Mixed Topics

Editor’s note: This profile is part of the Society of Hospital Medicine’s celebration of National Hospitalist Day on March 4. National Hospitalist Day occurs the first Thursday in March annually and celebrates the fastest growing specialty in modern medicine and hospitalists’ enduring contributions to the evolving health care landscape.

Bridget McGrath, PA-C, FHM, is a physician assistant and director of the nurse practitioner/physician assistant service line for the section of hospital medicine at the University of Chicago. She is a cochair of SHM’s NP/PA Special Interest Group.

Where did you receive your PA education/training? Was your intention always to be a PA?

I graduated from the PA program at Butler University, Indianapolis, in 2014. In college, whenever I shadowed a PA, I was always impressed that each one loved their job and said they would never change it. That universal passion for the PA profession really made an impression on me.

At what point in your PA education/training did you decide to practice hospital medicine? What about it appealed to you?

That occurred during my clinical rotation year at Butler. I had always thought I wanted to practice neonatology, but during my clinical rotation I really fell in love with adult medicine. I recall that during my clinical rotation, the preceptor said to me that the goal was not to have me understand every aspect of medicine, but to learn how to exist in a hospital setting. I was exposed to the breadth of hospital medicine practice and I fell in love with the complexity, the variety, and the environment itself.

I initially accepted a job as a med-peds hospitalist PA – which brought both of my passions together at that time – at Schneck Medical Center in Seymour, Ind. During that time, Schneck was a 100-bed rural community hospital which had recently been the recipient of the Malcolm Baldrige National Quality Award. It was there that I was able to practice with a phenomenal group of physicians, nurses, and social workers who really took me under their wing and taught me how to be a hospitalist PA. I practiced at Schneck for 3 years, and then moved to the University of Chicago in 2017.

I am now the director of NP/PA services for the section of hospital medicine, overseeing a group of seven on our NP/PA team, within a larger group of about 60 physicians.
 

What are your favorite areas of clinical practice?

Like many hospitalists, I enjoy the variety of medicine that hospitalists practice. One area that I find especially rewarding is my time in our transplant comanagement services. To be able to walk with patients on their transplant journey is very rewarding, and I am very appreciative of the mentoring I have received from some of my colleagues with a deeper understanding of transplant medicine.

In my administrative role, I have the privilege of helping to expand the professional education and training of my colleagues. I have a passion for medical education, and we have been working to develop interprofessional educational opportunities within our section. I have had time to think about the imprint of NPs and PAs in academic medicine, and how we can continue to meet the professional educational needs of our section while improving the care of our patients.
 

What are the most challenging aspects of practicing hospital medicine?

The volume of diagnoses that we are expected to manage on a daily basis can be challenging. This challenges you to continue learning. The complexity of discharge planning, particularly for patients in underserved communities, can also be challenging. You have to make sure your patients are ready mentally, physically and emotionally for discharge. As a hospitalist, you are continuously thinking about how to optimize patients to leave your care. For example, patients have different insurance situations, different access to care at home – you are always managing the medical needs of your patient in the context of these other issues.

How does a hospitalist PA work differently from a PA in other care settings?

We are meant to be generalists. We serve as the main provider in owning our patients’ care. A hospitalist PA serves as a cog in the wheel, with connections to specialists, consultants, nurses, social workers, pharmacists, etc., and we are tasked with synthesizing all aspects of patient care to ensure the best outcome.

What has your experience taught you about how NPs and PAs can best fit into hospital medicine groups?

Each hospital medicine group will know how to best integrate their NPs and PAs based on the skillsets of their NPs and PAs, and the needs of the section and the hospital. I personally feel that the best way to utilize NPs and PAs is to allow them to own all aspects of patient care and work at the highest scope of practice. By doing this you empower the NP or PA to continue to develop their skill set and set a precedent of collaboration and respect for interprofessional care models within your section’s culture.

Scope of practice for an NP or PA is going to be based on a conglomeration of roles and bylaws. We are certified nationally, and our scope of practice is determined at the state level and the hospital by level. For the individual NP and PA, it really depends on the hospital medicine group, and how well a practice incorporates a sense of collegiality.
 

What kind of resources do hospitalist PAs need to succeed, either from SHM or from their own institutions?

There are a few key things that need to happen in order for hospital medicine groups to set up their NPs and PAs for success. The first is for PAs to have exposure to inpatient rotations during clinical rotations. A hospital medicine group also should have a very intentional onboarding process for NPs and PAs. They should also establish a culture of acceptance. To do this, they should utilize resources like SHM’s NP/PA Hospital Medicine Onboarding Toolkit and the SHM/American Academy of Physician Assistants Hospitalist Bootcamp On Demand.

Mentoring is also remarkably important. I have been incredibly blessed to have mentors that helped make me into the PA that I am. I could not have done what I did in the field without people taking a chance on me, and it is important to pass that on to the next generation of PAs.
 

How has COVID-19 changed the practice of hospital medicine, specifically for advanced practice providers?

The pandemic has demonstrated opportunities for teamwork and utilization of NPs and PAs. The COVID pandemic forced everyone to reflect on why they originally got into medicine – to help patients. I think there will be many doors opening for NPs and PAs, and many pathways for leadership.

The hospitalist leadership at the University of Chicago truly identified that we needed to make wellness a main priority during the beginning of the pandemic. We developed a wellness work group that I have been coleading.
 

What’s on the horizon for NPs and PAs in hospital medicine?

We are seeing significant increases in hospitalist program utilization, so this is a time where NPs and PAs can be advocates for our profession and articulate how we can use our backgrounds and training to build better care models in order to meet the needs of our patients.

I hope we will see more NPs and PAs assuming leadership roles to ensure that our voices are heard. We should also be advocating for more collaboration and teamwork with our MD and DO colleagues.
 

Do you have any advice for PA students interested in hospital medicine?

I always tell my students that they should be sponges – you are not expected to know everything as a hospitalist PA, but you are expected to continue learning in order to develop into the best PA you can be. Always be open to where your career path can take you. Hospital medicine is a relatively young field within medicine, and the diversity of our field is very exciting looking forward.

Editor’s note: This profile is part of the Society of Hospital Medicine’s celebration of National Hospitalist Day on March 4. National Hospitalist Day occurs the first Thursday in March annually and celebrates the fastest growing specialty in modern medicine and hospitalists’ enduring contributions to the evolving health care landscape.

Bridget McGrath, PA-C, FHM, is a physician assistant and director of the nurse practitioner/physician assistant service line for the section of hospital medicine at the University of Chicago. She is a cochair of SHM’s NP/PA Special Interest Group.

Where did you receive your PA education/training? Was your intention always to be a PA?

I graduated from the PA program at Butler University, Indianapolis, in 2014. In college, whenever I shadowed a PA, I was always impressed that each one loved their job and said they would never change it. That universal passion for the PA profession really made an impression on me.

At what point in your PA education/training did you decide to practice hospital medicine? What about it appealed to you?

That occurred during my clinical rotation year at Butler. I had always thought I wanted to practice neonatology, but during my clinical rotation I really fell in love with adult medicine. I recall that during my clinical rotation, the preceptor said to me that the goal was not to have me understand every aspect of medicine, but to learn how to exist in a hospital setting. I was exposed to the breadth of hospital medicine practice and I fell in love with the complexity, the variety, and the environment itself.

I initially accepted a job as a med-peds hospitalist PA – which brought both of my passions together at that time – at Schneck Medical Center in Seymour, Ind. During that time, Schneck was a 100-bed rural community hospital which had recently been the recipient of the Malcolm Baldrige National Quality Award. It was there that I was able to practice with a phenomenal group of physicians, nurses, and social workers who really took me under their wing and taught me how to be a hospitalist PA. I practiced at Schneck for 3 years, and then moved to the University of Chicago in 2017.

I am now the director of NP/PA services for the section of hospital medicine, overseeing a group of seven on our NP/PA team, within a larger group of about 60 physicians.
 

What are your favorite areas of clinical practice?

Like many hospitalists, I enjoy the variety of medicine that hospitalists practice. One area that I find especially rewarding is my time in our transplant comanagement services. To be able to walk with patients on their transplant journey is very rewarding, and I am very appreciative of the mentoring I have received from some of my colleagues with a deeper understanding of transplant medicine.

In my administrative role, I have the privilege of helping to expand the professional education and training of my colleagues. I have a passion for medical education, and we have been working to develop interprofessional educational opportunities within our section. I have had time to think about the imprint of NPs and PAs in academic medicine, and how we can continue to meet the professional educational needs of our section while improving the care of our patients.
 

What are the most challenging aspects of practicing hospital medicine?

The volume of diagnoses that we are expected to manage on a daily basis can be challenging. This challenges you to continue learning. The complexity of discharge planning, particularly for patients in underserved communities, can also be challenging. You have to make sure your patients are ready mentally, physically and emotionally for discharge. As a hospitalist, you are continuously thinking about how to optimize patients to leave your care. For example, patients have different insurance situations, different access to care at home – you are always managing the medical needs of your patient in the context of these other issues.

How does a hospitalist PA work differently from a PA in other care settings?

We are meant to be generalists. We serve as the main provider in owning our patients’ care. A hospitalist PA serves as a cog in the wheel, with connections to specialists, consultants, nurses, social workers, pharmacists, etc., and we are tasked with synthesizing all aspects of patient care to ensure the best outcome.

What has your experience taught you about how NPs and PAs can best fit into hospital medicine groups?

Each hospital medicine group will know how to best integrate their NPs and PAs based on the skillsets of their NPs and PAs, and the needs of the section and the hospital. I personally feel that the best way to utilize NPs and PAs is to allow them to own all aspects of patient care and work at the highest scope of practice. By doing this you empower the NP or PA to continue to develop their skill set and set a precedent of collaboration and respect for interprofessional care models within your section’s culture.

Scope of practice for an NP or PA is going to be based on a conglomeration of roles and bylaws. We are certified nationally, and our scope of practice is determined at the state level and the hospital by level. For the individual NP and PA, it really depends on the hospital medicine group, and how well a practice incorporates a sense of collegiality.
 

What kind of resources do hospitalist PAs need to succeed, either from SHM or from their own institutions?

There are a few key things that need to happen in order for hospital medicine groups to set up their NPs and PAs for success. The first is for PAs to have exposure to inpatient rotations during clinical rotations. A hospital medicine group also should have a very intentional onboarding process for NPs and PAs. They should also establish a culture of acceptance. To do this, they should utilize resources like SHM’s NP/PA Hospital Medicine Onboarding Toolkit and the SHM/American Academy of Physician Assistants Hospitalist Bootcamp On Demand.

Mentoring is also remarkably important. I have been incredibly blessed to have mentors that helped make me into the PA that I am. I could not have done what I did in the field without people taking a chance on me, and it is important to pass that on to the next generation of PAs.
 

How has COVID-19 changed the practice of hospital medicine, specifically for advanced practice providers?

The pandemic has demonstrated opportunities for teamwork and utilization of NPs and PAs. The COVID pandemic forced everyone to reflect on why they originally got into medicine – to help patients. I think there will be many doors opening for NPs and PAs, and many pathways for leadership.

The hospitalist leadership at the University of Chicago truly identified that we needed to make wellness a main priority during the beginning of the pandemic. We developed a wellness work group that I have been coleading.
 

What’s on the horizon for NPs and PAs in hospital medicine?

We are seeing significant increases in hospitalist program utilization, so this is a time where NPs and PAs can be advocates for our profession and articulate how we can use our backgrounds and training to build better care models in order to meet the needs of our patients.

I hope we will see more NPs and PAs assuming leadership roles to ensure that our voices are heard. We should also be advocating for more collaboration and teamwork with our MD and DO colleagues.
 

Do you have any advice for PA students interested in hospital medicine?

I always tell my students that they should be sponges – you are not expected to know everything as a hospitalist PA, but you are expected to continue learning in order to develop into the best PA you can be. Always be open to where your career path can take you. Hospital medicine is a relatively young field within medicine, and the diversity of our field is very exciting looking forward.

Editor’s note: This profile is part of the Society of Hospital Medicine’s celebration of National Hospitalist Day on March 4. National Hospitalist Day occurs the first Thursday in March annually and celebrates the fastest growing specialty in modern medicine and hospitalists’ enduring contributions to the evolving health care landscape.

Bridget McGrath, PA-C, FHM, is a physician assistant and director of the nurse practitioner/physician assistant service line for the section of hospital medicine at the University of Chicago. She is a cochair of SHM’s NP/PA Special Interest Group.

Where did you receive your PA education/training? Was your intention always to be a PA?

I graduated from the PA program at Butler University, Indianapolis, in 2014. In college, whenever I shadowed a PA, I was always impressed that each one loved their job and said they would never change it. That universal passion for the PA profession really made an impression on me.

At what point in your PA education/training did you decide to practice hospital medicine? What about it appealed to you?

That occurred during my clinical rotation year at Butler. I had always thought I wanted to practice neonatology, but during my clinical rotation I really fell in love with adult medicine. I recall that during my clinical rotation, the preceptor said to me that the goal was not to have me understand every aspect of medicine, but to learn how to exist in a hospital setting. I was exposed to the breadth of hospital medicine practice and I fell in love with the complexity, the variety, and the environment itself.

I initially accepted a job as a med-peds hospitalist PA – which brought both of my passions together at that time – at Schneck Medical Center in Seymour, Ind. During that time, Schneck was a 100-bed rural community hospital which had recently been the recipient of the Malcolm Baldrige National Quality Award. It was there that I was able to practice with a phenomenal group of physicians, nurses, and social workers who really took me under their wing and taught me how to be a hospitalist PA. I practiced at Schneck for 3 years, and then moved to the University of Chicago in 2017.

I am now the director of NP/PA services for the section of hospital medicine, overseeing a group of seven on our NP/PA team, within a larger group of about 60 physicians.
 

What are your favorite areas of clinical practice?

Like many hospitalists, I enjoy the variety of medicine that hospitalists practice. One area that I find especially rewarding is my time in our transplant comanagement services. To be able to walk with patients on their transplant journey is very rewarding, and I am very appreciative of the mentoring I have received from some of my colleagues with a deeper understanding of transplant medicine.

In my administrative role, I have the privilege of helping to expand the professional education and training of my colleagues. I have a passion for medical education, and we have been working to develop interprofessional educational opportunities within our section. I have had time to think about the imprint of NPs and PAs in academic medicine, and how we can continue to meet the professional educational needs of our section while improving the care of our patients.
 

What are the most challenging aspects of practicing hospital medicine?

The volume of diagnoses that we are expected to manage on a daily basis can be challenging. This challenges you to continue learning. The complexity of discharge planning, particularly for patients in underserved communities, can also be challenging. You have to make sure your patients are ready mentally, physically and emotionally for discharge. As a hospitalist, you are continuously thinking about how to optimize patients to leave your care. For example, patients have different insurance situations, different access to care at home – you are always managing the medical needs of your patient in the context of these other issues.

How does a hospitalist PA work differently from a PA in other care settings?

We are meant to be generalists. We serve as the main provider in owning our patients’ care. A hospitalist PA serves as a cog in the wheel, with connections to specialists, consultants, nurses, social workers, pharmacists, etc., and we are tasked with synthesizing all aspects of patient care to ensure the best outcome.

What has your experience taught you about how NPs and PAs can best fit into hospital medicine groups?

Each hospital medicine group will know how to best integrate their NPs and PAs based on the skillsets of their NPs and PAs, and the needs of the section and the hospital. I personally feel that the best way to utilize NPs and PAs is to allow them to own all aspects of patient care and work at the highest scope of practice. By doing this you empower the NP or PA to continue to develop their skill set and set a precedent of collaboration and respect for interprofessional care models within your section’s culture.

Scope of practice for an NP or PA is going to be based on a conglomeration of roles and bylaws. We are certified nationally, and our scope of practice is determined at the state level and the hospital by level. For the individual NP and PA, it really depends on the hospital medicine group, and how well a practice incorporates a sense of collegiality.
 

What kind of resources do hospitalist PAs need to succeed, either from SHM or from their own institutions?

There are a few key things that need to happen in order for hospital medicine groups to set up their NPs and PAs for success. The first is for PAs to have exposure to inpatient rotations during clinical rotations. A hospital medicine group also should have a very intentional onboarding process for NPs and PAs. They should also establish a culture of acceptance. To do this, they should utilize resources like SHM’s NP/PA Hospital Medicine Onboarding Toolkit and the SHM/American Academy of Physician Assistants Hospitalist Bootcamp On Demand.

Mentoring is also remarkably important. I have been incredibly blessed to have mentors that helped make me into the PA that I am. I could not have done what I did in the field without people taking a chance on me, and it is important to pass that on to the next generation of PAs.
 

How has COVID-19 changed the practice of hospital medicine, specifically for advanced practice providers?

The pandemic has demonstrated opportunities for teamwork and utilization of NPs and PAs. The COVID pandemic forced everyone to reflect on why they originally got into medicine – to help patients. I think there will be many doors opening for NPs and PAs, and many pathways for leadership.

The hospitalist leadership at the University of Chicago truly identified that we needed to make wellness a main priority during the beginning of the pandemic. We developed a wellness work group that I have been coleading.
 

What’s on the horizon for NPs and PAs in hospital medicine?

We are seeing significant increases in hospitalist program utilization, so this is a time where NPs and PAs can be advocates for our profession and articulate how we can use our backgrounds and training to build better care models in order to meet the needs of our patients.

