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Pediatric hospitalists convene virtually to discuss PHM designation
A recent teleconference brought together an ad hoc panel of pediatric hospitalists, with more than 100 diverse voices discussing whether there ought to be an additional professional recognition or designation for the subspecialty, apart from the new pediatric hospital medicine (PHM) board certification that was launched in 2019.
The heterogeneity of PHM was on display during the discussion, as participants included university-based pediatric hospitalists and those from community hospitals, physicians trained in combined medicine and pediatrics or in family medicine, doctors who completed a general pediatric residency before going straight into PHM, niche practitioners such as newborn hospitalists, trainees, and a small but growing number of graduates of PHM fellowship programs. There are 61 PHM fellowships, and these programs graduate approximately 70 new fellows per year.
Although a route to some kind of professional designation for PHM – separate from board certification – was the centerpiece of the conference call, there is no proposal actively under consideration for developing such a designation, said Weijen W. Chang, MD, FAAP, SFHM, chief of pediatric hospital medicine at Baystate Medical Center in Springfield, Mass., and associate professor of pediatrics at the University of Massachusetts–Baystate Campus.
Who might develop such a proposal? “The hope is that the three major professional societies involved in pediatric hospital medicine – the Society of Hospital Medicine, the American Academy of Pediatrics, and the Academic Pediatric Association – would jointly develop such a designation,” Dr. Chang said. However, it is not clear whether the three societies could agree on this. An online survey of 551 pediatric hospitalists, shared during the conference call, found that the majority would like to see some kind of alternate designation.
The reality of the boards
The pediatric subspecialty of PHM was recognized by the American Board of Medical Specialties in 2015 following a petition by a group of PHM leaders seeking a way to credential their unique skill set. The first PHM board certification exam was offered by the American Board of Pediatrics on Nov. 12, 2019, with 1,491 hospitalists sitting for the exam and 84% passing. An estimated 4,000 pediatric hospitalists currently work in the field.
Certification as a subspecialty typically requires completing a fellowship, but new subspecialties often offer a “practice pathway” allowing those who already have experience working in the field to sit for the exam. A PHM practice pathway, and a combined fellowship and experience option for those whose fellowship training was less than 2 years, was offered for last year’s exam and will be offered again in 2021 and 2023. After that, board certification will only be available to graduates of recognized fellowships.
But concerns began to emerge last summer in advance of ABM’s initial PHM board exam, when some applicants were told that they weren’t eligible to sit for it, said H. Barrett Fromme, MD, associate dean for faculty development in medical education and section chief for pediatric hospital medicine at the University of Chicago. She also chairs the section of hospital medicine for the AAP.
Concerns including unintended gender bias against women, such as those hospitalists whose training is interrupted for maternity leave, were raised in a petition to ABP. The board promptly responded that gender bias was not supported by the facts, although its response did not account for selection bias in the data. But the ABP removed its practice interruption criteria.1,2
There are various reasons why a pediatric hospitalist might not be able or willing to pursue a 2-year fellowship or otherwise qualify for certification, Dr. Fromme said, including time and cost. For some, the practice pathway’s requirements, including a minimum number of hours worked in pediatrics in the previous 4 years, may be impossible to meet. Pediatric hospitalists boarded in family medicine are not eligible.
For hospitalists who can’t achieve board certification, what might that mean in terms of their future salary, employment opportunities, reimbursement, other career goals? Might they find themselves unable to qualify for PHM jobs at some university-based medical centers? The answers are not yet known.
What might self-designation look like?
PHM is distinct from adult hospital medicine by virtue of its designation as a board-certified subspecialty. But it can look to the broader HM field for examples of designations that bestow a kind of professional recognition, Dr. Chang said. These include SHM’s merit-based Fellow in Hospital Medicine program and the American Board of Medical Specialties’ Focused Practice in Hospital Medicine, a pathway for board recertification in internal medicine and family medicine, he said.
But PHM self-designation is not necessarily a pathway to hospital privileges. “If we build it, will they come? If they come, will it mean anything to them? That’s the million-dollar question?” Dr. Chang said.
Hospitalists need to appreciate that this issue is important to all three PHM professional societies, SHM, AAP, and APA, Dr. Fromme said. “We are concerned about how to support all of our members – certified, noncertified, nonphysician. Alternate designation is one idea, but we need time to understand it. We need a lot more conversations and a lot of people thinking about it.”
Dr. Fromme is part of the Council on Pediatric Hospital Medicine, a small circle of leaders of PHM interest groups within the three professional associations. It meets quarterly and will be reviewing the results of the conference call.
“I personally think we don’t understand the scope of the problem or the needs of pediatric hospitalists who are not able to sit for boards or pursue a fellowship,” she said. “We have empathy and concern for our colleagues who can’t take the boards. We don’t want them to feel excluded, and that includes advanced practice nurses and residents. But does an alternative designation actually provide what people think it provides?”
There are other ways to demonstrate that professionals are engaged with and serious about developing their practice. If they are looking to better themselves at quality improvement, leadership, education, and other elements of PHM practice, the associations can endeavor to provide more educational opportunities, Dr. Fromme said. “But if it’s about how they look as a candidate for hire, relative to board-certified candidates, that’s a different beast, and we need to think about what can help them the most.”
References
1. American Board of Pediatrics, Response to the Pediatric Hospital Medicine Petition. 2019 Aug 20. https://www.abp.org/sites/abp/files/phm-petition-response.pdf.
2. Chang WW et al. J Hosp Med. 2019 Oct;14(10):589-90.
A recent teleconference brought together an ad hoc panel of pediatric hospitalists, with more than 100 diverse voices discussing whether there ought to be an additional professional recognition or designation for the subspecialty, apart from the new pediatric hospital medicine (PHM) board certification that was launched in 2019.
The heterogeneity of PHM was on display during the discussion, as participants included university-based pediatric hospitalists and those from community hospitals, physicians trained in combined medicine and pediatrics or in family medicine, doctors who completed a general pediatric residency before going straight into PHM, niche practitioners such as newborn hospitalists, trainees, and a small but growing number of graduates of PHM fellowship programs. There are 61 PHM fellowships, and these programs graduate approximately 70 new fellows per year.
Although a route to some kind of professional designation for PHM – separate from board certification – was the centerpiece of the conference call, there is no proposal actively under consideration for developing such a designation, said Weijen W. Chang, MD, FAAP, SFHM, chief of pediatric hospital medicine at Baystate Medical Center in Springfield, Mass., and associate professor of pediatrics at the University of Massachusetts–Baystate Campus.
Who might develop such a proposal? “The hope is that the three major professional societies involved in pediatric hospital medicine – the Society of Hospital Medicine, the American Academy of Pediatrics, and the Academic Pediatric Association – would jointly develop such a designation,” Dr. Chang said. However, it is not clear whether the three societies could agree on this. An online survey of 551 pediatric hospitalists, shared during the conference call, found that the majority would like to see some kind of alternate designation.
The reality of the boards
The pediatric subspecialty of PHM was recognized by the American Board of Medical Specialties in 2015 following a petition by a group of PHM leaders seeking a way to credential their unique skill set. The first PHM board certification exam was offered by the American Board of Pediatrics on Nov. 12, 2019, with 1,491 hospitalists sitting for the exam and 84% passing. An estimated 4,000 pediatric hospitalists currently work in the field.
Certification as a subspecialty typically requires completing a fellowship, but new subspecialties often offer a “practice pathway” allowing those who already have experience working in the field to sit for the exam. A PHM practice pathway, and a combined fellowship and experience option for those whose fellowship training was less than 2 years, was offered for last year’s exam and will be offered again in 2021 and 2023. After that, board certification will only be available to graduates of recognized fellowships.
But concerns began to emerge last summer in advance of ABM’s initial PHM board exam, when some applicants were told that they weren’t eligible to sit for it, said H. Barrett Fromme, MD, associate dean for faculty development in medical education and section chief for pediatric hospital medicine at the University of Chicago. She also chairs the section of hospital medicine for the AAP.
Concerns including unintended gender bias against women, such as those hospitalists whose training is interrupted for maternity leave, were raised in a petition to ABP. The board promptly responded that gender bias was not supported by the facts, although its response did not account for selection bias in the data. But the ABP removed its practice interruption criteria.1,2
There are various reasons why a pediatric hospitalist might not be able or willing to pursue a 2-year fellowship or otherwise qualify for certification, Dr. Fromme said, including time and cost. For some, the practice pathway’s requirements, including a minimum number of hours worked in pediatrics in the previous 4 years, may be impossible to meet. Pediatric hospitalists boarded in family medicine are not eligible.
For hospitalists who can’t achieve board certification, what might that mean in terms of their future salary, employment opportunities, reimbursement, other career goals? Might they find themselves unable to qualify for PHM jobs at some university-based medical centers? The answers are not yet known.
What might self-designation look like?
PHM is distinct from adult hospital medicine by virtue of its designation as a board-certified subspecialty. But it can look to the broader HM field for examples of designations that bestow a kind of professional recognition, Dr. Chang said. These include SHM’s merit-based Fellow in Hospital Medicine program and the American Board of Medical Specialties’ Focused Practice in Hospital Medicine, a pathway for board recertification in internal medicine and family medicine, he said.
But PHM self-designation is not necessarily a pathway to hospital privileges. “If we build it, will they come? If they come, will it mean anything to them? That’s the million-dollar question?” Dr. Chang said.
Hospitalists need to appreciate that this issue is important to all three PHM professional societies, SHM, AAP, and APA, Dr. Fromme said. “We are concerned about how to support all of our members – certified, noncertified, nonphysician. Alternate designation is one idea, but we need time to understand it. We need a lot more conversations and a lot of people thinking about it.”
Dr. Fromme is part of the Council on Pediatric Hospital Medicine, a small circle of leaders of PHM interest groups within the three professional associations. It meets quarterly and will be reviewing the results of the conference call.
“I personally think we don’t understand the scope of the problem or the needs of pediatric hospitalists who are not able to sit for boards or pursue a fellowship,” she said. “We have empathy and concern for our colleagues who can’t take the boards. We don’t want them to feel excluded, and that includes advanced practice nurses and residents. But does an alternative designation actually provide what people think it provides?”
There are other ways to demonstrate that professionals are engaged with and serious about developing their practice. If they are looking to better themselves at quality improvement, leadership, education, and other elements of PHM practice, the associations can endeavor to provide more educational opportunities, Dr. Fromme said. “But if it’s about how they look as a candidate for hire, relative to board-certified candidates, that’s a different beast, and we need to think about what can help them the most.”
References
1. American Board of Pediatrics, Response to the Pediatric Hospital Medicine Petition. 2019 Aug 20. https://www.abp.org/sites/abp/files/phm-petition-response.pdf.
