Mark Leiser

In some ways, Femi Adewunmi, MD, MBA, CPE, SFHM, seemed destined to become a physician. He grew up in a medical family—his mother is an orthodontist; his father is an obstetrician/gynecologist. As a child, he often spent holidays visiting patients at the hospital where his dad worked. He grew to appreciate medicine as a noble profession, and when he reached his teens, he never seriously considered another career path.

“There were times when I was in medical school, dreading having to study for the numerous tests and exams, when I wished I had someone I could have blamed my decision to go to medical school on,” says Dr. Adewunmi, a native of Nigeria who has practiced as a hospitalist in the U.S. since 2003. “But no one pushed me to do it. It was something I always looked forward to doing, and I’m very glad I stuck with it.”

Dr. Adewunmi has only become more passionate about his work since then. His experience as a front-line hospitalist laid the foundation for a series of leadership roles, first directing the HM program at Johnston Memorial Hospital in Smithfield, N.C., and now as regional chief medical officer for Sound Physicians, which provides inpatient services to more than 70 hospitals nationally.

“I really want to be a good physician executive,” he says. “It’s definitely a case of ‘The more you learn, the more you realize how little you know.’ I still have a lot to learn, but I’m looking forward to the challenge.”

When did you decide to go into HM?

During residency, I realized I loved taking care of patients in the hospital, both along the wards and in the ICU. I enjoyed my outpatient clinics but found myself looking for any reason I could to stay in the hospital caring for patients. I was interested in patient safety and I was doing a little bit of utilization review, so I also felt it would give me a great overall perspective of the healthcare system.

What about leading the hospitalist program at Johnston Memorial appealed to you?

I enjoyed clinical medicine, and I still do, but I was looking to do more. I wanted to make an impact at a systems level, and I knew, to do that, I eventually had to gain some leadership experience.

What is the most valuable lesson you learned in that role?

Understanding that change doesn’t happen instantaneously. For instance, as a clinician, you sometimes admit patients with congestive heart failure. You diagnose correctly, treat appropriately, and in a few days, the patients do better and go home. You get pretty swift gratification. Administration is much different. You put processes in place and it could take weeks or several quarters before you start to see the effects of the changes you implement.

What appealed to you about moving from a single-site leadership position at Johnston to a regional position with Sound?

I wanted to continue evolving. I wanted more of a challenge and was seeking opportunities where I would have operational responsibility—overseeing performance improvement in quality, satisfaction, and financial performance for several programs. In addition, I wanted to be accountable for physician development, recruiting, negotiations, and the whole gamut of business development. It was the next logical step in my career.

Why did you pursue an MBA?

I’d made that decision just before I got into medical school. I recall first thinking about it after a conversation I had with my father as a teenager. When I told him that I had made up my mind to study medicine, he said, “You should consider getting an MBA as well. Your generation is going to need to have business experience and expertise, and be better in that area than our generation was.” It’s been invaluable for me in terms of preparing me for handling the business side of medicine, including ways to make operations more efficient and to reduce costs without compromising the quality of care provided.

You have worked in both hospital-employed and privately contracted HM programs. Do you prefer one model?

In general, the larger organizations tend to have an advantage in that they have established protocols and processes that work and have been refined over time. Couple that with the economies of scale they enjoy, as we move into an era of value-based purchasing, it’s becoming harder for the smaller community-based hospital to do that as well. That said, I have seen local hospital-run programs that function really well and have administrative support, so there is definitely enough room for both models.

You were in the inaugural FHM class. What did that recognition mean to you?

I saw it as validation of how we were starting to mature as a specialty and as recognition of a commitment to being a hospitalist, not just an internist. I never practiced outpatient medicine. I went straight from residency to hospitalist medicine. That’s how I identify myself, and I was happy to see that physicians specializing in hospital medicine were starting to get recognized.

What is your biggest professional reward?

The satisfaction from knowing you’re making a difference—not just by the care you provide one-on-one to your patients, but also knowing you’re contributing at a systems level or a population level because you’re making decisions and trying to redefine processes that actually could impact a much larger cohort.

What is your biggest professional challenge?

Trying to find enough hours in the day to do all that needs to be done.

What is next for you professionally?

I enjoy having varied opportunities and being involved in many different aspects of operations. That’s what attracted me to a larger company such as Sound Physicians, and I see myself staying in that type of role. Down the road, I’d love to be able to take some of my knowledge to Nigeria and find a way to help develop and shape the healthcare sector back home.

Why would that mean so much to you?

It would be a chance to give back. We still have people dying from largely preventable diseases, and our healthcare system is not what it should be. We don’t have enough physicians for the population, and most of the physicians are in urban areas.

Close to half of the members of my graduating medical school class are either in the U.S., Europe, Asia, or South Africa.

That type of brain drain has a tremendous effect over several decades. That’s a lot of talent outside the country, and we need that back home.

Mark Leiser is a freelance writer in New Jersey.

In some ways, Femi Adewunmi, MD, MBA, CPE, SFHM, seemed destined to become a physician. He grew up in a medical family—his mother is an orthodontist; his father is an obstetrician/gynecologist. As a child, he often spent holidays visiting patients at the hospital where his dad worked. He grew to appreciate medicine as a noble profession, and when he reached his teens, he never seriously considered another career path.

“There were times when I was in medical school, dreading having to study for the numerous tests and exams, when I wished I had someone I could have blamed my decision to go to medical school on,” says Dr. Adewunmi, a native of Nigeria who has practiced as a hospitalist in the U.S. since 2003. “But no one pushed me to do it. It was something I always looked forward to doing, and I’m very glad I stuck with it.”

Dr. Adewunmi has only become more passionate about his work since then. His experience as a front-line hospitalist laid the foundation for a series of leadership roles, first directing the HM program at Johnston Memorial Hospital in Smithfield, N.C., and now as regional chief medical officer for Sound Physicians, which provides inpatient services to more than 70 hospitals nationally.

“I really want to be a good physician executive,” he says. “It’s definitely a case of ‘The more you learn, the more you realize how little you know.’ I still have a lot to learn, but I’m looking forward to the challenge.”

When did you decide to go into HM?

During residency, I realized I loved taking care of patients in the hospital, both along the wards and in the ICU. I enjoyed my outpatient clinics but found myself looking for any reason I could to stay in the hospital caring for patients. I was interested in patient safety and I was doing a little bit of utilization review, so I also felt it would give me a great overall perspective of the healthcare system.

What about leading the hospitalist program at Johnston Memorial appealed to you?

I enjoyed clinical medicine, and I still do, but I was looking to do more. I wanted to make an impact at a systems level, and I knew, to do that, I eventually had to gain some leadership experience.

What is the most valuable lesson you learned in that role?

Understanding that change doesn’t happen instantaneously. For instance, as a clinician, you sometimes admit patients with congestive heart failure. You diagnose correctly, treat appropriately, and in a few days, the patients do better and go home. You get pretty swift gratification. Administration is much different. You put processes in place and it could take weeks or several quarters before you start to see the effects of the changes you implement.

What appealed to you about moving from a single-site leadership position at Johnston to a regional position with Sound?

I wanted to continue evolving. I wanted more of a challenge and was seeking opportunities where I would have operational responsibility—overseeing performance improvement in quality, satisfaction, and financial performance for several programs. In addition, I wanted to be accountable for physician development, recruiting, negotiations, and the whole gamut of business development. It was the next logical step in my career.

Why did you pursue an MBA?

I’d made that decision just before I got into medical school. I recall first thinking about it after a conversation I had with my father as a teenager. When I told him that I had made up my mind to study medicine, he said, “You should consider getting an MBA as well. Your generation is going to need to have business experience and expertise, and be better in that area than our generation was.” It’s been invaluable for me in terms of preparing me for handling the business side of medicine, including ways to make operations more efficient and to reduce costs without compromising the quality of care provided.

You have worked in both hospital-employed and privately contracted HM programs. Do you prefer one model?

In general, the larger organizations tend to have an advantage in that they have established protocols and processes that work and have been refined over time. Couple that with the economies of scale they enjoy, as we move into an era of value-based purchasing, it’s becoming harder for the smaller community-based hospital to do that as well. That said, I have seen local hospital-run programs that function really well and have administrative support, so there is definitely enough room for both models.

You were in the inaugural FHM class. What did that recognition mean to you?

I saw it as validation of how we were starting to mature as a specialty and as recognition of a commitment to being a hospitalist, not just an internist. I never practiced outpatient medicine. I went straight from residency to hospitalist medicine. That’s how I identify myself, and I was happy to see that physicians specializing in hospital medicine were starting to get recognized.

What is your biggest professional reward?

The satisfaction from knowing you’re making a difference—not just by the care you provide one-on-one to your patients, but also knowing you’re contributing at a systems level or a population level because you’re making decisions and trying to redefine processes that actually could impact a much larger cohort.

What is your biggest professional challenge?

Trying to find enough hours in the day to do all that needs to be done.

What is next for you professionally?

I enjoy having varied opportunities and being involved in many different aspects of operations. That’s what attracted me to a larger company such as Sound Physicians, and I see myself staying in that type of role. Down the road, I’d love to be able to take some of my knowledge to Nigeria and find a way to help develop and shape the healthcare sector back home.

Why would that mean so much to you?

It would be a chance to give back. We still have people dying from largely preventable diseases, and our healthcare system is not what it should be. We don’t have enough physicians for the population, and most of the physicians are in urban areas.

Close to half of the members of my graduating medical school class are either in the U.S., Europe, Asia, or South Africa.

That type of brain drain has a tremendous effect over several decades. That’s a lot of talent outside the country, and we need that back home.

Mark Leiser is a freelance writer in New Jersey.

In some ways, Femi Adewunmi, MD, MBA, CPE, SFHM, seemed destined to become a physician. He grew up in a medical family—his mother is an orthodontist; his father is an obstetrician/gynecologist. As a child, he often spent holidays visiting patients at the hospital where his dad worked. He grew to appreciate medicine as a noble profession, and when he reached his teens, he never seriously considered another career path.

“There were times when I was in medical school, dreading having to study for the numerous tests and exams, when I wished I had someone I could have blamed my decision to go to medical school on,” says Dr. Adewunmi, a native of Nigeria who has practiced as a hospitalist in the U.S. since 2003. “But no one pushed me to do it. It was something I always looked forward to doing, and I’m very glad I stuck with it.”

Dr. Adewunmi has only become more passionate about his work since then. His experience as a front-line hospitalist laid the foundation for a series of leadership roles, first directing the HM program at Johnston Memorial Hospital in Smithfield, N.C., and now as regional chief medical officer for Sound Physicians, which provides inpatient services to more than 70 hospitals nationally.

“I really want to be a good physician executive,” he says. “It’s definitely a case of ‘The more you learn, the more you realize how little you know.’ I still have a lot to learn, but I’m looking forward to the challenge.”

When did you decide to go into HM?

During residency, I realized I loved taking care of patients in the hospital, both along the wards and in the ICU. I enjoyed my outpatient clinics but found myself looking for any reason I could to stay in the hospital caring for patients. I was interested in patient safety and I was doing a little bit of utilization review, so I also felt it would give me a great overall perspective of the healthcare system.

What about leading the hospitalist program at Johnston Memorial appealed to you?

I enjoyed clinical medicine, and I still do, but I was looking to do more. I wanted to make an impact at a systems level, and I knew, to do that, I eventually had to gain some leadership experience.

What is the most valuable lesson you learned in that role?

Understanding that change doesn’t happen instantaneously. For instance, as a clinician, you sometimes admit patients with congestive heart failure. You diagnose correctly, treat appropriately, and in a few days, the patients do better and go home. You get pretty swift gratification. Administration is much different. You put processes in place and it could take weeks or several quarters before you start to see the effects of the changes you implement.

What appealed to you about moving from a single-site leadership position at Johnston to a regional position with Sound?

I wanted to continue evolving. I wanted more of a challenge and was seeking opportunities where I would have operational responsibility—overseeing performance improvement in quality, satisfaction, and financial performance for several programs. In addition, I wanted to be accountable for physician development, recruiting, negotiations, and the whole gamut of business development. It was the next logical step in my career.

Why did you pursue an MBA?

I’d made that decision just before I got into medical school. I recall first thinking about it after a conversation I had with my father as a teenager. When I told him that I had made up my mind to study medicine, he said, “You should consider getting an MBA as well. Your generation is going to need to have business experience and expertise, and be better in that area than our generation was.” It’s been invaluable for me in terms of preparing me for handling the business side of medicine, including ways to make operations more efficient and to reduce costs without compromising the quality of care provided.

You have worked in both hospital-employed and privately contracted HM programs. Do you prefer one model?

In general, the larger organizations tend to have an advantage in that they have established protocols and processes that work and have been refined over time. Couple that with the economies of scale they enjoy, as we move into an era of value-based purchasing, it’s becoming harder for the smaller community-based hospital to do that as well. That said, I have seen local hospital-run programs that function really well and have administrative support, so there is definitely enough room for both models.

You were in the inaugural FHM class. What did that recognition mean to you?

I saw it as validation of how we were starting to mature as a specialty and as recognition of a commitment to being a hospitalist, not just an internist. I never practiced outpatient medicine. I went straight from residency to hospitalist medicine. That’s how I identify myself, and I was happy to see that physicians specializing in hospital medicine were starting to get recognized.

What is your biggest professional reward?

The satisfaction from knowing you’re making a difference—not just by the care you provide one-on-one to your patients, but also knowing you’re contributing at a systems level or a population level because you’re making decisions and trying to redefine processes that actually could impact a much larger cohort.

What is your biggest professional challenge?

Trying to find enough hours in the day to do all that needs to be done.

What is next for you professionally?

I enjoy having varied opportunities and being involved in many different aspects of operations. That’s what attracted me to a larger company such as Sound Physicians, and I see myself staying in that type of role. Down the road, I’d love to be able to take some of my knowledge to Nigeria and find a way to help develop and shape the healthcare sector back home.

Why would that mean so much to you?

It would be a chance to give back. We still have people dying from largely preventable diseases, and our healthcare system is not what it should be. We don’t have enough physicians for the population, and most of the physicians are in urban areas.

Close to half of the members of my graduating medical school class are either in the U.S., Europe, Asia, or South Africa.

That type of brain drain has a tremendous effect over several decades. That’s a lot of talent outside the country, and we need that back home.

Mark Leiser is a freelance writer in New Jersey.

Tracy Cardin, ACNP-BC, entered college as a criminal justice major, believing her talent for crafting sound arguments and her passion for defending her point of view would translate into a successful law career.

Less than a year later, Cardin visited her gravely ill aunt and discovered her true calling. “I noticed a lot of small things: Her fingernails were a little long, her hair was sort of unkempt, and the environment wasn’t as clean as I would have liked,” Cardin says. “I didn’t feel the people who were caring for her were putting in the time or effort to make her as comfortable as possible. I didn’t see a lot of tender loving care, and I honestly felt I could do a better job.”

Cardin changed her major, pursued a nursing career, and now has 22 years of experience providing inpatient care.

