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Richard Quinn is an award-winning journalist with 15 years’ experience. He has worked at the Asbury Park Press in New Jersey and The Virginian-Pilot in Norfolk, Va., and currently is managing editor for a leading commercial real estate publication. His freelance work has appeared in The Jewish State, The Hospitalist, The Rheumatologist, ACEP Now, and ENT Today. He lives in New Jersey with his wife and three cats.
TeamHealth's Dr. Jasen Gunderson Designs Own Path to Hospital Medicine
Jasen Gundersen, MD, MBA, CPE, SFHM, didn’t take the straightest path to HM. First, as he entered University of Connecticut School of Medicine in Farmington, he thought he’d be an emergency medicine physician. Then he thought about being a rural primary care physician. To that end, he did his residency in family medicine at UMass Memorial Medical Center in Worcester.
And yet, somehow, he became a hospitalist.
“I found that I liked spending all my time in the hospital. I could spend all my time with patients and deal with higher-acuity issues,” says Dr. Gundersen, president of TeamHealth Hospital Medicine in Fort Lauderdale, Fla. “I found that I’d rather deal with acute and more complicated [cases] in the hospital setting than work in an office setting. I like the pace of working in an acute care setting.”
The move to HM, and later to an administrative role, shocked some of his friends and colleagues. But in medical school, the nature of emergency room crises became clear: For a cardiac case, the cardiologist would take over. For a surgical issue, surgeons rolled in.
“I found that if I was going to be doing primary care for folks, which is what happens in a lot of emergency rooms, I didn’t want to do it in a quick, in-and-out setting, where you don’t really get to know the patient,” he says.
Now, Dr. Gundersen is bringing his off-the-beaten path career insights to Team Hospitalist. He’s one of six new members of the volunteer editorial advisory board of The Hospitalist.
—Dr. Gundersen
Question: Was there a mentor who pushed you to HM?
Answer: It just kind of happened. I liked working in the hospital. I was really excited about my weeks in the hospital and when I was in the office, I was thinking about working in the hospital.
Q: How did HM help prepare you for your current position, in terms of growing and building a business?
A: It’s a rapidly growing field. The timing was perfect for me to be in the field and have a background in hospital medicine and grow in a leadership role. I think my background of knowing hospitals made it easier to be a HM leader, but along the way I had hospital leadership roles. The experience working in the hospital, as a hospitalist, touching all aspects of patient care, really set me up well for a leadership role in a hospital. That was a springboard for me, managing doctors, to step into the role I have now with TeamHealth.
Q: What do you miss most about clinical work, given that you spend most of your time now in business development?
A: The simplicity of it, compared to the complicated aspects of running a huge company. It’s nice to be able to just go in and be a doctor sometimes. You know, talk to patients about their illness, work through the systems, and just be a doc. Not thinking about fixing something and managing people.
Q: What is the best advice you’ve ever received?
A: Be honest. Always be honest. That’s be honest with yourself about what your abilities are, where your limitations are, and what your goals are and why you have them. And then be honest with all the people you work with about what you can do and can’t do. That is probably the most important thing. If you are a hospitalist and want to be a leader, be honest with yourself [about] why you want to do it. Is it because you enjoy it? Is it because you think you are going to have more time or make more money? Are you capable of handling the stress of being a leader?
Q: What is the worst piece of advice you’ve ever received?
A: I don’t know, probably because I just ignored it.
Q: Where do you see the field in five to 10 years?
A: I think the field of hospital medicine needs to be cautious of the pace [at which] we are growing, and some of the limitations and demands we have been trying to put on it. I think we need to embrace the growth and embrace what people are asking us to do. I think the role of hospitalists will get bigger and bigger. I think what has really happened is that we have transitioned into two types of physicians in general, and I think that is because of the hospitalist movement. Medical staffs will be made up of outpatient physicians and inpatient physicians.
Q: Any concerns about that growth?
A: I think we need to be cautious as we grow that we don’t overspecialize the hospital and that we realize that what has allowed us to grow is our flexibility. The ‘scope creep’ of what we cover and what we do is going to continue, and we’re going to have to work with it and seize that opportunity.
Richard Quinn is a freelance writer in New Jersey.
Jasen Gundersen, MD, MBA, CPE, SFHM, didn’t take the straightest path to HM. First, as he entered University of Connecticut School of Medicine in Farmington, he thought he’d be an emergency medicine physician. Then he thought about being a rural primary care physician. To that end, he did his residency in family medicine at UMass Memorial Medical Center in Worcester.
And yet, somehow, he became a hospitalist.
“I found that I liked spending all my time in the hospital. I could spend all my time with patients and deal with higher-acuity issues,” says Dr. Gundersen, president of TeamHealth Hospital Medicine in Fort Lauderdale, Fla. “I found that I’d rather deal with acute and more complicated [cases] in the hospital setting than work in an office setting. I like the pace of working in an acute care setting.”
The move to HM, and later to an administrative role, shocked some of his friends and colleagues. But in medical school, the nature of emergency room crises became clear: For a cardiac case, the cardiologist would take over. For a surgical issue, surgeons rolled in.
“I found that if I was going to be doing primary care for folks, which is what happens in a lot of emergency rooms, I didn’t want to do it in a quick, in-and-out setting, where you don’t really get to know the patient,” he says.
Now, Dr. Gundersen is bringing his off-the-beaten path career insights to Team Hospitalist. He’s one of six new members of the volunteer editorial advisory board of The Hospitalist.
—Dr. Gundersen
Question: Was there a mentor who pushed you to HM?
Answer: It just kind of happened. I liked working in the hospital. I was really excited about my weeks in the hospital and when I was in the office, I was thinking about working in the hospital.
Q: How did HM help prepare you for your current position, in terms of growing and building a business?
