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New careers for physicians

Hospitalists make the leap from clinical practice

November 2013

Published in the November 2013 issue of Today’s Hospitalist

ONE THING YOU HAVE TO GIVE HOSPITAL MEDICINE: It’s had great timing. Hospitalists started arriving in hospitals not only as outpatient physicians and specialists were rushing for the door. They also came on the scene when the use of information technology was about to explode and the call to ramp up and improve quality became a roar.

As a result, hospitalists have been thrust into a wide range of roles beyond patient care, giving them all kinds of new career options. It’s no surprise, then, that hospital medicine has proved to be a very effective stepping stone to other careers in health care, and that many hospitalists, still in their 30s or 40s, are feeling the lure of other interests or career options beyond clinical practice.

Here’s a look at several hospitalists who have exchanged their white coats and stethoscopes for pursuits far from the hospital floors.

Moving into management
Erik DeLue, MD, MBA

If you ask Erik DeLue, MD, MBA, why he has left clinical practice (for the most part) to take a position in hospital management, he points out that it’s been an evolution.

“I had been a hospitalist medical director for 12 years at three different systems,” says Dr. DeLue, who is program director of inpatient care services for Virtua, a large New Jersey health system, and medical director at Virtua Voorhees Hospital. “If you do a job well, at a certain point it’s time to try something different. It was for me, at least.”

As medical director at Virtua Voorhees, Dr. DeLue now oversees clinical issues across many disciplines “including surgery and obstetrics “for both self-employed and hospital-employed physicians. And as program director of inpatient care services across Virtua’s four hospitals, “I have the responsibility to standardize medical treatment across the system,” he says. “We have more than 1,000 doctors on staff.”

In his new roles, Dr. DeLue sometimes has to make decisions that have a big impact on positions he’s never held, such as nursing or finance. And he’s had to rethink his former notions of leadership.

As hospitalist director, he explains, “It’s easy to lead by example because you’re in the trenches with your colleagues.” But that track record still helps him lead the many doctors he now oversees who aren’t hospitalists.
“Most docs recognize that I have practiced for 13 years now, so I can speak their language and understand their needs,” he says. At the same time, he notes, “I can’t imagine being in my role without those years of hospitalist practice. Given that we live in the hospital as hospitalists, we grow in dog years in terms of learning a hospital’s culture. What would be the equivalent in terms of years in the hospital for specialists and internists who don’t spend much time there?”

While he’s had to become much more conversant with hospital business, policy and regulation, being outside a hospitalist program now “has reaffirmed what I have believed for a long time about hospital medicine: It’s really the foundation of the hospital.” Moving into management, he adds, makes complete sense.

“You know the hospital inside out,” says Dr. DeLue, who still works one day a week as a hospitalist, primarily as an admitter. “You know the nurses and the doctors, and they know your work. It’s a very natural transition.”

At the same time, “I appreciate clinical work more than I ever have,” Dr. DeLue says. “There’s an immediate reward in interacting with patients that you don’t experience as a medical director or an administrator.”

Diving into analytics
Ruben Nazario, MD

Five years ago, Ruben Nazario, MD, would not have predicted he would be working on the business side of health care. But now that Dr. Nazario, a pediatric hospitalist, has made the change “he’s with the Bowie, Md.-based Inovalon, which combines health care data analytics with targeted interventions to improve outcomes “it doesn’t feel like such a major stretch.

“I have always had other interests, so there were signs,” says Dr. Nazario, whose new title is medical director of clinical analytics. When he was working as a hospitalist with Inova Children’s Hospital in Virginia, he was tapped to help lead implementation of the system’s new electronic health record. “I could tell that physicians were glad to have a colleague in that position rather than a consultant, and I enjoyed it,” Dr. Nazario says.

But his 9-to-5 schedule now takes him completely out of the clinical realm and away from interactions with other physicians. He’s now one of only five doctors who spend their days thinking about CMS and NCQA quality measures and working with universities, insurers, pharmacy benefits firms, consultants and technology vendors to devise quality improvement solutions,

It’s all new, and that’s OK by him. “I’ve always had a restless mind,” he says. “That’s why I started looking for new avenues.”

It’s been a real challenge, he notes, to “prove” himself. That’s been a particularly big adjustment after working many years as a hospitalist in both academic and community settings. And Dr. Nazario didn’t expect his new corporate experience to change his view of health care so dramatically.

“Before, I always saw things from the clinical side,” Dr. Nazario says.
“Now I see how complex it really is and how many players, industries, regulatory bodies and businesses there are, and why it’s one-fifth of the economy.”

And while he spent his years in clinical practice resenting handing over “bits of health care decision-making to administrators, insurers or the government,” he now realizes those entities play a key role, and not in a bad way.

