Richard Quinn

Electronic decision support significantly improves VTE prophylaxis and hospital-acquired VTE rates, according to a new study in the Journal of Hospital Medicine.

The report, "Improving Hospital Venous Thromboembolism Prophylaxis With Electronic Decision Report," saw overall medical service prophylaxis rise to 82.1% from 61.9% (P<0.001) and pharmacologic VTE prophylaxis increase to 74.5% from 59% (P<0.001).

"Healthcare leaders talk about information technology (IT) as a means toward effecting improvements in quality and patient safety and, most of the time, they view that and discuss that in terms of the actual IT system being implemented," says lead author Rohit Bhalla, MD, MPH, associate professor of clinical medicine at Albert Einstein College of Medicine in New York City. "What our intervention really got to was once you've implemented an IT system ... how can it be modified, vis-à-vis decision support, so that it provides an even better result than you get with the product that comes out of the box."

Tailoring a health IT system to improve outcomes requires interdisciplinary work that includes quality officers, physicians, IT staff, and programmers. Hospitalist and fellow author Jason Adelman, MD, MS, patient safety officer at Montefiore Medical Center in the Bronx, N.Y., where the study was conducted, says that the research can help generate future buy-in from physicians who don't value electronic decision support tools.

It can "ease the swallowing of the bitter pill to know that it really makes a difference," Dr. Adelman says. "Don't be up in arms when you're forced to do something a little bit extra, because it really works."

 

Visit our website for more information about health information technology.

 

Electronic decision support significantly improves VTE prophylaxis and hospital-acquired VTE rates, according to a new study in the Journal of Hospital Medicine.

The report, "Improving Hospital Venous Thromboembolism Prophylaxis With Electronic Decision Report," saw overall medical service prophylaxis rise to 82.1% from 61.9% (P<0.001) and pharmacologic VTE prophylaxis increase to 74.5% from 59% (P<0.001).

"Healthcare leaders talk about information technology (IT) as a means toward effecting improvements in quality and patient safety and, most of the time, they view that and discuss that in terms of the actual IT system being implemented," says lead author Rohit Bhalla, MD, MPH, associate professor of clinical medicine at Albert Einstein College of Medicine in New York City. "What our intervention really got to was once you've implemented an IT system ... how can it be modified, vis-à-vis decision support, so that it provides an even better result than you get with the product that comes out of the box."

Tailoring a health IT system to improve outcomes requires interdisciplinary work that includes quality officers, physicians, IT staff, and programmers. Hospitalist and fellow author Jason Adelman, MD, MS, patient safety officer at Montefiore Medical Center in the Bronx, N.Y., where the study was conducted, says that the research can help generate future buy-in from physicians who don't value electronic decision support tools.

It can "ease the swallowing of the bitter pill to know that it really makes a difference," Dr. Adelman says. "Don't be up in arms when you're forced to do something a little bit extra, because it really works."

 

Visit our website for more information about health information technology.

 

Electronic decision support significantly improves VTE prophylaxis and hospital-acquired VTE rates, according to a new study in the Journal of Hospital Medicine.

The report, "Improving Hospital Venous Thromboembolism Prophylaxis With Electronic Decision Report," saw overall medical service prophylaxis rise to 82.1% from 61.9% (P<0.001) and pharmacologic VTE prophylaxis increase to 74.5% from 59% (P<0.001).

"Healthcare leaders talk about information technology (IT) as a means toward effecting improvements in quality and patient safety and, most of the time, they view that and discuss that in terms of the actual IT system being implemented," says lead author Rohit Bhalla, MD, MPH, associate professor of clinical medicine at Albert Einstein College of Medicine in New York City. "What our intervention really got to was once you've implemented an IT system ... how can it be modified, vis-à-vis decision support, so that it provides an even better result than you get with the product that comes out of the box."

Tailoring a health IT system to improve outcomes requires interdisciplinary work that includes quality officers, physicians, IT staff, and programmers. Hospitalist and fellow author Jason Adelman, MD, MS, patient safety officer at Montefiore Medical Center in the Bronx, N.Y., where the study was conducted, says that the research can help generate future buy-in from physicians who don't value electronic decision support tools.

It can "ease the swallowing of the bitter pill to know that it really makes a difference," Dr. Adelman says. "Don't be up in arms when you're forced to do something a little bit extra, because it really works."

 

Visit our website for more information about health information technology.

 

An author of a new study associating the hypnotic zolpidem (Ambien) with higher rates of patient falls says hospitalists should keep the popular drug’s risks front of mind.

The retrospective cohort study in the Journal of Hospital Medicine, “Zolpidem is Independently Associated with Increased Risk of Inpatient Falls,” found that the rate of falls increased nearly six times among patients taking the sleep agent. The research team at the Center for Sleep Medicine at the Mayo Clinic in Rochester, N.Y., calculated one additional fall for every 55 admitted patients who were administered the treatment.

“What this says to me is if one is going to use zolpidem, you have to be aware you’re increasing the risk of fall,” says sleep specialist Timothy Morgenthaler, MD, the Mayo Clinic’s chief patient officer. “Knowledgeable of that, one ought to consider whether there are alternatives or whether the risks outweigh the goal in that setting.”

Dr. Morgenthaler says zolpidem is the most commonly prescribed hypnotic at his hospital, and believes it to be the most common treatment in the U.S. He began studying the issue after nurses reported that it appeared patients were falling after taking the agent. In response to the study, Mayo Clinic removed zolpidem from many of its admission order sets and attempted to help improve patient sleep via other methods, including noise reduction.

“We haven’t removed it from our formulary, and I’m not saying it doesn’t have a role in some points,” he says, “but rather than encouraging it as an option in patients being admitted into the patient, we’re choosing instead now to encourage nonpharmacologic sleep enhancements.” 

Visit our website for more information about HM’s approach to patient falls.

 

An author of a new study associating the hypnotic zolpidem (Ambien) with higher rates of patient falls says hospitalists should keep the popular drug’s risks front of mind.

The retrospective cohort study in the Journal of Hospital Medicine, “Zolpidem is Independently Associated with Increased Risk of Inpatient Falls,” found that the rate of falls increased nearly six times among patients taking the sleep agent. The research team at the Center for Sleep Medicine at the Mayo Clinic in Rochester, N.Y., calculated one additional fall for every 55 admitted patients who were administered the treatment.

“What this says to me is if one is going to use zolpidem, you have to be aware you’re increasing the risk of fall,” says sleep specialist Timothy Morgenthaler, MD, the Mayo Clinic’s chief patient officer. “Knowledgeable of that, one ought to consider whether there are alternatives or whether the risks outweigh the goal in that setting.”

Dr. Morgenthaler says zolpidem is the most commonly prescribed hypnotic at his hospital, and believes it to be the most common treatment in the U.S. He began studying the issue after nurses reported that it appeared patients were falling after taking the agent. In response to the study, Mayo Clinic removed zolpidem from many of its admission order sets and attempted to help improve patient sleep via other methods, including noise reduction.

“We haven’t removed it from our formulary, and I’m not saying it doesn’t have a role in some points,” he says, “but rather than encouraging it as an option in patients being admitted into the patient, we’re choosing instead now to encourage nonpharmacologic sleep enhancements.” 

Visit our website for more information about HM’s approach to patient falls.

 

An author of a new study associating the hypnotic zolpidem (Ambien) with higher rates of patient falls says hospitalists should keep the popular drug’s risks front of mind.

The retrospective cohort study in the Journal of Hospital Medicine, “Zolpidem is Independently Associated with Increased Risk of Inpatient Falls,” found that the rate of falls increased nearly six times among patients taking the sleep agent. The research team at the Center for Sleep Medicine at the Mayo Clinic in Rochester, N.Y., calculated one additional fall for every 55 admitted patients who were administered the treatment.

“What this says to me is if one is going to use zolpidem, you have to be aware you’re increasing the risk of fall,” says sleep specialist Timothy Morgenthaler, MD, the Mayo Clinic’s chief patient officer. “Knowledgeable of that, one ought to consider whether there are alternatives or whether the risks outweigh the goal in that setting.”

Dr. Morgenthaler says zolpidem is the most commonly prescribed hypnotic at his hospital, and believes it to be the most common treatment in the U.S. He began studying the issue after nurses reported that it appeared patients were falling after taking the agent. In response to the study, Mayo Clinic removed zolpidem from many of its admission order sets and attempted to help improve patient sleep via other methods, including noise reduction.

“We haven’t removed it from our formulary, and I’m not saying it doesn’t have a role in some points,” he says, “but rather than encouraging it as an option in patients being admitted into the patient, we’re choosing instead now to encourage nonpharmacologic sleep enhancements.” 

Visit our website for more information about HM’s approach to patient falls.

 

Applying the HM model to specialties that can dedicate themselves to managing inpatients could improve care efficiency, says the coauthor of a new report from the American Hospital Association's (AHA) Physician Leadership Forum.

The 20-page report, "Creating the Hospital of the Future: The Implications for Hospital-Focused Physician Practice [PDF]," codified a daylong summit of hospitalist leaders and hospital administrators following the annual Health Forum/AHA Leadership Summit last July in San Francisco. SHM helped organize the meeting, which focused on the growing role and importance of "hyphenated hospitalists."

"With the hospitalist movement, it's critical that there is coordination between the inpatient and the outpatient world … but also inpatient-wise, there should be some coordination of services between the various specialties that are dedicated to the hospital," says John Combes, MD, AHA senior vice president. "We have an opportunity here, as more and more subspecialties develop hospital-based and hospital-focused practices, to construct it right."

Dr. Combes says the model is not applicable to all specialties, but early adoption by fields including OBGYN, orthopedics, neurology, and surgery is a good sign. Hospitalist could look at forming large, multispecialty groups to bring all hospital-focused programs under one proverbial roof. "So there's not only coordination at the hospital level, but also at the group level," he adds.

The continued growth of specialty hospitalists might hinge on whether research shows that the approach improves patient outcomes.

"The jury is out on that right now," Dr. Combes says. "As hospitalists get better at defining what their role is within the inpatient setting—particularly around care coordination, care improvement, efficiency, reduction of unnecessary procedures and testing—we'll be able to document more value."

 

Visit our website for more information about hospital-based medical practices.

 

Applying the HM model to specialties that can dedicate themselves to managing inpatients could improve care efficiency, says the coauthor of a new report from the American Hospital Association's (AHA) Physician Leadership Forum.

The 20-page report, "Creating the Hospital of the Future: The Implications for Hospital-Focused Physician Practice [PDF]," codified a daylong summit of hospitalist leaders and hospital administrators following the annual Health Forum/AHA Leadership Summit last July in San Francisco. SHM helped organize the meeting, which focused on the growing role and importance of "hyphenated hospitalists."

"With the hospitalist movement, it's critical that there is coordination between the inpatient and the outpatient world … but also inpatient-wise, there should be some coordination of services between the various specialties that are dedicated to the hospital," says John Combes, MD, AHA senior vice president. "We have an opportunity here, as more and more subspecialties develop hospital-based and hospital-focused practices, to construct it right."

Dr. Combes says the model is not applicable to all specialties, but early adoption by fields including OBGYN, orthopedics, neurology, and surgery is a good sign. Hospitalist could look at forming large, multispecialty groups to bring all hospital-focused programs under one proverbial roof. "So there's not only coordination at the hospital level, but also at the group level," he adds.

