The “He’s Not Heavy, He’s My Colleague Award” goes to Nashua, N.H.-based Southern New Hampshire Medical Center (SNHMC) hospitalists: Stewart Fulton, DO, SNHMC’s solo hospitalist for more than a year, answered call 24/7, with help from the community doctors whose inpatients he was following. Though he was joined eventually by the group’s second hospitalist, Suneetha Kammila, MD, chaos reigned for the next year. They hired a third hospitalist and eventually grew to five physicians and moved from call to shifts. By the third year, SNHMC had 10 hospitalists—two teams of five—and moved to the seven days on/seven days off schedule everyone wanted. The tenacity of HMG leaders Dr. Fulton and Dr. Kammila allowed the group to survive its early scheduling hardships.
The “If We Were Cars, We’d Be Benzes or Beemers Award” goes to the Colorado Kaiser-Permanente hospitalists in Denver. Part of an organization that prides itself on perfecting processes and improving transparency in healthcare, this group had all the tools to get their scheduling right. They started with the widely used seven on/seven off schedule but found it dissatisfying both personally and professionally. Through consensus, they arrived at a schedule of six consecutive eight-hour days of rounding with one triage physician handling after-hours call. There are two hospitalists on-site, 24 hours a day, seven days a week, and they admit and cross-cover after 4 p.m.
The “Planning Is Everything Award” goes to the Brockie Hospitalist Group in York, Pa. Both the hospital and the city of York are in a sustained growth mode. There are several large outpatient practices waiting for Brockie’s hospitalist group to assume their inpatients. The 18 hospitalists have wisely demurred, allowing their office-based colleagues to turn over the inpatient work only when the hospitalists can handle the additional load. Hospitalists choose either a 132-hour or a 147-hour schedule that is divided into blocks over three weeks, with a productivity/incentive program that changes as the increasing workload dictates.
The “Scheduling Is a Piece of Cake Award” goes out to Scott Oxenhandler, MD, chief hospitalist at Hollywood Memorial Hospital in Florida. Dr. Oxenhandler left an office practice for the hospitalist’s chance to practice acute care medicine with good compensation and benefits, reduced paperwork, and a great schedule. He recruited 21 hospitalists. Most work an 8 a.m. to 5 p.m. schedule, while a nocturnist covers the hours from 8 p.m. to 8 a.m. Ten physicians handle the 5 to 8 p.m. “short call” four times a month. The large number of hospitalists allows flexibility in scheduling to accommodate individual needs.
The “We Grew Past Our Mistakes Award” has been earned by Presbyterian Inpatient Care Systems in Charlotte, N.C. This program started as a two-physician, 5 p.m. to 7 a.m. admitting service for community physicians too busy to cover call. The hospitalists quit, wanting more out of medicine than an admitting service. Four hospitalists who were committed to providing inpatient care replaced them, with better results. The group now has more than 30 physicians working 12-hour shifts and co-managing, with sub-specialists, complex care. A nocturnist, working an eight-hour shift instead of the 12-hour shift that burned out a predecessor, covers night admissions and call.
Tighter Times?
Could the days of hospitalists fretting about work/life balance and optimal schedules be drawing to an end, as hospitals cast a jaundiced eye on the value hospitalists create versus what they cost? Chris Nussbaum, MD, CEO of Synergy Medical Group, based in Brandon, Fla., thinks so. He employs 10 hospitalists who cover six Tampa-area hospitals located within 15 minutes of each other. The group just switched from call to a 7 a.m. to 7 p.m. shift schedule. Dr. Nussbaum deploys hospitalists based on each hospital’s average daily census, so a doctor could cover several hospitals a day.