“It’s a privilege to take care of patients, and hospitalists have a wonderful opportunity to impact the quality of care they receive,” says Cardin, one of seven nonphysician providers (NPPs) in the Section of Hospital Medicine at the University of Chicago Medical Center. She also is Team Hospitalist’s only NPP member. “They are the reason I do what I do—and the reason I love what I do.”

Are there similarities between being a nurse practitioner (NP) and a litigator?

You definitely have to advocate for your patients. Both fields allow you to see the stories of the human condition. In my job, it’s all about the patients’ stories—how they came to be here and fitting your care for the patient within their narrative. And like the legal setting, people often find themselves in the healthcare world at a time of crisis. I like being there to help people in those times.

Why did you choose to practice in a hospital setting?

I like the objective data you get in a hospital. You have lab work, imaging, and vital signs. It helps create a better picture of what’s going on. I like that it’s very acute. Patients have a problem, hopefully you fix the problem or at least stabilize the person, and then they can go home. I also like that it’s fast-paced and varied. The hospital truly is one of the places I’m most comfortable.

What is your biggest professional reward?

When a patient knows it’s time to go home and die—when it’s their time and they are ready to go—and they need someone to help them get through that process. When patients and their families move from trying to solve unsolvable problems to an acceptance of their mortality, it’s a beautiful journey, and I really like helping them navigate that journey.

How would you describe the relationship between the physicians and NPPs in your program?

Like all relationships, it has gone through an evolution. It started with the “getting to know you” stage, during which the physicians weren’t sure what the NPPs do and the NPPs were very anxious to show our capabilities. There was this pushing and pulling. Over time, thanks to excellent leadership, we have a model that utilizes NPPs to the maximum of their capabilities. We have a very collaborative, collegial group, and it’s a special place to work. I have the utmost respect for the physicians, and I feel they have the utmost respect for our abilities.

Do most HM programs that bring on NPPs go through growing pains?

In the beginning, often there’s a little drama or controversy. Someone oversteps their bounds, someone is too rigid and doesn’t allow a mid-level provider to do something, or someone gets their feelings hurt.

How can you survive that process without the partnership breaking down?

It’s like when you’re driving a car and it starts to pull off the road. If you overcorrect and turn the wheel too hard, you’re going to end up crashing. Instead, you just turn the wheel a little bit. It’s very important that you don’t panic and try to overcorrect. Sometimes only a small adjustment needs to be made. If everyone is committed to one another, it will work out.

What advice would you give to NPPs who are thinking about joining an HM program?

First, be ready to work hard. It’s very rewarding, but it’s a rapid pace and it’s stressful. Second, align yourself with someone who is sympathetic to and supportive of the role of a mid-level provider within a hospitalist group. Third, never give up, because hospital medicine is a great career.

What advice would you give to physicians whose programs are considering hiring NPPs?

Check out the SHM website (www.hospitalmedicine.org), because it is a tremendous resource. Also, treat the NPPs the same way they would treat another physician. Give them the same assistance, invite them to the same meetings, and give them the same education or training. Realize that even though physicians, NPs, and physician assistants have different educations, everyone brings their own skill set to the table that adds to this stew of excellence.

How do you see the role of NPPs evolving as they become more prevalent in HM?

Given residency work-hour reforms and the fact there are not physicians to do all of the work, NPPs are going to be utilized much more. NPPs bring a ton of experience to the care of inpatients, so a hospital medicine group should utilize them in all kinds of roles, whether it’s orienting new physicians or educating nursing staff about the care of their specialized patients. NPPs also can take on leadership roles as part of quality improvement projects. We are going to be needed in patient care, but we shouldn’t just be relegated to patient care. The experience is there to help in many other areas.

You have spoken about the integration of NPs in hospitalist programs at two HM meetings and will do so again at HM12. What does that mean to you?

It’s my passion. I’m fascinated by the entire process. I always say, “Why am I up here speaking about this? Because I’ve made every mistake; learn from me.” My program director [Chad Whelan, MD, FHM], who was so calm and so rational and helped me integrate so well, has impacted me so greatly. I get to pass that on to other people, and it’s a tremendous opportunity.

Mark Leiser is a freelance writer in New Jersey.

Tracy Cardin, ACNP-BC, entered college as a criminal justice major, believing her talent for crafting sound arguments and her passion for defending her point of view would translate into a successful law career.

Less than a year later, Cardin visited her gravely ill aunt and discovered her true calling. “I noticed a lot of small things: Her fingernails were a little long, her hair was sort of unkempt, and the environment wasn’t as clean as I would have liked,” Cardin says. “I didn’t feel the people who were caring for her were putting in the time or effort to make her as comfortable as possible. I didn’t see a lot of tender loving care, and I honestly felt I could do a better job.”

Cardin changed her major, pursued a nursing career, and now has 22 years of experience providing inpatient care.

“It’s a privilege to take care of patients, and hospitalists have a wonderful opportunity to impact the quality of care they receive,” says Cardin, one of seven nonphysician providers (NPPs) in the Section of Hospital Medicine at the University of Chicago Medical Center. She also is Team Hospitalist’s only NPP member. “They are the reason I do what I do—and the reason I love what I do.”

Are there similarities between being a nurse practitioner (NP) and a litigator?

You definitely have to advocate for your patients. Both fields allow you to see the stories of the human condition. In my job, it’s all about the patients’ stories—how they came to be here and fitting your care for the patient within their narrative. And like the legal setting, people often find themselves in the healthcare world at a time of crisis. I like being there to help people in those times.

Why did you choose to practice in a hospital setting?

I like the objective data you get in a hospital. You have lab work, imaging, and vital signs. It helps create a better picture of what’s going on. I like that it’s very acute. Patients have a problem, hopefully you fix the problem or at least stabilize the person, and then they can go home. I also like that it’s fast-paced and varied. The hospital truly is one of the places I’m most comfortable.

What is your biggest professional reward?

When a patient knows it’s time to go home and die—when it’s their time and they are ready to go—and they need someone to help them get through that process. When patients and their families move from trying to solve unsolvable problems to an acceptance of their mortality, it’s a beautiful journey, and I really like helping them navigate that journey.

How would you describe the relationship between the physicians and NPPs in your program?

Like all relationships, it has gone through an evolution. It started with the “getting to know you” stage, during which the physicians weren’t sure what the NPPs do and the NPPs were very anxious to show our capabilities. There was this pushing and pulling. Over time, thanks to excellent leadership, we have a model that utilizes NPPs to the maximum of their capabilities. We have a very collaborative, collegial group, and it’s a special place to work. I have the utmost respect for the physicians, and I feel they have the utmost respect for our abilities.

Do most HM programs that bring on NPPs go through growing pains?

In the beginning, often there’s a little drama or controversy. Someone oversteps their bounds, someone is too rigid and doesn’t allow a mid-level provider to do something, or someone gets their feelings hurt.

How can you survive that process without the partnership breaking down?

It’s like when you’re driving a car and it starts to pull off the road. If you overcorrect and turn the wheel too hard, you’re going to end up crashing. Instead, you just turn the wheel a little bit. It’s very important that you don’t panic and try to overcorrect. Sometimes only a small adjustment needs to be made. If everyone is committed to one another, it will work out.

What advice would you give to NPPs who are thinking about joining an HM program?

First, be ready to work hard. It’s very rewarding, but it’s a rapid pace and it’s stressful. Second, align yourself with someone who is sympathetic to and supportive of the role of a mid-level provider within a hospitalist group. Third, never give up, because hospital medicine is a great career.

What advice would you give to physicians whose programs are considering hiring NPPs?

Check out the SHM website (www.hospitalmedicine.org), because it is a tremendous resource. Also, treat the NPPs the same way they would treat another physician. Give them the same assistance, invite them to the same meetings, and give them the same education or training. Realize that even though physicians, NPs, and physician assistants have different educations, everyone brings their own skill set to the table that adds to this stew of excellence.

How do you see the role of NPPs evolving as they become more prevalent in HM?

Given residency work-hour reforms and the fact there are not physicians to do all of the work, NPPs are going to be utilized much more. NPPs bring a ton of experience to the care of inpatients, so a hospital medicine group should utilize them in all kinds of roles, whether it’s orienting new physicians or educating nursing staff about the care of their specialized patients. NPPs also can take on leadership roles as part of quality improvement projects. We are going to be needed in patient care, but we shouldn’t just be relegated to patient care. The experience is there to help in many other areas.

You have spoken about the integration of NPs in hospitalist programs at two HM meetings and will do so again at HM12. What does that mean to you?

It’s my passion. I’m fascinated by the entire process. I always say, “Why am I up here speaking about this? Because I’ve made every mistake; learn from me.” My program director [Chad Whelan, MD, FHM], who was so calm and so rational and helped me integrate so well, has impacted me so greatly. I get to pass that on to other people, and it’s a tremendous opportunity.

Mark Leiser is a freelance writer in New Jersey.

Tracy Cardin, ACNP-BC, entered college as a criminal justice major, believing her talent for crafting sound arguments and her passion for defending her point of view would translate into a successful law career.

Less than a year later, Cardin visited her gravely ill aunt and discovered her true calling. “I noticed a lot of small things: Her fingernails were a little long, her hair was sort of unkempt, and the environment wasn’t as clean as I would have liked,” Cardin says. “I didn’t feel the people who were caring for her were putting in the time or effort to make her as comfortable as possible. I didn’t see a lot of tender loving care, and I honestly felt I could do a better job.”

Cardin changed her major, pursued a nursing career, and now has 22 years of experience providing inpatient care.

“It’s a privilege to take care of patients, and hospitalists have a wonderful opportunity to impact the quality of care they receive,” says Cardin, one of seven nonphysician providers (NPPs) in the Section of Hospital Medicine at the University of Chicago Medical Center. She also is Team Hospitalist’s only NPP member. “They are the reason I do what I do—and the reason I love what I do.”

Are there similarities between being a nurse practitioner (NP) and a litigator?

You definitely have to advocate for your patients. Both fields allow you to see the stories of the human condition. In my job, it’s all about the patients’ stories—how they came to be here and fitting your care for the patient within their narrative. And like the legal setting, people often find themselves in the healthcare world at a time of crisis. I like being there to help people in those times.

Why did you choose to practice in a hospital setting?

I like the objective data you get in a hospital. You have lab work, imaging, and vital signs. It helps create a better picture of what’s going on. I like that it’s very acute. Patients have a problem, hopefully you fix the problem or at least stabilize the person, and then they can go home. I also like that it’s fast-paced and varied. The hospital truly is one of the places I’m most comfortable.

What is your biggest professional reward?

When a patient knows it’s time to go home and die—when it’s their time and they are ready to go—and they need someone to help them get through that process. When patients and their families move from trying to solve unsolvable problems to an acceptance of their mortality, it’s a beautiful journey, and I really like helping them navigate that journey.

How would you describe the relationship between the physicians and NPPs in your program?

Like all relationships, it has gone through an evolution. It started with the “getting to know you” stage, during which the physicians weren’t sure what the NPPs do and the NPPs were very anxious to show our capabilities. There was this pushing and pulling. Over time, thanks to excellent leadership, we have a model that utilizes NPPs to the maximum of their capabilities. We have a very collaborative, collegial group, and it’s a special place to work. I have the utmost respect for the physicians, and I feel they have the utmost respect for our abilities.

Do most HM programs that bring on NPPs go through growing pains?

In the beginning, often there’s a little drama or controversy. Someone oversteps their bounds, someone is too rigid and doesn’t allow a mid-level provider to do something, or someone gets their feelings hurt.

How can you survive that process without the partnership breaking down?

It’s like when you’re driving a car and it starts to pull off the road. If you overcorrect and turn the wheel too hard, you’re going to end up crashing. Instead, you just turn the wheel a little bit. It’s very important that you don’t panic and try to overcorrect. Sometimes only a small adjustment needs to be made. If everyone is committed to one another, it will work out.

What advice would you give to NPPs who are thinking about joining an HM program?

First, be ready to work hard. It’s very rewarding, but it’s a rapid pace and it’s stressful. Second, align yourself with someone who is sympathetic to and supportive of the role of a mid-level provider within a hospitalist group. Third, never give up, because hospital medicine is a great career.

What advice would you give to physicians whose programs are considering hiring NPPs?

Check out the SHM website (www.hospitalmedicine.org), because it is a tremendous resource. Also, treat the NPPs the same way they would treat another physician. Give them the same assistance, invite them to the same meetings, and give them the same education or training. Realize that even though physicians, NPs, and physician assistants have different educations, everyone brings their own skill set to the table that adds to this stew of excellence.

How do you see the role of NPPs evolving as they become more prevalent in HM?

Given residency work-hour reforms and the fact there are not physicians to do all of the work, NPPs are going to be utilized much more. NPPs bring a ton of experience to the care of inpatients, so a hospital medicine group should utilize them in all kinds of roles, whether it’s orienting new physicians or educating nursing staff about the care of their specialized patients. NPPs also can take on leadership roles as part of quality improvement projects. We are going to be needed in patient care, but we shouldn’t just be relegated to patient care. The experience is there to help in many other areas.

You have spoken about the integration of NPs in hospitalist programs at two HM meetings and will do so again at HM12. What does that mean to you?

It’s my passion. I’m fascinated by the entire process. I always say, “Why am I up here speaking about this? Because I’ve made every mistake; learn from me.” My program director [Chad Whelan, MD, FHM], who was so calm and so rational and helped me integrate so well, has impacted me so greatly. I get to pass that on to other people, and it’s a tremendous opportunity.

Mark Leiser is a freelance writer in New Jersey.

Dan Hale, MD, FAAP, started to seriously consider a career in medicine while in college. A summer job as a camp counselor helped convince him he’d found his calling.

“I realized how much I enjoyed spending time with children,” says Dr. Hale, who began his two-year Team Hospitalist term in May. “Everything is new for them, and they bring the joy of life to everything they do. That’s when I really began thinking about pediatrics.”

After residency, he joined the staff at Intermed Pediatrics in Portland, Maine. He split his time seeing patients in the office and in the hospital. Within three years, he made the transition to HM.

“Once I was exposed to hospitals, I knew that’s where I wanted to be,” says Dr. Hale, a pediatric hospitalist with Floating Hospital for Children at Tufts Medical Center in Boston and medical director of Floating’s pediatric hospitalist program at Lawrence (Mass.) General Hospital.

“I’ve really enjoyed being a part of this new field of pediatric hospital medicine,” he adds. “There is humongous potential for change, and I’m excited about what those of us in the hospital can do to improve healthcare.”

Floating Hospital has outreach programs at four community hospitals. How do those programs work?

If a child is very sick and requires a pediatric intensive care unit, they go to Boston to the Floating Hospital PICU. But because pediatric hospitalists from Floating staff these four other sites 24 hours a day, there is always someone there to see these patients in hopes of keeping them in their own community.

What is the biggest advantage of those affiliations?

In pediatric medicine, even more than adult medicine, it’s a family affair. It’s a big deal if a family has to drive over an hour into the city to get a child medical care. It can be a foreign environment and families have to find a place to stay. Floating’s philosophy is to provide optimal care for pediatric patients wherever they are. It’s a very unique solution to modern healthcare.

What types of care can Lawrence General provide now that it couldn’t prior to its affiliation with Floating Hospital?

