Prepare for Change
What is the answer? Two hospitalists echoed the same, simple solutions: “Give us more money” and “We need more bodies.”
Simplicity aside, residency and hospital medicine programs will need to prepare for the change. “Instead of happening gradually, suddenly every [residency] program in the country will lose 20% of its capacity,” Dr. Rikfin says.
Michael Pistoria, DO, FACP, associate general division of internal medicine chief at Lehigh Valley Hospital in Allentown, Pa., believes institutions with closely aligned hospitalist and residency programs will benefit from “enlightenment on both sides. Residency programs are increasingly alert to the vital role that HMGs play in supporting residency programs,” he says. “They are more aware of the impact these types of decisions have on the staffing of HMGs.”
Mid-level providers are one possible solution. “Programs will increasingly look to supplement their existing group with advanced practice clinicians—physician assistants and non-physician providers―a less-expensive alternative,” Dr. Pistoria says
Does hiring mid-level practitioners pose a risk for unintended adverse events and delays to diagnosis? “There may be an extended growth curve for these providers,” Dr. Pistoria says, “due to less clinical exposure and experience than a new physician hospitalist just out of residency.”
However, these advanced practice clinicians often are quick to adapt to the hospitalist setting, learning the skills required to be an effective hospitalist through on-the-job training. “On-the-job training for physician hospitalists can focus on education, quality improvement, safety―some of the value-added pieces,” Dr. Pistoria points out.
Without a doubt, ACGME’s new cap on residency caseloads will impact hospital medicine, both at the national level and the individual group level. HMG efforts to recruit, schedule, train and pay hospitalists will be affected, as will the level of experience patients receive from recent residency graduates.
“It is incumbent on us to get involved in committees and process and performance improvement projects,” Dr. Pistoria says, “so that when leadership approaches administrators regarding residency caseload cutbacks, we can make a strong case for recruiting more hospitalists.” TH
Andrea M. Sattinger is a medical writer based in North Carolina and a frequent contributor to The Hospitalist.