2. Chang WW et al. J Hosp Med. 2019 Oct;14(10):589-90.
A recent teleconference brought together an ad hoc panel of pediatric hospitalists, with more than 100 diverse voices discussing whether there ought to be an additional professional recognition or designation for the subspecialty, apart from the new pediatric hospital medicine (PHM) board certification that was launched in 2019.
The heterogeneity of PHM was on display during the discussion, as participants included university-based pediatric hospitalists and those from community hospitals, physicians trained in combined medicine and pediatrics or in family medicine, doctors who completed a general pediatric residency before going straight into PHM, niche practitioners such as newborn hospitalists, trainees, and a small but growing number of graduates of PHM fellowship programs. There are 61 PHM fellowships, and these programs graduate approximately 70 new fellows per year.
Although a route to some kind of professional designation for PHM – separate from board certification – was the centerpiece of the conference call, there is no proposal actively under consideration for developing such a designation, said Weijen W. Chang, MD, FAAP, SFHM, chief of pediatric hospital medicine at Baystate Medical Center in Springfield, Mass., and associate professor of pediatrics at the University of Massachusetts–Baystate Campus.
Who might develop such a proposal? “The hope is that the three major professional societies involved in pediatric hospital medicine – the Society of Hospital Medicine, the American Academy of Pediatrics, and the Academic Pediatric Association – would jointly develop such a designation,” Dr. Chang said. However, it is not clear whether the three societies could agree on this. An online survey of 551 pediatric hospitalists, shared during the conference call, found that the majority would like to see some kind of alternate designation.
The reality of the boards
The pediatric subspecialty of PHM was recognized by the American Board of Medical Specialties in 2015 following a petition by a group of PHM leaders seeking a way to credential their unique skill set. The first PHM board certification exam was offered by the American Board of Pediatrics on Nov. 12, 2019, with 1,491 hospitalists sitting for the exam and 84% passing. An estimated 4,000 pediatric hospitalists currently work in the field.
Certification as a subspecialty typically requires completing a fellowship, but new subspecialties often offer a “practice pathway” allowing those who already have experience working in the field to sit for the exam. A PHM practice pathway, and a combined fellowship and experience option for those whose fellowship training was less than 2 years, was offered for last year’s exam and will be offered again in 2021 and 2023. After that, board certification will only be available to graduates of recognized fellowships.
But concerns began to emerge last summer in advance of ABM’s initial PHM board exam, when some applicants were told that they weren’t eligible to sit for it, said H. Barrett Fromme, MD, associate dean for faculty development in medical education and section chief for pediatric hospital medicine at the University of Chicago. She also chairs the section of hospital medicine for the AAP.
Concerns including unintended gender bias against women, such as those hospitalists whose training is interrupted for maternity leave, were raised in a petition to ABP. The board promptly responded that gender bias was not supported by the facts, although its response did not account for selection bias in the data. But the ABP removed its practice interruption criteria.1,2
There are various reasons why a pediatric hospitalist might not be able or willing to pursue a 2-year fellowship or otherwise qualify for certification, Dr. Fromme said, including time and cost. For some, the practice pathway’s requirements, including a minimum number of hours worked in pediatrics in the previous 4 years, may be impossible to meet. Pediatric hospitalists boarded in family medicine are not eligible.
For hospitalists who can’t achieve board certification, what might that mean in terms of their future salary, employment opportunities, reimbursement, other career goals? Might they find themselves unable to qualify for PHM jobs at some university-based medical centers? The answers are not yet known.
What might self-designation look like?
PHM is distinct from adult hospital medicine by virtue of its designation as a board-certified subspecialty. But it can look to the broader HM field for examples of designations that bestow a kind of professional recognition, Dr. Chang said. These include SHM’s merit-based Fellow in Hospital Medicine program and the American Board of Medical Specialties’ Focused Practice in Hospital Medicine, a pathway for board recertification in internal medicine and family medicine, he said.
But PHM self-designation is not necessarily a pathway to hospital privileges. “If we build it, will they come? If they come, will it mean anything to them? That’s the million-dollar question?” Dr. Chang said.
Hospitalists need to appreciate that this issue is important to all three PHM professional societies, SHM, AAP, and APA, Dr. Fromme said. “We are concerned about how to support all of our members – certified, noncertified, nonphysician. Alternate designation is one idea, but we need time to understand it. We need a lot more conversations and a lot of people thinking about it.”
Dr. Fromme is part of the Council on Pediatric Hospital Medicine, a small circle of leaders of PHM interest groups within the three professional associations. It meets quarterly and will be reviewing the results of the conference call.
“I personally think we don’t understand the scope of the problem or the needs of pediatric hospitalists who are not able to sit for boards or pursue a fellowship,” she said. “We have empathy and concern for our colleagues who can’t take the boards. We don’t want them to feel excluded, and that includes advanced practice nurses and residents. But does an alternative designation actually provide what people think it provides?”
There are other ways to demonstrate that professionals are engaged with and serious about developing their practice. If they are looking to better themselves at quality improvement, leadership, education, and other elements of PHM practice, the associations can endeavor to provide more educational opportunities, Dr. Fromme said. “But if it’s about how they look as a candidate for hire, relative to board-certified candidates, that’s a different beast, and we need to think about what can help them the most.”
References
1. American Board of Pediatrics, Response to the Pediatric Hospital Medicine Petition. 2019 Aug 20. https://www.abp.org/sites/abp/files/phm-petition-response.pdf.
2. Chang WW et al. J Hosp Med. 2019 Oct;14(10):589-90.
Combination nicotine replacement therapy better than single form
Background: NRT use after smoking cessation helps smokers transition to abstinence by reducing the intensity of craving and withdrawal symptoms. It is uncertain which forms of NRTs are more likely to result in long-term smoking cessation.
Study design: Meta-analysis.
Setting: Cochrane review of randomized trials.
Synopsis: In this Cochrane Review, the authors identified 63 randomized trials with 41,509 participants comparing one type of NRT with another.
Combination NRT (for example, the patch & a fast-acting form such as gum or lozenge) increases long-term quit rates versus single-form NRT (risk ratio, 1.25; 95% confidence interval, 1.15-1.36). Researchers compared 4 mg to 2 mg nicotine gum and found a benefit of the higher dose (RR, 1.43; 95% CI, 1.12-1.83), although possibly only among heavy users.
Bottom line: Prescribe combination patch and short-acting NRTs to smokers motivated to quit.
Citation: Lindson N et al. Different doses, durations, and modes of delivery of nicotine replacement therapy for smoking cessation. Cochrane Database Syst Rev. 2019 Apr 18;4:CD013308. doi: 10.1002/14651858.CD013308.
Dr. Miller is a hospitalist at the University of Colorado at Denver, Aurora.
Background: NRT use after smoking cessation helps smokers transition to abstinence by reducing the intensity of craving and withdrawal symptoms. It is uncertain which forms of NRTs are more likely to result in long-term smoking cessation.
Study design: Meta-analysis.
Setting: Cochrane review of randomized trials.
Synopsis: In this Cochrane Review, the authors identified 63 randomized trials with 41,509 participants comparing one type of NRT with another.
Combination NRT (for example, the patch & a fast-acting form such as gum or lozenge) increases long-term quit rates versus single-form NRT (risk ratio, 1.25; 95% confidence interval, 1.15-1.36). Researchers compared 4 mg to 2 mg nicotine gum and found a benefit of the higher dose (RR, 1.43; 95% CI, 1.12-1.83), although possibly only among heavy users.
Bottom line: Prescribe combination patch and short-acting NRTs to smokers motivated to quit.
Citation: Lindson N et al. Different doses, durations, and modes of delivery of nicotine replacement therapy for smoking cessation. Cochrane Database Syst Rev. 2019 Apr 18;4:CD013308. doi: 10.1002/14651858.CD013308.
Dr. Miller is a hospitalist at the University of Colorado at Denver, Aurora.
Background: NRT use after smoking cessation helps smokers transition to abstinence by reducing the intensity of craving and withdrawal symptoms. It is uncertain which forms of NRTs are more likely to result in long-term smoking cessation.
Study design: Meta-analysis.
Setting: Cochrane review of randomized trials.
Synopsis: In this Cochrane Review, the authors identified 63 randomized trials with 41,509 participants comparing one type of NRT with another.
Combination NRT (for example, the patch & a fast-acting form such as gum or lozenge) increases long-term quit rates versus single-form NRT (risk ratio, 1.25; 95% confidence interval, 1.15-1.36). Researchers compared 4 mg to 2 mg nicotine gum and found a benefit of the higher dose (RR, 1.43; 95% CI, 1.12-1.83), although possibly only among heavy users.
Bottom line: Prescribe combination patch and short-acting NRTs to smokers motivated to quit.
Citation: Lindson N et al. Different doses, durations, and modes of delivery of nicotine replacement therapy for smoking cessation. Cochrane Database Syst Rev. 2019 Apr 18;4:CD013308. doi: 10.1002/14651858.CD013308.
Dr. Miller is a hospitalist at the University of Colorado at Denver, Aurora.
Goals of care conferences for incapacitated ICU patients
Background: Previous studies suggest that clinicians and surrogates rarely discuss patient values in ICU family conferences about goals of care despite recommendations from international critical care societies.
Study design: Analysis of audiotaped goals of care conferences.
Setting: ICUs in six U.S. academic centers.
Synopsis: The authors analyzed 249 audiotaped family conferences concerning goals of care for severely critically ill, incapacitated patients with acute respiratory distress syndrome and found that information about patient values and preferences was discussed in only 68.4% of the conferences.
Moreover, there was no deliberation about how to apply patient values and preferences to clinical decisions in 55.7% of the conferences. Surrogates were more likely to bring up these elements of shared decision making than were physicians.
Bottom line: Care providers and surrogates of critically ill ICU patients often fail to discuss patient preferences, values, and how they apply to care decisions in goals of care conferences.
Citation: Scheunemann LP et al. Clinician-family communication about patients’ values and preferences in intensive care units. JAMA Intern Med. 2019;179(5):676-84.
Dr. Mastalerz is a hospitalist and medical director of 9A Accountable Care Unit at the Colorado Health Foundation.
Background: Previous studies suggest that clinicians and surrogates rarely discuss patient values in ICU family conferences about goals of care despite recommendations from international critical care societies.
Study design: Analysis of audiotaped goals of care conferences.
Setting: ICUs in six U.S. academic centers.
Synopsis: The authors analyzed 249 audiotaped family conferences concerning goals of care for severely critically ill, incapacitated patients with acute respiratory distress syndrome and found that information about patient values and preferences was discussed in only 68.4% of the conferences.
Moreover, there was no deliberation about how to apply patient values and preferences to clinical decisions in 55.7% of the conferences. Surrogates were more likely to bring up these elements of shared decision making than were physicians.
