The hospitalists are deeply connected to the community, knowing when to bring in pastoral care or family therapy, as well as joining in celebrations for weddings and anniversaries.
SAGH has made typical Planetree physical changes, including remodeling one floor into six-patient nursing pods versus one nursing station for 42 patients, along with adding meditation rooms, libraries, a piano in the lobby, and a fish tank. Physicians, patients, and visitors are treated to Brahms’ Lullaby over the loudspeaker system every time a baby is born and can experience pet visitations and aromatherapy.
The Schedule
UF’s hospitalists initially adopted a rotation of seven days on, seven days off. When the group’s nocturnist left because of the heavy burden of night admissions, the nine hospitalists decided to cover call themselves instead of hiring a replacement nocturnist. Every ninth week, a hospitalist takes call Monday through Thursday, with residents carrying the weekend. It isn’t ideal, but it distributes call evenly and ensures hospitalists two free weekends a month.
Like most hospital medicine groups, UF’s hospitalists are trying to tinker with the schedule to make it more flexible. They had some give for Scott Medley, MD, who retired from his large Gainesville private practice of 10 physicians, 65 employees, five offices, and 40,000 patients in 2002 at age 55.
“My private [practice] kept me busy seven days a week. I had been there, done that, got the T-shirt,” says Dr. Medley. “I had enough of private practice, but I didn’t want to leave medicine. On reflection, I realized that what I enjoyed most is taking care of really sick patients, so I contacted Whit Curry, and he hired me as a hospitalist Monday through Friday mornings.”
Dr. Medley loves being an employee, doesn’t mind covering for younger colleagues on holidays, and is now collaborating with specialists who have been his friends and colleagues for 25 years. “I also enjoy teaching younger docs both the art and the economics of medicine—and not having to worry where my next paycheck is coming from,” he says.
Looking ahead, Dr. Miller relishes being a hospitalist at age 47, but wonders what the pace will feel like another decade out. To be more flexible, the group is considering allowing physicians to work more days but fewer hours, initiating job sharing, and recruiting more retirees like Dr. Medley, who can work shorter days and are willing to pinch-hit when coverage is tight. They are working toward consensus on maximizing flexibility while maintaining coverage. Still, there’s no easy solution to fluctuations in census, and Dr. Curry notes that some days span 7:30 a.m. to 3:30 p.m., while others stretch into the night. “We haven’t found a better solution yet to providing care 24 hours a day, 365 days a year,” concludes Dr. Medley.