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AGA releases POWER – an obesity practice guide for gastroenterologists
The obesity epidemic has reached critical proportions. A new practice guide from the American Gastroenterological Association aims to help gastroenterologists engage in a multidisciplinary effort to tackle the problem.
The guide, entitled “POWER: Practice Guide on Obesity and Weight Management, Education and Resources,” includes a comprehensive clinical process for assessing and safely and effectively managing patients with obesity, as well as a framework focused on helping practitioners navigate the business operational issues related to the management of obesity. Both are in press for the May issue of Clinical Gastroenterology and Hepatology (2016. doi: 10.1016/j.cgh.2016.10.023).
The POWER model recognizes obesity as an epidemic and as an economic and societal burden that should be embraced as a chronic, relapsing disease best managed across a flexible care cycle using a team approach.
“Every single gastroenterologist is at the front line of this obesity epidemic. Before patients develop diabetes or joint problems or cardiovascular disease, they are already in our clinics, they already have [gastroesophageal reflux disease], they have nonalcoholic fatty liver disease, they have colon cancer – and those conditions present even earlier than the other complications of obesity,” said Dr. Acosta of the Mayo Clinic, Rochester, Minn.
The guide is a model for addressing obesity – the root cause of many of these conditions – rather than simply treating its symptoms, he added.
The approach to obesity management promoted by POWER involves four phases along a continuum of care: assessment, intensive weight loss intervention, weight stabilization and reintensification when needed, and prevention of weight regain.
Lifestyle changes are the cornerstones of obesity management and maintenance of weight loss, but the POWER model includes much more, as it incorporates guidance on the use of pharmacotherapy, bariatric endoscopy, and surgery.
“We tried to make it extremely simple, bringing it down to the busy clinician level,” Dr. Acosta said. “We want to be able to embrace and tackle obesity... in a very straightforward manner.”
Gastroenterologists shouldn’t be afraid of taking on obesity, he added.
“We feel comfortable managing extremely complicated medications, so we should be able to handle the obesity medications. We are already endoscopists... so we want all gastroenterologists to say, ‘I can do this, too; I can incorporate this into my practice,’ ” he said.
Further, gastroenterologists already have a relationship with bariatric surgeons, so referring those with obesity for surgery if appropriate is also simple, he added.
When it comes to moving through the four phases of care, each should be addressed separately using the best evidence available. Realistic goals should be set, and only when those goals are met should care move to the next phase, according to the guide. Learn how to implement the AGA Obesity Practice Guide at www.gastro.org/obesity.
The assessment phase should include a medical evaluation to identify underlying etiologies, screen for causes of secondary weight gain, and identify related comorbidities. A nutrition evaluation should focus not only on nutritional status and appetite, but also on the patient’s relationship with food, food allergies and intolerances, and food environment. A physical activity/exercise evaluation should explore the patient’s activity level and preferences, as well as limiting factors such as joint disease.
A psychosocial evaluation is particularly important, as behavioral modification is a critical component of successful obesity management, and some patients – such as those with a low score on the weight Efficacy Lifestyle Questionnaire Short-Form – may benefit from referral to a health care professional experienced in obesity counseling and behavioral therapy.
Gastroenterologists already work with other specialists, including nutritionists, psychiatrists, and psychologists within their institutions and communities, so the POWER model is an extension of that.
“That’s what this proposes – a multidisciplinary team effort,” he said.
The approach to treatment should be based on the findings of these assessments.
“Physicians should discuss all the appropriate options and their expected weight loss, potential side effects, and figure in the patient’s wishes and goals. Furthermore, physicians should recognize special comorbidities that may favor one intervention over another,” the authors wrote.
The intensive weight loss intervention phase should be based on modest initial weight loss goals, which increase the likelihood of success, increase patient confidence, and encourage ongoing efforts to lose weight. Further, modest weight loss vs. larger amounts of weight loss is more easily achieved and maintained. In addition to lifestyle changes, an evaluation of whether other interventions are needed is important, particularly in patients with weight regain or plateaus in weight loss.
The weight stabilization and intensification therapy for relapse phase is essential to prevent weight regain and its associated consequences. This phase introduces patients to the attitudes and behaviors that are likely to lead to long-term maintenance of weight loss, the authors note.
The prevention of weight regain phase – a maintenance phase – is unique among obesity care guidelines, and is a critical component of obesity management, Dr. Acosta said.
“Helping patients lose weight and keep it off requires a comprehensive and sustained effort that involves devising an individualized approach to diet, behavior, and exercise,” he and his colleagues wrote.
In addition to detailed steps and tips for moving through this care cycle, the POWER guide also details the various tools to facilitate adherence to a healthier diet and lifestyle. Various medications, including phentermine, extended-release phentermine/topiramate, lorcaserin, and liraglutide are described, as are various types of bariatric endoscopy and bariatric surgery.
A section on addressing the unique needs of obese children and adolescents is also included in the guide for those gastroenterologists who treat children.
“Obesity really begins in childhood, so it is a pediatric disease in its origin, so it was important to us to incorporate issues unique to children for our pediatric GI colleagues,” Dr. Streett said.
Importantly, the practice guide was developed with input from the Society of American Gastrointestinal and Endoscopic Surgeons, The Obesity Society, the Academy of Nutrition and Dietetics, and the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition. and the program has been endorsed with additional input by the American Society for Gastrointestinal Endoscopy, American Society for Metabolic and Bariatric Surgery, American Association for the Study of Liver Diseases, and the Obesity Medicine Association.
This collaborative approach is also unique among existing guidelines, and is important, given the need for practitioners across the care spectrum to work together to address obesity, she said.
“What we’ve been doing [individually] hasn’t worked successfully, so that is something that people recognize in the field of medicine: Obesity is something that has physiological, nutritional, dietetic, socioeconomic, and behavioral aspects and we need to have a multipronged approach for success. We need patients to be hearing similar messages and having their care integrated,” she said, adding that “as we move toward a value-based schema, this is the perfect disorder to address in that way.”
Dr. Acosta is a stockholder of Gila Therapeutics and serves on the scientific advisory board or board of directors of Gila Therapeutics, Inversago, and General Mills. Dr. Streett reported having no disclosures.
The obesity epidemic has reached critical proportions. A new practice guide from the American Gastroenterological Association aims to help gastroenterologists engage in a multidisciplinary effort to tackle the problem.
The guide, entitled “POWER: Practice Guide on Obesity and Weight Management, Education and Resources,” includes a comprehensive clinical process for assessing and safely and effectively managing patients with obesity, as well as a framework focused on helping practitioners navigate the business operational issues related to the management of obesity. Both are in press for the May issue of Clinical Gastroenterology and Hepatology (2016. doi: 10.1016/j.cgh.2016.10.023).
The POWER model recognizes obesity as an epidemic and as an economic and societal burden that should be embraced as a chronic, relapsing disease best managed across a flexible care cycle using a team approach.
“Every single gastroenterologist is at the front line of this obesity epidemic. Before patients develop diabetes or joint problems or cardiovascular disease, they are already in our clinics, they already have [gastroesophageal reflux disease], they have nonalcoholic fatty liver disease, they have colon cancer – and those conditions present even earlier than the other complications of obesity,” said Dr. Acosta of the Mayo Clinic, Rochester, Minn.
The guide is a model for addressing obesity – the root cause of many of these conditions – rather than simply treating its symptoms, he added.
The approach to obesity management promoted by POWER involves four phases along a continuum of care: assessment, intensive weight loss intervention, weight stabilization and reintensification when needed, and prevention of weight regain.
Lifestyle changes are the cornerstones of obesity management and maintenance of weight loss, but the POWER model includes much more, as it incorporates guidance on the use of pharmacotherapy, bariatric endoscopy, and surgery.
“We tried to make it extremely simple, bringing it down to the busy clinician level,” Dr. Acosta said. “We want to be able to embrace and tackle obesity... in a very straightforward manner.”
Gastroenterologists shouldn’t be afraid of taking on obesity, he added.
“We feel comfortable managing extremely complicated medications, so we should be able to handle the obesity medications. We are already endoscopists... so we want all gastroenterologists to say, ‘I can do this, too; I can incorporate this into my practice,’ ” he said.
Further, gastroenterologists already have a relationship with bariatric surgeons, so referring those with obesity for surgery if appropriate is also simple, he added.
When it comes to moving through the four phases of care, each should be addressed separately using the best evidence available. Realistic goals should be set, and only when those goals are met should care move to the next phase, according to the guide. Learn how to implement the AGA Obesity Practice Guide at www.gastro.org/obesity.
The assessment phase should include a medical evaluation to identify underlying etiologies, screen for causes of secondary weight gain, and identify related comorbidities. A nutrition evaluation should focus not only on nutritional status and appetite, but also on the patient’s relationship with food, food allergies and intolerances, and food environment. A physical activity/exercise evaluation should explore the patient’s activity level and preferences, as well as limiting factors such as joint disease.
A psychosocial evaluation is particularly important, as behavioral modification is a critical component of successful obesity management, and some patients – such as those with a low score on the weight Efficacy Lifestyle Questionnaire Short-Form – may benefit from referral to a health care professional experienced in obesity counseling and behavioral therapy.
Gastroenterologists already work with other specialists, including nutritionists, psychiatrists, and psychologists within their institutions and communities, so the POWER model is an extension of that.
“That’s what this proposes – a multidisciplinary team effort,” he said.
The approach to treatment should be based on the findings of these assessments.
“Physicians should discuss all the appropriate options and their expected weight loss, potential side effects, and figure in the patient’s wishes and goals. Furthermore, physicians should recognize special comorbidities that may favor one intervention over another,” the authors wrote.
The intensive weight loss intervention phase should be based on modest initial weight loss goals, which increase the likelihood of success, increase patient confidence, and encourage ongoing efforts to lose weight. Further, modest weight loss vs. larger amounts of weight loss is more easily achieved and maintained. In addition to lifestyle changes, an evaluation of whether other interventions are needed is important, particularly in patients with weight regain or plateaus in weight loss.
The weight stabilization and intensification therapy for relapse phase is essential to prevent weight regain and its associated consequences. This phase introduces patients to the attitudes and behaviors that are likely to lead to long-term maintenance of weight loss, the authors note.
The prevention of weight regain phase – a maintenance phase – is unique among obesity care guidelines, and is a critical component of obesity management, Dr. Acosta said.
“Helping patients lose weight and keep it off requires a comprehensive and sustained effort that involves devising an individualized approach to diet, behavior, and exercise,” he and his colleagues wrote.
In addition to detailed steps and tips for moving through this care cycle, the POWER guide also details the various tools to facilitate adherence to a healthier diet and lifestyle. Various medications, including phentermine, extended-release phentermine/topiramate, lorcaserin, and liraglutide are described, as are various types of bariatric endoscopy and bariatric surgery.
A section on addressing the unique needs of obese children and adolescents is also included in the guide for those gastroenterologists who treat children.
“Obesity really begins in childhood, so it is a pediatric disease in its origin, so it was important to us to incorporate issues unique to children for our pediatric GI colleagues,” Dr. Streett said.
Importantly, the practice guide was developed with input from the Society of American Gastrointestinal and Endoscopic Surgeons, The Obesity Society, the Academy of Nutrition and Dietetics, and the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition. and the program has been endorsed with additional input by the American Society for Gastrointestinal Endoscopy, American Society for Metabolic and Bariatric Surgery, American Association for the Study of Liver Diseases, and the Obesity Medicine Association.
This collaborative approach is also unique among existing guidelines, and is important, given the need for practitioners across the care spectrum to work together to address obesity, she said.
“What we’ve been doing [individually] hasn’t worked successfully, so that is something that people recognize in the field of medicine: Obesity is something that has physiological, nutritional, dietetic, socioeconomic, and behavioral aspects and we need to have a multipronged approach for success. We need patients to be hearing similar messages and having their care integrated,” she said, adding that “as we move toward a value-based schema, this is the perfect disorder to address in that way.”
Dr. Acosta is a stockholder of Gila Therapeutics and serves on the scientific advisory board or board of directors of Gila Therapeutics, Inversago, and General Mills. Dr. Streett reported having no disclosures.
The obesity epidemic has reached critical proportions. A new practice guide from the American Gastroenterological Association aims to help gastroenterologists engage in a multidisciplinary effort to tackle the problem.
The guide, entitled “POWER: Practice Guide on Obesity and Weight Management, Education and Resources,” includes a comprehensive clinical process for assessing and safely and effectively managing patients with obesity, as well as a framework focused on helping practitioners navigate the business operational issues related to the management of obesity. Both are in press for the May issue of Clinical Gastroenterology and Hepatology (2016. doi: 10.1016/j.cgh.2016.10.023).
The POWER model recognizes obesity as an epidemic and as an economic and societal burden that should be embraced as a chronic, relapsing disease best managed across a flexible care cycle using a team approach.
“Every single gastroenterologist is at the front line of this obesity epidemic. Before patients develop diabetes or joint problems or cardiovascular disease, they are already in our clinics, they already have [gastroesophageal reflux disease], they have nonalcoholic fatty liver disease, they have colon cancer – and those conditions present even earlier than the other complications of obesity,” said Dr. Acosta of the Mayo Clinic, Rochester, Minn.
The guide is a model for addressing obesity – the root cause of many of these conditions – rather than simply treating its symptoms, he added.
The approach to obesity management promoted by POWER involves four phases along a continuum of care: assessment, intensive weight loss intervention, weight stabilization and reintensification when needed, and prevention of weight regain.
Lifestyle changes are the cornerstones of obesity management and maintenance of weight loss, but the POWER model includes much more, as it incorporates guidance on the use of pharmacotherapy, bariatric endoscopy, and surgery.
“We tried to make it extremely simple, bringing it down to the busy clinician level,” Dr. Acosta said. “We want to be able to embrace and tackle obesity... in a very straightforward manner.”
Gastroenterologists shouldn’t be afraid of taking on obesity, he added.
“We feel comfortable managing extremely complicated medications, so we should be able to handle the obesity medications. We are already endoscopists... so we want all gastroenterologists to say, ‘I can do this, too; I can incorporate this into my practice,’ ” he said.
Further, gastroenterologists already have a relationship with bariatric surgeons, so referring those with obesity for surgery if appropriate is also simple, he added.
