the hospitalist movement, 2004
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The Hospitalist Movement, 2004The Hospitalist Movement, 2004
Eric M. Siegal, M.D.Eric M. Siegal, M.D.Assistant Professor of Medicine (CHS)Assistant Professor of Medicine (CHS)
Director, Hospitalist ProgramDirector, Hospitalist Program
University of WisconsinUniversity of Wisconsin
es2@medicine.wisc.edues2@medicine.wisc.edu
Objectives
Recent history of the Recent history of the hospitalist movementhospitalist movement
Impact of hospitalists on Impact of hospitalists on health care: what we health care: what we do, don’t and should do, don’t and should knowknow
Where the hospitalist Where the hospitalist movement is goingmovement is going
Hospitalists at the Hospitalists at the University of WisconsinUniversity of Wisconsin
Disclosure
This talk has not been sponsored by any organization.This talk has not been sponsored by any organization.
No pharmaceutical representatives were harmed in the No pharmaceutical representatives were harmed in the making of this presentation.making of this presentation.
What is a Hospitalist?What is a Hospitalist?
““Hospitalist” first coined in 1996 by Wachter Hospitalist” first coined in 1996 by Wachter and Goldmanand Goldman
Hospitalists are physicians whose primary Hospitalists are physicians whose primary professional focus is the general medical professional focus is the general medical care of hospitalized patients. They may care of hospitalized patients. They may engage in clinical care, teaching, research engage in clinical care, teaching, research or leadership in the field of general hospital or leadership in the field of general hospital medicine.medicine.
Wachter, Goldman: NEJM, 1996; 335:514-7
Workforce CompositionWorkforce Composition
88% Medicine trained88% Medicine trained 83% GIM83% GIM 5% medical subspecialists5% medical subspecialists
12% Peds and Family Medicine12% Peds and Family Medicine
SHM Hospitalist Productivity and Compensation Survey, 2002
Is This Really a New Idea?
Not entirely:Not entirely:Canada, Britain, Australia and NZ have Canada, Britain, Australia and NZ have maintained hospitalist-like models for maintained hospitalist-like models for decades.decades.
Redelmeier. A Canadian Perspective on the American Hospitalist Movement. Arch Intern Med. 1999;159:1665-1668
Bindman, Majeed. Organisation of primary care in the United States. BMJ. 2002; 326: 631-634
Explosive GrowthExplosive Growth
NAIP/SHM founded in 1997 at a breakout NAIP/SHM founded in 1997 at a breakout session of the ACP meetingsession of the ACP meeting
1997: 23 members1997: 23 members 2003: 3,900 members2003: 3,900 members Currently 7-8,000 hospitalistsCurrently 7-8,000 hospitalists Potential size: 20,000 – 30,000Potential size: 20,000 – 30,000 There are about 20,000 cardiologists in the There are about 20,000 cardiologists in the
United StatesUnited States
Lurie et al. The Potential Size of the Hospitalist Workforce in the United States. Am J Med. 1999; 106:441-5
Inpatient Services, PCInpatient Services, PC
Denver, CO hospitalist practiceDenver, CO hospitalist practice Founded in 1998 by 4 physicians at 2 Founded in 1998 by 4 physicians at 2
hospitals seeing 35 encounters per dayhospitals seeing 35 encounters per day As of 12/03: 22 physicians at 4 As of 12/03: 22 physicians at 4
hospitals seeing 190 encounters per hospitals seeing 190 encounters per dayday
This is happening across the countryThis is happening across the country
Why is the Hospitalist Why is the Hospitalist Movement Growing so Fast?Movement Growing so Fast?
DemandDemand::Physicians (PCPs & specialists)Physicians (PCPs & specialists)HospitalsHospitalsThird party payersThird party payers
SupplySupply: : Increasing numbers of physicians perceive Increasing numbers of physicians perceive hospital medicine as a viable long-term hospital medicine as a viable long-term career.career.