A: It’s a rapidly growing field. The timing was perfect for me to be in the field and have a background in hospital medicine and grow in a leadership role. I think my background of knowing hospitals made it easier to be a HM leader, but along the way I had hospital leadership roles. The experience working in the hospital, as a hospitalist, touching all aspects of patient care, really set me up well for a leadership role in a hospital. That was a springboard for me, managing doctors, to step into the role I have now with TeamHealth.
Q: What do you miss most about clinical work, given that you spend most of your time now in business development?
A: The simplicity of it, compared to the complicated aspects of running a huge company. It’s nice to be able to just go in and be a doctor sometimes. You know, talk to patients about their illness, work through the systems, and just be a doc. Not thinking about fixing something and managing people.
Q: What is the best advice you’ve ever received?
A: Be honest. Always be honest. That’s be honest with yourself about what your abilities are, where your limitations are, and what your goals are and why you have them. And then be honest with all the people you work with about what you can do and can’t do. That is probably the most important thing. If you are a hospitalist and want to be a leader, be honest with yourself [about] why you want to do it. Is it because you enjoy it? Is it because you think you are going to have more time or make more money? Are you capable of handling the stress of being a leader?
Q: What is the worst piece of advice you’ve ever received?
A: I don’t know, probably because I just ignored it.
Q: Where do you see the field in five to 10 years?
A: I think the field of hospital medicine needs to be cautious of the pace [at which] we are growing, and some of the limitations and demands we have been trying to put on it. I think we need to embrace the growth and embrace what people are asking us to do. I think the role of hospitalists will get bigger and bigger. I think what has really happened is that we have transitioned into two types of physicians in general, and I think that is because of the hospitalist movement. Medical staffs will be made up of outpatient physicians and inpatient physicians.
Q: Any concerns about that growth?
A: I think we need to be cautious as we grow that we don’t overspecialize the hospital and that we realize that what has allowed us to grow is our flexibility. The ‘scope creep’ of what we cover and what we do is going to continue, and we’re going to have to work with it and seize that opportunity.
Richard Quinn is a freelance writer in New Jersey.
Jasen Gundersen, MD, MBA, CPE, SFHM, didn’t take the straightest path to HM. First, as he entered University of Connecticut School of Medicine in Farmington, he thought he’d be an emergency medicine physician. Then he thought about being a rural primary care physician. To that end, he did his residency in family medicine at UMass Memorial Medical Center in Worcester.
And yet, somehow, he became a hospitalist.
“I found that I liked spending all my time in the hospital. I could spend all my time with patients and deal with higher-acuity issues,” says Dr. Gundersen, president of TeamHealth Hospital Medicine in Fort Lauderdale, Fla. “I found that I’d rather deal with acute and more complicated [cases] in the hospital setting than work in an office setting. I like the pace of working in an acute care setting.”
The move to HM, and later to an administrative role, shocked some of his friends and colleagues. But in medical school, the nature of emergency room crises became clear: For a cardiac case, the cardiologist would take over. For a surgical issue, surgeons rolled in.
“I found that if I was going to be doing primary care for folks, which is what happens in a lot of emergency rooms, I didn’t want to do it in a quick, in-and-out setting, where you don’t really get to know the patient,” he says.
Now, Dr. Gundersen is bringing his off-the-beaten path career insights to Team Hospitalist. He’s one of six new members of the volunteer editorial advisory board of The Hospitalist.
—Dr. Gundersen
Question: Was there a mentor who pushed you to HM?
Answer: It just kind of happened. I liked working in the hospital. I was really excited about my weeks in the hospital and when I was in the office, I was thinking about working in the hospital.
Q: How did HM help prepare you for your current position, in terms of growing and building a business?
A: It’s a rapidly growing field. The timing was perfect for me to be in the field and have a background in hospital medicine and grow in a leadership role. I think my background of knowing hospitals made it easier to be a HM leader, but along the way I had hospital leadership roles. The experience working in the hospital, as a hospitalist, touching all aspects of patient care, really set me up well for a leadership role in a hospital. That was a springboard for me, managing doctors, to step into the role I have now with TeamHealth.
Q: What do you miss most about clinical work, given that you spend most of your time now in business development?
A: The simplicity of it, compared to the complicated aspects of running a huge company. It’s nice to be able to just go in and be a doctor sometimes. You know, talk to patients about their illness, work through the systems, and just be a doc. Not thinking about fixing something and managing people.
Q: What is the best advice you’ve ever received?
A: Be honest. Always be honest. That’s be honest with yourself about what your abilities are, where your limitations are, and what your goals are and why you have them. And then be honest with all the people you work with about what you can do and can’t do. That is probably the most important thing. If you are a hospitalist and want to be a leader, be honest with yourself [about] why you want to do it. Is it because you enjoy it? Is it because you think you are going to have more time or make more money? Are you capable of handling the stress of being a leader?
Q: What is the worst piece of advice you’ve ever received?
A: I don’t know, probably because I just ignored it.
Q: Where do you see the field in five to 10 years?
A: I think the field of hospital medicine needs to be cautious of the pace [at which] we are growing, and some of the limitations and demands we have been trying to put on it. I think we need to embrace the growth and embrace what people are asking us to do. I think the role of hospitalists will get bigger and bigger. I think what has really happened is that we have transitioned into two types of physicians in general, and I think that is because of the hospitalist movement. Medical staffs will be made up of outpatient physicians and inpatient physicians.
Q: Any concerns about that growth?
A: I think we need to be cautious as we grow that we don’t overspecialize the hospital and that we realize that what has allowed us to grow is our flexibility. The ‘scope creep’ of what we cover and what we do is going to continue, and we’re going to have to work with it and seize that opportunity.
Richard Quinn is a freelance writer in New Jersey.
Hospitalist Continuity Doesn’t Affect Adverse Events among Inpatients
Hospitalist continuity does not appear to be associated with the incidence of adverse events (AEs), according to a new report in the Journal of Hospital Medicine.