Bottom line: Care providers and surrogates of critically ill ICU patients often fail to discuss patient preferences, values, and how they apply to care decisions in goals of care conferences.
Citation: Scheunemann LP et al. Clinician-family communication about patients’ values and preferences in intensive care units. JAMA Intern Med. 2019;179(5):676-84.
Dr. Mastalerz is a hospitalist and medical director of 9A Accountable Care Unit at the Colorado Health Foundation.
Background: Previous studies suggest that clinicians and surrogates rarely discuss patient values in ICU family conferences about goals of care despite recommendations from international critical care societies.
Study design: Analysis of audiotaped goals of care conferences.
Setting: ICUs in six U.S. academic centers.
Synopsis: The authors analyzed 249 audiotaped family conferences concerning goals of care for severely critically ill, incapacitated patients with acute respiratory distress syndrome and found that information about patient values and preferences was discussed in only 68.4% of the conferences.
Moreover, there was no deliberation about how to apply patient values and preferences to clinical decisions in 55.7% of the conferences. Surrogates were more likely to bring up these elements of shared decision making than were physicians.
Bottom line: Care providers and surrogates of critically ill ICU patients often fail to discuss patient preferences, values, and how they apply to care decisions in goals of care conferences.
Citation: Scheunemann LP et al. Clinician-family communication about patients’ values and preferences in intensive care units. JAMA Intern Med. 2019;179(5):676-84.
Dr. Mastalerz is a hospitalist and medical director of 9A Accountable Care Unit at the Colorado Health Foundation.
Anticoagulation in cirrhosis: Best practices
Background: Alterations to the coagulation cascade put cirrhotic patients at higher risk for bleeding and thrombotic complications.
Study design: Expert review.
Setting: Literature review.
Synopsis: The authors provide 12 best practice recommendations, including use blood products sparingly in the absence of active bleeding out of concern for raising portal pressures; low-risk paracentesis, thoracentesis, and upper endoscopy do not require routine correction of thrombocytopenia or coagulopathy; for active bleeding or high-risk procedures, correct hematocrit to above 25%, platelets to more than 50,000, and fibrinogen to above 120 mg/dL; the risk of thrombosis, including venous thromboembolism and portal vein thrombosis, is high in these patients despite elevated INR values.
As such, pharmacologic VTE prophylaxis is often underutilized in patients admitted with cirrhosis; for patients requiring therapeutic anticoagulation, direct oral anticoagulants are safe in stable patients with mild cirrhosis, but should be avoided in Child-Pugh B and C patients.
Bottom line: Cirrhotic patients do not require routine correction of coagulopathy prior to low-risk procedures.
Citation: O’Leary JG et al. AGA Clinical Practice Update: Coagulation in cirrhosis. Gastroenterology. 2019. doi: 10.1053/j.gastro.2019.03.070.
Dr. Lublin is a hospitalist at the University of Colorado at Denver, Aurora.
Background: Alterations to the coagulation cascade put cirrhotic patients at higher risk for bleeding and thrombotic complications.
Study design: Expert review.
Setting: Literature review.
Synopsis: The authors provide 12 best practice recommendations, including use blood products sparingly in the absence of active bleeding out of concern for raising portal pressures; low-risk paracentesis, thoracentesis, and upper endoscopy do not require routine correction of thrombocytopenia or coagulopathy; for active bleeding or high-risk procedures, correct hematocrit to above 25%, platelets to more than 50,000, and fibrinogen to above 120 mg/dL; the risk of thrombosis, including venous thromboembolism and portal vein thrombosis, is high in these patients despite elevated INR values.
As such, pharmacologic VTE prophylaxis is often underutilized in patients admitted with cirrhosis; for patients requiring therapeutic anticoagulation, direct oral anticoagulants are safe in stable patients with mild cirrhosis, but should be avoided in Child-Pugh B and C patients.
Bottom line: Cirrhotic patients do not require routine correction of coagulopathy prior to low-risk procedures.
Citation: O’Leary JG et al. AGA Clinical Practice Update: Coagulation in cirrhosis. Gastroenterology. 2019. doi: 10.1053/j.gastro.2019.03.070.
Dr. Lublin is a hospitalist at the University of Colorado at Denver, Aurora.
Background: Alterations to the coagulation cascade put cirrhotic patients at higher risk for bleeding and thrombotic complications.
Study design: Expert review.
Setting: Literature review.
Synopsis: The authors provide 12 best practice recommendations, including use blood products sparingly in the absence of active bleeding out of concern for raising portal pressures; low-risk paracentesis, thoracentesis, and upper endoscopy do not require routine correction of thrombocytopenia or coagulopathy; for active bleeding or high-risk procedures, correct hematocrit to above 25%, platelets to more than 50,000, and fibrinogen to above 120 mg/dL; the risk of thrombosis, including venous thromboembolism and portal vein thrombosis, is high in these patients despite elevated INR values.
As such, pharmacologic VTE prophylaxis is often underutilized in patients admitted with cirrhosis; for patients requiring therapeutic anticoagulation, direct oral anticoagulants are safe in stable patients with mild cirrhosis, but should be avoided in Child-Pugh B and C patients.
Bottom line: Cirrhotic patients do not require routine correction of coagulopathy prior to low-risk procedures.
Citation: O’Leary JG et al. AGA Clinical Practice Update: Coagulation in cirrhosis. Gastroenterology. 2019. doi: 10.1053/j.gastro.2019.03.070.
Dr. Lublin is a hospitalist at the University of Colorado at Denver, Aurora.
Dr. Eric E. Howell assumes new role as CEO of SHM
The Society of Hospital Medicine officially welcomed Eric E. Howell, MD, MHM, as chief executive officer on July 1, 2020. Dr. Howell reports to the Society of Hospital Medicine board of directors and is tasked with ensuring that SHM continues to serve the evolving needs and interests of its members while overseeing the organization’s strategic direction.
“The SHM board of directors is excited to work with Dr. Howell to navigate the future of SHM and of the hospital medicine specialty,” said Danielle Scheurer, MD, MSCR, SFHM, SHM president and chair of the CEO Search Committee. “With his extensive knowledge of the health care landscape and of SHM, Dr. Howell embodies the society’s dedication to empowering hospitalists to be positive change agents in their institutions and in the health care system as a whole.”
Prior to his current role, Dr. Howell served as chief operating officer of SHM for 2 years; in that role, he led senior management’s planning and defined organizational goals to drive growth. As the senior physician adviser to SHM’s Center for Quality Improvement for 5 years, he consulted for the society’s arm that conducts quality improvement programs for hospitalist teams. In addition to being a past president of SHM’s board of directors, he is the course director for the SHM Leadership Academies.
“Now more than ever, SHM has an opportunity to superserve hospitalists and the patients they serve, and I couldn’t be more excited to lead the society into its next chapter,” Dr. Howell said. “Supported by a dedicated member base and innovative staff, I am confident that SHM will continue on its successful path forward and will provide its members with the products, services, and tools that hospitalists need to improve patient care and adapt to the constantly evolving environment.”
In addition to serving in various capacities at SHM, Dr. Howell has served as a professor of medicine in the department of medicine at Johns Hopkins University, Baltimore. He has held multiple titles within the Johns Hopkins medical institutions, including chief of the division of hospital medicine at Johns Hopkins Bayview, section chief of hospital medicine for Johns Hopkins Community Physicians, deputy director of hospital operations for the department of medicine at Johns Hopkins Bayview Medical Center, and chief medical officer of operations at Johns Hopkins Bayview. Dr. Howell joined the Johns Hopkins Bayview hospitalist program in 2000, began the Howard County (Md.) General Hospital hospitalist program in 2010, and oversaw nearly 200 physicians and clinical staff providing patient care in three hospitals. Along with his role as SHM CEO, he will remain a member of the adjunct faculty at Johns Hopkins University.
More recently, Dr. Howell served as chief medical officer for the Baltimore Convention Center Field Hospital, a fully functional, 250-bed hospital created to care for patients in the Baltimore metropolitan area who were suffering from complications from COVID-19.
Dr. Howell received his electrical engineering degree from the University of Maryland, College Park, which has proven instrumental in his mastery of managing and implementing change in the hospital. His research has focused on the relationship between the emergency department and medicine floors, improving communication, throughput and patient outcomes.
The nationwide search process that led to Dr. Howell’s appointment was led by a CEO Search Committee, which included members of the SHM board of directors and was assisted by the executive search firm Spencer Stuart.
Dr. Howell succeeds Laurence Wellikson, MD, MHM, who helped in founding the Society of Hospital Medicine, its first and only CEO since 2000 prior to Dr. Howell’s appointment.
The Society of Hospital Medicine officially welcomed Eric E. Howell, MD, MHM, as chief executive officer on July 1, 2020. Dr. Howell reports to the Society of Hospital Medicine board of directors and is tasked with ensuring that SHM continues to serve the evolving needs and interests of its members while overseeing the organization’s strategic direction.
“The SHM board of directors is excited to work with Dr. Howell to navigate the future of SHM and of the hospital medicine specialty,” said Danielle Scheurer, MD, MSCR, SFHM, SHM president and chair of the CEO Search Committee. “With his extensive knowledge of the health care landscape and of SHM, Dr. Howell embodies the society’s dedication to empowering hospitalists to be positive change agents in their institutions and in the health care system as a whole.”
Prior to his current role, Dr. Howell served as chief operating officer of SHM for 2 years; in that role, he led senior management’s planning and defined organizational goals to drive growth. As the senior physician adviser to SHM’s Center for Quality Improvement for 5 years, he consulted for the society’s arm that conducts quality improvement programs for hospitalist teams. In addition to being a past president of SHM’s board of directors, he is the course director for the SHM Leadership Academies.
“Now more than ever, SHM has an opportunity to superserve hospitalists and the patients they serve, and I couldn’t be more excited to lead the society into its next chapter,” Dr. Howell said. “Supported by a dedicated member base and innovative staff, I am confident that SHM will continue on its successful path forward and will provide its members with the products, services, and tools that hospitalists need to improve patient care and adapt to the constantly evolving environment.”
In addition to serving in various capacities at SHM, Dr. Howell has served as a professor of medicine in the department of medicine at Johns Hopkins University, Baltimore. He has held multiple titles within the Johns Hopkins medical institutions, including chief of the division of hospital medicine at Johns Hopkins Bayview, section chief of hospital medicine for Johns Hopkins Community Physicians, deputy director of hospital operations for the department of medicine at Johns Hopkins Bayview Medical Center, and chief medical officer of operations at Johns Hopkins Bayview. Dr. Howell joined the Johns Hopkins Bayview hospitalist program in 2000, began the Howard County (Md.) General Hospital hospitalist program in 2010, and oversaw nearly 200 physicians and clinical staff providing patient care in three hospitals. Along with his role as SHM CEO, he will remain a member of the adjunct faculty at Johns Hopkins University.
