Fly Solo

The Hospitalist. 2007 October;2007(10):

October 1, 2007 | The Hospitalist

HoW TO GO IT ALONE

Hospitalists from a variety of settings and programs shared the following tips for their colleagues who will step into the shoes of the lone hospitalist:

Remain flexible and malleable. Expect the unpredictable.
Know what you’re getting into in terms of structure, responsibilities, and policies. Question administrators about rapid response, night and weekend coverage, working with the ED, the ratio of patient volume to current staff, and plans for hospitalist coverage as volumes increase.
Start plans for recruitment of a second hospitalist quickly if this has not been done when you become the lone hospitalist. Within a year, that is likely to become imperative—not optional.
Make yourself indispensable. It’s helpful if there are no plans to grow the hospitalist program.
Know your limitations and set your boundaries.
Find mentors. Mentors can answer questions from everything to contract negotiations, conflict resolution, clinical questions, or someone to bounce ideas off of. SHM has resources for mentoring options—if you are not a lone hospitalist, sign up to mentor one.
Track and trend from the beginning. Follow volumes for the doctors. Anticipate increases in volume and time required to care for patients.
Plan to get immediate help when you face emergent critical care with one or more patients on your floor(s).
Maintain a philosophy of balance.
Survey workplace attitudes and expectations of what your role(s) will be.
Clarify with specialists and administrators their expectations and yours. Know that you will be assigned some patients you may not think are appropriate (e.g., hip fracture, chest pain, postoperative). If you are not expecting them, you may feel frustrated.
Find colleagues in your department whom you can work with and rely on for advice.
Consider the advantages and disadvantages of committee work. If you are not able to participate because of your workload as a lone hospitalist, you may be able to design a work-around so that you can still let your voice be heard. —AS

Pluses and Minuses

Martin C. Johns, MD, a rural internal medicine and pediatrics hospitalist at Gifford Medical Center in Randolph, Vt., sees some definite advantages to being a lone hospitalist, a post he has held for the 1 1/2 years. “It allowed me the time to interact with all the other modalities and to establish with physician therapy, occupational therapy, care management, pharmacy, what was lacking in the previous model with a variety of docs covering,” Dr. Johns says. “I was trying to create standards that made sense for everyone. The establishment of my being the only hospitalist was determinant primarily on my ability to create those relationships and ensure that they were solid, and also to have the support of all the primary care doctors.”

Gifford’s administration was also supportive. “Because we are a critical access hospital, there are certain restrictions and requirements that we have to take into consideration with Medicare and Medicaid,” Dr. Johns says. “Being the sole hospitalist as we’re expanding allowed me to set the stage: what was lacking, what was missing, what we could improve on, what was already working quite well. [I incorporated] the help of the administration to fill in the gaps of what we needed.”

The primary nonclinical challenge for the lone hospitalist is finding patients to care for and doctors to share coverage. Christopher Farrar, MD, lead hospitalist at Anderson Hospital in Maryville, Ill., began the program there. His employer, the hospitalist company Inpatient Management Inc., based in St. Louis, Mo., manages 18 hospitalist programs in 12 states. “As I was ending my primary care role,” says Dr. Farrar, “this opportunity came available. I think that they weren’t expecting someone to jump in so quickly. They didn’t have the luxury of time to find another physician right away.”