Authors used two methods to measure continuity: the Number of Physicians Index (NPI) represented the total number of unique hospitalists caring for a patient, while the Usual Provider of Care (UPC) Index was the proportion of encounters with the most frequently encountered hospitalist.
Researchers reported that, in unadjusted models, each one-unit increase in the NPI—meaning less continuity—was significantly associated with the incidence of one or more AEs (odds ratio, 1.75; P<0.001). In addition, UPC was not associated with incidence of AEs. Across all adjusted models, neither index was "significantly associated" with the incidence of AEs.
Lead author Kevin O'Leary, MD, MS, SFHM, of Northwestern University's Feinberg School of Medicine in Chicago, says that the data could be used to help determine how best to structure handoffs.
"Where I think this has a major impact is that a whole lot of groups [are] trying to figure out how long should our rotation length be," Dr. O'Leary says. "All of those programs that are really trying to maximize continuity because they think it's the safest thing and best thing for patient outcomes, they can probably relax a little bit and swing the pendulum a little bit further toward what they think is the right model for the work-life balance of their hospitalist. [They can] worry a little bit less about the impact on the patients because there doesn't seem to be much." TH
Visit our website for more information on transitions of care.
Hospitalist continuity does not appear to be associated with the incidence of adverse events (AEs), according to a new report in the Journal of Hospital Medicine.
Authors used two methods to measure continuity: the Number of Physicians Index (NPI) represented the total number of unique hospitalists caring for a patient, while the Usual Provider of Care (UPC) Index was the proportion of encounters with the most frequently encountered hospitalist.
Researchers reported that, in unadjusted models, each one-unit increase in the NPI—meaning less continuity—was significantly associated with the incidence of one or more AEs (odds ratio, 1.75; P<0.001). In addition, UPC was not associated with incidence of AEs. Across all adjusted models, neither index was "significantly associated" with the incidence of AEs.
Lead author Kevin O'Leary, MD, MS, SFHM, of Northwestern University's Feinberg School of Medicine in Chicago, says that the data could be used to help determine how best to structure handoffs.
"Where I think this has a major impact is that a whole lot of groups [are] trying to figure out how long should our rotation length be," Dr. O'Leary says. "All of those programs that are really trying to maximize continuity because they think it's the safest thing and best thing for patient outcomes, they can probably relax a little bit and swing the pendulum a little bit further toward what they think is the right model for the work-life balance of their hospitalist. [They can] worry a little bit less about the impact on the patients because there doesn't seem to be much." TH
Visit our website for more information on transitions of care.
Hospitalist continuity does not appear to be associated with the incidence of adverse events (AEs), according to a new report in the Journal of Hospital Medicine.
Authors used two methods to measure continuity: the Number of Physicians Index (NPI) represented the total number of unique hospitalists caring for a patient, while the Usual Provider of Care (UPC) Index was the proportion of encounters with the most frequently encountered hospitalist.
Researchers reported that, in unadjusted models, each one-unit increase in the NPI—meaning less continuity—was significantly associated with the incidence of one or more AEs (odds ratio, 1.75; P<0.001). In addition, UPC was not associated with incidence of AEs. Across all adjusted models, neither index was "significantly associated" with the incidence of AEs.
Lead author Kevin O'Leary, MD, MS, SFHM, of Northwestern University's Feinberg School of Medicine in Chicago, says that the data could be used to help determine how best to structure handoffs.
"Where I think this has a major impact is that a whole lot of groups [are] trying to figure out how long should our rotation length be," Dr. O'Leary says. "All of those programs that are really trying to maximize continuity because they think it's the safest thing and best thing for patient outcomes, they can probably relax a little bit and swing the pendulum a little bit further toward what they think is the right model for the work-life balance of their hospitalist. [They can] worry a little bit less about the impact on the patients because there doesn't seem to be much." TH
Visit our website for more information on transitions of care.
Hospitalists Gear Up for HM15
Hospital medicine will descend on Washington, D.C., again.
At least 2,500 attendees are expected at SHM's annual meeting, HM15, which kicks off March 29 at the Gaylord National Resort & Convention Center in National Harbor, Md. The four-day conference—SHM's third in the nation's capital in six years—ends April 1 and encompasses:
- Seven pre-courses on March 29 that can be applied toward continuing medical education credits;
- Dozens of educational sessions over three days, including the debut of its "Young Hospitalists" track on March 30;
- The largest Research, Innovations, and Clinical Vignettes poster competition ever; and
- Plenary sessions from patient-safety guru Peter Pronovost, MD, PhD, FCCM; HM pioneer Robert Wachter, MD, MHM; and Maureen Bisognano, president and CEO of the Institute for Healthcare Improvement.
"The opportunity to learn about faculty development, the opportunity to learn about administrative concerns in running a hospital medicine program, the opportunity to address quality improvement…the opportunity to meet other folks who are doing very similar work and learn from them, all of those things exist,” says assistant course director Melissa Mattison, MD, SFHM.
In addition, SHM's advocacy event, Hospitalists on the Hill Day, is scheduled for April 1 and will see physicians holding hundreds of meetings with Capitol Hill legislators and staffers.
"Every congressman has physicians in their community, and they value the opinion of those physicians," SHM Public Policy Committee Chair Ron Greeno, MD, MHM, says. "Nothing is more effective than having one of our members meet with a representative from their home district about the issues that we care about."
Visit our website for more information on HM15.
Hospital medicine will descend on Washington, D.C., again.
At least 2,500 attendees are expected at SHM's annual meeting, HM15, which kicks off March 29 at the Gaylord National Resort & Convention Center in National Harbor, Md. The four-day conference—SHM's third in the nation's capital in six years—ends April 1 and encompasses:
- Seven pre-courses on March 29 that can be applied toward continuing medical education credits;
- Dozens of educational sessions over three days, including the debut of its "Young Hospitalists" track on March 30;
- The largest Research, Innovations, and Clinical Vignettes poster competition ever; and
- Plenary sessions from patient-safety guru Peter Pronovost, MD, PhD, FCCM; HM pioneer Robert Wachter, MD, MHM; and Maureen Bisognano, president and CEO of the Institute for Healthcare Improvement.
