There is value to having residents, agrees Dr. Iobst. “There’s the value of serving as a mentor; of training future colleagues; and the value for people who are enthused by the opportunity to teach. The key is to clearly establish all the boundaries and get them on the table to begin with, define which ones are absolutely required and are not flexible, and to ensure that the administration of the hospital that is supporting the hospitalists understands that need.”
Dr. Amin believes program directors need hospitalists to serve as faculty and that hospitalists need to take into account residency rules and regulations so the program can retain accreditation status.
“It’s a two-way street,” he says. “It doesn’t help anybody if the residency program is not accredited, and it doesn’t help anybody if the hospitalist faculty members don’t have good morale.” At UC Irvine, he says: “We try not to develop systems that overwhelm the residents; we also try not to develop systems that allow faculty to be overwhelmed. On the other hand, patient care is not predictable all the time, so some of the ACGME rules may put people into difficult situations.”
Goals and Relationships
Dr. Amin believes that if hospitalists and residency program directors can advocate for their own programs and work together for the greater good, they can craft an exponentially better team model.
One way to achieve this is to encourage more hospitalist directors to also serve as associate program directors/program directors of residency programs. This, he says, “could potentially help facilitate a stronger bridge between both programs.”
Within hospitalist groups, directors can encourage understanding about the dual sets of goals. It’s important for group leaders to involve everyone in the group when making decisions so people feel they are part of the process, says Alan L. Wang, MD, chief medical officer at Emory Johns Creek Hospital in Ga., and co-director of the hospitalist program.
Another tool for aligning hospitalists on their team with hospital goals, he says, is to share the patient workload. “One of the most important ways for medical directors to increase their credibility with the team members is to do shift work,” he asserts. “Getting in the trenches allows you to understand the day-to-day issues and problems that your hospitalists face.”
Dr. Shabbir notes that the burden of good relationship building should not fall solely to the group leaders. “There has to be an effort on all sides,” he says. “It can’t work with the leader alone trying. As a hospitalist, I think the focus has to be not only patient care, but also system efficiency, because, in the end, that makes for better overall patient care.”
Dr. Amin and others believe tensions between residency and hospitalist programs will resolve over time, in part due to hospitalists taking associate program director and program director roles, and in part to increased cooperation.
“The hospitalist could be the program director’s best friend and viewed as a vehicle for developing and training residents in system-based practice, competency-based learning and refinement of communication skills,” he says. TH
Gretchen Henkel is a frequent contributor to The Hospitalist.