Rising costs of care. Decreasing access to care. Inequities in access to quality care. Inequities in care. Systemic bias and racism. Polarizing politics. Decreasing resources. Aging systems. Aging itself. Increasing medical coding complexities. Rising mental health needs. Urban consolidation, rural abandonment. Burnout. The American medical system is facing a crisis horrific enough to give up—and some are. The great resignation, the big quit, the great reshuffle, quiet quitting. Health care workers have not escaped this consequence, and many are leaving the field—retiring early, seeking other paths, and not choosing medicine in the first place.
Dr. Thompson
“In the midst of every crisis, lies great opportunity,” at least according to Albert Einstein. I ask you to look back over the last three years and see the power of what we can do when we’re rightfully motivated, even if by fear of something as big as a pandemic. We came together in ways no one could predict we would. We generated new knowledge in a matter of weeks that historically would have taken years. We found ways to expand our networks, and our ability to care.
Hospitalists played multiple vital roles in the pandemic response. We cared for more than 75% of patients hospitalized with COVID-19, and we took it to the next level. We led the development of infrastructure and innovation. We are the key leaders and change agents in acute care medicine. We are innovators and poised to make a difference. Our health systems experienced our power first-hand and are now demanding we step up to solve the puzzle of the future of acute care.
While we settle into this new normal with COVID-19 alongside influenza, RSV, etc., we’re also confronted with the multiple stressors facing health care and a societal disequilibrium that defines our 2023 reality. It can be overwhelming but let’s think back to our collective accomplishments.
We are BOLD. We developed new efficiencies of care. We implemented geo-rounding for everything from COVID-19 units to COVID-19 field hospitals. We challenged outdated bylaws and prevailed to allow our nurse practitioner and physician assistant colleagues to practice at the top of their licenses, celebrating our inclusive community. We tested myriad staffing solutions to spread the resources of clinicians and caregivers as broadly as we could. We are agile and flexible. We are not afraid to fail forward.
We are INNOVATIVE. We quickly adopted remote monitoring for admission avoidance and early discharge. We flexed into tele rounding, sometimes with nothing more than an iPad. We experimented with hospital at home, and some truly leveraged this. We think outside the box, designing new ways to provide care.
We are COMPASSIONATE. Not only did we care for the medical disease in front of us, but we also considered the whole person. We led efforts to ensure Goals of Care evaluations. We led state discussions of how to ration care if and when it came to it. We recognized inequities in care and outcomes, and we are determined to address these. We supported our colleagues. We care for our patients, and our communities; and we care for each other.
We are CONNECTED. We participated in unprecedented inter-system communication and collaboration. We leveraged our hospital medicine networks across historically rival health systems. We leveraged our broader networks across specialties to provide coordinated care. Our teams brought the rapidly developed scientific knowledge from the bench to the bedside to the patient. We are stronger together.
Reflecting on all that we’ve accomplished as the collective of hospital medicine, I have no doubt it will be our people, our community, that will bring us out of this storm and into a brighter future.
In 2022 we emboldened our voice. We no longer fear staking a claim; we know it’s our duty. We will let you know that we believe gun violence in America is a health care crisis born of a lack of attention to our people and that abortion is health care, not political policy. We meticulously review and critique the Centers for Medicare and Medicaid rules finding every tiny detail that impacts our community. We take a stand and shout about per-country caps on green cards and how our colleagues and their families live under the threat of being sent away despite their great personal sacrifice to care for the American people. We did not back down when the X-waiver returned, and we prevailed in eliminating this blockade to provide appropriate care for patients. In the omnibus package at the close of 2022, we achieved a two-year expansion for telehealth flexibilities; we achieved an extension of the Conrad State 30 program to protect hospitalist immigrants, who are vital to the health care system; we mitigated an 8% cut in Medicare reimbursement, reducing this to 2%; we extended the Alternative Payment Model incentive in the hopes they will continue their evolution; and we extended the Hospital at Home waiver through the end of 2023. We supported getting the Dr. Lorna Breen Health Care Provider Protection Act into law, opening new avenues to fund mental and behavioral health for clinicians and caregivers. And all of this was just in 2022. Our SHM team and colleagues are poised to continue this work into 2023 and beyond.
In 2022 our community came together at SHM Converge and in many other venues made possible by SHM. Our chapters are growing strong and providing local and regional support and networking. Our special interest groups offer platforms for us to converse, collaborate, and construct. Our publications are reaching further and further. Our committees embrace essential tasks on behalf of all of our members to help create a better world. We launched “The Prez Room,” a setting where members can speak directly with our Board about real issues we face daily. We’ve hosted several “Prez Room” sessions exploring pediatrics, leadership, and joy in medicine, and discussing SHM strategic planning. SHM provides a community where all people can participate and contribute.
With SHM at our backs, let’s all dig down and not just find, but resurface that bright piece inside each of us, because WE are so much more than any one of us. Remember why you are here; why we are here; what we are capable of; and reflect this collective power forward for a better tomorrow.
Dr. Thompson is the chief medical officer at Snoqualmie Valley Hospital and Public Health District in Snoqualmie, Wash., and SHM’s president.