More recently, Dr. Howell served as chief medical officer for the Baltimore Convention Center Field Hospital, a fully functional, 250-bed hospital created to care for patients in the Baltimore metropolitan area who were suffering from complications from COVID-19.
Dr. Howell received his electrical engineering degree from the University of Maryland, College Park, which has proven instrumental in his mastery of managing and implementing change in the hospital. His research has focused on the relationship between the emergency department and medicine floors, improving communication, throughput and patient outcomes.
The nationwide search process that led to Dr. Howell’s appointment was led by a CEO Search Committee, which included members of the SHM board of directors and was assisted by the executive search firm Spencer Stuart.
Dr. Howell succeeds Laurence Wellikson, MD, MHM, who helped in founding the Society of Hospital Medicine, its first and only CEO since 2000 prior to Dr. Howell’s appointment.
The Society of Hospital Medicine officially welcomed Eric E. Howell, MD, MHM, as chief executive officer on July 1, 2020. Dr. Howell reports to the Society of Hospital Medicine board of directors and is tasked with ensuring that SHM continues to serve the evolving needs and interests of its members while overseeing the organization’s strategic direction.
“The SHM board of directors is excited to work with Dr. Howell to navigate the future of SHM and of the hospital medicine specialty,” said Danielle Scheurer, MD, MSCR, SFHM, SHM president and chair of the CEO Search Committee. “With his extensive knowledge of the health care landscape and of SHM, Dr. Howell embodies the society’s dedication to empowering hospitalists to be positive change agents in their institutions and in the health care system as a whole.”
Prior to his current role, Dr. Howell served as chief operating officer of SHM for 2 years; in that role, he led senior management’s planning and defined organizational goals to drive growth. As the senior physician adviser to SHM’s Center for Quality Improvement for 5 years, he consulted for the society’s arm that conducts quality improvement programs for hospitalist teams. In addition to being a past president of SHM’s board of directors, he is the course director for the SHM Leadership Academies.
“Now more than ever, SHM has an opportunity to superserve hospitalists and the patients they serve, and I couldn’t be more excited to lead the society into its next chapter,” Dr. Howell said. “Supported by a dedicated member base and innovative staff, I am confident that SHM will continue on its successful path forward and will provide its members with the products, services, and tools that hospitalists need to improve patient care and adapt to the constantly evolving environment.”
In addition to serving in various capacities at SHM, Dr. Howell has served as a professor of medicine in the department of medicine at Johns Hopkins University, Baltimore. He has held multiple titles within the Johns Hopkins medical institutions, including chief of the division of hospital medicine at Johns Hopkins Bayview, section chief of hospital medicine for Johns Hopkins Community Physicians, deputy director of hospital operations for the department of medicine at Johns Hopkins Bayview Medical Center, and chief medical officer of operations at Johns Hopkins Bayview. Dr. Howell joined the Johns Hopkins Bayview hospitalist program in 2000, began the Howard County (Md.) General Hospital hospitalist program in 2010, and oversaw nearly 200 physicians and clinical staff providing patient care in three hospitals. Along with his role as SHM CEO, he will remain a member of the adjunct faculty at Johns Hopkins University.
More recently, Dr. Howell served as chief medical officer for the Baltimore Convention Center Field Hospital, a fully functional, 250-bed hospital created to care for patients in the Baltimore metropolitan area who were suffering from complications from COVID-19.
Dr. Howell received his electrical engineering degree from the University of Maryland, College Park, which has proven instrumental in his mastery of managing and implementing change in the hospital. His research has focused on the relationship between the emergency department and medicine floors, improving communication, throughput and patient outcomes.
The nationwide search process that led to Dr. Howell’s appointment was led by a CEO Search Committee, which included members of the SHM board of directors and was assisted by the executive search firm Spencer Stuart.
Dr. Howell succeeds Laurence Wellikson, MD, MHM, who helped in founding the Society of Hospital Medicine, its first and only CEO since 2000 prior to Dr. Howell’s appointment.
One-year mortality after dialysis initiation nearly double prior estimates
Background: The United States Renal Data System registry estimates that approximately 30% of patients die within 1 year of initiating hemodialysis.
Study design: Retrospective, observational analysis.
Setting: The Health and Retirement Study is a nationally representative survey of Medicare beneficiaries during 1998-2014. Medicare claims were linked to mortality data from the National Death Index.
Synopsis: Among 391 patients who initiated dialysis, 22.5%, 44.2%, and 54.5% died within 30 days, 6 months, and 1 year, respectively. After multivariate adjustment, 1-year mortality was higher among those who initiated dialysis while inpatients (hazard ratio, 2.17; 62.2%), had any activity of daily living dependence prior to dialysis (HR, 1.88; 73.0%), or had more than four comorbidities (HR, 1.5; 59.9%).
Bottom line: Medicare beneficiaries may have significantly higher mortality after initiating dialysis than prior data suggest.
Citation: Wachterman MW et al. One-year mortality after dialysis initiation among older adults. JAMA Intern Med. 2019 Apr 22. doi: 10.1001/jamainternmed.2019.0125.
Dr. Lublin is a hospitalist at the University of Colorado at Denver, Aurora.
Background: The United States Renal Data System registry estimates that approximately 30% of patients die within 1 year of initiating hemodialysis.
Study design: Retrospective, observational analysis.
Setting: The Health and Retirement Study is a nationally representative survey of Medicare beneficiaries during 1998-2014. Medicare claims were linked to mortality data from the National Death Index.
Synopsis: Among 391 patients who initiated dialysis, 22.5%, 44.2%, and 54.5% died within 30 days, 6 months, and 1 year, respectively. After multivariate adjustment, 1-year mortality was higher among those who initiated dialysis while inpatients (hazard ratio, 2.17; 62.2%), had any activity of daily living dependence prior to dialysis (HR, 1.88; 73.0%), or had more than four comorbidities (HR, 1.5; 59.9%).
Bottom line: Medicare beneficiaries may have significantly higher mortality after initiating dialysis than prior data suggest.
Citation: Wachterman MW et al. One-year mortality after dialysis initiation among older adults. JAMA Intern Med. 2019 Apr 22. doi: 10.1001/jamainternmed.2019.0125.
Dr. Lublin is a hospitalist at the University of Colorado at Denver, Aurora.
Background: The United States Renal Data System registry estimates that approximately 30% of patients die within 1 year of initiating hemodialysis.
Study design: Retrospective, observational analysis.
Setting: The Health and Retirement Study is a nationally representative survey of Medicare beneficiaries during 1998-2014. Medicare claims were linked to mortality data from the National Death Index.
Synopsis: Among 391 patients who initiated dialysis, 22.5%, 44.2%, and 54.5% died within 30 days, 6 months, and 1 year, respectively. After multivariate adjustment, 1-year mortality was higher among those who initiated dialysis while inpatients (hazard ratio, 2.17; 62.2%), had any activity of daily living dependence prior to dialysis (HR, 1.88; 73.0%), or had more than four comorbidities (HR, 1.5; 59.9%).
Bottom line: Medicare beneficiaries may have significantly higher mortality after initiating dialysis than prior data suggest.
Citation: Wachterman MW et al. One-year mortality after dialysis initiation among older adults. JAMA Intern Med. 2019 Apr 22. doi: 10.1001/jamainternmed.2019.0125.
Dr. Lublin is a hospitalist at the University of Colorado at Denver, Aurora.
Pride profile: Sarah Jones, PA-C
Sarah Jones, PA-C, is a physician assistant on the overnight hospitalist team at Indiana University Health Methodist Hospital in Indianapolis, where she has worked for about 8 years. She studied chemistry and biology as an undergraduate at the University of Indianapolis, and then attended PA school at Butler University in Indianapolis. She came out as lesbian/queer just before PA school. She joined the Society of Hospital Medicine in 2020 and serves on SHM’s Diversity and Inclusion Special Interest Group.
How important is it to you to openly identify as a physician assistant who is a member of the LGBTQ community?
I think it’s important to show other people that I am part of the LGBTQ community and that I’ve been able to overcome obstacles and pursue this career and be successful. I can help other people and be in that role [of mentor], and show people that they can do it, too.
What challenges have you faced because of your sexual orientation in the different stages of your career, from training to practicing as a physician assistant?
When my training started, I was much closer to the time when I came out, so my confidence level was a little bit low. I was much more fearful at that point about how people would view me – if I would be thought of as inferior, or not taken as seriously, or that I wasn’t intelligent. I think over the years I’ve grown into this role and it’s helped me become more confident, because I know who I am now. And it’s not something that definitely defines me but I’m confident that I know medicine, and I know how to treat patients and that confidence has gotten much better.
So far at work, everyone’s been great, all my coworkers have been great. I’ve never once felt that my sexuality was holding anyone back from getting to know me better.
Have you heard about the experiences of other LGBTQ clinicians who may not have been as fortunate as you, especially transgender people?
There is just a lot of ignorance around LGBTQ persons and especially transgender persons, because people don’t understand it, they don’t get it. So their first inclination is to not approve of it, or be scared of it, or just automatically think that it’s wrong.
If someone’s sexuality comes across much more “obviously” than that of other people, for example, if there’s a gay man who’s a little more flamboyant, [it could be an issue for some patients]. I know there are some gay male nurses who have had patients who don’t want them serving as their nurse, because they’re “obviously” gay. Or a queer woman clinician who has more of an edgier haircut or looks a little bit more masculine; I know that there have been some patients who have said certain things to them that have been discriminating.
Have you been especially conscious of how you ‘wear’ your sexual orientation? Have you ever had to change how you’ve presented yourself, lest you have some unpleasant reaction?
I think initially, yes. I would say I’m a little more on the androgynous side with my style. When I was coming out I was trying to figure out where I was and who I was and how I wanted to be, and for the longest time I was dressing more femininely and I wasn’t as comfortable. Since then, I’ve had times where I’ve had short hair or a little bit more of a masculine haircut and wear more masculine clothes and things like that, and I feel much more comfortable doing that.
It’s kind of hard to play the part of a more masculine LGBTQ person at work when you just wear scrubs. I probably don’t portray it as much – I don’t make it as obvious as some other people, but I’ve definitely never shied away from having a conversation with anyone about it.
Health care is an intimate profession because of your close interaction with patients and others. Did being a member of the LGBTQ community factor into your decision to enter the health care field, either for or against?
There were times when I didn’t feel well or my mental health was not great because I didn’t know where I was, or hadn’t accepted myself, and I really needed someone who could help me talk through things and try to figure out what my life path was going to be. When I figured those things out with the help of other people, it was life-changing. I respected those people, and that’s what I wanted to do and how I wanted to help. I think that was part of why I got into medicine.
