Administrative
Hospitalists can pursue leadership opportunities in academic, hospital-based, or community-based settings. Administrative hospitalists develop and guide programs: hospitalist, hospital-based, and multidisciplinary. Hospitalist-leaders serve as program managers, division heads, and medical directors in operational leadership. Aside from running the day-to-day operations of physician groups and hospital units, hospitalists lead in other arenas, such as utilization management, QI and patient safety, medical informatics, and hospital operations.
When serving as physician advisor or utilization management director, it is an opportunity for the hospitalist to lead care coordination within an organization and identify where opportunities related to hospital utilization exist. Many hospitalists lead multidisciplinary hospital committees in QI and patient safety. Hospitalists are perfectly positioned to identify areas within patient care where existing practices need improvement. As quality leaders, hospitalists facilitate the process changes necessary to implement evidence-based care. Some of the hospitalist-led QI areas include care transitions (patients moving from one setting to another; for example, inpatient to outpatient), VTE prophylaxis, inpatient glycemic control, and reduction of hospital-associated conditions.
Directing or guiding medical informatics as health systems across the country implement electronic health records (EHR) is an area where hospitalists can impact both quality and efficiency of care. Medical informaticists can guide clinical-decision support systems within an EHR, easing evidence-based, disease-specific care for other clinicians. As EHR becomes more available, this opportunity for hospitalists will grow.
In addition to these areas, hospitalists can manage or direct a hospital’s patient flow or throughput. Considering that more EDs and hospitals are overcrowded, improving patient flow is an area where hospitalists can join or lead a hospital’s throughput initiative. Evidence has shown that hospitalist-driven active bed management can improve ED crowding and overall hospital flow.3
So now that you know there is more to an HM career than the seven-on, seven-off job that you get between residency and fellowship, determining how and where to find that just-right combination is up to you—with a little help from your local hospitalist mentor. TH
Dr. McAllister is assistant professor in the division of hospital medicine at Cooper University Hospital/UMDNJ-Robert Wood Johnson Medical School in Camden, N.J. Dr. Kupersmith is assistant professor of medicine, UMDNJ-Robert Wood Johnson Medical School, division head, hospital medicine, medical director throughput, Cooper Health System.
References
- Hauer KE, Wachter RM, McCulloch CE, Woo GA, Auerbach AD. Effects of hospitalist attending physicians on trainee satisfaction with teaching and with internal medicine rotations. Arch Intern Med. 2004;164(17):1866-1871.
- Career options. SHM website. Available at: www.hospitalmedicine.org/AM/Template.cfm?Section=Young_Physicians&Template=/CM/HTMLDisplay.cfm&ContentID=22474. Accessed Dec. 28, 2010.
- Howell E, Bessman E, Kravet S, Kolodner K, Marshall R, Wright S. Active bed management by hospitalists and emergency department throughput. Ann Intern Med. 2008;149(11):804-811.