Published in the September 2008 issue of Today’s Hospitalist
AS I TRAVEL AROUND THE COUNTRY, I hear more and more about the growing job dissatisfaction among physicians. Doctors, it seems, increasingly complain about too many hours, too many hassles and too little personal return on their practice of medicine.
So I ask myself and my peers: How can physicians today find professional satisfaction? The answer seems obvious: As physicians, we are trained to care for patients. For us, satisfaction comes from solving a diagnostic dilemma, implementing an effective treatment plan or, in some cases, saving a life. The satisfaction we derive from making a difference in patients’ lives is a big part of what drew us to medicine in the first place.
Increasingly, however, caring for patients is only one aspect of our job. As I work closely with fellow physicians and hospitals, I see the many challenges “mounting paperwork for HIPAA regulations, DRG billing and risk management “that can chip away at job satisfaction.
But I submit that physicians can derive tremendous satisfaction from meeting these challenges. And I would argue that this is more true for hospitalists than perhaps any other group of physicians.
While satisfaction is an issue for all physicians, it’s particularly important for hospitalists.
On a day-to-day basis, hospitalists probably deal with more issues that lead to dissatisfaction than other specialties. We run the risk of taking on too many services, for example, and leaving ourselves open to burnout. We often have the stress of providing care to the hospital’s entire population of medically indigent patients. And we see firsthand the bureaucratic inertia or misuse of resources that make it hard to deliver high-quality care.
But while hospitalists may be at ground zero for all the factors that can lead to dissatisfaction, there is good news: By virtue of our central role, hospitalists now exert increasingly greater control over how care is delivered in our hospitals. We can leverage that control to enhance our own job satisfaction.
Needed: new skills
To tap into that potential satisfaction, hospitalists need to embrace new skills. As a group, we need to move beyond what we’ve been traditionally trained to do, which is to provide day-today medical rounding and to establish a diagnosis and treatment plan.
As more physicians move from primary care to hospital medicine, hospitalists must learn to augment our clinical skills with new expertise in process re-engineering. Instead of working as “internists without offices,” we need to embrace our full potential as inpatient physicians.
How do hospitalists differ from internists without offices? An internist without an office sees one patient with pneumonia and develops an individual treatment. A hospitalist not only sees and treats that one patient with pneumonia today, but is standardizing care and designing a more efficient way to treat the 300 patients admitted for pneumonia at the hospital during the entire year. The hospitalist is managing care for entire populations of patients with specific diagnoses, acquiring not only a greater skill level but also the ability to affect how that entire population is managed.
Hospitalists need to drive quality improvements, organize and lead care teams, and harness technology to improve physician performance. Without these skills, we may find ourselves overwhelmed and see our professional satisfaction slipping. But those of us who embrace our role as the driver of inpatient change stand to reap tremendous personal and professional rewards.
Exerting new leadership
Hospitalists can use new operational expertise to participate on or even chair hospital committees. We can engage in the joint operating committees with case management and utilization review personnel administrators, health plan executives, and specialists. We can even answer a call to act as chief of staff, a position that helps us shape clinical care and hospital culture beyond the hospitalist program. In fact, about 70%of IPC hospitalists are part of hospital committees.
Hospitalists are now the key players in quality efforts related to the Joint Commission and in the continuing growth of pay-for-performance initiatives sponsored by the Centers for Medicare and Medicaid Services. In addition, hospitalists can champion and cultivate nationwide programs to improve patient care such as the “5Million Lives” campaign from the Institute for Healthcare Improvement.
These new avenues of professional development promise to exert a profound effect on the future delivery of inpatient care. As the specialty matures, our influence “and our corresponding satisfaction “will only get greater.
The impact of new skill sets goes far beyond the individual patients we treat. Instead, our evolving skills create a powerful ripple effect that reverberates throughout a hospital system.
Physicians’ thorough documentation, for example, allows more accurate DRG coding, leading to higher hospital revenues and better funding for programs. Expertise with information technology makes it possible to deliver safer care and to assess “and improve “our own clinical performance.
The vital support that hospitalists provide makes it possible for specialists to focus on delivering high-quality outpatient care, giving them more control over their time, workflow and revenue. That, in turn, plays an increasingly pivotal role in improving the work lives of the community physicians with whom we interact.
There will always be doctors for whom job satisfaction is simply a matter of providing good care in return for a solid paycheck and decent hours. But the hospitalists I meet who derive the most satisfaction from their jobs are setting new parameters for hospital medicine and rising to the challenge of building a better health care system for all patients.
Adam Singer, MD, is chief executive officer of IPC The Hospitalist Company.