"The opportunity to learn about faculty development, the opportunity to learn about administrative concerns in running a hospital medicine program, the opportunity to address quality improvement…the opportunity to meet other folks who are doing very similar work and learn from them, all of those things exist,” says assistant course director Melissa Mattison, MD, SFHM.
In addition, SHM's advocacy event, Hospitalists on the Hill Day, is scheduled for April 1 and will see physicians holding hundreds of meetings with Capitol Hill legislators and staffers.
"Every congressman has physicians in their community, and they value the opinion of those physicians," SHM Public Policy Committee Chair Ron Greeno, MD, MHM, says. "Nothing is more effective than having one of our members meet with a representative from their home district about the issues that we care about."
Visit our website for more information on HM15.
Hospital medicine will descend on Washington, D.C., again.
At least 2,500 attendees are expected at SHM's annual meeting, HM15, which kicks off March 29 at the Gaylord National Resort & Convention Center in National Harbor, Md. The four-day conference—SHM's third in the nation's capital in six years—ends April 1 and encompasses:
- Seven pre-courses on March 29 that can be applied toward continuing medical education credits;
- Dozens of educational sessions over three days, including the debut of its "Young Hospitalists" track on March 30;
- The largest Research, Innovations, and Clinical Vignettes poster competition ever; and
- Plenary sessions from patient-safety guru Peter Pronovost, MD, PhD, FCCM; HM pioneer Robert Wachter, MD, MHM; and Maureen Bisognano, president and CEO of the Institute for Healthcare Improvement.
"The opportunity to learn about faculty development, the opportunity to learn about administrative concerns in running a hospital medicine program, the opportunity to address quality improvement…the opportunity to meet other folks who are doing very similar work and learn from them, all of those things exist,” says assistant course director Melissa Mattison, MD, SFHM.
In addition, SHM's advocacy event, Hospitalists on the Hill Day, is scheduled for April 1 and will see physicians holding hundreds of meetings with Capitol Hill legislators and staffers.
"Every congressman has physicians in their community, and they value the opinion of those physicians," SHM Public Policy Committee Chair Ron Greeno, MD, MHM, says. "Nothing is more effective than having one of our members meet with a representative from their home district about the issues that we care about."
Visit our website for more information on HM15.
Hospitalists' Holistic Approach Draws Monal Shah, MD to Hospital Medicine
There was just something about hospitalized patients and the folks who cared for them that drew the attention of Monal Shah, MD. Midway through residency, he decided that the best word for it was respect. For the doctors and the people they treated—respect.
“I also liked that [the hospitalists] had a depth of knowledge outside of clinical care that was still important in managing patients: e.g. what insurance pays for what service, how to facilitate outpatient follow-up appointments, the importance of social factors in preventing a patient from returning to the hospital, etc.,” Dr. Shah says. “Even though we weren’t in an outpatient setting, I really appreciated that holistic approach and knowledge base required to care for inpatients.”
That was more than a decade ago at the University of Texas Health Science Center in San Antonio. In the intervening years, Dr. Shah has become involved in clinical informatics and works with a nonprofit company developing prediction models and surveillance analytics for healthcare systems. He also serves as a physician advisor for Parkland Health and Hospital System in Dallas.
Question: I have your CV, but tell me a little more about your training in medical school and residency. What did you like most [and] dislike during the process? Was there a single moment you knew “I can do this”?
Answer: I really enjoyed the camaraderie of residency, especially when I was on an inpatient service and worked with a team [residents, interns, students, and attending]. I was fortunate to have an amazing group of people who inspired me to become a better clinician. I liked clinic the least. I still have days when I’m not sure if “I can do this.”
Q: What’s the biggest change you would like to see in hospital medicine?
A: With information overload, I feel like it’s pretty easy to figure out how to clinically care for a patient. For example, knowing which antibiotic to give for a certain infection is pretty easy to figure out. But knowing which IV antibiotics can/should be given in a nursing facility or at home is more nuanced and forces providers to address and think about the financial and social implications of healthcare. I think that it’s helpful for all specialties to have understanding about this, so the earlier that this type of training occurs (i.e., medical school), the better.
Q: Clinical informatics is clearly a growing area of interest for many. What about it appeals to you? How would you like to apply that knowledge to HM?
A: I found the EHR [electronic health record] to be very valuable, and it’s become difficult to imagine what it was like practicing in the pre-electronic era, but, with it, there definitely is information overload. Specifically, there is lots of duplicative/repetitive information coupled with new information (e.g. labs, vitals, imaging, notes) continuously being generated. Unless you’re sitting at the EMR [electronic medical record] or being notified every time something new appears, it’s almost impossible to know what is going on with the patient in real time. Clinical informatics has the ability to look for the most salient pieces of information—for instance, specific labs or radiology findings or specific words a clinician/nurse might use through natural language processing, etc. [We can] synthesize that information in real time to identify patients with certain diseases—like sepsis, where treatment with antibiotics is time-sensitive, or those who are at risk for adverse events. [We can identify,] for example, those patients at risk for cardiopulmonary arrest, readmission, etc.
Q: You’ve talked about access to data. How do you access the technology? How often? What about it works best for you? Is it something you wish older docs used more?
A: There is so much information ... that is constantly being generated [that] it makes it almost impossible to stay up to date on everything. Rather than even attempt to memorize every single treatment, I make an effort to know where to look for standard of care treatment regimens (e.g. ACCP [American College of Chest Physicians] anticoagulation guidelines, IDSA [Infectious Diseases Society of America] guidelines, ACC/AHA [American College of Cardiology/American Heart Association] peri-operative guidelines). I use technology daily, probably looking up something on at least half of the patients I’m taking care of [on] a given day.