The continued growth of specialty hospitalists might hinge on whether research shows that the approach improves patient outcomes.

"The jury is out on that right now," Dr. Combes says. "As hospitalists get better at defining what their role is within the inpatient setting—particularly around care coordination, care improvement, efficiency, reduction of unnecessary procedures and testing—we'll be able to document more value."

 

Visit our website for more information about hospital-based medical practices.

 

Applying the HM model to specialties that can dedicate themselves to managing inpatients could improve care efficiency, says the coauthor of a new report from the American Hospital Association's (AHA) Physician Leadership Forum.

The 20-page report, "Creating the Hospital of the Future: The Implications for Hospital-Focused Physician Practice [PDF]," codified a daylong summit of hospitalist leaders and hospital administrators following the annual Health Forum/AHA Leadership Summit last July in San Francisco. SHM helped organize the meeting, which focused on the growing role and importance of "hyphenated hospitalists."

"With the hospitalist movement, it's critical that there is coordination between the inpatient and the outpatient world … but also inpatient-wise, there should be some coordination of services between the various specialties that are dedicated to the hospital," says John Combes, MD, AHA senior vice president. "We have an opportunity here, as more and more subspecialties develop hospital-based and hospital-focused practices, to construct it right."

Dr. Combes says the model is not applicable to all specialties, but early adoption by fields including OBGYN, orthopedics, neurology, and surgery is a good sign. Hospitalist could look at forming large, multispecialty groups to bring all hospital-focused programs under one proverbial roof. "So there's not only coordination at the hospital level, but also at the group level," he adds.

The continued growth of specialty hospitalists might hinge on whether research shows that the approach improves patient outcomes.

"The jury is out on that right now," Dr. Combes says. "As hospitalists get better at defining what their role is within the inpatient setting—particularly around care coordination, care improvement, efficiency, reduction of unnecessary procedures and testing—we'll be able to document more value."

 

Visit our website for more information about hospital-based medical practices.

 

Competition is cutthroat in the world of locum tenens physicians. As agencies fight to hire hospitalists and other subspecialists they can assign to positions across the nation, those temporary staffers become a commodity in and of themselves.

Dr. Mohammed is one of those hard assets.

An agency physician placed by Barton Associates in a mid-Atlantic hospital, he did not want to disclose his full name because he is transitioning to full-time locums from his current, full-time position, and he doesn’t want to alienate colleagues by talking publicly of his plans to leave. Barton Associates does not want his name disclosed due to the time, effort, and resources that the firm has invested in him. Barton has been shepherding Dr. Mohammed through the licensing process.

Dr. Mohammed’s reason for transitioning to full-time locum work is simple: flexibility.

“With locums, you have a variety of choices,” he says. “When you’re going into your first permanent job interview, you’re just desperate. You don’t know how the system functions. ... If I would have known about the locum opportunity before I started doing the permanent job, then I would have taken the locums right away.”

Dr. Mohammed, whose ultimate goal is to work for a government facility in South Florida, says he is excited about the opportunities locums work offers. He can move around the country with little difficulty and gain exposure in urban settings, rural hospitals, and everything in between.

And, of course, there is the money. Locum physicians can gross 30% to 40% more per year for the same number of shifts as a typical FTE hospitalist.

“Definitely income─there’s no question,” Dr. Mohammed adds. “When you’re coming out of residency, you don’t have very good income. Some of us that have school debt, family responsibilities—you just want to take care of the financial part.”

Richard Quinn is a freelance writer in New Jersey.

Competition is cutthroat in the world of locum tenens physicians. As agencies fight to hire hospitalists and other subspecialists they can assign to positions across the nation, those temporary staffers become a commodity in and of themselves.

Dr. Mohammed is one of those hard assets.

An agency physician placed by Barton Associates in a mid-Atlantic hospital, he did not want to disclose his full name because he is transitioning to full-time locums from his current, full-time position, and he doesn’t want to alienate colleagues by talking publicly of his plans to leave. Barton Associates does not want his name disclosed due to the time, effort, and resources that the firm has invested in him. Barton has been shepherding Dr. Mohammed through the licensing process.

Dr. Mohammed’s reason for transitioning to full-time locum work is simple: flexibility.

“With locums, you have a variety of choices,” he says. “When you’re going into your first permanent job interview, you’re just desperate. You don’t know how the system functions. ... If I would have known about the locum opportunity before I started doing the permanent job, then I would have taken the locums right away.”

Dr. Mohammed, whose ultimate goal is to work for a government facility in South Florida, says he is excited about the opportunities locums work offers. He can move around the country with little difficulty and gain exposure in urban settings, rural hospitals, and everything in between.

And, of course, there is the money. Locum physicians can gross 30% to 40% more per year for the same number of shifts as a typical FTE hospitalist.

“Definitely income─there’s no question,” Dr. Mohammed adds. “When you’re coming out of residency, you don’t have very good income. Some of us that have school debt, family responsibilities—you just want to take care of the financial part.”

Richard Quinn is a freelance writer in New Jersey.

Competition is cutthroat in the world of locum tenens physicians. As agencies fight to hire hospitalists and other subspecialists they can assign to positions across the nation, those temporary staffers become a commodity in and of themselves.

Dr. Mohammed is one of those hard assets.

An agency physician placed by Barton Associates in a mid-Atlantic hospital, he did not want to disclose his full name because he is transitioning to full-time locums from his current, full-time position, and he doesn’t want to alienate colleagues by talking publicly of his plans to leave. Barton Associates does not want his name disclosed due to the time, effort, and resources that the firm has invested in him. Barton has been shepherding Dr. Mohammed through the licensing process.

Dr. Mohammed’s reason for transitioning to full-time locum work is simple: flexibility.

“With locums, you have a variety of choices,” he says. “When you’re going into your first permanent job interview, you’re just desperate. You don’t know how the system functions. ... If I would have known about the locum opportunity before I started doing the permanent job, then I would have taken the locums right away.”

Dr. Mohammed, whose ultimate goal is to work for a government facility in South Florida, says he is excited about the opportunities locums work offers. He can move around the country with little difficulty and gain exposure in urban settings, rural hospitals, and everything in between.

And, of course, there is the money. Locum physicians can gross 30% to 40% more per year for the same number of shifts as a typical FTE hospitalist.

“Definitely income─there’s no question,” Dr. Mohammed adds. “When you’re coming out of residency, you don’t have very good income. Some of us that have school debt, family responsibilities—you just want to take care of the financial part.”

Richard Quinn is a freelance writer in New Jersey.

Listen to Robert Bessler, CEO of Sound Physicians, discuss the importance of locum agencies.

Listen to Brent Bormaster, of StaffCare, discuss expectations for filling an open hospitalist position and what to look for in a locum agency.

 

Listen to Robert Bessler, CEO of Sound Physicians, discuss the importance of locum agencies.

Listen to Brent Bormaster, of StaffCare, discuss expectations for filling an open hospitalist position and what to look for in a locum agency.

 

Listen to Robert Bessler, CEO of Sound Physicians, discuss the importance of locum agencies.

Listen to Brent Bormaster, of StaffCare, discuss expectations for filling an open hospitalist position and what to look for in a locum agency.

 

There are 10 industry-changing recommendations in the recent Institute of Medicine (IOM) report “Best Care at Lower Cost: The Path to Continuously Learning Health Care in America.” Suggestions include reforming payment, adopting digital infrastructure, and improving the continuity of care. And to Brent James, MD, all of those recommendations are areas in which hospitalists can help lead healthcare from fee-for-service to an organized-care model.

Dr. James, executive director of the Institute for Health Care Delivery Research and chief quality officer at Intermountain Healthcare in Salt Lake City, says hospitalists can be linchpins to that hoped-for sea change because the specialty’s growth the past 15 years shows that physicians taking a collaborative, evidence-based approach to patient care can improve outcomes and lower costs.

“In some sense, the hospitalist movement triggered [the move to organized care],” says Dr. James, one of the IOM report’s authors. “You started to have teams caring for inpatients in a coordinated way. Pieces started to kind of fall into place underneath it. So I regard this as … [hospitalists] coming into their own, their vision of the future starting to really take hold.”

The report estimates the national cost of unnecessary or wasteful healthcare at $750 billion per year. Published in September, the report was crafted by a nationwide committee of healthcare leaders, including hospitalist and medical researcher David Meltzer, MD, PhD, chief of University of Chicago’s Division of Hospital Medicine and director of the Center for Health and Social Sciences in Chicago.

Dr. Meltzer says that for a relatively young specialty, hospitalists have been “remarkably forward-looking.” The specialty, in his view, has embraced teamwork, digital infrastructure, and quality initiatives. As the U.S. healthcare system evolves, he notes, HM leaders need to keep that mentality. Hospitalists are confronted daily with a combination of sicker patients and more treatment options, and making the right decisions is paramount to a “learning healthcare system,” Dr. Meltzer adds.

“As the database of options grows, decision-making becomes more difficult,” he says. “We have an important role to play in how to think about trying to control costs.”

Gary Kaplan, MD, FACP, FACMPE, FACPE, chairman and chief executive officer of Virginia Mason Health System in Seattle, agrees that HM’s priorities dovetail nicely with reform efforts. He hopes the IOM report’s findings will serve as a springboard for hospitalists to further spearhead improvements.

In particular, Dr. Kaplan notes that healthcare delivery organizations should develop, implement, and fine-tune their “systems, engineering tools, and process-improvement methods.” Such changes would help “eliminate inefficiencies, remove unnecessary burdens on clinicians and staff, enhance patient experience, and improve patient health outcomes,” he says.

“The hospitalists and the care teams with which the hospitalist connects are very critical to streamlining operations,” Dr. Kaplan adds.

Dr. James, who has long championed process improvement as the key to improved clinical outcomes, says that extending the hospitalist model throughout healthcare can only have good results. He preaches the implementation of standardized protocols and sees hospitalists as natural torchbearers for the cause.

 

“When you start to focus on process—our old jargon for it was ‘continuum of care’—it forces you to patient-centered care,” he says. “Instead of building your care around the physicians, or around the hospital, or around the technology, you build the care around the patient.”

Dr. James has heard physicians say protocols are too rigid and do not improve patient care. He disagrees—vehemently.

“It’s not just that we allow, or even that we encourage, we demand that you modify [the protocol] for individual patient needs,” he says. “What I have is a standard process of care. That means that you don’t have to bird-dog every little step. I take my most important resource—a trained, expert mind—and focus it on that relatively small set of problems that need to be modified. We’ve found that it massively improves patient outcomes.”

Many of the IOM report’s complaints about unnecessary testing, poor communication, and inefficient care delivery connect with the quality, patient-safety, and practice-management improvements HM groups already push, Dr. Kaplan adds. To advance healthcare delivery’s evolution, hospitalists should view the task of reform as an opportunity, not a challenge.

“There are very powerful opportunities for the hospitalist now to have great impact,” he says. “To not just be the passive participants in a broken and dysfunctional system, but in many ways, [to be] one of the architects of an improved care system going forward.”

Richard Quinn is a freelance writer in New Jersey.

