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2022: Covid volumes were down, but covid-driven problems persisted

December 2022

2022 WAS THE THIRD year that hospitalists, at least at the beginning of the year, continued to treat waves of covid patients. By year’s end, hospitals had more patients with flu than covid.

But hospitalists continue to deal with a ton of fallout from the pandemic, including staff shortages, limited transfer options, doctors cutting back hours and the threat of burnout.

Here are some of this year’s Today’s Hospitalist highlights:

Among big stories, there was some good news. In “Rising comp: Is it a blip or a trend?” (July/August), we reported that during the pandemic, hospitalists saw at least double-digit pay hikes. And as covid volumes waned, clinicians had some breathing room to consider this question: “Pandemic-driven innovations: What to keep?” (May/June). With the immediate crisis passing, clinicians could pick which pandemic-driven changes—in roles, workflows and leadership—they wanted to maintain.

But there were new problems, including “Is the big quit hitting hospital medicine?” (March/April). At least one source in that article told us, “Many of us are now looking at life through a different lens, reassessing what’s really important in the long run.”

Transfer delays” (September-October) delved into what happens when health systems are always at capacity. Community hospitals can’t transfer patients out, while mergers among large health systems mean there are now fewer beds available.

Perhaps this year’s key cover story was “Is your group calling in backup too often?” (November/December). After working through covid, doctors won’t pick up extra shifts, and hospitals strapped for revenue won’t consider hiring locums. Instead of PRN staffing, a hallmark of hospital medicine for years, at least one article source in our article advocated for an “overhire strategy” to “allow programs to better weather surges and retain their hospitalists.”

medical-education-trainingMedical education during the plague years” (January/February) looked at how residents and students experienced innovation and community as well as burnout and lethal disinformation. “Negotiating tips” (July/August) was a good reminder that you need negotiating skills to succeed in clinical practice.

And “The push is on for higher productivity” (November/December) raised one of the biggest worries hospitalists now have. Even though some doctors have cut shifts and nurse staffing remains unstable, the pressure is on for clinicians to do more with less.

Many of our shorter articles looked at teamwork. Gauging covid’s impact on teamwork (November/December), for instance, underscored the importance of a healthy team culture, while “A mobile app to manage team workflows” (July/August) highlighted a tool that allows clinical teams to share a virtual workspace.

Gossip is good!” (March/April)—or at least healthy gossip—can improve group efficiency, while “What are best practices for clinical texting” (September/October) found that doctors and nurses have very different ideas on texting best practices.

But just as important were articles that highlighted physician wellbeing and work-life balance.Parental leave: Programs need to do better” (July/August) revisited a tough topic that became much more complicated during covid.

And in “How to preserve an overwhelmed workforce” (January/February), we spoke to the lead author of an opinion piece that made it clear that physicians need a lot more than wellness resources. She and her coauthors proposed a 10-point plan that called on institutions, regulatory bodies and organized medicine to provide tactical support and comprehensive mental health resources.

Several What Works features dealt with key problems during the pandemic: “Preventing pressure injuries in proned patients” (March/April) underscored the need for specialized nursing in patients on ventilators, while “Structured review cuts SNF discharges in half” (January/February) spoke to the challenge (one that hasn’t been resolved) of finding post-acute beds.

Then there was this reminder of the other deadly epidemic: “Transforming buprenorphine treatment, culture” (May/June). The article underscored the need for hospitalists to initiate treatment in at-risk patients.

Our “Medicine and music as healing arts” (May/June) profile featured a physician with the improbable dual career as hospitalist and music promoter. Hospitalist Stella Fitzgibbons, MD, in “What I wish someone had told my younger self” (May/June) described key lessons learned on the job.

And in our “Palliative care: (a lot) more than a DNR service” (March/April) commentary, a physician author made the case for hospitalists to call in palliative care for many more patients—and a lot sooner.

We were lucky again this year to run “Progress Notes,” the comic collaboration between hospitalist Leo Motter, MD, and his illustrator colleague Dan Langsdale.”Thanksgiving in the ER” (November/December) catalogued holiday hazards, including the blunt-force trauma that can result from families talking politics around the table.

And “Denial: an essential part of every pandemic” (January/February) placed covid in a long line of killer diseases from bubonic plague and AIDS to the opioid epidemic. The constants across them all: finding some group to blame and repudiating science.

Thanks to everyone who shared their time and insights and to all our readers. Best wishes for a healthy and fulfilling New Year.

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