New Hospitals in Denver
Three new hospitals opening across metro Three new hospitals opening across metro Denver in 2004Denver in 2004
All three hospitals plan to contract hospitalist All three hospitals plan to contract hospitalist groups to provide inpatient coverage from groups to provide inpatient coverage from day oneday one
Why: Many community physicians (PCPs Why: Many community physicians (PCPs and specialists) made patient referrals and specialists) made patient referrals contingent upon having pre-existing contingent upon having pre-existing hospitalist groups on sitehospitalist groups on site
What’s Fueling Physician Demand for Hospitalists?
Inpatient medicine is becoming more Inpatient medicine is becoming more demanding and difficultdemanding and difficult
Physicians are increasingly concerned about Physicians are increasingly concerned about lifestyle issueslifestyle issues
Unassigned / ER callUnassigned / ER call Financial pressures are driving physicians to Financial pressures are driving physicians to
look for more efficient ways to deliver health look for more efficient ways to deliver health carecare
Is Inpatient Medicine Becoming More Difficult?
Aging populationAging population
++ Increasing co-morbidities Increasing co-morbidities
+ Care shifting to ambulatory setting+ Care shifting to ambulatory setting
Sicker patients in the hospitalSicker patients in the hospital
Sicker patients inevitably demand more Sicker patients inevitably demand more physician time and expertisephysician time and expertise
Sicker Patients at UWHC
Case Mix IndexCase Mix Index: : A numerical score of A numerical score of blended patient acuity:blended patient acuity:1: minor 2: moderate 3: major 4: extreme1: minor 2: moderate 3: major 4: extreme
From 7/97 – 9/03, CMI at UWHC increased From 7/97 – 9/03, CMI at UWHC increased from 1.65 to 1.79 (p <.0001)from 1.65 to 1.79 (p <.0001)
CMI has been increasing by .01 every four CMI has been increasing by .01 every four months for the past six yearsmonths for the past six years
UWHC Case Mix Index 07/97 – 09/03
1.40
1.45
1.50
1.55
1.60
1.65
1.70
1.75
1.80
1.85
1.90
Month
CMI
Sicker Patients NationallySicker Patients Nationally
18.2 million CA inpatients (1993-97)18.2 million CA inpatients (1993-97)
Acuity index: 1.69 Acuity index: 1.69 1.79 1.79 By 2025: A.I. 2.50 (40% increase)By 2025: A.I. 2.50 (40% increase)
Institute for Health and Socio-economic Policy: California Healthcare: Institute for Health and Socio-economic Policy: California Healthcare: Sicker Patients, Fewer Nurses, Fewer Staffed Beds; 1999Sicker Patients, Fewer Nurses, Fewer Staffed Beds; 1999
Physician Lifestyle
Physicians are increasingly concerned about Physicians are increasingly concerned about balancing lifestyle and practicebalancing lifestyle and practice
Juggling inpatient and outpatient medical Juggling inpatient and outpatient medical practice is stressful and time-consumingpractice is stressful and time-consuming
The more primary care physicians practice The more primary care physicians practice inpatient medicine, the more they are likely to inpatient medicine, the more they are likely to express job dissatisfaction and burnout.express job dissatisfaction and burnout.
