SHM prides itself on being a “big tent” organization—inclusive of care providers with different training backgrounds, from varied clinical settings, and representing a multitude of hospital roles. SHM’s diversity expands beyond care providers to include other key stakeholders, such as administrators of hospitalist programs or departments. The diversity was highlighted in the society’s 2007-2008 “Bi-annual Survey on the State of the Hospital Medicine Movement,” which shows that 40% of our members are hospital-employed, 20% are from academic settings, about 15% work in large multistate management companies, and the remaining 25% are equally split between multispecialty practices and local hospitalist groups. The diversity extends to internists, pediatricians, family practitioners, nurse practitioners, physician assistants, specialists—the list goes on.
All of us at SHM appreciate that diversity and routinely try to nurture it. Our board of directors includes physicians from all the aforementioned practice settings and includes dedicated seats for such key constituencies as pediatrics. We have more than 25 committees and task-force groups representing all the key factions of our membership. These groups address issues of relevance to every type of hospitalist and hospitalist group. Our annual meeting has evolved to meet the needs of this diverse membership by addressing an enormous volume of topics and incorporating a variety of tracks that cater to general hospitalists, quality experts, academics, and pediatricians.
One notable area in which we lack diversity: age. We are a young specialty; the average hospitalist is 40 years old.
SHM’s organizational diversity creates challenges; new issues surface every year. One key issue is the balance between academic hospitalists and community hospitalists. Academic hospitalists have wanted SHM to more aggressively support their interests. Community hospitalists want SHM to advocate for their interests, as well as develop programs and projects to meet their needs.
With my election as president and the recent election of another academic hospitalist to serve as SHM president in 2010-2011, there might be some concern that community hospitalists could get lost in an academic agenda. Interestingly, academic hospitalists might have raised similar concerns several years ago following the election of a second consecutive community hospitalist as society president. We have been fortunate to have leaders who can see the whole HM picture, regardless of their professional backgrounds.
One Tent, Many Spikes in the Ground
The issues are more complex than simply the differences between academic and community hospitalists. Appropriately, each of our members wants their groups’ issues discussed and addressed. Although workforce might be an issue for private-practice hospitalists, academic hospitalists share these same issues—just in a different environment. Pediatricians see SHM develop core competencies for adult medicine, then want their own pediatric core competencies; SHM needs to look for a way to make this happen. Nurse practitioners (NPs), physician assistants (PAs), and administrators have looked to SHM to represent not just physicians in HM, but also their interests.
As a result, SHM has developed committees and approaches to engage the professional societies representing PAs and NPs, along with the Medical Group Management Association, to design specific projects and programs. At any point in time, there might be a group of members who see a need for SHM to pay attention to “their” issue or perceive that a current approach, while relevant to one group, falls short of the needs of another. As our diversity grows, the frequency of these situations will increase.
So, is this worrisome? Quite the contrary. I believe it is healthy.