What progress have you seen with regard to LGBTQ health care professionals and patients over the past 5 to 10 years, including subtle changes in culture, attitude, or workplace policies?
Just being interviewed for a profile like this is a step in the right direction. Never once did I think that I would be highlighted for being an LGBTQ person, especially in the workplace.
I think that there are more companies, particularly in health care, and more hospitals that are coming out in support of their LGBTQ employees, especially during Pride month. IU Health walks every year in the Pride parade, which last year was about 3 hours long. Five years previously it was only 30 minutes long. So there are more employers getting involved and recognizing their employees as well. Companies and health care facilities are trying to be more cognizant of their LGBTQ employees and patients and trying to make them more comfortable.
What main steps toward more progress would you like to see?
There needs to be greater understanding that people who undergo discrimination actually have more negative health outcomes like heart disease, high blood pressure, and stroke. There needs to be better medical coverage in the LGBTQ community, especially for transgender persons and LGBTQ people who are trying to start families. We need better mental health access, more affordable mental health access, particularly for LGBTQ youth, and we definitely need to continue to raise awareness with hopes that we can eradicate the violence against, and killing of, black transgender persons.
How do you see the Society of Hospital Medicine’s role in this regard?
SHM has a big platform and can certainly reach a lot of people, especially hospitalists who see LGBTQ patients every day. With SHM’s help and the continued training of hospitalists who are members of the society, we can reach out to other clinicians, and to their organizations, and help teach them. SHM really has a good platform to be able to do that, and do it well.
Can you recall a specific interaction with an LGBTQ patient that left you with a potent feeling that “this is what it’s all about”?
I do remember a transgender patient who was homeless. They didn’t have insurance, they couldn’t afford their hormone treatment, and I remember they were struggling with some mental health issues and were “acting out” overnight. Some of the nurses were not using the correct pronouns. I’m more cognizant of their struggles because I’m a member of the LGBTQ community and I was able to recognize this.
I sat down and I talked with the patient for quite a while, we were able to form a bond, and I was able to get a little bit more information from them, and by the end of the night, they felt much better. And just being able to be their voice, when they weren’t able to express exactly how they were feeling, was something that made me thankful that I went into medicine, to help other LGBTQ patients.
I’ve had many LGBTQ patients in the hospital whom I’ve been able to form a bit of a bond with, just knowing that the patient could be me.
Sarah Jones, PA-C, is a physician assistant on the overnight hospitalist team at Indiana University Health Methodist Hospital in Indianapolis, where she has worked for about 8 years. She studied chemistry and biology as an undergraduate at the University of Indianapolis, and then attended PA school at Butler University in Indianapolis. She came out as lesbian/queer just before PA school. She joined the Society of Hospital Medicine in 2020 and serves on SHM’s Diversity and Inclusion Special Interest Group.
How important is it to you to openly identify as a physician assistant who is a member of the LGBTQ community?
I think it’s important to show other people that I am part of the LGBTQ community and that I’ve been able to overcome obstacles and pursue this career and be successful. I can help other people and be in that role [of mentor], and show people that they can do it, too.
What challenges have you faced because of your sexual orientation in the different stages of your career, from training to practicing as a physician assistant?
When my training started, I was much closer to the time when I came out, so my confidence level was a little bit low. I was much more fearful at that point about how people would view me – if I would be thought of as inferior, or not taken as seriously, or that I wasn’t intelligent. I think over the years I’ve grown into this role and it’s helped me become more confident, because I know who I am now. And it’s not something that definitely defines me but I’m confident that I know medicine, and I know how to treat patients and that confidence has gotten much better.
So far at work, everyone’s been great, all my coworkers have been great. I’ve never once felt that my sexuality was holding anyone back from getting to know me better.
Have you heard about the experiences of other LGBTQ clinicians who may not have been as fortunate as you, especially transgender people?
There is just a lot of ignorance around LGBTQ persons and especially transgender persons, because people don’t understand it, they don’t get it. So their first inclination is to not approve of it, or be scared of it, or just automatically think that it’s wrong.
If someone’s sexuality comes across much more “obviously” than that of other people, for example, if there’s a gay man who’s a little more flamboyant, [it could be an issue for some patients]. I know there are some gay male nurses who have had patients who don’t want them serving as their nurse, because they’re “obviously” gay. Or a queer woman clinician who has more of an edgier haircut or looks a little bit more masculine; I know that there have been some patients who have said certain things to them that have been discriminating.
Have you been especially conscious of how you ‘wear’ your sexual orientation? Have you ever had to change how you’ve presented yourself, lest you have some unpleasant reaction?
I think initially, yes. I would say I’m a little more on the androgynous side with my style. When I was coming out I was trying to figure out where I was and who I was and how I wanted to be, and for the longest time I was dressing more femininely and I wasn’t as comfortable. Since then, I’ve had times where I’ve had short hair or a little bit more of a masculine haircut and wear more masculine clothes and things like that, and I feel much more comfortable doing that.
It’s kind of hard to play the part of a more masculine LGBTQ person at work when you just wear scrubs. I probably don’t portray it as much – I don’t make it as obvious as some other people, but I’ve definitely never shied away from having a conversation with anyone about it.
Health care is an intimate profession because of your close interaction with patients and others. Did being a member of the LGBTQ community factor into your decision to enter the health care field, either for or against?
There were times when I didn’t feel well or my mental health was not great because I didn’t know where I was, or hadn’t accepted myself, and I really needed someone who could help me talk through things and try to figure out what my life path was going to be. When I figured those things out with the help of other people, it was life-changing. I respected those people, and that’s what I wanted to do and how I wanted to help. I think that was part of why I got into medicine.
What progress have you seen with regard to LGBTQ health care professionals and patients over the past 5 to 10 years, including subtle changes in culture, attitude, or workplace policies?
Just being interviewed for a profile like this is a step in the right direction. Never once did I think that I would be highlighted for being an LGBTQ person, especially in the workplace.
I think that there are more companies, particularly in health care, and more hospitals that are coming out in support of their LGBTQ employees, especially during Pride month. IU Health walks every year in the Pride parade, which last year was about 3 hours long. Five years previously it was only 30 minutes long. So there are more employers getting involved and recognizing their employees as well. Companies and health care facilities are trying to be more cognizant of their LGBTQ employees and patients and trying to make them more comfortable.
What main steps toward more progress would you like to see?
There needs to be greater understanding that people who undergo discrimination actually have more negative health outcomes like heart disease, high blood pressure, and stroke. There needs to be better medical coverage in the LGBTQ community, especially for transgender persons and LGBTQ people who are trying to start families. We need better mental health access, more affordable mental health access, particularly for LGBTQ youth, and we definitely need to continue to raise awareness with hopes that we can eradicate the violence against, and killing of, black transgender persons.
How do you see the Society of Hospital Medicine’s role in this regard?
SHM has a big platform and can certainly reach a lot of people, especially hospitalists who see LGBTQ patients every day. With SHM’s help and the continued training of hospitalists who are members of the society, we can reach out to other clinicians, and to their organizations, and help teach them. SHM really has a good platform to be able to do that, and do it well.
Can you recall a specific interaction with an LGBTQ patient that left you with a potent feeling that “this is what it’s all about”?
I do remember a transgender patient who was homeless. They didn’t have insurance, they couldn’t afford their hormone treatment, and I remember they were struggling with some mental health issues and were “acting out” overnight. Some of the nurses were not using the correct pronouns. I’m more cognizant of their struggles because I’m a member of the LGBTQ community and I was able to recognize this.
I sat down and I talked with the patient for quite a while, we were able to form a bond, and I was able to get a little bit more information from them, and by the end of the night, they felt much better. And just being able to be their voice, when they weren’t able to express exactly how they were feeling, was something that made me thankful that I went into medicine, to help other LGBTQ patients.
I’ve had many LGBTQ patients in the hospital whom I’ve been able to form a bit of a bond with, just knowing that the patient could be me.
Sarah Jones, PA-C, is a physician assistant on the overnight hospitalist team at Indiana University Health Methodist Hospital in Indianapolis, where she has worked for about 8 years. She studied chemistry and biology as an undergraduate at the University of Indianapolis, and then attended PA school at Butler University in Indianapolis. She came out as lesbian/queer just before PA school. She joined the Society of Hospital Medicine in 2020 and serves on SHM’s Diversity and Inclusion Special Interest Group.
How important is it to you to openly identify as a physician assistant who is a member of the LGBTQ community?
I think it’s important to show other people that I am part of the LGBTQ community and that I’ve been able to overcome obstacles and pursue this career and be successful. I can help other people and be in that role [of mentor], and show people that they can do it, too.
What challenges have you faced because of your sexual orientation in the different stages of your career, from training to practicing as a physician assistant?
When my training started, I was much closer to the time when I came out, so my confidence level was a little bit low. I was much more fearful at that point about how people would view me – if I would be thought of as inferior, or not taken as seriously, or that I wasn’t intelligent. I think over the years I’ve grown into this role and it’s helped me become more confident, because I know who I am now. And it’s not something that definitely defines me but I’m confident that I know medicine, and I know how to treat patients and that confidence has gotten much better.
So far at work, everyone’s been great, all my coworkers have been great. I’ve never once felt that my sexuality was holding anyone back from getting to know me better.
Have you heard about the experiences of other LGBTQ clinicians who may not have been as fortunate as you, especially transgender people?
There is just a lot of ignorance around LGBTQ persons and especially transgender persons, because people don’t understand it, they don’t get it. So their first inclination is to not approve of it, or be scared of it, or just automatically think that it’s wrong.
If someone’s sexuality comes across much more “obviously” than that of other people, for example, if there’s a gay man who’s a little more flamboyant, [it could be an issue for some patients]. I know there are some gay male nurses who have had patients who don’t want them serving as their nurse, because they’re “obviously” gay. Or a queer woman clinician who has more of an edgier haircut or looks a little bit more masculine; I know that there have been some patients who have said certain things to them that have been discriminating.
Have you been especially conscious of how you ‘wear’ your sexual orientation? Have you ever had to change how you’ve presented yourself, lest you have some unpleasant reaction?
I think initially, yes. I would say I’m a little more on the androgynous side with my style. When I was coming out I was trying to figure out where I was and who I was and how I wanted to be, and for the longest time I was dressing more femininely and I wasn’t as comfortable. Since then, I’ve had times where I’ve had short hair or a little bit more of a masculine haircut and wear more masculine clothes and things like that, and I feel much more comfortable doing that.
It’s kind of hard to play the part of a more masculine LGBTQ person at work when you just wear scrubs. I probably don’t portray it as much – I don’t make it as obvious as some other people, but I’ve definitely never shied away from having a conversation with anyone about it.
Health care is an intimate profession because of your close interaction with patients and others. Did being a member of the LGBTQ community factor into your decision to enter the health care field, either for or against?
