“I think hospital medicine is a very accessible profession for women on a number of levels,” says Dr. Wellikson. “This is a young, growing, evolving field—as opposed to some of the more static fields in medicine, like orthopedics or thoracic surgery. One of the hallmarks of hospital medicine is creating true teams of health professionals. Women come in as equals, with good ideas, and I think this is mirrored on the SHM Board.”
Currently, four of the 12 SHM board members are women; Jean Huddleston, MD, of the Mayo Clinic is a past president; and the incoming president, Mary Jo Gorman, MD, of IPC, is also a woman. “We [the Society of Hospital Medicine] are very much an open tent,” remarks Dr. Wellikson.
According to Sylvia Cheney McKean, MD, FACP, medical director of the Brigham and Women’s Hospital/Faulkner Hospitalist Service in Boston, there are pros and cons to hospital medicine being a new specialty.
“In some ways, because [hospital medicine] is a new specialty, women may have been given the opportunity to lead hospitalist programs because early hospitalist services—at least initially—were viewed as experimental,” she says. “Many hospital leaders hired hospitalists to function as ‘super residents’ rather than as leaders. So, therefore, academic institutions didn’t really feel that they had much to lose by hiring women versus men, and many hospitalist leaders—male and female—found themselves functioning as middle managers without necessarily having much input into their job descriptions.
“Even in 2006 some physician administrators hire hospitalists with the expectation that turnover is inevitable as physicians advance to other specialties,” continues Dr. McKean. “Hospital administrators and residency directors may not understand the evolving role of hospitalists as change agents in the hospital setting and may not recognize that hospitalists offer special expertise in addition to on-site availability. So it’s a two-edged sword. A lot of hospital medicine programs, because they have not only young physician leaders, but also proportionately more female physician leaders, may find that they really cannot have the same amount of clout as other established specialties within the department of medicine hierarchy.”
Dr. Halasyamani believes that the male hierarchy may be changing. In hospital medicine, she notes, “because the emphasis in inpatient care delivery is so team focused, the leaders in hospital medicine who are able to best meet those goals and have those skills are really the ones who are being given the most opportunity. If the structures within organizations are very hierarchical, then care delivery ends up looking that way. But if the leadership and decision-making structures are more collaborative, then I think care reflects that.”
At her institution, Dr. Halasyamani has had numerous opportunities to help build some of those new structures. For example, in the past year, she helped form an institutional quality and patient safety collaborative practice team, which she chaired jointly with the head of nursing. The team “brings together people who touch the patient; they identify the barriers in delivering the type of care that we want to be proud of every time, and to help solve those problems.”
Possible Pitfalls
Can hospital medicine, in fact, succeed in developing new leadership paradigms? Much will depend on consciously constructing new systems for nurturing talent and leaders. “You really have to think through your mechanisms for recognizing and rewarding achievement and ask if those mechanisms encourage the behaviors you want to encourage, or do they disadvantage people who do the work that you most want done?” says Dr. Ash.
For example, she says, the collaborative nature of hospital medicine can create problems with career advancement. “To do something meaningful, you may need to involve 20 people on a five-year project,” she explains. “How do you ensure that those people don’t get punished for choosing that work?”