There are 10 industry-changing recommendations in the recent Institute of Medicine (IOM) report “Best Care at Lower Cost: The Path to Continuously Learning Health Care in America.” Suggestions include reforming payment, adopting digital infrastructure, and improving the continuity of care. And to Brent James, MD, all of those recommendations are areas in which hospitalists can help lead healthcare from fee-for-service to an organized-care model.

Dr. James, executive director of the Institute for Health Care Delivery Research and chief quality officer at Intermountain Healthcare in Salt Lake City, says hospitalists can be linchpins to that hoped-for sea change because the specialty’s growth the past 15 years shows that physicians taking a collaborative, evidence-based approach to patient care can improve outcomes and lower costs.

“In some sense, the hospitalist movement triggered [the move to organized care],” says Dr. James, one of the IOM report’s authors. “You started to have teams caring for inpatients in a coordinated way. Pieces started to kind of fall into place underneath it. So I regard this as … [hospitalists] coming into their own, their vision of the future starting to really take hold.”

The report estimates the national cost of unnecessary or wasteful healthcare at $750 billion per year. Published in September, the report was crafted by a nationwide committee of healthcare leaders, including hospitalist and medical researcher David Meltzer, MD, PhD, chief of University of Chicago’s Division of Hospital Medicine and director of the Center for Health and Social Sciences in Chicago.

Dr. Meltzer says that for a relatively young specialty, hospitalists have been “remarkably forward-looking.” The specialty, in his view, has embraced teamwork, digital infrastructure, and quality initiatives. As the U.S. healthcare system evolves, he notes, HM leaders need to keep that mentality. Hospitalists are confronted daily with a combination of sicker patients and more treatment options, and making the right decisions is paramount to a “learning healthcare system,” Dr. Meltzer adds.

“As the database of options grows, decision-making becomes more difficult,” he says. “We have an important role to play in how to think about trying to control costs.”

Gary Kaplan, MD, FACP, FACMPE, FACPE, chairman and chief executive officer of Virginia Mason Health System in Seattle, agrees that HM’s priorities dovetail nicely with reform efforts. He hopes the IOM report’s findings will serve as a springboard for hospitalists to further spearhead improvements.

In particular, Dr. Kaplan notes that healthcare delivery organizations should develop, implement, and fine-tune their “systems, engineering tools, and process-improvement methods.” Such changes would help “eliminate inefficiencies, remove unnecessary burdens on clinicians and staff, enhance patient experience, and improve patient health outcomes,” he says.

“The hospitalists and the care teams with which the hospitalist connects are very critical to streamlining operations,” Dr. Kaplan adds.

Dr. James, who has long championed process improvement as the key to improved clinical outcomes, says that extending the hospitalist model throughout healthcare can only have good results. He preaches the implementation of standardized protocols and sees hospitalists as natural torchbearers for the cause.

 

“When you start to focus on process—our old jargon for it was ‘continuum of care’—it forces you to patient-centered care,” he says. “Instead of building your care around the physicians, or around the hospital, or around the technology, you build the care around the patient.”

Dr. James has heard physicians say protocols are too rigid and do not improve patient care. He disagrees—vehemently.

“It’s not just that we allow, or even that we encourage, we demand that you modify [the protocol] for individual patient needs,” he says. “What I have is a standard process of care. That means that you don’t have to bird-dog every little step. I take my most important resource—a trained, expert mind—and focus it on that relatively small set of problems that need to be modified. We’ve found that it massively improves patient outcomes.”

Many of the IOM report’s complaints about unnecessary testing, poor communication, and inefficient care delivery connect with the quality, patient-safety, and practice-management improvements HM groups already push, Dr. Kaplan adds. To advance healthcare delivery’s evolution, hospitalists should view the task of reform as an opportunity, not a challenge.

“There are very powerful opportunities for the hospitalist now to have great impact,” he says. “To not just be the passive participants in a broken and dysfunctional system, but in many ways, [to be] one of the architects of an improved care system going forward.”

Richard Quinn is a freelance writer in New Jersey.

There are 10 industry-changing recommendations in the recent Institute of Medicine (IOM) report “Best Care at Lower Cost: The Path to Continuously Learning Health Care in America.” Suggestions include reforming payment, adopting digital infrastructure, and improving the continuity of care. And to Brent James, MD, all of those recommendations are areas in which hospitalists can help lead healthcare from fee-for-service to an organized-care model.

Dr. James, executive director of the Institute for Health Care Delivery Research and chief quality officer at Intermountain Healthcare in Salt Lake City, says hospitalists can be linchpins to that hoped-for sea change because the specialty’s growth the past 15 years shows that physicians taking a collaborative, evidence-based approach to patient care can improve outcomes and lower costs.

“In some sense, the hospitalist movement triggered [the move to organized care],” says Dr. James, one of the IOM report’s authors. “You started to have teams caring for inpatients in a coordinated way. Pieces started to kind of fall into place underneath it. So I regard this as … [hospitalists] coming into their own, their vision of the future starting to really take hold.”

The report estimates the national cost of unnecessary or wasteful healthcare at $750 billion per year. Published in September, the report was crafted by a nationwide committee of healthcare leaders, including hospitalist and medical researcher David Meltzer, MD, PhD, chief of University of Chicago’s Division of Hospital Medicine and director of the Center for Health and Social Sciences in Chicago.

Dr. Meltzer says that for a relatively young specialty, hospitalists have been “remarkably forward-looking.” The specialty, in his view, has embraced teamwork, digital infrastructure, and quality initiatives. As the U.S. healthcare system evolves, he notes, HM leaders need to keep that mentality. Hospitalists are confronted daily with a combination of sicker patients and more treatment options, and making the right decisions is paramount to a “learning healthcare system,” Dr. Meltzer adds.

“As the database of options grows, decision-making becomes more difficult,” he says. “We have an important role to play in how to think about trying to control costs.”

Gary Kaplan, MD, FACP, FACMPE, FACPE, chairman and chief executive officer of Virginia Mason Health System in Seattle, agrees that HM’s priorities dovetail nicely with reform efforts. He hopes the IOM report’s findings will serve as a springboard for hospitalists to further spearhead improvements.

In particular, Dr. Kaplan notes that healthcare delivery organizations should develop, implement, and fine-tune their “systems, engineering tools, and process-improvement methods.” Such changes would help “eliminate inefficiencies, remove unnecessary burdens on clinicians and staff, enhance patient experience, and improve patient health outcomes,” he says.

“The hospitalists and the care teams with which the hospitalist connects are very critical to streamlining operations,” Dr. Kaplan adds.

Dr. James, who has long championed process improvement as the key to improved clinical outcomes, says that extending the hospitalist model throughout healthcare can only have good results. He preaches the implementation of standardized protocols and sees hospitalists as natural torchbearers for the cause.

 

“When you start to focus on process—our old jargon for it was ‘continuum of care’—it forces you to patient-centered care,” he says. “Instead of building your care around the physicians, or around the hospital, or around the technology, you build the care around the patient.”

Dr. James has heard physicians say protocols are too rigid and do not improve patient care. He disagrees—vehemently.

“It’s not just that we allow, or even that we encourage, we demand that you modify [the protocol] for individual patient needs,” he says. “What I have is a standard process of care. That means that you don’t have to bird-dog every little step. I take my most important resource—a trained, expert mind—and focus it on that relatively small set of problems that need to be modified. We’ve found that it massively improves patient outcomes.”

Many of the IOM report’s complaints about unnecessary testing, poor communication, and inefficient care delivery connect with the quality, patient-safety, and practice-management improvements HM groups already push, Dr. Kaplan adds. To advance healthcare delivery’s evolution, hospitalists should view the task of reform as an opportunity, not a challenge.

“There are very powerful opportunities for the hospitalist now to have great impact,” he says. “To not just be the passive participants in a broken and dysfunctional system, but in many ways, [to be] one of the architects of an improved care system going forward.”

Richard Quinn is a freelance writer in New Jersey.

Born, raised, educated, and trained in the shadow of the Statue of Liberty, Nick Fitterman, MD, FACP, SFHM, is as New York as New Yorkers get. After 14 years in private practice, he “saw the handwriting on the wall” and founded a hospitalist program in the community hospital down the street. He served six years as HM group director at Huntington (N.Y.) Hospital, immersing himself in patient care and the inner workings of the health system.

Six months ago, he moved into a new, full-time administrative position as medical director of group health management for North Shore Long Island Jewish Health System, a 16-hospital system that includes 408-bed Huntington. The post is in a newly created department and focuses on “connecting parts of our healthcare system that will help serve us in the new landscape of healthcare reform as we move from individual health to population health, as we move from a model of illness to a model of wellness,” he says.

“Parts are already in our system, and my job is to link them together, help build up what needs to be built up, and to fill gaps where they exist,” he says.

Dr. Fitterman, who joined Team Hospitalist earlier this year, plans to continue working a few hospitalist shifts a month with his former group, but his new mission is clear: “Getting providers to recognize the need and the sense of urgency to redesign the way they practice medicine,” he says.

Question: What is the biggest difference between outpatient and inpatient care?

Answer: There are two significant differences. One would be the acuity of the patient. The outpatient is not as acutely ill as those in the hospital. That’s one of the things that drew me to hospital medicine. The other big difference is continuity; it is lost in the hospital. In outpatient medicine, I was able to take care of multiple generations of the same family over many years. In hospital medicine, I would only see an individual patient for three to five days.

Q: What do you like most about working as a hospitalist?

A: I enjoy the challenge of taking care of the acutely ill. An illness may be compressed into a few days, and you need to figure out quickly, and take action that has meaningful impact swiftly. I find that challenging. The other thing that I found quite challenging is the opportunity for hospitalists to help create and execute policy in the hospital that will impact the care of the whole community. As a hospitalist, you can be involved in drafting and executing policy that will impact literally tens of thousands of lives in your community. In your office, you will be more limited to the average 2,500-patient panel that an internist has.

Q: Why have you dedicated yourself to committee work?

A: I encourage any early-career physician to get involved in committees. I entered into a lot of committees … and then I broadened my committee involvement to have a better idea of all the on-goings in the hospital. It also served as a teaching vehicle, to help me understand that people are working on things just like you want to. Committee work allows you to collaborate with people who have mutual interests, instead of feeling like you’re at the end of a process and being prescribed some policy.

 

Q: It sounds like you’re seeing patients less and doing more what you consider “population health.” How has your experience as a hospitalist helped you in your new position?

A: All of the committee work that I did set the tone for these changes in my career. And that committee work included committee work in my practice, committee work at the hospital, committee work in national organizations, such as SHM and the American College of Physicians.

Q: When you speak about population health, what types of problems and solutions are you looking at?

A: It’s important to recognize that healthcare is only a small part of population health. Now, understanding the other side of social issues that impact our patients, you can bring to them the best healthcare possible, but if we don’t address those other needs or at least recognize them and steer them to a place where they help them with those needs, our care will not be as meaningful as we hope.

Q: Can you give an example?

A: The asthmatic who’s in your ED four times a year and gets excellent care but gets discharged home with an inability to get their medicine or to take their medicines appropriately or to reduce an environmental exposure that keeps triggering the asthmatic exacerbations. These are all the things that population health must now consider. We cannot confine ourselves simply to what we do behind closed doors of the office or within the four walls of a hospital.

Q: How much of your new job is the offspring of regulations coming down the pipe from healthcare reform?