Saint et al. What Effect Does Increasing Inpatient Time Have on Outpatient-oriented Internist Satisfaction? JGIM. 2003; 18: 725-729
The Unassigned Call Crisis
Management of unassigned patients is reaching crisis Management of unassigned patients is reaching crisis levels across the nationlevels across the nation
Unassigned patients are typically difficult: No access to Unassigned patients are typically difficult: No access to pre-hospital primary care, difficult follow-up, higher pre-hospital primary care, difficult follow-up, higher rates of substance abuse, noncompliance…rates of substance abuse, noncompliance…
Reimbursement is generally poorReimbursement is generally poor Unassigned patients have become problematic for all Unassigned patients have become problematic for all
parties: Internists, ERs, hospitals and patientsparties: Internists, ERs, hospitals and patients Hospitalists are increasingly perceived as the solutionHospitalists are increasingly perceived as the solution
Edlich et al. A National Epidemic of Unassigned Patients: Is the Hospitalist the Solution? J. Emerg Med. 2002; 23: 297-300
Financial PressuresFinancial Pressures
Inpatient/outpatient medical practices are Inpatient/outpatient medical practices are generally inefficientgenerally inefficient Travel timeTravel time Divided attention interrupts efficiency in the Divided attention interrupts efficiency in the
clinicclinic Some large practices rotate inpatient call Some large practices rotate inpatient call
One physician manages everyone’s One physician manages everyone’s inpatientsinpatients
This is really a quasi-hospitalist modelThis is really a quasi-hospitalist model
Financial Bottom Line
Hospitalists may improve generalists’ Hospitalists may improve generalists’ bottom line by $40,000 by allowing bottom line by $40,000 by allowing increased outpatient productivityincreased outpatient productivity
Falk CT, Miller C. Hospitalist Programs: Towards a New Practice of Inpatient Care. Washington, DC: Advisory
Board Company; 1998:1-59.
Why Do Why Do SpecialistsSpecialists Like Like Hospitalists?Hospitalists?
““I think, therefore I am ---undercompensated”I think, therefore I am ---undercompensated”
DoingDoing pays pays wayway better than better than thinkingthinking 30-74 min. critical care = 4.00 RVUs30-74 min. critical care = 4.00 RVUs single-vessel PTCA = 14.84 RVUssingle-vessel PTCA = 14.84 RVUs
In areas with shortages of specialists, hospitalists can In areas with shortages of specialists, hospitalists can fill some of the voids, allowing specialists to fill some of the voids, allowing specialists to concentrate on the most complicated patientsconcentrate on the most complicated patients
Specialists would rather practice their specialitesSpecialists would rather practice their specialites
Hospitalists Can:
Make PCPs and specialists more Make PCPs and specialists more productiveproductive
Allow specialists to concentrate on their Allow specialists to concentrate on their specialtiesspecialties
Help their colleagues enjoy their careers Help their colleagues enjoy their careers
Why Do Why Do HospitalsHospitals Want Want Hospitalists?Hospitalists?
Do more with less:Do more with less: Sicker patientsSicker patients Worsening staffing shortagesWorsening staffing shortages Decreasing reimbursementDecreasing reimbursement
Prospective paymentProspective payment Unassigned patientsUnassigned patients 24:7 in-hospital attending coverage may 24:7 in-hospital attending coverage may
become mandatorybecome mandatory
Quality / Safety CrisisQuality / Safety Crisis
44,000-98,000 inpatient deaths per year 44,000-98,000 inpatient deaths per year attributed to medical errorsattributed to medical errors 88thth leading cause of death, exceeding MVA, leading cause of death, exceeding MVA,
breast cancer and AIDSbreast cancer and AIDS Cost: $17-29 billion per yearCost: $17-29 billion per year
Major system flaws and failures are endemic Major system flaws and failures are endemic to hospitalsto hospitals
“To Err is Human: Building a Safer Health System”: Institute of Medicine, 2000
Hospitalists are Uniquely Positioned to Champion Patient Safety and Quality Improvement Initiatives
Nobody knows the hospital better than a Nobody knows the hospital better than a hospitalisthospitalist
Hospitalists are uniquely invested: the Hospitalists are uniquely invested: the hospital is our homehospital is our home
Why Are Physicians Attracted to Why Are Physicians Attracted to Hospital Medicine?Hospital Medicine?
Why is a career that offers unpredictable Why is a career that offers unpredictable days, weird hours and perpetual days, weird hours and perpetual treatment as a house officer becoming treatment as a house officer becoming so popular?so popular?
