5. Recruitment
For years, HM has battled a workforce shortage, which has stifled growth and pushed providers to the verge of exhaustion. This problem persists despite offers of lucrative salaries, significant free time, and specialty status. The continuing workforce shortage should serve as a call to arms to improve recruitment into the field. An inability to increase the flow of providers will limit growth and tax the hospitalists we have in place. Ultimately, we will retard our progress toward achieving the improved outcomes articulated in No. 1.
6. Retention
We must address burnout and career satisfaction issues. Although exact numbers are tough to come by, it’s clear that many hospitalists are exhausted and overworked. This should not come as a surprise, considering we are a rapidly growing field constantly tasked with seeing more patients and solving all of a hospital’s problems. However, an inability to keep our current workforce sated and in HM jobs will amplify the workforce shortage.
7. PCPs Return
One interesting theory is that the floundering economy could prompt primary-care physicians (PCPs), whose hospital exodus we backfilled, to return to inpatient care in order to supplement their income. This isn’t likely to happen unless outpatient providers see such a drop in business that they cannot field a large-enough insured panel of patients to make ends meet. The possibility of PCPs seeing insured inpatients and leaving hospitalists with a largely uninsured population would be a game-changer. In the face of a large PCP shortage, however, this seems an unlikely scenario.
8. PCP Payment Reform
It is more likely our primary-care colleagues will get an ever-so-deserved pay raise. This is central to the proposed medical-home model and a key point of many healthcare reform plans. To stay competitive, hospitalists might also see a resultant pay increase. Anything short of this could further strain HM recruitment, as working hospitalists and new grads might migrate back toward primary-care jobs.
9. Bundling
It’s too early to know the effects of the proposed bundling of physician and hospital payments into one fee, which would compensate both hospitals and physicians. On the one hand, it could be a boon, as HM efficiency could be rewarded in ways not currently allowed. On the other hand, if hospitals continue to struggle financially and we are completely dependent upon bundled payments for our revenue, it could be a financial calamity.
10. Healthcare Reform
Without a clear sense of President Obama’s plans for healthcare reform, it’s tough to predict the future. We could try to paint numerous rosy scenarios that derive from a plan that includes a universal payor, improved access, and increased technology. However, it’s possible this reform would hamstring our efforts through reduced reimbursement, increased regulation, and cumbersome federal mandates.
Final Thought
I believe HM is strong and will overcome future threats. But it pays to consider and mitigate the hazards we might confront. Still, after much deliberation, I just cannot conceive of a reasonable scenario that results in a future without hospitalists.
Then again, Henry Ford probably felt the same about cars. TH
Dr. Glasheen is associate professor of medicine at the University of Colorado Denver, where he serves as director of hospital medicine and the hospitalist training program, and as associate program director of the Internal Medicine Residency Program.