A: Not so much because of the regulations. The changes we are seeing are driven by the market, driven by employers, and by states. Yes, the Affordable Care Act has an impact, but hopefully only to accelerate changes that we already saw taking shape. Our hope is to create a system that will provide that help to the individual and help the population to do that or reduce per-capita cost, but also by enriching the lives of providers and, of course, doing this before the regulations tell us how before someone tells us how to do it.

Q: As a former chief resident, what advice do you have for trainees entering into a new paradigm of medicine?

A: They should consider the population and not just the individual. They should consider the model wellness and not just illness to focus on in an acute-care setting. They should be trained and well-prepared. This is what hospitalist medicine does quite well: to continuously look at quality improvement and PDSA [Plan-Do-Study-Act] cycles. It should be common that they are reviewing quality metrics and planning on how they can get better as a group or even as an individual in a practice and the concept of team medicine.

Q: What is the biggest challenge hospitalists face today?

A: We need to be better versed in the change equation, how to manage change. That’s the biggest challenge.

Q: Tell me about your work with SHM. What does the society mean to you?

A: The society has really helped me understand the process in managing change, in quality-improvement cycles. Having participated in one of the mentored implementation programs [Project BOOST], I was afforded an opportunity to be coached by experts in the field. The toolkits on the SHM website I found very helpful. It was a mini-fellowship, if you will. If I didn’t take the interest that I have in SHM, I don’t think I would have either known the opportunities I have or availed myself of all the opportunities SHM can provide.

 

Q: What has the senior fellowship in HM meant to you?

A: It was a proud moment standing up with the first class of Senior Fellows in Hospital Medicine. We all recognize the importance of embracing the movement, recognizing the need to help lead this movement, and how we can impact the lives of hospitalist patients in our community by bringing to bear the quality initiatives, the call for focus on quality in hospital medicine that this specialty has.

Richard Quinn is a freelance writer in New Jersey.

Born, raised, educated, and trained in the shadow of the Statue of Liberty, Nick Fitterman, MD, FACP, SFHM, is as New York as New Yorkers get. After 14 years in private practice, he “saw the handwriting on the wall” and founded a hospitalist program in the community hospital down the street. He served six years as HM group director at Huntington (N.Y.) Hospital, immersing himself in patient care and the inner workings of the health system.

Six months ago, he moved into a new, full-time administrative position as medical director of group health management for North Shore Long Island Jewish Health System, a 16-hospital system that includes 408-bed Huntington. The post is in a newly created department and focuses on “connecting parts of our healthcare system that will help serve us in the new landscape of healthcare reform as we move from individual health to population health, as we move from a model of illness to a model of wellness,” he says.

“Parts are already in our system, and my job is to link them together, help build up what needs to be built up, and to fill gaps where they exist,” he says.

Dr. Fitterman, who joined Team Hospitalist earlier this year, plans to continue working a few hospitalist shifts a month with his former group, but his new mission is clear: “Getting providers to recognize the need and the sense of urgency to redesign the way they practice medicine,” he says.

Question: What is the biggest difference between outpatient and inpatient care?

Answer: There are two significant differences. One would be the acuity of the patient. The outpatient is not as acutely ill as those in the hospital. That’s one of the things that drew me to hospital medicine. The other big difference is continuity; it is lost in the hospital. In outpatient medicine, I was able to take care of multiple generations of the same family over many years. In hospital medicine, I would only see an individual patient for three to five days.

Q: What do you like most about working as a hospitalist?

A: I enjoy the challenge of taking care of the acutely ill. An illness may be compressed into a few days, and you need to figure out quickly, and take action that has meaningful impact swiftly. I find that challenging. The other thing that I found quite challenging is the opportunity for hospitalists to help create and execute policy in the hospital that will impact the care of the whole community. As a hospitalist, you can be involved in drafting and executing policy that will impact literally tens of thousands of lives in your community. In your office, you will be more limited to the average 2,500-patient panel that an internist has.

Q: Why have you dedicated yourself to committee work?

A: I encourage any early-career physician to get involved in committees. I entered into a lot of committees … and then I broadened my committee involvement to have a better idea of all the on-goings in the hospital. It also served as a teaching vehicle, to help me understand that people are working on things just like you want to. Committee work allows you to collaborate with people who have mutual interests, instead of feeling like you’re at the end of a process and being prescribed some policy.

 

Q: It sounds like you’re seeing patients less and doing more what you consider “population health.” How has your experience as a hospitalist helped you in your new position?

A: All of the committee work that I did set the tone for these changes in my career. And that committee work included committee work in my practice, committee work at the hospital, committee work in national organizations, such as SHM and the American College of Physicians.

Q: When you speak about population health, what types of problems and solutions are you looking at?

A: It’s important to recognize that healthcare is only a small part of population health. Now, understanding the other side of social issues that impact our patients, you can bring to them the best healthcare possible, but if we don’t address those other needs or at least recognize them and steer them to a place where they help them with those needs, our care will not be as meaningful as we hope.

Q: Can you give an example?

A: The asthmatic who’s in your ED four times a year and gets excellent care but gets discharged home with an inability to get their medicine or to take their medicines appropriately or to reduce an environmental exposure that keeps triggering the asthmatic exacerbations. These are all the things that population health must now consider. We cannot confine ourselves simply to what we do behind closed doors of the office or within the four walls of a hospital.

Q: How much of your new job is the offspring of regulations coming down the pipe from healthcare reform?

A: Not so much because of the regulations. The changes we are seeing are driven by the market, driven by employers, and by states. Yes, the Affordable Care Act has an impact, but hopefully only to accelerate changes that we already saw taking shape. Our hope is to create a system that will provide that help to the individual and help the population to do that or reduce per-capita cost, but also by enriching the lives of providers and, of course, doing this before the regulations tell us how before someone tells us how to do it.

Q: As a former chief resident, what advice do you have for trainees entering into a new paradigm of medicine?

A: They should consider the population and not just the individual. They should consider the model wellness and not just illness to focus on in an acute-care setting. They should be trained and well-prepared. This is what hospitalist medicine does quite well: to continuously look at quality improvement and PDSA [Plan-Do-Study-Act] cycles. It should be common that they are reviewing quality metrics and planning on how they can get better as a group or even as an individual in a practice and the concept of team medicine.

Q: What is the biggest challenge hospitalists face today?

A: We need to be better versed in the change equation, how to manage change. That’s the biggest challenge.

Q: Tell me about your work with SHM. What does the society mean to you?

A: The society has really helped me understand the process in managing change, in quality-improvement cycles. Having participated in one of the mentored implementation programs [Project BOOST], I was afforded an opportunity to be coached by experts in the field. The toolkits on the SHM website I found very helpful. It was a mini-fellowship, if you will. If I didn’t take the interest that I have in SHM, I don’t think I would have either known the opportunities I have or availed myself of all the opportunities SHM can provide.

 

Q: What has the senior fellowship in HM meant to you?

A: It was a proud moment standing up with the first class of Senior Fellows in Hospital Medicine. We all recognize the importance of embracing the movement, recognizing the need to help lead this movement, and how we can impact the lives of hospitalist patients in our community by bringing to bear the quality initiatives, the call for focus on quality in hospital medicine that this specialty has.

Richard Quinn is a freelance writer in New Jersey.

Born, raised, educated, and trained in the shadow of the Statue of Liberty, Nick Fitterman, MD, FACP, SFHM, is as New York as New Yorkers get. After 14 years in private practice, he “saw the handwriting on the wall” and founded a hospitalist program in the community hospital down the street. He served six years as HM group director at Huntington (N.Y.) Hospital, immersing himself in patient care and the inner workings of the health system.

Six months ago, he moved into a new, full-time administrative position as medical director of group health management for North Shore Long Island Jewish Health System, a 16-hospital system that includes 408-bed Huntington. The post is in a newly created department and focuses on “connecting parts of our healthcare system that will help serve us in the new landscape of healthcare reform as we move from individual health to population health, as we move from a model of illness to a model of wellness,” he says.

“Parts are already in our system, and my job is to link them together, help build up what needs to be built up, and to fill gaps where they exist,” he says.

Dr. Fitterman, who joined Team Hospitalist earlier this year, plans to continue working a few hospitalist shifts a month with his former group, but his new mission is clear: “Getting providers to recognize the need and the sense of urgency to redesign the way they practice medicine,” he says.

Question: What is the biggest difference between outpatient and inpatient care?

Answer: There are two significant differences. One would be the acuity of the patient. The outpatient is not as acutely ill as those in the hospital. That’s one of the things that drew me to hospital medicine. The other big difference is continuity; it is lost in the hospital. In outpatient medicine, I was able to take care of multiple generations of the same family over many years. In hospital medicine, I would only see an individual patient for three to five days.

Q: What do you like most about working as a hospitalist?

A: I enjoy the challenge of taking care of the acutely ill. An illness may be compressed into a few days, and you need to figure out quickly, and take action that has meaningful impact swiftly. I find that challenging. The other thing that I found quite challenging is the opportunity for hospitalists to help create and execute policy in the hospital that will impact the care of the whole community. As a hospitalist, you can be involved in drafting and executing policy that will impact literally tens of thousands of lives in your community. In your office, you will be more limited to the average 2,500-patient panel that an internist has.

Q: Why have you dedicated yourself to committee work?

A: I encourage any early-career physician to get involved in committees. I entered into a lot of committees … and then I broadened my committee involvement to have a better idea of all the on-goings in the hospital. It also served as a teaching vehicle, to help me understand that people are working on things just like you want to. Committee work allows you to collaborate with people who have mutual interests, instead of feeling like you’re at the end of a process and being prescribed some policy.

 

Q: It sounds like you’re seeing patients less and doing more what you consider “population health.” How has your experience as a hospitalist helped you in your new position?

A: All of the committee work that I did set the tone for these changes in my career. And that committee work included committee work in my practice, committee work at the hospital, committee work in national organizations, such as SHM and the American College of Physicians.

Q: When you speak about population health, what types of problems and solutions are you looking at?

A: It’s important to recognize that healthcare is only a small part of population health. Now, understanding the other side of social issues that impact our patients, you can bring to them the best healthcare possible, but if we don’t address those other needs or at least recognize them and steer them to a place where they help them with those needs, our care will not be as meaningful as we hope.

Q: Can you give an example?

A: The asthmatic who’s in your ED four times a year and gets excellent care but gets discharged home with an inability to get their medicine or to take their medicines appropriately or to reduce an environmental exposure that keeps triggering the asthmatic exacerbations. These are all the things that population health must now consider. We cannot confine ourselves simply to what we do behind closed doors of the office or within the four walls of a hospital.

Q: How much of your new job is the offspring of regulations coming down the pipe from healthcare reform?

A: Not so much because of the regulations. The changes we are seeing are driven by the market, driven by employers, and by states. Yes, the Affordable Care Act has an impact, but hopefully only to accelerate changes that we already saw taking shape. Our hope is to create a system that will provide that help to the individual and help the population to do that or reduce per-capita cost, but also by enriching the lives of providers and, of course, doing this before the regulations tell us how before someone tells us how to do it.

Q: As a former chief resident, what advice do you have for trainees entering into a new paradigm of medicine?