Asthma and bronchiolitis are very common pediatric illnesses in winter, and they require very close monitoring. The hospitalists’ presence helps us keep those patients in the community hospital.

Can you quantify how many more patients are at Lawrence General?

Since starting the program in January, we decreased transfers for common pediatric conditions by 50%—from 10 pediatric transfers a month, on average, to about five per month.

Each community hospital’s pediatric HM program has its own medical director. Do you work with each other?

We work very closely together. Because every hospital is different, we learn from each other. We see what works and what doesn’t work at each site, and we build on that.

Can you give an example of how that network has improved the quality of care?

We have an asthma protocol developed by Floating Hospital for Children, and it was instituted at one of the community sites. It worked so well, we adopted a similar program at Lawrence General. It’s a perfect example of tailoring something that works well at one hospital to fit your patients’ needs rather than reinventing the wheel.

Did you have to overcome any obstacles when the affiliation launched?

The biggest hurdle was earning the trust of the nurses, the referring pediatricians, and the patients themselves. We started family-centered rounds, where we meet with every patient, their family, and the nurse to come up with a daily care plan. Slowly, by taking excellent care of every one of those patients and communicating at every single admission with the primary-care physician (PCP), we earned the trust of everyone.

Do you think these types of affiliations will become more common?

Yes. It’s truly a win-win situation. Lawrence General wins because they’re keeping more patients in the community. The patients win because they are close to home. Tufts Medical Center wins because it’s more involved in the community.

How pleased are PCPs in the community?

It’s definitely a win for them, too. If there is someone in their office that requires hospitalization, they can call the hospitalist and refer the patient directly to the pediatric inpatient unit, so there’s no going to the emergency room and no wait time. Also, if a pediatrician can refer to a hospitalist, they’re not leaving their office early to go see someone at the hospital. If they know their patient is getting really good care at the hospital, they can focus on delivering better, more efficient care in their practice.

Do you have to take a different approach to care because you are treating children?

The biggest difference is that you have two patients, the child and their family, so you have to spend more time explaining everything you do. No. 2, because you’re treating a child, you have to make sure you respect them by communicating with them and examining them in a nonthreatening way. The best part is, you’re required to have fun every day.

What is the biggest challenge pediatric hospitalists face?

The standardizing of care is new to our field, but it’s very important. Protocols and guidelines are still in development. I think it’s off to a good start, but there are still many new ways of thinking.

What is your biggest professional reward?

Because we’re a new field, the reward is seeing our field grow every year in terms of the number of pediatric hospitalists. Another is what we’re doing at Lawrence General, and seeing how our field keeps expanding and improving pediatric care in hospitals across the country. To have a job I can go to that’s so enjoyable, and at the end of every day I’m helping a smiling child, that makes it all worthwhile.

Mark Leiser is a freelance writer based in New Jersey.

Dan Hale, MD, FAAP, started to seriously consider a career in medicine while in college. A summer job as a camp counselor helped convince him he’d found his calling.

“I realized how much I enjoyed spending time with children,” says Dr. Hale, who began his two-year Team Hospitalist term in May. “Everything is new for them, and they bring the joy of life to everything they do. That’s when I really began thinking about pediatrics.”

After residency, he joined the staff at Intermed Pediatrics in Portland, Maine. He split his time seeing patients in the office and in the hospital. Within three years, he made the transition to HM.

“Once I was exposed to hospitals, I knew that’s where I wanted to be,” says Dr. Hale, a pediatric hospitalist with Floating Hospital for Children at Tufts Medical Center in Boston and medical director of Floating’s pediatric hospitalist program at Lawrence (Mass.) General Hospital.

“I’ve really enjoyed being a part of this new field of pediatric hospital medicine,” he adds. “There is humongous potential for change, and I’m excited about what those of us in the hospital can do to improve healthcare.”

Floating Hospital has outreach programs at four community hospitals. How do those programs work?

If a child is very sick and requires a pediatric intensive care unit, they go to Boston to the Floating Hospital PICU. But because pediatric hospitalists from Floating staff these four other sites 24 hours a day, there is always someone there to see these patients in hopes of keeping them in their own community.

What is the biggest advantage of those affiliations?

In pediatric medicine, even more than adult medicine, it’s a family affair. It’s a big deal if a family has to drive over an hour into the city to get a child medical care. It can be a foreign environment and families have to find a place to stay. Floating’s philosophy is to provide optimal care for pediatric patients wherever they are. It’s a very unique solution to modern healthcare.

What types of care can Lawrence General provide now that it couldn’t prior to its affiliation with Floating Hospital?

Asthma and bronchiolitis are very common pediatric illnesses in winter, and they require very close monitoring. The hospitalists’ presence helps us keep those patients in the community hospital.

Can you quantify how many more patients are at Lawrence General?

Since starting the program in January, we decreased transfers for common pediatric conditions by 50%—from 10 pediatric transfers a month, on average, to about five per month.

Each community hospital’s pediatric HM program has its own medical director. Do you work with each other?

We work very closely together. Because every hospital is different, we learn from each other. We see what works and what doesn’t work at each site, and we build on that.

Can you give an example of how that network has improved the quality of care?

We have an asthma protocol developed by Floating Hospital for Children, and it was instituted at one of the community sites. It worked so well, we adopted a similar program at Lawrence General. It’s a perfect example of tailoring something that works well at one hospital to fit your patients’ needs rather than reinventing the wheel.

Did you have to overcome any obstacles when the affiliation launched?

The biggest hurdle was earning the trust of the nurses, the referring pediatricians, and the patients themselves. We started family-centered rounds, where we meet with every patient, their family, and the nurse to come up with a daily care plan. Slowly, by taking excellent care of every one of those patients and communicating at every single admission with the primary-care physician (PCP), we earned the trust of everyone.

Do you think these types of affiliations will become more common?

Yes. It’s truly a win-win situation. Lawrence General wins because they’re keeping more patients in the community. The patients win because they are close to home. Tufts Medical Center wins because it’s more involved in the community.

How pleased are PCPs in the community?

It’s definitely a win for them, too. If there is someone in their office that requires hospitalization, they can call the hospitalist and refer the patient directly to the pediatric inpatient unit, so there’s no going to the emergency room and no wait time. Also, if a pediatrician can refer to a hospitalist, they’re not leaving their office early to go see someone at the hospital. If they know their patient is getting really good care at the hospital, they can focus on delivering better, more efficient care in their practice.

Do you have to take a different approach to care because you are treating children?

The biggest difference is that you have two patients, the child and their family, so you have to spend more time explaining everything you do. No. 2, because you’re treating a child, you have to make sure you respect them by communicating with them and examining them in a nonthreatening way. The best part is, you’re required to have fun every day.

What is the biggest challenge pediatric hospitalists face?

The standardizing of care is new to our field, but it’s very important. Protocols and guidelines are still in development. I think it’s off to a good start, but there are still many new ways of thinking.

What is your biggest professional reward?

Because we’re a new field, the reward is seeing our field grow every year in terms of the number of pediatric hospitalists. Another is what we’re doing at Lawrence General, and seeing how our field keeps expanding and improving pediatric care in hospitals across the country. To have a job I can go to that’s so enjoyable, and at the end of every day I’m helping a smiling child, that makes it all worthwhile.

Mark Leiser is a freelance writer based in New Jersey.

Dan Hale, MD, FAAP, started to seriously consider a career in medicine while in college. A summer job as a camp counselor helped convince him he’d found his calling.

“I realized how much I enjoyed spending time with children,” says Dr. Hale, who began his two-year Team Hospitalist term in May. “Everything is new for them, and they bring the joy of life to everything they do. That’s when I really began thinking about pediatrics.”

After residency, he joined the staff at Intermed Pediatrics in Portland, Maine. He split his time seeing patients in the office and in the hospital. Within three years, he made the transition to HM.

“Once I was exposed to hospitals, I knew that’s where I wanted to be,” says Dr. Hale, a pediatric hospitalist with Floating Hospital for Children at Tufts Medical Center in Boston and medical director of Floating’s pediatric hospitalist program at Lawrence (Mass.) General Hospital.

“I’ve really enjoyed being a part of this new field of pediatric hospital medicine,” he adds. “There is humongous potential for change, and I’m excited about what those of us in the hospital can do to improve healthcare.”

Floating Hospital has outreach programs at four community hospitals. How do those programs work?

If a child is very sick and requires a pediatric intensive care unit, they go to Boston to the Floating Hospital PICU. But because pediatric hospitalists from Floating staff these four other sites 24 hours a day, there is always someone there to see these patients in hopes of keeping them in their own community.

What is the biggest advantage of those affiliations?

In pediatric medicine, even more than adult medicine, it’s a family affair. It’s a big deal if a family has to drive over an hour into the city to get a child medical care. It can be a foreign environment and families have to find a place to stay. Floating’s philosophy is to provide optimal care for pediatric patients wherever they are. It’s a very unique solution to modern healthcare.

What types of care can Lawrence General provide now that it couldn’t prior to its affiliation with Floating Hospital?

Asthma and bronchiolitis are very common pediatric illnesses in winter, and they require very close monitoring. The hospitalists’ presence helps us keep those patients in the community hospital.

Can you quantify how many more patients are at Lawrence General?

Since starting the program in January, we decreased transfers for common pediatric conditions by 50%—from 10 pediatric transfers a month, on average, to about five per month.

Each community hospital’s pediatric HM program has its own medical director. Do you work with each other?

We work very closely together. Because every hospital is different, we learn from each other. We see what works and what doesn’t work at each site, and we build on that.

Can you give an example of how that network has improved the quality of care?

We have an asthma protocol developed by Floating Hospital for Children, and it was instituted at one of the community sites. It worked so well, we adopted a similar program at Lawrence General. It’s a perfect example of tailoring something that works well at one hospital to fit your patients’ needs rather than reinventing the wheel.

Did you have to overcome any obstacles when the affiliation launched?

The biggest hurdle was earning the trust of the nurses, the referring pediatricians, and the patients themselves. We started family-centered rounds, where we meet with every patient, their family, and the nurse to come up with a daily care plan. Slowly, by taking excellent care of every one of those patients and communicating at every single admission with the primary-care physician (PCP), we earned the trust of everyone.

Do you think these types of affiliations will become more common?

Yes. It’s truly a win-win situation. Lawrence General wins because they’re keeping more patients in the community. The patients win because they are close to home. Tufts Medical Center wins because it’s more involved in the community.

How pleased are PCPs in the community?

It’s definitely a win for them, too. If there is someone in their office that requires hospitalization, they can call the hospitalist and refer the patient directly to the pediatric inpatient unit, so there’s no going to the emergency room and no wait time. Also, if a pediatrician can refer to a hospitalist, they’re not leaving their office early to go see someone at the hospital. If they know their patient is getting really good care at the hospital, they can focus on delivering better, more efficient care in their practice.

Do you have to take a different approach to care because you are treating children?

The biggest difference is that you have two patients, the child and their family, so you have to spend more time explaining everything you do. No. 2, because you’re treating a child, you have to make sure you respect them by communicating with them and examining them in a nonthreatening way. The best part is, you’re required to have fun every day.

What is the biggest challenge pediatric hospitalists face?

The standardizing of care is new to our field, but it’s very important. Protocols and guidelines are still in development. I think it’s off to a good start, but there are still many new ways of thinking.

What is your biggest professional reward?

Because we’re a new field, the reward is seeing our field grow every year in terms of the number of pediatric hospitalists. Another is what we’re doing at Lawrence General, and seeing how our field keeps expanding and improving pediatric care in hospitals across the country. To have a job I can go to that’s so enjoyable, and at the end of every day I’m helping a smiling child, that makes it all worthwhile.

Mark Leiser is a freelance writer based in New Jersey.

Listen to Bob Wachter, MD, MHM

Andrew Auerbach, MD, MPH, SFHM, is an associate professor at one of the most highly regarded academic medical centers in the country, and he is a nationally respected researcher whose work has been published in prominent scientific publications.

His peers believe both roles prepared him well for his newest endeavor: editor-in-chief of the Journal of Hospital Medicine. His five-year term begins in January.

Dr. Auerbach’s affiliation with the University of California at San Francisco (UCSF), where he also serves as director of research for the division of hospital medicine and associate director of the General Medicine Research Fellowship, lends instant legitimacy to the journal, editorial team members say. His research has focused on evaluation of care-delivery models and methods for improving the measurement of quality of care.

That background, medical publishing experts believe, gives Dr. Auerbach a foundation in scientific accuracy and reporting transparency that is integral to a new editor’s effort to expand a journal’s reach and increase the quality of work it publishes.

Dr. Auerbach intends to do both, continuing JHM’s growth and solidifying it as the go-to resource for hospitalists. “It is an incredibly good platform for hospitalists to publish their work,” he adds. “I want people to look back at the journal in five years and say it’s even better than it is now.”

As Dr. Auerbach prepares to take over as editor-in-chief, he is focusing his efforts on how to best build on the success the journal has enjoyed since its 2006 launch.

“JHM’s core values are to reflect the field of hospital medicine broadly, to provide a venue where the field’s current scholarly work can be published, and to provide a point of reference for where future scholarly work might be directed and published,” he says. “JHM has been very successful at the first two. I think there is an opportunity to be somewhat more strategic in providing the reference point for future research directions, largely through the input of the editorial team and by paying close attention to JHM readers.”

The Right Choice

An eight-person committee embarked on a five-month search to identify the ideal candidate to replace JHM ’s founding editor-in-chief, Mark Williams, MD, FACP, FHM. The intense process reflected the search committee’s goal that the new editor strengthen the journal and the society it represents, says committee member Harold C. Sox, MD, MACP, a noted internist and author who served as editor of Annals of Internal Medicine from 2001 to 2009.

“A journal published by a professional organization is far and away the most visible manifestation of the organization and its values and ambitions,” Dr. Sox says. “The appointment was anything but pro forma. It had to be the right choice.”

Committee members wanted to select a physician who had a strong scientific background, the judgment required to be a leader, and a desire to better position the journal as a source for first-rate articles in the competitive landscape of medical publishing, Dr. Sox says. They also searched for a candidate who had considerable experience writing for publication.

Dr. Auerbach, who served as deputy editor of the Journal of General Internal Medicine from 2004 to 2007 and as a JHM reviewer, has been published in the New England Journal of Medicine, the Journal of the American Medical Association, Annals of Internal Medicine, and the Archives of Internal Medicine.

As editor of Annals, Dr. Sox shared responsibility for publishing two of Dr. Auerbach’s articles.

“I know something about how Dr. Auerbach thinks about science and about his own personal scientific standards—wanting to get it right, writing it in a way that people know exactly what happened, and interpreting the results in a way that will stand up over time, rather than trying to read too much into the results,” Dr. Sox says. “We also talked with some of the candidates about their strategy for trying to make the journal better, and I thought he showed himself to be very analytic and strategic in his thinking. I’m confident he’s going to move the journal forward.”

Dr. Auerbach believes his experience as a deputy editor and his mentoring role at UCSF, which requires him to provide constructive feedback on investigators’ papers, has prepared him for his new role.

“I have a good sense for how to approach the review process with the goal of getting a paper to the point where it can be accepted into a journal and, if not, have it leave the review process much better than it was when it arrived,” he says.

