Additionally, there are some challenges unique to academic hospitalists, a subset of our membership. Academic HM programs have been forced to grow at a dizzying speed in the past several years to keep up with increases in hospital discharges in an era of increased restrictions on the work hours of medical residents. These programs have grown by hiring many junior faculty with no advanced training in research, teaching, QI, or patient safety, let alone all the skills they need to bill, lead large teams, or manage complex hospital processes.
Of those problems, the most challenging, and arguably the most important to fix, is research training. To make lasting contributions to the practice of HM, rather than just implementing the practices, new treatments, and new care processes developed by other fields, HM needs to generate the new knowledge we use. That takes growing research, researchers, and sustainable academic programs. That, too, is not easy work.
HM Can Meet the Challenges
I am optimistic we can meet these myriad challenges, and I believe SHM is positioned to lead the charge. There is nothing we can do about the recession; hospitalists will have to weather the storm. Fortunately, HM has spent the last decade advocating not only its effectiveness, but also its cost-effectiveness. As a key hospital ally in the quality and safety wars, we are entrenched, and most hospital CEOs looking at ways to control costs should look beyond the core aspects of the local HM program. (They can take back my water cooler.)
It has not been lost on many at SHM that improving quality and safety at the hospital level requires engaging those outside our field. SHM is indeed tackling the daunting task of improving care transitions with its Project BOOST (Better Outcomes for Older Adults through Safe Transitions) program, but this comes after years of working with national quality organizations, policymakers, and other professional societies—including those that represent ED physicians and PCPs—in recognizing that fixing poor care transitions cannot be done by hospitalists alone.
Academic HM also is on SHM’s radar. The society, along with the Society of General Internal Medicine and the Association of Chiefs of General Internal Medicine, organized a summit to delineate and address the problems faced by academic HM. That meeting led to increased attention on the problems the field faces, enhanced advocacy at the federal level for research support, a “boot camp” designed for academic hospitalists to develop the skills they need to excel in an academic environment, and the beginnings of an SHM-funded faculty development research award.
All told, while there may be dark clouds on the horizon and rain in the forecast, SHM has spent years building a watertight organization and has foreseen many of the problems we now face. If we keep up the hard work, I am confident we, our patients, and the next generation of hospitalists will have brighter days ahead.
I look forward to the next year at the helm of SHM and am honored to represent SHM and its members, whose hard work and accomplishments never cease to amaze me.
Dr. Flanders is president of SHM.
Reference
- Epstein AM. Revisiting readmissions—changing the incentives for shared accountability. N Engl J Med. 2009;360(14):1457-1459.