And Then There Are Committees
Even though committee participation is technically considered “volunteer” time, physicians who are elected chiefs of their hospital sections are automatically expected to participate. It behooves hospitalists to participate in committee work at their institutions, believes Dr. Dallas, because this is often where governance decisions are made about how they will practice in the hospital.
Tom Baudendistel, MD, is associate residency program director at California Pacific Medical Center, a community-based hospital in San Francisco operated by Sutter Health. The hospitalists in his group are very involved in committee work. “The committees are important, and we want the administration to match our faces to our names, especially when it comes to budget negotiation time,” he explains. “That is a direct benefit of being visible participants in committees.”
Committee participation may be handled differently in purely academic settings. The time Dr. Rosenbloom spends in committees related to department support is credited to his work schedule. The problem comes when, once again, that participation takes more time than expected. One of his weekly committees routinely runs a half hour longer than its one-and-a-half hour time slot and requires five to eight hours of preparatory work. As is common with his peers, Dr. Rosenbloom has sometimes used his allotted consulting time to cover extra commitments related to his primary job.
Temptations to Say Yes
Invitations to participate in extra administrative or educational duties often naturally flow to productive people, observes Dr. Dallas. “You may be dragged into a lot of different work that you didn’t necessarily need to be into,” she says. “You just have to step back periodically and ask, ‘Is this right for me? Am I the right person to be involved? Are there other people who can do this? And then, say no. Really, that’s OK!” (See “Triage What’s Important,” p. 15, for tips.]
“It’s easy to get overloaded,” admits Dr. Baudendistel. “I certainly found myself overextended more often earlier in my career.” Saying yes to additional commitments can be related to workplace power dynamics, he believes. “When people who are in positions above you approach you about a project that is going to take time—whether or not it’s your passion or skill set—there is pressure to want to please that person. Saying no is a skill, and if you say ‘absolutely not’ early on in your career, you will not be asked to do other things. You may be shooting yourself in the foot.”
Defining Trails
It’s natural enough for hospitalists to feel optimistic about the openness of the future, says Dr. Hovan. Hospitalists may feel that the time investments they make now to nurture their profession within their institutions are temporary and may not always be as intense. The hope is that “the specialty is going to be more mature and [will] become more self-sustaining in the near future. Yet you glimpse over the horizon, and that’s not really true,” he says ruefully. “Everything in hospital medicine has nascency about it. There are no established trails. When we define one role, another one emerges.”
Many hospitalist services, for example, are now expanding beyond the medical floor to the surgical floor to perform consults to provide post-surgical management of medical issues.
Dr. McKean sees the “overwhelming demand for service” as one of hospital medicine’s trickiest challenges. “Basically, because hospitalists are young and energetic and wanting to please, it’s very easy for them to feel like they have to meet all the service obligations.” But this propensity can derail the overall mission of and vision for the hospitalist service if physicians do not set clear goals for themselves and their groups.