I hope we will see more NPs and PAs assuming leadership roles to ensure that our voices are heard. We should also be advocating for more collaboration and teamwork with our MD and DO colleagues.
 

Do you have any advice for PA students interested in hospital medicine?

I always tell my students that they should be sponges – you are not expected to know everything as a hospitalist PA, but you are expected to continue learning in order to develop into the best PA you can be. Always be open to where your career path can take you. Hospital medicine is a relatively young field within medicine, and the diversity of our field is very exciting looking forward.

In honor of National Hospitalist Day, the Society of Hospital Medicine and the Explore the Space podcast are teaming up to bring you a roundtable discussion, featuring a diverse group of hospitalists from all stages in their careers, on Thursday, March 4, at 7 p.m. ET / 4 p.m. PT.

Registration is required. Sign up here.

Hosted by Mark Shapiro, MD, hospitalist and founder, producer, and host of Explore the Space, the roundtable will include:

• Gurpreet Dhaliwal, MD, a clinician-educator and professor of medicine at the University of California, San Francisco. He studies, writes, and speaks about how doctors think – how they make diagnoses, how they develop diagnostic expertise, and what motivates them to improve their practice and the systems in which they work.
• Anika Kumar, MD, FHM, a clinical assistant professor of pediatrics at the Cleveland Clinic Lerner College of Medicine, and a pediatric hospitalist at Cleveland Clinic Children’s. She also serves as the pediatric editor of the Hospitalist, SHM’s monthly news magazine.
• Maylyn S. Martinez, MD, a clinician-researcher and clinical associate at the University of Chicago. Her research focuses on hospital-associated disability and she recently authored a perspectives piece in the Journal of Hospital Medicine with her mentor, Vineet Arora, MD, MHM, on why the COVID-19 pandemic might exacerbate this problem.
• Ndidi Unaka, MD, MEd, an associate professor in the division of hospital medicine at Cincinnati Children’s Hospital Medical Center. Dr. Unaka has served as the associate program director of the pediatric residency program since 2011. She is also the medical director of an inpatient unit that serves as the primary home.

For more information about SHM, please visit hospitalmedicine.org. To learn more about Explore the Space, please visit explorethespaceshow.com.

Register now.




 

In honor of National Hospitalist Day, the Society of Hospital Medicine and the Explore the Space podcast are teaming up to bring you a roundtable discussion, featuring a diverse group of hospitalists from all stages in their careers, on Thursday, March 4, at 7 p.m. ET / 4 p.m. PT.

Registration is required. Sign up here.

Hosted by Mark Shapiro, MD, hospitalist and founder, producer, and host of Explore the Space, the roundtable will include:

• Gurpreet Dhaliwal, MD, a clinician-educator and professor of medicine at the University of California, San Francisco. He studies, writes, and speaks about how doctors think – how they make diagnoses, how they develop diagnostic expertise, and what motivates them to improve their practice and the systems in which they work.
• Anika Kumar, MD, FHM, a clinical assistant professor of pediatrics at the Cleveland Clinic Lerner College of Medicine, and a pediatric hospitalist at Cleveland Clinic Children’s. She also serves as the pediatric editor of the Hospitalist, SHM’s monthly news magazine.
• Maylyn S. Martinez, MD, a clinician-researcher and clinical associate at the University of Chicago. Her research focuses on hospital-associated disability and she recently authored a perspectives piece in the Journal of Hospital Medicine with her mentor, Vineet Arora, MD, MHM, on why the COVID-19 pandemic might exacerbate this problem.
• Ndidi Unaka, MD, MEd, an associate professor in the division of hospital medicine at Cincinnati Children’s Hospital Medical Center. Dr. Unaka has served as the associate program director of the pediatric residency program since 2011. She is also the medical director of an inpatient unit that serves as the primary home.

For more information about SHM, please visit hospitalmedicine.org. To learn more about Explore the Space, please visit explorethespaceshow.com.

Register now.




 

In honor of National Hospitalist Day, the Society of Hospital Medicine and the Explore the Space podcast are teaming up to bring you a roundtable discussion, featuring a diverse group of hospitalists from all stages in their careers, on Thursday, March 4, at 7 p.m. ET / 4 p.m. PT.

Registration is required. Sign up here.

Hosted by Mark Shapiro, MD, hospitalist and founder, producer, and host of Explore the Space, the roundtable will include:

• Gurpreet Dhaliwal, MD, a clinician-educator and professor of medicine at the University of California, San Francisco. He studies, writes, and speaks about how doctors think – how they make diagnoses, how they develop diagnostic expertise, and what motivates them to improve their practice and the systems in which they work.
• Anika Kumar, MD, FHM, a clinical assistant professor of pediatrics at the Cleveland Clinic Lerner College of Medicine, and a pediatric hospitalist at Cleveland Clinic Children’s. She also serves as the pediatric editor of the Hospitalist, SHM’s monthly news magazine.
• Maylyn S. Martinez, MD, a clinician-researcher and clinical associate at the University of Chicago. Her research focuses on hospital-associated disability and she recently authored a perspectives piece in the Journal of Hospital Medicine with her mentor, Vineet Arora, MD, MHM, on why the COVID-19 pandemic might exacerbate this problem.
• Ndidi Unaka, MD, MEd, an associate professor in the division of hospital medicine at Cincinnati Children’s Hospital Medical Center. Dr. Unaka has served as the associate program director of the pediatric residency program since 2011. She is also the medical director of an inpatient unit that serves as the primary home.

For more information about SHM, please visit hospitalmedicine.org. To learn more about Explore the Space, please visit explorethespaceshow.com.

Register now.




 

Since the advent of COVID-19, health care has seen an unprecedented rise in virtual health. Telemedicine has come to the forefront of our conversations, and there are many speculations around its future state. One such discussion is around the sustainability and expansion of inpatient telemedicine programs post COVID, and if – and how – it is going to be helpful for health care.

Consider the following scenarios:

Scenario 1

A patient presents to an emergency department of a small community hospital. He needs to be seen by a specialist, but (s)he is not available, so patient gets transferred out to the ED of a different hospital several miles away from his hometown.

He is evaluated in the second ED by the specialist, has repeat testing done – some of those tests were already completed at the first hospital. After evaluating him, the specialist recommends that he does not need to be admitted to the hospital and can be safely followed up as an outpatient. The patient does not require any further intervention and is discharged from the ED.
 

Scenario 2

Dr. N is a hospitalist in a rural hospital that does not have intensivist support at night. She works 7 on/7 off and is on call 24/7 during her “on” week. Dr. N cannot be physically present in the hospital 24/7. She receives messages from the hospital around the clock and feels that this call schedule is no longer sustainable. She doesn’t feel comfortable admitting patients in the ICU who come to the hospital at night without physically seeing them and without ICU backup. Therefore, some of the patients who are sick enough to be admitted in ICU for closer monitoring but can be potentially handled in this rural hospital get transferred out to a different hospital.

Dr. N has been asking the hospital to provide her intensivist back up at night and to give her some flexibility in the call schedule. However, from hospital’s perspective, the volume isn’t high enough to hire a dedicated nocturnist, and because the hospital is in the small rural area, it is having a hard time attracting more intensivists. After multiple conversations between both parties, Dr. N finally resigns.
 

Scenario 3

Dr. A is a specialist who is on call covering different hospitals and seeing patients in clinic. His call is getting busier. He has received many new consults and also has to follow up on his other patients in hospital who he saw a day prior.

Dr. A started receiving many pages from the hospitals – some of his patients and their families are anxiously waiting on him so that he can let them go home once he sees them, while some are waiting to know what the next steps and plan of action are. He ends up canceling some of his clinic patients who had scheduled an appointment with him 3, 4, or even 5 months ago. It’s already afternoon.

Dr. A now drives to one hospital, sees his new consults, orders tests which may or may not get results the same day, follows up on other patients, reviews their test results, modifies treatment plans for some while clearing other patients for discharge. He then drives to the other hospital and follows the same process. Some of the patients aren’t happy because of the long wait, a few couldn’t arrange for the ride to go home and ended up staying in hospital 1 extra night, while the ER is getting backlogged waiting on discharges.

These scenarios highlight some of the important and prevalent pain points in health care as shown in Figure 1.

Dr. Zia is an internal medicine board-certified physician, serving as a hospitalist and physician adviser in a medically underserved area. She has also served as interim medical director of the department of hospital medicine, and medical staff president, at SIH Herrin Hospital, in Herrin, Ill., part of Southern Illinois Healthcare. She has a special interest in improving access to health care in physician shortage areas.

References

1. Kindermann DR et al. Emergency department transfers and transfer relationships in United States hospitals. Acad Emerg Med. 2015 Feb;22(2):157-65.

2. Sanders RB et al. New hospital telemedicine services: Potential market for a nighttime hospitalist service. Telemed J E Health. 2014 Oct 1;20(10):902-8.

3. Shanafelt T et al. The business case for investing in physician well-being. JAMA Intern Med. 2017;177(12):1826-32.

4. Pines JM et al. The impact of emergency department crowding measures on time to antibiotics for patients with community-acquired pneumonia. Ann Emerg Med. 2007 Nov;50(5):510-6.

5. Pines JM and Hollander JE. Emergency department crowding is associated with poor care for patients with severe pain. Ann Emerg Med. 2008 Jan;51(1):1-5.

6. Chalfin DB et al. Impact of delayed transfer of critically ill patients from the emergency department to the intensive care unit. Crit Care Med. 2007 Jun;35(6):1477-83.

7. Pines JM et al. The financial consequences of lost demand and reducing boarding in hospital emergency departments. Ann Emerg Med. 2011 Oct;58(4):331-40.

8. Natafgi N et al. Using tele-emergency to avoid patient transfers in rural emergency. J Telemed Telecare. 2018 Apri;24(3):193-201.

9. Providence.org/telehealthhospitalistcasestudy.

10. Woodruff Health Sciences Center. CMS report: eICU program reduced hospital stays, saved millions, eased provider shortage. 2017 Apr 5.

11. Lilly CM et al. ICU telemedicine program financial outcomes. Chest. 2017 Feb;151(2):286-97.

Since the advent of COVID-19, health care has seen an unprecedented rise in virtual health. Telemedicine has come to the forefront of our conversations, and there are many speculations around its future state. One such discussion is around the sustainability and expansion of inpatient telemedicine programs post COVID, and if – and how – it is going to be helpful for health care.

Consider the following scenarios:

Scenario 1

A patient presents to an emergency department of a small community hospital. He needs to be seen by a specialist, but (s)he is not available, so patient gets transferred out to the ED of a different hospital several miles away from his hometown.

He is evaluated in the second ED by the specialist, has repeat testing done – some of those tests were already completed at the first hospital. After evaluating him, the specialist recommends that he does not need to be admitted to the hospital and can be safely followed up as an outpatient. The patient does not require any further intervention and is discharged from the ED.
 

Scenario 2

Dr. N is a hospitalist in a rural hospital that does not have intensivist support at night. She works 7 on/7 off and is on call 24/7 during her “on” week. Dr. N cannot be physically present in the hospital 24/7. She receives messages from the hospital around the clock and feels that this call schedule is no longer sustainable. She doesn’t feel comfortable admitting patients in the ICU who come to the hospital at night without physically seeing them and without ICU backup. Therefore, some of the patients who are sick enough to be admitted in ICU for closer monitoring but can be potentially handled in this rural hospital get transferred out to a different hospital.

Dr. N has been asking the hospital to provide her intensivist back up at night and to give her some flexibility in the call schedule. However, from hospital’s perspective, the volume isn’t high enough to hire a dedicated nocturnist, and because the hospital is in the small rural area, it is having a hard time attracting more intensivists. After multiple conversations between both parties, Dr. N finally resigns.
 

Scenario 3

Dr. A is a specialist who is on call covering different hospitals and seeing patients in clinic. His call is getting busier. He has received many new consults and also has to follow up on his other patients in hospital who he saw a day prior.

Dr. A started receiving many pages from the hospitals – some of his patients and their families are anxiously waiting on him so that he can let them go home once he sees them, while some are waiting to know what the next steps and plan of action are. He ends up canceling some of his clinic patients who had scheduled an appointment with him 3, 4, or even 5 months ago. It’s already afternoon.

Dr. A now drives to one hospital, sees his new consults, orders tests which may or may not get results the same day, follows up on other patients, reviews their test results, modifies treatment plans for some while clearing other patients for discharge. He then drives to the other hospital and follows the same process. Some of the patients aren’t happy because of the long wait, a few couldn’t arrange for the ride to go home and ended up staying in hospital 1 extra night, while the ER is getting backlogged waiting on discharges.

These scenarios highlight some of the important and prevalent pain points in health care as shown in Figure 1.

Dr. Zia is an internal medicine board-certified physician, serving as a hospitalist and physician adviser in a medically underserved area. She has also served as interim medical director of the department of hospital medicine, and medical staff president, at SIH Herrin Hospital, in Herrin, Ill., part of Southern Illinois Healthcare. She has a special interest in improving access to health care in physician shortage areas.

References

1. Kindermann DR et al. Emergency department transfers and transfer relationships in United States hospitals. Acad Emerg Med. 2015 Feb;22(2):157-65.

2. Sanders RB et al. New hospital telemedicine services: Potential market for a nighttime hospitalist service. Telemed J E Health. 2014 Oct 1;20(10):902-8.

3. Shanafelt T et al. The business case for investing in physician well-being. JAMA Intern Med. 2017;177(12):1826-32.

4. Pines JM et al. The impact of emergency department crowding measures on time to antibiotics for patients with community-acquired pneumonia. Ann Emerg Med. 2007 Nov;50(5):510-6.

5. Pines JM and Hollander JE. Emergency department crowding is associated with poor care for patients with severe pain. Ann Emerg Med. 2008 Jan;51(1):1-5.

6. Chalfin DB et al. Impact of delayed transfer of critically ill patients from the emergency department to the intensive care unit. Crit Care Med. 2007 Jun;35(6):1477-83.

7. Pines JM et al. The financial consequences of lost demand and reducing boarding in hospital emergency departments. Ann Emerg Med. 2011 Oct;58(4):331-40.

8. Natafgi N et al. Using tele-emergency to avoid patient transfers in rural emergency. J Telemed Telecare. 2018 Apri;24(3):193-201.

9. Providence.org/telehealthhospitalistcasestudy.

10. Woodruff Health Sciences Center. CMS report: eICU program reduced hospital stays, saved millions, eased provider shortage. 2017 Apr 5.

11. Lilly CM et al. ICU telemedicine program financial outcomes. Chest. 2017 Feb;151(2):286-97.

Since the advent of COVID-19, health care has seen an unprecedented rise in virtual health. Telemedicine has come to the forefront of our conversations, and there are many speculations around its future state. One such discussion is around the sustainability and expansion of inpatient telemedicine programs post COVID, and if – and how – it is going to be helpful for health care.

Consider the following scenarios:

Scenario 1

A patient presents to an emergency department of a small community hospital. He needs to be seen by a specialist, but (s)he is not available, so patient gets transferred out to the ED of a different hospital several miles away from his hometown.

He is evaluated in the second ED by the specialist, has repeat testing done – some of those tests were already completed at the first hospital. After evaluating him, the specialist recommends that he does not need to be admitted to the hospital and can be safely followed up as an outpatient. The patient does not require any further intervention and is discharged from the ED.
 

Scenario 2

Dr. N is a hospitalist in a rural hospital that does not have intensivist support at night. She works 7 on/7 off and is on call 24/7 during her “on” week. Dr. N cannot be physically present in the hospital 24/7. She receives messages from the hospital around the clock and feels that this call schedule is no longer sustainable. She doesn’t feel comfortable admitting patients in the ICU who come to the hospital at night without physically seeing them and without ICU backup. Therefore, some of the patients who are sick enough to be admitted in ICU for closer monitoring but can be potentially handled in this rural hospital get transferred out to a different hospital.

Dr. N has been asking the hospital to provide her intensivist back up at night and to give her some flexibility in the call schedule. However, from hospital’s perspective, the volume isn’t high enough to hire a dedicated nocturnist, and because the hospital is in the small rural area, it is having a hard time attracting more intensivists. After multiple conversations between both parties, Dr. N finally resigns.
 

Scenario 3

Dr. A is a specialist who is on call covering different hospitals and seeing patients in clinic. His call is getting busier. He has received many new consults and also has to follow up on his other patients in hospital who he saw a day prior.

Dr. A started receiving many pages from the hospitals – some of his patients and their families are anxiously waiting on him so that he can let them go home once he sees them, while some are waiting to know what the next steps and plan of action are. He ends up canceling some of his clinic patients who had scheduled an appointment with him 3, 4, or even 5 months ago. It’s already afternoon.

Dr. A now drives to one hospital, sees his new consults, orders tests which may or may not get results the same day, follows up on other patients, reviews their test results, modifies treatment plans for some while clearing other patients for discharge. He then drives to the other hospital and follows the same process. Some of the patients aren’t happy because of the long wait, a few couldn’t arrange for the ride to go home and ended up staying in hospital 1 extra night, while the ER is getting backlogged waiting on discharges.

These scenarios highlight some of the important and prevalent pain points in health care as shown in Figure 1.

Dr. Zia is an internal medicine board-certified physician, serving as a hospitalist and physician adviser in a medically underserved area. She has also served as interim medical director of the department of hospital medicine, and medical staff president, at SIH Herrin Hospital, in Herrin, Ill., part of Southern Illinois Healthcare. She has a special interest in improving access to health care in physician shortage areas.

