Friday, June 13, 2008

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.


DrWes said...

I can hear it now from the hospital administrators (with which hospitalists, by their contractual employment relationships) collude:

"Yes, scut puppy, do the H&P and discharge planning, will you? Oh, and order more tests and consults, too - the hospital likes it when you do that, you know. After all, you're all making so much more than internists! Quit your bitchin'! Our surgeons have better things to do with their time... like operate!"

Yeah, that's a real model for sustainability.

(Nice to see you've got clarity on this... nice post.)

R. W. Donnell said...

Thanks for the feedback. More on this soon.

#1 Dinosaur said...

Hospital medicine is on a role.

Interesting malaproprism (wrong word.) I'm pretty sure you meant "...on a ROLL", as is rolling right along, picking up momentum, and not "role" as in "role playing", or trying to play something you're not.

Subliminal message here? Hm.

R. W. Donnell said...

Thanks, dinosaur. I fixed it. Gotta watch those malapropisms. NOt the first time it's happened. Probably won't be the last.

Joe Miller, SHM said...

As a senior executive with the Society of Hospital Medicine (SHM) I would like to respond to your concern that SHM is not making career satisfaction a priority. SHM has had a Career Satisfaction Task Force for over 4 years. The Task Force’s charge is

“to promote success and longevity in a career in hospital medicine. The Task Force will examine factors in career satisfaction and burnout with the aim of (1) articulating key work conditions that promote success and wellness in the practice of hospital medicine, (2) providing resources to hospitalists to enhance career satisfaction, and (3) promoting future research into career satisfaction and burnout in hospital medicine.”

The Task Force has conducted Career Satisfaction Workshops at SHM’s last three Annual Meetings. In addition, a Career Satisfaction White Paper has been prepared that provides concrete, practical advice to both hospitalists and hospitalist leaders. It is available for free download to SHM members and non-members at the following link:

Finally, the Task Force is seeking to develop a “survey service” using a survey instrument (PWS) that has been validated in several landmark national studies. Hospitalists and hospitalist leaders will be able to compare their career satisfaction to that of other programs across the country. Acknowledging that physician satisfaction is a difficult topic to address, the Task Force is attempting to develop and apply some thoughtful, practical tools to the specialty.

SHM has surveyed other medical professional societies as to their efforts with regard to career satisfaction and it appears that SHM’s initiatives make it a leader among the specialties.

Joseph A. Miller

R. W. Donnell said...

Thanks for that imformation. I hope the Task Force addresses the fact that hospitalists are being asked to do too many things. I don't see this concern at SMH meetings, but I'll definitely take a look at the white paper.