“A lot of what goes on in health care is generated by a financial motive,” says Dr. Nazario. “But there are many folks out there trying to improve patient care across the board, and I used to be much more skeptical about that.”

He also has had to cultivate new skills. “I have had to become more agile,” he says, as well as more adept researching esoteric topics and more open-minded about what his job description entails.

But the best part of his new gig? “I have dedicated time to think creatively, which I didn’t have before,” Dr. Nazario says. “I also have weekends off, and I want to keep it that way.”

Building a company from scratch
Julianna Lindsey, MD, MBA

When she moved from being a fulltime hospitalist to chief operations officer and strategist for a surgicalist startup she helped create, Julianna Lindsey, MD, MBA, had a hard time parting with one cherished aspect of
October 2008 being a nocturnist: her wardrobe. “I can’t wear my scrubs to work anymore,” Dr. Lindsey says. “That’s been a big adjustment.”

Some aspects of her new role as entrepreneur with Synergy Surgicalists “a national practice management company based in Bozeman, Mont., that places surgicalist programs in hospitals “aren’t a real stretch. Her MBA training, for instance, certainly “drove home that a process is a process, whether you’re making brake pads or getting patients to surgery on time,” says Dr. Lindsey, who still works several hospitalist shifts a month.

“Even before I went to business school, I looked at the financial side of things, like how much a test costs. I’m just doing that now on a broader scale.”

But many of the skills she’s developing to “sell” administrators on surgicalist programs are completely different from those used as a doctor on the wards.

“This is a completely different ball game,” she notes “one in which being a physician doesn’t guarantee a sale. Just like physicians may put more faith in what other doctors have to say, Dr. Lindsey finds the same is true for hospital executives.

“They engage in a lot of ‘group think,’ and their decisions are highly influenced by people they know,” she says. Coming in to sell them a new program, even with an MD, “you have no credibility. You’re a stranger in a strange land.”

Learning how to pitch the startup she’s building with MD/MBA colleagues isn’t the only new skill Dr. Lindsey is using. She’s creating the company’s infrastructure, setting up customer resource management and charge capture software.

She’s figuring out how to manage the company’s database, and to train and credential the surgicalists staffing the new programs. She’s even spending time analyzing graphic design in terms of the company’s marketing materials.

In the process, she’s garnered “elite” status on several airlines. “That’s something you don’t want,” she admits, “especially when you have little kids.”

Still, she’s thrilled she chose to be an entrepreneur, particularly with her current partners. But Dr. Lindsey points to one big lesson learned in the company’s first year.

“We’re ready now to find venture capital to facilitate hiring business development people,” she says. Who are they looking for to take those business development slots? “Former hospital administrators who can use their contacts. In this industry, you’ve got to know somebody. Unfortunately, there may always be a divide between doctors and hospital administrators.”

All-in on EHRs
Ned Jaleel, DO, MMM, CPE

If you look closely at what Ned Jaleel, DO, MMM, CPE, has been doing in his spare time over the last several years ” first earning a master’s degree in medical management, then a graduate certificate in health care IT “his relatively new position, as lead physician informaticist for the Boston-based EHR company Meditech, makes sense.

“I was headed in this direction, even if I didn’t really know it, because I have always had an interest in leveraging technology to improve patient safety,” Dr. Jaleel says. “Throughout my career, I was always trying to figure out how we can use EHRs to get the right information to hospitalists.”

That’s exactly what Dr. Jaleel is doing now, but on a much bigger scale. He spends most of his time helping Meditech develop its new inpatient EHR platform, even though he still devotes one week a month to hospitalist practice. That 25% chunk, he thinks, is “the minimum” for staying on top of the real-life issues hospitalists run into using technology.

The position, says Dr. Jaleel, was a “natural progression” from being a hospitalist medical director helping a hospital employer tweak its technology systems. But the job isn’t any easier.

“People ask me if it’s less stressful,” he says. “I tell them that it’s just a different kind of stress than running around doing admissions.”

Dr. Jaleel says he misses the camaraderie you develop on the floors. “I find myself outside my comfort zone sometimes in the corporate environment because it’s so formal,” he says.

“But who better to design an EHR for a hospital than a hospitalist? We’re intimately involved with the technology, and we understand physician workflow.”

And his new job has taught him a surprising lesson about himself: He really enjoys constantly speaking to an audience of chief information officers, C-suiters and physicians as one of the frontpeople for Meditech. A major responsibility in his new position is presenting demonstrations of product enhancements or new products in the pipeline.

“When I first signed up for the job, I had done public speaking only infrequently, so it used to be a big deal,” Dr. Jaleel says. “Now it’s becoming second nature.”

Bonnie Darves is a freelance health care writer based in Seattle.