Will the Society of Hospital Medicine lead its members in the right direction?

Hospital medicine is on a roll. It’s the fastest growing specialty in the history of medicine. Will the bubble burst? Our leaders hold the key. At SHM 2008 they presented a grandiose vision which, if not tempered, may send us on a collision course.

Attendees at SHM 2008 were told that hospitalists must prepare to expand their scope of services, venturing beyond their training and comfort zones into uncharted territories. Hospitalists, we were told, must prepare to admit a wider variety of patients and take over anything and everything under the nebulous category of “comanagement.” And there’s more. After taking over hospital care we’ll extend our sphere of influence into community health and public policy to become the grand integrators of health care. Romantic, maybe, but not a vision for sustainable growth.

The appeal for most physicians choosing hospital medicine derives from compensation and professional satisfaction. Compensation, given the anticipated shortage of hospitalists, is secure for the next decade or so. Professional satisfaction is problematic. Burnout is an ever present concern and turnover is high.

For me, professional satisfaction means being able to function as an internist in the original sense of internal medicine as a specialty. It’s the reason I chose internal medicine and it’s the way I was trained. It has recently been suggested that the only way to do that nowadays is to be a hospitalist. Internal medicine in the ambulatory setting has devolved away from that model to one of “family practice minus peds and Ob.” Internal medicine training has traditionally focused on hospital medicine. For many internists hospital medicine is seen as a way to focus in and ramp up the learning curve in the field they enjoy most. For much of the history of the hospitalist movement that has been a big draw.

Hospital medicine, however, may be in danger of devolving, like internal medicine, into something less professionally satisfying if the scenario of hospitalists “managing everything” plays out. Few doctors became hospitalists to be house doctors, H&P providers or discharge planners. The challenge of staying current in the rapidly changing field of hospital medicine, taking the best possible care of horribly ill and complex inpatients and working to promote hospital quality and safety (which I submit was the original mission of the hospitalist movement) is daunting. Isn’t it enough? Those are the challenges that attract doctors to hospital medicine as a career. If hospital medicine moves away from that model I predict that hospitalists programs will be increasingly staffed with transient labor---doctors looking to make decent money for a year or so until they decide on something else. My own experience in recruiting tells me that turnover is already a problem.

The web casts and blog of SMH made me more than a little concerned about whether our leaders are taking us in the right direction. There’s a lot at stake. Eventually hospital medicine, like most specialties of similar size, will have more than one professional society representing its ranks. This will happen sooner rather than later unless the Society of Hospital Medicine makes career satisfaction a higher priority.