When it comes to moving through the four phases of care, each should be addressed separately using the best evidence available. Realistic goals should be set, and only when those goals are met should care move to the next phase, according to the guide. Learn how to implement the AGA Obesity Practice Guide at www.gastro.org/obesity.
The assessment phase should include a medical evaluation to identify underlying etiologies, screen for causes of secondary weight gain, and identify related comorbidities. A nutrition evaluation should focus not only on nutritional status and appetite, but also on the patient’s relationship with food, food allergies and intolerances, and food environment. A physical activity/exercise evaluation should explore the patient’s activity level and preferences, as well as limiting factors such as joint disease.
A psychosocial evaluation is particularly important, as behavioral modification is a critical component of successful obesity management, and some patients – such as those with a low score on the weight Efficacy Lifestyle Questionnaire Short-Form – may benefit from referral to a health care professional experienced in obesity counseling and behavioral therapy.
Gastroenterologists already work with other specialists, including nutritionists, psychiatrists, and psychologists within their institutions and communities, so the POWER model is an extension of that.
“That’s what this proposes – a multidisciplinary team effort,” he said.
The approach to treatment should be based on the findings of these assessments.
“Physicians should discuss all the appropriate options and their expected weight loss, potential side effects, and figure in the patient’s wishes and goals. Furthermore, physicians should recognize special comorbidities that may favor one intervention over another,” the authors wrote.
The intensive weight loss intervention phase should be based on modest initial weight loss goals, which increase the likelihood of success, increase patient confidence, and encourage ongoing efforts to lose weight. Further, modest weight loss vs. larger amounts of weight loss is more easily achieved and maintained. In addition to lifestyle changes, an evaluation of whether other interventions are needed is important, particularly in patients with weight regain or plateaus in weight loss.
The weight stabilization and intensification therapy for relapse phase is essential to prevent weight regain and its associated consequences. This phase introduces patients to the attitudes and behaviors that are likely to lead to long-term maintenance of weight loss, the authors note.
The prevention of weight regain phase – a maintenance phase – is unique among obesity care guidelines, and is a critical component of obesity management, Dr. Acosta said.
“Helping patients lose weight and keep it off requires a comprehensive and sustained effort that involves devising an individualized approach to diet, behavior, and exercise,” he and his colleagues wrote.
In addition to detailed steps and tips for moving through this care cycle, the POWER guide also details the various tools to facilitate adherence to a healthier diet and lifestyle. Various medications, including phentermine, extended-release phentermine/topiramate, lorcaserin, and liraglutide are described, as are various types of bariatric endoscopy and bariatric surgery.
A section on addressing the unique needs of obese children and adolescents is also included in the guide for those gastroenterologists who treat children.
“Obesity really begins in childhood, so it is a pediatric disease in its origin, so it was important to us to incorporate issues unique to children for our pediatric GI colleagues,” Dr. Streett said.
Importantly, the practice guide was developed with input from the Society of American Gastrointestinal and Endoscopic Surgeons, The Obesity Society, the Academy of Nutrition and Dietetics, and the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition. and the program has been endorsed with additional input by the American Society for Gastrointestinal Endoscopy, American Society for Metabolic and Bariatric Surgery, American Association for the Study of Liver Diseases, and the Obesity Medicine Association.
This collaborative approach is also unique among existing guidelines, and is important, given the need for practitioners across the care spectrum to work together to address obesity, she said.
“What we’ve been doing [individually] hasn’t worked successfully, so that is something that people recognize in the field of medicine: Obesity is something that has physiological, nutritional, dietetic, socioeconomic, and behavioral aspects and we need to have a multipronged approach for success. We need patients to be hearing similar messages and having their care integrated,” she said, adding that “as we move toward a value-based schema, this is the perfect disorder to address in that way.”
Dr. Acosta is a stockholder of Gila Therapeutics and serves on the scientific advisory board or board of directors of Gila Therapeutics, Inversago, and General Mills. Dr. Streett reported having no disclosures.
Latest weekly flu data show no decline in visits
Outpatient visits for influenza-like illness (ILI) held steady for the week ending March 25, but the number of states at the “high” range of activity dropped from 12 from 10 the previous week, according to the Centers for Disease Prevention and Control.
The proportion of outpatient visits for ILI was 3.2% for the second consecutive week, which halted the slowdown in activity that began the week ending Feb. 18. That 3.2% represents just under 25,000 visits for ILI of the almost 747,000 total visits reported to the Outpatient Influenza-like Illness Surveillance Network (ILINet) for the week ending March 25. By age, the largest groups with ILI visits for the week were individuals aged 5-24 years (41%) and those aged 4 years and under (20%), the CDC reported.
There were six flu-related pediatric deaths reported during the week ending March 25, but all occurred in earlier weeks. The total number of such deaths is now 61 for the 2016-2017 season, the CDC said.
Outpatient visits for influenza-like illness (ILI) held steady for the week ending March 25, but the number of states at the “high” range of activity dropped from 12 from 10 the previous week, according to the Centers for Disease Prevention and Control.
The proportion of outpatient visits for ILI was 3.2% for the second consecutive week, which halted the slowdown in activity that began the week ending Feb. 18. That 3.2% represents just under 25,000 visits for ILI of the almost 747,000 total visits reported to the Outpatient Influenza-like Illness Surveillance Network (ILINet) for the week ending March 25. By age, the largest groups with ILI visits for the week were individuals aged 5-24 years (41%) and those aged 4 years and under (20%), the CDC reported.
There were six flu-related pediatric deaths reported during the week ending March 25, but all occurred in earlier weeks. The total number of such deaths is now 61 for the 2016-2017 season, the CDC said.
Outpatient visits for influenza-like illness (ILI) held steady for the week ending March 25, but the number of states at the “high” range of activity dropped from 12 from 10 the previous week, according to the Centers for Disease Prevention and Control.
The proportion of outpatient visits for ILI was 3.2% for the second consecutive week, which halted the slowdown in activity that began the week ending Feb. 18. That 3.2% represents just under 25,000 visits for ILI of the almost 747,000 total visits reported to the Outpatient Influenza-like Illness Surveillance Network (ILINet) for the week ending March 25. By age, the largest groups with ILI visits for the week were individuals aged 5-24 years (41%) and those aged 4 years and under (20%), the CDC reported.
There were six flu-related pediatric deaths reported during the week ending March 25, but all occurred in earlier weeks. The total number of such deaths is now 61 for the 2016-2017 season, the CDC said.
What’s new at HM17
There is only one annual meeting dedicated to hospitalists, designed by hospitalists, and focusing purely on issues important to hospitalists. But even that isn’t enough to make sure more hospitalists show up every year.
That’s because a yearly conference can’t just be a rehash of the last one.
A valuable conference, certainly one worth spending the bulk of a continuing medical budget on, offers something new every year. Or, to look at the schedule for HM17, a lot of new every year.
That’s an unlikely complaint this year. The annual meeting schedule for May 1-4 at Mandalay Bay Resort and Casino includes five new educational tracks: High Value Care, Clinical Updates, Health Policy, Diagnostic Reasoning, and Medical Education.
“We’re really excited to be able to offer more clinical content,” said HM17 course director Lenny Feldman, MD, FAAP, FACP, SFHM.
Dr. Feldman sees each of the new tracks as filling separate and specific needs of HM attendees who vary from nonphysician providers to hospitalists to medical students.
Take, for instance, the High Value Care, Clinical Updates, and Diagnostic Reasoning sessions that are debuting.
“We wanted to make sure that we had as many clinically oriented sessions as possible,” Dr. Feldman said. “Which meant we needed to increase the amount of clinical content we have offered compared to the past few years. The new clinical track allows us to add probably 12 or so different sessions that will fill the needs of our attendees.”
The Diagnostic Reasoning and High Value Care tracks, in particular, highlight the annual meeting’s continued evolution toward a focus on evidence-based care, as that mantra becomes a bedrock of clinical treatment.
“Training our hospitalists to use the best dialogistic reasoning in their approach to their patients is a big push in hospital medicine right now,” Dr. Feldman said, “Hopefully, a track on that topic will excite people who love thinking about medicine, who got into medicine because of the mystery and want a renewed focus on how to be a great diagnostician.”
Dr. Feldman also noted that the High Value Care track should be a hot topic, as hospitalists want to learn how to provide high quality and high value care to patients at the same time. The new tracks should appeal to different groups and make the annual meeting more appealing to a variety of attendees, not just rank-and-file doctors.
The mini Medical Education track, for instance, is a subset of a half-dozen sessions tailored directly to medical educators in academic settings who face different challenges than their counterparts in community settings. The same goes for the Health Policy track, which will offer a handful of sessions suitable for novices looking to learn more in an age of reform, or policy wonks hoping to expand their knowledge.
Meeting evolving needs
New offerings aren’t limited to the main conference schedule. The 2017 roster of pre-courses includes one titled, “Bugs, Drugs and You: Infectious Diseases ‘Boot Camp’ for Hospitalists.” This daylong session hasn’t been held since 2013, and copresenter Jennifer Hanrahan, DO, associate professor of medicine at Case Western Reserve University in Cleveland, says the timing is good.
“I don’t know that the percentage of people hospitalized for infection has increased,” she said. “Because we are doing things more quickly than we did in the past, length of stays are shorter and there is a lot of pressure to get patients out of the hospital. There is a lot of consultation with Infectious Disease.”
Dr. Hanrahan, who also serves as medical director of infection prevention at Cleveland’s MetroHealth Medical Center, says that with so many patients hospitalized for infections, the value of updating one’s knowledge every few years is critical.
“I’ve been an infectious disease physician for 18 years and I’m also a hospitalist,” she said. “The types of questions I get vary a great deal depending on the experience of the hospitalist. My hope would be that we would be able to provide a basic level of understanding so that people would be more confident in approaching these problems.”
Another new feature this year is offer some of the most popular sessions at multiple times. In years past, popular sessions – such as “Update and Pearls in Infectious Diseases” and “Non–Evidence-Based Medicine: Things We Do for No Reason” – are standing room only events with attendees sitting on floors or gathered to eavesdrop from doorways.
“That says something about the content that’s being delivered, but that’s not very comfortable for folks who want to sit through a session,” Dr. Feldman said. “We’ve decided to add repeat sessions of popular presentations. We want everyone to be comfortable while they’re learning the important clinical content that’s being delivered at these sessions.”
The 2017 focus on healthcare policy is also new. Educational sessions on the policy landscape will be formally buttressed by plenary presentations from Patrick Conway, MD, MSc, MHM, deputy administrator for Innovation and Quality at the Centers for Medicare & Medicaid Services and director of the Center for Medicare and Medicaid Innovation, and Karen DeSalvo, MD, MPH, MSc, a former acting assistant secretary for health at the U.S. Department of Health and Human Services and national coordinator for health information technology.
“There’s a thirst for (policy news) among members of the Society of Hospital Medicine,” Dr. Feldman said. “It is easy to get lost in the day-to-day work that we do, but I think most of us really enjoy hearing about the bigger picture, especially when the bigger picture is in flux.”
“Right now, this is critical,” added Dr. Finn. “Health insurance coverage has a huge impact on hospitals. I think all practicing hospitalists will need to engage with the hospital C-suite if insurance and coverage changes. Since we are hospital based, we are directly tied to anything that the federal government does in terms of health care changes. It’s important for hospitalists to be knowledgeable about health policy.”
One major highlight of the meeting calendar – less new and more historically under-appreciated, in Dr. Feldman’s view – should be the 18 workshop presentations, which are essentially 90-minute dissertations, whittled down from roughly 150 submissions.
“These are the best submissions that we received,” Dr. Feldman said. “We worked hard to make sure that the workshops encompass the breadth and depth of hospital medicine. It is not just one area that’s covered in every workshop. We’ll have workshops ranging from clinical reasoning and communication with patients, to quality improvement issues and high value care discussions, as well as a case-based approach to inpatient dermatology.”
While annual meetings’ new offerings are always an important draw, Dr. Feldman says that the annual “standbys,” such as practice management and pediatrics, are necessary to keep attendees up to date on best practices in changing times.
“It’s pretty self-evident that if we’re going to be an important specialty, we need to serve those who are caring for patients day in and day out, as well as folks who are researching how we can do it better,” he said. “Then we must make sure that data is disseminated to all of us who are taking care of patients. That’s one of the really important parts of this meeting: dissemination of the important work.”
There is only one annual meeting dedicated to hospitalists, designed by hospitalists, and focusing purely on issues important to hospitalists. But even that isn’t enough to make sure more hospitalists show up every year.
That’s because a yearly conference can’t just be a rehash of the last one.
A valuable conference, certainly one worth spending the bulk of a continuing medical budget on, offers something new every year. Or, to look at the schedule for HM17, a lot of new every year.
That’s an unlikely complaint this year. The annual meeting schedule for May 1-4 at Mandalay Bay Resort and Casino includes five new educational tracks: High Value Care, Clinical Updates, Health Policy, Diagnostic Reasoning, and Medical Education.
“We’re really excited to be able to offer more clinical content,” said HM17 course director Lenny Feldman, MD, FAAP, FACP, SFHM.
Dr. Feldman sees each of the new tracks as filling separate and specific needs of HM attendees who vary from nonphysician providers to hospitalists to medical students.
Take, for instance, the High Value Care, Clinical Updates, and Diagnostic Reasoning sessions that are debuting.
“We wanted to make sure that we had as many clinically oriented sessions as possible,” Dr. Feldman said. “Which meant we needed to increase the amount of clinical content we have offered compared to the past few years. The new clinical track allows us to add probably 12 or so different sessions that will fill the needs of our attendees.”
The Diagnostic Reasoning and High Value Care tracks, in particular, highlight the annual meeting’s continued evolution toward a focus on evidence-based care, as that mantra becomes a bedrock of clinical treatment.
“Training our hospitalists to use the best dialogistic reasoning in their approach to their patients is a big push in hospital medicine right now,” Dr. Feldman said, “Hopefully, a track on that topic will excite people who love thinking about medicine, who got into medicine because of the mystery and want a renewed focus on how to be a great diagnostician.”
Dr. Feldman also noted that the High Value Care track should be a hot topic, as hospitalists want to learn how to provide high quality and high value care to patients at the same time. The new tracks should appeal to different groups and make the annual meeting more appealing to a variety of attendees, not just rank-and-file doctors.