References

1. Kindermann DR et al. Emergency department transfers and transfer relationships in United States hospitals. Acad Emerg Med. 2015 Feb;22(2):157-65.

2. Sanders RB et al. New hospital telemedicine services: Potential market for a nighttime hospitalist service. Telemed J E Health. 2014 Oct 1;20(10):902-8.

3. Shanafelt T et al. The business case for investing in physician well-being. JAMA Intern Med. 2017;177(12):1826-32.

4. Pines JM et al. The impact of emergency department crowding measures on time to antibiotics for patients with community-acquired pneumonia. Ann Emerg Med. 2007 Nov;50(5):510-6.

5. Pines JM and Hollander JE. Emergency department crowding is associated with poor care for patients with severe pain. Ann Emerg Med. 2008 Jan;51(1):1-5.

6. Chalfin DB et al. Impact of delayed transfer of critically ill patients from the emergency department to the intensive care unit. Crit Care Med. 2007 Jun;35(6):1477-83.

7. Pines JM et al. The financial consequences of lost demand and reducing boarding in hospital emergency departments. Ann Emerg Med. 2011 Oct;58(4):331-40.

8. Natafgi N et al. Using tele-emergency to avoid patient transfers in rural emergency. J Telemed Telecare. 2018 Apri;24(3):193-201.

9. Providence.org/telehealthhospitalistcasestudy.

10. Woodruff Health Sciences Center. CMS report: eICU program reduced hospital stays, saved millions, eased provider shortage. 2017 Apr 5.

11. Lilly CM et al. ICU telemedicine program financial outcomes. Chest. 2017 Feb;151(2):286-97.

To the Editor:

Unilateral nevoid telangiectasia (UNT) is a rare cutaneous disease characterized by superficial telangiectases arranged in a unilateral linear pattern. First described by Alfred Blaschko in 1899, this rare disease has been reported in higher frequency in recent years, with approximately 100 cases published in the literature according to a PubMed search of articles indexed for MEDLINE using the term unilateral nevoid telangiectasia.¹ Unilateral nevoid telangiectasia can be congenital or acquired; occurs more commonly in women; and typically involves the dermatomal distributions of the trigeminal, cervical, and upper thoracic nerves. Although the pathogenesis of the disease remains unknown, the currently proposed etiology involves hyperestrogenic states, including puberty, pregnancy, and chronic liver disease.² We report a case of progressively worsening, pruritic, unilateral telangiectases of unknown etiology.

A 55-year-old woman presented to our dermatology clinic with progressive red spots involving the right side of the upper body of 3 years’ duration. She noted pruritus, and the rash was otherwise asymptomatic. Her medical history was notable for hypertension, dyspepsia, sciatica, uterine fibroids, and a hysterectomy. Her medications included lisinopril, hydrochlorothiazide, tramadol, aspirin, and a multivitamin. The patient did not report the use of oral contraceptive pills or hormone replacement therapy. She also denied the use of cigarettes or illicit drugs but reported occasional alcohol consumption. A review of systems was negative for any constitutional symptoms or symptoms of liver disease. Her family history also was noncontributory.

Physical examination revealed multiple, 1- to 3-mm, telangiectatic macules and patches in a blaschkoid distribution on the right side of the upper chest, back, shoulder, and arm (Figure, A–C). Darier sign was negative. There was no evidence of palmar erythema, hepatosplenomegaly, ascites, thyromegaly, or thyroid nodules. Dermoscopy confirmed the presence of telangiectasia (Figure, D). More specifically, dermoscopy revealed plump telangiectasia with faint pigment in the background, consistent with UNT. Additionally, there was no pink-white, shiny, scarlike background, and vessels were not thin or arborized, further supporting our diagnosis vs other entities included in the differential diagnosis.

Our case provides another unique presentation of UNT. Our patient was a healthy adult woman with no hyperestrogen-based etiology for disease. Importantly, our patient also represented a rare instance of UNT presenting with symptoms such as pruritus, though UNT classically is described as an asymptomatic phenomenon. In our patient, treatment with PDL was suggested and believed to be warranted not only for cosmetic improvement but also in light of the fact that her lesions were symptomatic.

To the Editor:

Unilateral nevoid telangiectasia (UNT) is a rare cutaneous disease characterized by superficial telangiectases arranged in a unilateral linear pattern. First described by Alfred Blaschko in 1899, this rare disease has been reported in higher frequency in recent years, with approximately 100 cases published in the literature according to a PubMed search of articles indexed for MEDLINE using the term unilateral nevoid telangiectasia.¹ Unilateral nevoid telangiectasia can be congenital or acquired; occurs more commonly in women; and typically involves the dermatomal distributions of the trigeminal, cervical, and upper thoracic nerves. Although the pathogenesis of the disease remains unknown, the currently proposed etiology involves hyperestrogenic states, including puberty, pregnancy, and chronic liver disease.² We report a case of progressively worsening, pruritic, unilateral telangiectases of unknown etiology.

A 55-year-old woman presented to our dermatology clinic with progressive red spots involving the right side of the upper body of 3 years’ duration. She noted pruritus, and the rash was otherwise asymptomatic. Her medical history was notable for hypertension, dyspepsia, sciatica, uterine fibroids, and a hysterectomy. Her medications included lisinopril, hydrochlorothiazide, tramadol, aspirin, and a multivitamin. The patient did not report the use of oral contraceptive pills or hormone replacement therapy. She also denied the use of cigarettes or illicit drugs but reported occasional alcohol consumption. A review of systems was negative for any constitutional symptoms or symptoms of liver disease. Her family history also was noncontributory.

Physical examination revealed multiple, 1- to 3-mm, telangiectatic macules and patches in a blaschkoid distribution on the right side of the upper chest, back, shoulder, and arm (Figure, A–C). Darier sign was negative. There was no evidence of palmar erythema, hepatosplenomegaly, ascites, thyromegaly, or thyroid nodules. Dermoscopy confirmed the presence of telangiectasia (Figure, D). More specifically, dermoscopy revealed plump telangiectasia with faint pigment in the background, consistent with UNT. Additionally, there was no pink-white, shiny, scarlike background, and vessels were not thin or arborized, further supporting our diagnosis vs other entities included in the differential diagnosis.

Our case provides another unique presentation of UNT. Our patient was a healthy adult woman with no hyperestrogen-based etiology for disease. Importantly, our patient also represented a rare instance of UNT presenting with symptoms such as pruritus, though UNT classically is described as an asymptomatic phenomenon. In our patient, treatment with PDL was suggested and believed to be warranted not only for cosmetic improvement but also in light of the fact that her lesions were symptomatic.

To the Editor:

Unilateral nevoid telangiectasia (UNT) is a rare cutaneous disease characterized by superficial telangiectases arranged in a unilateral linear pattern. First described by Alfred Blaschko in 1899, this rare disease has been reported in higher frequency in recent years, with approximately 100 cases published in the literature according to a PubMed search of articles indexed for MEDLINE using the term unilateral nevoid telangiectasia.¹ Unilateral nevoid telangiectasia can be congenital or acquired; occurs more commonly in women; and typically involves the dermatomal distributions of the trigeminal, cervical, and upper thoracic nerves. Although the pathogenesis of the disease remains unknown, the currently proposed etiology involves hyperestrogenic states, including puberty, pregnancy, and chronic liver disease.² We report a case of progressively worsening, pruritic, unilateral telangiectases of unknown etiology.

A 55-year-old woman presented to our dermatology clinic with progressive red spots involving the right side of the upper body of 3 years’ duration. She noted pruritus, and the rash was otherwise asymptomatic. Her medical history was notable for hypertension, dyspepsia, sciatica, uterine fibroids, and a hysterectomy. Her medications included lisinopril, hydrochlorothiazide, tramadol, aspirin, and a multivitamin. The patient did not report the use of oral contraceptive pills or hormone replacement therapy. She also denied the use of cigarettes or illicit drugs but reported occasional alcohol consumption. A review of systems was negative for any constitutional symptoms or symptoms of liver disease. Her family history also was noncontributory.

Physical examination revealed multiple, 1- to 3-mm, telangiectatic macules and patches in a blaschkoid distribution on the right side of the upper chest, back, shoulder, and arm (Figure, A–C). Darier sign was negative. There was no evidence of palmar erythema, hepatosplenomegaly, ascites, thyromegaly, or thyroid nodules. Dermoscopy confirmed the presence of telangiectasia (Figure, D). More specifically, dermoscopy revealed plump telangiectasia with faint pigment in the background, consistent with UNT. Additionally, there was no pink-white, shiny, scarlike background, and vessels were not thin or arborized, further supporting our diagnosis vs other entities included in the differential diagnosis.

Our case provides another unique presentation of UNT. Our patient was a healthy adult woman with no hyperestrogen-based etiology for disease. Importantly, our patient also represented a rare instance of UNT presenting with symptoms such as pruritus, though UNT classically is described as an asymptomatic phenomenon. In our patient, treatment with PDL was suggested and believed to be warranted not only for cosmetic improvement but also in light of the fact that her lesions were symptomatic.

In his role as head of the division of pediatric behavioral health at National Jewish Health, Denver, Bruce G. Bender, PhD, helps children and adults navigate the adverse effects of severe atopic dermatitis (AD) on their quality of life.

“There have been many surveys of adults with AD who report impairment of their sleep, reduced activity level, increased work absence, financial burden, emotional distress, and social avoidance,” he said at the Revolutionizing Atopic Dermatitis virtual symposium. “Similarly, children with AD or their parents report emotional distress, reduced activity, and increased school absence, social avoidance, and sleep disturbance. Families report financial burdens, conflict, particularly among the adults, social avoidance, sleep disturbance in the parents, and reduction of well-being in the siblings.”

Getting adequate sleep is especially challenging for patients with AD, and loss of sleep can have serious daytime consequences. In an effort to objectively measure sleep change in this population, Dr. Bender and colleagues recruited 14 adults with AD and 14 healthy controls who wore an ActiGraph for 1 week and completed questionnaires about sleep, itch, and quality of life. Patients with AD were awake almost twice as many minutes each night as the healthy controls (a mean of 57.3 vs. 32.3 minutes, respectively; P = .0480). Consequently, their sleep efficiency was significantly reduced based on the Pittsburgh sleep quality index (a mean of 90.6 vs. 95; P = .0305).

In another study, Dr. Bender and colleagues enrolled 20 adults with AD who underwent 2 nights of polysomnography and actigraphy. The lab was set up to measure a scratching event, which was recorded when a burst of electromyographic activity of at least 3 seconds was accompanied by a visible scratching motion. “We learned that sleep efficiency as measured by both PSG and actigraphy correlated with total body surface area and scratching index,” he said. “As we might assume, the more skin involved, the more patients scratch, the less well they sleep.”
 

Behavioral, neurocognitive effects

In a separate study of AD, sleep, and behavior, the researchers studied 1,041 children with asthma who were enrolled in the Childhood Asthma Management Program at eight North American sites. They used baseline parent ratings on standardized sleep and behavior rating scales and found that increased awakenings were associated with increased school absence and daytime behavior problems. “So, not only do children with AD sleep less well, but this shows up to impair their functioning during the day,” said Dr. Bender, professor of psychiatry at the University of Colorado, Denver.

In a report from Australia, researchers set out to explore the association between sleep and neurocognitive function in 21 children with eczema and 20 healthy controls. Participants underwent cognitive testing and polysomnography. The authors found that the children with eczema demonstrated lower test scores. Reduced scores were correlated with parental reports of sleep problems but not polysomnography.

In a much larger study funded by the Agency for Healthcare Research and Quality, investigators analyzed data on 354,416 children and 34,613 adults from 19 U.S. population surveys including the National Health Interview Survey 1997-2013 and the National Survey of Children’s Health 2003/4 and 2007/8. They found that AD was associated with ADHD in children (adjusted odds ratio, 1.14) and adults (aOR, 1.61). Higher odds of ADHD were found in children who had significant sleep disturbance (aOR, 16.83) and other allergic disease and asthma (aOR, 1.61).

“All of these findings show that AD can impact quality of life, especially sleep, with the result of poorer daytime functioning,” Dr. Bender said. “But those studies don’t answer this question: Are patients with AD at increased risk for psychological disorders such as depression and anxiety?”
 

Impact on depression, anxiety

Two systematic reviews on the topic suggest that patients with AD are twice as likely to experience depression. One was published in 2018 and the other in 2019. The 2018 review reported a little more than a twofold increase (OR, 2.19), the 2019 review a little bit less (OR, 1.71).

“At the more severe end of the depression continuum, we sometimes see suicidal ideation and suicide attempts,” Dr. Bender said. “A number of studies have asked whether these are increased in patients with AD. Quite a few studies collectively show an increased incidence of suicidal ideation. The question of suicide attempts is reflected in fewer studies. And while the result is small, it is significant. There is a significant increase reported of suicide attempts in AD patients.”

The 2018 review also found an increased incidence of anxiety in AD patients: a little more than twofold in adults (OR, 2.19) and a little less than twofold in children (OR, 1.81).

“It’s a two-way relationship between AD and psychological factors,” Dr. Bender said. “We generally think about AD – the stress that it brings, the burden that it puts on children, adults, and families. But it can work the other way around,” he said, referring to patients who have psychological problems, experience a great deal of stress, have trouble being adherent to their treatment regimen, and find it difficult to resist scratching. “The behavioral/psychological characteristics of the patient also drive the AD. It is well established that acute and chronic stress can result in a worsening of skin conditions in AD patients.”

Behavioral health interventions that have been described in the literature include cognitive therapy, stress management, biofeedback, hypnotherapy, relaxation training, mindfulness, habit reversal, and patient education – some of which have been tested in randomized trials. “All of them report a decrease in scratching as a consequence of the behavioral intervention,” Dr. Bender said.

“Other studies have been reported that look at the impact of behavioral interventions on the severity of the skin condition. Most report an improvement in the skin condition from these behavioral interventions but it’s not a perfect literature.” Critiques of these studies include the fact that there is often not enough detail about the intervention or the framework for the intervention that would allow a clinician to test an intervention in another study or actually pull that intervention into clinical practice (Cochrane Database Syst Rev. 2014 Jan 7;2014[1]:CD004054), (Int Arch Allergy Immunol.2007;144[1]:1-9).

“Some of the studies lack rigorous designs, some have sampling bias, and some have inadequate outcome measurements,” he said. “We really need additional, high-quality studies to look at what is helpful for patients with AD.”

Dr. Bender reported having no financial disclosures.

[email protected]

In his role as head of the division of pediatric behavioral health at National Jewish Health, Denver, Bruce G. Bender, PhD, helps children and adults navigate the adverse effects of severe atopic dermatitis (AD) on their quality of life.

“There have been many surveys of adults with AD who report impairment of their sleep, reduced activity level, increased work absence, financial burden, emotional distress, and social avoidance,” he said at the Revolutionizing Atopic Dermatitis virtual symposium. “Similarly, children with AD or their parents report emotional distress, reduced activity, and increased school absence, social avoidance, and sleep disturbance. Families report financial burdens, conflict, particularly among the adults, social avoidance, sleep disturbance in the parents, and reduction of well-being in the siblings.”

Getting adequate sleep is especially challenging for patients with AD, and loss of sleep can have serious daytime consequences. In an effort to objectively measure sleep change in this population, Dr. Bender and colleagues recruited 14 adults with AD and 14 healthy controls who wore an ActiGraph for 1 week and completed questionnaires about sleep, itch, and quality of life. Patients with AD were awake almost twice as many minutes each night as the healthy controls (a mean of 57.3 vs. 32.3 minutes, respectively; P = .0480). Consequently, their sleep efficiency was significantly reduced based on the Pittsburgh sleep quality index (a mean of 90.6 vs. 95; P = .0305).

In another study, Dr. Bender and colleagues enrolled 20 adults with AD who underwent 2 nights of polysomnography and actigraphy. The lab was set up to measure a scratching event, which was recorded when a burst of electromyographic activity of at least 3 seconds was accompanied by a visible scratching motion. “We learned that sleep efficiency as measured by both PSG and actigraphy correlated with total body surface area and scratching index,” he said. “As we might assume, the more skin involved, the more patients scratch, the less well they sleep.”
 

Behavioral, neurocognitive effects

In a separate study of AD, sleep, and behavior, the researchers studied 1,041 children with asthma who were enrolled in the Childhood Asthma Management Program at eight North American sites. They used baseline parent ratings on standardized sleep and behavior rating scales and found that increased awakenings were associated with increased school absence and daytime behavior problems. “So, not only do children with AD sleep less well, but this shows up to impair their functioning during the day,” said Dr. Bender, professor of psychiatry at the University of Colorado, Denver.

In a report from Australia, researchers set out to explore the association between sleep and neurocognitive function in 21 children with eczema and 20 healthy controls. Participants underwent cognitive testing and polysomnography. The authors found that the children with eczema demonstrated lower test scores. Reduced scores were correlated with parental reports of sleep problems but not polysomnography.

In a much larger study funded by the Agency for Healthcare Research and Quality, investigators analyzed data on 354,416 children and 34,613 adults from 19 U.S. population surveys including the National Health Interview Survey 1997-2013 and the National Survey of Children’s Health 2003/4 and 2007/8. They found that AD was associated with ADHD in children (adjusted odds ratio, 1.14) and adults (aOR, 1.61). Higher odds of ADHD were found in children who had significant sleep disturbance (aOR, 16.83) and other allergic disease and asthma (aOR, 1.61).