His research background also complements his new role, he says.

“Research is a way to take care of patients I never see and to disseminate things that are broadly applicable … that other people can look at and use to improve their healthcare delivery,” he says. “I see the journal as doing many of the same things.”

Strategies for Success

Dr. Auerbach, who has worked closely with Dr. Williams in recent months to ensure a smooth transition, says he does not intend to make substantial changes to the journal’s focus. But he is formulating strategies to make it more valuable and relevant to the hospitalists it serves.

Increasing the journal’s Impact Factor—currently 1.951, ranking it 40th out of 151 publications in its cohort—is one way to increase JHM ’s value, making it a destination for the highest-quality research, Dr. Auerbach says.

He also intends to solicit as many scholarly works as possible, employing “a marketing strategy and recruitment strategy all in one” to make sure JHM is on researchers’ short list of publications in which they consider submitting their work.

I’ve learned never to underestimate him. It’s an amazing characteristic, and it’s one that is very useful doing something like running a journal.

—Robert Wachter, MD, MHM, professor, associate chair, Department of Medicine, University of California at San Francisco, chief, division of hospital medicine, chief, medical service, UCSF Medical Center, former SHM president

He wants to take advantage of the growing number of hospitalists who are doing research and expand the journal’s reach beyond its traditional peer groups. “Are there intensive-care doctors, pulmonologists, cardiologists, or infectious-disease doctors who are doing work with hospitalists—or work that would align with hospital medicine—that could be published in JHM?” Dr. Auerbach asks, rhetorically.

He intends to empower members of his editorial team to serve as JHM ambassadors who promote the journal at professional meetings and encourage investigators who are pursuing interesting projects to submit their findings.

Dr. Auerbach expects to devise other content strategies in consultation with members of his editorial team. Certain aspects of content, such as case reports and scholarly reviews of conundrums in HM cases, could be enhanced, he says. Specific sections of the journal could be developed for effectiveness research or implementation research.

He also says he wants the journal to explore new content areas so that it appeals to readers who aren’t interested in randomized controlled trials.

He hopes to put the journal in the position to publish work supported by such new initiatives as the Patient-Centered Outcomes Research Institute and the Centers for Medicare & Medicaid Services’ Center for Medicare and Medicaid Innovation.

That might mean providing editorials or inviting papers that outline the importance of hospitalists’ involvement in those initiatives, then making sure the journal is opportunistic in reviewing and publishing high-quality work, he explains.

Andrew Auerbach, MD, MPH, SFHM

Age: 44

Academic rank: Associate professor of medicine, University of California at San Francisco’s Division of Hospital Medicine

Administrative titles at UCSF: Attending physician, Department of Medicine; director of research for division of hospital medicine; associate director of the General Medicine Research Fellowship; chair of the Clinical Content Governance Committee at UCSF Medical Center

Education: Bachelor’s degree in biochemistry from Bowdoin College, Brunswick, Maine (1988); medical degree from Dartmouth Medical School, Hanover, N.H. (1992); master’s of public health in clinical effectiveness from Harvard School of Public Health, Boston (1998)

Clinical training: Internship in internal medicine, Yale-New Haven Hospital, New Haven, Conn. (1992-1993); residency in internal medicine, Yale-New Haven Hospital, New Haven, Conn. (1993-1995); fellowship in general internal medicine, Beth Israel-Deaconess Medical Center, Boston (1996-1998)

Principal positions held: Attending physician at Moffitt-Long Hospitals in San Francisco (1998-present); clinical fellow at Beth Israel Deaconess Medical Center, Boston (1996-1998); emergency room physician at Milton Hospital, Milton, Mass. (1996-1998); physician and co-director of student health services at University of New Haven, New Haven, Conn. (1995-1996); hospitalist at Hospital of Saint Raphael, New Haven, Conn. (1995-1996); admitting officer at West Haven Veterans Administration Hospital, West Haven, Conn. (1994-1996)

Awards and honors: Western Society for Clinical Investigation, Investigator of the Year Award (2010); Orthopaedic Research Society Harris Award for Outstanding Research (2010); fellow, American College of Physicians (2009); James Rand Award for Outstanding Research Project (2008); Society of Hospital Medicine Young Investigator Award (2004)

Professional memberships: Association of Chiefs of General Internal Medicine, Society of Hospital Medicine, American Medical Association, American College of Physicians, Society of General Internal Medicine

Most Significant Co-Authored Publications

• Rothberg M, Maselli J, Pekow P, Lindenauer P, Auerbach AD. Cost-effectiveness of changes in care at U.S. hospitals from 2000-2004. In press, Health Affairs.
• Auerbach AD, Wachter RM, Cheng H, et al. Effects of a neurosurgery-hospitalist comanagement model on outcomes of patients with neurosurgical illnesses. In press, Arch Int Med.
• Auerbach AD, Hilton JF, Maselli JM, Pekow P, Rothberg M, Lindenauer PK. Follow the crowd or shop for the best: How volume and care quality influence outcomes of cardiac surgery. Annals Int Med. 2009;150(10):696-704.
• Auerbach AD, Landefeld CS, Shojania KS. The tension between needing to improve care and knowing how to do it. N Engl J Med. 2007;357(6):608-613.
• Lindenauer PK, Pekow P, Rothberg M, Benjamin E, Auerbach AD. Outcomes of patients treated by hospitalists, general internists, and family physicians. N Engl J Med. 2007;357(25):2589-2600.

Bold New Direction

The JHM team, which partners SHM leaders and the journal’s publisher, Wiley-Blackwell Inc., is revisiting the journal’s press relations and editorial strategy (Wiley-Blackwell also publishes The Hospitalist). Discussions also are under way about whether to increase the journal’s publishing frequency, as well as how the journal can increase its digital footprint and take advantage of social media outlets to increase the usability and visibility of its offerings, Dr. Auerbach says.

“One side effect of JHM ’s growth has been growing constraints on space to publish excellent work,” he says. “Our team will focus a great deal on strategies to increase JHM ’s ability to review and publish the many outstanding papers submitted each year.”

Dr. Williams characterizes Dr. Auerbach’s appointment as “a software upgrade to JHM 2.0.”

Dr. Auerbach’s connection to the top-ranked division of hospital medicine in the country provides instant credibility to the journal, and his diverse contacts should help his efforts to solicit an increasing volume of high-quality submissions, Dr. Williams says.

His appointment also can reinvigorate members of the editorial team, motivating them to step out of their comfort zone and embrace the challenge of adapting to the rapidly changing world of hospital medicine.

“He’ll bring renewed enthusiasm,” says Dr. Williams, a former SHM president who is a professor and chief of the Division of Hospital Medicine at Northwestern University’s Feinberg School of Medicine in Chicago. “I firmly believe that’s essential for any growing enterprise. You need an infusion of new energy and fresh thinking.”

With Dr. Auerbach at the helm, JHM is well-positioned to attract well-done, systematic reviews while appealing to authors who are writing about such relevant topics as change management, collaboration, models of care, and transitional care, says deputy editor Brian Harte, MD, SFHM, chief operating officer of Hillcrest Hospital in Mayfield Heights, Ohio, and chairman of hospital medicine at The Cleveland Clinic.

“I hope people say under Dr. Auerbach’s tenure we continued to innovate and do things as an editorial group that other journals hadn’t thought of doing, were not nimble enough to do, or were not creative enough to do,” Dr. Harte says. “And that it was an incubator of novel and innovative and, ultimately, very effective ideas that took the journal into strategic directions that other journals weren’t bold enough to go in.”

Dr. Auerbach is more than capable of steering JHM in those new directions, according to his mentor, Robert Wachter, MD, MHM, professor and associate chairman of the Department of Medicine at the University of California at San Francisco, and chief of the division of hospital medicine and chief of medical service at UCSF Medical Center, former SHM president, and author of the blog Wachter’s World (www.wachtersworld.com).

Dr. Auerbach is a broad thinker who is capable of recognizing what issues are important to his field before they become obvious to others, a trait that will help him to use the journal to help chart the course for HM, Dr. Wachter says.

He also has the perfect personality for the job. “He is the most doggedly persistent person I’ve ever met,” Dr. Wachter says. “I’ve seen him go through setbacks that would have caused lesser mortals to give up their ideas.…He’s like a prizefighter. He sits in the corner for a little bit, has someone dab the wounds, and then comes back out again for the next round and swings a little bit harder.

“I’ve learned never to underestimate him. It’s an amazing characteristic, and it’s one that is very useful doing something like running a journal.”

Mark Leiser is a freelance writer based in New Jersey.

Listen to Bob Wachter, MD, MHM

Andrew Auerbach, MD, MPH, SFHM, is an associate professor at one of the most highly regarded academic medical centers in the country, and he is a nationally respected researcher whose work has been published in prominent scientific publications.

His peers believe both roles prepared him well for his newest endeavor: editor-in-chief of the Journal of Hospital Medicine. His five-year term begins in January.

Dr. Auerbach’s affiliation with the University of California at San Francisco (UCSF), where he also serves as director of research for the division of hospital medicine and associate director of the General Medicine Research Fellowship, lends instant legitimacy to the journal, editorial team members say. His research has focused on evaluation of care-delivery models and methods for improving the measurement of quality of care.

That background, medical publishing experts believe, gives Dr. Auerbach a foundation in scientific accuracy and reporting transparency that is integral to a new editor’s effort to expand a journal’s reach and increase the quality of work it publishes.

Dr. Auerbach intends to do both, continuing JHM’s growth and solidifying it as the go-to resource for hospitalists. “It is an incredibly good platform for hospitalists to publish their work,” he adds. “I want people to look back at the journal in five years and say it’s even better than it is now.”

As Dr. Auerbach prepares to take over as editor-in-chief, he is focusing his efforts on how to best build on the success the journal has enjoyed since its 2006 launch.

“JHM’s core values are to reflect the field of hospital medicine broadly, to provide a venue where the field’s current scholarly work can be published, and to provide a point of reference for where future scholarly work might be directed and published,” he says. “JHM has been very successful at the first two. I think there is an opportunity to be somewhat more strategic in providing the reference point for future research directions, largely through the input of the editorial team and by paying close attention to JHM readers.”

The Right Choice

An eight-person committee embarked on a five-month search to identify the ideal candidate to replace JHM ’s founding editor-in-chief, Mark Williams, MD, FACP, FHM. The intense process reflected the search committee’s goal that the new editor strengthen the journal and the society it represents, says committee member Harold C. Sox, MD, MACP, a noted internist and author who served as editor of Annals of Internal Medicine from 2001 to 2009.

“A journal published by a professional organization is far and away the most visible manifestation of the organization and its values and ambitions,” Dr. Sox says. “The appointment was anything but pro forma. It had to be the right choice.”

Committee members wanted to select a physician who had a strong scientific background, the judgment required to be a leader, and a desire to better position the journal as a source for first-rate articles in the competitive landscape of medical publishing, Dr. Sox says. They also searched for a candidate who had considerable experience writing for publication.

Dr. Auerbach, who served as deputy editor of the Journal of General Internal Medicine from 2004 to 2007 and as a JHM reviewer, has been published in the New England Journal of Medicine, the Journal of the American Medical Association, Annals of Internal Medicine, and the Archives of Internal Medicine.

As editor of Annals, Dr. Sox shared responsibility for publishing two of Dr. Auerbach’s articles.

“I know something about how Dr. Auerbach thinks about science and about his own personal scientific standards—wanting to get it right, writing it in a way that people know exactly what happened, and interpreting the results in a way that will stand up over time, rather than trying to read too much into the results,” Dr. Sox says. “We also talked with some of the candidates about their strategy for trying to make the journal better, and I thought he showed himself to be very analytic and strategic in his thinking. I’m confident he’s going to move the journal forward.”

Dr. Auerbach believes his experience as a deputy editor and his mentoring role at UCSF, which requires him to provide constructive feedback on investigators’ papers, has prepared him for his new role.

“I have a good sense for how to approach the review process with the goal of getting a paper to the point where it can be accepted into a journal and, if not, have it leave the review process much better than it was when it arrived,” he says.

His research background also complements his new role, he says.

“Research is a way to take care of patients I never see and to disseminate things that are broadly applicable … that other people can look at and use to improve their healthcare delivery,” he says. “I see the journal as doing many of the same things.”

Strategies for Success

Dr. Auerbach, who has worked closely with Dr. Williams in recent months to ensure a smooth transition, says he does not intend to make substantial changes to the journal’s focus. But he is formulating strategies to make it more valuable and relevant to the hospitalists it serves.

Increasing the journal’s Impact Factor—currently 1.951, ranking it 40th out of 151 publications in its cohort—is one way to increase JHM ’s value, making it a destination for the highest-quality research, Dr. Auerbach says.

He also intends to solicit as many scholarly works as possible, employing “a marketing strategy and recruitment strategy all in one” to make sure JHM is on researchers’ short list of publications in which they consider submitting their work.

I’ve learned never to underestimate him. It’s an amazing characteristic, and it’s one that is very useful doing something like running a journal.

—Robert Wachter, MD, MHM, professor, associate chair, Department of Medicine, University of California at San Francisco, chief, division of hospital medicine, chief, medical service, UCSF Medical Center, former SHM president

He wants to take advantage of the growing number of hospitalists who are doing research and expand the journal’s reach beyond its traditional peer groups. “Are there intensive-care doctors, pulmonologists, cardiologists, or infectious-disease doctors who are doing work with hospitalists—or work that would align with hospital medicine—that could be published in JHM?” Dr. Auerbach asks, rhetorically.

He intends to empower members of his editorial team to serve as JHM ambassadors who promote the journal at professional meetings and encourage investigators who are pursuing interesting projects to submit their findings.

Dr. Auerbach expects to devise other content strategies in consultation with members of his editorial team. Certain aspects of content, such as case reports and scholarly reviews of conundrums in HM cases, could be enhanced, he says. Specific sections of the journal could be developed for effectiveness research or implementation research.

He also says he wants the journal to explore new content areas so that it appeals to readers who aren’t interested in randomized controlled trials.

He hopes to put the journal in the position to publish work supported by such new initiatives as the Patient-Centered Outcomes Research Institute and the Centers for Medicare & Medicaid Services’ Center for Medicare and Medicaid Innovation.

That might mean providing editorials or inviting papers that outline the importance of hospitalists’ involvement in those initiatives, then making sure the journal is opportunistic in reviewing and publishing high-quality work, he explains.