The mini Medical Education track, for instance, is a subset of a half-dozen sessions tailored directly to medical educators in academic settings who face different challenges than their counterparts in community settings. The same goes for the Health Policy track, which will offer a handful of sessions suitable for novices looking to learn more in an age of reform, or policy wonks hoping to expand their knowledge.
Meeting evolving needs
New offerings aren’t limited to the main conference schedule. The 2017 roster of pre-courses includes one titled, “Bugs, Drugs and You: Infectious Diseases ‘Boot Camp’ for Hospitalists.” This daylong session hasn’t been held since 2013, and copresenter Jennifer Hanrahan, DO, associate professor of medicine at Case Western Reserve University in Cleveland, says the timing is good.
“I don’t know that the percentage of people hospitalized for infection has increased,” she said. “Because we are doing things more quickly than we did in the past, length of stays are shorter and there is a lot of pressure to get patients out of the hospital. There is a lot of consultation with Infectious Disease.”
Dr. Hanrahan, who also serves as medical director of infection prevention at Cleveland’s MetroHealth Medical Center, says that with so many patients hospitalized for infections, the value of updating one’s knowledge every few years is critical.
“I’ve been an infectious disease physician for 18 years and I’m also a hospitalist,” she said. “The types of questions I get vary a great deal depending on the experience of the hospitalist. My hope would be that we would be able to provide a basic level of understanding so that people would be more confident in approaching these problems.”
Another new feature this year is offer some of the most popular sessions at multiple times. In years past, popular sessions – such as “Update and Pearls in Infectious Diseases” and “Non–Evidence-Based Medicine: Things We Do for No Reason” – are standing room only events with attendees sitting on floors or gathered to eavesdrop from doorways.
“That says something about the content that’s being delivered, but that’s not very comfortable for folks who want to sit through a session,” Dr. Feldman said. “We’ve decided to add repeat sessions of popular presentations. We want everyone to be comfortable while they’re learning the important clinical content that’s being delivered at these sessions.”
The 2017 focus on healthcare policy is also new. Educational sessions on the policy landscape will be formally buttressed by plenary presentations from Patrick Conway, MD, MSc, MHM, deputy administrator for Innovation and Quality at the Centers for Medicare & Medicaid Services and director of the Center for Medicare and Medicaid Innovation, and Karen DeSalvo, MD, MPH, MSc, a former acting assistant secretary for health at the U.S. Department of Health and Human Services and national coordinator for health information technology.
“There’s a thirst for (policy news) among members of the Society of Hospital Medicine,” Dr. Feldman said. “It is easy to get lost in the day-to-day work that we do, but I think most of us really enjoy hearing about the bigger picture, especially when the bigger picture is in flux.”
“Right now, this is critical,” added Dr. Finn. “Health insurance coverage has a huge impact on hospitals. I think all practicing hospitalists will need to engage with the hospital C-suite if insurance and coverage changes. Since we are hospital based, we are directly tied to anything that the federal government does in terms of health care changes. It’s important for hospitalists to be knowledgeable about health policy.”
One major highlight of the meeting calendar – less new and more historically under-appreciated, in Dr. Feldman’s view – should be the 18 workshop presentations, which are essentially 90-minute dissertations, whittled down from roughly 150 submissions.
“These are the best submissions that we received,” Dr. Feldman said. “We worked hard to make sure that the workshops encompass the breadth and depth of hospital medicine. It is not just one area that’s covered in every workshop. We’ll have workshops ranging from clinical reasoning and communication with patients, to quality improvement issues and high value care discussions, as well as a case-based approach to inpatient dermatology.”
While annual meetings’ new offerings are always an important draw, Dr. Feldman says that the annual “standbys,” such as practice management and pediatrics, are necessary to keep attendees up to date on best practices in changing times.
“It’s pretty self-evident that if we’re going to be an important specialty, we need to serve those who are caring for patients day in and day out, as well as folks who are researching how we can do it better,” he said. “Then we must make sure that data is disseminated to all of us who are taking care of patients. That’s one of the really important parts of this meeting: dissemination of the important work.”
There is only one annual meeting dedicated to hospitalists, designed by hospitalists, and focusing purely on issues important to hospitalists. But even that isn’t enough to make sure more hospitalists show up every year.
That’s because a yearly conference can’t just be a rehash of the last one.
A valuable conference, certainly one worth spending the bulk of a continuing medical budget on, offers something new every year. Or, to look at the schedule for HM17, a lot of new every year.
That’s an unlikely complaint this year. The annual meeting schedule for May 1-4 at Mandalay Bay Resort and Casino includes five new educational tracks: High Value Care, Clinical Updates, Health Policy, Diagnostic Reasoning, and Medical Education.
“We’re really excited to be able to offer more clinical content,” said HM17 course director Lenny Feldman, MD, FAAP, FACP, SFHM.
Dr. Feldman sees each of the new tracks as filling separate and specific needs of HM attendees who vary from nonphysician providers to hospitalists to medical students.
Take, for instance, the High Value Care, Clinical Updates, and Diagnostic Reasoning sessions that are debuting.
“We wanted to make sure that we had as many clinically oriented sessions as possible,” Dr. Feldman said. “Which meant we needed to increase the amount of clinical content we have offered compared to the past few years. The new clinical track allows us to add probably 12 or so different sessions that will fill the needs of our attendees.”
The Diagnostic Reasoning and High Value Care tracks, in particular, highlight the annual meeting’s continued evolution toward a focus on evidence-based care, as that mantra becomes a bedrock of clinical treatment.
“Training our hospitalists to use the best dialogistic reasoning in their approach to their patients is a big push in hospital medicine right now,” Dr. Feldman said, “Hopefully, a track on that topic will excite people who love thinking about medicine, who got into medicine because of the mystery and want a renewed focus on how to be a great diagnostician.”
Dr. Feldman also noted that the High Value Care track should be a hot topic, as hospitalists want to learn how to provide high quality and high value care to patients at the same time. The new tracks should appeal to different groups and make the annual meeting more appealing to a variety of attendees, not just rank-and-file doctors.
The mini Medical Education track, for instance, is a subset of a half-dozen sessions tailored directly to medical educators in academic settings who face different challenges than their counterparts in community settings. The same goes for the Health Policy track, which will offer a handful of sessions suitable for novices looking to learn more in an age of reform, or policy wonks hoping to expand their knowledge.
Meeting evolving needs
New offerings aren’t limited to the main conference schedule. The 2017 roster of pre-courses includes one titled, “Bugs, Drugs and You: Infectious Diseases ‘Boot Camp’ for Hospitalists.” This daylong session hasn’t been held since 2013, and copresenter Jennifer Hanrahan, DO, associate professor of medicine at Case Western Reserve University in Cleveland, says the timing is good.
“I don’t know that the percentage of people hospitalized for infection has increased,” she said. “Because we are doing things more quickly than we did in the past, length of stays are shorter and there is a lot of pressure to get patients out of the hospital. There is a lot of consultation with Infectious Disease.”
Dr. Hanrahan, who also serves as medical director of infection prevention at Cleveland’s MetroHealth Medical Center, says that with so many patients hospitalized for infections, the value of updating one’s knowledge every few years is critical.
“I’ve been an infectious disease physician for 18 years and I’m also a hospitalist,” she said. “The types of questions I get vary a great deal depending on the experience of the hospitalist. My hope would be that we would be able to provide a basic level of understanding so that people would be more confident in approaching these problems.”
Another new feature this year is offer some of the most popular sessions at multiple times. In years past, popular sessions – such as “Update and Pearls in Infectious Diseases” and “Non–Evidence-Based Medicine: Things We Do for No Reason” – are standing room only events with attendees sitting on floors or gathered to eavesdrop from doorways.
“That says something about the content that’s being delivered, but that’s not very comfortable for folks who want to sit through a session,” Dr. Feldman said. “We’ve decided to add repeat sessions of popular presentations. We want everyone to be comfortable while they’re learning the important clinical content that’s being delivered at these sessions.”
The 2017 focus on healthcare policy is also new. Educational sessions on the policy landscape will be formally buttressed by plenary presentations from Patrick Conway, MD, MSc, MHM, deputy administrator for Innovation and Quality at the Centers for Medicare & Medicaid Services and director of the Center for Medicare and Medicaid Innovation, and Karen DeSalvo, MD, MPH, MSc, a former acting assistant secretary for health at the U.S. Department of Health and Human Services and national coordinator for health information technology.
“There’s a thirst for (policy news) among members of the Society of Hospital Medicine,” Dr. Feldman said. “It is easy to get lost in the day-to-day work that we do, but I think most of us really enjoy hearing about the bigger picture, especially when the bigger picture is in flux.”
“Right now, this is critical,” added Dr. Finn. “Health insurance coverage has a huge impact on hospitals. I think all practicing hospitalists will need to engage with the hospital C-suite if insurance and coverage changes. Since we are hospital based, we are directly tied to anything that the federal government does in terms of health care changes. It’s important for hospitalists to be knowledgeable about health policy.”
One major highlight of the meeting calendar – less new and more historically under-appreciated, in Dr. Feldman’s view – should be the 18 workshop presentations, which are essentially 90-minute dissertations, whittled down from roughly 150 submissions.
“These are the best submissions that we received,” Dr. Feldman said. “We worked hard to make sure that the workshops encompass the breadth and depth of hospital medicine. It is not just one area that’s covered in every workshop. We’ll have workshops ranging from clinical reasoning and communication with patients, to quality improvement issues and high value care discussions, as well as a case-based approach to inpatient dermatology.”
While annual meetings’ new offerings are always an important draw, Dr. Feldman says that the annual “standbys,” such as practice management and pediatrics, are necessary to keep attendees up to date on best practices in changing times.
“It’s pretty self-evident that if we’re going to be an important specialty, we need to serve those who are caring for patients day in and day out, as well as folks who are researching how we can do it better,” he said. “Then we must make sure that data is disseminated to all of us who are taking care of patients. That’s one of the really important parts of this meeting: dissemination of the important work.”
Report: Psychiatry workforce needs better training, delivery models
More work needs to be done to address the shortage of psychiatrists, including improvements in training and models of health care delivery, according to a new report from the National Council for Behavioral Health’s Medical Director Institute.
In framing the problem, Joseph Parks, MD, a psychiatrist who serves as medical director of the National Council, said during a March 28 teleconference to introduce the report that “55% of the counties in the United States have no psychiatrist in them” and “77% of the counties report a severe shortage.” He noted that the number of psychiatrists available declined by 10% between 2003 and 2013 and that the average age of practicing psychiatrists is in the mid-50s. In other medical specialties, the average age is in the mid-40s, he said.
“This has resulted in people having long wait times and being unable to get psychiatric services,” Dr. Parks said. Those factors are leading patients to pursue psychiatric care in alternative places, such as in primary care physician practices and emergency departments.
In emergency departments, the average wait for dispositions for some psychiatric patients can reach 23 hours, the report says. And more people are going to EDs for care.
“There has been a 42% increase in patients going to the emergency rooms for psychiatric services in the past 3 years,” Dr. Parks said. “But most of them aren’t staffed with psychiatrists. So people end up stuck in the emergency rooms for hours – two to three times as long as they spend for general medical conditions.”
The report looks at causes, and makes actionable recommendations for payers and providers. It also makes recommendations about the infrastructure needed to train future psychiatrists.
A key part of the problem is the increased demand, which is partly attributable to the expansion of health care coverage through the Affordable Care Act’s Medicaid expansion provisions as well as the normalization of views on behavioral health.
“People want psychiatric services,” said Dr. Parks, who has practiced medicine and worked as a policy maker in Missouri. “They know treatment works. It’s less stigmatized than it used to be, so people are more willing to accept and seek treatment.”
Among the trends cited by the report is a shortage of new psychiatrists coming out of medical schools.
“There are problems with not enough training capacity,” he said. “We’ve had increases in federal support for increased training capacity for ob.gyns. and primary care, but we’ve not had that same increase and support, and there are [fewer] supports for training of psychiatrists and fewer slots.”
Burnout is another problem facing psychiatrists.
“Psychiatrists who are practicing are in many cases forced to do it at lower than usual reimbursements [and] are having short visits,” Dr. Parks said. “They are rushed ... they don’t get the same supports that other physicians get. They don’t get the same ancillary staff to assist them in caring for the patients.”
Elaborating on the issues surrounding reimbursement, Dr. Parks noted that 40% of psychiatrists work on a cash-only basis, and 75% of behavioral health organizations lose money on fees collected for psychiatric services.
An ongoing workforce concern, especially in light of changes to the H-1B program, is that 50% of new trainees are foreign medical graduates.
“Luckily, there is a broad range of solutions, and there is something for all the major players to do here,” Dr. Parks said, noting that the report highlights many of these solutions.
“We need to change the care delivery system so it’s not the psychiatrist seeing everybody continuously,” he said. “Psychiatrists need to be used more as expert consultants. People need to be identified using data analytics as opposed to waiting for the patient to complain. And they need to be working more in teams, so they are doing the essential things that only a psychiatrist can do.”
Dr. Parks added that psychiatrists need to delegate “other parts of care and follow-up for people who are stable or for services that can be done by other professionals, such as psychiatric nurses or perhaps physician assistants. “We need an increase not only in more training capacity for psychiatrists but [also in] more alternative providers.”
Patrick Runnels, MD, a psychiatrist who cochairs the Medical Director Institute, highlighted several of the training issues.
“[W]e determined that psychiatrists also bear responsibility for improving this workforce crisis,” Dr. Runnels said during the call. “That starts with making our training consistent with the emerging needs and models of care that are attractive to potential trainees.”
And getting more clinicians into areas of high need, like psychiatry, starts at the medical school level.
“We were able to determine [that] in medical school, medical students were more likely to be recruited into psychiatry based on two characteristics – that the medical school had a strong reputation within their psychiatry department, particularly a strong rotation that was well rated by medical students in psychiatry, and that the length of the rotation was longer,” he said. “When those two things are put together, more students choose to go into psychiatry residency.”
In addition, more exposure is needed to aspects of practice that fit with the way in which medical care is being delivered, including better training in team-based collaborative care and medication-assisted treatment for substance use disorders.
