A Program in Transition

Expert Advice on Managing Growth

Handling a hospitalist program’s growth effectively is a minefield—one that managers should navigate with guidance from change masters. Here are some pointers from experts:

John Nelson, MD, director of the hospitalist practice for Overlake Hospital of Bellevue, Wash., and columnist for “Practice Management,” (see p. 69) says:

• The popular 7-on/7-off schedule might paradoxically increase burnout. “Such a schedule has the doctor working a low number of days over the year, leading to the need to see many patients during the seven days on to keep the practice economically viable,” he explains. “Some doctors on this schedule live their lives only on their days off, leading to increased resentment of work.”
• In most cases “a patient volume cap is a bad idea for a whole practice such that non-hospitalists are obligated to help out … ,” he says. “Such a cap creates the appearance of the hospitalist practice operating like a team of residents. The other doctors probably don’t have a cap and you don’t want to stand out as the group that has to have outside help.”
• Hospitalist practices that are growing eventually need a separate night shift because increased patient volume makes it increasingly unreasonable to take calls from home.
• Good compensation helps with recruitment, but has little to do with long-term job satisfaction. Focusing on practice dynamics rather than pay may ensure happy doctors and thriving practices.

Billie Blair, PhD, president/CEO of Leading and Learning, Inc. of Temecula, Calif., offers these insights:

• A business plan that projects patient/staffing loads, break-even points, and so forth as a roadmap to growth management is necessary.
• Application of predictive algorithms is necessary for rapid growth areas (e.g., patient volume, peak admission times, number of referring physicians).
• Creation of a flexible staffing plan in advance must be done to accommodate uneven growth in the early years.
• Use of directed management coaching can support hospitalist leaders.
• Hospitalists need strong in-house education program or regular training opportunities to address growth and greater levels of program complexity.—MP