Andrew Auerbach, MD, MPH, SFHM

Age: 44

Academic rank: Associate professor of medicine, University of California at San Francisco’s Division of Hospital Medicine

Administrative titles at UCSF: Attending physician, Department of Medicine; director of research for division of hospital medicine; associate director of the General Medicine Research Fellowship; chair of the Clinical Content Governance Committee at UCSF Medical Center

Education: Bachelor’s degree in biochemistry from Bowdoin College, Brunswick, Maine (1988); medical degree from Dartmouth Medical School, Hanover, N.H. (1992); master’s of public health in clinical effectiveness from Harvard School of Public Health, Boston (1998)

Clinical training: Internship in internal medicine, Yale-New Haven Hospital, New Haven, Conn. (1992-1993); residency in internal medicine, Yale-New Haven Hospital, New Haven, Conn. (1993-1995); fellowship in general internal medicine, Beth Israel-Deaconess Medical Center, Boston (1996-1998)

Principal positions held: Attending physician at Moffitt-Long Hospitals in San Francisco (1998-present); clinical fellow at Beth Israel Deaconess Medical Center, Boston (1996-1998); emergency room physician at Milton Hospital, Milton, Mass. (1996-1998); physician and co-director of student health services at University of New Haven, New Haven, Conn. (1995-1996); hospitalist at Hospital of Saint Raphael, New Haven, Conn. (1995-1996); admitting officer at West Haven Veterans Administration Hospital, West Haven, Conn. (1994-1996)

Awards and honors: Western Society for Clinical Investigation, Investigator of the Year Award (2010); Orthopaedic Research Society Harris Award for Outstanding Research (2010); fellow, American College of Physicians (2009); James Rand Award for Outstanding Research Project (2008); Society of Hospital Medicine Young Investigator Award (2004)

Professional memberships: Association of Chiefs of General Internal Medicine, Society of Hospital Medicine, American Medical Association, American College of Physicians, Society of General Internal Medicine

Most Significant Co-Authored Publications

• Rothberg M, Maselli J, Pekow P, Lindenauer P, Auerbach AD. Cost-effectiveness of changes in care at U.S. hospitals from 2000-2004. In press, Health Affairs.
• Auerbach AD, Wachter RM, Cheng H, et al. Effects of a neurosurgery-hospitalist comanagement model on outcomes of patients with neurosurgical illnesses. In press, Arch Int Med.
• Auerbach AD, Hilton JF, Maselli JM, Pekow P, Rothberg M, Lindenauer PK. Follow the crowd or shop for the best: How volume and care quality influence outcomes of cardiac surgery. Annals Int Med. 2009;150(10):696-704.
• Auerbach AD, Landefeld CS, Shojania KS. The tension between needing to improve care and knowing how to do it. N Engl J Med. 2007;357(6):608-613.
• Lindenauer PK, Pekow P, Rothberg M, Benjamin E, Auerbach AD. Outcomes of patients treated by hospitalists, general internists, and family physicians. N Engl J Med. 2007;357(25):2589-2600.

Bold New Direction

The JHM team, which partners SHM leaders and the journal’s publisher, Wiley-Blackwell Inc., is revisiting the journal’s press relations and editorial strategy (Wiley-Blackwell also publishes The Hospitalist). Discussions also are under way about whether to increase the journal’s publishing frequency, as well as how the journal can increase its digital footprint and take advantage of social media outlets to increase the usability and visibility of its offerings, Dr. Auerbach says.

“One side effect of JHM ’s growth has been growing constraints on space to publish excellent work,” he says. “Our team will focus a great deal on strategies to increase JHM ’s ability to review and publish the many outstanding papers submitted each year.”

Dr. Williams characterizes Dr. Auerbach’s appointment as “a software upgrade to JHM 2.0.”

Dr. Auerbach’s connection to the top-ranked division of hospital medicine in the country provides instant credibility to the journal, and his diverse contacts should help his efforts to solicit an increasing volume of high-quality submissions, Dr. Williams says.

His appointment also can reinvigorate members of the editorial team, motivating them to step out of their comfort zone and embrace the challenge of adapting to the rapidly changing world of hospital medicine.

“He’ll bring renewed enthusiasm,” says Dr. Williams, a former SHM president who is a professor and chief of the Division of Hospital Medicine at Northwestern University’s Feinberg School of Medicine in Chicago. “I firmly believe that’s essential for any growing enterprise. You need an infusion of new energy and fresh thinking.”

With Dr. Auerbach at the helm, JHM is well-positioned to attract well-done, systematic reviews while appealing to authors who are writing about such relevant topics as change management, collaboration, models of care, and transitional care, says deputy editor Brian Harte, MD, SFHM, chief operating officer of Hillcrest Hospital in Mayfield Heights, Ohio, and chairman of hospital medicine at The Cleveland Clinic.

“I hope people say under Dr. Auerbach’s tenure we continued to innovate and do things as an editorial group that other journals hadn’t thought of doing, were not nimble enough to do, or were not creative enough to do,” Dr. Harte says. “And that it was an incubator of novel and innovative and, ultimately, very effective ideas that took the journal into strategic directions that other journals weren’t bold enough to go in.”

Dr. Auerbach is more than capable of steering JHM in those new directions, according to his mentor, Robert Wachter, MD, MHM, professor and associate chairman of the Department of Medicine at the University of California at San Francisco, and chief of the division of hospital medicine and chief of medical service at UCSF Medical Center, former SHM president, and author of the blog Wachter’s World (www.wachtersworld.com).

Dr. Auerbach is a broad thinker who is capable of recognizing what issues are important to his field before they become obvious to others, a trait that will help him to use the journal to help chart the course for HM, Dr. Wachter says.

He also has the perfect personality for the job. “He is the most doggedly persistent person I’ve ever met,” Dr. Wachter says. “I’ve seen him go through setbacks that would have caused lesser mortals to give up their ideas.…He’s like a prizefighter. He sits in the corner for a little bit, has someone dab the wounds, and then comes back out again for the next round and swings a little bit harder.

“I’ve learned never to underestimate him. It’s an amazing characteristic, and it’s one that is very useful doing something like running a journal.”

Mark Leiser is a freelance writer based in New Jersey.

Listen to Bob Wachter, MD, MHM

Andrew Auerbach, MD, MPH, SFHM, is an associate professor at one of the most highly regarded academic medical centers in the country, and he is a nationally respected researcher whose work has been published in prominent scientific publications.

His peers believe both roles prepared him well for his newest endeavor: editor-in-chief of the Journal of Hospital Medicine. His five-year term begins in January.

Dr. Auerbach’s affiliation with the University of California at San Francisco (UCSF), where he also serves as director of research for the division of hospital medicine and associate director of the General Medicine Research Fellowship, lends instant legitimacy to the journal, editorial team members say. His research has focused on evaluation of care-delivery models and methods for improving the measurement of quality of care.

That background, medical publishing experts believe, gives Dr. Auerbach a foundation in scientific accuracy and reporting transparency that is integral to a new editor’s effort to expand a journal’s reach and increase the quality of work it publishes.

Dr. Auerbach intends to do both, continuing JHM’s growth and solidifying it as the go-to resource for hospitalists. “It is an incredibly good platform for hospitalists to publish their work,” he adds. “I want people to look back at the journal in five years and say it’s even better than it is now.”

As Dr. Auerbach prepares to take over as editor-in-chief, he is focusing his efforts on how to best build on the success the journal has enjoyed since its 2006 launch.

“JHM’s core values are to reflect the field of hospital medicine broadly, to provide a venue where the field’s current scholarly work can be published, and to provide a point of reference for where future scholarly work might be directed and published,” he says. “JHM has been very successful at the first two. I think there is an opportunity to be somewhat more strategic in providing the reference point for future research directions, largely through the input of the editorial team and by paying close attention to JHM readers.”

The Right Choice

An eight-person committee embarked on a five-month search to identify the ideal candidate to replace JHM ’s founding editor-in-chief, Mark Williams, MD, FACP, FHM. The intense process reflected the search committee’s goal that the new editor strengthen the journal and the society it represents, says committee member Harold C. Sox, MD, MACP, a noted internist and author who served as editor of Annals of Internal Medicine from 2001 to 2009.

“A journal published by a professional organization is far and away the most visible manifestation of the organization and its values and ambitions,” Dr. Sox says. “The appointment was anything but pro forma. It had to be the right choice.”

Committee members wanted to select a physician who had a strong scientific background, the judgment required to be a leader, and a desire to better position the journal as a source for first-rate articles in the competitive landscape of medical publishing, Dr. Sox says. They also searched for a candidate who had considerable experience writing for publication.

Dr. Auerbach, who served as deputy editor of the Journal of General Internal Medicine from 2004 to 2007 and as a JHM reviewer, has been published in the New England Journal of Medicine, the Journal of the American Medical Association, Annals of Internal Medicine, and the Archives of Internal Medicine.

As editor of Annals, Dr. Sox shared responsibility for publishing two of Dr. Auerbach’s articles.

“I know something about how Dr. Auerbach thinks about science and about his own personal scientific standards—wanting to get it right, writing it in a way that people know exactly what happened, and interpreting the results in a way that will stand up over time, rather than trying to read too much into the results,” Dr. Sox says. “We also talked with some of the candidates about their strategy for trying to make the journal better, and I thought he showed himself to be very analytic and strategic in his thinking. I’m confident he’s going to move the journal forward.”

Dr. Auerbach believes his experience as a deputy editor and his mentoring role at UCSF, which requires him to provide constructive feedback on investigators’ papers, has prepared him for his new role.

“I have a good sense for how to approach the review process with the goal of getting a paper to the point where it can be accepted into a journal and, if not, have it leave the review process much better than it was when it arrived,” he says.

His research background also complements his new role, he says.

“Research is a way to take care of patients I never see and to disseminate things that are broadly applicable … that other people can look at and use to improve their healthcare delivery,” he says. “I see the journal as doing many of the same things.”

Strategies for Success

Dr. Auerbach, who has worked closely with Dr. Williams in recent months to ensure a smooth transition, says he does not intend to make substantial changes to the journal’s focus. But he is formulating strategies to make it more valuable and relevant to the hospitalists it serves.

Increasing the journal’s Impact Factor—currently 1.951, ranking it 40th out of 151 publications in its cohort—is one way to increase JHM ’s value, making it a destination for the highest-quality research, Dr. Auerbach says.

He also intends to solicit as many scholarly works as possible, employing “a marketing strategy and recruitment strategy all in one” to make sure JHM is on researchers’ short list of publications in which they consider submitting their work.

I’ve learned never to underestimate him. It’s an amazing characteristic, and it’s one that is very useful doing something like running a journal.

—Robert Wachter, MD, MHM, professor, associate chair, Department of Medicine, University of California at San Francisco, chief, division of hospital medicine, chief, medical service, UCSF Medical Center, former SHM president

He wants to take advantage of the growing number of hospitalists who are doing research and expand the journal’s reach beyond its traditional peer groups. “Are there intensive-care doctors, pulmonologists, cardiologists, or infectious-disease doctors who are doing work with hospitalists—or work that would align with hospital medicine—that could be published in JHM?” Dr. Auerbach asks, rhetorically.

He intends to empower members of his editorial team to serve as JHM ambassadors who promote the journal at professional meetings and encourage investigators who are pursuing interesting projects to submit their findings.

Dr. Auerbach expects to devise other content strategies in consultation with members of his editorial team. Certain aspects of content, such as case reports and scholarly reviews of conundrums in HM cases, could be enhanced, he says. Specific sections of the journal could be developed for effectiveness research or implementation research.

He also says he wants the journal to explore new content areas so that it appeals to readers who aren’t interested in randomized controlled trials.

He hopes to put the journal in the position to publish work supported by such new initiatives as the Patient-Centered Outcomes Research Institute and the Centers for Medicare & Medicaid Services’ Center for Medicare and Medicaid Innovation.

That might mean providing editorials or inviting papers that outline the importance of hospitalists’ involvement in those initiatives, then making sure the journal is opportunistic in reviewing and publishing high-quality work, he explains.

Andrew Auerbach, MD, MPH, SFHM

Age: 44

Academic rank: Associate professor of medicine, University of California at San Francisco’s Division of Hospital Medicine

Administrative titles at UCSF: Attending physician, Department of Medicine; director of research for division of hospital medicine; associate director of the General Medicine Research Fellowship; chair of the Clinical Content Governance Committee at UCSF Medical Center

Education: Bachelor’s degree in biochemistry from Bowdoin College, Brunswick, Maine (1988); medical degree from Dartmouth Medical School, Hanover, N.H. (1992); master’s of public health in clinical effectiveness from Harvard School of Public Health, Boston (1998)

Clinical training: Internship in internal medicine, Yale-New Haven Hospital, New Haven, Conn. (1992-1993); residency in internal medicine, Yale-New Haven Hospital, New Haven, Conn. (1993-1995); fellowship in general internal medicine, Beth Israel-Deaconess Medical Center, Boston (1996-1998)

Principal positions held: Attending physician at Moffitt-Long Hospitals in San Francisco (1998-present); clinical fellow at Beth Israel Deaconess Medical Center, Boston (1996-1998); emergency room physician at Milton Hospital, Milton, Mass. (1996-1998); physician and co-director of student health services at University of New Haven, New Haven, Conn. (1995-1996); hospitalist at Hospital of Saint Raphael, New Haven, Conn. (1995-1996); admitting officer at West Haven Veterans Administration Hospital, West Haven, Conn. (1994-1996)

Awards and honors: Western Society for Clinical Investigation, Investigator of the Year Award (2010); Orthopaedic Research Society Harris Award for Outstanding Research (2010); fellow, American College of Physicians (2009); James Rand Award for Outstanding Research Project (2008); Society of Hospital Medicine Young Investigator Award (2004)

Professional memberships: Association of Chiefs of General Internal Medicine, Society of Hospital Medicine, American Medical Association, American College of Physicians, Society of General Internal Medicine

Most Significant Co-Authored Publications

• Rothberg M, Maselli J, Pekow P, Lindenauer P, Auerbach AD. Cost-effectiveness of changes in care at U.S. hospitals from 2000-2004. In press, Health Affairs.
• Auerbach AD, Wachter RM, Cheng H, et al. Effects of a neurosurgery-hospitalist comanagement model on outcomes of patients with neurosurgical illnesses. In press, Arch Int Med.
• Auerbach AD, Hilton JF, Maselli JM, Pekow P, Rothberg M, Lindenauer PK. Follow the crowd or shop for the best: How volume and care quality influence outcomes of cardiac surgery. Annals Int Med. 2009;150(10):696-704.
• Auerbach AD, Landefeld CS, Shojania KS. The tension between needing to improve care and knowing how to do it. N Engl J Med. 2007;357(6):608-613.
• Lindenauer PK, Pekow P, Rothberg M, Benjamin E, Auerbach AD. Outcomes of patients treated by hospitalists, general internists, and family physicians. N Engl J Med. 2007;357(25):2589-2600.

Bold New Direction

The JHM team, which partners SHM leaders and the journal’s publisher, Wiley-Blackwell Inc., is revisiting the journal’s press relations and editorial strategy (Wiley-Blackwell also publishes The Hospitalist). Discussions also are under way about whether to increase the journal’s publishing frequency, as well as how the journal can increase its digital footprint and take advantage of social media outlets to increase the usability and visibility of its offerings, Dr. Auerbach says.

“One side effect of JHM ’s growth has been growing constraints on space to publish excellent work,” he says. “Our team will focus a great deal on strategies to increase JHM ’s ability to review and publish the many outstanding papers submitted each year.”

Dr. Williams characterizes Dr. Auerbach’s appointment as “a software upgrade to JHM 2.0.”

Dr. Auerbach’s connection to the top-ranked division of hospital medicine in the country provides instant credibility to the journal, and his diverse contacts should help his efforts to solicit an increasing volume of high-quality submissions, Dr. Williams says.