“We also think that residents need to be placed in a range of settings, some settings in which they don’t get very much placement right now, including federally qualified health centers, patient-centered medical homes, [and] experience with telepsychiatry,” said Dr. Runnels, who also serves as medical director of the Centers for Families and Children in Cleveland.
“On top of that, we need our psychiatry residents to graduate with skills in health care data analysis, particularly at the population level,” Dr. Runnels continued. “We need our residents to understand the impact of the treatments that we have on entire populations and how to best allocate resources to deal with the whole population. Those things are hugely important.”
The National Council, based in Washington, is made up of 2,900 member organizations across the country that serve 10 million adults, children, and families who are living with mental health and substance use disorders.
More work needs to be done to address the shortage of psychiatrists, including improvements in training and models of health care delivery, according to a new report from the National Council for Behavioral Health’s Medical Director Institute.
In framing the problem, Joseph Parks, MD, a psychiatrist who serves as medical director of the National Council, said during a March 28 teleconference to introduce the report that “55% of the counties in the United States have no psychiatrist in them” and “77% of the counties report a severe shortage.” He noted that the number of psychiatrists available declined by 10% between 2003 and 2013 and that the average age of practicing psychiatrists is in the mid-50s. In other medical specialties, the average age is in the mid-40s, he said.
“This has resulted in people having long wait times and being unable to get psychiatric services,” Dr. Parks said. Those factors are leading patients to pursue psychiatric care in alternative places, such as in primary care physician practices and emergency departments.
In emergency departments, the average wait for dispositions for some psychiatric patients can reach 23 hours, the report says. And more people are going to EDs for care.
“There has been a 42% increase in patients going to the emergency rooms for psychiatric services in the past 3 years,” Dr. Parks said. “But most of them aren’t staffed with psychiatrists. So people end up stuck in the emergency rooms for hours – two to three times as long as they spend for general medical conditions.”
The report looks at causes, and makes actionable recommendations for payers and providers. It also makes recommendations about the infrastructure needed to train future psychiatrists.
A key part of the problem is the increased demand, which is partly attributable to the expansion of health care coverage through the Affordable Care Act’s Medicaid expansion provisions as well as the normalization of views on behavioral health.
“People want psychiatric services,” said Dr. Parks, who has practiced medicine and worked as a policy maker in Missouri. “They know treatment works. It’s less stigmatized than it used to be, so people are more willing to accept and seek treatment.”
Among the trends cited by the report is a shortage of new psychiatrists coming out of medical schools.
“There are problems with not enough training capacity,” he said. “We’ve had increases in federal support for increased training capacity for ob.gyns. and primary care, but we’ve not had that same increase and support, and there are [fewer] supports for training of psychiatrists and fewer slots.”
Burnout is another problem facing psychiatrists.
“Psychiatrists who are practicing are in many cases forced to do it at lower than usual reimbursements [and] are having short visits,” Dr. Parks said. “They are rushed ... they don’t get the same supports that other physicians get. They don’t get the same ancillary staff to assist them in caring for the patients.”
Elaborating on the issues surrounding reimbursement, Dr. Parks noted that 40% of psychiatrists work on a cash-only basis, and 75% of behavioral health organizations lose money on fees collected for psychiatric services.
An ongoing workforce concern, especially in light of changes to the H-1B program, is that 50% of new trainees are foreign medical graduates.
“Luckily, there is a broad range of solutions, and there is something for all the major players to do here,” Dr. Parks said, noting that the report highlights many of these solutions.
“We need to change the care delivery system so it’s not the psychiatrist seeing everybody continuously,” he said. “Psychiatrists need to be used more as expert consultants. People need to be identified using data analytics as opposed to waiting for the patient to complain. And they need to be working more in teams, so they are doing the essential things that only a psychiatrist can do.”
Dr. Parks added that psychiatrists need to delegate “other parts of care and follow-up for people who are stable or for services that can be done by other professionals, such as psychiatric nurses or perhaps physician assistants. “We need an increase not only in more training capacity for psychiatrists but [also in] more alternative providers.”
Patrick Runnels, MD, a psychiatrist who cochairs the Medical Director Institute, highlighted several of the training issues.
“[W]e determined that psychiatrists also bear responsibility for improving this workforce crisis,” Dr. Runnels said during the call. “That starts with making our training consistent with the emerging needs and models of care that are attractive to potential trainees.”
And getting more clinicians into areas of high need, like psychiatry, starts at the medical school level.
“We were able to determine [that] in medical school, medical students were more likely to be recruited into psychiatry based on two characteristics – that the medical school had a strong reputation within their psychiatry department, particularly a strong rotation that was well rated by medical students in psychiatry, and that the length of the rotation was longer,” he said. “When those two things are put together, more students choose to go into psychiatry residency.”
In addition, more exposure is needed to aspects of practice that fit with the way in which medical care is being delivered, including better training in team-based collaborative care and medication-assisted treatment for substance use disorders.
“We also think that residents need to be placed in a range of settings, some settings in which they don’t get very much placement right now, including federally qualified health centers, patient-centered medical homes, [and] experience with telepsychiatry,” said Dr. Runnels, who also serves as medical director of the Centers for Families and Children in Cleveland.
“On top of that, we need our psychiatry residents to graduate with skills in health care data analysis, particularly at the population level,” Dr. Runnels continued. “We need our residents to understand the impact of the treatments that we have on entire populations and how to best allocate resources to deal with the whole population. Those things are hugely important.”
The National Council, based in Washington, is made up of 2,900 member organizations across the country that serve 10 million adults, children, and families who are living with mental health and substance use disorders.
More work needs to be done to address the shortage of psychiatrists, including improvements in training and models of health care delivery, according to a new report from the National Council for Behavioral Health’s Medical Director Institute.
In framing the problem, Joseph Parks, MD, a psychiatrist who serves as medical director of the National Council, said during a March 28 teleconference to introduce the report that “55% of the counties in the United States have no psychiatrist in them” and “77% of the counties report a severe shortage.” He noted that the number of psychiatrists available declined by 10% between 2003 and 2013 and that the average age of practicing psychiatrists is in the mid-50s. In other medical specialties, the average age is in the mid-40s, he said.
“This has resulted in people having long wait times and being unable to get psychiatric services,” Dr. Parks said. Those factors are leading patients to pursue psychiatric care in alternative places, such as in primary care physician practices and emergency departments.
In emergency departments, the average wait for dispositions for some psychiatric patients can reach 23 hours, the report says. And more people are going to EDs for care.
“There has been a 42% increase in patients going to the emergency rooms for psychiatric services in the past 3 years,” Dr. Parks said. “But most of them aren’t staffed with psychiatrists. So people end up stuck in the emergency rooms for hours – two to three times as long as they spend for general medical conditions.”
The report looks at causes, and makes actionable recommendations for payers and providers. It also makes recommendations about the infrastructure needed to train future psychiatrists.
A key part of the problem is the increased demand, which is partly attributable to the expansion of health care coverage through the Affordable Care Act’s Medicaid expansion provisions as well as the normalization of views on behavioral health.
“People want psychiatric services,” said Dr. Parks, who has practiced medicine and worked as a policy maker in Missouri. “They know treatment works. It’s less stigmatized than it used to be, so people are more willing to accept and seek treatment.”
Among the trends cited by the report is a shortage of new psychiatrists coming out of medical schools.
“There are problems with not enough training capacity,” he said. “We’ve had increases in federal support for increased training capacity for ob.gyns. and primary care, but we’ve not had that same increase and support, and there are [fewer] supports for training of psychiatrists and fewer slots.”
Burnout is another problem facing psychiatrists.
“Psychiatrists who are practicing are in many cases forced to do it at lower than usual reimbursements [and] are having short visits,” Dr. Parks said. “They are rushed ... they don’t get the same supports that other physicians get. They don’t get the same ancillary staff to assist them in caring for the patients.”
Elaborating on the issues surrounding reimbursement, Dr. Parks noted that 40% of psychiatrists work on a cash-only basis, and 75% of behavioral health organizations lose money on fees collected for psychiatric services.
An ongoing workforce concern, especially in light of changes to the H-1B program, is that 50% of new trainees are foreign medical graduates.
“Luckily, there is a broad range of solutions, and there is something for all the major players to do here,” Dr. Parks said, noting that the report highlights many of these solutions.
“We need to change the care delivery system so it’s not the psychiatrist seeing everybody continuously,” he said. “Psychiatrists need to be used more as expert consultants. People need to be identified using data analytics as opposed to waiting for the patient to complain. And they need to be working more in teams, so they are doing the essential things that only a psychiatrist can do.”
Dr. Parks added that psychiatrists need to delegate “other parts of care and follow-up for people who are stable or for services that can be done by other professionals, such as psychiatric nurses or perhaps physician assistants. “We need an increase not only in more training capacity for psychiatrists but [also in] more alternative providers.”
Patrick Runnels, MD, a psychiatrist who cochairs the Medical Director Institute, highlighted several of the training issues.
“[W]e determined that psychiatrists also bear responsibility for improving this workforce crisis,” Dr. Runnels said during the call. “That starts with making our training consistent with the emerging needs and models of care that are attractive to potential trainees.”
And getting more clinicians into areas of high need, like psychiatry, starts at the medical school level.
“We were able to determine [that] in medical school, medical students were more likely to be recruited into psychiatry based on two characteristics – that the medical school had a strong reputation within their psychiatry department, particularly a strong rotation that was well rated by medical students in psychiatry, and that the length of the rotation was longer,” he said. “When those two things are put together, more students choose to go into psychiatry residency.”
In addition, more exposure is needed to aspects of practice that fit with the way in which medical care is being delivered, including better training in team-based collaborative care and medication-assisted treatment for substance use disorders.
“We also think that residents need to be placed in a range of settings, some settings in which they don’t get very much placement right now, including federally qualified health centers, patient-centered medical homes, [and] experience with telepsychiatry,” said Dr. Runnels, who also serves as medical director of the Centers for Families and Children in Cleveland.
“On top of that, we need our psychiatry residents to graduate with skills in health care data analysis, particularly at the population level,” Dr. Runnels continued. “We need our residents to understand the impact of the treatments that we have on entire populations and how to best allocate resources to deal with the whole population. Those things are hugely important.”
The National Council, based in Washington, is made up of 2,900 member organizations across the country that serve 10 million adults, children, and families who are living with mental health and substance use disorders.
What do you call a general medicine hospitalist who focuses on comanaging with a single medical subspecialty?
For more than 2 decades, U.S. health systems have drawn on hospitalists’ expertise to lower length of stay and enhance safety for general medical patients. Many hospital medicine groups have extended this successful practice model across a growing list of services, stretching the role of generalists as far as it can go. While a diverse scope of practice excites some hospitalists, others find career satisfaction with a specific patient population. Some even balk at rotating through all of the possible primary and comanagement services staffed by their group. A growing number of job opportunities have emerged for individuals who are drawn to a specialized patient population but either remain generalist at heart or don’t want to complete a fellowship.
The latest State of Hospital Medicine (SoHM) report provides new insight into this trend, which brings our unique talents to subspecialty populations.
To understand the prevalence of this practice style, the following topic was added to the 2016 SoHM survey: “Some hospital medicine groups include hospitalists who focus their practice exclusively or predominantly in a single medical subspecialty area (e.g., a general internist who exclusively cares for patients on an oncology service in collaboration with oncologists).” Groups were asked to report whether one or more members of their group practiced this way and with which specialty. Although less than a quarter of groups responded to this question, we learned that a substantial portion of respondent groups employ such individuals (see table below).
We look forward to tracking this area with subsequent surveys. Already, national meetings are developing for specialty hospitalists (for example, in oncology), and we see opportunities for specialty hospitalists to network through the Society of Hospital Medicine annual meeting and HMX online. My prediction is for growth in the number of groups reporting the employment of specialty hospitalists, but only time will tell. Hospital medicine group leaders should consider both participating in the next SOHM survey and digging into the details of the current report as ways to advance the best practices for developing specialty hospitalist positions.
Dr. White is associate professor of medicine at the University of Washington, Seattle, and a member of SHM’s Practice Analysis Committee.
For more than 2 decades, U.S. health systems have drawn on hospitalists’ expertise to lower length of stay and enhance safety for general medical patients. Many hospital medicine groups have extended this successful practice model across a growing list of services, stretching the role of generalists as far as it can go. While a diverse scope of practice excites some hospitalists, others find career satisfaction with a specific patient population. Some even balk at rotating through all of the possible primary and comanagement services staffed by their group. A growing number of job opportunities have emerged for individuals who are drawn to a specialized patient population but either remain generalist at heart or don’t want to complete a fellowship.
The latest State of Hospital Medicine (SoHM) report provides new insight into this trend, which brings our unique talents to subspecialty populations.
To understand the prevalence of this practice style, the following topic was added to the 2016 SoHM survey: “Some hospital medicine groups include hospitalists who focus their practice exclusively or predominantly in a single medical subspecialty area (e.g., a general internist who exclusively cares for patients on an oncology service in collaboration with oncologists).” Groups were asked to report whether one or more members of their group practiced this way and with which specialty. Although less than a quarter of groups responded to this question, we learned that a substantial portion of respondent groups employ such individuals (see table below).
We look forward to tracking this area with subsequent surveys. Already, national meetings are developing for specialty hospitalists (for example, in oncology), and we see opportunities for specialty hospitalists to network through the Society of Hospital Medicine annual meeting and HMX online. My prediction is for growth in the number of groups reporting the employment of specialty hospitalists, but only time will tell. Hospital medicine group leaders should consider both participating in the next SOHM survey and digging into the details of the current report as ways to advance the best practices for developing specialty hospitalist positions.
Dr. White is associate professor of medicine at the University of Washington, Seattle, and a member of SHM’s Practice Analysis Committee.
For more than 2 decades, U.S. health systems have drawn on hospitalists’ expertise to lower length of stay and enhance safety for general medical patients. Many hospital medicine groups have extended this successful practice model across a growing list of services, stretching the role of generalists as far as it can go. While a diverse scope of practice excites some hospitalists, others find career satisfaction with a specific patient population. Some even balk at rotating through all of the possible primary and comanagement services staffed by their group. A growing number of job opportunities have emerged for individuals who are drawn to a specialized patient population but either remain generalist at heart or don’t want to complete a fellowship.