Q: What is your biggest professional challenge?
A: Being able to say no.
Q: What is your biggest professional reward?
A: Students and residents that I’ve worked with who choose a career in HM.
Q: What aspect of patient care is most rewarding?
A: Seeing a patient get well enough to be discharged home or to a lower level of care.
Q: What’s the best advice you ever received?
A: Say yes to anyone asking for help in managing a patient.
Q: What’s the worst advice you ever received?
A: Say yes to every job opportunity.
Q: Did you have a mentor during training or early career? If so, who was the mentor and what were the most important lessons you learned from him/her?
A: My division chief, although he probably didn’t know it. He was firm and had a clear direction for the division/program; however, he was very affable and had a delicate touch when dealing with the other physicians.
Richard Quinn is a freelance writer in New Jersey.
There was just something about hospitalized patients and the folks who cared for them that drew the attention of Monal Shah, MD. Midway through residency, he decided that the best word for it was respect. For the doctors and the people they treated—respect.
“I also liked that [the hospitalists] had a depth of knowledge outside of clinical care that was still important in managing patients: e.g. what insurance pays for what service, how to facilitate outpatient follow-up appointments, the importance of social factors in preventing a patient from returning to the hospital, etc.,” Dr. Shah says. “Even though we weren’t in an outpatient setting, I really appreciated that holistic approach and knowledge base required to care for inpatients.”
That was more than a decade ago at the University of Texas Health Science Center in San Antonio. In the intervening years, Dr. Shah has become involved in clinical informatics and works with a nonprofit company developing prediction models and surveillance analytics for healthcare systems. He also serves as a physician advisor for Parkland Health and Hospital System in Dallas.
Question: I have your CV, but tell me a little more about your training in medical school and residency. What did you like most [and] dislike during the process? Was there a single moment you knew “I can do this”?
Answer: I really enjoyed the camaraderie of residency, especially when I was on an inpatient service and worked with a team [residents, interns, students, and attending]. I was fortunate to have an amazing group of people who inspired me to become a better clinician. I liked clinic the least. I still have days when I’m not sure if “I can do this.”
Q: What’s the biggest change you would like to see in hospital medicine?
A: With information overload, I feel like it’s pretty easy to figure out how to clinically care for a patient. For example, knowing which antibiotic to give for a certain infection is pretty easy to figure out. But knowing which IV antibiotics can/should be given in a nursing facility or at home is more nuanced and forces providers to address and think about the financial and social implications of healthcare. I think that it’s helpful for all specialties to have understanding about this, so the earlier that this type of training occurs (i.e., medical school), the better.
Q: Clinical informatics is clearly a growing area of interest for many. What about it appeals to you? How would you like to apply that knowledge to HM?
A: I found the EHR [electronic health record] to be very valuable, and it’s become difficult to imagine what it was like practicing in the pre-electronic era, but, with it, there definitely is information overload. Specifically, there is lots of duplicative/repetitive information coupled with new information (e.g. labs, vitals, imaging, notes) continuously being generated. Unless you’re sitting at the EMR [electronic medical record] or being notified every time something new appears, it’s almost impossible to know what is going on with the patient in real time. Clinical informatics has the ability to look for the most salient pieces of information—for instance, specific labs or radiology findings or specific words a clinician/nurse might use through natural language processing, etc. [We can] synthesize that information in real time to identify patients with certain diseases—like sepsis, where treatment with antibiotics is time-sensitive, or those who are at risk for adverse events. [We can identify,] for example, those patients at risk for cardiopulmonary arrest, readmission, etc.
Q: You’ve talked about access to data. How do you access the technology? How often? What about it works best for you? Is it something you wish older docs used more?
A: There is so much information ... that is constantly being generated [that] it makes it almost impossible to stay up to date on everything. Rather than even attempt to memorize every single treatment, I make an effort to know where to look for standard of care treatment regimens (e.g. ACCP [American College of Chest Physicians] anticoagulation guidelines, IDSA [Infectious Diseases Society of America] guidelines, ACC/AHA [American College of Cardiology/American Heart Association] peri-operative guidelines). I use technology daily, probably looking up something on at least half of the patients I’m taking care of [on] a given day.
Q: What is your biggest professional challenge?
A: Being able to say no.
Q: What is your biggest professional reward?
A: Students and residents that I’ve worked with who choose a career in HM.
Q: What aspect of patient care is most rewarding?
A: Seeing a patient get well enough to be discharged home or to a lower level of care.
Q: What’s the best advice you ever received?
A: Say yes to anyone asking for help in managing a patient.
Q: What’s the worst advice you ever received?
A: Say yes to every job opportunity.
Q: Did you have a mentor during training or early career? If so, who was the mentor and what were the most important lessons you learned from him/her?
A: My division chief, although he probably didn’t know it. He was firm and had a clear direction for the division/program; however, he was very affable and had a delicate touch when dealing with the other physicians.
Richard Quinn is a freelance writer in New Jersey.
There was just something about hospitalized patients and the folks who cared for them that drew the attention of Monal Shah, MD. Midway through residency, he decided that the best word for it was respect. For the doctors and the people they treated—respect.
“I also liked that [the hospitalists] had a depth of knowledge outside of clinical care that was still important in managing patients: e.g. what insurance pays for what service, how to facilitate outpatient follow-up appointments, the importance of social factors in preventing a patient from returning to the hospital, etc.,” Dr. Shah says. “Even though we weren’t in an outpatient setting, I really appreciated that holistic approach and knowledge base required to care for inpatients.”
That was more than a decade ago at the University of Texas Health Science Center in San Antonio. In the intervening years, Dr. Shah has become involved in clinical informatics and works with a nonprofit company developing prediction models and surveillance analytics for healthcare systems. He also serves as a physician advisor for Parkland Health and Hospital System in Dallas.