A: They should consider the population and not just the individual. They should consider the model wellness and not just illness to focus on in an acute-care setting. They should be trained and well-prepared. This is what hospitalist medicine does quite well: to continuously look at quality improvement and PDSA [Plan-Do-Study-Act] cycles. It should be common that they are reviewing quality metrics and planning on how they can get better as a group or even as an individual in a practice and the concept of team medicine.

Q: What is the biggest challenge hospitalists face today?

A: We need to be better versed in the change equation, how to manage change. That’s the biggest challenge.

Q: Tell me about your work with SHM. What does the society mean to you?

A: The society has really helped me understand the process in managing change, in quality-improvement cycles. Having participated in one of the mentored implementation programs [Project BOOST], I was afforded an opportunity to be coached by experts in the field. The toolkits on the SHM website I found very helpful. It was a mini-fellowship, if you will. If I didn’t take the interest that I have in SHM, I don’t think I would have either known the opportunities I have or availed myself of all the opportunities SHM can provide.

 

Q: What has the senior fellowship in HM meant to you?

A: It was a proud moment standing up with the first class of Senior Fellows in Hospital Medicine. We all recognize the importance of embracing the movement, recognizing the need to help lead this movement, and how we can impact the lives of hospitalist patients in our community by bringing to bear the quality initiatives, the call for focus on quality in hospital medicine that this specialty has.

Richard Quinn is a freelance writer in New Jersey.

Michael Manning, MD, medical director of Murphy Medical Center in Murphy, N.C., needed a doctor. Tasked with building the hospitalist program for his 57-bed hospital 90 miles from the closest city, Dr. Manning turned to a locum tenens firm for help, and the company seemed to find a perfect fit. They found a physician who wanted to commit to a one-year stint. The physician was eminently competent, had lined up housing for the year, and, perhaps most important, was eager to serve the residents of seven rural counties in western North Carolina, northern Georgia, and eastern Tennessee.

Then the new hire had a change of heart and backed out of the position. As medical director, Dr. Manning has taken on up to 10 hospitalist shifts a month to cover the absence, and the hospital-employed group is now looking at paying temporary staffers even more as the nascent group struggles to reach its optimal staffing level. To Dr. Manning, the hope-to-heartburn scenario typifies the “two-edged sword” that is locum tenens.

“Overall, I would say it’s a necessary evil,” he says. “You’ve got to have your service staffed. You can’t go without physicians filling slots. The evil for us is the cost.”

The cost of paying temporary physicians over the long term can be overwhelming for cash-strapped hospitals and health systems. But that’s done little to stop hospitalists from becoming the leading specialty in the temporary staffing market, according to a proprietary annual review compiled by Staffing Industry Analysis of Mountain View, Calif., on behalf of the National Association of Locum Tenens Organizations (NALTO). Hospitalists accounted for 17% of locum tenens revenue generated in the first half of 2011, the report states. The only other specialty in double-digit figures was emergency medicine, which tallied 14% of the $548 million in revenue measured by the report. Survey respondents reported year-over-year revenue growth of 9.5% in the first half of 2011, with aggregate revenue generated by hospitalists jumping more than 34%.

A survey of hospitalists released in October showed that nearly 12% had worked locum tenens in the previous 12 months; 64% had done the work in addition to their full-time jobs.¹ The survey, crafted by Locum Leaders of Alpharetta, Ga., was among the first to capture just how prevalent the practice of temporary staffing is and what motivates physicians to do the work.

The reasons hospitalists choose to work locums are as varied as HM practices. In the short term, hospital-based physicians are looking for geographic flexibility, higher earning potential, and the chance to “try something on for size before they buy,” says Robert Harrington Jr., MD, SFHM, chief medical officer for Locum Leaders and a SHM board member. Early-career hospitalists can use temporary work to determine what they want to do with their careers, while older physicians can use it to finish their careers focused solely on clinical care.

Regardless of motivation, hospital administrators can utilize temporary staffing to save money on health, retirement, and retention benefits, as well as costs related to training and career development. But staffing via locum tenens has downsides, too. Cost is the concern most commonly noted, with expenses including negotiated fees to locum companies and, depending on contracts, travel and lodging costs (most contracts cover malpractice costs, industry players say). Some critics question the quality of temporary physicians, while others worry about the potential of doctors distracted by their “day” jobs.

 

Detractors also note that using temporary physicians can have a deleterious effect on teamwork, as more transient workers are less invested in an institution’s mission, vision, and long-term goals. Patricia Stone, PhD, RN, FAAN, who has studied the use of agency nurses, says that how well a locum tenens worker integrates into a team setting depends on how willing that person is to bond with colleagues.

“There are things that happen in a hospital for which a team is needed,” says Stone, director of the Center for Health Policy and the PhD program at the Columbia University School of Nursing in New York City. “The nurse needs to know how much she can count on that physician. The physician needs to know how much they can count on that nurse.”

Hospitalists = Prime Targets

The use of locum tenens in HM has skyrocketed in recent years, as the number of hospitals adding hospitalists has grown. And, for now, it doesn’t seem like there’s any end in sight, particularly as cost-conscious hospitals look for ways to save money.

“Trees don’t grow to the sky, but...we’ll be very curious to see what the next survey tells us about how the second half of 2011 did,” says Tony Gregoire, senior research analyst for Staffing Industry Analysts. “But as of yet, we just can’t speak to any plateauing. It just seems like there is more room for growth here. The big factor will be supply shortage because there is such demand for hospitalists.”

To wit, the 2011 Survey of Temporary Physician Staffing Trends found that 85% of healthcare facilities managers reported using temporary physicians in 2010, up from 72% in 2009.² And the number of facilities seeking locum tenens staffers is rising, despite the “downturn in physician utilization caused by the recession,” the report added. Some 41% of those surveyed were looking for locum tenens physicians in 2010, up 1% from the year before.

Brent Bormaster, divisional vice president of Staff Care of Dallas—whose firm publishes an annual report, the 2011 Survey on temporary staffing trends—says that the use of temporary staffing makes economic sense in a growing specialty such as HM because it allows programs to start up and staff up more quickly. And because turnover can be an issue in the early days of any group, temporary staffers can either fill in while the group recruits a permanent physician or can step in when a physician leaves, giving the practice time to run a proper search.

“You can still maintain your continuity of staff and continuity of care,” Bormaster says. “All the while, you’re still recruiting for your permanent physician and permanent replacement, which may take upwards of six to eight months.”

The temporary staffing market in HM has grown so competitive in recent years that one large hospitalist group started its own placement division for physicians. Robert Bessler, MD, president and CEO of Tacoma, Wash.-based Sound Physicians, says his company launched Echo Locum Tenens of Dallas in August 2011 to take advantage of the firm’s economies of scale. Sound employs more than 500 hospitalists and post-acute physicians, and partners with about 70 hospitals nationwide (see “DIY Locum?”, right).

“We felt there was an opportunity to be a niche provider to serve our own needs … to fill the short-term demand for temporary help, whether we’re starting up a program quickly or have a gap in coverage due to illness or maternity leave or something else,” Dr. Bessler says. “We found that we could build a more accountable model by having it be part of our organization.”

 

Another reason for the growth in temporary staffing may be the appeal it has for physicians who want to focus simply on clinical care, says Dorothy Nemec, MD, MSPH, a board-certified internist who runs MDPA Locums in Punta Gordo, Fla., with her physician assistant husband, Larry Rand, PA-C. The couple started their temporary staffing firm in 1996 and has authored a book, “Finding Private Locums,” that outlines how to launch a career in locum tenens.³

“When we started our own business, what we found was we were able to do what we are trained to do, and you don’t have to deal with the politics,” Dr. Nemec explains. “You don’t have to deal with all of the other things that you get involved with when you’re in permanent practices. So you can devote all of your time to taking care of patients.”

The Cost Equation

The biggest question surrounding the use of locums is the cost-benefit analysis, a point not lost on hospital executives and locum physicians who answered Staff Care’s last report. Eighty-six percent of those surveyed said cost was the biggest drawback to the use of locum doctors, a dramatic increase from the previous year, when just 58% pointed to cost as the largest detriment. Locum physicians can gross 30% to 40% more per year for the same number of shifts as a typical FTE hospitalist.

But Dr. Harrington believes the ability to earn more money continues to push physicians into working locums. “Hospitals now realize that they have to have a hospitalist program,” Dr. Harrington says. “The issue for them is more around reimbursement and where that money is going to come from.”

Bormaster, of Staff Care, says that while the higher salaries for locum physicians can seem like an expensive proposition, the cost has to be viewed in context. Because the typical temporary physician is an independent contractor, compensation does not include many of the costly expenses tied to permanent hires.

“You’re paying us on an hourly basis, and you don’t have any ancillary benefits, healthcare, 401(k), malpractice insurance, anything like that,” Bormaster adds. “All you’re doing is paying straight for the hours worked or hours produced by that hospitalist that is contracted with us.”

Surveys show part-time and temporary physicians’ lack of familiarity with their work setting can be detrimental. It’s shortsighted to undervalue the role continuity plays in the hospital setting, as it can lower the quality of care delivered and impact both patient and worker satisfaction, says Stone, the Columbia University nurse-researcher.

“It’s not necessarily the cheapest way to go because of the decreased quality,” she says, adding she hopes the topic is one tackled in future research. “It needs to be looked at. The hospitalist environment has just grown so much....How to do it right? We just don’t know enough about it yet.”

Is the Sky the Limit?

It is often said that HM is the country’s fastest-growing medical specialty. Combined with the recent reduction in resident work-hours at academic centers and the impending physician shortfall nationwide, there may be a perfect storm looming.

“Supply will eventually adjust to the demand, but that demand is only going to keep increasing,” says Gregoire, the senior research analyst.

MaryAnn Stolgitis, vice president of operations for Boston-based national staffing firm Barton Associates, says hospitals and healthcare organizations will often have little choice but to continue using temporary physicians to bridge personnel gaps.

Stolgitis says that beyond the supply-demand curve, another factor in temporary staffing’s growth is the increased desire of physicians to generate additional revenue. The exact motivation will vary, from new physicians looking to pay off increasingly burdensome student loans to late-career physicians looking for financial security as they transition into retirement. Others will enjoy the idea of traveling the country via a spider web of locum tenens positions.

 

“We’re recruiting doctors who were full-time doctors, permanent doctors. There are a lot of people making that switch,” she says. “I think there’s not only increased demand for patient care, but there’s also a shortage of physicians out there willing to accept full-time jobs because now they see this other way of life and they’re willing to do that.”

Dr. Manning says that quality locum firms can take advantage of that situation by continually recruiting the strongest physicians.

“When you find a good company providing you physicians that want to work and do their job and are patient-friendly, you just need to go with it,” he says. “The only problem, is you’re going to pay more for it.”

Jason Daeffler, a marketing director for Barton, adds that the physician shortage in the coming years will only exacerbate the issue of staffing issues at hospitals. He says supplementing full-time hospitalists with locum doctors will offer HM group leaders the scheduling flexibility needed to maintain optimal coverage levels and maximize revenue generation. HM groups without that leverage could struggle to cover all shifts as effectively, he adds.

Plus, physicians who take on locum tenens work will create financial flexibility for themselves at a time when payrolls are under tremendous pressure from C-suite executives looking to trim budgets. Individually, each factor might not be as powerful, but when combined, Stolgitis says the stage is set for continued success.