The latest State of Hospital Medicine (SoHM) report provides new insight into this trend, which brings our unique talents to subspecialty populations.
To understand the prevalence of this practice style, the following topic was added to the 2016 SoHM survey: “Some hospital medicine groups include hospitalists who focus their practice exclusively or predominantly in a single medical subspecialty area (e.g., a general internist who exclusively cares for patients on an oncology service in collaboration with oncologists).” Groups were asked to report whether one or more members of their group practiced this way and with which specialty. Although less than a quarter of groups responded to this question, we learned that a substantial portion of respondent groups employ such individuals (see table below).
We look forward to tracking this area with subsequent surveys. Already, national meetings are developing for specialty hospitalists (for example, in oncology), and we see opportunities for specialty hospitalists to network through the Society of Hospital Medicine annual meeting and HMX online. My prediction is for growth in the number of groups reporting the employment of specialty hospitalists, but only time will tell. Hospital medicine group leaders should consider both participating in the next SOHM survey and digging into the details of the current report as ways to advance the best practices for developing specialty hospitalist positions.
Dr. White is associate professor of medicine at the University of Washington, Seattle, and a member of SHM’s Practice Analysis Committee.
HM17’s ‘must-see sessions’
LAS VEGAS — Not to sound like a Sin City come on, but pick a course, any course.
No, seriously.
Hospitalists and other attendees at the Hospitalist Medicine 2017 meeting next month will do well to figure out what sessions they want to attend before arriving at the Mandalay Bay Resort and Casino. This 4-day Super Bowl of hospital medicine prides itself on offering more than any attendee can find time for. This year is no exception, as the annual meeting has added five new educational tracks: High-Value Care, Clinical Updates, Health Policy, Diagnostic Reasoning, and Medical Education.
The committee does its job to fill the meeting with best-in-class educational sessions. Here are some of the group’s recommendations for this year’s meeting:
1. “The Hospitalist’s Role in the Opioid Epidemic” – Tuesday, May 2; 1:35 p.m.–2:35 p.m.
2. “Opioids for Acute Pain Management in the Seriously Ill – How to Safely Prescribe” – Wednesday, May 3; 2:50 p.m.–3:30 p.m.
3. “Non-opiate Pain Management for the Hospitalist” – Wednesday, May 3; 4:20 p.m.–5:00 p.m.
Elizabeth Cook, MD, medical director of the hospitalist division of Medical Associates of Central Virginia in Lynchburg, said, “The historical emphasis on pain control has helped contributed to the current epidemic of opioid abuse, overdoses, and deaths. Hospitalists have a need to use these medications for care of the hospitalized patient but have an important part to play in leading the way to appropriate use and patient education regarding the dangers of these medications. These sessions will provide hospitalists with some tools to use in beginning to effect a shift in pain management strategies and responsible use of narcotic pain medications.”
Miguel Angel Villagra, MD, FACP, FHM, hospitalist department program medical director at White River Medical Center in Batesville, Ark., said, “As primary front-line providers in the acute care setting, we face the everyday struggles in the management of chronic opioid users. Acquiring some general guidelines can help us tailor our approach within an ethical focus to improve the care of this population.”
Sarah Stella, MD, an academic hospitalist at Denver Health, said, “This is a crucial and timely topic. Hospitalists have had a hand in perpetuating the opioid epidemic and can play an important role in helping to end it. In this regard, there are many opportunities to do good, such as judicious prescribing and tapering medications for acute pain, starting eligible patients on Suboxone [buprenorphine] in-house, and arranging substance abuse treatment follow-up.”
4. “Focus on POCUS - Introduction to Point-of-Care Ultrasound for Pediatric Hospitalists” – Tuesday, May 2; 10:35 a.m.–11:35 a.m.
Weijen Chang, MD, SFHM, FAAP, chief of the division of pediatric hospital medicine, Baystate Medical Center/Baystate Children’s Hospital, Springfield, Mass., said, “This is the first pediatric POCUS session offered at SHM ever. And it does not require an additional cost ... the pediatric track is critically important, as a substantial number of athlete attendees are either Peds or MedPeds. I think SHM aims to create a pediatric track that discusses topics that are less covered in other meetings, such as the value equation and issues facing women leaders in HM.”
6. “Foundations of a Hospital Medicine Telemedicine Program” – Wednesday, May 3; 415 p.m.–5:20 p.m.
Dr. Villagra added, “Telemedicine is a new innovative technology with the promise of overcoming geographical barriers to health care providers. A lot of new companies and software development has made this technology more user/patient friendly.”
7. “Hot Topics in Health Policy for Hospitalists” – Thursday, May 4; 7:40 a.m.–8:35 a.m.
8. “The Impact of the New Administration on Health Care Reform” – Thursday, May 4; 8:45 a.m.–9:40 a.m.
9. “Health Care Payment Reform for Hospitalist 2017: Tips for MIPS and Beyond” – Thursday, May 4; 9:50 a.m.–10:45 a.m.
Dr. Stella said, “As a safety-net hospitalist in Colorado, a state which largely expanded Medicare under the Affordable Care Act (ACA), I am concerned about the impact repealing the ACA would have on my patients as well as on safety-net hospitals such as my own. I hope that these sessions will increase my understanding of the issues and my ability to advocate for my patients.”
Dr. Cook said, “The U.S. government is functioning in historically unprecedented ways with major shifts in health care policy expected to occur over the next 4 years. It is essential that physician leaders play an active role in shaping the discussion around these important topics ... hospitalists have an opportunity to provide leadership in this arena, and these sessions will help participants to build the knowledge about these complex issues that is crucial to being an active part of the dialogue.”
10. “Workshop: Hospitalists as Leaders in Patient Flow and Hospital Throughput” – Thursday, May 4; 10 a.m.–11:30 a.m.
Dr. Stella said, “Recently, I was appointed to a leadership role on a major initiative to improve hospital patient flow at my institution. We are concentrating on several different areas, including avoidable hospitalizations, preventable excess days, delayed discharges, and variable access to services. I was excited to see a workshop this year dedicated to how hospitalists can successfully lead such initiatives. I will definitely be attending this session as I am interested in what others are doing in their institutions to creatively overcome patient flow challenges.”
11. “Hospitalist Careers: So Many Options” – Tuesday, May 2; 10:35 a.m.–11:15 a.m.
Dr. Villagra said, “Hospital medicine has so many pathways for a full career development and is not a pit stop before fellowship. Early- and mid-career hospitalists can benefit from interactions with senior hospitalists for the understanding of what hospital medicine has to offer for their professional growth.”
Richard Quinn is a freelance writer in New Jersey.
LAS VEGAS — Not to sound like a Sin City come on, but pick a course, any course.
No, seriously.
Hospitalists and other attendees at the Hospitalist Medicine 2017 meeting next month will do well to figure out what sessions they want to attend before arriving at the Mandalay Bay Resort and Casino. This 4-day Super Bowl of hospital medicine prides itself on offering more than any attendee can find time for. This year is no exception, as the annual meeting has added five new educational tracks: High-Value Care, Clinical Updates, Health Policy, Diagnostic Reasoning, and Medical Education.
The committee does its job to fill the meeting with best-in-class educational sessions. Here are some of the group’s recommendations for this year’s meeting:
1. “The Hospitalist’s Role in the Opioid Epidemic” – Tuesday, May 2; 1:35 p.m.–2:35 p.m.
2. “Opioids for Acute Pain Management in the Seriously Ill – How to Safely Prescribe” – Wednesday, May 3; 2:50 p.m.–3:30 p.m.
3. “Non-opiate Pain Management for the Hospitalist” – Wednesday, May 3; 4:20 p.m.–5:00 p.m.
Elizabeth Cook, MD, medical director of the hospitalist division of Medical Associates of Central Virginia in Lynchburg, said, “The historical emphasis on pain control has helped contributed to the current epidemic of opioid abuse, overdoses, and deaths. Hospitalists have a need to use these medications for care of the hospitalized patient but have an important part to play in leading the way to appropriate use and patient education regarding the dangers of these medications. These sessions will provide hospitalists with some tools to use in beginning to effect a shift in pain management strategies and responsible use of narcotic pain medications.”
Miguel Angel Villagra, MD, FACP, FHM, hospitalist department program medical director at White River Medical Center in Batesville, Ark., said, “As primary front-line providers in the acute care setting, we face the everyday struggles in the management of chronic opioid users. Acquiring some general guidelines can help us tailor our approach within an ethical focus to improve the care of this population.”
Sarah Stella, MD, an academic hospitalist at Denver Health, said, “This is a crucial and timely topic. Hospitalists have had a hand in perpetuating the opioid epidemic and can play an important role in helping to end it. In this regard, there are many opportunities to do good, such as judicious prescribing and tapering medications for acute pain, starting eligible patients on Suboxone [buprenorphine] in-house, and arranging substance abuse treatment follow-up.”
4. “Focus on POCUS - Introduction to Point-of-Care Ultrasound for Pediatric Hospitalists” – Tuesday, May 2; 10:35 a.m.–11:35 a.m.
Weijen Chang, MD, SFHM, FAAP, chief of the division of pediatric hospital medicine, Baystate Medical Center/Baystate Children’s Hospital, Springfield, Mass., said, “This is the first pediatric POCUS session offered at SHM ever. And it does not require an additional cost ... the pediatric track is critically important, as a substantial number of athlete attendees are either Peds or MedPeds. I think SHM aims to create a pediatric track that discusses topics that are less covered in other meetings, such as the value equation and issues facing women leaders in HM.”
6. “Foundations of a Hospital Medicine Telemedicine Program” – Wednesday, May 3; 415 p.m.–5:20 p.m.
Dr. Villagra added, “Telemedicine is a new innovative technology with the promise of overcoming geographical barriers to health care providers. A lot of new companies and software development has made this technology more user/patient friendly.”
7. “Hot Topics in Health Policy for Hospitalists” – Thursday, May 4; 7:40 a.m.–8:35 a.m.
8. “The Impact of the New Administration on Health Care Reform” – Thursday, May 4; 8:45 a.m.–9:40 a.m.
9. “Health Care Payment Reform for Hospitalist 2017: Tips for MIPS and Beyond” – Thursday, May 4; 9:50 a.m.–10:45 a.m.
Dr. Stella said, “As a safety-net hospitalist in Colorado, a state which largely expanded Medicare under the Affordable Care Act (ACA), I am concerned about the impact repealing the ACA would have on my patients as well as on safety-net hospitals such as my own. I hope that these sessions will increase my understanding of the issues and my ability to advocate for my patients.”
Dr. Cook said, “The U.S. government is functioning in historically unprecedented ways with major shifts in health care policy expected to occur over the next 4 years. It is essential that physician leaders play an active role in shaping the discussion around these important topics ... hospitalists have an opportunity to provide leadership in this arena, and these sessions will help participants to build the knowledge about these complex issues that is crucial to being an active part of the dialogue.”
10. “Workshop: Hospitalists as Leaders in Patient Flow and Hospital Throughput” – Thursday, May 4; 10 a.m.–11:30 a.m.
Dr. Stella said, “Recently, I was appointed to a leadership role on a major initiative to improve hospital patient flow at my institution. We are concentrating on several different areas, including avoidable hospitalizations, preventable excess days, delayed discharges, and variable access to services. I was excited to see a workshop this year dedicated to how hospitalists can successfully lead such initiatives. I will definitely be attending this session as I am interested in what others are doing in their institutions to creatively overcome patient flow challenges.”
11. “Hospitalist Careers: So Many Options” – Tuesday, May 2; 10:35 a.m.–11:15 a.m.
Dr. Villagra said, “Hospital medicine has so many pathways for a full career development and is not a pit stop before fellowship. Early- and mid-career hospitalists can benefit from interactions with senior hospitalists for the understanding of what hospital medicine has to offer for their professional growth.”
Richard Quinn is a freelance writer in New Jersey.
LAS VEGAS — Not to sound like a Sin City come on, but pick a course, any course.
No, seriously.
Hospitalists and other attendees at the Hospitalist Medicine 2017 meeting next month will do well to figure out what sessions they want to attend before arriving at the Mandalay Bay Resort and Casino. This 4-day Super Bowl of hospital medicine prides itself on offering more than any attendee can find time for. This year is no exception, as the annual meeting has added five new educational tracks: High-Value Care, Clinical Updates, Health Policy, Diagnostic Reasoning, and Medical Education.
The committee does its job to fill the meeting with best-in-class educational sessions. Here are some of the group’s recommendations for this year’s meeting:
1. “The Hospitalist’s Role in the Opioid Epidemic” – Tuesday, May 2; 1:35 p.m.–2:35 p.m.
2. “Opioids for Acute Pain Management in the Seriously Ill – How to Safely Prescribe” – Wednesday, May 3; 2:50 p.m.–3:30 p.m.
3. “Non-opiate Pain Management for the Hospitalist” – Wednesday, May 3; 4:20 p.m.–5:00 p.m.
Elizabeth Cook, MD, medical director of the hospitalist division of Medical Associates of Central Virginia in Lynchburg, said, “The historical emphasis on pain control has helped contributed to the current epidemic of opioid abuse, overdoses, and deaths. Hospitalists have a need to use these medications for care of the hospitalized patient but have an important part to play in leading the way to appropriate use and patient education regarding the dangers of these medications. These sessions will provide hospitalists with some tools to use in beginning to effect a shift in pain management strategies and responsible use of narcotic pain medications.”
Miguel Angel Villagra, MD, FACP, FHM, hospitalist department program medical director at White River Medical Center in Batesville, Ark., said, “As primary front-line providers in the acute care setting, we face the everyday struggles in the management of chronic opioid users. Acquiring some general guidelines can help us tailor our approach within an ethical focus to improve the care of this population.”
Sarah Stella, MD, an academic hospitalist at Denver Health, said, “This is a crucial and timely topic. Hospitalists have had a hand in perpetuating the opioid epidemic and can play an important role in helping to end it. In this regard, there are many opportunities to do good, such as judicious prescribing and tapering medications for acute pain, starting eligible patients on Suboxone [buprenorphine] in-house, and arranging substance abuse treatment follow-up.”
4. “Focus on POCUS - Introduction to Point-of-Care Ultrasound for Pediatric Hospitalists” – Tuesday, May 2; 10:35 a.m.–11:35 a.m.
