To be an effective member of a hospital board committee, a hospitalist must represent the greater interests of all stakeholders—not just his or her own self-interest, cautions Dr. Combes. However, “as physicians become more stressed and production-oriented, giving up clinical time to participate in governance activities becomes more and more difficult,” he concedes. Hospitalists should choose committee assignments based on their interests and expertise.
Dr. Williams encourages hospitalists in his group to pick one committee—preferably one focused on care delivery (quality improvement, pharmacy and therapeutics, utilization review) and take an active role. “Then, over time, I encourage them to try to chair committees to obtain leadership experience,” he says.
Taking on too many extracurricular committee tasks can be counterproductive. To avoid this, Flores advises younger hospitalists to ask themselves the following:
- What will my committee participation do to support the goals of the committee and the organization?
- By participating in this committee, can I expand my own knowledge or understanding of the culture and politics of the organization?
- Can I become more comfortable interacting on an organizational level?
- Can I network and get to know people I wouldn’t otherwise encounter, who can be helpful to me personally?
In addition, Dr. Atchley believes rotating committee assignments is also beneficial, especially for the younger hospitalist. In his tenure as a hospitalist, Dr. Atchley has served as chairman of the Department of Medicine’s credentials and quality assurance committees, and as vice president of the medical staff. Each committee furnishes hospitalists with a different perspective about how the hospital functions.
“I think hospitalists should understand the medical staff bylaws and procedures,” says Dr. Atchley. “Each hospital medicine staff has this governance structure, and I have found it beneficial in resolving conflicts about patient care and interaction between physicians.”
Mary A. Dallas, MD, has seen the committee situation from both sides of the fence. She is medical information officer for Presbyterian Healthcare Services, an integrated healthcare delivery network in Albuquerque, N.M., but served as medical director of Presbyterian’s hospitalist group for five years before that.
“Hospitalists have a vested interest in making sure their work area is protected, so they need to plant some people in strategic places for the governance and medical staff,” says Dr. Dallas. “In order to be effective in the governance of the hospital, you have to be part of that medical substructure and get involved.”
For instance, as medical director, she sat on the hospital’s credential committee and found it allowed her to keep tabs on new HMG hires going through the credentialing process. “This [the hospital] is your work environment,” she explains. “You are here day in and day out, and you should shape that environment, have a say in policies and rules, so that you can make your job more successful and make patient care better.”
The Quandary over Compensation
Many hospitalists feel frustrated when committee obligations impinge on clinical duties. Is compensation the answer for filling committee slots? Opinions are mixed.
Dr. Williams says he is “a little uncomfortable with the concept of people getting paid every time they attend a committee meeting. For hospitalists who receive funding from the hospital to support their programs, it’s important for the leader [of the HMG] to ensure that they’re collaborating with hospital administration. The hospital has the expectation that, as part of our salary structure, we will be members of committees. That needs to be part of the job.”
Dr. Dallas agrees: “Regardless of whether you’re getting paid or not, this is your work environment. I think it’s very important to be involved, so that your voice is heard and so that you can help make the [hospital] structure better.”