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Designing a career for the long haul

September 2008

Published in the September 2008 issue of Today’s Hospitalist

WHAT’S THE SECRET TO WORKING IN HOSPITAL MEDICINE long into your career? According to G. Ronald Nicholis, MD, the solution is to embrace change.

Dr. Nicholis, 61, has gone from being a community pediatrician, a medical director of a staff model HMO and the director of one of the country’s first pediatric hospitalist programs to working fulltime in medical informatics. That diversity has helped him actively support a specialty that many view as a better fit for younger physicians.

He began his hospitalist career at Children’s Mercy South, a satellite of the large teaching hospital, Children’s Mercy Hospital in Kansas City, Mo. Named section chief of the hospitalist program in 1998, he knew that he wanted the community-hospital program to eventually grow to include the main campus. He also knew that as he got older, he would not be able to maintain the rigorous pace of hospitalist practice at a tertiary care center.

“I knew the program would become too complex,” says Dr. Nicholis. “I realized that as I got into my late 50s, the pressure I would put on myself to perform clinically at the main hospital, along with doing nights and weekends, would lead to a heart attack.”

But Dr. Nicholis has learned that when one door closes, another one often opens “if you pay attention to the needs of your hospital. In his first year with the Mercy South program, he helped design an electronic template for discharge summaries.

That template worked so well that the hospitalist group developed a similar one for history and physicals. Within a year, all the hospitalists at the satellite facility had switched from paper to all-electronic documentation and to computer physician-order entry within three years.

A homegrown handheld documentation system soon followed. Dr. Nicholis then helped migrate that technology, along with the hospitalist program, to the main Children’s Mercy campus.

Needing time to teach subspecialists how to use those information systems, he went half-time in informatics in 2004, then full-time in 2006. He is now helping both hospitals switch to a new electronic medical record system “and relying on his decades of clinical experience to choose and develop the best point-of-care electronic tools.

His advice to young hospitalists for forging a long-term career is the same now as when he first started hiring them in 1998. “Embrace change, and try different things” says Dr. Nicholis. “You’ll get really good at some of them and find yourself being offered opportunities later in your career that you never dreamed possible.”