“You’re going to see more and more locum tenens in the future,” she says. “Whether you’re looking at the retiree population, physicians right out of residency or fellowship training, or someone who’s been working two or three years...they are beginning to see locum tenens as a better lifestyle for them.”

Richard Quinn is a freelance writer in New Jersey.

References

1. Locum Leaders. 2012 Hospitalist Locum Tenens Survey. Locum Leaders website. Available at http://www.locumleaders.com/assets/downloads/2012_hospitalist_locum_tenens_survey_locum_leaders.pdf. Accessed Oct. 1, 2012.
2. Staff Care. 2011 Survey of Temporary Physician Staffing Trends. Staff Care website. Available at: http://www.staffcare.com/pdf/2011_Survey_of_Temporary_Physician_Staffing_Trends.pdf. Accessed Sept. 28, 2012.
3. Nemec DK, Rand LD. Finding Private Locums. 1st edition. MDPA Locums Inc.: Punta Gordo, Fla.: 2006.

Michael Manning, MD, medical director of Murphy Medical Center in Murphy, N.C., needed a doctor. Tasked with building the hospitalist program for his 57-bed hospital 90 miles from the closest city, Dr. Manning turned to a locum tenens firm for help, and the company seemed to find a perfect fit. They found a physician who wanted to commit to a one-year stint. The physician was eminently competent, had lined up housing for the year, and, perhaps most important, was eager to serve the residents of seven rural counties in western North Carolina, northern Georgia, and eastern Tennessee.

Then the new hire had a change of heart and backed out of the position. As medical director, Dr. Manning has taken on up to 10 hospitalist shifts a month to cover the absence, and the hospital-employed group is now looking at paying temporary staffers even more as the nascent group struggles to reach its optimal staffing level. To Dr. Manning, the hope-to-heartburn scenario typifies the “two-edged sword” that is locum tenens.

“Overall, I would say it’s a necessary evil,” he says. “You’ve got to have your service staffed. You can’t go without physicians filling slots. The evil for us is the cost.”

The cost of paying temporary physicians over the long term can be overwhelming for cash-strapped hospitals and health systems. But that’s done little to stop hospitalists from becoming the leading specialty in the temporary staffing market, according to a proprietary annual review compiled by Staffing Industry Analysis of Mountain View, Calif., on behalf of the National Association of Locum Tenens Organizations (NALTO). Hospitalists accounted for 17% of locum tenens revenue generated in the first half of 2011, the report states. The only other specialty in double-digit figures was emergency medicine, which tallied 14% of the $548 million in revenue measured by the report. Survey respondents reported year-over-year revenue growth of 9.5% in the first half of 2011, with aggregate revenue generated by hospitalists jumping more than 34%.

A survey of hospitalists released in October showed that nearly 12% had worked locum tenens in the previous 12 months; 64% had done the work in addition to their full-time jobs.¹ The survey, crafted by Locum Leaders of Alpharetta, Ga., was among the first to capture just how prevalent the practice of temporary staffing is and what motivates physicians to do the work.

The reasons hospitalists choose to work locums are as varied as HM practices. In the short term, hospital-based physicians are looking for geographic flexibility, higher earning potential, and the chance to “try something on for size before they buy,” says Robert Harrington Jr., MD, SFHM, chief medical officer for Locum Leaders and a SHM board member. Early-career hospitalists can use temporary work to determine what they want to do with their careers, while older physicians can use it to finish their careers focused solely on clinical care.

Regardless of motivation, hospital administrators can utilize temporary staffing to save money on health, retirement, and retention benefits, as well as costs related to training and career development. But staffing via locum tenens has downsides, too. Cost is the concern most commonly noted, with expenses including negotiated fees to locum companies and, depending on contracts, travel and lodging costs (most contracts cover malpractice costs, industry players say). Some critics question the quality of temporary physicians, while others worry about the potential of doctors distracted by their “day” jobs.

 

Detractors also note that using temporary physicians can have a deleterious effect on teamwork, as more transient workers are less invested in an institution’s mission, vision, and long-term goals. Patricia Stone, PhD, RN, FAAN, who has studied the use of agency nurses, says that how well a locum tenens worker integrates into a team setting depends on how willing that person is to bond with colleagues.

“There are things that happen in a hospital for which a team is needed,” says Stone, director of the Center for Health Policy and the PhD program at the Columbia University School of Nursing in New York City. “The nurse needs to know how much she can count on that physician. The physician needs to know how much they can count on that nurse.”

Hospitalists = Prime Targets

The use of locum tenens in HM has skyrocketed in recent years, as the number of hospitals adding hospitalists has grown. And, for now, it doesn’t seem like there’s any end in sight, particularly as cost-conscious hospitals look for ways to save money.

“Trees don’t grow to the sky, but...we’ll be very curious to see what the next survey tells us about how the second half of 2011 did,” says Tony Gregoire, senior research analyst for Staffing Industry Analysts. “But as of yet, we just can’t speak to any plateauing. It just seems like there is more room for growth here. The big factor will be supply shortage because there is such demand for hospitalists.”

To wit, the 2011 Survey of Temporary Physician Staffing Trends found that 85% of healthcare facilities managers reported using temporary physicians in 2010, up from 72% in 2009.² And the number of facilities seeking locum tenens staffers is rising, despite the “downturn in physician utilization caused by the recession,” the report added. Some 41% of those surveyed were looking for locum tenens physicians in 2010, up 1% from the year before.

Brent Bormaster, divisional vice president of Staff Care of Dallas—whose firm publishes an annual report, the 2011 Survey on temporary staffing trends—says that the use of temporary staffing makes economic sense in a growing specialty such as HM because it allows programs to start up and staff up more quickly. And because turnover can be an issue in the early days of any group, temporary staffers can either fill in while the group recruits a permanent physician or can step in when a physician leaves, giving the practice time to run a proper search.

“You can still maintain your continuity of staff and continuity of care,” Bormaster says. “All the while, you’re still recruiting for your permanent physician and permanent replacement, which may take upwards of six to eight months.”

The temporary staffing market in HM has grown so competitive in recent years that one large hospitalist group started its own placement division for physicians. Robert Bessler, MD, president and CEO of Tacoma, Wash.-based Sound Physicians, says his company launched Echo Locum Tenens of Dallas in August 2011 to take advantage of the firm’s economies of scale. Sound employs more than 500 hospitalists and post-acute physicians, and partners with about 70 hospitals nationwide (see “DIY Locum?”, right).

“We felt there was an opportunity to be a niche provider to serve our own needs … to fill the short-term demand for temporary help, whether we’re starting up a program quickly or have a gap in coverage due to illness or maternity leave or something else,” Dr. Bessler says. “We found that we could build a more accountable model by having it be part of our organization.”

 

Another reason for the growth in temporary staffing may be the appeal it has for physicians who want to focus simply on clinical care, says Dorothy Nemec, MD, MSPH, a board-certified internist who runs MDPA Locums in Punta Gordo, Fla., with her physician assistant husband, Larry Rand, PA-C. The couple started their temporary staffing firm in 1996 and has authored a book, “Finding Private Locums,” that outlines how to launch a career in locum tenens.³

“When we started our own business, what we found was we were able to do what we are trained to do, and you don’t have to deal with the politics,” Dr. Nemec explains. “You don’t have to deal with all of the other things that you get involved with when you’re in permanent practices. So you can devote all of your time to taking care of patients.”

The Cost Equation

The biggest question surrounding the use of locums is the cost-benefit analysis, a point not lost on hospital executives and locum physicians who answered Staff Care’s last report. Eighty-six percent of those surveyed said cost was the biggest drawback to the use of locum doctors, a dramatic increase from the previous year, when just 58% pointed to cost as the largest detriment. Locum physicians can gross 30% to 40% more per year for the same number of shifts as a typical FTE hospitalist.

But Dr. Harrington believes the ability to earn more money continues to push physicians into working locums. “Hospitals now realize that they have to have a hospitalist program,” Dr. Harrington says. “The issue for them is more around reimbursement and where that money is going to come from.”

Bormaster, of Staff Care, says that while the higher salaries for locum physicians can seem like an expensive proposition, the cost has to be viewed in context. Because the typical temporary physician is an independent contractor, compensation does not include many of the costly expenses tied to permanent hires.

“You’re paying us on an hourly basis, and you don’t have any ancillary benefits, healthcare, 401(k), malpractice insurance, anything like that,” Bormaster adds. “All you’re doing is paying straight for the hours worked or hours produced by that hospitalist that is contracted with us.”

Surveys show part-time and temporary physicians’ lack of familiarity with their work setting can be detrimental. It’s shortsighted to undervalue the role continuity plays in the hospital setting, as it can lower the quality of care delivered and impact both patient and worker satisfaction, says Stone, the Columbia University nurse-researcher.

“It’s not necessarily the cheapest way to go because of the decreased quality,” she says, adding she hopes the topic is one tackled in future research. “It needs to be looked at. The hospitalist environment has just grown so much....How to do it right? We just don’t know enough about it yet.”

Is the Sky the Limit?

It is often said that HM is the country’s fastest-growing medical specialty. Combined with the recent reduction in resident work-hours at academic centers and the impending physician shortfall nationwide, there may be a perfect storm looming.

“Supply will eventually adjust to the demand, but that demand is only going to keep increasing,” says Gregoire, the senior research analyst.

MaryAnn Stolgitis, vice president of operations for Boston-based national staffing firm Barton Associates, says hospitals and healthcare organizations will often have little choice but to continue using temporary physicians to bridge personnel gaps.

Stolgitis says that beyond the supply-demand curve, another factor in temporary staffing’s growth is the increased desire of physicians to generate additional revenue. The exact motivation will vary, from new physicians looking to pay off increasingly burdensome student loans to late-career physicians looking for financial security as they transition into retirement. Others will enjoy the idea of traveling the country via a spider web of locum tenens positions.

 

“We’re recruiting doctors who were full-time doctors, permanent doctors. There are a lot of people making that switch,” she says. “I think there’s not only increased demand for patient care, but there’s also a shortage of physicians out there willing to accept full-time jobs because now they see this other way of life and they’re willing to do that.”

Dr. Manning says that quality locum firms can take advantage of that situation by continually recruiting the strongest physicians.

“When you find a good company providing you physicians that want to work and do their job and are patient-friendly, you just need to go with it,” he says. “The only problem, is you’re going to pay more for it.”

Jason Daeffler, a marketing director for Barton, adds that the physician shortage in the coming years will only exacerbate the issue of staffing issues at hospitals. He says supplementing full-time hospitalists with locum doctors will offer HM group leaders the scheduling flexibility needed to maintain optimal coverage levels and maximize revenue generation. HM groups without that leverage could struggle to cover all shifts as effectively, he adds.

Plus, physicians who take on locum tenens work will create financial flexibility for themselves at a time when payrolls are under tremendous pressure from C-suite executives looking to trim budgets. Individually, each factor might not be as powerful, but when combined, Stolgitis says the stage is set for continued success.

“You’re going to see more and more locum tenens in the future,” she says. “Whether you’re looking at the retiree population, physicians right out of residency or fellowship training, or someone who’s been working two or three years...they are beginning to see locum tenens as a better lifestyle for them.”

