Troy Ahlstrom writes…

Our group has partnered with facilities that have need for Hospitalists capable of the fullest spectrum of hospital-based patient care.  The ICUs are busy.  Step-down and med-surg floors turn patients over quickly.  A steady stream of stress tests rolls through non-invasive cardiology.  But they’re not all busy at the same time… excepting the occasions when they really are all busy concurrently.  Meanwhile, everyone’s sicker.  It seems acuity doubles every two years matching Moore’s Law.  Yet, there’s no Intel, Apple, Microsoft, Oracle, or HP inventing increasingly capable providers to meet the pressing need.

Much to the contrary, I find myself wondering, “Are we actually training physicians to be less adaptable?” (more…)

John Nelson writes . . .

Recently one of our blog readers wrote in with the following question for our blogging team:

Our small general IM group (3) is interested in starting a hospitalist group for our small community hospital (50bed) because neither our group or our family practice groups can recruit without one. There are no hospitals our size that have hospitalists. Where do we start?

My blogging colleagues may have additional thoughts on this subject, but I’ll get the ball rolling with the following (more…)

Mike Radzienda writes…

A man presented with urinary retention and a UTI. He also complained  of mid -thoracic spine pain that was sub-acute. His PMD treated him with antibiotics but his symptoms persisted. He had worsening urinary symptoms and developed lower extremity weakness. On presentation to the hospital, he was admitted to the neurology service and was found to have spastic paralysis of his lower extremities. Exam at that time showed marked upper motor neuron sign in his legs. A brain MRI was read as normal. An MRI of the spine revealed no evidence of spinal cord disease but the thoracic images were not interpretable due to motion artifact. The neurologist commented in his note that the MRI of the spine was normal. The following day the MRI was redone and reported out as, “a retro-pulsed disc is compressing the spinal cord at T-8 and there is enhancement in the anterior portion of the cord adjacent to the area of cord flattening.”

Subsequently, the team never (more…)

Troy Ahlstrom writes…

My wife and I managed to get away for a weekend this spring.  It’s something we hadn’t done for years with everything else going on, and we were both looking forward to it.

I made reservations at a nice resort about an hour away from home.  They had a romantic getaway package with a nice room, champagne, and chocolate covered strawberries.  I reserved the package and off we went.  We had a great time, but there was a small glitch.  (more…)

Mike Radzienda writes…

Over the past ten years, hospitals have been bombarded with external regulatory mandates aimed at improving quality of care.  Amidst these challenges, payer mixes have dwindled and operating margins have narrowed.  This has left hospitals few resources for implementing thoughtful and robust quality improvement infrastructures.  As a result, hospital COOs struggle to develop meaningful partnerships with physicians who can effectively advance the local QI agenda.

Due to a dearth of availability and leadership in the traditional physician staff model, hospital administrators have taken on this QI agenda. This tactic has failed (more…)

Mike Radzienda writes…

Hospitalists’ certitude number one-hundred-one: “It is never a good thing to be speaking with the chairman of Emergency Medicine at 1:00 AM on a Monday.”

And there I was trying to explain why the admitting medical officer hadn’t returned a page to the emergency department (ED) for thirty minutes; and why, when he did, he seemed “so overwhelmed.”

This was not flu pandemic season; it was just one of those busy “full moon” nights. Our hospitalists (more…)

John Nelson writes…

As I’ve written before (here and here), nearly every specialty in medicine is continuing to turn to the hospitalist model.  I’m aware of community, and in many cases academic, hospitalist practices in nearly every specialty in medicine including surgical (general surgery) hospitalists, orthopedic hospitalist, and more.  The list includes psychiatry, obstetrics, gastroenterology, infectious disease, and on and on.  Someone once told me he knew of a dermatology hospitalist somewhere. (I’d love to talk to this doctor, but never got any details and wonder if this was a myth or a very loose interpretation of what makes one a hospitalist.)

How can we document this growth?
(more…)

Jack Percelay writes…

Do you get paid holiday time off as a hospitalist? Or are you told that everyday you are not working is time off, just like the kids who ask, “If there’s a Mothers’ Day and a Fathers’ Day, why isn’t there a Children’s Day?” and are told,  “Everyday is Children’s Day.”

As is true for most of my pediatric hospitalist colleagues, I am an employee of the hospital/Department of Pediatrics.  I am not an independent contractor, do not own my own group, nor am I employed by a larger Hospital Medicine company.  I love my work, work hard, and expect to work my fair share of nights and weekends.  I respect my general pediatrician colleagues, but prefer the inpatient setting to the outpatient setting.  (Guess I have too much ADD to treat it.)  I value their work, and value mine equally.   Their patient volume is higher with lower acuity.  My acuity is higher with lower volume.  In an ideal world, I would say that our work is of equal value and we should be equally compensated.

So, leaving out the night call and weekend call issues aside for now (I’d go crazy answering calls overnight or on the weekend in the middle of flu season), let’s examine the question of holidays. (more…)

John Nelson writes…

Compensation and production surveys generally set the standard on physician compensation and production.  The longer I spend looking at survey methodologies and results, the more I’m convinced that there are a lot of devils in the details that may misled many people who rely on these surveys.  As an example, I’ve adapted below something originally written by, Leslie Flores, who is the director of SHM’s Practice Management Institute and my consulting colleague.  What follows was written in response to a question about the differences in the SHM and MGMA surveys of hospitalist productivity and compensation, especially related to their results in the South.  It serves an example of the complexity of interpreting the surveys. (more…)

John Nelson writes…

In my work with practices around the country, I’m struck by the wide variation in how each practice defines what constitutes full-time work.  This is a pretty big deal for reasons that are obvious and not so obvious.

Say you’re in a practice that defines full-time as 181 shifts annually.  The practice across town provides higher compensation and also requires 181 shifts annually.  The other practice gets a better deal, right?  (more…)