“All of these findings show that AD can impact quality of life, especially sleep, with the result of poorer daytime functioning,” Dr. Bender said. “But those studies don’t answer this question: Are patients with AD at increased risk for psychological disorders such as depression and anxiety?”
 

Impact on depression, anxiety

Two systematic reviews on the topic suggest that patients with AD are twice as likely to experience depression. One was published in 2018 and the other in 2019. The 2018 review reported a little more than a twofold increase (OR, 2.19), the 2019 review a little bit less (OR, 1.71).

“At the more severe end of the depression continuum, we sometimes see suicidal ideation and suicide attempts,” Dr. Bender said. “A number of studies have asked whether these are increased in patients with AD. Quite a few studies collectively show an increased incidence of suicidal ideation. The question of suicide attempts is reflected in fewer studies. And while the result is small, it is significant. There is a significant increase reported of suicide attempts in AD patients.”

The 2018 review also found an increased incidence of anxiety in AD patients: a little more than twofold in adults (OR, 2.19) and a little less than twofold in children (OR, 1.81).

“It’s a two-way relationship between AD and psychological factors,” Dr. Bender said. “We generally think about AD – the stress that it brings, the burden that it puts on children, adults, and families. But it can work the other way around,” he said, referring to patients who have psychological problems, experience a great deal of stress, have trouble being adherent to their treatment regimen, and find it difficult to resist scratching. “The behavioral/psychological characteristics of the patient also drive the AD. It is well established that acute and chronic stress can result in a worsening of skin conditions in AD patients.”

Behavioral health interventions that have been described in the literature include cognitive therapy, stress management, biofeedback, hypnotherapy, relaxation training, mindfulness, habit reversal, and patient education – some of which have been tested in randomized trials. “All of them report a decrease in scratching as a consequence of the behavioral intervention,” Dr. Bender said.

“Other studies have been reported that look at the impact of behavioral interventions on the severity of the skin condition. Most report an improvement in the skin condition from these behavioral interventions but it’s not a perfect literature.” Critiques of these studies include the fact that there is often not enough detail about the intervention or the framework for the intervention that would allow a clinician to test an intervention in another study or actually pull that intervention into clinical practice (Cochrane Database Syst Rev. 2014 Jan 7;2014[1]:CD004054), (Int Arch Allergy Immunol.2007;144[1]:1-9).

“Some of the studies lack rigorous designs, some have sampling bias, and some have inadequate outcome measurements,” he said. “We really need additional, high-quality studies to look at what is helpful for patients with AD.”

Dr. Bender reported having no financial disclosures.

[email protected]

In his role as head of the division of pediatric behavioral health at National Jewish Health, Denver, Bruce G. Bender, PhD, helps children and adults navigate the adverse effects of severe atopic dermatitis (AD) on their quality of life.

“There have been many surveys of adults with AD who report impairment of their sleep, reduced activity level, increased work absence, financial burden, emotional distress, and social avoidance,” he said at the Revolutionizing Atopic Dermatitis virtual symposium. “Similarly, children with AD or their parents report emotional distress, reduced activity, and increased school absence, social avoidance, and sleep disturbance. Families report financial burdens, conflict, particularly among the adults, social avoidance, sleep disturbance in the parents, and reduction of well-being in the siblings.”

Getting adequate sleep is especially challenging for patients with AD, and loss of sleep can have serious daytime consequences. In an effort to objectively measure sleep change in this population, Dr. Bender and colleagues recruited 14 adults with AD and 14 healthy controls who wore an ActiGraph for 1 week and completed questionnaires about sleep, itch, and quality of life. Patients with AD were awake almost twice as many minutes each night as the healthy controls (a mean of 57.3 vs. 32.3 minutes, respectively; P = .0480). Consequently, their sleep efficiency was significantly reduced based on the Pittsburgh sleep quality index (a mean of 90.6 vs. 95; P = .0305).

In another study, Dr. Bender and colleagues enrolled 20 adults with AD who underwent 2 nights of polysomnography and actigraphy. The lab was set up to measure a scratching event, which was recorded when a burst of electromyographic activity of at least 3 seconds was accompanied by a visible scratching motion. “We learned that sleep efficiency as measured by both PSG and actigraphy correlated with total body surface area and scratching index,” he said. “As we might assume, the more skin involved, the more patients scratch, the less well they sleep.”
 

Behavioral, neurocognitive effects

In a separate study of AD, sleep, and behavior, the researchers studied 1,041 children with asthma who were enrolled in the Childhood Asthma Management Program at eight North American sites. They used baseline parent ratings on standardized sleep and behavior rating scales and found that increased awakenings were associated with increased school absence and daytime behavior problems. “So, not only do children with AD sleep less well, but this shows up to impair their functioning during the day,” said Dr. Bender, professor of psychiatry at the University of Colorado, Denver.

In a report from Australia, researchers set out to explore the association between sleep and neurocognitive function in 21 children with eczema and 20 healthy controls. Participants underwent cognitive testing and polysomnography. The authors found that the children with eczema demonstrated lower test scores. Reduced scores were correlated with parental reports of sleep problems but not polysomnography.

In a much larger study funded by the Agency for Healthcare Research and Quality, investigators analyzed data on 354,416 children and 34,613 adults from 19 U.S. population surveys including the National Health Interview Survey 1997-2013 and the National Survey of Children’s Health 2003/4 and 2007/8. They found that AD was associated with ADHD in children (adjusted odds ratio, 1.14) and adults (aOR, 1.61). Higher odds of ADHD were found in children who had significant sleep disturbance (aOR, 16.83) and other allergic disease and asthma (aOR, 1.61).

“All of these findings show that AD can impact quality of life, especially sleep, with the result of poorer daytime functioning,” Dr. Bender said. “But those studies don’t answer this question: Are patients with AD at increased risk for psychological disorders such as depression and anxiety?”
 

Impact on depression, anxiety

Two systematic reviews on the topic suggest that patients with AD are twice as likely to experience depression. One was published in 2018 and the other in 2019. The 2018 review reported a little more than a twofold increase (OR, 2.19), the 2019 review a little bit less (OR, 1.71).

“At the more severe end of the depression continuum, we sometimes see suicidal ideation and suicide attempts,” Dr. Bender said. “A number of studies have asked whether these are increased in patients with AD. Quite a few studies collectively show an increased incidence of suicidal ideation. The question of suicide attempts is reflected in fewer studies. And while the result is small, it is significant. There is a significant increase reported of suicide attempts in AD patients.”

The 2018 review also found an increased incidence of anxiety in AD patients: a little more than twofold in adults (OR, 2.19) and a little less than twofold in children (OR, 1.81).

“It’s a two-way relationship between AD and psychological factors,” Dr. Bender said. “We generally think about AD – the stress that it brings, the burden that it puts on children, adults, and families. But it can work the other way around,” he said, referring to patients who have psychological problems, experience a great deal of stress, have trouble being adherent to their treatment regimen, and find it difficult to resist scratching. “The behavioral/psychological characteristics of the patient also drive the AD. It is well established that acute and chronic stress can result in a worsening of skin conditions in AD patients.”

Behavioral health interventions that have been described in the literature include cognitive therapy, stress management, biofeedback, hypnotherapy, relaxation training, mindfulness, habit reversal, and patient education – some of which have been tested in randomized trials. “All of them report a decrease in scratching as a consequence of the behavioral intervention,” Dr. Bender said.

“Other studies have been reported that look at the impact of behavioral interventions on the severity of the skin condition. Most report an improvement in the skin condition from these behavioral interventions but it’s not a perfect literature.” Critiques of these studies include the fact that there is often not enough detail about the intervention or the framework for the intervention that would allow a clinician to test an intervention in another study or actually pull that intervention into clinical practice (Cochrane Database Syst Rev. 2014 Jan 7;2014[1]:CD004054), (Int Arch Allergy Immunol.2007;144[1]:1-9).

“Some of the studies lack rigorous designs, some have sampling bias, and some have inadequate outcome measurements,” he said. “We really need additional, high-quality studies to look at what is helpful for patients with AD.”

Dr. Bender reported having no financial disclosures.

[email protected]

The American Society for Dermatologic Surgery Association and the department of dermatology at Northwestern University, Chicago, have launched the Cutaneous Procedures Adverse Events Reporting (CAPER) registry.

CAPER is a voluntary reporting system designed to collect reports of patients’ adverse events encountered during dermatologic surgery procedures, both cosmetic and those related to skin cancer. The goals of the CAPER registry are to provide safety monitoring, identify practice and/or education gaps associated with adverse events, and identify potential adverse event risk factors.

“CAPER is a registry overseen by a group of board-certified dermatologists, clinicians, and researchers with more than 20 years of experience in patient care and physician advocacy who are committed to improving safety outcomes,” according to an ASDSA press release. “The collaboration between Northwestern University and ASDSA will ensure that CAPER becomes the common place for dermatologic surgeons and their staff to report adverse events from devices, drugs or biologics.”

The launch of the database is important because it fills a gap in adverse event reporting, Murad Alam, MD, professor of dermatology and chief of cutaneous and aesthetic surgery in the department of dermatology at Northwestern University, said in an interview.

There has been no central registry specifically for reporting adverse events associated with dermatologic surgical procedures, including cosmetic and injectable treatments, he said. “While minimally invasive cosmetic and skin procedures have been proven to be exceedingly safe, this registry will provide an early warning system to identify any problems that do occur, so these can be addressed promptly. This registry will allow dermatologists, patients, and industry scientists to work together to further improve the safety of dermatologic procedures,” added Dr. Alam, the past ASDSA president, and current chair of the ASDSA’s Federal Affairs Work Group.

In addition, “recent reports of the possible interaction between some filler injections and certain COVID vaccines confirms the timeliness of redoubling our emphasis on safety. Dermatologists have always been at the forefront of maximizing the patient experience while minimizing risk; this registry is further evidence of that ongoing commitment,” he emphasized.

The CAPER database will gather information on a variety of dermatologic and cosmetic procedures, including those involving topicals and injectables (such as botulinum toxin, fillers, and chemical peels), devices (such as lasers and microneedling devices), cellular-based therapies (such as platelet-rich plasma and stem cell treatments), and surgical treatments (such as liposuction and hair transplantation), Dr. Alam said.

“Novel procedures, and those yet to be devised, as long as they relate to skin surgery or cosmetic improvement, will also be able to be reported. We encourage the reporting of all associated adverse events, even if it is not clear what caused the event. No dermatologic or cosmetic procedures will be excluded from reporting,” he added.

The purpose of the CAPER registry is “to help patients, physicians, and industry work collaboratively to ensure the highest levels of patient safety,” Dr. Alam continued. Data entered into the registry will be deidentified and will remain confidential, and as data on particular topics accumulate, the data “may be analyzed to better understand the patient experience and, secondly, to develop strategies to further improve safety,” he noted.

“One unique element of this registry is that it is focused on dermatologic and cosmetic procedures,” Dr. Alam added. “As a result, those managing and analyzing the data collected will be attuned to the particular concerns associated with such procedures and the patients receiving them.”

For more information and to report dermatologic surgery-related adverse events, go to caper.net.

The American Society for Dermatologic Surgery Association and the department of dermatology at Northwestern University, Chicago, have launched the Cutaneous Procedures Adverse Events Reporting (CAPER) registry.

CAPER is a voluntary reporting system designed to collect reports of patients’ adverse events encountered during dermatologic surgery procedures, both cosmetic and those related to skin cancer. The goals of the CAPER registry are to provide safety monitoring, identify practice and/or education gaps associated with adverse events, and identify potential adverse event risk factors.

“CAPER is a registry overseen by a group of board-certified dermatologists, clinicians, and researchers with more than 20 years of experience in patient care and physician advocacy who are committed to improving safety outcomes,” according to an ASDSA press release. “The collaboration between Northwestern University and ASDSA will ensure that CAPER becomes the common place for dermatologic surgeons and their staff to report adverse events from devices, drugs or biologics.”

The launch of the database is important because it fills a gap in adverse event reporting, Murad Alam, MD, professor of dermatology and chief of cutaneous and aesthetic surgery in the department of dermatology at Northwestern University, said in an interview.

There has been no central registry specifically for reporting adverse events associated with dermatologic surgical procedures, including cosmetic and injectable treatments, he said. “While minimally invasive cosmetic and skin procedures have been proven to be exceedingly safe, this registry will provide an early warning system to identify any problems that do occur, so these can be addressed promptly. This registry will allow dermatologists, patients, and industry scientists to work together to further improve the safety of dermatologic procedures,” added Dr. Alam, the past ASDSA president, and current chair of the ASDSA’s Federal Affairs Work Group.

In addition, “recent reports of the possible interaction between some filler injections and certain COVID vaccines confirms the timeliness of redoubling our emphasis on safety. Dermatologists have always been at the forefront of maximizing the patient experience while minimizing risk; this registry is further evidence of that ongoing commitment,” he emphasized.

The CAPER database will gather information on a variety of dermatologic and cosmetic procedures, including those involving topicals and injectables (such as botulinum toxin, fillers, and chemical peels), devices (such as lasers and microneedling devices), cellular-based therapies (such as platelet-rich plasma and stem cell treatments), and surgical treatments (such as liposuction and hair transplantation), Dr. Alam said.

“Novel procedures, and those yet to be devised, as long as they relate to skin surgery or cosmetic improvement, will also be able to be reported. We encourage the reporting of all associated adverse events, even if it is not clear what caused the event. No dermatologic or cosmetic procedures will be excluded from reporting,” he added.

The purpose of the CAPER registry is “to help patients, physicians, and industry work collaboratively to ensure the highest levels of patient safety,” Dr. Alam continued. Data entered into the registry will be deidentified and will remain confidential, and as data on particular topics accumulate, the data “may be analyzed to better understand the patient experience and, secondly, to develop strategies to further improve safety,” he noted.

“One unique element of this registry is that it is focused on dermatologic and cosmetic procedures,” Dr. Alam added. “As a result, those managing and analyzing the data collected will be attuned to the particular concerns associated with such procedures and the patients receiving them.”

For more information and to report dermatologic surgery-related adverse events, go to caper.net.

The American Society for Dermatologic Surgery Association and the department of dermatology at Northwestern University, Chicago, have launched the Cutaneous Procedures Adverse Events Reporting (CAPER) registry.

CAPER is a voluntary reporting system designed to collect reports of patients’ adverse events encountered during dermatologic surgery procedures, both cosmetic and those related to skin cancer. The goals of the CAPER registry are to provide safety monitoring, identify practice and/or education gaps associated with adverse events, and identify potential adverse event risk factors.

“CAPER is a registry overseen by a group of board-certified dermatologists, clinicians, and researchers with more than 20 years of experience in patient care and physician advocacy who are committed to improving safety outcomes,” according to an ASDSA press release. “The collaboration between Northwestern University and ASDSA will ensure that CAPER becomes the common place for dermatologic surgeons and their staff to report adverse events from devices, drugs or biologics.”

The launch of the database is important because it fills a gap in adverse event reporting, Murad Alam, MD, professor of dermatology and chief of cutaneous and aesthetic surgery in the department of dermatology at Northwestern University, said in an interview.

There has been no central registry specifically for reporting adverse events associated with dermatologic surgical procedures, including cosmetic and injectable treatments, he said. “While minimally invasive cosmetic and skin procedures have been proven to be exceedingly safe, this registry will provide an early warning system to identify any problems that do occur, so these can be addressed promptly. This registry will allow dermatologists, patients, and industry scientists to work together to further improve the safety of dermatologic procedures,” added Dr. Alam, the past ASDSA president, and current chair of the ASDSA’s Federal Affairs Work Group.

In addition, “recent reports of the possible interaction between some filler injections and certain COVID vaccines confirms the timeliness of redoubling our emphasis on safety. Dermatologists have always been at the forefront of maximizing the patient experience while minimizing risk; this registry is further evidence of that ongoing commitment,” he emphasized.

The CAPER database will gather information on a variety of dermatologic and cosmetic procedures, including those involving topicals and injectables (such as botulinum toxin, fillers, and chemical peels), devices (such as lasers and microneedling devices), cellular-based therapies (such as platelet-rich plasma and stem cell treatments), and surgical treatments (such as liposuction and hair transplantation), Dr. Alam said.

“Novel procedures, and those yet to be devised, as long as they relate to skin surgery or cosmetic improvement, will also be able to be reported. We encourage the reporting of all associated adverse events, even if it is not clear what caused the event. No dermatologic or cosmetic procedures will be excluded from reporting,” he added.

The purpose of the CAPER registry is “to help patients, physicians, and industry work collaboratively to ensure the highest levels of patient safety,” Dr. Alam continued. Data entered into the registry will be deidentified and will remain confidential, and as data on particular topics accumulate, the data “may be analyzed to better understand the patient experience and, secondly, to develop strategies to further improve safety,” he noted.

“One unique element of this registry is that it is focused on dermatologic and cosmetic procedures,” Dr. Alam added. “As a result, those managing and analyzing the data collected will be attuned to the particular concerns associated with such procedures and the patients receiving them.”

For more information and to report dermatologic surgery-related adverse events, go to caper.net.

Editor’s note: This profile is part of SHM’s celebration of National Hospitalist Day on March 4. National Hospitalist Day occurs the first Thursday in March annually, and celebrates the fastest growing specialty in modern medicine and hospitalists’ enduring contributions to the evolving health care landscape.

