

“That means that hospitalists need to own the care transition.”

The debut offerings don’t stop there. Three new pre-courses are on this year’s agenda: “Cardiology: What Hospitalists Need to Know as Front-Line Providers,” “Efficient High-Value Evidence-Based Medicine for the Practicing Hospitalist,” and “NP/PA Playbook for Hospital Medicine.”

“As a pre-course director, I think the educational aspect is what sets the tone for the whole meeting,” says Leslie Flores, MHA, a partner in Nelson Flores Hospital Medicine Consultants, a member of SHM’s Practice Analysis Committee, and co-director for the practice management pre-course, “Where the Rubber Meets the Road: Managing in the Era of Healthcare Reform. “People come looking to improve their clinical skills and their hospitalist groups.”

Pre-courses are critical to the meeting’s educational offerings. In that vein, HM14 is keeping pace with generational reform in care delivery and payment methodologies.

“The educational component—particularly the practice management track—is increasingly important in this era of rapid change,” Flores adds. “I don’t think any hospitalist anywhere in the country can afford to put his or her head in the sand and pretend it’s business as usual.”

To that end, another new feature at HM14 is a panel discussion titled, “Obamacare Is Here: What Does It Mean for You and Your Hospital?” The participants are a who’s who of the specialty’s thought leaders: Centers for Medicare & Medicaid Services chief medical officer Patrick Conway, MD, MSc, FAAP, SFHM; executive director and CEO of the Medical University of South Carolina and former SHM president Patrick Cawley, MD, MHM, FACP; veteran healthcare executive Patrick Courneya, MD; and American Enterprise Institute resident fellow Scott Gottlieb, MD.

“The SHM annual meeting is pretty much the only place a hospitalist can go to learn about these changes,” Flores says, “and how to cope with them from a hospitalist’s perspective.”

---

Richard Quinn is a freelance writer in New Jersey.

 

SHM’s annual meeting offers something new each year. For HM14, a timely new track dubbed “Bending the Cost Curve” will focus on hospitalists’ role in improving cost effectiveness for the healthcare system as a whole.

“The value equation has always been something that’s near and dear to us,” says HM14 course director Daniel Brotman, MD, SFHM. “What’s different now is that cost shifting to the outpatient setting is something that is now being recognized as a potential unintended consequence of rushing through hospitalizations. And as we’re moving into the accountable-care world, making sure that the cost shifting does not occur…is really important.

“That means that hospitalists need to own the care transition.”

The debut offerings don’t stop there. Three new pre-courses are on this year’s agenda: “Cardiology: What Hospitalists Need to Know as Front-Line Providers,” “Efficient High-Value Evidence-Based Medicine for the Practicing Hospitalist,” and “NP/PA Playbook for Hospital Medicine.”

“As a pre-course director, I think the educational aspect is what sets the tone for the whole meeting,” says Leslie Flores, MHA, a partner in Nelson Flores Hospital Medicine Consultants, a member of SHM’s Practice Analysis Committee, and co-director for the practice management pre-course, “Where the Rubber Meets the Road: Managing in the Era of Healthcare Reform. “People come looking to improve their clinical skills and their hospitalist groups.”

Pre-courses are critical to the meeting’s educational offerings. In that vein, HM14 is keeping pace with generational reform in care delivery and payment methodologies.

“The educational component—particularly the practice management track—is increasingly important in this era of rapid change,” Flores adds. “I don’t think any hospitalist anywhere in the country can afford to put his or her head in the sand and pretend it’s business as usual.”

To that end, another new feature at HM14 is a panel discussion titled, “Obamacare Is Here: What Does It Mean for You and Your Hospital?” The participants are a who’s who of the specialty’s thought leaders: Centers for Medicare & Medicaid Services chief medical officer Patrick Conway, MD, MSc, FAAP, SFHM; executive director and CEO of the Medical University of South Carolina and former SHM president Patrick Cawley, MD, MHM, FACP; veteran healthcare executive Patrick Courneya, MD; and American Enterprise Institute resident fellow Scott Gottlieb, MD.

