Wachter’s “Mega-trends”
As is traditional at SHM meetings, Bob Wachter wrapped up the meeting with his insights on the present and future of hospital medicine. Dr. Wachter, who coined the term “hospitalist,” presented “Whipsawed: Can Hospitalists Survive in the Face of Co-Management, Non-Teaching Services, Transparency and the Reality of Perpetual Change.”
Dr. Wachter sees six “mega-trends” affecting hospital medicine:
1. Quality and value issues: “Even if payer pay-for-performance stalls out, local programs will grow,” he predicted. “When transparency increases, your CMO will start asking for accountability from the hospital medicine program. There will likely be a bonus scheme attached to this.”
2. Patient safety: “The emergence of state reporting systems is huge,” Wachter said. “I’m not sure if that’s good or not.” One key shift is the National Quality Forum’s list of 28 “never events,” or errors that are clearly identifiable, preventable, and serious for patients. “You’ll start to see more pressure from state bureaucrats on this.”
3. Information technology: The downside of enhanced technology, Wachter believes, is that “IT leads to dislocation of medicine. The physician relationships that are formed while we’re on the floor are gone.” Doctors can now complete their notes at home or in their office.
4. Co-management: There is massive growth in opportunities for co-managing patients. Dr. Wachter sees this as inevitable: “Don’t bother trying to not own it. It’s going to happen.”
5. ACGME regulations for teaching institutions: “We’ve seen the end of using residents as a cheap labor pools,” Dr. Wachter said. “Now academic hospitals have to figure out how to be like community hospitals.”
6. Work force issues: Tremendous growth requires comprehensive changes to how business is done. “Thriving now takes a new set of skills: leadership, change management, team building, and the skill to say ‘No’ or ‘Yes, if you can …’ ” said Dr. Wachter. Sharing those skills with your clinical hospitalists is imperative, he stressed: “Now, leadership and innovation must be everyone’s job. Your practice must become a bureaucracy.”
There is good news, Dr. Wachter stressed: “We’re in the driver’s seat. We can demand” what we need to survive and thrive.