Published in the December 2013 issue of Today’s Hospitalist
YOUR HOSPITALIST GROUP SEEMS TO BE THRIVING. Your doctors (and midlevels, if you have them) are productive and satisfied with their jobs, the hospital administrators look happy to see you in the halls, and the new guy who just joined seems to like the group fine. The ER nurses have your phone number memorized and call you when an unassigned patient needs an admission or a consult.
But things can change in just a few months. The most popular member of your group is lured away by a teaching program, and another decides to pursue fellowship training. The hospital has a new vice president or financial officer who makes it clear that your group’s length of stay and cost-per-case numbers do not meet with his approval. And the remarks you hear at the most recent general staff meeting are decidedly uncomplimentary.
Let’s take a look at what makes a group successful ” and at those telltale signs that your favorable situation is beginning to unravel.
“We’re so happy your group has joined us”
As members of the hospital staff lose interest in taking ER call, contracting with or hiring a hospitalist group “and there are many possible arrangements, ranging from loose contracts to hospital employment to national practice companies “looks like a good way to fill the bill. For a while, things are rosy as the doctors who don’t have to answer ER calls welcome your arrival and the administration is happy to have solved that problem, even if it has to subsidize the care of indigent patients.
But in just a few months, particularly if the hospital is in an area with a large percentage of uninsured patients, you may be handed some figures that make you look bad in comparison with the rest of the hospital staff.
Your patient satisfaction rating, for instance, is lower than that of a private-practice internist who admits longstanding patients from her office. She can even beat your average length of stay because her patients’ insurance covers stays in a skilled nursing facility and home IV antibiotics.
Making things look better
It is hard to underestimate the importance of a good practice group leader. Meeting with administrators every month or so (a regularly scheduled meeting, not one called on short notice by an unhappy VP) gives that leader a chance to both present your statistics in a positive light and point out the differences between your practice and that of Dr. Cadillac.
A good leader can also make suggestions to improve readmission rates by using data from programs in other areas, offer to help organize wound care clinics or infusion visits, and give an occasional in-service for the nurses who make post-discharge phone calls to high-risk patients.
What about the committees that do much of a hospital’s most important work? A hospitalist group can’t afford not to be part of the ones that make decisions for ICUs and ERs. And taking part in other committees lets others see group members as valued colleagues, not outsiders or competitors.
Unless you’re in a teaching program where the department chair heads the medicine section in your hospital, the medicine chief “and chief of staff “are probably elected by your fellow physicians, many of whom don’t want the extra chores of leadership. These positions give you some control over meeting agendas, advance warning of administrators’ plans and a way to solidify your position.
It’s far harder for a power-seeking administrator to pressure out doctors who are helping maintain the institution’s quality and stability.
Keeping those eggs in different baskets
When I was a hospitalist with a large corporate group, I often got tired of being urged to “grow the practice” when we were already busy. But if most or all of your patients come from your hospital contract or from a single primary care group, your practice is in danger if the situation changes.
Offer to admit your consultants’ patients and make sure the surgeons know you’re available to help with patients’ medical problems. Not only will you expand your group, but those financial people who have been complaining will have less to say.
Consultant Martin Buser of Hospitalist Management Resources LLC, a national hospitalist consulting firm based in Del Mar, Calif., and Colorado Springs, Colo., points out that great patient care by hospitalists isn’t enough to ensure the longevity of your group. Instead, a sound political base and credibility “supported by the statistics that administrators take as evidence of your performance “are critical.
“Effective hospitalist leaders get so ingrained in the political fabric of the organization,” Mr. Buser says, “that it is almost impossible to replace them without a major battle.” Support from surgeons is doubly valuable because administrators tend to think of surgeons as doctors who bring income into the hospital.
Protect your Achilles’ heel
With hospitalists now one of the most hotly recruited specialties, it is all too easy for a member of your group to be lured away, often on very short notice.
If your group is large, the loss of one member won’t affect productivity much. But if you have only three or four members, that loss can be a mortal wound.
If you’re responsible for covering ER shifts, you may have to drop some of them, which leads to your being seen as unreliable. That in turn leads to a drop in your business … You get the picture.
Adam Singer, MD, founder and CEO of IPC The Hospitalist Company Inc., the national hospitalist practice company, recommends that hospitalist groups stay in a perpetual recruiting mode. Why? As Dr. Singer puts it, “not all departures are planned.” Younger doctors may stay only until their educational debts are paid off, while those of any age may need to relocate if there’s a family illness or a spouse’s transfer.
Staying in recruiting mode may be easier for a group affiliated with a larger company. That’s because corporate resources include recruiters who can save the cost of headhunters and because larger companies often have their own “traveling” physicians who can cover gaps until slots are filled.
Stop, look and listen
If there’s been a recent shift in the tone of your meetings with administration, don’t write it off as a temporary mood swing. Find out who and what is behind the increased complaints, and talk with your supporters about possible remedies.
You may be able to counter negative statistics with some of your own, particularly if you point to ones that have improved since your group came on board. Listen to the other doctors in your group, and ask how much flexibility you can offer in work schedules and productivity pay. One physician may want to take a reduced number of shifts instead of leaving entirely, or he or she may at least recommend your group to a friend looking for a new practice.
Keep the lines of communication open, pay attention to what you hear in the halls and the doctors’ lounge, and ask your friends to do the same. A high-quality hospitalist group can make a huge difference in a hospital’s operations and quality of care “and it is well worth fighting for.
Don’t wait until it’s too late to take action to keep your group prospering.
Stella Fitzgibbons, MD, has been a hospitalist since 2002 and has worked with a variety of small and large groups. She welcomes comments, criticisms and flashbacks from colleagues.