“The SHM annual meeting is pretty much the only place a hospitalist can go to learn about these changes,” Flores says, “and how to cope with them from a hospitalist’s perspective.”

---

Richard Quinn is a freelance writer in New Jersey.

 

SHM’s annual meeting offers something new each year. For HM14, a timely new track dubbed “Bending the Cost Curve” will focus on hospitalists’ role in improving cost effectiveness for the healthcare system as a whole.

“The value equation has always been something that’s near and dear to us,” says HM14 course director Daniel Brotman, MD, SFHM. “What’s different now is that cost shifting to the outpatient setting is something that is now being recognized as a potential unintended consequence of rushing through hospitalizations. And as we’re moving into the accountable-care world, making sure that the cost shifting does not occur…is really important.

“That means that hospitalists need to own the care transition.”

The debut offerings don’t stop there. Three new pre-courses are on this year’s agenda: “Cardiology: What Hospitalists Need to Know as Front-Line Providers,” “Efficient High-Value Evidence-Based Medicine for the Practicing Hospitalist,” and “NP/PA Playbook for Hospital Medicine.”

“As a pre-course director, I think the educational aspect is what sets the tone for the whole meeting,” says Leslie Flores, MHA, a partner in Nelson Flores Hospital Medicine Consultants, a member of SHM’s Practice Analysis Committee, and co-director for the practice management pre-course, “Where the Rubber Meets the Road: Managing in the Era of Healthcare Reform. “People come looking to improve their clinical skills and their hospitalist groups.”

Pre-courses are critical to the meeting’s educational offerings. In that vein, HM14 is keeping pace with generational reform in care delivery and payment methodologies.

“The educational component—particularly the practice management track—is increasingly important in this era of rapid change,” Flores adds. “I don’t think any hospitalist anywhere in the country can afford to put his or her head in the sand and pretend it’s business as usual.”

To that end, another new feature at HM14 is a panel discussion titled, “Obamacare Is Here: What Does It Mean for You and Your Hospital?” The participants are a who’s who of the specialty’s thought leaders: Centers for Medicare & Medicaid Services chief medical officer Patrick Conway, MD, MSc, FAAP, SFHM; executive director and CEO of the Medical University of South Carolina and former SHM president Patrick Cawley, MD, MHM, FACP; veteran healthcare executive Patrick Courneya, MD; and American Enterprise Institute resident fellow Scott Gottlieb, MD.

“The SHM annual meeting is pretty much the only place a hospitalist can go to learn about these changes,” Flores says, “and how to cope with them from a hospitalist’s perspective.”

---

Richard Quinn is a freelance writer in New Jersey.

 

Hospitalists needn't worry much about federal data released this month that shows healthcare employment figures dropping for the first time in a decade. A recent report from the Bureau of Labor Statistics reflects the loss of 6,000 jobs in healthcare last December, and employment gains falling to 17,000 per month on average in 2013 compared with 27,000 per month in 2012.

"The overall decline in healthcare spending and employment will have a small effect on hospitalist growth," says Anupam Jena, MD, PhD, assistant professor of healthcare policy and medicine at Harvard Medical School, and an internist at Massachusetts General Hospital, both in Boston. "It certainly is true that the demand for hospital care has decreased over the last two decades and will continue to decrease as hospitals and providers become more incentivized to keep patients out of the hospital. But this effect is offset by the fact that hospitalists continue to account for larger and larger shares of all inpatient care in the U.S."

Dr. Jena says the fact that healthcare companies lost 6,000 positions last December—the first monthly loss since July 2003, according to CNN—isn't surprising, as it comes on the heels of a report from the Centers for Medicare and Medicaid Services that the rate of increases in healthcare spending has slowed over the past four years as well.

Dr. Jena says that, while healthcare reform under the Affordable Care Act may "trim the fat" by reducing the amount of lower-value health services and the number of providers that perform them, HM is still a budding field. As long as the specialty continues to demonstrate value via cost savings and reduced length of stay, that scenario isn’t likely to change, he adds.