Richard Quinn is a freelance writer in New Jersey.

References

1. Locum Leaders. 2012 Hospitalist Locum Tenens Survey. Locum Leaders website. Available at http://www.locumleaders.com/assets/downloads/2012_hospitalist_locum_tenens_survey_locum_leaders.pdf. Accessed Oct. 1, 2012.
2. Staff Care. 2011 Survey of Temporary Physician Staffing Trends. Staff Care website. Available at: http://www.staffcare.com/pdf/2011_Survey_of_Temporary_Physician_Staffing_Trends.pdf. Accessed Sept. 28, 2012.
3. Nemec DK, Rand LD. Finding Private Locums. 1st edition. MDPA Locums Inc.: Punta Gordo, Fla.: 2006.

Michael Manning, MD, medical director of Murphy Medical Center in Murphy, N.C., needed a doctor. Tasked with building the hospitalist program for his 57-bed hospital 90 miles from the closest city, Dr. Manning turned to a locum tenens firm for help, and the company seemed to find a perfect fit. They found a physician who wanted to commit to a one-year stint. The physician was eminently competent, had lined up housing for the year, and, perhaps most important, was eager to serve the residents of seven rural counties in western North Carolina, northern Georgia, and eastern Tennessee.

Then the new hire had a change of heart and backed out of the position. As medical director, Dr. Manning has taken on up to 10 hospitalist shifts a month to cover the absence, and the hospital-employed group is now looking at paying temporary staffers even more as the nascent group struggles to reach its optimal staffing level. To Dr. Manning, the hope-to-heartburn scenario typifies the “two-edged sword” that is locum tenens.

“Overall, I would say it’s a necessary evil,” he says. “You’ve got to have your service staffed. You can’t go without physicians filling slots. The evil for us is the cost.”

The cost of paying temporary physicians over the long term can be overwhelming for cash-strapped hospitals and health systems. But that’s done little to stop hospitalists from becoming the leading specialty in the temporary staffing market, according to a proprietary annual review compiled by Staffing Industry Analysis of Mountain View, Calif., on behalf of the National Association of Locum Tenens Organizations (NALTO). Hospitalists accounted for 17% of locum tenens revenue generated in the first half of 2011, the report states. The only other specialty in double-digit figures was emergency medicine, which tallied 14% of the $548 million in revenue measured by the report. Survey respondents reported year-over-year revenue growth of 9.5% in the first half of 2011, with aggregate revenue generated by hospitalists jumping more than 34%.

A survey of hospitalists released in October showed that nearly 12% had worked locum tenens in the previous 12 months; 64% had done the work in addition to their full-time jobs.¹ The survey, crafted by Locum Leaders of Alpharetta, Ga., was among the first to capture just how prevalent the practice of temporary staffing is and what motivates physicians to do the work.

The reasons hospitalists choose to work locums are as varied as HM practices. In the short term, hospital-based physicians are looking for geographic flexibility, higher earning potential, and the chance to “try something on for size before they buy,” says Robert Harrington Jr., MD, SFHM, chief medical officer for Locum Leaders and a SHM board member. Early-career hospitalists can use temporary work to determine what they want to do with their careers, while older physicians can use it to finish their careers focused solely on clinical care.

Regardless of motivation, hospital administrators can utilize temporary staffing to save money on health, retirement, and retention benefits, as well as costs related to training and career development. But staffing via locum tenens has downsides, too. Cost is the concern most commonly noted, with expenses including negotiated fees to locum companies and, depending on contracts, travel and lodging costs (most contracts cover malpractice costs, industry players say). Some critics question the quality of temporary physicians, while others worry about the potential of doctors distracted by their “day” jobs.

 

Detractors also note that using temporary physicians can have a deleterious effect on teamwork, as more transient workers are less invested in an institution’s mission, vision, and long-term goals. Patricia Stone, PhD, RN, FAAN, who has studied the use of agency nurses, says that how well a locum tenens worker integrates into a team setting depends on how willing that person is to bond with colleagues.

“There are things that happen in a hospital for which a team is needed,” says Stone, director of the Center for Health Policy and the PhD program at the Columbia University School of Nursing in New York City. “The nurse needs to know how much she can count on that physician. The physician needs to know how much they can count on that nurse.”

Hospitalists = Prime Targets

The use of locum tenens in HM has skyrocketed in recent years, as the number of hospitals adding hospitalists has grown. And, for now, it doesn’t seem like there’s any end in sight, particularly as cost-conscious hospitals look for ways to save money.

“Trees don’t grow to the sky, but...we’ll be very curious to see what the next survey tells us about how the second half of 2011 did,” says Tony Gregoire, senior research analyst for Staffing Industry Analysts. “But as of yet, we just can’t speak to any plateauing. It just seems like there is more room for growth here. The big factor will be supply shortage because there is such demand for hospitalists.”

To wit, the 2011 Survey of Temporary Physician Staffing Trends found that 85% of healthcare facilities managers reported using temporary physicians in 2010, up from 72% in 2009.² And the number of facilities seeking locum tenens staffers is rising, despite the “downturn in physician utilization caused by the recession,” the report added. Some 41% of those surveyed were looking for locum tenens physicians in 2010, up 1% from the year before.

Brent Bormaster, divisional vice president of Staff Care of Dallas—whose firm publishes an annual report, the 2011 Survey on temporary staffing trends—says that the use of temporary staffing makes economic sense in a growing specialty such as HM because it allows programs to start up and staff up more quickly. And because turnover can be an issue in the early days of any group, temporary staffers can either fill in while the group recruits a permanent physician or can step in when a physician leaves, giving the practice time to run a proper search.

“You can still maintain your continuity of staff and continuity of care,” Bormaster says. “All the while, you’re still recruiting for your permanent physician and permanent replacement, which may take upwards of six to eight months.”

The temporary staffing market in HM has grown so competitive in recent years that one large hospitalist group started its own placement division for physicians. Robert Bessler, MD, president and CEO of Tacoma, Wash.-based Sound Physicians, says his company launched Echo Locum Tenens of Dallas in August 2011 to take advantage of the firm’s economies of scale. Sound employs more than 500 hospitalists and post-acute physicians, and partners with about 70 hospitals nationwide (see “DIY Locum?”, right).

“We felt there was an opportunity to be a niche provider to serve our own needs … to fill the short-term demand for temporary help, whether we’re starting up a program quickly or have a gap in coverage due to illness or maternity leave or something else,” Dr. Bessler says. “We found that we could build a more accountable model by having it be part of our organization.”

 

Another reason for the growth in temporary staffing may be the appeal it has for physicians who want to focus simply on clinical care, says Dorothy Nemec, MD, MSPH, a board-certified internist who runs MDPA Locums in Punta Gordo, Fla., with her physician assistant husband, Larry Rand, PA-C. The couple started their temporary staffing firm in 1996 and has authored a book, “Finding Private Locums,” that outlines how to launch a career in locum tenens.³

“When we started our own business, what we found was we were able to do what we are trained to do, and you don’t have to deal with the politics,” Dr. Nemec explains. “You don’t have to deal with all of the other things that you get involved with when you’re in permanent practices. So you can devote all of your time to taking care of patients.”

The Cost Equation

The biggest question surrounding the use of locums is the cost-benefit analysis, a point not lost on hospital executives and locum physicians who answered Staff Care’s last report. Eighty-six percent of those surveyed said cost was the biggest drawback to the use of locum doctors, a dramatic increase from the previous year, when just 58% pointed to cost as the largest detriment. Locum physicians can gross 30% to 40% more per year for the same number of shifts as a typical FTE hospitalist.

But Dr. Harrington believes the ability to earn more money continues to push physicians into working locums. “Hospitals now realize that they have to have a hospitalist program,” Dr. Harrington says. “The issue for them is more around reimbursement and where that money is going to come from.”

Bormaster, of Staff Care, says that while the higher salaries for locum physicians can seem like an expensive proposition, the cost has to be viewed in context. Because the typical temporary physician is an independent contractor, compensation does not include many of the costly expenses tied to permanent hires.

“You’re paying us on an hourly basis, and you don’t have any ancillary benefits, healthcare, 401(k), malpractice insurance, anything like that,” Bormaster adds. “All you’re doing is paying straight for the hours worked or hours produced by that hospitalist that is contracted with us.”

Surveys show part-time and temporary physicians’ lack of familiarity with their work setting can be detrimental. It’s shortsighted to undervalue the role continuity plays in the hospital setting, as it can lower the quality of care delivered and impact both patient and worker satisfaction, says Stone, the Columbia University nurse-researcher.

“It’s not necessarily the cheapest way to go because of the decreased quality,” she says, adding she hopes the topic is one tackled in future research. “It needs to be looked at. The hospitalist environment has just grown so much....How to do it right? We just don’t know enough about it yet.”

Is the Sky the Limit?

It is often said that HM is the country’s fastest-growing medical specialty. Combined with the recent reduction in resident work-hours at academic centers and the impending physician shortfall nationwide, there may be a perfect storm looming.

“Supply will eventually adjust to the demand, but that demand is only going to keep increasing,” says Gregoire, the senior research analyst.

MaryAnn Stolgitis, vice president of operations for Boston-based national staffing firm Barton Associates, says hospitals and healthcare organizations will often have little choice but to continue using temporary physicians to bridge personnel gaps.

Stolgitis says that beyond the supply-demand curve, another factor in temporary staffing’s growth is the increased desire of physicians to generate additional revenue. The exact motivation will vary, from new physicians looking to pay off increasingly burdensome student loans to late-career physicians looking for financial security as they transition into retirement. Others will enjoy the idea of traveling the country via a spider web of locum tenens positions.

 

“We’re recruiting doctors who were full-time doctors, permanent doctors. There are a lot of people making that switch,” she says. “I think there’s not only increased demand for patient care, but there’s also a shortage of physicians out there willing to accept full-time jobs because now they see this other way of life and they’re willing to do that.”

Dr. Manning says that quality locum firms can take advantage of that situation by continually recruiting the strongest physicians.

“When you find a good company providing you physicians that want to work and do their job and are patient-friendly, you just need to go with it,” he says. “The only problem, is you’re going to pay more for it.”

Jason Daeffler, a marketing director for Barton, adds that the physician shortage in the coming years will only exacerbate the issue of staffing issues at hospitals. He says supplementing full-time hospitalists with locum doctors will offer HM group leaders the scheduling flexibility needed to maintain optimal coverage levels and maximize revenue generation. HM groups without that leverage could struggle to cover all shifts as effectively, he adds.

Plus, physicians who take on locum tenens work will create financial flexibility for themselves at a time when payrolls are under tremendous pressure from C-suite executives looking to trim budgets. Individually, each factor might not be as powerful, but when combined, Stolgitis says the stage is set for continued success.

“You’re going to see more and more locum tenens in the future,” she says. “Whether you’re looking at the retiree population, physicians right out of residency or fellowship training, or someone who’s been working two or three years...they are beginning to see locum tenens as a better lifestyle for them.”

Richard Quinn is a freelance writer in New Jersey.