Because…Because…
Logical transition from I.M. residencyLogical transition from I.M. residency Fast-paceFast-pace High-acuity, interesting casesHigh-acuity, interesting cases Daily interaction with subspecialistsDaily interaction with subspecialists Alternative to primary care for people Alternative to primary care for people
who don’t want to subspecializewho don’t want to subspecialize ““It’s why I became an internist”It’s why I became an internist”
Is the Proliferation of Is the Proliferation of Hospitalists a Good Thing?Hospitalists a Good Thing?
Why it Could be Bad
Discontinuous care Discontinuous care of hospitalized of hospitalized patients:patients: Misinformed Misinformed
caregiverscaregivers Nobody knows Nobody knows
patients’ wishes or patients’ wishes or social situationsocial situation
Fumbled handoffsFumbled handoffs
Why it Could be Bad - II
Could increase the sense of Could increase the sense of marginalization already felt by many marginalization already felt by many primary care physiciansprimary care physicians
Could precipitate a schism in Internal Could precipitate a schism in Internal Medicine by creating discrete Medicine by creating discrete specialties in outpatient and inpatient specialties in outpatient and inpatient practicepractice
Why it Could be GoodWhy it Could be Good
Discontinuity of care isn’t always badDiscontinuity of care isn’t always bad Internal Medicine might actually benefit from Internal Medicine might actually benefit from
differentiating outpatient and inpatient tracksdifferentiating outpatient and inpatient tracks Physicians who focus solely on hospital care Physicians who focus solely on hospital care
might do it better than physicians who don’tmight do it better than physicians who don’t Hospitals might function betterHospitals might function better Could actually increase the allure and Could actually increase the allure and
prestige of a generalist careerprestige of a generalist career
Christakis, Wachter. Does Continuity of Care Matter? West Med. 2001; 175: 174-75
How Do We Decide?How Do We Decide?
User satisfaction:User satisfaction:PCP/specialistsPCP/specialistsPatientsPatientsHospitals and staffHospitals and staff
Resource utilization and outcomesResource utilization and outcomes Impact upon General Internal MedicineImpact upon General Internal Medicine Impact upon Medicine as a wholeImpact upon Medicine as a whole
Do We Have Enough Data to Do We Have Enough Data to Decide?Decide?
No – Studies to date are small and No – Studies to date are small and limited in scope and powerlimited in scope and power
Ongoing areas of research:Ongoing areas of research: User satisfactionUser satisfaction Resource utilizationResource utilization OutcomesOutcomes
Do Hospitalists Improve Do Hospitalists Improve Patient Satisfaction?Patient Satisfaction?
No large, well-designed studies to dateNo large, well-designed studies to date My impression:My impression:
Patient concern about abandonment by their PCP Patient concern about abandonment by their PCP when they’re sick may be offset by greater when they’re sick may be offset by greater availability and attentiveness from hospitalistsavailability and attentiveness from hospitalists
Patients are deeply concerned that their PCPs are Patients are deeply concerned that their PCPs are informed and involved in their care. They are less informed and involved in their care. They are less concerned whether or not the PCP is making the concerned whether or not the PCP is making the day to day decisionsday to day decisions
Do Hospitalists Improve Nurses’ Job Satisfaction?
Again, no published studiesAgain, no published studies Anecdotally, nurses love hospitalists.Anecdotally, nurses love hospitalists. Hospitalists:Hospitalists:
Are readily availableAre readily available Understand hospital protocols and systemsUnderstand hospital protocols and systems Probably know the RNs on a first-name basisProbably know the RNs on a first-name basis Attuned to the team-based care model that is Attuned to the team-based care model that is
central to nursing carecentral to nursing care
“ “ From a nursing perspective, it is hard From a nursing perspective, it is hard to imagine the Hospitalist role as to imagine the Hospitalist role as anything but a dream come true. ”anything but a dream come true. ”
Elizabeth Henneman, PhD, RN.Elizabeth Henneman, PhD, RN.