"Although healthcare reforms will probably reduce hospitalizations, I expect the demand for hospitalists to continue to grow," Dr. Jena says. "There are still 30% of hospitalizations in the U.S. that are not covered by hospitalists, which means there is room to grow."

Visit our website for more information on healthcare economics.

 

Hospitalists needn't worry much about federal data released this month that shows healthcare employment figures dropping for the first time in a decade. A recent report from the Bureau of Labor Statistics reflects the loss of 6,000 jobs in healthcare last December, and employment gains falling to 17,000 per month on average in 2013 compared with 27,000 per month in 2012.

"The overall decline in healthcare spending and employment will have a small effect on hospitalist growth," says Anupam Jena, MD, PhD, assistant professor of healthcare policy and medicine at Harvard Medical School, and an internist at Massachusetts General Hospital, both in Boston. "It certainly is true that the demand for hospital care has decreased over the last two decades and will continue to decrease as hospitals and providers become more incentivized to keep patients out of the hospital. But this effect is offset by the fact that hospitalists continue to account for larger and larger shares of all inpatient care in the U.S."

Dr. Jena says the fact that healthcare companies lost 6,000 positions last December—the first monthly loss since July 2003, according to CNN—isn't surprising, as it comes on the heels of a report from the Centers for Medicare and Medicaid Services that the rate of increases in healthcare spending has slowed over the past four years as well.

Dr. Jena says that, while healthcare reform under the Affordable Care Act may "trim the fat" by reducing the amount of lower-value health services and the number of providers that perform them, HM is still a budding field. As long as the specialty continues to demonstrate value via cost savings and reduced length of stay, that scenario isn’t likely to change, he adds.

"Although healthcare reforms will probably reduce hospitalizations, I expect the demand for hospitalists to continue to grow," Dr. Jena says. "There are still 30% of hospitalizations in the U.S. that are not covered by hospitalists, which means there is room to grow."

Visit our website for more information on healthcare economics.

 

Hospitalists needn't worry much about federal data released this month that shows healthcare employment figures dropping for the first time in a decade. A recent report from the Bureau of Labor Statistics reflects the loss of 6,000 jobs in healthcare last December, and employment gains falling to 17,000 per month on average in 2013 compared with 27,000 per month in 2012.

"The overall decline in healthcare spending and employment will have a small effect on hospitalist growth," says Anupam Jena, MD, PhD, assistant professor of healthcare policy and medicine at Harvard Medical School, and an internist at Massachusetts General Hospital, both in Boston. "It certainly is true that the demand for hospital care has decreased over the last two decades and will continue to decrease as hospitals and providers become more incentivized to keep patients out of the hospital. But this effect is offset by the fact that hospitalists continue to account for larger and larger shares of all inpatient care in the U.S."

Dr. Jena says the fact that healthcare companies lost 6,000 positions last December—the first monthly loss since July 2003, according to CNN—isn't surprising, as it comes on the heels of a report from the Centers for Medicare and Medicaid Services that the rate of increases in healthcare spending has slowed over the past four years as well.

Dr. Jena says that, while healthcare reform under the Affordable Care Act may "trim the fat" by reducing the amount of lower-value health services and the number of providers that perform them, HM is still a budding field. As long as the specialty continues to demonstrate value via cost savings and reduced length of stay, that scenario isn’t likely to change, he adds.

"Although healthcare reforms will probably reduce hospitalizations, I expect the demand for hospitalists to continue to grow," Dr. Jena says. "There are still 30% of hospitalizations in the U.S. that are not covered by hospitalists, which means there is room to grow."

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Clinical question: In patients with peptic ulcer bleeding, are oral PPIs of equal benefit to intravenous PPIs?

Background: PPI therapy has been shown in several studies to reduce re-bleeding risk in patients when used adjunctively for peptic ulcer bleeding. In spite of this data, there is still uncertainty about the optimal dose and route of administration.

Study design: Meta-analysis of prospective, randomized control trials.

Setting: OVID database search in June 2012.