There were times when I didn’t feel well or my mental health was not great because I didn’t know where I was, or hadn’t accepted myself, and I really needed someone who could help me talk through things and try to figure out what my life path was going to be. When I figured those things out with the help of other people, it was life-changing. I respected those people, and that’s what I wanted to do and how I wanted to help. I think that was part of why I got into medicine.
What progress have you seen with regard to LGBTQ health care professionals and patients over the past 5 to 10 years, including subtle changes in culture, attitude, or workplace policies?
Just being interviewed for a profile like this is a step in the right direction. Never once did I think that I would be highlighted for being an LGBTQ person, especially in the workplace.
I think that there are more companies, particularly in health care, and more hospitals that are coming out in support of their LGBTQ employees, especially during Pride month. IU Health walks every year in the Pride parade, which last year was about 3 hours long. Five years previously it was only 30 minutes long. So there are more employers getting involved and recognizing their employees as well. Companies and health care facilities are trying to be more cognizant of their LGBTQ employees and patients and trying to make them more comfortable.
What main steps toward more progress would you like to see?
There needs to be greater understanding that people who undergo discrimination actually have more negative health outcomes like heart disease, high blood pressure, and stroke. There needs to be better medical coverage in the LGBTQ community, especially for transgender persons and LGBTQ people who are trying to start families. We need better mental health access, more affordable mental health access, particularly for LGBTQ youth, and we definitely need to continue to raise awareness with hopes that we can eradicate the violence against, and killing of, black transgender persons.
How do you see the Society of Hospital Medicine’s role in this regard?
SHM has a big platform and can certainly reach a lot of people, especially hospitalists who see LGBTQ patients every day. With SHM’s help and the continued training of hospitalists who are members of the society, we can reach out to other clinicians, and to their organizations, and help teach them. SHM really has a good platform to be able to do that, and do it well.
Can you recall a specific interaction with an LGBTQ patient that left you with a potent feeling that “this is what it’s all about”?
I do remember a transgender patient who was homeless. They didn’t have insurance, they couldn’t afford their hormone treatment, and I remember they were struggling with some mental health issues and were “acting out” overnight. Some of the nurses were not using the correct pronouns. I’m more cognizant of their struggles because I’m a member of the LGBTQ community and I was able to recognize this.
I sat down and I talked with the patient for quite a while, we were able to form a bond, and I was able to get a little bit more information from them, and by the end of the night, they felt much better. And just being able to be their voice, when they weren’t able to express exactly how they were feeling, was something that made me thankful that I went into medicine, to help other LGBTQ patients.
I’ve had many LGBTQ patients in the hospital whom I’ve been able to form a bit of a bond with, just knowing that the patient could be me.
Worrisome health disparities among transgender adults
Background: The transgender population historically has not been identified in population research. Little is known about their health care needs.
Study design: Survey review.
Setting: Large, continuously operative health survey.
Synopsis: The Centers for Disease Control and Prevention added an optional Sexual Orientation and Gender Identity module to the Behavioral Risk Factor Surveillance System in 2014. Compared with non–transgender responders, transgender adults (0.55% of responders) were more likely to report “fair” or “poor” health status (24.5% vs. 18.2%), were more likely to have experienced severe mental distress in the last 30 days (20.3% vs. 11.6), and were more likely to be physically inactive (35% vs. 25.6%), smoke cigarettes (19.2% vs. 16.3%), and lack health care coverage (20.1% vs. 14.6%).
Bottom line: Transgender adults report worse physical and mental health status. Physicians should consider these disparities during screening and treatment.
Citation: Baker K. Findings from the Behavioral Risk Factor Surveillance System on health-related quality of life among U.S. transgender adults, 2014-2017. JAMA Intern Med. 2019 Apr 22. doi: 10.1001/jamainternmed.2018.7931.
Dr. Hoegh is a hospitalist at the University of Colorado at Denver, Aurora.
Background: The transgender population historically has not been identified in population research. Little is known about their health care needs.
Study design: Survey review.
Setting: Large, continuously operative health survey.
Synopsis: The Centers for Disease Control and Prevention added an optional Sexual Orientation and Gender Identity module to the Behavioral Risk Factor Surveillance System in 2014. Compared with non–transgender responders, transgender adults (0.55% of responders) were more likely to report “fair” or “poor” health status (24.5% vs. 18.2%), were more likely to have experienced severe mental distress in the last 30 days (20.3% vs. 11.6), and were more likely to be physically inactive (35% vs. 25.6%), smoke cigarettes (19.2% vs. 16.3%), and lack health care coverage (20.1% vs. 14.6%).
Bottom line: Transgender adults report worse physical and mental health status. Physicians should consider these disparities during screening and treatment.
Citation: Baker K. Findings from the Behavioral Risk Factor Surveillance System on health-related quality of life among U.S. transgender adults, 2014-2017. JAMA Intern Med. 2019 Apr 22. doi: 10.1001/jamainternmed.2018.7931.
Dr. Hoegh is a hospitalist at the University of Colorado at Denver, Aurora.
Background: The transgender population historically has not been identified in population research. Little is known about their health care needs.
Study design: Survey review.
Setting: Large, continuously operative health survey.
Synopsis: The Centers for Disease Control and Prevention added an optional Sexual Orientation and Gender Identity module to the Behavioral Risk Factor Surveillance System in 2014. Compared with non–transgender responders, transgender adults (0.55% of responders) were more likely to report “fair” or “poor” health status (24.5% vs. 18.2%), were more likely to have experienced severe mental distress in the last 30 days (20.3% vs. 11.6), and were more likely to be physically inactive (35% vs. 25.6%), smoke cigarettes (19.2% vs. 16.3%), and lack health care coverage (20.1% vs. 14.6%).
Bottom line: Transgender adults report worse physical and mental health status. Physicians should consider these disparities during screening and treatment.
Citation: Baker K. Findings from the Behavioral Risk Factor Surveillance System on health-related quality of life among U.S. transgender adults, 2014-2017. JAMA Intern Med. 2019 Apr 22. doi: 10.1001/jamainternmed.2018.7931.
Dr. Hoegh is a hospitalist at the University of Colorado at Denver, Aurora.
Canagliflozin protects diabetic kidneys
Background: Type 2 diabetes is the leading cause of kidney failure worldwide. Few treatment options exist to help improve on this outcome in patients with chronic kidney disease.
Study design: CREDENCE (industry-sponsored) double-blind, randomized placebo-controlled trial.
Setting: 695 sites in 34 countries, 4,401 patients.
Synopsis: The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. Canagliflozin reduced serious adverse renal events or death from renal or cardiovascular causes at 2.62 years (11.1% vs. 15.5% with placebo; number needed to treat, 23).Bottom line: Canagliflozin lowered serious adverse renal events people with type 2 diabetics who also had chronic kidney disease.
Citation: Perkovic V et al. Canagliflozin and renal outcomes in type 2 diabetes and nephropathy. N Engl J Med. 2019 Apr 14. doi: 10-1056/NEJMoa1811744.
Dr. Hoegh is a hospitalist at the University of Colorado at Denver, Aurora.
Background: Type 2 diabetes is the leading cause of kidney failure worldwide. Few treatment options exist to help improve on this outcome in patients with chronic kidney disease.
Study design: CREDENCE (industry-sponsored) double-blind, randomized placebo-controlled trial.
Setting: 695 sites in 34 countries, 4,401 patients.
Synopsis: The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. Canagliflozin reduced serious adverse renal events or death from renal or cardiovascular causes at 2.62 years (11.1% vs. 15.5% with placebo; number needed to treat, 23).Bottom line: Canagliflozin lowered serious adverse renal events people with type 2 diabetics who also had chronic kidney disease.
Citation: Perkovic V et al. Canagliflozin and renal outcomes in type 2 diabetes and nephropathy. N Engl J Med. 2019 Apr 14. doi: 10-1056/NEJMoa1811744.
Dr. Hoegh is a hospitalist at the University of Colorado at Denver, Aurora.
Background: Type 2 diabetes is the leading cause of kidney failure worldwide. Few treatment options exist to help improve on this outcome in patients with chronic kidney disease.
Study design: CREDENCE (industry-sponsored) double-blind, randomized placebo-controlled trial.
Setting: 695 sites in 34 countries, 4,401 patients.
Synopsis: The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. Canagliflozin reduced serious adverse renal events or death from renal or cardiovascular causes at 2.62 years (11.1% vs. 15.5% with placebo; number needed to treat, 23).Bottom line: Canagliflozin lowered serious adverse renal events people with type 2 diabetics who also had chronic kidney disease.
Citation: Perkovic V et al. Canagliflozin and renal outcomes in type 2 diabetes and nephropathy. N Engl J Med. 2019 Apr 14. doi: 10-1056/NEJMoa1811744.
Dr. Hoegh is a hospitalist at the University of Colorado at Denver, Aurora.
The wave of the future
Longtime CEO bids farewell to SHM
Changing times
After more than 20 years, my leadership role as CEO at the Society of Hospital Medicine (SHM) has ended with the transition to Dr. Eric Howell as the new SHM CEO on July 1, 2020. Looking back, I think we can all be proud of how we have helped to shape the specialty of hospital medicine over these two decades and of how strong SHM has become to support our new specialty.
In 2000, few people knew what a hospitalist was (or more importantly what we could become) and the specialty of hospital medicine had not even been named yet. Today the reputation of SHM is firmly established and the specialty has been defined by a unique curriculum through the Core Competencies in Hospital Medicine for both adult and pediatric patients, and by several textbooks in hospital medicine. There are divisions or departments of hospital medicine at many hospitals and academic medical centers. We even managed to convince the American Board of Internal Medicine, the American Board of Family Medicine, and the American Board of Medical Specialties to create a credential of Focused Practice in Hospital Medicine as the first-ever certification not tied to specific fellowship training.
To recognize the contributions of our members, SHM has established Awards of Excellence and the Fellow and Senior Fellow in Hospital Medicine (FHM and SFHM) designations. We have gone from a small national association in Philadelphia to create 68 active chapters and more than 20 Special Interest Groups. In my time at SHM I have attended more than 75-chapter meetings and met with thousands of hospitalists in 46 states. We now have over 20,000 members at SHM, making us the fastest growing medical specialty ever.
When I started at the National Association of Inpatient Physicians (NAIP) our only meeting was an annual CME meeting for about 150-200 people. We now hold a national meeting every year for more than 4,000 attendees that is the “Center of the Universe for Hospital Medicine.” Understanding that we needed to educate the people who will lead change in our health care system, we developed from scratch a set of Leadership Academies that has already educated more than 2,500 hospitalist leaders. To train the educators in quality improvement in medical education we developed our Quality and Safety Educator Academy (QSEA) programs, and to promote career development of academic hospitalists we created our Academic Hospitalist Academy.
