Medicus Healthcare Solutions

Identifying the Symptoms of a Fractured Hospital Medicine Program

Executive summary
Over the past decade, the field of hospital medicine (HM) has grown tremendously and continues to accelerate the demand for hospitalists. With this growth come issues surrounding the supply of an adequate number of qualified providers. This article provides a snapshot of the industry and suggests two steps that hospitals should take to evaluate their HM programs and best position themselves to attract and retain providers.

Present and future HM demand and supply
Most industry experts agree that the actual number of hospitalists needed nationwide hovers between 45,000 and 55,000. With approximately 805,000 staffed beds spread across 5,700 acute care community hospitals, the number of hospitalists needed to cover all these beds (at least in the near future) certainly balloons beyond expert suggestions. And the implications and potential result of adding over 30 million insured patients due to the Affordable Care Act and other healthcare changes would increase the demand for hospitalists even more. At present, best estimates indicate a total of 35,000 practicing hospitalists in the U.S. today; some of whom are not FTEs, but rather part-time providers.

Steps for building a sustainable—and scalable—HM program
With the limited number of current HM providers and a supply-demand scenario that promises to remain heavily weighted on the demand side, it is imperative that hospitals migrate toward a system of provider retention, shunning the notion that the next hospitalist is just around the corner. Here are two steps hospitals should take:

Step 1: Identify the symptoms of a fractured HM program
Hospital medicine (HM) programs must learn how to identify the early signs and symptoms of a fractured program. The question is: What are the symptoms of a fractured HM program? Many would argue (correctly) that the symptoms are numerous and program dependent. While I agree with this position, identifying provider turnover (for established programs) and difficulty recruiting (for new programs) is a solid place to start. Identifying either of these symptoms provides one of the most reliable ways to diagnose a troubled program—or, at the other end of the spectrum, confirm a healthy HM program when neither symptom is present.

I place the following in the category of “secondary symptoms,” as they fall more in the realm of inadequate administrative and hospitalist leadership:

  • Suboptimal patient satisfaction scores
  • Poor core measure performance
  • Suboptimal readmission rates
  • Poor ED throughput
  • Higher-than-expected resource utilization
  • Poor colleague satisfaction

Step 2: Move in earnest to employ sustainable solutions that will not simply steady the ship but will strategically position you for the future
In this HM landscape with limited supply of and high demand for hospitalist services, providers have a very low threshold for discomfort. This is not to imply that hospital leaders must bend to the whims of providers, but consistent and deliberate attention to provider needs and concerns is an absolute must. Hospital leaders must insist on a sustainable HM model that is built on the foundation of trust, ownership, professionalism, and respect. This means:

  1. A carefully crafted compensation plan that has the proper mix of a competitive base salary and incentives to drive desired behaviors
  2. A schedule and staffing ratio designed to avoid burnout
  3. Recognition of and demonstrated commitment to the importance of work-life balance
  4. Constant provider-administrative dialogue using all the new technologies—but not forgetting the often-missed personal conversation

Most hospital leaders will quickly identify with at least some of the symptoms of a fractured HM program mentioned above. The next steps beyond recognition can be complicated and difficult to achieve. Some institutions will have the infrastructure and personnel who can identify and focus on these issues and dedicate themselves to foster the dialogue and changes necessary to achieve a healthy HM program, maybe eventually even yielding the elusive Shared Institutional Vision. Others will quickly realize their institutional limitations. For the latter, seek help from a qualified hospitalist consultant. A proper assessment of your program and/or situation can yield rapid yet sustained improvement, especially when failure is just not an option.

Contact us
Medicus Consulting Services, LLC (MCS) partners with clients to launch, transition, or restructure hospital medicine programs. We specialize in helping organizations not only assess their current performance against both organizational goals and industry best practices, but implement the changes necessary to improve efficiency and performance. Contact us at consulting@medicushcs.com to discuss your needs.