Clinical Specialist, MICU, UCLAClinical Specialist, MICU, UCLA
Do Hospitalists Improve PCP Job Satisfaction? 708 PCPs surveyed: 524 responded (74%)708 PCPs surveyed: 524 responded (74%) 62% of physicians surveyed had hospitalists available 62% of physicians surveyed had hospitalists available
to themto them PCPs with experience with hospitalists believed that PCPs with experience with hospitalists believed that
hospitalists:hospitalists: Had no effect on their income (69%)Had no effect on their income (69%) Decreased their workload (53%)Decreased their workload (53%) Increased their practice satisfaction (50%)Increased their practice satisfaction (50%) Decreased the quality of their relationships with their Decreased the quality of their relationships with their
patients (28%)patients (28%)
Fernandez et al. Friend or Foe? How Primary Care Physicians Perceive Hospitalists. Arch Int Med. 2000; 160: 2902-2908
Are Hospitalists Better Than General Internists at Inpatient Care?
High volume and subspecialization High volume and subspecialization improve outcomes and efficiency improve outcomes and efficiency (surgery, cardiology, critical care)(surgery, cardiology, critical care)
It makes intuitive sense that this should It makes intuitive sense that this should apply to hospital medicine as wellapply to hospital medicine as well
Do Hospitalists Improve Do Hospitalists Improve Resource Utilization?Resource Utilization? 19 studies comparing hospitalists and 19 studies comparing hospitalists and
generalistsgeneralists 15 studies: Hospitalists significantly 15 studies: Hospitalists significantly
decreased costs (average: 13.4%) and decreased costs (average: 13.4%) and lengths of stay (average: 16.6%)lengths of stay (average: 16.6%)
Outcomes were at least neutralOutcomes were at least neutral Limitations: Many of these studies were Limitations: Many of these studies were
small and retrospectivesmall and retrospective
Wachter, Goldman. The Hospitalist Movement 5 Years Later. JAMA. 2002;287:487-494.
How About Quality of Care?
Two recent studies: One at a community Two recent studies: One at a community hospital, the other at an academic centerhospital, the other at an academic center
Short-term relative risk of death for patients Short-term relative risk of death for patients admitted to hospitalist services was about admitted to hospitalist services was about 0.70.7
Auerbach et al. Implementation of a Voluntary Hospitalist Service at a Community Teaching Hospital: Improved Clinical Efficiency and Patient Outcomes. Ann Intern Med. 2002; 137: 859-865
Meltzer et al. Effects of Physician Experience on Costs and Outcomes on an Academic General Medicine Service: Results of a Trial of Hospitalists. Ann Intern Med. 2002; 137: 866-874
Intriguing Results, but Intriguing Results, but HardlyHardly DefinitiveDefinitive
RetrospectiveRetrospective VeryVery limited scope: 7 hospitalists at 2 limited scope: 7 hospitalists at 2
hospitals – Difficult to generalize this to the hospitals – Difficult to generalize this to the entire medical communityentire medical community
Stay tuned – more data are comingStay tuned – more data are coming
What Can We Say About Hospitalists in 2004?
Probably utilize inpatient resources more Probably utilize inpatient resources more efficiently than generalistsefficiently than generalists
Probably do not adversely affect outcomes Probably do not adversely affect outcomes and and mightmight improve them improve them
May improve hospital staff satisfactionMay improve hospital staff satisfaction Should improve physician satisfaction in a Should improve physician satisfaction in a
voluntary systemvoluntary system Effect on patient satisfaction unclearEffect on patient satisfaction unclear
Could “Hospitalism” be a Could “Hospitalism” be a Distinct Medical Subspecialty?Distinct Medical Subspecialty?
Not until we come up with a better Not until we come up with a better name than “Hospitalism”name than “Hospitalism”
(Hospitalism(Hospitalism first coined in 1869 to describe first coined in 1869 to describe unhygienic conditions in old, overcrowded unhygienic conditions in old, overcrowded hospitals)hospitals)
““Hospital Medicine”?Hospital Medicine”? ““Hospitology”?Hospitology”? ““Hospiturgery”?Hospiturgery”? ““Overgrown interns”Overgrown interns”
What Defines a Specialty?What Defines a Specialty?