Question: I have your CV, but tell me a little more about your training in medical school and residency. What did you like most [and] dislike during the process? Was there a single moment you knew “I can do this”?
Answer: I really enjoyed the camaraderie of residency, especially when I was on an inpatient service and worked with a team [residents, interns, students, and attending]. I was fortunate to have an amazing group of people who inspired me to become a better clinician. I liked clinic the least. I still have days when I’m not sure if “I can do this.”
Q: What’s the biggest change you would like to see in hospital medicine?
A: With information overload, I feel like it’s pretty easy to figure out how to clinically care for a patient. For example, knowing which antibiotic to give for a certain infection is pretty easy to figure out. But knowing which IV antibiotics can/should be given in a nursing facility or at home is more nuanced and forces providers to address and think about the financial and social implications of healthcare. I think that it’s helpful for all specialties to have understanding about this, so the earlier that this type of training occurs (i.e., medical school), the better.
Q: Clinical informatics is clearly a growing area of interest for many. What about it appeals to you? How would you like to apply that knowledge to HM?
A: I found the EHR [electronic health record] to be very valuable, and it’s become difficult to imagine what it was like practicing in the pre-electronic era, but, with it, there definitely is information overload. Specifically, there is lots of duplicative/repetitive information coupled with new information (e.g. labs, vitals, imaging, notes) continuously being generated. Unless you’re sitting at the EMR [electronic medical record] or being notified every time something new appears, it’s almost impossible to know what is going on with the patient in real time. Clinical informatics has the ability to look for the most salient pieces of information—for instance, specific labs or radiology findings or specific words a clinician/nurse might use through natural language processing, etc. [We can] synthesize that information in real time to identify patients with certain diseases—like sepsis, where treatment with antibiotics is time-sensitive, or those who are at risk for adverse events. [We can identify,] for example, those patients at risk for cardiopulmonary arrest, readmission, etc.
Q: You’ve talked about access to data. How do you access the technology? How often? What about it works best for you? Is it something you wish older docs used more?
A: There is so much information ... that is constantly being generated [that] it makes it almost impossible to stay up to date on everything. Rather than even attempt to memorize every single treatment, I make an effort to know where to look for standard of care treatment regimens (e.g. ACCP [American College of Chest Physicians] anticoagulation guidelines, IDSA [Infectious Diseases Society of America] guidelines, ACC/AHA [American College of Cardiology/American Heart Association] peri-operative guidelines). I use technology daily, probably looking up something on at least half of the patients I’m taking care of [on] a given day.
Q: What is your biggest professional challenge?
A: Being able to say no.
Q: What is your biggest professional reward?
A: Students and residents that I’ve worked with who choose a career in HM.
Q: What aspect of patient care is most rewarding?
A: Seeing a patient get well enough to be discharged home or to a lower level of care.
Q: What’s the best advice you ever received?
A: Say yes to anyone asking for help in managing a patient.
Q: What’s the worst advice you ever received?
A: Say yes to every job opportunity.
Q: Did you have a mentor during training or early career? If so, who was the mentor and what were the most important lessons you learned from him/her?
A: My division chief, although he probably didn’t know it. He was firm and had a clear direction for the division/program; however, he was very affable and had a delicate touch when dealing with the other physicians.
Richard Quinn is a freelance writer in New Jersey.
Threat of Facility Closure Puts Pressure on Rural Hospitalists
A pair of rural South Carolina hospitals that may soon shutter their doors is the latest example of the pressure on rural hospitalists, says a veteran HM director. But hospital closures also give rural hospitalists the opportunity to carve out a niche doing medical work that best serves their community.
Marlboro Park Hospital and Chesterfield General Hospital, 15 miles apart in northeastern South Carolina, are set to close this spring as Community Health Systems—which runs the hospitals and employs hospital staff—announced it would not renew its operating lease. A new operator is being sought.
The fear of a rural institution closing is a common one for hospitalists, says Dana Giarrizzi, DO, FHM, national medical director for telehospitalist services for Eagle Hospital Physicians and section leader for the rural section of SHM.
"There's always that feeling of walking the tightrope," Dr. Giarrizzi says. "It's a fine line because you can't offer everything…there aren't enough physicians."
And while hospitals' shrinking bottom lines, more intensive reporting and quality protocols, and ongoing changes to the rules of the Affordable Care Act have roiled rural hospitalists, Dr. Giarrizzi sees the current environment as one that offers rural groups an opportunity to focus on what they do best and home in on that.
"It's really important [for rural hospitalist groups] to figure out what their niche is, figure out what works for them, and then to run that well," Dr. Giarrizzi adds. "I think it hurts them when they're pushed or when they feel like they have to do everything…you don't have that ability. These small rural hospitals serve their purpose, but their purpose isn't to serve everything."
Visit our website for more information on rural hospitals.
A pair of rural South Carolina hospitals that may soon shutter their doors is the latest example of the pressure on rural hospitalists, says a veteran HM director. But hospital closures also give rural hospitalists the opportunity to carve out a niche doing medical work that best serves their community.
Marlboro Park Hospital and Chesterfield General Hospital, 15 miles apart in northeastern South Carolina, are set to close this spring as Community Health Systems—which runs the hospitals and employs hospital staff—announced it would not renew its operating lease. A new operator is being sought.
The fear of a rural institution closing is a common one for hospitalists, says Dana Giarrizzi, DO, FHM, national medical director for telehospitalist services for Eagle Hospital Physicians and section leader for the rural section of SHM.
"There's always that feeling of walking the tightrope," Dr. Giarrizzi says. "It's a fine line because you can't offer everything…there aren't enough physicians."
