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Opting for experience in a young physicians' field



Published in the June 2010 issue of Today's Hospitalist

CHARLES HODGES, MD, thinks that his hospitalist service is the most experienced program in the country.
While he has no definitive data to back up his claim, Dr. Hodges points to the nearly 250 years of combined practice experience among the 13 physicians in his group. In his mind, that makes the group, which works at Duke Raleigh Hospital in Raleigh, N.C., the most experienced hospitalist program in the country, at least relative to its size.

According to the latest Society of Hospital Medicine data, the median age of hospitalists is 37. According to Dr. Hodges, who is director of the Duke Raleigh inpatient medical service, the median age in his group is 55. One physician is over 60, and six others (including himself ) are over 50. In addition, 10 group members worked in primary care practices before switching to hospital medicine. Even the three physicians in the group who've worked only in hospital medicine had at least five years experience before they were hired.

Dr. Hodges—who joined the group in 2001 after 12 years in private practice—says that having so many team members with a deep background in primary care offers many advantages. For one, there's so little turnover that the group has lost only three physicians in nine years, and it hasn't lost one in the past five years.

"The group knows what's out there, and the doctors don't need to go to private practice to see if they like it," Dr. Hodges says. "Because we were always expected to put in very long hours, this is less work for us than in our previous careers."

That track record gives group members an appreciation for primary care physicians' needs. And it allows the doctors to establish, Dr. Hodges feels, a quick social rapport with patients. That's a big plus in a field where "you have to gain trust with patients, especially older ones."

You might think that with so much medical decision-making experience, the group sees a high volume of patients. But Dr. Hodges notes that each group member is expected to see only an average of 15 patients per shift—and that the older physicians in his group don't round as fast as "the newer folks."

"When new hires come here, they tend to change," he says. "The culture of our group encourages spending more time with patients, and that tends to slow the younger physicians down over time."

What about covering nights? Each doctor pulls no more than two consecutive night shifts per month, in part out of deference to the group's median age.

And while the group previously stuck with only experienced physicians, a physician right out of training is joining the program in September— the first such hire since the program was launched in 1999. "She's a really strong physician, and she's from this area and wants to stay," says Dr. Hodges. "We're overcoming our fears."
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