Physicians who self-identify and Physicians who self-identify and organize as a distinct grouporganize as a distinct group
Distinct scholarly activityDistinct scholarly activity Distinct body of knowledgeDistinct body of knowledge Demonstrable value in specializationDemonstrable value in specialization
Physicians Who Self-Identify and Physicians Who Self-Identify and Organize as a Distinct GroupOrganize as a Distinct Group
Growing number of pure hospitalist Growing number of pure hospitalist practicespractices
Society of Hospital MedicineSociety of Hospital Medicine National and regional hospitalist National and regional hospitalist
meetings that are rapidly increasing in meetings that are rapidly increasing in size, scope and sophisticationsize, scope and sophistication
Growing Number of Pure Growing Number of Pure Hospitalist PracticesHospitalist Practices Lawrence Wellikson, MD, SHM Hospitalist Productivity and Compensation Survey, 2002
20022002 20002000 19971997
Hospital ownedHospital owned 38%38% 33%33% 23%23%
Multispecialty groupMultispecialty group 17 %17 % 24%24% 35%35%
University facultyUniversity faculty 9%9% 10%10% 5%5%
Hospitalist onlyHospitalist only 19%19% 12%12% 12%12%
Insurance companyInsurance company 9%9% 10%10% 14%14%
Distinct Scholarly ActivityDistinct Scholarly Activity
National journal: “The Hospitalist”National journal: “The Hospitalist” Hospital medicine textbookHospital medicine textbook Fellowships in Hospital MedicineFellowships in Hospital Medicine Novel research in patient safety, quality, Novel research in patient safety, quality,
hospital systems and best practiceshospital systems and best practices
Distinct Body of Knowledge?Distinct Body of Knowledge?(Isn’t this what categorical Medicine residents have been learning for decades?)
New skills:New skills: QA/QIQA/QI OperationsOperations Systems improvementSystems improvement Team-based medicineTeam-based medicine
Established skills: Established skills: Medical consultationMedical consultation Palliative / end of life Palliative / end of life
carecare Medical ethicsMedical ethics Critical careCritical care Rehabilitation / sub-Rehabilitation / sub-
acute careacute care
PrecedentsPrecedents
Quasi-specialties:Quasi-specialties:Geriatric MedicineGeriatric MedicineGIMGIM
Site-specific specialties:Site-specific specialties:Critical CareCritical CareEmergency MedicineEmergency Medicine
Demonstrable Value?
Is medicine better due to the presence Is medicine better due to the presence of hospitalists?of hospitalists?
Controversies and Problems
Moving target phenomenonMoving target phenomenon IncomeIncome Hospitalists in the ICUHospitalists in the ICU Longevity and BurnoutLongevity and Burnout Impact on General Internal MedicineImpact on General Internal Medicine
Moving Target: As Hospitalists Make Everyone Else Better, They Make Themselves Look Worse
Hospitalists improve hospital quality, Hospitalists improve hospital quality, systems and efficiencies: This affects systems and efficiencies: This affects everyone who practiceseveryone who practices
The generalists who choose to remain The generalists who choose to remain in the hospital are usually the ones who in the hospital are usually the ones who are most motivated to do it wellare most motivated to do it well
Hospitalists Can’t Generate Their Own Incomes 80-85% of all hospitalist practices receive 80-85% of all hospitalist practices receive
financial supportfinancial support Poor reimbursement for cognitive specialtiesPoor reimbursement for cognitive specialties Adverse payer mixesAdverse payer mixes ““Unbillable” time spent coordinating careUnbillable” time spent coordinating care
ROI for hospitals that support hospitalists ROI for hospitals that support hospitalists groups is 3-5:1groups is 3-5:1
Hospitalists Don’t Belong in Hospitalists Don’t Belong in the ICUthe ICU When compared to generalists, intensivists When compared to generalists, intensivists
lower ICU mortalitylower ICU mortality Unfortunately, there aren’t enough of them:Unfortunately, there aren’t enough of them:
22% shortfall by 202022% shortfall by 2020 35% by 203035% by 2030
Not every ICU patient needs an intensivistNot every ICU patient needs an intensivist We need to decide how to share the burden of We need to decide how to share the burden of
caring for patients in the ICUcaring for patients in the ICU
Current and projected workforce requirements for care of the critically ill and patients with pulmonary disease. Can we meet the requirements of an aging population? JAMA. 2000;284:2762-2770.