His appointment also can reinvigorate members of the editorial team, motivating them to step out of their comfort zone and embrace the challenge of adapting to the rapidly changing world of hospital medicine.

“He’ll bring renewed enthusiasm,” says Dr. Williams, a former SHM president who is a professor and chief of the Division of Hospital Medicine at Northwestern University’s Feinberg School of Medicine in Chicago. “I firmly believe that’s essential for any growing enterprise. You need an infusion of new energy and fresh thinking.”

With Dr. Auerbach at the helm, JHM is well-positioned to attract well-done, systematic reviews while appealing to authors who are writing about such relevant topics as change management, collaboration, models of care, and transitional care, says deputy editor Brian Harte, MD, SFHM, chief operating officer of Hillcrest Hospital in Mayfield Heights, Ohio, and chairman of hospital medicine at The Cleveland Clinic.

“I hope people say under Dr. Auerbach’s tenure we continued to innovate and do things as an editorial group that other journals hadn’t thought of doing, were not nimble enough to do, or were not creative enough to do,” Dr. Harte says. “And that it was an incubator of novel and innovative and, ultimately, very effective ideas that took the journal into strategic directions that other journals weren’t bold enough to go in.”

Dr. Auerbach is more than capable of steering JHM in those new directions, according to his mentor, Robert Wachter, MD, MHM, professor and associate chairman of the Department of Medicine at the University of California at San Francisco, and chief of the division of hospital medicine and chief of medical service at UCSF Medical Center, former SHM president, and author of the blog Wachter’s World (www.wachtersworld.com).

Dr. Auerbach is a broad thinker who is capable of recognizing what issues are important to his field before they become obvious to others, a trait that will help him to use the journal to help chart the course for HM, Dr. Wachter says.

He also has the perfect personality for the job. “He is the most doggedly persistent person I’ve ever met,” Dr. Wachter says. “I’ve seen him go through setbacks that would have caused lesser mortals to give up their ideas.…He’s like a prizefighter. He sits in the corner for a little bit, has someone dab the wounds, and then comes back out again for the next round and swings a little bit harder.

“I’ve learned never to underestimate him. It’s an amazing characteristic, and it’s one that is very useful doing something like running a journal.”

Mark Leiser is a freelance writer based in New Jersey.

Click here to listen to Dr. Wachter.

Click here to listen to Dr. Sox.

Click here to listen to Dr. Wachter.

Click here to listen to Dr. Sox.

Click here to listen to Dr. Wachter.

Click here to listen to Dr. Sox.

Click here to listen to Dr. Williams

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Michelle Mourad, MD, says she’s always had “the doctor gene.” As a child, she spent countless hours playing with her Fisher-Price medical kit, and she gained an early appreciation for the scientific method thanks to family members who encouraged her to answer her own questions through discovery and experimentation. A youthful fascination evolved into a calling during high school, when she participated in a summer mentoring program at Santa Clara Valley Medical Center in San Jose, Calif. Paired with two neurosurgeons, she spent 12-hour days accompanying them on rounds, observing surgeries in the operating room, and attending case conferences.

“Right away, I was hooked,” says Dr. Mourad, assistant professor and director of quality for the division of hospital medicine at the University of California at San Francisco (UCSF) Medical Center and medical director of UCSF’s Congestive Heart Failure and Oncology hospitalist services, which comanage bone-marrow transplant and advanced-heart-failure patients in partnership with oncologists and cardiologists.

“I loved the community of medicine and I loved the hospital,” adds Dr. Mourad, one of the newest members of Team Hospitalist. “The interdisciplinary nature really resonated with me. That was when I realized this lifelong feeling of ‘I’m going to be a doctor’ actually had a lot of foundation to it.”

Question: Did you always intend to become a hospitalist?

Answer: I didn’t know hospitalists existed when I started medical school. I gravitated toward internal medicine and was pretty sure I would specialize. I went to internal-medicine residency thinking I wanted to be a gastroenterologist, but I found that a little limiting. I decided to be a pulmonary critical-care doctor, but realized, although I enjoy taking care of patients who are critically ill, I didn’t really want that to be my whole focus. When I started thinking about other options, I knew I was reaching.

Q: So how did you wind up in HM?

A: I enjoyed the community of the hospital—the fast pace, the ability to make treatment decisions and see your changes real-time, the ability to work with residents and interns, the intense time you spend with families during which you can really make or break their hospital experience and make a difference in the care they receive. When I realized I loved those things, the decision was easy.

Q: What does it mean to you to practice at one of the most highly respected HM programs in the country?

A: People want you to succeed. We are encouraged to get involved in the way the hospital works and make it about more than clinical care. The variety of things people do at our institution makes you realize hospitalists are not only clinicians; they are leaders, thinkers, role models, and advocates for patient safety. That’s incredibly motivating.

Q: Your career includes clinical, quality improvement, and administrative roles. Is there one aspect you enjoy most?

A: I need that variety. Allowing us to have that balance here has made the program great. My passion is quality improvement—the ability to affect patients on a personal level but to say, “How do I put systems in place to make hospitals safer and a better experience for every patient?” Figuring out how to navigate your own institution to engender change is challenging, but when you see that change manifest and you have providers and patients thank you for it, it’s probably the most rewarding thing I do.

Q: As director of quality, you strive to improve transitions of care around the time of discharge. What strategies have you implemented to improve that transition?

A: A hospitalist cannot do it alone. Discharge involves case managers and nurses and physical therapists and pharmacists. Our goal has been to create consensus and an urgency for change. … If you can show people their data and show how that is at odds with the vision of the care they are providing, that’s a really powerful force for change.

Q: What can other hospitalists do to improve transitions of care?

A: Form this group and take a good hard look at your data. Use that group to take small baby steps toward change, whether that’s always talking to primary-care physicians or having every patient who leaves have a follow-up appointment in two weeks, or calling every patient after discharge. I think people know what should be in their toolkit for a really safe transition. The problem is fighting the system and creating a group coalition that wants to do that with you.

Q: Have you noticed quantifiable improvements since you took over that role?

A: We put in place a program with residents to make it easier for them to do discharge summaries. They’re templated, they draw from the EMR, they’re concise, and they have what PCPs want. Nurses use them to provide targeted patient education and make sure patients understand their discharge instructions. That probably is my biggest tangible win. The biggest win overall is the culture change.

Q: How has the culture changed?

A: Faculty come up to you and say, “I had a readmission this month. I’m sorry. I really couldn’t prevent it. There’s nothing I could do.” Residents say, “I’ve been so good about communicating with PCPs this month. I can’t wait to see the audit data because I think my team has done really well.” We’re all thinking about what it takes to do a good discharge.

Q: What is the biggest advantage of UCSF’s comanagement service model?

A: The complexity of heart failure and oncology patients is incredible. That complexity means you need a subspecialist like a cardiologist or an oncologist, plus a hospitalist, because there are so many medicine issues along with cardiology or oncology issues. There are infections. There is renal failure. It takes a medicine head as well as a subspecialty head to take care of these patients.

Q: Do you believe that model will become popular for other programs?

A: I do, particularly on the surgical side. A lot of quality gains can be made by having a hospitalist partner with surgeons. The hospitalist can see a large number of patients and make sure everything has been thought about. When are they starting anticoagulation? When do those antibiotics need to come on or off? Those are quality measures that hospitalists are really good at, and I think that will make a fine partnership with surgical subspecialties.

Q: You strive to integrate QI initiatives into house staff education. Why is that important?

A: At an academic institution, you don’t provide care except going through the house staff. It’s important to make sure they understand this isn’t just one more box to be checked off or another thing their attending is asking of them. This is as fundamental as picking the right antibiotic to treat pneumonia or communicating with a PCP about a complicated discharge. That isn’t intuitively obvious. It became more apparent to me as I realized quality of care comes from clinical decisions as well as all of the extra effort we put into things like discharge and communication.

Mark Leiser is a freelance writer based in New Jersey.

Michelle Mourad, MD, says she’s always had “the doctor gene.” As a child, she spent countless hours playing with her Fisher-Price medical kit, and she gained an early appreciation for the scientific method thanks to family members who encouraged her to answer her own questions through discovery and experimentation. A youthful fascination evolved into a calling during high school, when she participated in a summer mentoring program at Santa Clara Valley Medical Center in San Jose, Calif. Paired with two neurosurgeons, she spent 12-hour days accompanying them on rounds, observing surgeries in the operating room, and attending case conferences.

“Right away, I was hooked,” says Dr. Mourad, assistant professor and director of quality for the division of hospital medicine at the University of California at San Francisco (UCSF) Medical Center and medical director of UCSF’s Congestive Heart Failure and Oncology hospitalist services, which comanage bone-marrow transplant and advanced-heart-failure patients in partnership with oncologists and cardiologists.

“I loved the community of medicine and I loved the hospital,” adds Dr. Mourad, one of the newest members of Team Hospitalist. “The interdisciplinary nature really resonated with me. That was when I realized this lifelong feeling of ‘I’m going to be a doctor’ actually had a lot of foundation to it.”

Question: Did you always intend to become a hospitalist?

Answer: I didn’t know hospitalists existed when I started medical school. I gravitated toward internal medicine and was pretty sure I would specialize. I went to internal-medicine residency thinking I wanted to be a gastroenterologist, but I found that a little limiting. I decided to be a pulmonary critical-care doctor, but realized, although I enjoy taking care of patients who are critically ill, I didn’t really want that to be my whole focus. When I started thinking about other options, I knew I was reaching.

Q: So how did you wind up in HM?

A: I enjoyed the community of the hospital—the fast pace, the ability to make treatment decisions and see your changes real-time, the ability to work with residents and interns, the intense time you spend with families during which you can really make or break their hospital experience and make a difference in the care they receive. When I realized I loved those things, the decision was easy.

Q: What does it mean to you to practice at one of the most highly respected HM programs in the country?

A: People want you to succeed. We are encouraged to get involved in the way the hospital works and make it about more than clinical care. The variety of things people do at our institution makes you realize hospitalists are not only clinicians; they are leaders, thinkers, role models, and advocates for patient safety. That’s incredibly motivating.

Q: Your career includes clinical, quality improvement, and administrative roles. Is there one aspect you enjoy most?

A: I need that variety. Allowing us to have that balance here has made the program great. My passion is quality improvement—the ability to affect patients on a personal level but to say, “How do I put systems in place to make hospitals safer and a better experience for every patient?” Figuring out how to navigate your own institution to engender change is challenging, but when you see that change manifest and you have providers and patients thank you for it, it’s probably the most rewarding thing I do.

Q: As director of quality, you strive to improve transitions of care around the time of discharge. What strategies have you implemented to improve that transition?

A: A hospitalist cannot do it alone. Discharge involves case managers and nurses and physical therapists and pharmacists. Our goal has been to create consensus and an urgency for change. … If you can show people their data and show how that is at odds with the vision of the care they are providing, that’s a really powerful force for change.

Q: What can other hospitalists do to improve transitions of care?

A: Form this group and take a good hard look at your data. Use that group to take small baby steps toward change, whether that’s always talking to primary-care physicians or having every patient who leaves have a follow-up appointment in two weeks, or calling every patient after discharge. I think people know what should be in their toolkit for a really safe transition. The problem is fighting the system and creating a group coalition that wants to do that with you.

Q: Have you noticed quantifiable improvements since you took over that role?

A: We put in place a program with residents to make it easier for them to do discharge summaries. They’re templated, they draw from the EMR, they’re concise, and they have what PCPs want. Nurses use them to provide targeted patient education and make sure patients understand their discharge instructions. That probably is my biggest tangible win. The biggest win overall is the culture change.

Q: How has the culture changed?

A: Faculty come up to you and say, “I had a readmission this month. I’m sorry. I really couldn’t prevent it. There’s nothing I could do.” Residents say, “I’ve been so good about communicating with PCPs this month. I can’t wait to see the audit data because I think my team has done really well.” We’re all thinking about what it takes to do a good discharge.

Q: What is the biggest advantage of UCSF’s comanagement service model?

A: The complexity of heart failure and oncology patients is incredible. That complexity means you need a subspecialist like a cardiologist or an oncologist, plus a hospitalist, because there are so many medicine issues along with cardiology or oncology issues. There are infections. There is renal failure. It takes a medicine head as well as a subspecialty head to take care of these patients.

Q: Do you believe that model will become popular for other programs?

A: I do, particularly on the surgical side. A lot of quality gains can be made by having a hospitalist partner with surgeons. The hospitalist can see a large number of patients and make sure everything has been thought about. When are they starting anticoagulation? When do those antibiotics need to come on or off? Those are quality measures that hospitalists are really good at, and I think that will make a fine partnership with surgical subspecialties.

Q: You strive to integrate QI initiatives into house staff education. Why is that important?

A: At an academic institution, you don’t provide care except going through the house staff. It’s important to make sure they understand this isn’t just one more box to be checked off or another thing their attending is asking of them. This is as fundamental as picking the right antibiotic to treat pneumonia or communicating with a PCP about a complicated discharge. That isn’t intuitively obvious. It became more apparent to me as I realized quality of care comes from clinical decisions as well as all of the extra effort we put into things like discharge and communication.

Mark Leiser is a freelance writer based in New Jersey.

Michelle Mourad, MD, says she’s always had “the doctor gene.” As a child, she spent countless hours playing with her Fisher-Price medical kit, and she gained an early appreciation for the scientific method thanks to family members who encouraged her to answer her own questions through discovery and experimentation. A youthful fascination evolved into a calling during high school, when she participated in a summer mentoring program at Santa Clara Valley Medical Center in San Jose, Calif. Paired with two neurosurgeons, she spent 12-hour days accompanying them on rounds, observing surgeries in the operating room, and attending case conferences.

“Right away, I was hooked,” says Dr. Mourad, assistant professor and director of quality for the division of hospital medicine at the University of California at San Francisco (UCSF) Medical Center and medical director of UCSF’s Congestive Heart Failure and Oncology hospitalist services, which comanage bone-marrow transplant and advanced-heart-failure patients in partnership with oncologists and cardiologists.

“I loved the community of medicine and I loved the hospital,” adds Dr. Mourad, one of the newest members of Team Hospitalist. “The interdisciplinary nature really resonated with me. That was when I realized this lifelong feeling of ‘I’m going to be a doctor’ actually had a lot of foundation to it.”

Question: Did you always intend to become a hospitalist?

Answer: I didn’t know hospitalists existed when I started medical school. I gravitated toward internal medicine and was pretty sure I would specialize. I went to internal-medicine residency thinking I wanted to be a gastroenterologist, but I found that a little limiting. I decided to be a pulmonary critical-care doctor, but realized, although I enjoy taking care of patients who are critically ill, I didn’t really want that to be my whole focus. When I started thinking about other options, I knew I was reaching.

Q: So how did you wind up in HM?

A: I enjoyed the community of the hospital—the fast pace, the ability to make treatment decisions and see your changes real-time, the ability to work with residents and interns, the intense time you spend with families during which you can really make or break their hospital experience and make a difference in the care they receive. When I realized I loved those things, the decision was easy.

Q: What does it mean to you to practice at one of the most highly respected HM programs in the country?