Grace C. Huang, MD, is a hospitalist at Beth Israel Deaconess Medical Center and an associate professor of medicine at Harvard Medical School, both in Boston.

Dr. Huang currently serves as vice chair for career development and mentoring in the department of medicine at Beth Israel Deaconess as well as director of the Office of Academic Careers and Faculty Development, and codirector of the Beth Israel Deaconess Academy of Medical Educators. She is also director of the Rabkin Fellowship in Medical Education, a program for Harvard Medical School faculty designed to help develop the skills needed to launch or advance academic careers in medical education or academic leadership.

Additionally, Dr. Huang is the editor in chief of MedEdPORTAL, a MEDLINE-indexed, open-access journal of the Association of American Medical Colleges.
 

At what point in your training did you decide to practice hospital medicine, and what about it appealed to you?

I trained at a point in time where it was rare for people to aspire to go in to hospital medicine. It just wasn’t that common, and there were so few examples of what a career trajectory in hospital medicine would look like. So I don’t know that I actively chose to go into hospital medicine; I chose it because it was what I knew how to do, based on my residency experience.

But it is really easy and authentic for me now to share about what makes hospital medicine such a vibrant career choice. I’m doing a lot of things in my job other than hospital medicine, but when I am on service, it reminds me acutely what it means to stay connected to why I became a doctor. The practice of hospital medicine means to be there at the most intense time of many people’s lives, to shoulder the responsibility of knowing that what I say to my patients will be remembered forever, and to be challenged by some of medicine’s hardest problems.

Hospital medicine has a way of putting you at the nexus of individual, family, society, government, and planet. But it also means that, even while I am witness to disease, suffering, broken relationships, social injustice, and environmental issues, I get a privileged look at what it means to comfort, to identify what really matters to people, to understand what gives us dignity as human beings. Lastly, I always come back to the fact that working as a team has made my clinical job so much more enriching; it’s not trench warfare, but you do create bonds quickly with learners, colleagues, and other health professionals in such an intense, fast-paced environment.
 

What is your current role at Beth Israel Deaconess Medical Center?

At Beth Israel Deaconess, I’m holding four different jobs. It’s sometimes hard for me to keep track of them, but they all center on career and faculty development. I’m a vice chair for career development within the department of medicine, and I also have an institutional role for faculty development for clinicians, educators, and researchers. I provide academic promotion support for the faculty, provide ad hoc mentorship, and run professional development programming. I also direct a year-long medical education fellowship. On the side, I am the editor in chief for a medical education journal.

What are your favorite areas of clinical practice and research?

Being a generalist means I love a lot of areas of clinical practice. I’m not sure there’s a particular area that I enjoy more than others. I love teaching specific topics – antibiotics, pharmacology, direct oral anticoagulants, the microbiology of common infections. I love thinking about how the heart and kidney battle for dominance each day and being the mediator. I have a particular interest in high-value care and lab ordering (or the fact that we should do much less of it). I love complex diagnostic problems and mapping them out on paper for my team.

The research that I’ve been doing over the past 20 years has focused on how we train internists and internists-to-be to do bedside procedures. It stemmed from my own ineptitude in doing procedures, and it caused me to question the age-old approach we took in sticking needles into patients without standardized training, supervision, or safety measures.

I’ve been proud of the small role I’ve been able to play in influencing how residents are taught to do procedures, and now I’m working with others to focus on how we should teach procedures to hospitalists, who don’t do procedures on a regular basis, and aren’t under the same expectations for ongoing skill development.
 

What are the most challenging aspects of practicing hospital medicine, and what are the most rewarding?

The intensity is probably what’s hardest for me about hospital medicine. At this point in my career, if I’m on service for a week, it takes me just as long to recover. It’s the cognitive load of needing to keep track of details that can make a big difference, the rapidity at which patients can deteriorate, the need to change course in an instant because of new information, and wanting to be mentally present and available for my patients and my learners.

It’s also hard to see suffering up close and personal and to leave feeling helpless to change the course of severe illness or to optimize care within the constraints of the health care system. This is why I do – and have to – extract satisfaction from the smallest of wins and brief moments of connection. Like seeing a patient turn the corner after being on the brink. Or gaining trust from an initially upset family member. Getting a copy of the eulogy from the daughter of my patient. A phone call from a patient I cared for 18 months ago, thanking me for my care. Visiting patients in the hospital socially that I had gotten to know over the years.
 

How has COVID-19 impacted hospitalist practice, and what changes will outlast the pandemic?

What you read in the lay press has put a spotlight on hospital-based work. What has been shared resonates with my own experience – the loss of connection from visitor restrictions, the isolation patients experience when everyone is wearing personal protective equipment, the worsening of everything that was already hard to begin with, like health care disparities, mental health, access to community supports, financial challenges, the disproportionate burden on unpaid caregivers, etc.

After the pandemic is “over,” I hope that we will retain a sense of intentionality how we address limited resources, the importance of social connection, the structural racism that has disadvantaged patients and physicians of color.
 

How will hospital medicine as a field change in the next decade or 2?

The hospitalist model has already influenced other specialties, like ob.gyn., neurology, and cardiology, and I expect that to continue. Hospitalists have already become leaders at the highest levels, and we will see them in higher numbers throughout health care leadership.

Are there any particular mentors who have been influential in your journey as a hospitalist?

Because I’m one of the older hospitalists in my group, there were fewer mentors, other than my boss, Joe Li, MD, SFHM, [section chief in hospital medicine at Beth Israel Deaconess], who has been an amazing role model. I think also of my colleagues as peer mentors, who continue to push me to be a better doctor. Whether it means remaining curious during the physical exam, or inspiring me with their excitement about clinical cases.

Do you have any advice for students and residents interested in hospital medicine?

When I talk to trainees about career development as a hospitalist, I encourage them to think about what will make them a “Hospitalist Plus.” Whether that Plus is teaching, research, or leadership, being a hospitalist gives you an opportunity to extend your impact as a physician into related realm.

I look around at our hospital medicine group, and every person has their Plus. We have educators, quality improvement leaders, a health services researcher, a health policy expert, a textbook editor – everyone brings special expertise to the group. My Plus now is much bigger than my footprint as a hospitalist, but I would never have gotten here had I not chosen a career path that would allow me to explore the farthest reaches of my potential as a physician.
 

Editor’s note: This profile is part of SHM’s celebration of National Hospitalist Day on March 4. National Hospitalist Day occurs the first Thursday in March annually, and celebrates the fastest growing specialty in modern medicine and hospitalists’ enduring contributions to the evolving health care landscape.

Grace C. Huang, MD, is a hospitalist at Beth Israel Deaconess Medical Center and an associate professor of medicine at Harvard Medical School, both in Boston.

Dr. Huang currently serves as vice chair for career development and mentoring in the department of medicine at Beth Israel Deaconess as well as director of the Office of Academic Careers and Faculty Development, and codirector of the Beth Israel Deaconess Academy of Medical Educators. She is also director of the Rabkin Fellowship in Medical Education, a program for Harvard Medical School faculty designed to help develop the skills needed to launch or advance academic careers in medical education or academic leadership.

Additionally, Dr. Huang is the editor in chief of MedEdPORTAL, a MEDLINE-indexed, open-access journal of the Association of American Medical Colleges.
 

At what point in your training did you decide to practice hospital medicine, and what about it appealed to you?

I trained at a point in time where it was rare for people to aspire to go in to hospital medicine. It just wasn’t that common, and there were so few examples of what a career trajectory in hospital medicine would look like. So I don’t know that I actively chose to go into hospital medicine; I chose it because it was what I knew how to do, based on my residency experience.

But it is really easy and authentic for me now to share about what makes hospital medicine such a vibrant career choice. I’m doing a lot of things in my job other than hospital medicine, but when I am on service, it reminds me acutely what it means to stay connected to why I became a doctor. The practice of hospital medicine means to be there at the most intense time of many people’s lives, to shoulder the responsibility of knowing that what I say to my patients will be remembered forever, and to be challenged by some of medicine’s hardest problems.

Hospital medicine has a way of putting you at the nexus of individual, family, society, government, and planet. But it also means that, even while I am witness to disease, suffering, broken relationships, social injustice, and environmental issues, I get a privileged look at what it means to comfort, to identify what really matters to people, to understand what gives us dignity as human beings. Lastly, I always come back to the fact that working as a team has made my clinical job so much more enriching; it’s not trench warfare, but you do create bonds quickly with learners, colleagues, and other health professionals in such an intense, fast-paced environment.
 

What is your current role at Beth Israel Deaconess Medical Center?

At Beth Israel Deaconess, I’m holding four different jobs. It’s sometimes hard for me to keep track of them, but they all center on career and faculty development. I’m a vice chair for career development within the department of medicine, and I also have an institutional role for faculty development for clinicians, educators, and researchers. I provide academic promotion support for the faculty, provide ad hoc mentorship, and run professional development programming. I also direct a year-long medical education fellowship. On the side, I am the editor in chief for a medical education journal.

What are your favorite areas of clinical practice and research?

Being a generalist means I love a lot of areas of clinical practice. I’m not sure there’s a particular area that I enjoy more than others. I love teaching specific topics – antibiotics, pharmacology, direct oral anticoagulants, the microbiology of common infections. I love thinking about how the heart and kidney battle for dominance each day and being the mediator. I have a particular interest in high-value care and lab ordering (or the fact that we should do much less of it). I love complex diagnostic problems and mapping them out on paper for my team.

The research that I’ve been doing over the past 20 years has focused on how we train internists and internists-to-be to do bedside procedures. It stemmed from my own ineptitude in doing procedures, and it caused me to question the age-old approach we took in sticking needles into patients without standardized training, supervision, or safety measures.

I’ve been proud of the small role I’ve been able to play in influencing how residents are taught to do procedures, and now I’m working with others to focus on how we should teach procedures to hospitalists, who don’t do procedures on a regular basis, and aren’t under the same expectations for ongoing skill development.
 

What are the most challenging aspects of practicing hospital medicine, and what are the most rewarding?

The intensity is probably what’s hardest for me about hospital medicine. At this point in my career, if I’m on service for a week, it takes me just as long to recover. It’s the cognitive load of needing to keep track of details that can make a big difference, the rapidity at which patients can deteriorate, the need to change course in an instant because of new information, and wanting to be mentally present and available for my patients and my learners.

It’s also hard to see suffering up close and personal and to leave feeling helpless to change the course of severe illness or to optimize care within the constraints of the health care system. This is why I do – and have to – extract satisfaction from the smallest of wins and brief moments of connection. Like seeing a patient turn the corner after being on the brink. Or gaining trust from an initially upset family member. Getting a copy of the eulogy from the daughter of my patient. A phone call from a patient I cared for 18 months ago, thanking me for my care. Visiting patients in the hospital socially that I had gotten to know over the years.
 

How has COVID-19 impacted hospitalist practice, and what changes will outlast the pandemic?

What you read in the lay press has put a spotlight on hospital-based work. What has been shared resonates with my own experience – the loss of connection from visitor restrictions, the isolation patients experience when everyone is wearing personal protective equipment, the worsening of everything that was already hard to begin with, like health care disparities, mental health, access to community supports, financial challenges, the disproportionate burden on unpaid caregivers, etc.

After the pandemic is “over,” I hope that we will retain a sense of intentionality how we address limited resources, the importance of social connection, the structural racism that has disadvantaged patients and physicians of color.
 

How will hospital medicine as a field change in the next decade or 2?

The hospitalist model has already influenced other specialties, like ob.gyn., neurology, and cardiology, and I expect that to continue. Hospitalists have already become leaders at the highest levels, and we will see them in higher numbers throughout health care leadership.

Are there any particular mentors who have been influential in your journey as a hospitalist?

Because I’m one of the older hospitalists in my group, there were fewer mentors, other than my boss, Joe Li, MD, SFHM, [section chief in hospital medicine at Beth Israel Deaconess], who has been an amazing role model. I think also of my colleagues as peer mentors, who continue to push me to be a better doctor. Whether it means remaining curious during the physical exam, or inspiring me with their excitement about clinical cases.

Do you have any advice for students and residents interested in hospital medicine?

When I talk to trainees about career development as a hospitalist, I encourage them to think about what will make them a “Hospitalist Plus.” Whether that Plus is teaching, research, or leadership, being a hospitalist gives you an opportunity to extend your impact as a physician into related realm.

I look around at our hospital medicine group, and every person has their Plus. We have educators, quality improvement leaders, a health services researcher, a health policy expert, a textbook editor – everyone brings special expertise to the group. My Plus now is much bigger than my footprint as a hospitalist, but I would never have gotten here had I not chosen a career path that would allow me to explore the farthest reaches of my potential as a physician.
 

Editor’s note: This profile is part of SHM’s celebration of National Hospitalist Day on March 4. National Hospitalist Day occurs the first Thursday in March annually, and celebrates the fastest growing specialty in modern medicine and hospitalists’ enduring contributions to the evolving health care landscape.

Grace C. Huang, MD, is a hospitalist at Beth Israel Deaconess Medical Center and an associate professor of medicine at Harvard Medical School, both in Boston.

Dr. Huang currently serves as vice chair for career development and mentoring in the department of medicine at Beth Israel Deaconess as well as director of the Office of Academic Careers and Faculty Development, and codirector of the Beth Israel Deaconess Academy of Medical Educators. She is also director of the Rabkin Fellowship in Medical Education, a program for Harvard Medical School faculty designed to help develop the skills needed to launch or advance academic careers in medical education or academic leadership.

Additionally, Dr. Huang is the editor in chief of MedEdPORTAL, a MEDLINE-indexed, open-access journal of the Association of American Medical Colleges.
 

At what point in your training did you decide to practice hospital medicine, and what about it appealed to you?

I trained at a point in time where it was rare for people to aspire to go in to hospital medicine. It just wasn’t that common, and there were so few examples of what a career trajectory in hospital medicine would look like. So I don’t know that I actively chose to go into hospital medicine; I chose it because it was what I knew how to do, based on my residency experience.

But it is really easy and authentic for me now to share about what makes hospital medicine such a vibrant career choice. I’m doing a lot of things in my job other than hospital medicine, but when I am on service, it reminds me acutely what it means to stay connected to why I became a doctor. The practice of hospital medicine means to be there at the most intense time of many people’s lives, to shoulder the responsibility of knowing that what I say to my patients will be remembered forever, and to be challenged by some of medicine’s hardest problems.

Hospital medicine has a way of putting you at the nexus of individual, family, society, government, and planet. But it also means that, even while I am witness to disease, suffering, broken relationships, social injustice, and environmental issues, I get a privileged look at what it means to comfort, to identify what really matters to people, to understand what gives us dignity as human beings. Lastly, I always come back to the fact that working as a team has made my clinical job so much more enriching; it’s not trench warfare, but you do create bonds quickly with learners, colleagues, and other health professionals in such an intense, fast-paced environment.
 

What is your current role at Beth Israel Deaconess Medical Center?

At Beth Israel Deaconess, I’m holding four different jobs. It’s sometimes hard for me to keep track of them, but they all center on career and faculty development. I’m a vice chair for career development within the department of medicine, and I also have an institutional role for faculty development for clinicians, educators, and researchers. I provide academic promotion support for the faculty, provide ad hoc mentorship, and run professional development programming. I also direct a year-long medical education fellowship. On the side, I am the editor in chief for a medical education journal.

What are your favorite areas of clinical practice and research?

Being a generalist means I love a lot of areas of clinical practice. I’m not sure there’s a particular area that I enjoy more than others. I love teaching specific topics – antibiotics, pharmacology, direct oral anticoagulants, the microbiology of common infections. I love thinking about how the heart and kidney battle for dominance each day and being the mediator. I have a particular interest in high-value care and lab ordering (or the fact that we should do much less of it). I love complex diagnostic problems and mapping them out on paper for my team.

The research that I’ve been doing over the past 20 years has focused on how we train internists and internists-to-be to do bedside procedures. It stemmed from my own ineptitude in doing procedures, and it caused me to question the age-old approach we took in sticking needles into patients without standardized training, supervision, or safety measures.

I’ve been proud of the small role I’ve been able to play in influencing how residents are taught to do procedures, and now I’m working with others to focus on how we should teach procedures to hospitalists, who don’t do procedures on a regular basis, and aren’t under the same expectations for ongoing skill development.
 

What are the most challenging aspects of practicing hospital medicine, and what are the most rewarding?

The intensity is probably what’s hardest for me about hospital medicine. At this point in my career, if I’m on service for a week, it takes me just as long to recover. It’s the cognitive load of needing to keep track of details that can make a big difference, the rapidity at which patients can deteriorate, the need to change course in an instant because of new information, and wanting to be mentally present and available for my patients and my learners.

It’s also hard to see suffering up close and personal and to leave feeling helpless to change the course of severe illness or to optimize care within the constraints of the health care system. This is why I do – and have to – extract satisfaction from the smallest of wins and brief moments of connection. Like seeing a patient turn the corner after being on the brink. Or gaining trust from an initially upset family member. Getting a copy of the eulogy from the daughter of my patient. A phone call from a patient I cared for 18 months ago, thanking me for my care. Visiting patients in the hospital socially that I had gotten to know over the years.
 

How has COVID-19 impacted hospitalist practice, and what changes will outlast the pandemic?

