Monday, June 16, 2008

SHM must focus on hospitalist career satisfaction

When Bob Wachter gave Grand Rounds at UT-Houston (you can find his presentation in the archives here) he noted that hospitalists have become “this pluripotential group of physicians who can basically help fix a wide variety of problems and issues as they arise.” In his talk (and elsewhere) Dr. Wachter described the hospitslist’s career as “life as a Swiss Army knife.” He told the audience “This is a terrible job for somebody that wants to know exactly what their job will look like ten years from now.”

Comments such as these, also heard at SMH 2008, raise red flags concerning the future of the movement. As the specialty of hospital medicine matures it should be defining its boundaries. While we can’t know exactly what the field will look like in ten years we do need a job description. These days the description is a little fuzzy. Some vague notion of the hospitalist’s job morphing into a little bit of everything may be fine for doctors seeking temporary employment, but doctors looking for a career need a road map which offers some promise of long term professional satisfaction.

The specialty will be stronger if it can attract career hospitalists, but, as I wrote last week, it will be manned increasingly by transient labor unless leaders provide a stronger vision for career satisfaction. According to an article in the latest issue of Today’s Hospitalist the trend is already underway:

Like a growing number of program directors around the country, Dr. Tsuboi often has little choice but to hire short-timers. But like many colleagues, he wonders if by hiring short-timers, he’s setting himself—and the specialty—up for problems down the road.

The article goes on to describe some of the problems:

But Dr. DeLue’s biggest concern is that a revolving door creates an image issue for the specialty. “It makes more prevalent the idea that ‘good hospitalists’ don’t stick around,” he says. “The other thing is that it is hard to maintain the chemistry you build among the team if you have people leaving every year.”

Hospitalists are taking on too much too fast. If leadership doesn’t take definitive steps to moderate the trend it will be costly for the specialty. A quote from another article in Today’s Hospitalist sums it up well:

“When we started out, we were going to be the key to hospital cost control, then we took on quality and safety,” said presenter Tosha Wetterneck, MD. “Now we’re taking over care of medical subspecialists’ patients and, with the resident work hour restrictions, some of that duty as well. The question is: Are we going to be able to be all things to all people?” Not without incurring the risk of broad-scale burnout in the specialty, replied Dr. Wetterneck, assistant professor of medicine and a practicing hospitalist at the University of Wisconsin- Madison.

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