Weijen Chang, MD, SFHM, FAAP, chief of the division of pediatric hospital medicine, Baystate Medical Center/Baystate Children’s Hospital, Springfield, Mass., said, “This is the first pediatric POCUS session offered at SHM ever. And it does not require an additional cost ... the pediatric track is critically important, as a substantial number of athlete attendees are either Peds or MedPeds. I think SHM aims to create a pediatric track that discusses topics that are less covered in other meetings, such as the value equation and issues facing women leaders in HM.”
6. “Foundations of a Hospital Medicine Telemedicine Program” – Wednesday, May 3; 415 p.m.–5:20 p.m.
Dr. Villagra added, “Telemedicine is a new innovative technology with the promise of overcoming geographical barriers to health care providers. A lot of new companies and software development has made this technology more user/patient friendly.”
7. “Hot Topics in Health Policy for Hospitalists” – Thursday, May 4; 7:40 a.m.–8:35 a.m.
8. “The Impact of the New Administration on Health Care Reform” – Thursday, May 4; 8:45 a.m.–9:40 a.m.
9. “Health Care Payment Reform for Hospitalist 2017: Tips for MIPS and Beyond” – Thursday, May 4; 9:50 a.m.–10:45 a.m.
Dr. Stella said, “As a safety-net hospitalist in Colorado, a state which largely expanded Medicare under the Affordable Care Act (ACA), I am concerned about the impact repealing the ACA would have on my patients as well as on safety-net hospitals such as my own. I hope that these sessions will increase my understanding of the issues and my ability to advocate for my patients.”
Dr. Cook said, “The U.S. government is functioning in historically unprecedented ways with major shifts in health care policy expected to occur over the next 4 years. It is essential that physician leaders play an active role in shaping the discussion around these important topics ... hospitalists have an opportunity to provide leadership in this arena, and these sessions will help participants to build the knowledge about these complex issues that is crucial to being an active part of the dialogue.”
10. “Workshop: Hospitalists as Leaders in Patient Flow and Hospital Throughput” – Thursday, May 4; 10 a.m.–11:30 a.m.
Dr. Stella said, “Recently, I was appointed to a leadership role on a major initiative to improve hospital patient flow at my institution. We are concentrating on several different areas, including avoidable hospitalizations, preventable excess days, delayed discharges, and variable access to services. I was excited to see a workshop this year dedicated to how hospitalists can successfully lead such initiatives. I will definitely be attending this session as I am interested in what others are doing in their institutions to creatively overcome patient flow challenges.”
11. “Hospitalist Careers: So Many Options” – Tuesday, May 2; 10:35 a.m.–11:15 a.m.
Dr. Villagra said, “Hospital medicine has so many pathways for a full career development and is not a pit stop before fellowship. Early- and mid-career hospitalists can benefit from interactions with senior hospitalists for the understanding of what hospital medicine has to offer for their professional growth.”
Richard Quinn is a freelance writer in New Jersey.
Fellows and Awards of Excellence
Vineet Arora, MD, understands the unique value of being named one of this year’s three Masters in Hospital Medicine. It’s an honor bestowed for hospitalists, by hospitalists.
“I take a lot of pride in an honor determined by peers,” said Dr. Arora, an academic hospitalist at University of Chicago Medicine. “While peers are often the biggest support you receive in your professional career, because they are in the trenches with you, they can also be your best critics. That is especially true of the type of work that I do, which relies on the buy-in of frontline clinicians – including hospitalists and trainees – to achieve better patient care and education.”
The designation of new Masters in Hospital Medicine is a major moment at SHM’s annual meeting. The 2017 list of awardees is headlined by Dr. Arora and the other MHM designees: former SHM President Burke Kealey, MD, and Richard Slataper, MD, who was heavily involved with the National Association of Inpatient Physicians, a predecessor to SHM. The three new masters bring to 24 the number of MHMs the society has named since unveiling the honor in 2010.
Dr. Arora understands that after 20 years as a specialty, just two dozen practitioners have reached hospital medicine’s highest professional distinction.
“I think of ‘mastery’ as someone who has achieved the highest level of expertise in a field, so an honor like Master in Hospital Medicine definitely means a lot to me,” she said. “Especially given the prior recipients of this honor, and the importance of SHM in my own professional growth and development since I was a trainee.”
In addition to the top honor, HM17 will see the induction of 159 Fellows in Hospital Medicine (FHM) and 58 Senior Fellows in Hospital Medicine (SFHM). This year’s fellows join the thousands of physicians and nonphysician providers (NPPs) that have attained the distinction.
SHM also bestows its annual Awards of Excellence (past winners listed here include Dr. Arora and Dr. Kealey) that recognize practitioners across skill sets. The awards are meant to honor SHM members “whose exemplary contributions to the hospital medicine movement deserve acknowledgment and respect,” according to the society’s website.
The 2017 Award winners include:
• Excellence in Teamwork in Quality Improvement: Johnston Memorial Hospital in Abingdon, Va.
• Excellence in Research: Jeffrey Barsuk, MD, MS, SFHM.
• Excellence in Teaching: Steven Cohn, MD, FACP, SFHM.
• Excellence in Hospital Medicine for Non-Physicians: Michael McFall.
• Outstanding Service in Hospital Medicine: Jeffrey Greenwald, MD, SFHM.
• Clinical Excellence: Barbara Slawski, MD.
• Excellence in Humanitarian Services: Jonathan Crocker, MD, FHM.
Dr. Arora, who has served on the SHM committee that analyzes all nominees for the annual awards, recognizes the value of honoring these high-achieving clinicians.
“There is great value to having our specialty society recognize members in different ways,” she said “The awards of excellence serve as a wonderful reminder of the incredible impact that hospitalists have in many diverse ways … while having the distinction of a fellow or senior fellow serves as a nice benchmark to which new hospitalists can aspire and gain recognition as they emerge as leaders in the field.”
Vineet Arora, MD, understands the unique value of being named one of this year’s three Masters in Hospital Medicine. It’s an honor bestowed for hospitalists, by hospitalists.
“I take a lot of pride in an honor determined by peers,” said Dr. Arora, an academic hospitalist at University of Chicago Medicine. “While peers are often the biggest support you receive in your professional career, because they are in the trenches with you, they can also be your best critics. That is especially true of the type of work that I do, which relies on the buy-in of frontline clinicians – including hospitalists and trainees – to achieve better patient care and education.”
The designation of new Masters in Hospital Medicine is a major moment at SHM’s annual meeting. The 2017 list of awardees is headlined by Dr. Arora and the other MHM designees: former SHM President Burke Kealey, MD, and Richard Slataper, MD, who was heavily involved with the National Association of Inpatient Physicians, a predecessor to SHM. The three new masters bring to 24 the number of MHMs the society has named since unveiling the honor in 2010.
Dr. Arora understands that after 20 years as a specialty, just two dozen practitioners have reached hospital medicine’s highest professional distinction.
“I think of ‘mastery’ as someone who has achieved the highest level of expertise in a field, so an honor like Master in Hospital Medicine definitely means a lot to me,” she said. “Especially given the prior recipients of this honor, and the importance of SHM in my own professional growth and development since I was a trainee.”
In addition to the top honor, HM17 will see the induction of 159 Fellows in Hospital Medicine (FHM) and 58 Senior Fellows in Hospital Medicine (SFHM). This year’s fellows join the thousands of physicians and nonphysician providers (NPPs) that have attained the distinction.
SHM also bestows its annual Awards of Excellence (past winners listed here include Dr. Arora and Dr. Kealey) that recognize practitioners across skill sets. The awards are meant to honor SHM members “whose exemplary contributions to the hospital medicine movement deserve acknowledgment and respect,” according to the society’s website.
The 2017 Award winners include:
• Excellence in Teamwork in Quality Improvement: Johnston Memorial Hospital in Abingdon, Va.
• Excellence in Research: Jeffrey Barsuk, MD, MS, SFHM.
• Excellence in Teaching: Steven Cohn, MD, FACP, SFHM.
• Excellence in Hospital Medicine for Non-Physicians: Michael McFall.
• Outstanding Service in Hospital Medicine: Jeffrey Greenwald, MD, SFHM.
• Clinical Excellence: Barbara Slawski, MD.
• Excellence in Humanitarian Services: Jonathan Crocker, MD, FHM.
Dr. Arora, who has served on the SHM committee that analyzes all nominees for the annual awards, recognizes the value of honoring these high-achieving clinicians.
“There is great value to having our specialty society recognize members in different ways,” she said “The awards of excellence serve as a wonderful reminder of the incredible impact that hospitalists have in many diverse ways … while having the distinction of a fellow or senior fellow serves as a nice benchmark to which new hospitalists can aspire and gain recognition as they emerge as leaders in the field.”
Vineet Arora, MD, understands the unique value of being named one of this year’s three Masters in Hospital Medicine. It’s an honor bestowed for hospitalists, by hospitalists.
“I take a lot of pride in an honor determined by peers,” said Dr. Arora, an academic hospitalist at University of Chicago Medicine. “While peers are often the biggest support you receive in your professional career, because they are in the trenches with you, they can also be your best critics. That is especially true of the type of work that I do, which relies on the buy-in of frontline clinicians – including hospitalists and trainees – to achieve better patient care and education.”
The designation of new Masters in Hospital Medicine is a major moment at SHM’s annual meeting. The 2017 list of awardees is headlined by Dr. Arora and the other MHM designees: former SHM President Burke Kealey, MD, and Richard Slataper, MD, who was heavily involved with the National Association of Inpatient Physicians, a predecessor to SHM. The three new masters bring to 24 the number of MHMs the society has named since unveiling the honor in 2010.
Dr. Arora understands that after 20 years as a specialty, just two dozen practitioners have reached hospital medicine’s highest professional distinction.
“I think of ‘mastery’ as someone who has achieved the highest level of expertise in a field, so an honor like Master in Hospital Medicine definitely means a lot to me,” she said. “Especially given the prior recipients of this honor, and the importance of SHM in my own professional growth and development since I was a trainee.”
In addition to the top honor, HM17 will see the induction of 159 Fellows in Hospital Medicine (FHM) and 58 Senior Fellows in Hospital Medicine (SFHM). This year’s fellows join the thousands of physicians and nonphysician providers (NPPs) that have attained the distinction.
SHM also bestows its annual Awards of Excellence (past winners listed here include Dr. Arora and Dr. Kealey) that recognize practitioners across skill sets. The awards are meant to honor SHM members “whose exemplary contributions to the hospital medicine movement deserve acknowledgment and respect,” according to the society’s website.
The 2017 Award winners include:
• Excellence in Teamwork in Quality Improvement: Johnston Memorial Hospital in Abingdon, Va.
• Excellence in Research: Jeffrey Barsuk, MD, MS, SFHM.
• Excellence in Teaching: Steven Cohn, MD, FACP, SFHM.
• Excellence in Hospital Medicine for Non-Physicians: Michael McFall.
• Outstanding Service in Hospital Medicine: Jeffrey Greenwald, MD, SFHM.
• Clinical Excellence: Barbara Slawski, MD.
• Excellence in Humanitarian Services: Jonathan Crocker, MD, FHM.
Dr. Arora, who has served on the SHM committee that analyzes all nominees for the annual awards, recognizes the value of honoring these high-achieving clinicians.
“There is great value to having our specialty society recognize members in different ways,” she said “The awards of excellence serve as a wonderful reminder of the incredible impact that hospitalists have in many diverse ways … while having the distinction of a fellow or senior fellow serves as a nice benchmark to which new hospitalists can aspire and gain recognition as they emerge as leaders in the field.”
VIDEO: Occult cancers contribute to GI bleeding in anticoagulated patients
Occult cancers accounted for one in about every 12 major gastrointestinal bleeding events among patients taking warfarin or dabigatran for atrial fibrillation, according to a retrospective analysis of data from a randomized prospective trial reported in the May issue of Clinical Gastroenterology and Hepatology (2017. doi: org/10.1016/j.cgh.2016.10.011).
These bleeding events caused similarly significant morbidity among patients taking either drug, Kathryn F. Flack, MD, of Icahn School of Medicine at Mount Sinai in New York and her associates wrote. “Patients bleeding from cancer required a mean of approximately 10 nights in the hospital, and approximately one-fourth required intensive care, but 0 of 44 died as a direct result of the bleeding,” the researchers reported. They hoped the specific dabigatran reversal agent, idarucizumab (Praxbind), will improve bleeding outcomes in patients receiving dabigatran.
Source: American Gastroenterological Association
Major gastrointestinal bleeding (MGIB) is the first sign of occult malignancy in certain patients receiving anticoagulation therapy. Starting an anticoagulant is a type of “stress test” that can reveal an occult cancer, the researchers said. Although dabigatran etexilate (Pradaxa) is generally safe and effective, a twice-daily, 150-mg dose of this direct oral anticoagulant slightly increased MGIB, compared with a lower dose in the international, multicenter RE-LY (Randomized Evaluation of Long Term Anticoagulant Therapy) trial (N Engl J Med. 2009;361:1139-51). Furthermore, unlike warfarin, dabigatran therapy places active anticoagulant within the luminal gastrointestinal tract, which “might promote bleeding from friable gastrointestinal cancers,” the investigators noted. To explore this possibility, they evaluated 546 unique MGIB events among RE-LY patients.
Medical chart reviews identified 44 (8.1%) MGIB events resulting from occult gastrointestinal cancers. Cancer accounted for similar proportions of MGIB among warfarin and dabigatran recipients (8.5% and 6.8%; P = .6). Nearly all cancers were colorectal or gastric, except for one case each of ampullary cancer, renal cell carcinoma, and melanoma that had metastasized to the luminal gastrointestinal tract. Colorectal cancer accounted for 80% of cancer-related MGIB overall, including 88% in the dabigatran group and 50% in the warfarin group (P = .02). Conversely, warfarin recipients had more MGIB associated with gastric cancer (50%) than did dabigatran recipients (2.9%; P = .001).
Short-term outcomes of MGIB associated with cancer did not vary by anticoagulant, the investigators said. There were no deaths, but two (4.5%) MGIB events required emergency endoscopic treatment, one (2.3%) required emergency surgery, and 33 (75%) required at least one red blood cell transfusion. Compared with patients whose MGIB was unrelated to cancer, those with cancer were more likely to bleed for more than 7 days (27.3% vs. 63.6%; P less than .001). Patients with occult cancer also developed MGIB sooner after starting anticoagulation (223 vs. 343 days; P = .003), but time to bleeding did not significantly vary by type of anticoagulant.