References

1. Locum Leaders. 2012 Hospitalist Locum Tenens Survey. Locum Leaders website. Available at http://www.locumleaders.com/assets/downloads/2012_hospitalist_locum_tenens_survey_locum_leaders.pdf. Accessed Oct. 1, 2012.
2. Staff Care. 2011 Survey of Temporary Physician Staffing Trends. Staff Care website. Available at: http://www.staffcare.com/pdf/2011_Survey_of_Temporary_Physician_Staffing_Trends.pdf. Accessed Sept. 28, 2012.
3. Nemec DK, Rand LD. Finding Private Locums. 1st edition. MDPA Locums Inc.: Punta Gordo, Fla.: 2006.

Last year, HM firm Sound Physicians launched its own locum tenens staffing affiliate, Echo Locum Tenens in Dallas, to help fill vacancies across its national platform. Shortly thereafter, research came out that showed HM is the fastest-growing segment of the locum field, as measured by revenue generation. So is do-it-yourself locum tenens an economically viable approach for hospitalist programs?

The answer is: not likely.

Tony Gregoire, senior research analyst with research firm Staffing Industry Analysts, says that the temptation to rush into a quickly growing field is natural, but it could be self-defeating. Gregoire’s firm conducts a twice-a-year survey in conjunction with the National Association of Locum Tenens Organizations (NALTO). The analysis of the first six months of 2011 showed a 34% jump in the in revenue locum agencies generated by placing hospitalists compared with the first half of 2010. “One thing to keep in mind is the market might be growing by 34%, but you have to keep in mind the number of entrants, too,” Gregoire says, adding more colorfully that if “the pie gets twice as big, but you have twice as many people , the piece doesn’t get any bigger.”

So why did Sound Physicians launch its own staffing entity?

“There are certain quality doctors in the locums pool, but I would say the accountability of the staffing person at another firm is not the same accountability we hold our people to,” says Robert Bessler, MD, the firm’s president and chief executive. “These guys have to work with us again tomorrow and the next day, so the doctors they present to our chief medical officers have to be of the same quality as the people that we are choosing to have as partners and owners in our organization.”

Dr. Bessler encourages any national HM group considering launching its own locum arm to consider the costs and manpower commitments required.

“It’s expensive,” he says. “We’ve got a new team of 23 people to start up the new company, no revenue coming in before you start. And then you have to pay doctors right away. … You need a clear business model.”

—Richard Quinn

Last year, HM firm Sound Physicians launched its own locum tenens staffing affiliate, Echo Locum Tenens in Dallas, to help fill vacancies across its national platform. Shortly thereafter, research came out that showed HM is the fastest-growing segment of the locum field, as measured by revenue generation. So is do-it-yourself locum tenens an economically viable approach for hospitalist programs?

The answer is: not likely.

Tony Gregoire, senior research analyst with research firm Staffing Industry Analysts, says that the temptation to rush into a quickly growing field is natural, but it could be self-defeating. Gregoire’s firm conducts a twice-a-year survey in conjunction with the National Association of Locum Tenens Organizations (NALTO). The analysis of the first six months of 2011 showed a 34% jump in the in revenue locum agencies generated by placing hospitalists compared with the first half of 2010. “One thing to keep in mind is the market might be growing by 34%, but you have to keep in mind the number of entrants, too,” Gregoire says, adding more colorfully that if “the pie gets twice as big, but you have twice as many people , the piece doesn’t get any bigger.”

So why did Sound Physicians launch its own staffing entity?

“There are certain quality doctors in the locums pool, but I would say the accountability of the staffing person at another firm is not the same accountability we hold our people to,” says Robert Bessler, MD, the firm’s president and chief executive. “These guys have to work with us again tomorrow and the next day, so the doctors they present to our chief medical officers have to be of the same quality as the people that we are choosing to have as partners and owners in our organization.”

Dr. Bessler encourages any national HM group considering launching its own locum arm to consider the costs and manpower commitments required.

“It’s expensive,” he says. “We’ve got a new team of 23 people to start up the new company, no revenue coming in before you start. And then you have to pay doctors right away. … You need a clear business model.”

—Richard Quinn

Last year, HM firm Sound Physicians launched its own locum tenens staffing affiliate, Echo Locum Tenens in Dallas, to help fill vacancies across its national platform. Shortly thereafter, research came out that showed HM is the fastest-growing segment of the locum field, as measured by revenue generation. So is do-it-yourself locum tenens an economically viable approach for hospitalist programs?

The answer is: not likely.

Tony Gregoire, senior research analyst with research firm Staffing Industry Analysts, says that the temptation to rush into a quickly growing field is natural, but it could be self-defeating. Gregoire’s firm conducts a twice-a-year survey in conjunction with the National Association of Locum Tenens Organizations (NALTO). The analysis of the first six months of 2011 showed a 34% jump in the in revenue locum agencies generated by placing hospitalists compared with the first half of 2010. “One thing to keep in mind is the market might be growing by 34%, but you have to keep in mind the number of entrants, too,” Gregoire says, adding more colorfully that if “the pie gets twice as big, but you have twice as many people , the piece doesn’t get any bigger.”

So why did Sound Physicians launch its own staffing entity?

“There are certain quality doctors in the locums pool, but I would say the accountability of the staffing person at another firm is not the same accountability we hold our people to,” says Robert Bessler, MD, the firm’s president and chief executive. “These guys have to work with us again tomorrow and the next day, so the doctors they present to our chief medical officers have to be of the same quality as the people that we are choosing to have as partners and owners in our organization.”

Dr. Bessler encourages any national HM group considering launching its own locum arm to consider the costs and manpower commitments required.

“It’s expensive,” he says. “We’ve got a new team of 23 people to start up the new company, no revenue coming in before you start. And then you have to pay doctors right away. … You need a clear business model.”

—Richard Quinn

Pushing healthcare toward pay-for-performance models that provide financial rewards for patient outcomes might not be the best direction for healthcare, according to an article published by a duo of doctors and a behavioral economist.

“Will Pay for Performance Backfire? Insights from Behavioral Economics” posted at Healthaffairs.org, questions the validity of paying for outcomes, particularly as there is no evidence yet that the model improves patient outcomes.

“You’re not actually paying for quality,” says David Himmelstein, MD, a professor at City University of New York School of Public Health at Hunter College, New York. “What you’re paying for is some very gameable measurement that doctors will find a way to cheat.”

The blog post notes that monetary rewards can actually undermine motivation for tasks that are intrinsically interesting or rewarding, a phenomenon known as “motivational crowd-out.” Dr. Himmelstein says it could focus attention on coding, rather than patients, or encourage providers to avoid noncompliant patients who will make their measured performances look bad.

“Injecting different monetary incentives into healthcare can certainly change it,” according to the article, “but not necessarily in the ways that policy makers would plan, much less hope for.”

Dr. Himmelstein says that without evidence for, or against, pay for performance, it’s difficult to say whether it will improve outcomes over the long term. Given the government push toward pay-for-performance programs—such as value-based purchasing (VBP)—he suggests physicians prepare themselves to comply. Accordingly, SHM supports policies that link "quality measurement to performance-based payment” and has created a toolkit to help hospitalists prepare for VBP, one of the most targeted pay-for-performance programs.

Even as HM moves toward adopting pay for performance as a mantra, Dr. Himmelstein believes hospitalists are in a good position to lead discussions on whether pay for performance is the only way to move forward.

“It can feel like a fait d’accompli, but things can change, and they can change rapidly,” Dr. Himmelstein adds. “The first step is to have real discussions about it. Up to now, much of the medical literature is saying, ‘It’s not working. We must have the wrong incentives.’ What if there are no right incentives?”

 

Visit our website for more information about pay-for-performance programs.

 

Pushing healthcare toward pay-for-performance models that provide financial rewards for patient outcomes might not be the best direction for healthcare, according to an article published by a duo of doctors and a behavioral economist.

“Will Pay for Performance Backfire? Insights from Behavioral Economics” posted at Healthaffairs.org, questions the validity of paying for outcomes, particularly as there is no evidence yet that the model improves patient outcomes.

“You’re not actually paying for quality,” says David Himmelstein, MD, a professor at City University of New York School of Public Health at Hunter College, New York. “What you’re paying for is some very gameable measurement that doctors will find a way to cheat.”

The blog post notes that monetary rewards can actually undermine motivation for tasks that are intrinsically interesting or rewarding, a phenomenon known as “motivational crowd-out.” Dr. Himmelstein says it could focus attention on coding, rather than patients, or encourage providers to avoid noncompliant patients who will make their measured performances look bad.

“Injecting different monetary incentives into healthcare can certainly change it,” according to the article, “but not necessarily in the ways that policy makers would plan, much less hope for.”

Dr. Himmelstein says that without evidence for, or against, pay for performance, it’s difficult to say whether it will improve outcomes over the long term. Given the government push toward pay-for-performance programs—such as value-based purchasing (VBP)—he suggests physicians prepare themselves to comply. Accordingly, SHM supports policies that link "quality measurement to performance-based payment” and has created a toolkit to help hospitalists prepare for VBP, one of the most targeted pay-for-performance programs.

Even as HM moves toward adopting pay for performance as a mantra, Dr. Himmelstein believes hospitalists are in a good position to lead discussions on whether pay for performance is the only way to move forward.

“It can feel like a fait d’accompli, but things can change, and they can change rapidly,” Dr. Himmelstein adds. “The first step is to have real discussions about it. Up to now, much of the medical literature is saying, ‘It’s not working. We must have the wrong incentives.’ What if there are no right incentives?”

 

Visit our website for more information about pay-for-performance programs.

 

Pushing healthcare toward pay-for-performance models that provide financial rewards for patient outcomes might not be the best direction for healthcare, according to an article published by a duo of doctors and a behavioral economist.

“Will Pay for Performance Backfire? Insights from Behavioral Economics” posted at Healthaffairs.org, questions the validity of paying for outcomes, particularly as there is no evidence yet that the model improves patient outcomes.

“You’re not actually paying for quality,” says David Himmelstein, MD, a professor at City University of New York School of Public Health at Hunter College, New York. “What you’re paying for is some very gameable measurement that doctors will find a way to cheat.”

The blog post notes that monetary rewards can actually undermine motivation for tasks that are intrinsically interesting or rewarding, a phenomenon known as “motivational crowd-out.” Dr. Himmelstein says it could focus attention on coding, rather than patients, or encourage providers to avoid noncompliant patients who will make their measured performances look bad.

“Injecting different monetary incentives into healthcare can certainly change it,” according to the article, “but not necessarily in the ways that policy makers would plan, much less hope for.”

Dr. Himmelstein says that without evidence for, or against, pay for performance, it’s difficult to say whether it will improve outcomes over the long term. Given the government push toward pay-for-performance programs—such as value-based purchasing (VBP)—he suggests physicians prepare themselves to comply. Accordingly, SHM supports policies that link "quality measurement to performance-based payment” and has created a toolkit to help hospitalists prepare for VBP, one of the most targeted pay-for-performance programs.

Even as HM moves toward adopting pay for performance as a mantra, Dr. Himmelstein believes hospitalists are in a good position to lead discussions on whether pay for performance is the only way to move forward.

“It can feel like a fait d’accompli, but things can change, and they can change rapidly,” Dr. Himmelstein adds. “The first step is to have real discussions about it. Up to now, much of the medical literature is saying, ‘It’s not working. We must have the wrong incentives.’ What if there are no right incentives?”

 

Visit our website for more information about pay-for-performance programs.