Synopsis: A literature search identified six prospective randomized control trials. Overall, 615 patients were included across the six trials. No significant difference in risk of re-bleeding was discovered between the two groups (8.6% oral vs. 9.3% IV, RR: 0.92, 95% CI: 0.56–1.5). Length of hospital stay was statistically significantly lower for oral PPIs (-0.74 day, 95% CI: -1.10 to -0.39 day).

Because these findings are based on a meta-analysis of studies with notable flaws—including lack of blinding—it is difficult to draw any definitive conclusions from this data. Hospitalists should use care before changing their practice patterns, given the risk of bias and need for further study.

Bottom line: Oral PPIs may reduce hospital length of stay without an increased risk of re-bleeding; however, further study with a well-powered, double-blind, randomized control trial is necessary.

Citation: Tsoi KK, Hirai HW, Sung JJ. Meta-analysis: Comparison of oral vs. intravenous proton pump inhibitors in patients with peptic ulcer bleeding. Aliment Pharmacol Ther. 2013;38(7):721-728.

Visit our website for more information on the use of proton pump inhibitors.

 

 

 

 

 

Clinical question: In patients with peptic ulcer bleeding, are oral PPIs of equal benefit to intravenous PPIs?

Background: PPI therapy has been shown in several studies to reduce re-bleeding risk in patients when used adjunctively for peptic ulcer bleeding. In spite of this data, there is still uncertainty about the optimal dose and route of administration.

Study design: Meta-analysis of prospective, randomized control trials.

Setting: OVID database search in June 2012.

Synopsis: A literature search identified six prospective randomized control trials. Overall, 615 patients were included across the six trials. No significant difference in risk of re-bleeding was discovered between the two groups (8.6% oral vs. 9.3% IV, RR: 0.92, 95% CI: 0.56–1.5). Length of hospital stay was statistically significantly lower for oral PPIs (-0.74 day, 95% CI: -1.10 to -0.39 day).

Because these findings are based on a meta-analysis of studies with notable flaws—including lack of blinding—it is difficult to draw any definitive conclusions from this data. Hospitalists should use care before changing their practice patterns, given the risk of bias and need for further study.

Bottom line: Oral PPIs may reduce hospital length of stay without an increased risk of re-bleeding; however, further study with a well-powered, double-blind, randomized control trial is necessary.

Citation: Tsoi KK, Hirai HW, Sung JJ. Meta-analysis: Comparison of oral vs. intravenous proton pump inhibitors in patients with peptic ulcer bleeding. Aliment Pharmacol Ther. 2013;38(7):721-728.

Visit our website for more information on the use of proton pump inhibitors.

 

 

 

 

 

Clinical question: In patients with peptic ulcer bleeding, are oral PPIs of equal benefit to intravenous PPIs?

Background: PPI therapy has been shown in several studies to reduce re-bleeding risk in patients when used adjunctively for peptic ulcer bleeding. In spite of this data, there is still uncertainty about the optimal dose and route of administration.

Study design: Meta-analysis of prospective, randomized control trials.

Setting: OVID database search in June 2012.

Synopsis: A literature search identified six prospective randomized control trials. Overall, 615 patients were included across the six trials. No significant difference in risk of re-bleeding was discovered between the two groups (8.6% oral vs. 9.3% IV, RR: 0.92, 95% CI: 0.56–1.5). Length of hospital stay was statistically significantly lower for oral PPIs (-0.74 day, 95% CI: -1.10 to -0.39 day).

Because these findings are based on a meta-analysis of studies with notable flaws—including lack of blinding—it is difficult to draw any definitive conclusions from this data. Hospitalists should use care before changing their practice patterns, given the risk of bias and need for further study.

Bottom line: Oral PPIs may reduce hospital length of stay without an increased risk of re-bleeding; however, further study with a well-powered, double-blind, randomized control trial is necessary.

Citation: Tsoi KK, Hirai HW, Sung JJ. Meta-analysis: Comparison of oral vs. intravenous proton pump inhibitors in patients with peptic ulcer bleeding. Aliment Pharmacol Ther. 2013;38(7):721-728.

Visit our website for more information on the use of proton pump inhibitors.