What you read in the lay press has put a spotlight on hospital-based work. What has been shared resonates with my own experience – the loss of connection from visitor restrictions, the isolation patients experience when everyone is wearing personal protective equipment, the worsening of everything that was already hard to begin with, like health care disparities, mental health, access to community supports, financial challenges, the disproportionate burden on unpaid caregivers, etc.

After the pandemic is “over,” I hope that we will retain a sense of intentionality how we address limited resources, the importance of social connection, the structural racism that has disadvantaged patients and physicians of color.
 

How will hospital medicine as a field change in the next decade or 2?

The hospitalist model has already influenced other specialties, like ob.gyn., neurology, and cardiology, and I expect that to continue. Hospitalists have already become leaders at the highest levels, and we will see them in higher numbers throughout health care leadership.

Are there any particular mentors who have been influential in your journey as a hospitalist?

Because I’m one of the older hospitalists in my group, there were fewer mentors, other than my boss, Joe Li, MD, SFHM, [section chief in hospital medicine at Beth Israel Deaconess], who has been an amazing role model. I think also of my colleagues as peer mentors, who continue to push me to be a better doctor. Whether it means remaining curious during the physical exam, or inspiring me with their excitement about clinical cases.

Do you have any advice for students and residents interested in hospital medicine?

When I talk to trainees about career development as a hospitalist, I encourage them to think about what will make them a “Hospitalist Plus.” Whether that Plus is teaching, research, or leadership, being a hospitalist gives you an opportunity to extend your impact as a physician into related realm.

I look around at our hospital medicine group, and every person has their Plus. We have educators, quality improvement leaders, a health services researcher, a health policy expert, a textbook editor – everyone brings special expertise to the group. My Plus now is much bigger than my footprint as a hospitalist, but I would never have gotten here had I not chosen a career path that would allow me to explore the farthest reaches of my potential as a physician.
 

Editor’s note: This profile is part of SHM’s celebration of National Hospitalist Day on March 4. National Hospitalist Day occurs the first Thursday in March annually, and celebrates the fastest growing specialty in modern medicine and hospitalists’ enduring contributions to the evolving health care landscape.

For Eric E. Howell, MD, MHM, CEO since July 2020 for the Society of Hospital Medicine, an undergraduate degree in electrical engineering and a lifelong proclivity for figuring out puzzles, solving problems, and taking things apart to see how they fit back together were building blocks for an exemplary career as a hospitalist, group administrator, and medical educator.

When he was growing up in historic Annapolis, Md., near the shores of Chesapeake Bay, things to put back together included remote control airplanes, small boat engines, and cars. As a hospitalist, his interest in solving problems and facility with numbers and systems led him to become an expert on quality improvement, transitions of care, and conflict management.

Courtesy Dr. Eric Howell

“I was one of the first four doctors hired. I thought I’d just do it for a year, but I loved inpatient work, so I stayed,” Dr. Howell said. “Roy mentored me for the next 20 years and helped me to become an above average hospitalist.”

Early on, Dr. Howell’s department chair, David Hellman, MD, who had worked at the University of California–San Francisco with hospital medicine pioneer Robert Wachter, MD, MHM, sent Dr. Howell to San Francisco to be mentored by Dr. Wachter, since there were few hospital mentors on the East Coast at that time.

“What I took away from that experience was how important it was to professionalize hospital medicine – in order to develop specialized expertise,” Dr. Howell recalled. “Dr. Wachter taught me that hospitalists need to have a professional focus. Quality improvement, systems-based improvement, and value all became part of that,” he said.

“Many people thought to be a hospitalist all you had to know was basic medicine. But it turns out medicine in the hospital is just as specialized as any other specialty. The hospital itself requires specialized knowledge that didn’t even exist 20 years ago.” Because of complicated disease states and clinical systems, hospitalists have to be better at navigating the software of today’s hospital.
 

New job opportunities

Dr. Howell describes his career path as a new job focus opening up every 5 years or so, redefining what he does and trying something new and exciting with better pay. His first was a focus on clinical hospital medicine and learning how to be a better doctor. Then in 2005 he began work as a teacher at Johns Hopkins School of Medicine. There he mastered the teaching of medical trainees, winning awards as an instructor, including SHM’s award for excellence in teaching.

In 2010 he again changed his focus to program building, leading the expansion of the hospitalist service for Bayview and three other hospitals in the Johns Hopkins system. Dr. Howell helped grow the service to nearly 200 clinicians while becoming skilled at operational and program development.

His fourth job incarnation, starting in 2015, was the obsessive pursuit of quality improvement, marshaling data to measure and improve clinical and other outcomes on the quality dashboard – mortality, length of stay, readmissions, rates of adverse events – and putting quality improvement strategies in place.

“Our mortality rates at Bayview were well below national standards. We came up with an amazing program. A lot of hospital medicine programs pursue improvement, but we really measured it. We benchmarked ourselves against other programs at Hopkins,” he said. “I set up a dedicated conference room, as many QI programs do. We called it True North, and each wall had a different QI focus, with updates on the reported metrics. Every other week we met there to talk about the metrics,” he said.

That experience led to working with SHM, which he had joined as a member early in his career and for which he had previously served as president. He became SHM’s quality improvement liaison and a co-principal investigator on Project BOOST (Better Outcomes for Older adults through Safe Transitions), SHM’s pioneering, national mentored-implementation model aimed at improving transitions of care from participating hospitals to reduce readmissions. “BOOST really established SHM’s reputation as a quality improvement-oriented organization. It was a stake in the ground for quality and led to SHM receiving the Joint Commission’s 2011 John M. Eisenberg Award for Innovation in Patient Safety and Quality,” he said.

Dr. Howell’s fifth career phase, medical society management, emerged when he was recruited to apply for the SHM chief executive position – held since its inception by retiring CEO Larry Wellikson, MD, MHM. Dr. Howell started work at SHM in the midst of the pandemic, spending much of his time working from home – especially when Philadelphia implemented stricter COVID-19 restrictions. Once pandemic restrictions are loosened, he expects to do a lot of traveling. But for now, the external-facing part of his job is mainly on Zoom.
 

Making the world a better place

Dr. Howell said he has held fast to three mottos in life, which have guided his career path as well as his personal life: (1) to make the world a better place; (2) to be ethical and transparent; and (3) to invest in people. His wife of 19 years, Heather Howell, an Annapolis realtor, says making the world a better place is what they taught their children, Mason, 18, who starts college at Rice University in fall 2021 with an interest in premed, and Anna, 16, a competitive sailor. “We always had a poster hanging in our house extolling that message,” Ms. Howell said.

Dr. Howell grew up in a nautical family, with many of his relatives working in the maritime business. His kids grew up on the water, learning to pilot a powerboat before driving a car, as he did. “We boat all the time on the bay” in his lobster boat, which he often works on to keep it seaworthy, Ms. Howell said.

“There’s nothing like taking care of hospitalized patients to make you feel you’re making the world a better place,” Dr. Howell observed. “Very often you can make a huge difference for the patients you do care for, and that is incredibly rewarding.” Although the demands of his SHM leadership position required relinquishing most of his responsibilities at Johns Hopkins, he continues to see patients and teach residents there 2-4 weeks a year on a teaching service.

“Why do I still see patients? I find it so rewarding. And I get to teach, which I love,” he said. “To be honest, I don’t think you truly need to see patients to be head of a professional medical society like SHM. Maybe someday I’ll give that up. But only if it’s necessary to make the society more successful.”

Half of Dr. Howell’s Society work now is planned and half is “putting out fires” – while learning members’ needs in real time. “Right now, we’re worried about burnout and PTSD, because frankly it’s stressful to take care of COVID patients. It’s scary for a lot of clinicians. I’m working with our members to make sure they have what they need to be clinically prepared, including resources to be more resilient professionally.”

Every step of his career, Dr. Howell said, has seemed like the best job he ever had. “Making the world a better place is still important to me. I tell SHM members that it’s important to know they are making a difference. What they’re doing is really important, especially with COVID, and it needs to be sustainable,” he said.

“SHM has such a powerful mission – it’s about making patient care better, and making hospitalists better clinicians. I know the Society is having a powerful impact, and that’s good enough for me. I’m into teams. Hospital medicine is a team sport, but so is SHM, interacting with its members, staff, and board.”
 

Initiating another new program

One of Dr. Howell’s last major projects for Hopkins was to launch and be chief medical officer for the Joint Commission–accredited Baltimore Civic Center Field Hospital for COVID-19 patients, opened in March 2020.

Courtesy Dr. Eric Howell

With a surge capacity of 250 beds, and a negative pressure ward set up in the center’s exhibit hall, it is jointly operated by the University of Maryland Medical System and Johns Hopkins Hospital. The field hospital’s mission has since expanded to include viral tests, infusions of monoclonal antibodies, and COVID-19 vaccinations.

Planning for a smooth transition, Dr. Howell brought Melinda E. Kantsiper, MD, director of clinical operations, Division of Hospital Medicine at Johns Hopkins Bayview, on board as associate medical officer, to eventually replace him as CMO after a few months working alongside him. “Eric brings that logical engineering eye to problem solving,” Dr. Kantsiper said.

Courtesy Johns Hopkins Medicine

Editor’s note: This profile is part of SHM’s celebration of National Hospitalist Day on March 4. National Hospitalist Day occurs the first Thursday in March annually, and celebrates the fastest growing specialty in modern medicine and hospitalists’ enduring contributions to the evolving health care landscape.

For Eric E. Howell, MD, MHM, CEO since July 2020 for the Society of Hospital Medicine, an undergraduate degree in electrical engineering and a lifelong proclivity for figuring out puzzles, solving problems, and taking things apart to see how they fit back together were building blocks for an exemplary career as a hospitalist, group administrator, and medical educator.

When he was growing up in historic Annapolis, Md., near the shores of Chesapeake Bay, things to put back together included remote control airplanes, small boat engines, and cars. As a hospitalist, his interest in solving problems and facility with numbers and systems led him to become an expert on quality improvement, transitions of care, and conflict management.

Courtesy Dr. Eric Howell

“I was one of the first four doctors hired. I thought I’d just do it for a year, but I loved inpatient work, so I stayed,” Dr. Howell said. “Roy mentored me for the next 20 years and helped me to become an above average hospitalist.”

Early on, Dr. Howell’s department chair, David Hellman, MD, who had worked at the University of California–San Francisco with hospital medicine pioneer Robert Wachter, MD, MHM, sent Dr. Howell to San Francisco to be mentored by Dr. Wachter, since there were few hospital mentors on the East Coast at that time.

“What I took away from that experience was how important it was to professionalize hospital medicine – in order to develop specialized expertise,” Dr. Howell recalled. “Dr. Wachter taught me that hospitalists need to have a professional focus. Quality improvement, systems-based improvement, and value all became part of that,” he said.

“Many people thought to be a hospitalist all you had to know was basic medicine. But it turns out medicine in the hospital is just as specialized as any other specialty. The hospital itself requires specialized knowledge that didn’t even exist 20 years ago.” Because of complicated disease states and clinical systems, hospitalists have to be better at navigating the software of today’s hospital.
 

New job opportunities

Dr. Howell describes his career path as a new job focus opening up every 5 years or so, redefining what he does and trying something new and exciting with better pay. His first was a focus on clinical hospital medicine and learning how to be a better doctor. Then in 2005 he began work as a teacher at Johns Hopkins School of Medicine. There he mastered the teaching of medical trainees, winning awards as an instructor, including SHM’s award for excellence in teaching.

In 2010 he again changed his focus to program building, leading the expansion of the hospitalist service for Bayview and three other hospitals in the Johns Hopkins system. Dr. Howell helped grow the service to nearly 200 clinicians while becoming skilled at operational and program development.

His fourth job incarnation, starting in 2015, was the obsessive pursuit of quality improvement, marshaling data to measure and improve clinical and other outcomes on the quality dashboard – mortality, length of stay, readmissions, rates of adverse events – and putting quality improvement strategies in place.

“Our mortality rates at Bayview were well below national standards. We came up with an amazing program. A lot of hospital medicine programs pursue improvement, but we really measured it. We benchmarked ourselves against other programs at Hopkins,” he said. “I set up a dedicated conference room, as many QI programs do. We called it True North, and each wall had a different QI focus, with updates on the reported metrics. Every other week we met there to talk about the metrics,” he said.

That experience led to working with SHM, which he had joined as a member early in his career and for which he had previously served as president. He became SHM’s quality improvement liaison and a co-principal investigator on Project BOOST (Better Outcomes for Older adults through Safe Transitions), SHM’s pioneering, national mentored-implementation model aimed at improving transitions of care from participating hospitals to reduce readmissions. “BOOST really established SHM’s reputation as a quality improvement-oriented organization. It was a stake in the ground for quality and led to SHM receiving the Joint Commission’s 2011 John M. Eisenberg Award for Innovation in Patient Safety and Quality,” he said.

Dr. Howell’s fifth career phase, medical society management, emerged when he was recruited to apply for the SHM chief executive position – held since its inception by retiring CEO Larry Wellikson, MD, MHM. Dr. Howell started work at SHM in the midst of the pandemic, spending much of his time working from home – especially when Philadelphia implemented stricter COVID-19 restrictions. Once pandemic restrictions are loosened, he expects to do a lot of traveling. But for now, the external-facing part of his job is mainly on Zoom.
 

Making the world a better place

Dr. Howell said he has held fast to three mottos in life, which have guided his career path as well as his personal life: (1) to make the world a better place; (2) to be ethical and transparent; and (3) to invest in people. His wife of 19 years, Heather Howell, an Annapolis realtor, says making the world a better place is what they taught their children, Mason, 18, who starts college at Rice University in fall 2021 with an interest in premed, and Anna, 16, a competitive sailor. “We always had a poster hanging in our house extolling that message,” Ms. Howell said.

Dr. Howell grew up in a nautical family, with many of his relatives working in the maritime business. His kids grew up on the water, learning to pilot a powerboat before driving a car, as he did. “We boat all the time on the bay” in his lobster boat, which he often works on to keep it seaworthy, Ms. Howell said.

“There’s nothing like taking care of hospitalized patients to make you feel you’re making the world a better place,” Dr. Howell observed. “Very often you can make a huge difference for the patients you do care for, and that is incredibly rewarding.” Although the demands of his SHM leadership position required relinquishing most of his responsibilities at Johns Hopkins, he continues to see patients and teach residents there 2-4 weeks a year on a teaching service.

“Why do I still see patients? I find it so rewarding. And I get to teach, which I love,” he said. “To be honest, I don’t think you truly need to see patients to be head of a professional medical society like SHM. Maybe someday I’ll give that up. But only if it’s necessary to make the society more successful.”

Half of Dr. Howell’s Society work now is planned and half is “putting out fires” – while learning members’ needs in real time. “Right now, we’re worried about burnout and PTSD, because frankly it’s stressful to take care of COVID patients. It’s scary for a lot of clinicians. I’m working with our members to make sure they have what they need to be clinically prepared, including resources to be more resilient professionally.”

Every step of his career, Dr. Howell said, has seemed like the best job he ever had. “Making the world a better place is still important to me. I tell SHM members that it’s important to know they are making a difference. What they’re doing is really important, especially with COVID, and it needs to be sustainable,” he said.

“SHM has such a powerful mission – it’s about making patient care better, and making hospitalists better clinicians. I know the Society is having a powerful impact, and that’s good enough for me. I’m into teams. Hospital medicine is a team sport, but so is SHM, interacting with its members, staff, and board.”
 

Initiating another new program

One of Dr. Howell’s last major projects for Hopkins was to launch and be chief medical officer for the Joint Commission–accredited Baltimore Civic Center Field Hospital for COVID-19 patients, opened in March 2020.

Courtesy Dr. Eric Howell

With a surge capacity of 250 beds, and a negative pressure ward set up in the center’s exhibit hall, it is jointly operated by the University of Maryland Medical System and Johns Hopkins Hospital. The field hospital’s mission has since expanded to include viral tests, infusions of monoclonal antibodies, and COVID-19 vaccinations.

Planning for a smooth transition, Dr. Howell brought Melinda E. Kantsiper, MD, director of clinical operations, Division of Hospital Medicine at Johns Hopkins Bayview, on board as associate medical officer, to eventually replace him as CMO after a few months working alongside him. “Eric brings that logical engineering eye to problem solving,” Dr. Kantsiper said.

Courtesy Johns Hopkins Medicine

Editor’s note: This profile is part of SHM’s celebration of National Hospitalist Day on March 4. National Hospitalist Day occurs the first Thursday in March annually, and celebrates the fastest growing specialty in modern medicine and hospitalists’ enduring contributions to the evolving health care landscape.

For Eric E. Howell, MD, MHM, CEO since July 2020 for the Society of Hospital Medicine, an undergraduate degree in electrical engineering and a lifelong proclivity for figuring out puzzles, solving problems, and taking things apart to see how they fit back together were building blocks for an exemplary career as a hospitalist, group administrator, and medical educator.

When he was growing up in historic Annapolis, Md., near the shores of Chesapeake Bay, things to put back together included remote control airplanes, small boat engines, and cars. As a hospitalist, his interest in solving problems and facility with numbers and systems led him to become an expert on quality improvement, transitions of care, and conflict management.

Courtesy Dr. Eric Howell

“I was one of the first four doctors hired. I thought I’d just do it for a year, but I loved inpatient work, so I stayed,” Dr. Howell said. “Roy mentored me for the next 20 years and helped me to become an above average hospitalist.”