SHM is the leader in adult in-practice learning, specifically designed for hospitalists. SHM members have access to a state-of-the-art comprehensive hospitalist-based online education system as well as board review and maintenance of certification (MOC) review tools in our SPARK program, specifically for hospital medicine.
In the area of quality improvement, most medical societies convene a panel of experts, develop guidelines, publish them, and hope that change will occur. SHM has been much more proactive, creating the Center for Quality Improvement that has raised more than $10 million and developed Quality Improvement programs in more than 400 hospitals over the years, winning the prestigious Eisenberg Award along the way.
When I started at NAIP in 2000, our only communication tools were a 4-page newsletter and an email listserv. Along the way we have developed a broadly read newsmagazine (The Hospitalist), a well-recognized peer reviewed journal (Journal of Hospital Medicine), a robust website, and a significant social media presence.
From the very early days we knew that our specialty would not be totally successful by only facing inward. Change was coming to our health care system and hospitalists were going to be right in the middle. Despite our young age and limited resources, we have always hit above our weight class in advocacy. We actively participated in the development of the Affordable Care Act (Obamacare), making suggestions in payment reform, expanding the workforce with visa reform, and expanding the team of clinicians. Along the way SHM members rose to run the Centers for Medicare & Medicaid Services (CMS) and the Food and Drug Administration (FDA), and serve as U.S. Surgeon General.
Today in these troubled times, SHM continues to be a positive voice in promoting the use of PPE, the need for increased COVID-19 testing, and the recognition of our nation’s 60,000 hospitalists as essential frontline workers in the COVID-19 pandemic. With its longstanding role in promoting diversity and overcoming social injustice, SHM has had a positive national voice during the protests over police brutality.
We have proved to be a good partner with many other organizations and consistently were invited to partner in coalitions with the ED physicians (ACEP), the critical care docs (SCCM), the hospitals (AHA), the house of medicine (AMA), other internists (ACP), surgeons (ACS), and pediatricians (AAP), and so many other much more established societies, because we could be an active, flexible, and knowledgeable partner for more than 20 years.
Today, SHM and hospital medicine are clearly recognized as a force in the rapidly evolving health care system. With this comes not only influence but also responsibility, and I am certain the SHM Board, membership, and staff are ready for this challenge. The economic toll of our current pandemic will see colleges and other major companies and institutions go out of business and leave the landscape. SHM has a deep foundation and a well of strength to call on and will survive and thrive into the future.
SHM has been a good fit for me professionally and personally. Many of my skills and strengths have served SHM in our “early” years. I am very proud of what we have been able to accomplish TOGETHER. In the end it is the people I have been fortunate enough to meet and work with throughout these past 20 years that will stay with me, many of whom are lifelong friends. My mother, even today at 93, has always asked me to leave anything I do better off than when I came in the door. As I look back at my time helping to shape and lead SHM, I am sure I have answered my mother’s challenge and more.
I look forward to seeing many of you at a future SHM meeting and reveling in the way that hospitalists will actively play an important role in shaping our health care system in the future.
Dr. Wellikson is retiring as CEO of SHM.
Live long and prosper
Back in 2000, I was extremely fortunate to land my dream job as a hospitalist at Johns Hopkins Bayview in Baltimore. That dream exceeded my wildest aspirations. During my 20-year career as faculty in the Johns Hopkins School of Medicine I grew our tiny, 4 physician hospitalist group at Johns Hopkins Bayview into a multihospital program, complete with more than 150 physicians. That exceedingly rewarding work helped to shape the field of hospital medicine nationally and provided the foundation for my promotion to professor of medicine at Johns Hopkins in 2016.
Most professionals are lucky if they find one inspiring institution; I have found two. SHM has been my professional home since I became a hospitalist in 2000, and in that time I have dedicated as much creative energy to SHM as I have at Johns Hopkins.
Even at this time when the medical profession, and the entire world, has been rocked by the coronavirus, the fundamentals that have made SHM so successful will serve us well through the effects of this pandemic and beyond. It takes a skilled leader to nurture a professional society through the growth from only a few hundred members to thousands upon thousands, and at the same time crafting the profession into one of quality and high impact. These past 22 years Dr. Larry Wellikson, our retiring CEO, has skillfully accomplished just that by building lasting programs and people.
As you might imagine, my approach will work to add onto the legacy that Larry has left us. Yes, we will have to adapt SHM to the realities of the near future: virtual meetings, in-person events (yes, those will return one day) with appropriate social distancing until the coronavirus has faded, modified chapter meetings, and more. Someday the world will find a new normal, and SHM will evolve to meet the needs of our members and the patients we serve.
Through this pandemic and beyond, my vision – in partnership with the Board of Directors – will be to:
- Continue the work to enhance member engagement. We are primarily a membership organization, after all.
- Maintain our profession’s leadership role in the care continuum, particularly acute care.
- Be a deliberate sponsor of diversity and inclusion. I believe social justice is a moral imperative, and good business.
- Invest in teams: Chapters, special interest groups, and committees are key to success.
- Be financially prudent, so that this organization can serve its members through the best of times and those most challenging times.
Back in 2000 I joined my dream society, the Society of Hospital Medicine. That society exceeded my wildest aspirations. During my 20-year membership I started an SHM Chapter, was a leader in the Leadership Academies, joined the Board of Directors, participated in Annual Conferences, and helped lead the SHM Center for Quality Improvement. That exceedingly rewarding partnership helped shape the field of hospital medicine nationally and provided the foundation for my next role at SHM. I am excited and grateful to be the CEO of SHM.
I’ll end with something I use every day – “Eric Howell’s Core Values”:
- Make the world a better place.
- Invest in people.
- Be ethical and transparent.
- Do what you love.
- Try to use Star Trek references whenever possible. (Okay, this last one is not really a core value, but maybe a character trait?) At least the Vulcan greeting is appropriate for our times: Live long and prosper.
Dr. Howell is the new CEO for SHM as of July 1, 2020.
Longtime CEO bids farewell to SHM
Longtime CEO bids farewell to SHM
Changing times
After more than 20 years, my leadership role as CEO at the Society of Hospital Medicine (SHM) has ended with the transition to Dr. Eric Howell as the new SHM CEO on July 1, 2020. Looking back, I think we can all be proud of how we have helped to shape the specialty of hospital medicine over these two decades and of how strong SHM has become to support our new specialty.
In 2000, few people knew what a hospitalist was (or more importantly what we could become) and the specialty of hospital medicine had not even been named yet. Today the reputation of SHM is firmly established and the specialty has been defined by a unique curriculum through the Core Competencies in Hospital Medicine for both adult and pediatric patients, and by several textbooks in hospital medicine. There are divisions or departments of hospital medicine at many hospitals and academic medical centers. We even managed to convince the American Board of Internal Medicine, the American Board of Family Medicine, and the American Board of Medical Specialties to create a credential of Focused Practice in Hospital Medicine as the first-ever certification not tied to specific fellowship training.
To recognize the contributions of our members, SHM has established Awards of Excellence and the Fellow and Senior Fellow in Hospital Medicine (FHM and SFHM) designations. We have gone from a small national association in Philadelphia to create 68 active chapters and more than 20 Special Interest Groups. In my time at SHM I have attended more than 75-chapter meetings and met with thousands of hospitalists in 46 states. We now have over 20,000 members at SHM, making us the fastest growing medical specialty ever.
When I started at the National Association of Inpatient Physicians (NAIP) our only meeting was an annual CME meeting for about 150-200 people. We now hold a national meeting every year for more than 4,000 attendees that is the “Center of the Universe for Hospital Medicine.” Understanding that we needed to educate the people who will lead change in our health care system, we developed from scratch a set of Leadership Academies that has already educated more than 2,500 hospitalist leaders. To train the educators in quality improvement in medical education we developed our Quality and Safety Educator Academy (QSEA) programs, and to promote career development of academic hospitalists we created our Academic Hospitalist Academy.
SHM is the leader in adult in-practice learning, specifically designed for hospitalists. SHM members have access to a state-of-the-art comprehensive hospitalist-based online education system as well as board review and maintenance of certification (MOC) review tools in our SPARK program, specifically for hospital medicine.
In the area of quality improvement, most medical societies convene a panel of experts, develop guidelines, publish them, and hope that change will occur. SHM has been much more proactive, creating the Center for Quality Improvement that has raised more than $10 million and developed Quality Improvement programs in more than 400 hospitals over the years, winning the prestigious Eisenberg Award along the way.
When I started at NAIP in 2000, our only communication tools were a 4-page newsletter and an email listserv. Along the way we have developed a broadly read newsmagazine (The Hospitalist), a well-recognized peer reviewed journal (Journal of Hospital Medicine), a robust website, and a significant social media presence.
From the very early days we knew that our specialty would not be totally successful by only facing inward. Change was coming to our health care system and hospitalists were going to be right in the middle. Despite our young age and limited resources, we have always hit above our weight class in advocacy. We actively participated in the development of the Affordable Care Act (Obamacare), making suggestions in payment reform, expanding the workforce with visa reform, and expanding the team of clinicians. Along the way SHM members rose to run the Centers for Medicare & Medicaid Services (CMS) and the Food and Drug Administration (FDA), and serve as U.S. Surgeon General.
Today in these troubled times, SHM continues to be a positive voice in promoting the use of PPE, the need for increased COVID-19 testing, and the recognition of our nation’s 60,000 hospitalists as essential frontline workers in the COVID-19 pandemic. With its longstanding role in promoting diversity and overcoming social injustice, SHM has had a positive national voice during the protests over police brutality.
We have proved to be a good partner with many other organizations and consistently were invited to partner in coalitions with the ED physicians (ACEP), the critical care docs (SCCM), the hospitals (AHA), the house of medicine (AMA), other internists (ACP), surgeons (ACS), and pediatricians (AAP), and so many other much more established societies, because we could be an active, flexible, and knowledgeable partner for more than 20 years.
Today, SHM and hospital medicine are clearly recognized as a force in the rapidly evolving health care system. With this comes not only influence but also responsibility, and I am certain the SHM Board, membership, and staff are ready for this challenge. The economic toll of our current pandemic will see colleges and other major companies and institutions go out of business and leave the landscape. SHM has a deep foundation and a well of strength to call on and will survive and thrive into the future.
SHM has been a good fit for me professionally and personally. Many of my skills and strengths have served SHM in our “early” years. I am very proud of what we have been able to accomplish TOGETHER. In the end it is the people I have been fortunate enough to meet and work with throughout these past 20 years that will stay with me, many of whom are lifelong friends. My mother, even today at 93, has always asked me to leave anything I do better off than when I came in the door. As I look back at my time helping to shape and lead SHM, I am sure I have answered my mother’s challenge and more.
