Dr. Howell, like many hospitalists, helped operationalize the COVID-19 clinical infrastructure on the wards during the pandemic.
Ad Astra Per Aspera is an ancient Latin motto used by numerous organizations and often quoted in works of art, including television. In fact, TV is where I was reacquainted with it just this year, but more on that later. The literal translation is “to the stars through difficulty”, but it’s an inspirational motto, and I prefer my own slightly broader interpretation of “reaching the stars is hard.”
To me, this motto perfectly sums up what it means to be a hospitalist today, and what it will mean for us in the future: getting where we are today was through hard work, and continuing to reach for those even brighter stars will take effort in the future. My professional path as a hospitalist was not always easy, but it was worth it. Ad Astra Per Aspera.
Hospital medicine has reached the stars, by any measure
Measured by sheer numbers alone, hospitalists have reached the stars; we have grown into one of the largest specialties. SHM members and staff evaluated Medicare data and published in the Journal of Hospital Medicine that there were 44,000 adult hospitalists in 2019.1 SHM reevaluated the Medicare data from 2021 (the most recent data available) and found the number of adult hospitalists had grown by 4,000 in those two years, to 48,000! For context, that number is about as large as or larger than emergency medicine (49,000), OB/GYN (43,500), and anesthesia (43,000), when using the most recent Association of American Medical Colleges data. Based on our data, it seems likely that with a growth rate of 4,000 between 2019 and 2021, there are likely more than 50,000 adult hospitalists today.
For those hospitalists who are pediatricians, pediatric hospitalists are not in Medicare billing data and SHM will have to find another measurement process.
It is not just the large number of hospitalists who have propelled our specialty to the stars. What we have done is as impressive as our sheer size. Even before the pandemic, we were improving efficiency, focusing on quality, and reshaping medical education. Much of my own mid-career work was on quality and quality improvement. But the pandemic, as difficult as it was, really proved the value of hospitalists. When the house of medicine was (figuratively) on fire, hospitalists ran into that building and saved lives. I reviewed state-level data, as well as data available from the Institute for Health Metrics and Evaluation at the time; hospitalists took care of the vast majority of the 7 million COVID-19 patients who were hospitalized. If our institutions’ clinical response to the COVID-19 pandemic could be likened to a four-legged table, nurses, intensivists, and emergency medicine physicians would be three of those four legs, but that stout fourth leg, supporting our nation’s hospitals, consisted of hospitalists.
Not only were hospitalists essential for the clinical care directly provided to millions of patients, but many of us, myself included, were responsible for operationalizing the COVID-19 clinical infrastructure on the wards. The pandemic was terrible, and I hope I don’t see another, yet it would have been significantly worse without hospitalists’ skill and determination. The pandemic solidified our place among the medical stars. Ad Astra Per Aspera.
We have reached the stars. But the future is full of difficult problems that need solving. Together, we can make the path to solutions easier.
Some difficult challenges remain for our specialty:
- How do we address workload?
- What are the limits to our ever-expanding clinical roles?
- Are there real solutions to mitigate burnout?
- What about the important role of research to our specialty to explore those workload and patient care questions we are trying to understand?
- How can we address the challenge of limited funding for hospitalist researchers?
At SHM, we’re partnering with our hospitalist members to try and develop tools, find answers, and chart a path forward together. Two examples of successful co-development include the State of Hospital Medicine (SoHM) report and the Hospital Medicine Workforce Experience Report.
The SoHM report is an every-other-year report on important aspects like pay, scheduling, PTO, hospital financial support, plus other operational aspects helpful to running a clinical hospital medicine program. One tidbit of information is that the average salary for adult hospitalists is now $323.5k, and $259k for pediatric hospitalists! We’re getting ready to launch the 2025 State of Hospital Medicine Survey next month and would appreciate you participating and sharing your insight.
The Hospital Medicine Workforce Experience Report was developed in collaboration with our membership to gather information on the clinical experience, workload perceptions, and factors contributing to and mitigating burnout. Interestingly, the report shows hospitalist burnout has decreased from a pandemic high of 60% plus to the current 45%. Better, but still clearly with a lot of work left to do. Ad Astra Per Aspera. One factor that was found to help mitigate burnout was hospitalist leadership. Respondents reported burnout at a much lower rate (26.5%) when they strongly agreed with the statement “my supervisor, manager, or clinical leaders seriously considers staff suggestions for improving provider well-being,” compared to those who responded that they strongly disagreed with that statement (78.6% reported burnout).
We’re working with our academic hospitalist colleagues to explore how hospitalists can access more of the federal grant funding. I was intrigued by a recent article by Vaughn et al., reporting that hospitalists cared for many COVID-19 patients, but rarely disseminated new COVID-19 knowledge.2 That struck a chord with me: We do make the world a better place but need to communicate that work through scholarship and get credit for the novel work we do.
The future of hospital medicine
The sky’s the limit (but no one said it would be easy)!
The future is bright for our field: Our specialty is growing, we are making our part of the world a better place, we have the ability to shape our future, and we are finding solutions to complex problems together. We have a lot of work left to do: mitigating burnout, preparing ourselves to be leaders at the bedside and beyond, and advancing the science of our field are just a few of the challenges that remain.
It’s no secret I am a huge Star Trek fan. Like many forms of fiction, it can highlight the human condition and offer inspirational solutions, like working together to solve complex problems. Ad Astra Per Aspera was the title of a recent Star Trek episode, and it reminded me of hospital medicine: professionals dedicated to excellence and collaboration, overcoming difficult obstacles. Ad Astra Per Aspera: reaching the stars is hard. I hope that together, we can make it Ad Astra (with a little less) Per Aspera.
References
- Lapps J, et al. Growth trends of the adult hospitalist workforce between 2012 and 2019. J Hosp Med. 2022;17(11):888-892.
- Bonk N, et al. COVID-19-related publications by hospitalists in the United States. Cureus. 2023;15(2):e35553. doi: 10.7759/cureus.35553.