Mid-Life Hospitalists

The Hospitalist. 2006 May;2006(05):

May 1, 2006 | The Hospitalist

The 49-year-old doctor eases the transition for other mid-lifers, recognizing that avoiding burnout as a hospitalist requires mental and physical preparation.

“The sheer volume of rounding, whether for an [average daily census] of 18 or 13 consults a day is tough,” says Dr. Jacobs. “They’ve got to be solid internists with strong ICU skills. I like diverse teams of older and younger docs. They work well because a team of hospitalists all just out of residency can easily burn out. They need the experience and mentoring of older docs to augment their up-to-date clinical skills.”

Academia is also fertile ground for mid-career changes. A doctor with an office practice and a faculty appointment may someday close the office and return to the hospital he or she loves. (See the profile of Joseph Snitzer, MD: “Sibling Rivalry,” in The Hospitalist, Sept. 2005.) Scott Wilson, MD, of The University of Iowa Hospitals and Clinic, Rapid City, left to start a hospitalist program in 2000 for the 880-bed University Hospital and its 250-bed Veterans Affairs Hospital after many years of teaching in the medical school. Dr. Wilson was tapped to start the hospitalist program because of improvements he had made in educating physicians.

I like diverse teams of older and younger docs. They work well because a team of hospitalists all just out of residency can easily burn out. They need the experience and mentoring of older docs to augment their up-to-date clinical skills.

—Ron Jacobs, MD

“Our program has some unique features, particularly our interaction with residents, improving the med school curriculum, and building research into our practice,” says Dr. Wilson.

In 2004 that included a study showing that patients managed by hospitalists had shorter length of stay (LOS) and lower costs than patients managed by non-hospitalists, but had higher costs per day. (Kaboli PJ, Barnett MJ, Rosenthal GE. Associations with reduced length of stay and costs on an academic hospitalist service. Am J Manag Care. 2004 Aug;10 (8):561-568). The schedule’s tough for a non-20-something: call every fourth night, three-week blocks for six months, then six months of research.

Dr. Wilson enjoys the challenge and the $1 million hospital support the program garnered in 2005. “We meet their needs to reduce LOS and improve quality, and we keep growing our program through new tasks such as surgical co-management of orthopedics,” he says.

Recruiting Them

Hospital administrators who want to recruit mid-career physicians as hospitalists need look no further than their own backyards. The internist or family practice doctor who relishes hospital rounds but has to rush back to the office, such as Dr. Oxenhandler, is a prime candidate for hospitalist recruitment. Areas where medical groups have trouble recruiting new doctors because reimbursements are flat (e.g., San Pablo) are also fertile ground for recruiting. Entrepreneurial physicians like Drs. Brannon and Jacobs, who had already dabbled in other medical careers before becoming hospitalists, are another choice.

Doctors in each of these categories are still brimming with energy and enthusiasm for medicine and are a looking for ways to make things better for patients and themselves. They might be your next hospitalist recruit. TH

Exit an Office Practice Gracefully

A mid-career physician leaving an office practice to become a hospitalist should think twice about before turning out the lights, says Martin Moll, Esq., who heads the healthcare practice of the Lake Oswego, Ore.-based law firm Aldrich Kilbride & Tatone.

“Even if it’s not doing well financially don’t assume the practice has no value,” says Moll. “Your patient list has real monetary value. Physicians who are part of a group usually sell their interest back to their partners without much hassle, but Moll advises scrutiny of the partnership agreement.

“That’s particularly important if you have a non-compete covenant, which is geographical rather than geared to practice types,” he says. “If that’s the case, the group has to waive that clause for a physician to assume a hospitalist position in the same town.”

Hospital administrators courting a mid-life career-changer who’s thinking of becoming a hospitalist can offer to cover costs such as malpractice insurance to cover future claims and help with the costs of closing the office such as severance pay for office employees.

“Since hospitalist demand outstrips supply, doctors closing offices have the upper hand now,” says Moll. “That will be true for at least the next five years, but eventually the hospitals will figure it out and they won’t be as generous to physicians looking to exit their practices.”

That may also drive down hospitalist salaries and eliminate sweetheart deals for favorable perks.

Legal issues aside, Moll suggests that becoming an employee may be traumatic for office-based physicians. “You go from an entrepreneurial top dog to a cog in the wheel of a big organization. You do what they want, not what you want with your professional life. You have to be careful because the hospital can find another hospitalist to replace you if things go sour,” he cautions.

The options are poor for a physician who closes his practice to become a hospitalist and finds he decided wrongly. “Restarting a practice is prohibitively expensive, and if you left a group they’ve probably replaced you,” says Moll. Negotiating a trial period in advance with the hospital and a one- or two-year re-entry clause with the group may cushion the blow for an ill-advised career move.—MP