Longevity and Burnout
How many 55 year old cardiologists, How many 55 year old cardiologists, surgeons or intensivists do you regularly see surgeons or intensivists do you regularly see rounding in the hospital?rounding in the hospital?
Inpatient physicians tend to work weird hours, Inpatient physicians tend to work weird hours, weekends and holidaysweekends and holidays
Lack of control over dayLack of control over day Most specialists can shift to outpatient Most specialists can shift to outpatient
practices as they get older—hospitalists can’tpractices as they get older—hospitalists can’t
Longevity and Burnout
Recognize that this is a high-stress job and Recognize that this is a high-stress job and plan accordinglyplan accordingly
Limit workloadsLimit workloads Embrace shift work as a necessary Embrace shift work as a necessary
component and build systems to make it work component and build systems to make it work wellwell
Respect circadian rhythmsRespect circadian rhythms Emergency Medicine may provide a templateEmergency Medicine may provide a template
Hospitalists are Bad for GIM
Hospitalists are overwhelmingly Hospitalists are overwhelmingly generalistsgeneralists
Generalist (primary care) careers are Generalist (primary care) careers are losing appeallosing appeal
Hospital medicine is the only generalist Hospital medicine is the only generalist specialty that is growing (briskly!)specialty that is growing (briskly!)
Hospital medicine is breathing new life Hospital medicine is breathing new life into general medicineinto general medicine
Can We (Should We?) Train Internists to Become Expert in Both Inpatient and Outpatient Medicine in 3 Years?
One Potential Model
All Medicine residents train identically in PG-1 All Medicine residents train identically in PG-1 and PG-2 yearsand PG-2 years
PG-3: Either Inpatient or Outpatient Medicine PG-3: Either Inpatient or Outpatient Medicine / Primary Care track/ Primary Care track
If practice environment demands both skill If practice environment demands both skill sets, can take both tracks and do a four year sets, can take both tracks and do a four year residencyresidency
If subspecializing, can pick track most If subspecializing, can pick track most appropriate to the specialtyappropriate to the specialty
What Issues Have Hospitalists Been Asked to Tackle at UW?UWHCUWHC Improve integration of Improve integration of
care across disciplinescare across disciplines Fill voids left by a Fill voids left by a
contracting housestaff contracting housestaff programprogram
Improve resource Improve resource utilization and LOSutilization and LOS
More effective More effective deployment of deployment of specialistsspecialists
MeriterMeriter Unattached patients!!!Unattached patients!!! 24/7 & emergency 24/7 & emergency
coveragecoverage Referrals from outlying Referrals from outlying
areasareas Improve qualityImprove quality Support those PCPs Support those PCPs
who no longer want to who no longer want to do inpatient medicinedo inpatient medicine
The Future of Hospitalists at UW Internists are tightly woven into the fabric of inpatient Internists are tightly woven into the fabric of inpatient
health carehealth care Hospitalists bring a new level of service and Hospitalists bring a new level of service and
responsiveness to the medical staffresponsiveness to the medical staff Hospitalists drive progressive systemic improvements Hospitalists drive progressive systemic improvements
in efficiency, quality, safety and outcomesin efficiency, quality, safety and outcomes The hospital becomes a “living laboratory” for novel The hospital becomes a “living laboratory” for novel
healthcare outcomes researchhealthcare outcomes research Develop a unique educational curriculum Develop a unique educational curriculum
(fellowship?) in hospital medicine(fellowship?) in hospital medicine Become role models for housestaff and studentsBecome role models for housestaff and students
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