Tuesday, May 05, 2009

DB posts a hospitalist’s lament

DB, the blogger at Medical Rants, posts some comments from a frustrated hospitalist:

I am a hospitalist and respect outpatient internists and family practitioners too much to consider myself as noble as them. But I am an internist and today, a pain management specialist paged me for a consult, I mean, comanagement, I mean, “take care of all the paperwork under the guise of controlling her already under control chronic illnesses”.

DB tells of another hospitalist who had to do some job hopping before he found professional satisfaction:

At Internal Medicine 2009, I ran into a former resident (from the 1980s when I was a program director.) I asked him about his career, and he told me of 15 years in private practice. He then left to become a hospitalist. He is finally happy in his 3rd hospitalist job.

These stories illustrate problems in the hospitalist movement which I’ve written about many times before. Here are the main points:

The original appeal of hospital medicine was that it was an opportunity for a clinician to focus on and ascend the unique clinical learning curve of hospital based internal medicine.

But because the role has not been carefully defined it is morphing into that of a jack-of-all-trades house doctor, a career few of us signed up for.

Uncritical enthusiasm for some nebulous notion of “comanagement” has blurred the boundaries of responsibility among hospitalists and other specialists and forced hospitalists into clinical encounters way beyond the scope of their training, pushing them out of their comfort zones and creating liability concerns.

Under the rubric of comanagement some hospitalist programs are being made to function as H&P and discharge planning services in which they perform the clerical scut work on surgical and subspecialty patients who have no need of their clinical expertise.

Hospitalists are increasingly coming to be viewed as administrative and business solutions more than clinicians. Not exactly what a candidate looks for in a career.

These factors may increase the risk of burnout, increase turnover in hospitalist programs and exacerbate the shortage in the work force.

Given this climate candidates who seek hospitalist jobs are increasingly likely to be short timers---docs who are moonlighting, are between jobs or are waiting to grab a fellowship.

DB goes on to say:

I have cautioned frequently in essays that the title does not define the job. I know of outstanding hospitalist jobs, and I know of jobs that represent semi-advanced resident positions.

Indeed. If you’re looking at hospitalist jobs ask tough questions. Find out what comanagement really means in the program you’re considering. In today’s market you can be picky. There are some good programs out there that will provide you with professional satisfaction. And there are some that will burn you out.

He concludes with:

Internists tend to say yes. We become the "least common denominator" for patient care - we get the patients who others "refuse." We are the nice guys and gals.

The best hospitalist programs set clear limits on their responsibilities. As hospital medicine evolves, it needs strong leadership based upon sound principles.

Does hospital medicine have the leadership it needs to address these issues? Hospital Medicine 2009, our national meeting, is about to start. We’ll see what our leaders have to say. If Hospital Medicine 2008 is any indication I’m not optimistic.

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