Big Kahunas

The Hospitalist. 2007 February;2007(02):

February 1, 2007 | The Hospitalist

The Upside to Independents

One factor that helps hospitals decide between bringing in a national company and using an independent local group is the cost.

“[Local programs] may not be as expensive as the large groups,” says Dr. Atchley. “When my hospital sent out an RFP [request for proposal], we saw that some of our costs were much less than what a national company” has to charge.

One major concern individual hospitalists and smaller groups may have regarding employment in a national corporation is loss of autonomy. Would they be expected to follow rigid rules and regulations set forth by a distant corporation office? The leaders in those offices say no, absolutely not.

“We actually manage down to a small practice,” says Dr. Singer. “Concerns are that there will be a loss of autonomy; that’s not true.”

Regardless of which type of hospital medicine program one prefers, having options is good for both the hospital and the physician. “Competition is good,” maintains Dr. Atchley. “When these companies come in, they’ll definitely provide superior infrastructure and can track outcomes. Homegrown hospital medicine programs should use the same approach.”

A Glimpse of the Future

Will all hospitalists eventually work for a behemoth corporation? Not a chance, say the CEOs and CMOs of the current hospital medicine company leaders. “There are lessons to be learned from the emergency department,” says Dr. Wagner. “Large companies don’t have the majority of ED contracts. There’s only so much [large companies] can manage before it starts to get picked off by smaller, younger practices that are more nimble and quick to respond.

“All the big players won’t be dominant from a market-share point of view,” he adds. “But what they will do is set expectations for good hospital medicine practices.”

However, the employment model for hospitalists will continue to change. “We’re going to see existing [large] companies increase their regional presence,” predicts Dr. Reynolds. “The hospital-owned model will fade away. Physicians make lousy hospital employees—they just don’t fit into the hospital’s view of an employee.”

Dr. Atchley agrees with this point: “We’ll probably see fewer and fewer programs where the physician is employed by the hospital. That’s pretty much what the SHM surveys are showing.”

And when will the booming market for hospitalists start to slow? “I see [the market] growing well beyond my crystal ball,” says Dr. Singer. “I see a soon-to-be emerging trend of hospitals wanting hospitalists rather than internists. More groups are going to step up and add that—make an internist into a subspecialist. It’s a new way of thinking.”

Even without a crystal ball, leaders in hospital medicine forecast that the field will continue to grow and that hospitalists will become better trained, credentialed, and accepted as a specialty—regardless of what type of organization they work for. TH

Jane Jerrard writes “Career Development” and “Public Policy” for The Hospitalist.

View from the Hospital Floor

The co-founders, CEOs, and chairs of the nation’s largest hospital medicine providers have shared their thoughts and perspectives. But what is it actually like to work for one of these companies? Below, an employee-hospitalist who previously worked for an independent practice shares his ground-level perspective.

Christopher Frost, MD, is regional medical director of TeamHealth MidSouth in Oak Ridge, Tenn. Before joining TeamHealth six years ago, Dr. Frost was chief resident and worked for a hematology/oncology group as a hospitalist. He was promoted to regional medical director three-and-a-half years ago.

More Time for Clinical Work

Asked about the differences in working for a large corporation, Dr. Frost immediately mentions assistance with recruiting efforts. “When the individual physician is tasked with recruiting, it can detract from his or her clinical work,” he points out. “TeamHealth has a fantastic recruiting team that allows the clinician to practice medicine while the recruiter finds the ‘right fit’ for the open position.”

In addition to saving valuable time for physician leaders, having a central office that handles recruitment has an important benefit. “TeamHealth’s physician turnover is less than half the national average,” says Dr. Frost. “I think this is a testament to their ability to match the right person to the right job.”

Dr. Frost also appreciates what he calls “the depth of resources” that TeamHealth provides, saying that this “allows physicians to exclusively concentrate on providing excellent patient care.”

These resources include physician education—quality care education as well as education on coding and billing. “TeamHealth proactively educates their physicians about all that is ‘sacred’ to hospital medicine,” explains Dr. Frost. “The nice thing is that TeamHealth and corporations take care of this. You don’t have to reinvent the wheel; you can focus on using these [resources] to provide quality patient care.”

He is impressed with the in-house education opportunities for physicians and for the group’s leaders. “[TeamHealth] offer[s] educational opportunities through outside resources, such as the SHM Leadership Academy, as well as internal resources from our own TeamHealth Institute,” says Dr. Frost. “They also have multiple listservs available to facilitate dynamic discussions and sharing of best practices.”

TeamHealth works with partner companies to customize or use technology for their physicians such as charge-capture software and listservs to use for clinical and leadership discussions. “We’re even in the process of setting up our own benchmark metrics,” says Dr. Frost.

Another strength of TeamHealth, says Dr. Frost, is its leadership. “Their reputation allows them to recruit industry leaders like Stacy Goldsholl,” he says—and so the growing organization continues to build on its advantage.

The result of having these resources provided by a corporate headquarters, says Dr. Frost, is that “it allows physicians not to see more patients, necessarily, but to see patients in a more confident, timely fashion.”

Corporate Versus Independent

Dr. Frost knows that smaller, independent hospital medicine groups treasure their autonomy. “With large groups, there’s a fear of losing that autonomy as the corporation takes over,” he says. “But TeamHealth recognizes that each group has its own needs and culture.”

He explains that every TeamHealth practice and hospital has its own needs and cultures. “We have best practices that we’re willing to share, but we don’t have to,” he says. “We don’t force it. TeamHealth brings best practices to the table; then the client[s] can pick and choose what they need.”

Dr. Frost has carefully considered the differences between working for TeamHealth and being a part of an organization like his former employer, and he believes that the resources his company provides enable him and his hospitalist staff to provide better clinical care, while supporting overall best practices for the specialty.

“Hospital medicine is kind of a “Field of Dreams” phenomenon: If you build it, they will come,” says Dr. Frost. “And [large companies] have taken it from the back yard to the major leagues.”

Of course, Dr. Frost’s views of his employer don’t represent those of the hundreds of other hospitalists who work for major hospital medicine groups. But it’s obvious that he appreciates his company’s support and infrastructure, which allow him to concentrate on his truly important work. And that does sound like the major leagues.—JJ