Early on, Dr. Howell’s department chair, David Hellman, MD, who had worked at the University of California–San Francisco with hospital medicine pioneer Robert Wachter, MD, MHM, sent Dr. Howell to San Francisco to be mentored by Dr. Wachter, since there were few hospital mentors on the East Coast at that time.

“What I took away from that experience was how important it was to professionalize hospital medicine – in order to develop specialized expertise,” Dr. Howell recalled. “Dr. Wachter taught me that hospitalists need to have a professional focus. Quality improvement, systems-based improvement, and value all became part of that,” he said.

“Many people thought to be a hospitalist all you had to know was basic medicine. But it turns out medicine in the hospital is just as specialized as any other specialty. The hospital itself requires specialized knowledge that didn’t even exist 20 years ago.” Because of complicated disease states and clinical systems, hospitalists have to be better at navigating the software of today’s hospital.
 

New job opportunities

Dr. Howell describes his career path as a new job focus opening up every 5 years or so, redefining what he does and trying something new and exciting with better pay. His first was a focus on clinical hospital medicine and learning how to be a better doctor. Then in 2005 he began work as a teacher at Johns Hopkins School of Medicine. There he mastered the teaching of medical trainees, winning awards as an instructor, including SHM’s award for excellence in teaching.

In 2010 he again changed his focus to program building, leading the expansion of the hospitalist service for Bayview and three other hospitals in the Johns Hopkins system. Dr. Howell helped grow the service to nearly 200 clinicians while becoming skilled at operational and program development.

His fourth job incarnation, starting in 2015, was the obsessive pursuit of quality improvement, marshaling data to measure and improve clinical and other outcomes on the quality dashboard – mortality, length of stay, readmissions, rates of adverse events – and putting quality improvement strategies in place.

“Our mortality rates at Bayview were well below national standards. We came up with an amazing program. A lot of hospital medicine programs pursue improvement, but we really measured it. We benchmarked ourselves against other programs at Hopkins,” he said. “I set up a dedicated conference room, as many QI programs do. We called it True North, and each wall had a different QI focus, with updates on the reported metrics. Every other week we met there to talk about the metrics,” he said.

That experience led to working with SHM, which he had joined as a member early in his career and for which he had previously served as president. He became SHM’s quality improvement liaison and a co-principal investigator on Project BOOST (Better Outcomes for Older adults through Safe Transitions), SHM’s pioneering, national mentored-implementation model aimed at improving transitions of care from participating hospitals to reduce readmissions. “BOOST really established SHM’s reputation as a quality improvement-oriented organization. It was a stake in the ground for quality and led to SHM receiving the Joint Commission’s 2011 John M. Eisenberg Award for Innovation in Patient Safety and Quality,” he said.

Dr. Howell’s fifth career phase, medical society management, emerged when he was recruited to apply for the SHM chief executive position – held since its inception by retiring CEO Larry Wellikson, MD, MHM. Dr. Howell started work at SHM in the midst of the pandemic, spending much of his time working from home – especially when Philadelphia implemented stricter COVID-19 restrictions. Once pandemic restrictions are loosened, he expects to do a lot of traveling. But for now, the external-facing part of his job is mainly on Zoom.
 

Making the world a better place

Dr. Howell said he has held fast to three mottos in life, which have guided his career path as well as his personal life: (1) to make the world a better place; (2) to be ethical and transparent; and (3) to invest in people. His wife of 19 years, Heather Howell, an Annapolis realtor, says making the world a better place is what they taught their children, Mason, 18, who starts college at Rice University in fall 2021 with an interest in premed, and Anna, 16, a competitive sailor. “We always had a poster hanging in our house extolling that message,” Ms. Howell said.

Dr. Howell grew up in a nautical family, with many of his relatives working in the maritime business. His kids grew up on the water, learning to pilot a powerboat before driving a car, as he did. “We boat all the time on the bay” in his lobster boat, which he often works on to keep it seaworthy, Ms. Howell said.

“There’s nothing like taking care of hospitalized patients to make you feel you’re making the world a better place,” Dr. Howell observed. “Very often you can make a huge difference for the patients you do care for, and that is incredibly rewarding.” Although the demands of his SHM leadership position required relinquishing most of his responsibilities at Johns Hopkins, he continues to see patients and teach residents there 2-4 weeks a year on a teaching service.

“Why do I still see patients? I find it so rewarding. And I get to teach, which I love,” he said. “To be honest, I don’t think you truly need to see patients to be head of a professional medical society like SHM. Maybe someday I’ll give that up. But only if it’s necessary to make the society more successful.”

Half of Dr. Howell’s Society work now is planned and half is “putting out fires” – while learning members’ needs in real time. “Right now, we’re worried about burnout and PTSD, because frankly it’s stressful to take care of COVID patients. It’s scary for a lot of clinicians. I’m working with our members to make sure they have what they need to be clinically prepared, including resources to be more resilient professionally.”

Every step of his career, Dr. Howell said, has seemed like the best job he ever had. “Making the world a better place is still important to me. I tell SHM members that it’s important to know they are making a difference. What they’re doing is really important, especially with COVID, and it needs to be sustainable,” he said.

“SHM has such a powerful mission – it’s about making patient care better, and making hospitalists better clinicians. I know the Society is having a powerful impact, and that’s good enough for me. I’m into teams. Hospital medicine is a team sport, but so is SHM, interacting with its members, staff, and board.”
 

Initiating another new program

One of Dr. Howell’s last major projects for Hopkins was to launch and be chief medical officer for the Joint Commission–accredited Baltimore Civic Center Field Hospital for COVID-19 patients, opened in March 2020.

Courtesy Dr. Eric Howell

With a surge capacity of 250 beds, and a negative pressure ward set up in the center’s exhibit hall, it is jointly operated by the University of Maryland Medical System and Johns Hopkins Hospital. The field hospital’s mission has since expanded to include viral tests, infusions of monoclonal antibodies, and COVID-19 vaccinations.

Planning for a smooth transition, Dr. Howell brought Melinda E. Kantsiper, MD, director of clinical operations, Division of Hospital Medicine at Johns Hopkins Bayview, on board as associate medical officer, to eventually replace him as CMO after a few months working alongside him. “Eric brings that logical engineering eye to problem solving,” Dr. Kantsiper said.

Courtesy Johns Hopkins Medicine

As Jade Myers set out to help create the virtual platform for SHM Converge, she was aware, through surveys and other communication, that the top wish of members of the Society of Hospital Medicine was an extensive and interactive educational experience.

“People really wanted to get back to the in-person conference,” said Ms. Myers, SHM’s director of meetings. “While we couldn’t do that, we can provide the same caliber and as robust an experience from an educational perspective as we would for an in-person activity.”

That has required significant revamping of the virtual platform compared to the platform for last year’s annual conference. In 2020, there was only one session running live at a time. This year, there will be 12 sessions running at the same time. There will also be more opportunities for networking, as well as other features for enjoyment and a sense of calm.

Here are some features of the SHM Converge platform:

• A host segment to kick-start each day, with an introduction of the day’s sessions and events.
• Nine didactic educational sessions at any given time. These sessions will include a live chat for peer-to-peer engagement, as well as questions and answers throughout the session to continue the discussion between speakers and participants.
• Three workshops at any given time. These sessions – on topics such as communication, gender equity, and clinical guidelines – will provide an opportunity for dynamic small-group discussion.
• A scientific abstract poster competition and reception, with an e-gallery of about 700 posters, providing a networking opportunity and highlighting emerging scientific and clinical cases.
• Special Interest Forums, in the form of live, interactive Zoom conferences. There will be 25 forums, which are designed to build community and facilitate collaboration.
• A variety of games, including trivia and a word scramble.
• Personalized profiles with information such as “Hospitalist in Training,” or “Committee Member.” These will be visible to other attendees to make it easier for people to connect when they have something in common.
• Early- and Mid-Career Speed Mentorship, in which a mentor and mentee can interact one-on-one, with each mentee able to meet with two mentors, with pairings designed for the best mentorship experience.
• Sessions on wellness and resilience.

“People are kind of Zoom fatigued,” Ms. Myers said, “so we’re trying to meet their needs while also offering an opportunity for respite, because our attendees are on the front lines right now, and they’re dealing with all types of fatigue and challenging times.”

The annual conference was on target for a banner year in 2020 before the COVID-19 pandemic forced the cancellation of the in-person conference in San Diego, and SHM Converge is a product of planning that began then, as organizers started considering a virtual event.

“In 2020, we were slated to have the largest conference in person that we have ever had,” said Hayleigh Scott, SHM’s meeting projects manager. “San Diego was going to be our really big year.”

But attendance at last year’s virtual conference was a fraction of what was expected at the in-person conference. This year, that seems poised to improve. There will be many more offerings, with more than 125 AMA PRA Category 1 Credits™ and 45 Maintenance of Certification points possible, Ms. Myers said. Because attendees won’t have to worry about being in two places at once, it will be possible to secure more CME credits at SHM Converge than at any previous SHM annual conference, she said.

The volume of content will be a heavy load on SHM personnel. Last year, three society staff members were on hand at each session to make sure it ran smoothly and to answer questions. With 12 sessions running simultaneously this year, many more staff members will need to be involved. But that is not unfamiliar for the society during meeting week, Ms. Myers said.

“We’re going to need to pull from pretty much our entire staff in order to make this conference happen, which is exciting and daunting,” she said. “It’s always been an all-hands-on-deck program and this is going to be more similar to an in-person conference in that way.”

As Jade Myers set out to help create the virtual platform for SHM Converge, she was aware, through surveys and other communication, that the top wish of members of the Society of Hospital Medicine was an extensive and interactive educational experience.

“People really wanted to get back to the in-person conference,” said Ms. Myers, SHM’s director of meetings. “While we couldn’t do that, we can provide the same caliber and as robust an experience from an educational perspective as we would for an in-person activity.”

That has required significant revamping of the virtual platform compared to the platform for last year’s annual conference. In 2020, there was only one session running live at a time. This year, there will be 12 sessions running at the same time. There will also be more opportunities for networking, as well as other features for enjoyment and a sense of calm.

Here are some features of the SHM Converge platform:

• A host segment to kick-start each day, with an introduction of the day’s sessions and events.
• Nine didactic educational sessions at any given time. These sessions will include a live chat for peer-to-peer engagement, as well as questions and answers throughout the session to continue the discussion between speakers and participants.
• Three workshops at any given time. These sessions – on topics such as communication, gender equity, and clinical guidelines – will provide an opportunity for dynamic small-group discussion.
• A scientific abstract poster competition and reception, with an e-gallery of about 700 posters, providing a networking opportunity and highlighting emerging scientific and clinical cases.
• Special Interest Forums, in the form of live, interactive Zoom conferences. There will be 25 forums, which are designed to build community and facilitate collaboration.
• A variety of games, including trivia and a word scramble.
• Personalized profiles with information such as “Hospitalist in Training,” or “Committee Member.” These will be visible to other attendees to make it easier for people to connect when they have something in common.
• Early- and Mid-Career Speed Mentorship, in which a mentor and mentee can interact one-on-one, with each mentee able to meet with two mentors, with pairings designed for the best mentorship experience.
• Sessions on wellness and resilience.

“People are kind of Zoom fatigued,” Ms. Myers said, “so we’re trying to meet their needs while also offering an opportunity for respite, because our attendees are on the front lines right now, and they’re dealing with all types of fatigue and challenging times.”

The annual conference was on target for a banner year in 2020 before the COVID-19 pandemic forced the cancellation of the in-person conference in San Diego, and SHM Converge is a product of planning that began then, as organizers started considering a virtual event.

“In 2020, we were slated to have the largest conference in person that we have ever had,” said Hayleigh Scott, SHM’s meeting projects manager. “San Diego was going to be our really big year.”

But attendance at last year’s virtual conference was a fraction of what was expected at the in-person conference. This year, that seems poised to improve. There will be many more offerings, with more than 125 AMA PRA Category 1 Credits™ and 45 Maintenance of Certification points possible, Ms. Myers said. Because attendees won’t have to worry about being in two places at once, it will be possible to secure more CME credits at SHM Converge than at any previous SHM annual conference, she said.

The volume of content will be a heavy load on SHM personnel. Last year, three society staff members were on hand at each session to make sure it ran smoothly and to answer questions. With 12 sessions running simultaneously this year, many more staff members will need to be involved. But that is not unfamiliar for the society during meeting week, Ms. Myers said.

“We’re going to need to pull from pretty much our entire staff in order to make this conference happen, which is exciting and daunting,” she said. “It’s always been an all-hands-on-deck program and this is going to be more similar to an in-person conference in that way.”

As Jade Myers set out to help create the virtual platform for SHM Converge, she was aware, through surveys and other communication, that the top wish of members of the Society of Hospital Medicine was an extensive and interactive educational experience.

“People really wanted to get back to the in-person conference,” said Ms. Myers, SHM’s director of meetings. “While we couldn’t do that, we can provide the same caliber and as robust an experience from an educational perspective as we would for an in-person activity.”

That has required significant revamping of the virtual platform compared to the platform for last year’s annual conference. In 2020, there was only one session running live at a time. This year, there will be 12 sessions running at the same time. There will also be more opportunities for networking, as well as other features for enjoyment and a sense of calm.

Here are some features of the SHM Converge platform:

• A host segment to kick-start each day, with an introduction of the day’s sessions and events.
• Nine didactic educational sessions at any given time. These sessions will include a live chat for peer-to-peer engagement, as well as questions and answers throughout the session to continue the discussion between speakers and participants.
• Three workshops at any given time. These sessions – on topics such as communication, gender equity, and clinical guidelines – will provide an opportunity for dynamic small-group discussion.
• A scientific abstract poster competition and reception, with an e-gallery of about 700 posters, providing a networking opportunity and highlighting emerging scientific and clinical cases.
• Special Interest Forums, in the form of live, interactive Zoom conferences. There will be 25 forums, which are designed to build community and facilitate collaboration.
• A variety of games, including trivia and a word scramble.
• Personalized profiles with information such as “Hospitalist in Training,” or “Committee Member.” These will be visible to other attendees to make it easier for people to connect when they have something in common.
• Early- and Mid-Career Speed Mentorship, in which a mentor and mentee can interact one-on-one, with each mentee able to meet with two mentors, with pairings designed for the best mentorship experience.
• Sessions on wellness and resilience.

“People are kind of Zoom fatigued,” Ms. Myers said, “so we’re trying to meet their needs while also offering an opportunity for respite, because our attendees are on the front lines right now, and they’re dealing with all types of fatigue and challenging times.”

The annual conference was on target for a banner year in 2020 before the COVID-19 pandemic forced the cancellation of the in-person conference in San Diego, and SHM Converge is a product of planning that began then, as organizers started considering a virtual event.

“In 2020, we were slated to have the largest conference in person that we have ever had,” said Hayleigh Scott, SHM’s meeting projects manager. “San Diego was going to be our really big year.”

But attendance at last year’s virtual conference was a fraction of what was expected at the in-person conference. This year, that seems poised to improve. There will be many more offerings, with more than 125 AMA PRA Category 1 Credits™ and 45 Maintenance of Certification points possible, Ms. Myers said. Because attendees won’t have to worry about being in two places at once, it will be possible to secure more CME credits at SHM Converge than at any previous SHM annual conference, she said.

The volume of content will be a heavy load on SHM personnel. Last year, three society staff members were on hand at each session to make sure it ran smoothly and to answer questions. With 12 sessions running simultaneously this year, many more staff members will need to be involved. But that is not unfamiliar for the society during meeting week, Ms. Myers said.

“We’re going to need to pull from pretty much our entire staff in order to make this conference happen, which is exciting and daunting,” she said. “It’s always been an all-hands-on-deck program and this is going to be more similar to an in-person conference in that way.”

With dozens and dozens of sessions on the SHM Converge program, picking what to go to can feel virtually impossible.

The editorial board of The Hospitalist is here to help. With knowledge in an array of subspecialties – and experience in attending many SHM annual conferences, they have pointed out sessions they consider “must see,” whether based on the importance of the topic, the entertainment aspect, or the dynamic qualities of the speakers.

Here are their selections:
 

Ilaria Gadalla, DMSc, PA-C, physician assistant department chair, South University, West Palm Beach, Fla.

What You Say, What They Hear: Conversations with Your Hospital C-suite (Tuesday, May 4, 1:40 p.m. to 2:40 p.m.)

“As a department leader, developing my communication skills is always an area I seek to improve,” Dr. Gadalla said. “Tips to help with interpreting the audience and tailoring presentations for receptive feedback are invaluable tools.”

Hiring the Right Hospitalist: The Other Kind of Choosing Wisely (Wednesday, May 5, 2 p.m. to 3 p.m.)

“[This] is also an interesting session – selection criteria in the age of virtual interviewing is challenging,” she said. “I look forward to benefiting from my colleagues’ experience to enhance my leadership style.”

Shyam Odeti, MD, SFHM, FAAFP, MBA, hospitalist at Ballad Health, Johnson City, Tenn.

Understanding High-Value Care: Cost, Rationing, Overuse, and Underuse: Workshop (Tuesday May 4, 1:40 p.m. to 2:40 p.m.)

“Health care in the U.S. is expensive, and we have to pay utmost attention to the cost while providing the highest-quality medical care and service to sustain the health care,” Dr. Odeti said. “I am excited about this workshop organized by Dr. Justin Glasgow, Dr. Sarah Baron, Dr. Mona Krouss, and Dr. Harry Cho. I have known these leaders in the health care quality and patient safety arena over several years and their immense contributions to their organizations and the quality improvement special interest group of SHM. This workshop will help us understand how to define value in health care, implement high-value care, and eliminate low-value care.”