“Most prior studies on cancer bleeding have been case reports and case series in patients receiving warfarin,” the investigators wrote. “Our study is relevant because of the increasing prevalence of atrial fibrillation and anticoagulation in the aging global population, the increasing prescription of direct oral anticoagulants, and the morbidity, mortality, and complex decision making associated with MGIB and especially cancer-related MGIB in patients receiving anticoagulation therapy.”
The RE-LY trial was sponsored by Boehringer Ingelheim . Dr. Flack reported no conflicts of interest. Senior author James Aisenberg, MD, disclosed advisory board and consulting relationships with Boehringer Ingelheim and Portola Pharmaceuticals. Five other coinvestigators disclosed ties to several pharmaceutical companies, and two coinvestigators reported employment with Boehringer Ingelheim. The other coinvestigators had no conflicts.
Dr. Flack and her colleagues should be congratulated for providing important data as they reviewed 546 major GI bleeding events from a large randomized prospective trial of long-term anticoagulation in subjects with AF. They found that 1 in every 12 major GI bleeding events in patients on warfarin or dabigatran was associated with an occult cancer; colorectal cancer being the most common.
How will these results help us in clinical practice? First, when faced with GI bleeding in AF subjects on anticoagulants, a proactive diagnostic approach is needed for the search for a potential luminal GI malignancy; whether screening for GI malignancy before initiating anticoagulants is beneficial requires prospective studies with cost analysis. Second, cancer-related GI bleeding in dabigatran users occurs earlier than noncancer-related bleeding. Given that a fraction of GI bleeding events were not investigated, one cannot exclude the possibility of undiagnosed luminal GI cancers in the comparator group. Third, cancer-related bleeding is associated with prolonged hospital stay. We should seize the opportunity to study the effects of this double-edged sword; anticoagulants may help us reveal occult malignancy, but more importantly, we need to determine whether dabigatranreversal agent idarucizumab can improve bleeding outcomes in patients on dabigatran presenting with cancer-related bleeding.
Siew C. Ng, MD, PhD, AGAF, is professor at the department of medicine and therapeutics, Institute of Digestive Disease, Chinese University of Hong Kong. She has no conflicts of interest.
Dr. Flack and her colleagues should be congratulated for providing important data as they reviewed 546 major GI bleeding events from a large randomized prospective trial of long-term anticoagulation in subjects with AF. They found that 1 in every 12 major GI bleeding events in patients on warfarin or dabigatran was associated with an occult cancer; colorectal cancer being the most common.
How will these results help us in clinical practice? First, when faced with GI bleeding in AF subjects on anticoagulants, a proactive diagnostic approach is needed for the search for a potential luminal GI malignancy; whether screening for GI malignancy before initiating anticoagulants is beneficial requires prospective studies with cost analysis. Second, cancer-related GI bleeding in dabigatran users occurs earlier than noncancer-related bleeding. Given that a fraction of GI bleeding events were not investigated, one cannot exclude the possibility of undiagnosed luminal GI cancers in the comparator group. Third, cancer-related bleeding is associated with prolonged hospital stay. We should seize the opportunity to study the effects of this double-edged sword; anticoagulants may help us reveal occult malignancy, but more importantly, we need to determine whether dabigatranreversal agent idarucizumab can improve bleeding outcomes in patients on dabigatran presenting with cancer-related bleeding.
Siew C. Ng, MD, PhD, AGAF, is professor at the department of medicine and therapeutics, Institute of Digestive Disease, Chinese University of Hong Kong. She has no conflicts of interest.
Dr. Flack and her colleagues should be congratulated for providing important data as they reviewed 546 major GI bleeding events from a large randomized prospective trial of long-term anticoagulation in subjects with AF. They found that 1 in every 12 major GI bleeding events in patients on warfarin or dabigatran was associated with an occult cancer; colorectal cancer being the most common.
How will these results help us in clinical practice? First, when faced with GI bleeding in AF subjects on anticoagulants, a proactive diagnostic approach is needed for the search for a potential luminal GI malignancy; whether screening for GI malignancy before initiating anticoagulants is beneficial requires prospective studies with cost analysis. Second, cancer-related GI bleeding in dabigatran users occurs earlier than noncancer-related bleeding. Given that a fraction of GI bleeding events were not investigated, one cannot exclude the possibility of undiagnosed luminal GI cancers in the comparator group. Third, cancer-related bleeding is associated with prolonged hospital stay. We should seize the opportunity to study the effects of this double-edged sword; anticoagulants may help us reveal occult malignancy, but more importantly, we need to determine whether dabigatranreversal agent idarucizumab can improve bleeding outcomes in patients on dabigatran presenting with cancer-related bleeding.
Siew C. Ng, MD, PhD, AGAF, is professor at the department of medicine and therapeutics, Institute of Digestive Disease, Chinese University of Hong Kong. She has no conflicts of interest.
Occult cancers accounted for one in about every 12 major gastrointestinal bleeding events among patients taking warfarin or dabigatran for atrial fibrillation, according to a retrospective analysis of data from a randomized prospective trial reported in the May issue of Clinical Gastroenterology and Hepatology (2017. doi: org/10.1016/j.cgh.2016.10.011).
These bleeding events caused similarly significant morbidity among patients taking either drug, Kathryn F. Flack, MD, of Icahn School of Medicine at Mount Sinai in New York and her associates wrote. “Patients bleeding from cancer required a mean of approximately 10 nights in the hospital, and approximately one-fourth required intensive care, but 0 of 44 died as a direct result of the bleeding,” the researchers reported. They hoped the specific dabigatran reversal agent, idarucizumab (Praxbind), will improve bleeding outcomes in patients receiving dabigatran.
Source: American Gastroenterological Association
Major gastrointestinal bleeding (MGIB) is the first sign of occult malignancy in certain patients receiving anticoagulation therapy. Starting an anticoagulant is a type of “stress test” that can reveal an occult cancer, the researchers said. Although dabigatran etexilate (Pradaxa) is generally safe and effective, a twice-daily, 150-mg dose of this direct oral anticoagulant slightly increased MGIB, compared with a lower dose in the international, multicenter RE-LY (Randomized Evaluation of Long Term Anticoagulant Therapy) trial (N Engl J Med. 2009;361:1139-51). Furthermore, unlike warfarin, dabigatran therapy places active anticoagulant within the luminal gastrointestinal tract, which “might promote bleeding from friable gastrointestinal cancers,” the investigators noted. To explore this possibility, they evaluated 546 unique MGIB events among RE-LY patients.
Medical chart reviews identified 44 (8.1%) MGIB events resulting from occult gastrointestinal cancers. Cancer accounted for similar proportions of MGIB among warfarin and dabigatran recipients (8.5% and 6.8%; P = .6). Nearly all cancers were colorectal or gastric, except for one case each of ampullary cancer, renal cell carcinoma, and melanoma that had metastasized to the luminal gastrointestinal tract. Colorectal cancer accounted for 80% of cancer-related MGIB overall, including 88% in the dabigatran group and 50% in the warfarin group (P = .02). Conversely, warfarin recipients had more MGIB associated with gastric cancer (50%) than did dabigatran recipients (2.9%; P = .001).
Short-term outcomes of MGIB associated with cancer did not vary by anticoagulant, the investigators said. There were no deaths, but two (4.5%) MGIB events required emergency endoscopic treatment, one (2.3%) required emergency surgery, and 33 (75%) required at least one red blood cell transfusion. Compared with patients whose MGIB was unrelated to cancer, those with cancer were more likely to bleed for more than 7 days (27.3% vs. 63.6%; P less than .001). Patients with occult cancer also developed MGIB sooner after starting anticoagulation (223 vs. 343 days; P = .003), but time to bleeding did not significantly vary by type of anticoagulant.
“Most prior studies on cancer bleeding have been case reports and case series in patients receiving warfarin,” the investigators wrote. “Our study is relevant because of the increasing prevalence of atrial fibrillation and anticoagulation in the aging global population, the increasing prescription of direct oral anticoagulants, and the morbidity, mortality, and complex decision making associated with MGIB and especially cancer-related MGIB in patients receiving anticoagulation therapy.”
The RE-LY trial was sponsored by Boehringer Ingelheim . Dr. Flack reported no conflicts of interest. Senior author James Aisenberg, MD, disclosed advisory board and consulting relationships with Boehringer Ingelheim and Portola Pharmaceuticals. Five other coinvestigators disclosed ties to several pharmaceutical companies, and two coinvestigators reported employment with Boehringer Ingelheim. The other coinvestigators had no conflicts.
Occult cancers accounted for one in about every 12 major gastrointestinal bleeding events among patients taking warfarin or dabigatran for atrial fibrillation, according to a retrospective analysis of data from a randomized prospective trial reported in the May issue of Clinical Gastroenterology and Hepatology (2017. doi: org/10.1016/j.cgh.2016.10.011).
These bleeding events caused similarly significant morbidity among patients taking either drug, Kathryn F. Flack, MD, of Icahn School of Medicine at Mount Sinai in New York and her associates wrote. “Patients bleeding from cancer required a mean of approximately 10 nights in the hospital, and approximately one-fourth required intensive care, but 0 of 44 died as a direct result of the bleeding,” the researchers reported. They hoped the specific dabigatran reversal agent, idarucizumab (Praxbind), will improve bleeding outcomes in patients receiving dabigatran.
Source: American Gastroenterological Association
Major gastrointestinal bleeding (MGIB) is the first sign of occult malignancy in certain patients receiving anticoagulation therapy. Starting an anticoagulant is a type of “stress test” that can reveal an occult cancer, the researchers said. Although dabigatran etexilate (Pradaxa) is generally safe and effective, a twice-daily, 150-mg dose of this direct oral anticoagulant slightly increased MGIB, compared with a lower dose in the international, multicenter RE-LY (Randomized Evaluation of Long Term Anticoagulant Therapy) trial (N Engl J Med. 2009;361:1139-51). Furthermore, unlike warfarin, dabigatran therapy places active anticoagulant within the luminal gastrointestinal tract, which “might promote bleeding from friable gastrointestinal cancers,” the investigators noted. To explore this possibility, they evaluated 546 unique MGIB events among RE-LY patients.
Medical chart reviews identified 44 (8.1%) MGIB events resulting from occult gastrointestinal cancers. Cancer accounted for similar proportions of MGIB among warfarin and dabigatran recipients (8.5% and 6.8%; P = .6). Nearly all cancers were colorectal or gastric, except for one case each of ampullary cancer, renal cell carcinoma, and melanoma that had metastasized to the luminal gastrointestinal tract. Colorectal cancer accounted for 80% of cancer-related MGIB overall, including 88% in the dabigatran group and 50% in the warfarin group (P = .02). Conversely, warfarin recipients had more MGIB associated with gastric cancer (50%) than did dabigatran recipients (2.9%; P = .001).
Short-term outcomes of MGIB associated with cancer did not vary by anticoagulant, the investigators said. There were no deaths, but two (4.5%) MGIB events required emergency endoscopic treatment, one (2.3%) required emergency surgery, and 33 (75%) required at least one red blood cell transfusion. Compared with patients whose MGIB was unrelated to cancer, those with cancer were more likely to bleed for more than 7 days (27.3% vs. 63.6%; P less than .001). Patients with occult cancer also developed MGIB sooner after starting anticoagulation (223 vs. 343 days; P = .003), but time to bleeding did not significantly vary by type of anticoagulant.
“Most prior studies on cancer bleeding have been case reports and case series in patients receiving warfarin,” the investigators wrote. “Our study is relevant because of the increasing prevalence of atrial fibrillation and anticoagulation in the aging global population, the increasing prescription of direct oral anticoagulants, and the morbidity, mortality, and complex decision making associated with MGIB and especially cancer-related MGIB in patients receiving anticoagulation therapy.”
The RE-LY trial was sponsored by Boehringer Ingelheim . Dr. Flack reported no conflicts of interest. Senior author James Aisenberg, MD, disclosed advisory board and consulting relationships with Boehringer Ingelheim and Portola Pharmaceuticals. Five other coinvestigators disclosed ties to several pharmaceutical companies, and two coinvestigators reported employment with Boehringer Ingelheim. The other coinvestigators had no conflicts.
FROM CLINICAL GASTROENTEROLOGY AND HEPATOLOGY
Key clinical point: Occult cancers accounted for about 1 in every 12 major gastrointestinal bleeding events among patients receiving warfarin or dabigatran for atrial fibrillation.
Major finding: A total of 44 (8.1%) major gastrointestinal bleeds were associated with occult cancers.Data source: A retrospective analysis of 546 unique major gastrointestinal bleeding events from the Randomized Evaluation of Long Term Anticoagulant Therapy (RE-LY) trial.
Disclosures: RE-LY was sponsored by Boehringer Ingleheim. Dr. Flack had no conflicts of interest. Senior author James Aisenberg, MD, disclosed advisory board and consulting relationships with Boehringer Ingelheim and Portola Pharmaceuticals. Five other coinvestigators disclosed ties to several pharmaceutical companies, and two coinvestigators reported employment with Boehringer Ingelheim. The other coinvestigators had no conflicts.
Adapting to change: Dr. Robert Wachter
Robert Wachter, MD, MHM, has given the final plenary address at every SHM annual meeting since 2007. His talks are peppered with his one-of-a-kind take on the confluence of medicine, politics, and policy – and at least once he broke into an Elton John parody.
Where does that point of view come from? As the “dean” of hospital medicine says in his ever-popular Twitter bio, he is “what happens when a poli sci major becomes an academic physician.”
That’s a needed perspective this year, as the level of political upheaval in the United States ups the ante on the tumult the health care field has experienced over the past few years. Questions surrounding the implementation of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and the continued struggles experienced by clinicians using electronic health records (EHR) are among the topics to be addressed.
“While [President] Trump brings massive uncertainty, the shift to value and the increasing importance of building a strong culture, a method to continuously improve, and a way to use the EHR to make things better is unlikely to go away,” Dr. Wachter said. His closing plenary is titled, “Mergers, MACRA, and Mission-Creep: Can Hospitalists Thrive in the New World of Health Care?”