And while hospitals' shrinking bottom lines, more intensive reporting and quality protocols, and ongoing changes to the rules of the Affordable Care Act have roiled rural hospitalists, Dr. Giarrizzi sees the current environment as one that offers rural groups an opportunity to focus on what they do best and home in on that.
"It's really important [for rural hospitalist groups] to figure out what their niche is, figure out what works for them, and then to run that well," Dr. Giarrizzi adds. "I think it hurts them when they're pushed or when they feel like they have to do everything…you don't have that ability. These small rural hospitals serve their purpose, but their purpose isn't to serve everything."
Visit our website for more information on rural hospitals.
A pair of rural South Carolina hospitals that may soon shutter their doors is the latest example of the pressure on rural hospitalists, says a veteran HM director. But hospital closures also give rural hospitalists the opportunity to carve out a niche doing medical work that best serves their community.
Marlboro Park Hospital and Chesterfield General Hospital, 15 miles apart in northeastern South Carolina, are set to close this spring as Community Health Systems—which runs the hospitals and employs hospital staff—announced it would not renew its operating lease. A new operator is being sought.
The fear of a rural institution closing is a common one for hospitalists, says Dana Giarrizzi, DO, FHM, national medical director for telehospitalist services for Eagle Hospital Physicians and section leader for the rural section of SHM.
"There's always that feeling of walking the tightrope," Dr. Giarrizzi says. "It's a fine line because you can't offer everything…there aren't enough physicians."
And while hospitals' shrinking bottom lines, more intensive reporting and quality protocols, and ongoing changes to the rules of the Affordable Care Act have roiled rural hospitalists, Dr. Giarrizzi sees the current environment as one that offers rural groups an opportunity to focus on what they do best and home in on that.
"It's really important [for rural hospitalist groups] to figure out what their niche is, figure out what works for them, and then to run that well," Dr. Giarrizzi adds. "I think it hurts them when they're pushed or when they feel like they have to do everything…you don't have that ability. These small rural hospitals serve their purpose, but their purpose isn't to serve everything."
Visit our website for more information on rural hospitals.
Hospitalists Optimistic over ABIM Changes to Maintenance of Certification Requirements
News that the American Board of Internal Medicine (ABIM) will reboot its controversial Maintenance of Certification (MOC) program is an opportunity for hospitalists to help shape their own professional development, according to former ABIM chair and hospital medicine pioneer Robert Wachter, MD, MHM.
A year ago, ABIM moved from an MOC every 10 years to a more continuous certification process. The goal was to keep physicians more current, but the change sparked backlash over education costs, the applicability and usefulness of exam questions, and bureaucratic burdens of the new process.
In a public statement last week, ABIM president and CEO Richard Baron, MD, acknowledged that "ABIM clearly got it wrong. We launched programs that weren't ready and we didn't deliver an MOC program that physicians found meaningful."
Dr. Wachter, who was ABIM's chair when Dr. Baron was hired, says that ABIM's new plan to reach out to specialty societies means SHM can lobby for an MOC process that is more current, more applicable, and more meaningful to practitioners. Given that HM as a specialty was launched as a novel idea on what would make a good care model for hospitalized patients, Dr. Wachter is confident that SHM can be helpful in guiding the creation of a better MOC process.
Hospital medicine "was built on out-of-the-box thinking, on accepting certain parts of the old model of what a good doctor was but throwing other parts out and saying, 'We want to rethink this,'" Dr. Wachter says. "I can't think of a specialty that’s better positioned to help."
Meanwhile, hospitalist and ABIM Council member Jeff Wiese, MD, MHM, sees an opportunity to make sure the overall process for "knowledge improvement" is enhanced so that disconnects between practitioners and ABIM do not continue.
"We have to ensure that what happened over the past 20 years doesn't happen again," Dr. Wiese says. "Namely, that the world of medicine doesn't move so fast that the ABIM MOC requirements don't keep up. If we engage as physicians and specialty organizations in meaningful dialogues…then we have a much better chance of making MOC sufficiently dynamic to meet the changing times."
SHM President Burke Kealey, MD, SFHM, says that hospitalists were less impacted than some other specialists by the MOC change because they could use the Focused Practice in Hospital Medicine (FPHM) exam. The FPHM test was crafted by "real practicing hospitalists [writing] the questions for hospitalists from the point of view of what a hospitalist needs to know to do their job," he says.
Dr. Kealey adds that SHM plans to help hospitalists prepare for exams through courses featured at next month’s annual meeting and with the publication of a study guide due out this fall focused on the test's nonclinical aspects. Since it was posted last week, Dr. Kealey's blog on "The Hospital Leader" has attracted the interest of thousands of hospitalists and has been shared more than 70 times.
Visit our website for more information on Maintenance of Certification issues.
News that the American Board of Internal Medicine (ABIM) will reboot its controversial Maintenance of Certification (MOC) program is an opportunity for hospitalists to help shape their own professional development, according to former ABIM chair and hospital medicine pioneer Robert Wachter, MD, MHM.
A year ago, ABIM moved from an MOC every 10 years to a more continuous certification process. The goal was to keep physicians more current, but the change sparked backlash over education costs, the applicability and usefulness of exam questions, and bureaucratic burdens of the new process.
In a public statement last week, ABIM president and CEO Richard Baron, MD, acknowledged that "ABIM clearly got it wrong. We launched programs that weren't ready and we didn't deliver an MOC program that physicians found meaningful."
Dr. Wachter, who was ABIM's chair when Dr. Baron was hired, says that ABIM's new plan to reach out to specialty societies means SHM can lobby for an MOC process that is more current, more applicable, and more meaningful to practitioners. Given that HM as a specialty was launched as a novel idea on what would make a good care model for hospitalized patients, Dr. Wachter is confident that SHM can be helpful in guiding the creation of a better MOC process.
Hospital medicine "was built on out-of-the-box thinking, on accepting certain parts of the old model of what a good doctor was but throwing other parts out and saying, 'We want to rethink this,'" Dr. Wachter says. "I can't think of a specialty that’s better positioned to help."