A: People want you to succeed. We are encouraged to get involved in the way the hospital works and make it about more than clinical care. The variety of things people do at our institution makes you realize hospitalists are not only clinicians; they are leaders, thinkers, role models, and advocates for patient safety. That’s incredibly motivating.

Q: Your career includes clinical, quality improvement, and administrative roles. Is there one aspect you enjoy most?

A: I need that variety. Allowing us to have that balance here has made the program great. My passion is quality improvement—the ability to affect patients on a personal level but to say, “How do I put systems in place to make hospitals safer and a better experience for every patient?” Figuring out how to navigate your own institution to engender change is challenging, but when you see that change manifest and you have providers and patients thank you for it, it’s probably the most rewarding thing I do.

Q: As director of quality, you strive to improve transitions of care around the time of discharge. What strategies have you implemented to improve that transition?

A: A hospitalist cannot do it alone. Discharge involves case managers and nurses and physical therapists and pharmacists. Our goal has been to create consensus and an urgency for change. … If you can show people their data and show how that is at odds with the vision of the care they are providing, that’s a really powerful force for change.

Q: What can other hospitalists do to improve transitions of care?

A: Form this group and take a good hard look at your data. Use that group to take small baby steps toward change, whether that’s always talking to primary-care physicians or having every patient who leaves have a follow-up appointment in two weeks, or calling every patient after discharge. I think people know what should be in their toolkit for a really safe transition. The problem is fighting the system and creating a group coalition that wants to do that with you.

Q: Have you noticed quantifiable improvements since you took over that role?

A: We put in place a program with residents to make it easier for them to do discharge summaries. They’re templated, they draw from the EMR, they’re concise, and they have what PCPs want. Nurses use them to provide targeted patient education and make sure patients understand their discharge instructions. That probably is my biggest tangible win. The biggest win overall is the culture change.

Q: How has the culture changed?

A: Faculty come up to you and say, “I had a readmission this month. I’m sorry. I really couldn’t prevent it. There’s nothing I could do.” Residents say, “I’ve been so good about communicating with PCPs this month. I can’t wait to see the audit data because I think my team has done really well.” We’re all thinking about what it takes to do a good discharge.

Q: What is the biggest advantage of UCSF’s comanagement service model?

A: The complexity of heart failure and oncology patients is incredible. That complexity means you need a subspecialist like a cardiologist or an oncologist, plus a hospitalist, because there are so many medicine issues along with cardiology or oncology issues. There are infections. There is renal failure. It takes a medicine head as well as a subspecialty head to take care of these patients.

Q: Do you believe that model will become popular for other programs?

A: I do, particularly on the surgical side. A lot of quality gains can be made by having a hospitalist partner with surgeons. The hospitalist can see a large number of patients and make sure everything has been thought about. When are they starting anticoagulation? When do those antibiotics need to come on or off? Those are quality measures that hospitalists are really good at, and I think that will make a fine partnership with surgical subspecialties.

Q: You strive to integrate QI initiatives into house staff education. Why is that important?

A: At an academic institution, you don’t provide care except going through the house staff. It’s important to make sure they understand this isn’t just one more box to be checked off or another thing their attending is asking of them. This is as fundamental as picking the right antibiotic to treat pneumonia or communicating with a PCP about a complicated discharge. That isn’t intuitively obvious. It became more apparent to me as I realized quality of care comes from clinical decisions as well as all of the extra effort we put into things like discharge and communication.

Mark Leiser is a freelance writer based in New Jersey.

When Joshua Lenchus, DO, RPh, FACP, FHM, discussed his love for chemistry with his high school guidance counselors, they told him it could take him in one of two directions: teaching or a career in pharmacy.

Intrigued by the latter option, he decided to become a volunteer in the pharmacy department at a local hospital. Soon after, he became a full-time pharmacy technician and eventually enrolled in pharmacy school at the University of Florida.

“I always knew I wanted to be a physician, and everybody needs a bachelor’s degree in something,” Dr. Lenchus says. “I thought, ‘What better way to do it than to get a bachelor’s degree in pharmacy and then move into medicine?’ ”

After college, he worked as a retail pharmacist, then moved to the institutional setting, creating the position of clinical pharmacist at Wellington (Fla.) Regional Medical Center. Three years later, he entered medical school and ultimately pursued a career as an academic hospitalist.

Dr. Lenchus now serves as associate professor of clinical medicine at the University of Miami’s (UM) Miller School of Medicine, associate program director of Jackson Memorial Hospital’s (JMH) internal medicine residency training program, and associate director of the UM-JMH Center for Patient Safety, which trains about 1,000 medical students, residents, and interns each year.

“Pharmacy has provided an invaluable background for becoming a physician,” says Dr. Lenchus, who was appointed a member of Team Hospitalist in May. “Many physicians order a medication and have no idea what the other half of the equation entails. My experience gave me a solid footing from which I could springboard.”

Q: You spend considerable time mentoring the next generation of physicians. What’s the best advice you can give them?

A: Physicians have these altruistic notions about wanting to help people, but you really have to do what you love. There’s another hospital a mile and a half away from my house, whereas Jackson is 35 miles away and it takes me an hour in transit time each way. But I couldn’t do what I’m doing now at any other facility. I stay because I love what I’m doing.

Q: Why is the UM-JMH Center for Patient Safety so beneficial?

A: The greatest benefit is the ability to be exposed to and tackle real-life scenarios in a risk-free environment. We use life-size mannequins to re-create scenarios that medical personnel will see during their training. We try to re-create the chaos that will ensue.

Q: So it’s similar to a pilot using a flight simulator.

A: Exactly. When a plane crashes and the NTSB goes to see what happened, they perform what we in medicine call a root-cause analysis. They’re not blaming an individual; they want to see what they can change on a system level to prevent an error like that from happening again. We culminate our training with a debriefing that we approach the same way, so nobody walks away thinking they failed.

Q: How effective can simulation-based education be?

A: There will be some limitations because the technology simply cannot account for every aspect of a human. But there’s a wealth of data that supports this as a pretty good surrogate. The technology provides for an incredible amount of experience and exposure without any potential harm to a patient, and it provides [trainees] an opportunity to do things they otherwise would have to wait to do until a clinical scenario demanded it.

Q: Do you think this is the wave of the future?

A: Absolutely. And as the Accreditation Council for Graduate Medical Education promulgates new rules that limit the hours trainees can work, it’s going to be incumbent on training programs to be creative in providing equal or near-equal experience in a much shorter time. Simulation can help fill that bill.

Q: You created a crisis-management simulation course for IM residents. How did that come about?

A: When we have a crisis like a code blue, I witnessed the chaos that ensued. I thought some of the paltry resuscitation rate could be due to the fact there was no meaningful communication in that scenario.

Using full-scale mannequins, I put nurses and residents into those types of situations and videotaped what ensued. Frequently we saw the same chaos we see in reality, and many rather basic, commonsensical concepts went out the window.

Q: Can you offer an example?

A: A big one is situational awareness. If the head of the gurney is in a seated position, that’s not a conducive way to do chest compressions. If the side rails of the bed are up, you can lower them so you aren’t reaching over them. Was a team leader assigned or were roles delegated? These aren’t novel concepts, but when faced with a crisis, everybody tends to focus on their own thing. In a crisis, you need to break those silos down and operate as a team.

Q: How effective is the training?

A: After the first scenario, we show the video and debrief them for 10 or 15 minutes, keying in on some behaviors that can be employed in a crisis. Then we expose them to a different crisis scenario immediately thereafter. Often we see an immediate change in their behavior.

Q: You developed a curriculum through which residents are taught in a standardized manner how to perform invasive bedside procedures. How does it work?

A: They have 12 hours of hands-on instruction using fluid-filled, ultrasound-capable mannequins. A faculty attending teaches these procedures. We took it a step further and made a four-week rotation as a mandatory component of the residency program. They carry a beeper, and any service within the hospital can call the procedure team to do one of the procedures on which they were already trained.

Q: How successful is the effort?

A: This is the beginning of our fifth year, and we’ve been called more than 4,000 times to do procedures on hospitalized patients. We’ve published our curriculum. We’ve shown a significant improvement in knowledge, technical skills, and confidence level, and we have data we’re going to publish later this year that shows our complication rates are better than complication rates that are published elsewhere.

Q: What is your biggest professional reward?

A: The ability to impact the next generation. With the procedural training alone, we have just trained our 1,000th person. Each one of them is going to take care of thousands of patients in their professional careers. That’s an expansive influence.

Q: What is your biggest professional challenge?

A: The culture of medicine. It is infused with hundreds of years of tradition and, at times, it feels like trying to move a mountain. It may take a generation to do it, but there will come a time—at least within the field of patient safety—when more people are attuned to it and understand the concepts really are lifesaving. That doesn’t happen as fast as I would like it to, but if we keep plugging away one year at a time, we will be able to make an impact.

Mark Leiser is a freelance writer based in New Jersey.

When Joshua Lenchus, DO, RPh, FACP, FHM, discussed his love for chemistry with his high school guidance counselors, they told him it could take him in one of two directions: teaching or a career in pharmacy.

Intrigued by the latter option, he decided to become a volunteer in the pharmacy department at a local hospital. Soon after, he became a full-time pharmacy technician and eventually enrolled in pharmacy school at the University of Florida.

“I always knew I wanted to be a physician, and everybody needs a bachelor’s degree in something,” Dr. Lenchus says. “I thought, ‘What better way to do it than to get a bachelor’s degree in pharmacy and then move into medicine?’ ”

After college, he worked as a retail pharmacist, then moved to the institutional setting, creating the position of clinical pharmacist at Wellington (Fla.) Regional Medical Center. Three years later, he entered medical school and ultimately pursued a career as an academic hospitalist.

Dr. Lenchus now serves as associate professor of clinical medicine at the University of Miami’s (UM) Miller School of Medicine, associate program director of Jackson Memorial Hospital’s (JMH) internal medicine residency training program, and associate director of the UM-JMH Center for Patient Safety, which trains about 1,000 medical students, residents, and interns each year.

“Pharmacy has provided an invaluable background for becoming a physician,” says Dr. Lenchus, who was appointed a member of Team Hospitalist in May. “Many physicians order a medication and have no idea what the other half of the equation entails. My experience gave me a solid footing from which I could springboard.”

Q: You spend considerable time mentoring the next generation of physicians. What’s the best advice you can give them?

A: Physicians have these altruistic notions about wanting to help people, but you really have to do what you love. There’s another hospital a mile and a half away from my house, whereas Jackson is 35 miles away and it takes me an hour in transit time each way. But I couldn’t do what I’m doing now at any other facility. I stay because I love what I’m doing.

Q: Why is the UM-JMH Center for Patient Safety so beneficial?

A: The greatest benefit is the ability to be exposed to and tackle real-life scenarios in a risk-free environment. We use life-size mannequins to re-create scenarios that medical personnel will see during their training. We try to re-create the chaos that will ensue.

Q: So it’s similar to a pilot using a flight simulator.

A: Exactly. When a plane crashes and the NTSB goes to see what happened, they perform what we in medicine call a root-cause analysis. They’re not blaming an individual; they want to see what they can change on a system level to prevent an error like that from happening again. We culminate our training with a debriefing that we approach the same way, so nobody walks away thinking they failed.

Q: How effective can simulation-based education be?

A: There will be some limitations because the technology simply cannot account for every aspect of a human. But there’s a wealth of data that supports this as a pretty good surrogate. The technology provides for an incredible amount of experience and exposure without any potential harm to a patient, and it provides [trainees] an opportunity to do things they otherwise would have to wait to do until a clinical scenario demanded it.

Q: Do you think this is the wave of the future?

A: Absolutely. And as the Accreditation Council for Graduate Medical Education promulgates new rules that limit the hours trainees can work, it’s going to be incumbent on training programs to be creative in providing equal or near-equal experience in a much shorter time. Simulation can help fill that bill.

Q: You created a crisis-management simulation course for IM residents. How did that come about?

A: When we have a crisis like a code blue, I witnessed the chaos that ensued. I thought some of the paltry resuscitation rate could be due to the fact there was no meaningful communication in that scenario.

Using full-scale mannequins, I put nurses and residents into those types of situations and videotaped what ensued. Frequently we saw the same chaos we see in reality, and many rather basic, commonsensical concepts went out the window.

Q: Can you offer an example?

A: A big one is situational awareness. If the head of the gurney is in a seated position, that’s not a conducive way to do chest compressions. If the side rails of the bed are up, you can lower them so you aren’t reaching over them. Was a team leader assigned or were roles delegated? These aren’t novel concepts, but when faced with a crisis, everybody tends to focus on their own thing. In a crisis, you need to break those silos down and operate as a team.

Q: How effective is the training?

A: After the first scenario, we show the video and debrief them for 10 or 15 minutes, keying in on some behaviors that can be employed in a crisis. Then we expose them to a different crisis scenario immediately thereafter. Often we see an immediate change in their behavior.

Q: You developed a curriculum through which residents are taught in a standardized manner how to perform invasive bedside procedures. How does it work?

A: They have 12 hours of hands-on instruction using fluid-filled, ultrasound-capable mannequins. A faculty attending teaches these procedures. We took it a step further and made a four-week rotation as a mandatory component of the residency program. They carry a beeper, and any service within the hospital can call the procedure team to do one of the procedures on which they were already trained.

Q: How successful is the effort?

A: This is the beginning of our fifth year, and we’ve been called more than 4,000 times to do procedures on hospitalized patients. We’ve published our curriculum. We’ve shown a significant improvement in knowledge, technical skills, and confidence level, and we have data we’re going to publish later this year that shows our complication rates are better than complication rates that are published elsewhere.

Q: What is your biggest professional reward?

A: The ability to impact the next generation. With the procedural training alone, we have just trained our 1,000th person. Each one of them is going to take care of thousands of patients in their professional careers. That’s an expansive influence.

Q: What is your biggest professional challenge?

A: The culture of medicine. It is infused with hundreds of years of tradition and, at times, it feels like trying to move a mountain. It may take a generation to do it, but there will come a time—at least within the field of patient safety—when more people are attuned to it and understand the concepts really are lifesaving. That doesn’t happen as fast as I would like it to, but if we keep plugging away one year at a time, we will be able to make an impact.

Mark Leiser is a freelance writer based in New Jersey.

When Joshua Lenchus, DO, RPh, FACP, FHM, discussed his love for chemistry with his high school guidance counselors, they told him it could take him in one of two directions: teaching or a career in pharmacy.

Intrigued by the latter option, he decided to become a volunteer in the pharmacy department at a local hospital. Soon after, he became a full-time pharmacy technician and eventually enrolled in pharmacy school at the University of Florida.

“I always knew I wanted to be a physician, and everybody needs a bachelor’s degree in something,” Dr. Lenchus says. “I thought, ‘What better way to do it than to get a bachelor’s degree in pharmacy and then move into medicine?’ ”

After college, he worked as a retail pharmacist, then moved to the institutional setting, creating the position of clinical pharmacist at Wellington (Fla.) Regional Medical Center. Three years later, he entered medical school and ultimately pursued a career as an academic hospitalist.