In an email interview with The Hospitalist, Dr. Wachter, chair of the department of medicine at the University of California San Francisco, said the Trump administration is a once-in-a-lifetime anomaly that has both physicians and patients nervous, especially at a time when health care reform seemed to be stabilizing.
The new president “adds an amazing wild card, at every level,” he said. “If it weren’t for his administration, I think we’d be on a fairly stable, predictable path. Not that that path didn’t include a ton of change, but at least it was a predictable path.”
Dr. Wachter, who famously helped coin the term “hospitalist” in a 1996 New England Journal of Medicine paper, said that one of the biggest challenges to hospital medicine in the future is how hospitals will be paid – and how they pay their employees.
“The business model for hospitals will be massively challenged, and it could get worse if a lot of your patients lose insurance or their payments go way down,” he said.
But if the past decade of Dr. Wachter’s insights delivered at SHM annual meetings are any indication, his message of trepidation and concern will end on a high note.
The veteran doctor in him says “don’t get too distracted by all of the zigs and zags.” The utopian politico in him says “don’t ever forget the core values and imperatives remain.”
Perhaps that really is what happens when a political science major becomes an academic physician.
Robert Wachter, MD, MHM, has given the final plenary address at every SHM annual meeting since 2007. His talks are peppered with his one-of-a-kind take on the confluence of medicine, politics, and policy – and at least once he broke into an Elton John parody.
Where does that point of view come from? As the “dean” of hospital medicine says in his ever-popular Twitter bio, he is “what happens when a poli sci major becomes an academic physician.”
That’s a needed perspective this year, as the level of political upheaval in the United States ups the ante on the tumult the health care field has experienced over the past few years. Questions surrounding the implementation of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and the continued struggles experienced by clinicians using electronic health records (EHR) are among the topics to be addressed.
“While [President] Trump brings massive uncertainty, the shift to value and the increasing importance of building a strong culture, a method to continuously improve, and a way to use the EHR to make things better is unlikely to go away,” Dr. Wachter said. His closing plenary is titled, “Mergers, MACRA, and Mission-Creep: Can Hospitalists Thrive in the New World of Health Care?”
In an email interview with The Hospitalist, Dr. Wachter, chair of the department of medicine at the University of California San Francisco, said the Trump administration is a once-in-a-lifetime anomaly that has both physicians and patients nervous, especially at a time when health care reform seemed to be stabilizing.
The new president “adds an amazing wild card, at every level,” he said. “If it weren’t for his administration, I think we’d be on a fairly stable, predictable path. Not that that path didn’t include a ton of change, but at least it was a predictable path.”
Dr. Wachter, who famously helped coin the term “hospitalist” in a 1996 New England Journal of Medicine paper, said that one of the biggest challenges to hospital medicine in the future is how hospitals will be paid – and how they pay their employees.
“The business model for hospitals will be massively challenged, and it could get worse if a lot of your patients lose insurance or their payments go way down,” he said.
But if the past decade of Dr. Wachter’s insights delivered at SHM annual meetings are any indication, his message of trepidation and concern will end on a high note.
The veteran doctor in him says “don’t get too distracted by all of the zigs and zags.” The utopian politico in him says “don’t ever forget the core values and imperatives remain.”
Perhaps that really is what happens when a political science major becomes an academic physician.
Robert Wachter, MD, MHM, has given the final plenary address at every SHM annual meeting since 2007. His talks are peppered with his one-of-a-kind take on the confluence of medicine, politics, and policy – and at least once he broke into an Elton John parody.
Where does that point of view come from? As the “dean” of hospital medicine says in his ever-popular Twitter bio, he is “what happens when a poli sci major becomes an academic physician.”
That’s a needed perspective this year, as the level of political upheaval in the United States ups the ante on the tumult the health care field has experienced over the past few years. Questions surrounding the implementation of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and the continued struggles experienced by clinicians using electronic health records (EHR) are among the topics to be addressed.
“While [President] Trump brings massive uncertainty, the shift to value and the increasing importance of building a strong culture, a method to continuously improve, and a way to use the EHR to make things better is unlikely to go away,” Dr. Wachter said. His closing plenary is titled, “Mergers, MACRA, and Mission-Creep: Can Hospitalists Thrive in the New World of Health Care?”
In an email interview with The Hospitalist, Dr. Wachter, chair of the department of medicine at the University of California San Francisco, said the Trump administration is a once-in-a-lifetime anomaly that has both physicians and patients nervous, especially at a time when health care reform seemed to be stabilizing.
The new president “adds an amazing wild card, at every level,” he said. “If it weren’t for his administration, I think we’d be on a fairly stable, predictable path. Not that that path didn’t include a ton of change, but at least it was a predictable path.”
Dr. Wachter, who famously helped coin the term “hospitalist” in a 1996 New England Journal of Medicine paper, said that one of the biggest challenges to hospital medicine in the future is how hospitals will be paid – and how they pay their employees.
“The business model for hospitals will be massively challenged, and it could get worse if a lot of your patients lose insurance or their payments go way down,” he said.
But if the past decade of Dr. Wachter’s insights delivered at SHM annual meetings are any indication, his message of trepidation and concern will end on a high note.
The veteran doctor in him says “don’t get too distracted by all of the zigs and zags.” The utopian politico in him says “don’t ever forget the core values and imperatives remain.”
Perhaps that really is what happens when a political science major becomes an academic physician.
Networking: A skill worth learning
Ivan Misner once spent one week on Necker Island – the tony 74-acre island in the British Virgin Islands that is entirely owned by billionaire Sir Richard Branson – because he met a guy at a convention.
And Misner is really good at networking.
“I stayed in touch with the person, and when there was an opportunity, I got invited to this incredible ethics program on Necker where I had a chance to meet Sir Richard. It all comes from building relationships with people,” said Misner, founder and chairman of BNI (Business Network International), a 32-year-old global business networking platform based in Charlotte, N.C., that has led CNN to call him “the father of modern networking.”
The why doesn’t matter most, Misner said. A person’s approach to networking, regardless of the hoped-for outcome, should always remain the same.
“The two key themes that I would address would be the mindset and the skill set,” he said.
The mindset is making sure one’s approach doesn’t “feel artificial,” Misner said.
“A lot of people, when they go to some kind of networking environment, they feel like they need to get a shower afterwards and think, ‘Ick, I don’t like that,’” Misner said. “The best way to become an effective networker is to go to networking events with the idea of being willing to help people and really believe in that and practice that. I’ve been doing this a long time and where I see it done wrong is when people use face-to-face networking as a cold-calling opportunity.”
Instead, Misner suggests, approach networking like it is “more about farming than it is about hunting.” Cultivate relationships with time and tenacity and don’t just expect them to be instant. Once the approach is set, Misner has a process he calls VCP – visibility, credibility, and profitability.
“Credibility is what takes time,” he said. “You really want to build credibility with somebody. It doesn’t happen overnight. People have to get to know, like, and trust you. It is the most time consuming portion of the VCP process... then, and only then, can you get to profitability. Where people know who you are, they know what you do, they know you’re good at it, and they’re willing to refer a business to you. They’re willing to put you in touch with other people.”
But even when a relationship gets struck early on, networking must be more than a few minutes at an SHM conference, a local chapter mixer, or a medical school reunion.
It’s the follow-up that makes all the impact. Misner calls that process 24/7/30.
Within 24 hours, send the person a note. An email, or even the seemingly lost art of a hand-written card. (If your handwriting is sloppy, Misner often recommends services that will send out legible notes on your behalf.)
Within a week, connect on social media. Focus on whatever platform that person has on their business card, or email signature. Connect where they like to connect to show the person you’re willing to make the effort.
Within a month, reach out to the person and set a time to talk, either face-to-face or via a telecommunication service like Skype.
“It’s these touch points that you make with people that build the relationship,” Misner said. “Without building a real relationship, there is almost no value in the networking effort because you basically are just waiting to stumble upon opportunities as opposed to building relationships and opportunities. It has to be more than just bumping into somebody at a meeting... otherwise you’re really wasting your time.”
Misner also notes that the point of networking is collaboration at some point. That partnership could be working on a research paper or a pilot project. Or just even getting a phone call returned to talk about something important to you.
“It’s not what you know or who you know, it’s how well you know each other that really counts,” he added. “And meeting people at events like HM17 is only the start of the process. It’s not the end of the process by any means, if you want to do this well.”
Ivan Misner once spent one week on Necker Island – the tony 74-acre island in the British Virgin Islands that is entirely owned by billionaire Sir Richard Branson – because he met a guy at a convention.
And Misner is really good at networking.
“I stayed in touch with the person, and when there was an opportunity, I got invited to this incredible ethics program on Necker where I had a chance to meet Sir Richard. It all comes from building relationships with people,” said Misner, founder and chairman of BNI (Business Network International), a 32-year-old global business networking platform based in Charlotte, N.C., that has led CNN to call him “the father of modern networking.”
The why doesn’t matter most, Misner said. A person’s approach to networking, regardless of the hoped-for outcome, should always remain the same.
“The two key themes that I would address would be the mindset and the skill set,” he said.
The mindset is making sure one’s approach doesn’t “feel artificial,” Misner said.
“A lot of people, when they go to some kind of networking environment, they feel like they need to get a shower afterwards and think, ‘Ick, I don’t like that,’” Misner said. “The best way to become an effective networker is to go to networking events with the idea of being willing to help people and really believe in that and practice that. I’ve been doing this a long time and where I see it done wrong is when people use face-to-face networking as a cold-calling opportunity.”
Instead, Misner suggests, approach networking like it is “more about farming than it is about hunting.” Cultivate relationships with time and tenacity and don’t just expect them to be instant. Once the approach is set, Misner has a process he calls VCP – visibility, credibility, and profitability.
“Credibility is what takes time,” he said. “You really want to build credibility with somebody. It doesn’t happen overnight. People have to get to know, like, and trust you. It is the most time consuming portion of the VCP process... then, and only then, can you get to profitability. Where people know who you are, they know what you do, they know you’re good at it, and they’re willing to refer a business to you. They’re willing to put you in touch with other people.”
But even when a relationship gets struck early on, networking must be more than a few minutes at an SHM conference, a local chapter mixer, or a medical school reunion.
It’s the follow-up that makes all the impact. Misner calls that process 24/7/30.
Within 24 hours, send the person a note. An email, or even the seemingly lost art of a hand-written card. (If your handwriting is sloppy, Misner often recommends services that will send out legible notes on your behalf.)
Within a week, connect on social media. Focus on whatever platform that person has on their business card, or email signature. Connect where they like to connect to show the person you’re willing to make the effort.
Within a month, reach out to the person and set a time to talk, either face-to-face or via a telecommunication service like Skype.
“It’s these touch points that you make with people that build the relationship,” Misner said. “Without building a real relationship, there is almost no value in the networking effort because you basically are just waiting to stumble upon opportunities as opposed to building relationships and opportunities. It has to be more than just bumping into somebody at a meeting... otherwise you’re really wasting your time.”
Misner also notes that the point of networking is collaboration at some point. That partnership could be working on a research paper or a pilot project. Or just even getting a phone call returned to talk about something important to you.
“It’s not what you know or who you know, it’s how well you know each other that really counts,” he added. “And meeting people at events like HM17 is only the start of the process. It’s not the end of the process by any means, if you want to do this well.”
Ivan Misner once spent one week on Necker Island – the tony 74-acre island in the British Virgin Islands that is entirely owned by billionaire Sir Richard Branson – because he met a guy at a convention.
And Misner is really good at networking.
“I stayed in touch with the person, and when there was an opportunity, I got invited to this incredible ethics program on Necker where I had a chance to meet Sir Richard. It all comes from building relationships with people,” said Misner, founder and chairman of BNI (Business Network International), a 32-year-old global business networking platform based in Charlotte, N.C., that has led CNN to call him “the father of modern networking.”
The why doesn’t matter most, Misner said. A person’s approach to networking, regardless of the hoped-for outcome, should always remain the same.
“The two key themes that I would address would be the mindset and the skill set,” he said.
The mindset is making sure one’s approach doesn’t “feel artificial,” Misner said.
“A lot of people, when they go to some kind of networking environment, they feel like they need to get a shower afterwards and think, ‘Ick, I don’t like that,’” Misner said. “The best way to become an effective networker is to go to networking events with the idea of being willing to help people and really believe in that and practice that. I’ve been doing this a long time and where I see it done wrong is when people use face-to-face networking as a cold-calling opportunity.”
Instead, Misner suggests, approach networking like it is “more about farming than it is about hunting.” Cultivate relationships with time and tenacity and don’t just expect them to be instant. Once the approach is set, Misner has a process he calls VCP – visibility, credibility, and profitability.
“Credibility is what takes time,” he said. “You really want to build credibility with somebody. It doesn’t happen overnight. People have to get to know, like, and trust you. It is the most time consuming portion of the VCP process... then, and only then, can you get to profitability. Where people know who you are, they know what you do, they know you’re good at it, and they’re willing to refer a business to you. They’re willing to put you in touch with other people.”
But even when a relationship gets struck early on, networking must be more than a few minutes at an SHM conference, a local chapter mixer, or a medical school reunion.
It’s the follow-up that makes all the impact. Misner calls that process 24/7/30.
Within 24 hours, send the person a note. An email, or even the seemingly lost art of a hand-written card. (If your handwriting is sloppy, Misner often recommends services that will send out legible notes on your behalf.)
Within a week, connect on social media. Focus on whatever platform that person has on their business card, or email signature. Connect where they like to connect to show the person you’re willing to make the effort.
Within a month, reach out to the person and set a time to talk, either face-to-face or via a telecommunication service like Skype.
“It’s these touch points that you make with people that build the relationship,” Misner said. “Without building a real relationship, there is almost no value in the networking effort because you basically are just waiting to stumble upon opportunities as opposed to building relationships and opportunities. It has to be more than just bumping into somebody at a meeting... otherwise you’re really wasting your time.”
Misner also notes that the point of networking is collaboration at some point. That partnership could be working on a research paper or a pilot project. Or just even getting a phone call returned to talk about something important to you.
“It’s not what you know or who you know, it’s how well you know each other that really counts,” he added. “And meeting people at events like HM17 is only the start of the process. It’s not the end of the process by any means, if you want to do this well.”