Archive for October 2014

The Best Possible Day

by Dr. Howard Epstein MD, FHM I have practiced medicine for more than 20 years now, and it still amazes me how poorly the health care system meets the needs of those nearing end of life. The chance to do better and help others do so led me to become a hospice and palliative medicine physician, start a hospital-based palliative care program at Regions Hospital in St. Paul, chair the former Society of Hospital Medicine (SHM) Palliative Care Task Force,  serve on the SHM Board, and as President of the Minnesota Network of Hospice & Palliative Care. Last April, I was honored to be invited to speak on Choosing Wisely® at a triple aim health improvement conference in Columbia, South Carolina. As often happens at these events, they hosted a faculty and sponsor dinner with cocktails, handshakes, and schmoozing followed by dinner. How fortunate I was to score a seat…

7-on/7-off Is Growing, but Will We Be Asked to Peel It back?

The new SHM/MGMA State of Hospital Medicine (SOHM) report has just been released and as always it is full of interesting nuggets about the way hospital medicine is practiced these days in our country. One fact/trend caught my eye. The number of 7-on/7-off scheduled programs is climbing. In the past two years, we have seen a rise from 41.9% in 2012 to now 53.8% of programs are working their schedule this way. I personally have always been a fan of win-win solutions and 7-on/7-off to me has been the mother of win-win solutions in hospital medicine. It’s a win for many doctors (but not all) in allowing blocks of time off to either focus on personal pursuits, or to manage your quality/safety/educational side of your job at your own pace and schedule. It’s a win for hospitals because it guarantees a steady presence of invested doctors ready to care for…

What’s going on?

I talk a lot with different physicians about integrating NP/PA providers into their practice.  I am frequently astonished by the level of reluctance, resistance and downright animosity from these physicians.  Many times a doctor will have a medical "horror story" with the NP/PA  playing  the  villain.  One bad encounter or event seems to  justify a complete rejection of the many positive attributes and contributions of these NP/PA providers, and negates the many studies that reveal comparable and safe care and outcomes.  Besides I have a few "horror stories" of my own, and guess who the villains are? I'm always mystified by this.  I practice in a very supportive environment.  This culture extends from the hospital leadership, both medical and nursing, which seems to understand what we do and values the care we provide, to my section leadership, to the consulting services, to the RNs I work with and most of…

THe AAFP just spent $20M over five years to promote family medicine…

Think about that.  The equivalent move for SHM would be $2-3M to promote HM.  That's a lot of dough. Organizations have tough choices.  Does SHM spend their money on research grants, exam recertification programs, services to members, advocacy in DC, or developing communications platforms (like the blog)?  You may not know it, but choices like these keep board leaders awake at night.  We just pay our dues and annual meeting fees. I highlight the AAFP (collaborative) spend for one reason.  In 2019, how will AAFP measure success?  Will market forces squash what in hindsight, might be too meager a sum and offensive.  Other organizations burn through those sums of cash in half the time or less, and they already have their captured interests established in the right places  (think bringing a knife to a gun fight). We'll see, but family practice has a tough hill to climb.  I will be pulling for them,…

A Day in the Life of a Young Hospitalist

by Joshua Allen-Dicker, MD, MPH I am a young hospitalist who is 16 months into my role at an urban academic medical center. Unlike many of my more-senior colleagues who found their way to hospital medicine by circumstance, luck, or as a second-career path, I have been planning my career in hospital medicine since the beginning of my residency training. The things that drew me to hospital medicine as a trainee—its emphasis on problem-solving, strong communication skills, teamwork and leadership—are still what excite me each day as a young hospitalist. When friends, family and patients ask me about my job, I often tell them about these passions and describe what a “day in the life” looks like for me. While no two days are ever exactly the same in hospital medicine, the following is an account of a Wednesday I had last month. I arrive at the large office I…
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