Crunch Time

The Hospitalist. 2009 February;2009(02):

February 1, 2009 | The Hospitalist

Dr. Westle refers to his method as “weaving yourself into the fabric of the health system.” Caring for the unassigned adult population and handling internal medicine assignments is low-hanging fruit for hospital medicine groups. He suggests creating programs to teach residents who are participating in hospital quality committees or other panels to deal with coding and billing, staffing LTACs, and improving the referral process for smaller, outlying hospitals to send patients to larger hospitals.

And, of course, there is relationship-building. Although tight economic times will require hospitalists to provide more quantitative data to prove their worth, the hospitalist model thrives on doctor-to-doctor interactions. Connections built with proceduralists and nurses, who can vouch for the value of a hospital medicine group, can mean a lot when hospital boards are searching for areas to trim costs.

“If you talk to seasoned directors of hospitalist programs, you win over hearts and minds one at a time,” Pham says. Most hospital executives “know there is value beyond that which can be proven on the balance sheet. It’s difficult to price things like convenience, satisfaction.”

Insulation strategies for individual hospitalists

A hospitalist’s most important economy is his or her own employment. So what can individual hospitalists do to protect themselves in turbulent times? Hospital medicine professionals say the key is differentiating yourself from others:

Position yourself as the go-to doctor. Referrals are a business of reputation, so perform well, be professional, answer consults timely, and develop relationships.
Search out programs that add lines to your resume, even if they’re not yet accredited. SHM has started a Fellow in Hospital Medicine designation and other, more formal programs exist. Each requires a certain level of commitment and time. Decide how important the title is to you.
Talk to your boss. Ask what you can to do to be more valuable, then act on those suggestions. Take the initiative, but be sure to follow through. Accomplished managers will notice the eagerness and start to think of you as a potential leader within the practice.
Know the hospital leadership. Never make the mistake of overstepping your boundaries, but given the appropriate opportunity, introduce yourself to the movers and shakers. Given the choice of cutting one of two equal doctors—one a stranger, one with a name and a face—most managers will choose the stranger.

What’s Next

Doug Cutler, MD, a hospitalist at Banner Sun City Hospitalists in Arizona, which serves 800-plus beds in two hospitals in Sun City and Sun City West, has watched economics change his situation. His old employer, Banner Health, recently merged its two hospitals with Sun Health. The new owners are learning how Cutler’s group works, talking to both hospitalists and other hospital staff. They have the group’s documentation to review, but individual doctors now have the opportunity to prove themselves as standouts.

“Find out the needs and service them the best you can,” Dr. Cutler says. “If it’s a throughput issue, work with them on that. Are you on committees? Are you on the quality committee? Pharmacy and therapeutics? Find what they need and fill a niche. Talk to medical directors, work with case managers. Don’t be the one that they hate to page; be the one they’re not worried about stopping in the hallways because you’re the go-to physician.”

SHM’s Miller agrees that individual hospitalists should take every opportunity to stand out. Whether it’s making sure hospital executives know your name, earning as many certifications as applicable, or applying for the society’s new Fellow in Hospital Medicine program, each doctor has to look at the economic crisis from a professional and personal viewpoint.