New Paradigm Here to Stay
The factors behind this newfound stability are numerous. Among them is the recognized importance of a well-managed HM program. In many institutions, the alternatives to hospitalists (primary-care physicians, surgeons managing all post-operative care, specialists admitting their own patients, etc.) have left the building. There is no going back, and there is no “plan B” if HM programs fold.
The recognition by prospective hospitalists—residents and students—that HM is a viable career path has increased interest in the field, and, in turn, has given many programs more choices among qualified applicants. Hospitalists currently employed in a reasonably functioning program are less likely to jump ship every year looking for something slightly better. And I expect the current economic climate has been a factor as well. As hospitals see operating margins erode, plans for infrastructure growth are delayed, funding for new programs shrinks, and hospitalist groups are asked to do more with less. In other words, they are not hiring as many new hospitalists.
In some sense, the perceived slowing in the growth of hospitalists might be concerning. I see it a different way. Slowing growth in overall numbers allows programs and the field to stabilize a bit, and this growth in stability creates enormous opportunity. Programs formerly struggling to survive can begin to innovate. We’ve seen that in Michigan, as the interest among hospitalist programs that want to participate in QI collaborations has grown. And when we hear what some programs are working on, it’s an impressive list of high-impact projects.
Hospitalists are taking ownership of care transitions, prevention of hospital-acquired complications, and disease-based QI initiatives centered on patients with heart failure, COPD, and diabetes.
Nationally, we have seen hospitalist programs coming together to successfully compete for federal research grants or foundation support targeting important national healthcare priorities. If the current healthcare reform legislation passes, it will better position HM to lead the transformation of healthcare in U.S. hospitals.
My big hope is that 10 to 20 years from now, HM is better known for its second phase of growth. Right now, we are more famous for our rapid growth and, to some extent, our impact on efficiency of care. Efficiency clearly is important; dollars saved from waste can be better put to use improving quality. But I want the field to be judged by our ability to innovate, improve the quality of hospital-care delivery, and to generate new knowledge that advances the care of all patients. Those accomplishments will have a more lasting impact on healthcare.
The stabilization of HM is making all of this possible. Our population expects and deserves great things from the nation’s fastest-growing “specialty,” and I am optimistic we will not let them down. TH
Dr. Flanders is president of SHM.