Hospitalists Piloting the Twin Engines of the Mid-Revenue Cycle Ship: A Primer on Utilization Management and Clinical Documentation Improvement (Thursday, May 6, 2:30 p.m. to 3:30 p.m.)

“The business of running hospitals carries with it many financial challenges,” Dr. Odeti said. “The intersection of tremendous fixed overhead and the vagaries of payer behavior is the cause. The COVID-19 pandemic and its devastating impact have compounded the problem. Hospitalists are natural institution leaders who are fundamental in overcoming this impasse through taking command and piloting the twin-engine ship of utilization management and clinical documentation improvement. These two domains working in synergy with experienced pilots are critical to attaining both high-quality care and the long-term viability of our health care systems. Dr. Aziz Ansari has been an expert in this domain and a highly sought-after speaker at SHM annual conferences. His sessions are incredibly captivating and educational.”

Harry Cho, MD, FACP, SFHM, chief value officer at NYC Health+ Hospitals

Medical Jeopardy (Thursday, May 6, 2:30 p.m. to 3:10 p.m.)

“[I am] always looking forward to a fun-filled session for medical learning with this fantastic group of facilitators,” Dr. Cho said.

Back to the Future - Things I Wish I Knew Earlier in my Career (Wednesday, May 5, 3:50 p.m. to 4:30 p.m.)

“Listening to Brad Sharpe brings me back to the days in training, eagerly absorbing every pearl of wisdom from mentors,” he said.

Marina Farah, MD, MHA, performance improvement consultant, FarahMD Consulting, Corvallis, Ore.

James Kim, MD, associate professor of medicine, Emory University, Atlanta

Health Equity and Disparities in Hospitalized Patients (Tuesday, May 4, 3:30 p.m. to 4:10 p.m. )

“[Kimberly Manning, MD] is an amazing speaker, and I know that this is a topic that she can speak about both eloquently and passionately,” Dr. Kim said. “She has been advocating for her patients at Grady for years and so this is something that she has first-hand experience about.”

Top 5 Clinical Practice Guidelines Every Hospitalist Needs to Know: Workshop (Wednesday, May 5, 3:50 p.m. to 4:50 p.m. )

“This sounds like a high-yield session,” he said. “For busy clinicians, being able to know what guidelines should affect your daily practice is extremely important.”

Lonika Sood, MD, MHPE, FACP, FHM, clinical education director of internal medicine, Washington State University, Spokane

Anika Kumar, MD, FAAP, FHM, assistant professor of pediatrics, Cleveland Clinic Lerner College of Medicine

Fireside Chat: Story-telling and the Nocturnist in Pediatrics (Tuesday, May 4, 3:30 p.m. to 4:50 p.m.)

“I look forward to their discussion about storytelling and the role narrative medicine plays in patient care, especially pediatrics,” Dr. Kumar said.

Febrile Infant Update (Thursday, May 6, 3:10 p.m. to 3:50 p.m.)

“This clinical update session with Dr. Russell McCulloh will be exciting, as caring for febrile infants is bread-and-butter pediatric hospital medicine,” she said. “And this update will help review new research in this diagnosis.”

Kranthi Sitammagari, MD, FACP, CHCQM-PHYADV, director of clinical operations, quality, and patient experience, Atrium Health Hospitalist Group, Monroe, N.C.

Any session in the “Clinical Updates” and “Quality” tracks

“I would recommend ‘Clinical Updates’ and ‘Quality’ sessions, as they are so close to my practice and I look forward to those sessions,” Dr. Sitammagari said. “Clinical Updates provide the latest updates in clinical practice which is very useful for everyday patient management for hospitalists. Quality sessions discuss innovative ways to improve the quality of hospitalist practice.”

Raman Palabindala, MD, SFHM, medical director of utilization management, University of Mississippi Medical Center, Jackson

Medical Jeopardy (Thursday, May 6, 2:30 p.m. to 3:10 p.m.)

“I will always promote my fun event, Medical Jeopardy (Dr. Palabindala is a moderator). It is going to be a challenge between three great attendings from three great organizations across the country to win the national Jeopardy competition. Not only will you learn a lot, but you also will have a lot of fun. I am sure it is going to be more entertaining this time, given virtual play.”

LAMA’s DRAMA: Left AMA – Documentation & Rules of AMA (Friday, May 7, 3:30 p.m. to 4:30 p.m.)

“I also recommend the talk by Dr. Medarametla not just for the title LAMA DRAMA (for ‘left against medical advice’),” he said. “We all need to learn this one to the core and I am sure he will deliver the most engaging presentation.”

With dozens and dozens of sessions on the SHM Converge program, picking what to go to can feel virtually impossible.

The editorial board of The Hospitalist is here to help. With knowledge in an array of subspecialties – and experience in attending many SHM annual conferences, they have pointed out sessions they consider “must see,” whether based on the importance of the topic, the entertainment aspect, or the dynamic qualities of the speakers.

Here are their selections:
 

Ilaria Gadalla, DMSc, PA-C, physician assistant department chair, South University, West Palm Beach, Fla.

What You Say, What They Hear: Conversations with Your Hospital C-suite (Tuesday, May 4, 1:40 p.m. to 2:40 p.m.)

“As a department leader, developing my communication skills is always an area I seek to improve,” Dr. Gadalla said. “Tips to help with interpreting the audience and tailoring presentations for receptive feedback are invaluable tools.”

Hiring the Right Hospitalist: The Other Kind of Choosing Wisely (Wednesday, May 5, 2 p.m. to 3 p.m.)

“[This] is also an interesting session – selection criteria in the age of virtual interviewing is challenging,” she said. “I look forward to benefiting from my colleagues’ experience to enhance my leadership style.”

Shyam Odeti, MD, SFHM, FAAFP, MBA, hospitalist at Ballad Health, Johnson City, Tenn.

Understanding High-Value Care: Cost, Rationing, Overuse, and Underuse: Workshop (Tuesday May 4, 1:40 p.m. to 2:40 p.m.)

“Health care in the U.S. is expensive, and we have to pay utmost attention to the cost while providing the highest-quality medical care and service to sustain the health care,” Dr. Odeti said. “I am excited about this workshop organized by Dr. Justin Glasgow, Dr. Sarah Baron, Dr. Mona Krouss, and Dr. Harry Cho. I have known these leaders in the health care quality and patient safety arena over several years and their immense contributions to their organizations and the quality improvement special interest group of SHM. This workshop will help us understand how to define value in health care, implement high-value care, and eliminate low-value care.”

Hospitalists Piloting the Twin Engines of the Mid-Revenue Cycle Ship: A Primer on Utilization Management and Clinical Documentation Improvement (Thursday, May 6, 2:30 p.m. to 3:30 p.m.)

“The business of running hospitals carries with it many financial challenges,” Dr. Odeti said. “The intersection of tremendous fixed overhead and the vagaries of payer behavior is the cause. The COVID-19 pandemic and its devastating impact have compounded the problem. Hospitalists are natural institution leaders who are fundamental in overcoming this impasse through taking command and piloting the twin-engine ship of utilization management and clinical documentation improvement. These two domains working in synergy with experienced pilots are critical to attaining both high-quality care and the long-term viability of our health care systems. Dr. Aziz Ansari has been an expert in this domain and a highly sought-after speaker at SHM annual conferences. His sessions are incredibly captivating and educational.”

Harry Cho, MD, FACP, SFHM, chief value officer at NYC Health+ Hospitals

Medical Jeopardy (Thursday, May 6, 2:30 p.m. to 3:10 p.m.)

“[I am] always looking forward to a fun-filled session for medical learning with this fantastic group of facilitators,” Dr. Cho said.

Back to the Future - Things I Wish I Knew Earlier in my Career (Wednesday, May 5, 3:50 p.m. to 4:30 p.m.)

“Listening to Brad Sharpe brings me back to the days in training, eagerly absorbing every pearl of wisdom from mentors,” he said.

Marina Farah, MD, MHA, performance improvement consultant, FarahMD Consulting, Corvallis, Ore.

James Kim, MD, associate professor of medicine, Emory University, Atlanta

Health Equity and Disparities in Hospitalized Patients (Tuesday, May 4, 3:30 p.m. to 4:10 p.m. )

“[Kimberly Manning, MD] is an amazing speaker, and I know that this is a topic that she can speak about both eloquently and passionately,” Dr. Kim said. “She has been advocating for her patients at Grady for years and so this is something that she has first-hand experience about.”

Top 5 Clinical Practice Guidelines Every Hospitalist Needs to Know: Workshop (Wednesday, May 5, 3:50 p.m. to 4:50 p.m. )

“This sounds like a high-yield session,” he said. “For busy clinicians, being able to know what guidelines should affect your daily practice is extremely important.”

Lonika Sood, MD, MHPE, FACP, FHM, clinical education director of internal medicine, Washington State University, Spokane

Anika Kumar, MD, FAAP, FHM, assistant professor of pediatrics, Cleveland Clinic Lerner College of Medicine

Fireside Chat: Story-telling and the Nocturnist in Pediatrics (Tuesday, May 4, 3:30 p.m. to 4:50 p.m.)

“I look forward to their discussion about storytelling and the role narrative medicine plays in patient care, especially pediatrics,” Dr. Kumar said.

Febrile Infant Update (Thursday, May 6, 3:10 p.m. to 3:50 p.m.)

“This clinical update session with Dr. Russell McCulloh will be exciting, as caring for febrile infants is bread-and-butter pediatric hospital medicine,” she said. “And this update will help review new research in this diagnosis.”

Kranthi Sitammagari, MD, FACP, CHCQM-PHYADV, director of clinical operations, quality, and patient experience, Atrium Health Hospitalist Group, Monroe, N.C.

Any session in the “Clinical Updates” and “Quality” tracks

“I would recommend ‘Clinical Updates’ and ‘Quality’ sessions, as they are so close to my practice and I look forward to those sessions,” Dr. Sitammagari said. “Clinical Updates provide the latest updates in clinical practice which is very useful for everyday patient management for hospitalists. Quality sessions discuss innovative ways to improve the quality of hospitalist practice.”

Raman Palabindala, MD, SFHM, medical director of utilization management, University of Mississippi Medical Center, Jackson

Medical Jeopardy (Thursday, May 6, 2:30 p.m. to 3:10 p.m.)

“I will always promote my fun event, Medical Jeopardy (Dr. Palabindala is a moderator). It is going to be a challenge between three great attendings from three great organizations across the country to win the national Jeopardy competition. Not only will you learn a lot, but you also will have a lot of fun. I am sure it is going to be more entertaining this time, given virtual play.”

LAMA’s DRAMA: Left AMA – Documentation & Rules of AMA (Friday, May 7, 3:30 p.m. to 4:30 p.m.)

“I also recommend the talk by Dr. Medarametla not just for the title LAMA DRAMA (for ‘left against medical advice’),” he said. “We all need to learn this one to the core and I am sure he will deliver the most engaging presentation.”

With dozens and dozens of sessions on the SHM Converge program, picking what to go to can feel virtually impossible.

The editorial board of The Hospitalist is here to help. With knowledge in an array of subspecialties – and experience in attending many SHM annual conferences, they have pointed out sessions they consider “must see,” whether based on the importance of the topic, the entertainment aspect, or the dynamic qualities of the speakers.

Here are their selections:
 

Ilaria Gadalla, DMSc, PA-C, physician assistant department chair, South University, West Palm Beach, Fla.

What You Say, What They Hear: Conversations with Your Hospital C-suite (Tuesday, May 4, 1:40 p.m. to 2:40 p.m.)

“As a department leader, developing my communication skills is always an area I seek to improve,” Dr. Gadalla said. “Tips to help with interpreting the audience and tailoring presentations for receptive feedback are invaluable tools.”

Hiring the Right Hospitalist: The Other Kind of Choosing Wisely (Wednesday, May 5, 2 p.m. to 3 p.m.)

“[This] is also an interesting session – selection criteria in the age of virtual interviewing is challenging,” she said. “I look forward to benefiting from my colleagues’ experience to enhance my leadership style.”

Shyam Odeti, MD, SFHM, FAAFP, MBA, hospitalist at Ballad Health, Johnson City, Tenn.

Understanding High-Value Care: Cost, Rationing, Overuse, and Underuse: Workshop (Tuesday May 4, 1:40 p.m. to 2:40 p.m.)

“Health care in the U.S. is expensive, and we have to pay utmost attention to the cost while providing the highest-quality medical care and service to sustain the health care,” Dr. Odeti said. “I am excited about this workshop organized by Dr. Justin Glasgow, Dr. Sarah Baron, Dr. Mona Krouss, and Dr. Harry Cho. I have known these leaders in the health care quality and patient safety arena over several years and their immense contributions to their organizations and the quality improvement special interest group of SHM. This workshop will help us understand how to define value in health care, implement high-value care, and eliminate low-value care.”

Hospitalists Piloting the Twin Engines of the Mid-Revenue Cycle Ship: A Primer on Utilization Management and Clinical Documentation Improvement (Thursday, May 6, 2:30 p.m. to 3:30 p.m.)

“The business of running hospitals carries with it many financial challenges,” Dr. Odeti said. “The intersection of tremendous fixed overhead and the vagaries of payer behavior is the cause. The COVID-19 pandemic and its devastating impact have compounded the problem. Hospitalists are natural institution leaders who are fundamental in overcoming this impasse through taking command and piloting the twin-engine ship of utilization management and clinical documentation improvement. These two domains working in synergy with experienced pilots are critical to attaining both high-quality care and the long-term viability of our health care systems. Dr. Aziz Ansari has been an expert in this domain and a highly sought-after speaker at SHM annual conferences. His sessions are incredibly captivating and educational.”

Harry Cho, MD, FACP, SFHM, chief value officer at NYC Health+ Hospitals

Medical Jeopardy (Thursday, May 6, 2:30 p.m. to 3:10 p.m.)

“[I am] always looking forward to a fun-filled session for medical learning with this fantastic group of facilitators,” Dr. Cho said.

Back to the Future - Things I Wish I Knew Earlier in my Career (Wednesday, May 5, 3:50 p.m. to 4:30 p.m.)

“Listening to Brad Sharpe brings me back to the days in training, eagerly absorbing every pearl of wisdom from mentors,” he said.

Marina Farah, MD, MHA, performance improvement consultant, FarahMD Consulting, Corvallis, Ore.

James Kim, MD, associate professor of medicine, Emory University, Atlanta

Health Equity and Disparities in Hospitalized Patients (Tuesday, May 4, 3:30 p.m. to 4:10 p.m. )

“[Kimberly Manning, MD] is an amazing speaker, and I know that this is a topic that she can speak about both eloquently and passionately,” Dr. Kim said. “She has been advocating for her patients at Grady for years and so this is something that she has first-hand experience about.”

Top 5 Clinical Practice Guidelines Every Hospitalist Needs to Know: Workshop (Wednesday, May 5, 3:50 p.m. to 4:50 p.m. )

“This sounds like a high-yield session,” he said. “For busy clinicians, being able to know what guidelines should affect your daily practice is extremely important.”

Lonika Sood, MD, MHPE, FACP, FHM, clinical education director of internal medicine, Washington State University, Spokane

Anika Kumar, MD, FAAP, FHM, assistant professor of pediatrics, Cleveland Clinic Lerner College of Medicine

Fireside Chat: Story-telling and the Nocturnist in Pediatrics (Tuesday, May 4, 3:30 p.m. to 4:50 p.m.)

“I look forward to their discussion about storytelling and the role narrative medicine plays in patient care, especially pediatrics,” Dr. Kumar said.

Febrile Infant Update (Thursday, May 6, 3:10 p.m. to 3:50 p.m.)

“This clinical update session with Dr. Russell McCulloh will be exciting, as caring for febrile infants is bread-and-butter pediatric hospital medicine,” she said. “And this update will help review new research in this diagnosis.”

Kranthi Sitammagari, MD, FACP, CHCQM-PHYADV, director of clinical operations, quality, and patient experience, Atrium Health Hospitalist Group, Monroe, N.C.

Any session in the “Clinical Updates” and “Quality” tracks

“I would recommend ‘Clinical Updates’ and ‘Quality’ sessions, as they are so close to my practice and I look forward to those sessions,” Dr. Sitammagari said. “Clinical Updates provide the latest updates in clinical practice which is very useful for everyday patient management for hospitalists. Quality sessions discuss innovative ways to improve the quality of hospitalist practice.”

Raman Palabindala, MD, SFHM, medical director of utilization management, University of Mississippi Medical Center, Jackson

Medical Jeopardy (Thursday, May 6, 2:30 p.m. to 3:10 p.m.)

“I will always promote my fun event, Medical Jeopardy (Dr. Palabindala is a moderator). It is going to be a challenge between three great attendings from three great organizations across the country to win the national Jeopardy competition. Not only will you learn a lot, but you also will have a lot of fun. I am sure it is going to be more entertaining this time, given virtual play.”

LAMA’s DRAMA: Left AMA – Documentation & Rules of AMA (Friday, May 7, 3:30 p.m. to 4:30 p.m.)

“I also recommend the talk by Dr. Medarametla not just for the title LAMA DRAMA (for ‘left against medical advice’),” he said. “We all need to learn this one to the core and I am sure he will deliver the most engaging presentation.”