Shift Coverage
Ease and availability of shift coverage varies greatly between small and large groups. In the latter, for example, physicians experience a good deal of schedule flexibility because more people can cover shifts or do the work. When Donna Beeson, DO, a hospitalist at Kadlec Medical Center in Richland, Wash., worked at the large St. Luke’s Health System in Kansas City, Mo., she had help in most aspects of practice.
“There was interventional radiology for all procedures, eICU [technology] to help with intensive care patients, a more experienced ancillary staff available for emergency situations, more partners to help out when your load gets to be too much,” Dr. Beeson says. She also had strong ancillary support at St. Luke’s, where three nurses were available to the HMG at all times.
Having so many people, however, prevented Dr. Beeson from learning her staff’s strengths and weaknesses. That’s where a smaller group has its advantages. What it lacks in physician and staff availability, it makes up for in operating as a cohesive unit, Dr. Metcalf says. “A small group of physicians is more likely to be more relationally connected and, therefore, more willing to provide help to their colleagues when special needs arise and patient-care assistance is needed,” he says.
The hospital medicine group at Riverside Tappahannock Hospital in Tappahannock, Va., exemplifies the small, cohesive group. Randy Ferrance, MD, medical director there, says having a small group made it easier to work out a three-weeks-on, one-week-off schedule (necessary because the physicians sometimes work 100-hour weeks).
In addition, though there are fewer hands in a smaller program, certain tasks, such as X-rays, reports and lab tests get accomplished with fewer hiccups. Plus, knowing the staff’s idiosyncrasies means understanding when a matter needs immediate attention or when it can be addressed later.
Dr. Beeson believes this phenomenon has made her a stronger doctor. “You know that you cannot always rely on someone else,” she says. “You realize that you have to do something or you have to make the diagnosis, because the consultant may not [do so] and you do not have a willing IR staff to help you with procedures.”
That means wearing many hats, an aspect of working in a small HMG that Dr. Ferrance says he loves. “I get to treat a lot of clinical cases that in a large hospital, a specialist might be called in to treat, whether that is necessary or not.”
One drawback to a smaller HMG is the difficulty transferring patients to bigger hospitals. It is more time consuming and challenging, Dr. Beeson says, and you lose the ability to follow through with a patient to the end of a diagnosis or disease process.
Advancement and Research Opportunities
It may seem like a no-brainer that opportunities for research and career advancement exist more within larger groups. This isn’t always the case, however, says Brian Wolfe, MD, a hospitalist with Cogent Healthcare who practices at Temple University in Philadelphia. “The ability for a group to offer protected time to do research may be more linked to the setting and schedule than whether a group is large or small.”
Of course, it doesn’t hurt to work at an institution that conducts a good deal of research, such as UMass Memorial Medical Center in Worcester Mass. Elizabeth Gundersen, MD, a hospitalist there, says she enjoys the large group’s abundant opportunities to participate in quality projects in areas of medicine that interest her. “I also enjoy having a large and diverse group of colleagues,” she adds. “I get to interact with my fellow hospitalists during the workday, whether it is to bounce ideas off them or just to socialize. There is a great amount of energy within the group.”