Dr. Wachter

Bob Wachter, MD, MHM, the dean of hospital medicine, is pretty much the first to do anything in the field. First, he helped name it. Then, he helped it stand out. Now, he’s the first to give The Hospitalist a Twitter interview, a fitting nod to his technological prowess and knowledge of what’s what in the field. On stage at HM14 next month in Las Vegas, Dr. Wachter will give his 10th annual closing address, appropriately titled “10 Years of Wachter Keynotes: And Now for Something Completely Different.”

“I don’t know if he’s going to dress in something Vegas-esque,” says HM14 course director Daniel Brotman, MD, FACP, SFHM. “Who knows?”

QUESTION: How do you get excited for these end-of-meeting addresses year after year after year after—well, more than a few years now?

ANSWER: I build 1 big new tlk a yr:mtg gives me chnce 2 do so, takng some risks w/ frndly crowd. Speakng to >1K #hospitalists:how could tht get old?

Q: What is your talk-building process? As the veritable father of the field, how do you decide what you want to impart?

A: I try to pick one big topic/yr: doc of the future, changes in pt safety, how IT is transformng HC. Which one? Tickles my fancy, emergng trend.

Q: And what’s most important for this year, as the winds of the ACA, Obamacare exchanges, and pay for performance blow stronger?

A: Still musing. The uber-trends–the ones that’ll have legs ovr decades–are push to population health, wiring of HC system, and cost pressures.

Q: Those are terms HM docs didn’t learn in med school. How do they adjust to this new world of costs and wiring and population, oh my?

A: Remember, we’re 1 of th key disruptv inovatns of th pst 20 yrs. If we stop changng, we’ll be lapped by thos who fix probms. & we’ll deserv it.

Q: What changes do you see coming in the next year as the morass of ACA, ACO, VBP becomes more and more important?

A: ACA: fix the website. ACOs: hosps/med grps/insurrs scramblng to forge partnerships. VBP: move frm process 2 outcomes, new efficiency measurs & the fix of the SGR will entail some new, creative quality measures 4 docs: you’ll get your money but some will be at risk based on quality.

Q: You seem like an optimist on HM’s ability lead this change. What, specifically, makes u c the specialty as uniquely suited to the challenge?

A: HM is the 1st specialty 2 brand itself as being about both pt care AND systems improvement. Ths allows us 2 welcome change & lead the charge.

Q: What do you say to docs who say they’re so busy with pt care that systems change is a back burner issue for them?

A: I feel their pain; burnout & change fatigue r real. But I dont see a choice: we need 2 fix systems to ultimatly allow us 2 do our work, & well.

Q: Does systems change make the job any easier for HM docs, in addition to improving efficiency? How so?

A: Devil’s truly in the details, 2 simplistc 2 say it always does. Systems need 2 balance needs of pts, org, & wrkrs. Hard 2 always improv all 3.

Q: Last question: will this year’s talk have Vegas flair (shimmering outfits, hairpieces, or dancers) to entertain your fans?

A: Not quite that, but something in that genre... we’ll have to leave it at that. I figure for my 10th anniversary, what the hell. It’s Vegas.

–Richard Quinn

Hospital Medicine Pioneer Bob Wachter, MD, MHM, Twitters Insights on HM14 Address