Career Development

Building a Practice that People Want to be Part Of

As those of you who have followed my posts on this blog know, I’ve been spending a lot of time mulling over issues related to hospitalist job satisfaction and career sustainability. I’ve written about concrete things like re-thinking hospitalist work schedules and minimizing low-value interruptions, as well as more abstract concepts like assessing your group’s “gross happiness index.” My fascination with these issues and my concern about their potential impact on the specialty of hospital medicine eventually led John and me, as course directors, to the theme of this year’s practice management pre-course at HM17 – Practice Management Success Strategies: Building a Practice That People Want to Be Part Of. Perhaps, like me, you are interested in digging deeper into matters of career satisfaction and sustainability. Or perhaps you are simply focused on the more mundane struggle just to recruit and retain enough qualified providers for your group. In either…

We Go to the Altar Together

Last month, I wrote about onboarding and the important responsibility that everyone associated with a hospitalist program has to ensure that each new provider quickly comes to believe he or she made a terrific choice to join the group. Upon reflection, it seems important to address the other side of this equation. I’m talking about the responsibilities that each candidate has when deciding whether to apply for a job, to interview, and to accept or reject a group’s offer. The relationship between a hospitalist and the group he or she is part of is a lot like a marriage. Both parties go to the altar together, and the relationship is most likely to be successful when both enter it with their eyes open, having done their due diligence, and with an intention to align their interests and support each other. Here are some things every hospitalist should be thinking about as…

Is Patient-Centered Care Bad for Resident Education? #JHMChat Explores #meded & #ptexp

The term “patient-centered” has become a healthcare buzzword and was certainly popularized by the creation of the patient-centered medical home in ambulatory care. In the inpatient world, patient-centered rounds symbolizes this effort to improve patient experience and is the subject of a new study in this month’s Journal of Hospital Medicine, which we'll discuss on next Monday's #JHMChat at 9 p.m. EST on Twitter. In a randomized trial, Brad Monash and UCSF colleagues explored the impact of patient-centered rounds on patient experience. Patient-centered rounds was a bundle of 5 evidence-based practices: 1) pre-rounds huddle; 2) bedside rounds; 3) nurse integration; 4) real-time order entry; and 5) whiteboard updates. The control group continued with routine practice of attending rounds. The study was impressive for several reasons, but one in particular caught my attention – an army of 30 pre-med students volunteered to be observers (and also get shadowing experience?) to monitor…

The Upside of Anger

Recently, I heard from a number of NP/PA providers in response to Dr. John Nelson’s editorial published in the January edition of The Hospitalist. In the editorial, Dr. Nelson refers to an article in the Journal of Clinical Outcomes. The single-site study compared routine versus expanded PA care in a community hospital, and the intervention group delivered a three percent reduction in costs with similar measures in quality. In discussing the results, Dr. Nelson concluded that this article showed that, with proper planning and infrastructure, care delivered primarily by PAs can go "OK". Many of you took offense at the lack of enthusiasm or support for the model studied and felt that it demonstrated poor understanding for the migration of roles for NP/PA providers in hospital medicine. So who is right? Was it merely one tiny study that showed “OK” results? Or was it an impactful article that demonstrates the…

Equal Time for Hospital Execs

Last month, I wrote a letter to hospital executives, urging them to deliberately invest their own personal time and effort in fostering hospitalist wellbeing. I suggested several actions that leaders can take to enhance hospitalist job satisfaction and reduce the risk of burnout and turnover. Following publication of that post, I heard from several hospital executives and was pleasantly surprised that they all responded positively to my message. Several execs told me that they gained valuable new insights about their hospitalists’ challenges and needs or that they planned to take action on one or more of my suggestions that had never occurred to them before.  Especially useful to them was the idea of a hospitalist “hierarchy of needs,” in which basics such as well-designed work (including adequate staffing), belonging, and esteem must be addressed before expecting hospitalists to undertake “self-actualizing” work, such as engagement in organizational performance improvement initiatives. Their…