I look forward to seeing many of you at a future SHM meeting and reveling in the way that hospitalists will actively play an important role in shaping our health care system in the future.
Dr. Wellikson is retiring as CEO of SHM.
Live long and prosper
Back in 2000, I was extremely fortunate to land my dream job as a hospitalist at Johns Hopkins Bayview in Baltimore. That dream exceeded my wildest aspirations. During my 20-year career as faculty in the Johns Hopkins School of Medicine I grew our tiny, 4 physician hospitalist group at Johns Hopkins Bayview into a multihospital program, complete with more than 150 physicians. That exceedingly rewarding work helped to shape the field of hospital medicine nationally and provided the foundation for my promotion to professor of medicine at Johns Hopkins in 2016.
Most professionals are lucky if they find one inspiring institution; I have found two. SHM has been my professional home since I became a hospitalist in 2000, and in that time I have dedicated as much creative energy to SHM as I have at Johns Hopkins.
Even at this time when the medical profession, and the entire world, has been rocked by the coronavirus, the fundamentals that have made SHM so successful will serve us well through the effects of this pandemic and beyond. It takes a skilled leader to nurture a professional society through the growth from only a few hundred members to thousands upon thousands, and at the same time crafting the profession into one of quality and high impact. These past 22 years Dr. Larry Wellikson, our retiring CEO, has skillfully accomplished just that by building lasting programs and people.
As you might imagine, my approach will work to add onto the legacy that Larry has left us. Yes, we will have to adapt SHM to the realities of the near future: virtual meetings, in-person events (yes, those will return one day) with appropriate social distancing until the coronavirus has faded, modified chapter meetings, and more. Someday the world will find a new normal, and SHM will evolve to meet the needs of our members and the patients we serve.
Through this pandemic and beyond, my vision – in partnership with the Board of Directors – will be to:
- Continue the work to enhance member engagement. We are primarily a membership organization, after all.
- Maintain our profession’s leadership role in the care continuum, particularly acute care.
- Be a deliberate sponsor of diversity and inclusion. I believe social justice is a moral imperative, and good business.
- Invest in teams: Chapters, special interest groups, and committees are key to success.
- Be financially prudent, so that this organization can serve its members through the best of times and those most challenging times.
Back in 2000 I joined my dream society, the Society of Hospital Medicine. That society exceeded my wildest aspirations. During my 20-year membership I started an SHM Chapter, was a leader in the Leadership Academies, joined the Board of Directors, participated in Annual Conferences, and helped lead the SHM Center for Quality Improvement. That exceedingly rewarding partnership helped shape the field of hospital medicine nationally and provided the foundation for my next role at SHM. I am excited and grateful to be the CEO of SHM.
I’ll end with something I use every day – “Eric Howell’s Core Values”:
- Make the world a better place.
- Invest in people.
- Be ethical and transparent.
- Do what you love.
- Try to use Star Trek references whenever possible. (Okay, this last one is not really a core value, but maybe a character trait?) At least the Vulcan greeting is appropriate for our times: Live long and prosper.
Dr. Howell is the new CEO for SHM as of July 1, 2020.
Changing times
After more than 20 years, my leadership role as CEO at the Society of Hospital Medicine (SHM) has ended with the transition to Dr. Eric Howell as the new SHM CEO on July 1, 2020. Looking back, I think we can all be proud of how we have helped to shape the specialty of hospital medicine over these two decades and of how strong SHM has become to support our new specialty.
In 2000, few people knew what a hospitalist was (or more importantly what we could become) and the specialty of hospital medicine had not even been named yet. Today the reputation of SHM is firmly established and the specialty has been defined by a unique curriculum through the Core Competencies in Hospital Medicine for both adult and pediatric patients, and by several textbooks in hospital medicine. There are divisions or departments of hospital medicine at many hospitals and academic medical centers. We even managed to convince the American Board of Internal Medicine, the American Board of Family Medicine, and the American Board of Medical Specialties to create a credential of Focused Practice in Hospital Medicine as the first-ever certification not tied to specific fellowship training.
To recognize the contributions of our members, SHM has established Awards of Excellence and the Fellow and Senior Fellow in Hospital Medicine (FHM and SFHM) designations. We have gone from a small national association in Philadelphia to create 68 active chapters and more than 20 Special Interest Groups. In my time at SHM I have attended more than 75-chapter meetings and met with thousands of hospitalists in 46 states. We now have over 20,000 members at SHM, making us the fastest growing medical specialty ever.
When I started at the National Association of Inpatient Physicians (NAIP) our only meeting was an annual CME meeting for about 150-200 people. We now hold a national meeting every year for more than 4,000 attendees that is the “Center of the Universe for Hospital Medicine.” Understanding that we needed to educate the people who will lead change in our health care system, we developed from scratch a set of Leadership Academies that has already educated more than 2,500 hospitalist leaders. To train the educators in quality improvement in medical education we developed our Quality and Safety Educator Academy (QSEA) programs, and to promote career development of academic hospitalists we created our Academic Hospitalist Academy.
SHM is the leader in adult in-practice learning, specifically designed for hospitalists. SHM members have access to a state-of-the-art comprehensive hospitalist-based online education system as well as board review and maintenance of certification (MOC) review tools in our SPARK program, specifically for hospital medicine.
In the area of quality improvement, most medical societies convene a panel of experts, develop guidelines, publish them, and hope that change will occur. SHM has been much more proactive, creating the Center for Quality Improvement that has raised more than $10 million and developed Quality Improvement programs in more than 400 hospitals over the years, winning the prestigious Eisenberg Award along the way.
When I started at NAIP in 2000, our only communication tools were a 4-page newsletter and an email listserv. Along the way we have developed a broadly read newsmagazine (The Hospitalist), a well-recognized peer reviewed journal (Journal of Hospital Medicine), a robust website, and a significant social media presence.
From the very early days we knew that our specialty would not be totally successful by only facing inward. Change was coming to our health care system and hospitalists were going to be right in the middle. Despite our young age and limited resources, we have always hit above our weight class in advocacy. We actively participated in the development of the Affordable Care Act (Obamacare), making suggestions in payment reform, expanding the workforce with visa reform, and expanding the team of clinicians. Along the way SHM members rose to run the Centers for Medicare & Medicaid Services (CMS) and the Food and Drug Administration (FDA), and serve as U.S. Surgeon General.
Today in these troubled times, SHM continues to be a positive voice in promoting the use of PPE, the need for increased COVID-19 testing, and the recognition of our nation’s 60,000 hospitalists as essential frontline workers in the COVID-19 pandemic. With its longstanding role in promoting diversity and overcoming social injustice, SHM has had a positive national voice during the protests over police brutality.
We have proved to be a good partner with many other organizations and consistently were invited to partner in coalitions with the ED physicians (ACEP), the critical care docs (SCCM), the hospitals (AHA), the house of medicine (AMA), other internists (ACP), surgeons (ACS), and pediatricians (AAP), and so many other much more established societies, because we could be an active, flexible, and knowledgeable partner for more than 20 years.
Today, SHM and hospital medicine are clearly recognized as a force in the rapidly evolving health care system. With this comes not only influence but also responsibility, and I am certain the SHM Board, membership, and staff are ready for this challenge. The economic toll of our current pandemic will see colleges and other major companies and institutions go out of business and leave the landscape. SHM has a deep foundation and a well of strength to call on and will survive and thrive into the future.
SHM has been a good fit for me professionally and personally. Many of my skills and strengths have served SHM in our “early” years. I am very proud of what we have been able to accomplish TOGETHER. In the end it is the people I have been fortunate enough to meet and work with throughout these past 20 years that will stay with me, many of whom are lifelong friends. My mother, even today at 93, has always asked me to leave anything I do better off than when I came in the door. As I look back at my time helping to shape and lead SHM, I am sure I have answered my mother’s challenge and more.
I look forward to seeing many of you at a future SHM meeting and reveling in the way that hospitalists will actively play an important role in shaping our health care system in the future.
Dr. Wellikson is retiring as CEO of SHM.
Live long and prosper
Back in 2000, I was extremely fortunate to land my dream job as a hospitalist at Johns Hopkins Bayview in Baltimore. That dream exceeded my wildest aspirations. During my 20-year career as faculty in the Johns Hopkins School of Medicine I grew our tiny, 4 physician hospitalist group at Johns Hopkins Bayview into a multihospital program, complete with more than 150 physicians. That exceedingly rewarding work helped to shape the field of hospital medicine nationally and provided the foundation for my promotion to professor of medicine at Johns Hopkins in 2016.
Most professionals are lucky if they find one inspiring institution; I have found two. SHM has been my professional home since I became a hospitalist in 2000, and in that time I have dedicated as much creative energy to SHM as I have at Johns Hopkins.
Even at this time when the medical profession, and the entire world, has been rocked by the coronavirus, the fundamentals that have made SHM so successful will serve us well through the effects of this pandemic and beyond. It takes a skilled leader to nurture a professional society through the growth from only a few hundred members to thousands upon thousands, and at the same time crafting the profession into one of quality and high impact. These past 22 years Dr. Larry Wellikson, our retiring CEO, has skillfully accomplished just that by building lasting programs and people.
As you might imagine, my approach will work to add onto the legacy that Larry has left us. Yes, we will have to adapt SHM to the realities of the near future: virtual meetings, in-person events (yes, those will return one day) with appropriate social distancing until the coronavirus has faded, modified chapter meetings, and more. Someday the world will find a new normal, and SHM will evolve to meet the needs of our members and the patients we serve.
Through this pandemic and beyond, my vision – in partnership with the Board of Directors – will be to:
- Continue the work to enhance member engagement. We are primarily a membership organization, after all.
- Maintain our profession’s leadership role in the care continuum, particularly acute care.
- Be a deliberate sponsor of diversity and inclusion. I believe social justice is a moral imperative, and good business.
- Invest in teams: Chapters, special interest groups, and committees are key to success.
- Be financially prudent, so that this organization can serve its members through the best of times and those most challenging times.
Back in 2000 I joined my dream society, the Society of Hospital Medicine. That society exceeded my wildest aspirations. During my 20-year membership I started an SHM Chapter, was a leader in the Leadership Academies, joined the Board of Directors, participated in Annual Conferences, and helped lead the SHM Center for Quality Improvement. That exceedingly rewarding partnership helped shape the field of hospital medicine nationally and provided the foundation for my next role at SHM. I am excited and grateful to be the CEO of SHM.
I’ll end with something I use every day – “Eric Howell’s Core Values”:
- Make the world a better place.
- Invest in people.
- Be ethical and transparent.
- Do what you love.
- Try to use Star Trek references whenever possible. (Okay, this last one is not really a core value, but maybe a character trait?) At least the Vulcan greeting is appropriate for our times: Live long and prosper.
Dr. Howell is the new CEO for SHM as of July 1, 2020.