Meanwhile, hospitalist and ABIM Council member Jeff Wiese, MD, MHM, sees an opportunity to make sure the overall process for "knowledge improvement" is enhanced so that disconnects between practitioners and ABIM do not continue.
"We have to ensure that what happened over the past 20 years doesn't happen again," Dr. Wiese says. "Namely, that the world of medicine doesn't move so fast that the ABIM MOC requirements don't keep up. If we engage as physicians and specialty organizations in meaningful dialogues…then we have a much better chance of making MOC sufficiently dynamic to meet the changing times."
SHM President Burke Kealey, MD, SFHM, says that hospitalists were less impacted than some other specialists by the MOC change because they could use the Focused Practice in Hospital Medicine (FPHM) exam. The FPHM test was crafted by "real practicing hospitalists [writing] the questions for hospitalists from the point of view of what a hospitalist needs to know to do their job," he says.
Dr. Kealey adds that SHM plans to help hospitalists prepare for exams through courses featured at next month’s annual meeting and with the publication of a study guide due out this fall focused on the test's nonclinical aspects. Since it was posted last week, Dr. Kealey's blog on "The Hospital Leader" has attracted the interest of thousands of hospitalists and has been shared more than 70 times.
Visit our website for more information on Maintenance of Certification issues.
News that the American Board of Internal Medicine (ABIM) will reboot its controversial Maintenance of Certification (MOC) program is an opportunity for hospitalists to help shape their own professional development, according to former ABIM chair and hospital medicine pioneer Robert Wachter, MD, MHM.
A year ago, ABIM moved from an MOC every 10 years to a more continuous certification process. The goal was to keep physicians more current, but the change sparked backlash over education costs, the applicability and usefulness of exam questions, and bureaucratic burdens of the new process.
In a public statement last week, ABIM president and CEO Richard Baron, MD, acknowledged that "ABIM clearly got it wrong. We launched programs that weren't ready and we didn't deliver an MOC program that physicians found meaningful."
Dr. Wachter, who was ABIM's chair when Dr. Baron was hired, says that ABIM's new plan to reach out to specialty societies means SHM can lobby for an MOC process that is more current, more applicable, and more meaningful to practitioners. Given that HM as a specialty was launched as a novel idea on what would make a good care model for hospitalized patients, Dr. Wachter is confident that SHM can be helpful in guiding the creation of a better MOC process.
Hospital medicine "was built on out-of-the-box thinking, on accepting certain parts of the old model of what a good doctor was but throwing other parts out and saying, 'We want to rethink this,'" Dr. Wachter says. "I can't think of a specialty that’s better positioned to help."
Meanwhile, hospitalist and ABIM Council member Jeff Wiese, MD, MHM, sees an opportunity to make sure the overall process for "knowledge improvement" is enhanced so that disconnects between practitioners and ABIM do not continue.
"We have to ensure that what happened over the past 20 years doesn't happen again," Dr. Wiese says. "Namely, that the world of medicine doesn't move so fast that the ABIM MOC requirements don't keep up. If we engage as physicians and specialty organizations in meaningful dialogues…then we have a much better chance of making MOC sufficiently dynamic to meet the changing times."
SHM President Burke Kealey, MD, SFHM, says that hospitalists were less impacted than some other specialists by the MOC change because they could use the Focused Practice in Hospital Medicine (FPHM) exam. The FPHM test was crafted by "real practicing hospitalists [writing] the questions for hospitalists from the point of view of what a hospitalist needs to know to do their job," he says.
Dr. Kealey adds that SHM plans to help hospitalists prepare for exams through courses featured at next month’s annual meeting and with the publication of a study guide due out this fall focused on the test's nonclinical aspects. Since it was posted last week, Dr. Kealey's blog on "The Hospital Leader" has attracted the interest of thousands of hospitalists and has been shared more than 70 times.
Visit our website for more information on Maintenance of Certification issues.
LISTEN NOW: Peter Pronovost, MD, PhD, Explains Hospitalists' Role in Improving the U.S. Healthcare System
LISTEN NOW: Ron Greeno Discusses Key Policy Issues Facing Hospitalists
SHM Public Policy Committee Chair Ron Greeno, MD, MHM, talks about policy issues facing hospitalist, and how "Hill Day 2015" works as an advocacy tool.
SHM Public Policy Committee Chair Ron Greeno, MD, MHM, talks about policy issues facing hospitalist, and how "Hill Day 2015" works as an advocacy tool.
SHM Public Policy Committee Chair Ron Greeno, MD, MHM, talks about policy issues facing hospitalist, and how "Hill Day 2015" works as an advocacy tool.
LISTEN NOW: HM15 Course Director Explains How You Can Maximize SHM's Annual Meeting
Society of Hospital Medicine's 2015 Annual Meeting Preview
And, naturally, SHM is planning hundreds of meetings with legislators and their staffers to spread the gospel of hospital medicine.
“I’ll be honest. I’m exhausted when I get back,” says course director Efren Manjarrez, MD, SFHM, but “it’s the most uplifting exhaustion you could ever have.”
Richard Quinn is a freelance writer in New Jersey.
And, naturally, SHM is planning hundreds of meetings with legislators and their staffers to spread the gospel of hospital medicine.
“I’ll be honest. I’m exhausted when I get back,” says course director Efren Manjarrez, MD, SFHM, but “it’s the most uplifting exhaustion you could ever have.”
Richard Quinn is a freelance writer in New Jersey.
And, naturally, SHM is planning hundreds of meetings with legislators and their staffers to spread the gospel of hospital medicine.
“I’ll be honest. I’m exhausted when I get back,” says course director Efren Manjarrez, MD, SFHM, but “it’s the most uplifting exhaustion you could ever have.”
Richard Quinn is a freelance writer in New Jersey.