Dr. Lenchus now serves as associate professor of clinical medicine at the University of Miami’s (UM) Miller School of Medicine, associate program director of Jackson Memorial Hospital’s (JMH) internal medicine residency training program, and associate director of the UM-JMH Center for Patient Safety, which trains about 1,000 medical students, residents, and interns each year.

“Pharmacy has provided an invaluable background for becoming a physician,” says Dr. Lenchus, who was appointed a member of Team Hospitalist in May. “Many physicians order a medication and have no idea what the other half of the equation entails. My experience gave me a solid footing from which I could springboard.”

Q: You spend considerable time mentoring the next generation of physicians. What’s the best advice you can give them?

A: Physicians have these altruistic notions about wanting to help people, but you really have to do what you love. There’s another hospital a mile and a half away from my house, whereas Jackson is 35 miles away and it takes me an hour in transit time each way. But I couldn’t do what I’m doing now at any other facility. I stay because I love what I’m doing.

Q: Why is the UM-JMH Center for Patient Safety so beneficial?

A: The greatest benefit is the ability to be exposed to and tackle real-life scenarios in a risk-free environment. We use life-size mannequins to re-create scenarios that medical personnel will see during their training. We try to re-create the chaos that will ensue.

Q: So it’s similar to a pilot using a flight simulator.

A: Exactly. When a plane crashes and the NTSB goes to see what happened, they perform what we in medicine call a root-cause analysis. They’re not blaming an individual; they want to see what they can change on a system level to prevent an error like that from happening again. We culminate our training with a debriefing that we approach the same way, so nobody walks away thinking they failed.

Q: How effective can simulation-based education be?

A: There will be some limitations because the technology simply cannot account for every aspect of a human. But there’s a wealth of data that supports this as a pretty good surrogate. The technology provides for an incredible amount of experience and exposure without any potential harm to a patient, and it provides [trainees] an opportunity to do things they otherwise would have to wait to do until a clinical scenario demanded it.

Q: Do you think this is the wave of the future?

A: Absolutely. And as the Accreditation Council for Graduate Medical Education promulgates new rules that limit the hours trainees can work, it’s going to be incumbent on training programs to be creative in providing equal or near-equal experience in a much shorter time. Simulation can help fill that bill.

Q: You created a crisis-management simulation course for IM residents. How did that come about?

A: When we have a crisis like a code blue, I witnessed the chaos that ensued. I thought some of the paltry resuscitation rate could be due to the fact there was no meaningful communication in that scenario.

Using full-scale mannequins, I put nurses and residents into those types of situations and videotaped what ensued. Frequently we saw the same chaos we see in reality, and many rather basic, commonsensical concepts went out the window.

Q: Can you offer an example?

A: A big one is situational awareness. If the head of the gurney is in a seated position, that’s not a conducive way to do chest compressions. If the side rails of the bed are up, you can lower them so you aren’t reaching over them. Was a team leader assigned or were roles delegated? These aren’t novel concepts, but when faced with a crisis, everybody tends to focus on their own thing. In a crisis, you need to break those silos down and operate as a team.

Q: How effective is the training?

A: After the first scenario, we show the video and debrief them for 10 or 15 minutes, keying in on some behaviors that can be employed in a crisis. Then we expose them to a different crisis scenario immediately thereafter. Often we see an immediate change in their behavior.

Q: You developed a curriculum through which residents are taught in a standardized manner how to perform invasive bedside procedures. How does it work?

A: They have 12 hours of hands-on instruction using fluid-filled, ultrasound-capable mannequins. A faculty attending teaches these procedures. We took it a step further and made a four-week rotation as a mandatory component of the residency program. They carry a beeper, and any service within the hospital can call the procedure team to do one of the procedures on which they were already trained.

Q: How successful is the effort?

A: This is the beginning of our fifth year, and we’ve been called more than 4,000 times to do procedures on hospitalized patients. We’ve published our curriculum. We’ve shown a significant improvement in knowledge, technical skills, and confidence level, and we have data we’re going to publish later this year that shows our complication rates are better than complication rates that are published elsewhere.

Q: What is your biggest professional reward?

A: The ability to impact the next generation. With the procedural training alone, we have just trained our 1,000th person. Each one of them is going to take care of thousands of patients in their professional careers. That’s an expansive influence.

Q: What is your biggest professional challenge?

A: The culture of medicine. It is infused with hundreds of years of tradition and, at times, it feels like trying to move a mountain. It may take a generation to do it, but there will come a time—at least within the field of patient safety—when more people are attuned to it and understand the concepts really are lifesaving. That doesn’t happen as fast as I would like it to, but if we keep plugging away one year at a time, we will be able to make an impact.

Mark Leiser is a freelance writer based in New Jersey.

Like many physicians, Larry Holder, MD, FACP, FHM, entered the medical profession with the desire to make a difference. After completing a fellowship in hematology and oncology in 1988, he joined Cancer Care Specialists of Central Illinois, a community oncology practice based in Decatur, and anticipated a lengthy career in which he would contribute to significant breakthroughs in cancer treatment.

After 12 years, however, he changed direction.

“I had become a bit disillusioned and realized we weren’t making big impacts, especially on the more common cancers,” he says. “I also got very attached to my patients, and in oncology, that’s not always a good thing. It became very trying emotionally.”

Dr. Holder spent the next five years practicing internal medicine at Community Health Improvement Center in Decatur. In 2005, he joined the hospitalist program at Decatur Memorial Hospital. Last year, he became medical director of hospitalist services, chief medical informatics officer (CMIO), and medical director of information systems.

Although he has found a new niche, his philosophy remains the same.

“Everything I do comes down to the fact I still love taking care of patients,” says Dr. Holder, one of six new members of Team Hospitalist. “That’s why I became a doctor. It’s very rewarding, and I never want to give that up.”

As a physician, I still find [clinical work] extremely rewarding. As medical director, I need to be in the trenches to know what the hospitalists are going through and what problems they are having. As CMIO, it’s very important that I use the system I’m in charge of trying to optimize.

Question: You left oncology partly because you became attached to your patients. Does that approach help you as a hospitalist?

Answer: Definitely. I try to teach younger hospitalists the value of developing a rapport with patients. I enjoy building that emotional or intellectual attachment. I’m a big believer in the human aspect of what we do, and it’s one of the aspects of my job I love the most.

Q: Did you join Decatur Memorial with aspirations of leading its hospitalist program?

A: No. My plan was to focus on giving good patient care, get involved on the quality side, and become the CMIO for the hospital. When the medical director role opened up, it seemed to be sitting there waiting to be filled. I structured it so I could continue to see patients and split my administrative time between being the medical director of the hospitalists and being the CMIO.

Q: Why is it so important for you to still see patients?

A: As a physician, I still find it extremely rewarding. As medical director, I need to be in the trenches to know what the hospitalists are going through and what problems they are having. As CMIO, it’s very important that I use the system I’m in charge of trying to optimize.

Q: What advice would you give to a physician who is about to become leader of a program?

A: You need to anticipate growth. I was caught off guard by how fast our program continued to grow, and how quickly we reached the point where we needed more hospitalists. In retrospect, I should have immediately started looking to recruit. I also was not prepared for the financial aspect. If you don’t have a financial background, I would very quickly get training in that area.

Q: What is your biggest challenge as medical director?

A: Getting others in the hospital to accept change, even when all indications are it’s for the better.

Q: Have you identified a strategy that helps make that process easier?

A: The first step is to establish a sense of urgency. Then I try to get people who will be involved in the process or people who don’t oppose change to help set up a vision for the project and communicate that vision. Once you get empowerment to do the project, go for a short, early win that shows the concept is viable and can make it.

Q: How did you develop your interest in information systems?

A: I’ve always been interested in computers and how we can use computerization and informatic systems to improve patient care. When I became a hospitalist, I got much more involved. Decatur Memorial implemented computer physician order entry (CPOE). I became the physician champion for that, and my interest grew from there. I’m fortunate our administration is very good at pushing to improve our information systems.

Q: Does that interest fit with your approach toward medicine?

A: Absolutely. I’m a big believer in evidenced-based medicine. I think computer systems complement that very well.

Q: You were a finalist for McKesson’s Distinguished Achieve-ment Award and received an award this year from the Association of Medical Directors of Information Systems. What were those honors for?

A: We did a complete cultural change with nurses and physicians in terms of how they deal with diabetes. As part of that project, I developed a CPOE order set that automatically calculated the basal, nutritional, and correctional insulin dosage for the physician based on the patient’s weight and height. It made the right thing to do the easy thing to do. The concept involved the use of evidence-based medicine, project improvement with the Six Sigma process, and the high-level use of informatics.

Q: Has that improved patient care?

A: I was able to demonstrate a statistically significant improvement in glucose control without a change in hypoglycemia, so I did demonstrate an improved clinical outcome.

Q: What’s next for you professionally?

A: I have no intention of changing jobs, but I will continue to be very involved in quality projects. The biggest long-term project is developing more patient- and family-centered care at our hospital. I went to a national conference in February, and a big component was patient-centered care. I was very intrigued by it and brought the vision back to our hospital.

Q: Where does the effort stand?

A: I thought our hospitalist group would be a good group to do an initial component of the project. It went over really well, and people started asking me to present it to others. It took on a life of its own, and I wound up on a bit of a lecture series. It has since become an official Six Sigma project. We got the charter for it and it’s going in the hospital’s strategic plan, which I’m very pleased about.

Q: You earned FHM designation earlier this year. What does that mean to you?

A: It means a great deal. It’s tremendous recognition for the work I’ve done, the quality improvement projects I’ve been involved with, and the leadership roles I’ve taken on. At the same time, when you are able to show a national society views your work as important, I think it gives me even more credibility with the administration and the support staff.

Mark Leiser is a freelance writer based in New Jersey.

Like many physicians, Larry Holder, MD, FACP, FHM, entered the medical profession with the desire to make a difference. After completing a fellowship in hematology and oncology in 1988, he joined Cancer Care Specialists of Central Illinois, a community oncology practice based in Decatur, and anticipated a lengthy career in which he would contribute to significant breakthroughs in cancer treatment.

After 12 years, however, he changed direction.

“I had become a bit disillusioned and realized we weren’t making big impacts, especially on the more common cancers,” he says. “I also got very attached to my patients, and in oncology, that’s not always a good thing. It became very trying emotionally.”

Dr. Holder spent the next five years practicing internal medicine at Community Health Improvement Center in Decatur. In 2005, he joined the hospitalist program at Decatur Memorial Hospital. Last year, he became medical director of hospitalist services, chief medical informatics officer (CMIO), and medical director of information systems.

Although he has found a new niche, his philosophy remains the same.

“Everything I do comes down to the fact I still love taking care of patients,” says Dr. Holder, one of six new members of Team Hospitalist. “That’s why I became a doctor. It’s very rewarding, and I never want to give that up.”

As a physician, I still find [clinical work] extremely rewarding. As medical director, I need to be in the trenches to know what the hospitalists are going through and what problems they are having. As CMIO, it’s very important that I use the system I’m in charge of trying to optimize.

Question: You left oncology partly because you became attached to your patients. Does that approach help you as a hospitalist?

Answer: Definitely. I try to teach younger hospitalists the value of developing a rapport with patients. I enjoy building that emotional or intellectual attachment. I’m a big believer in the human aspect of what we do, and it’s one of the aspects of my job I love the most.

Q: Did you join Decatur Memorial with aspirations of leading its hospitalist program?

A: No. My plan was to focus on giving good patient care, get involved on the quality side, and become the CMIO for the hospital. When the medical director role opened up, it seemed to be sitting there waiting to be filled. I structured it so I could continue to see patients and split my administrative time between being the medical director of the hospitalists and being the CMIO.

Q: Why is it so important for you to still see patients?

A: As a physician, I still find it extremely rewarding. As medical director, I need to be in the trenches to know what the hospitalists are going through and what problems they are having. As CMIO, it’s very important that I use the system I’m in charge of trying to optimize.

Q: What advice would you give to a physician who is about to become leader of a program?

A: You need to anticipate growth. I was caught off guard by how fast our program continued to grow, and how quickly we reached the point where we needed more hospitalists. In retrospect, I should have immediately started looking to recruit. I also was not prepared for the financial aspect. If you don’t have a financial background, I would very quickly get training in that area.

Q: What is your biggest challenge as medical director?

A: Getting others in the hospital to accept change, even when all indications are it’s for the better.

Q: Have you identified a strategy that helps make that process easier?

A: The first step is to establish a sense of urgency. Then I try to get people who will be involved in the process or people who don’t oppose change to help set up a vision for the project and communicate that vision. Once you get empowerment to do the project, go for a short, early win that shows the concept is viable and can make it.

Q: How did you develop your interest in information systems?

A: I’ve always been interested in computers and how we can use computerization and informatic systems to improve patient care. When I became a hospitalist, I got much more involved. Decatur Memorial implemented computer physician order entry (CPOE). I became the physician champion for that, and my interest grew from there. I’m fortunate our administration is very good at pushing to improve our information systems.

Q: Does that interest fit with your approach toward medicine?

A: Absolutely. I’m a big believer in evidenced-based medicine. I think computer systems complement that very well.

Q: You were a finalist for McKesson’s Distinguished Achieve-ment Award and received an award this year from the Association of Medical Directors of Information Systems. What were those honors for?

A: We did a complete cultural change with nurses and physicians in terms of how they deal with diabetes. As part of that project, I developed a CPOE order set that automatically calculated the basal, nutritional, and correctional insulin dosage for the physician based on the patient’s weight and height. It made the right thing to do the easy thing to do. The concept involved the use of evidence-based medicine, project improvement with the Six Sigma process, and the high-level use of informatics.

Q: Has that improved patient care?

A: I was able to demonstrate a statistically significant improvement in glucose control without a change in hypoglycemia, so I did demonstrate an improved clinical outcome.

Q: What’s next for you professionally?

A: I have no intention of changing jobs, but I will continue to be very involved in quality projects. The biggest long-term project is developing more patient- and family-centered care at our hospital. I went to a national conference in February, and a big component was patient-centered care. I was very intrigued by it and brought the vision back to our hospital.

Q: Where does the effort stand?

A: I thought our hospitalist group would be a good group to do an initial component of the project. It went over really well, and people started asking me to present it to others. It took on a life of its own, and I wound up on a bit of a lecture series. It has since become an official Six Sigma project. We got the charter for it and it’s going in the hospital’s strategic plan, which I’m very pleased about.

Q: You earned FHM designation earlier this year. What does that mean to you?

A: It means a great deal. It’s tremendous recognition for the work I’ve done, the quality improvement projects I’ve been involved with, and the leadership roles I’ve taken on. At the same time, when you are able to show a national society views your work as important, I think it gives me even more credibility with the administration and the support staff.

Mark Leiser is a freelance writer based in New Jersey.

Like many physicians, Larry Holder, MD, FACP, FHM, entered the medical profession with the desire to make a difference. After completing a fellowship in hematology and oncology in 1988, he joined Cancer Care Specialists of Central Illinois, a community oncology practice based in Decatur, and anticipated a lengthy career in which he would contribute to significant breakthroughs in cancer treatment.

After 12 years, however, he changed direction.

“I had become a bit disillusioned and realized we weren’t making big impacts, especially on the more common cancers,” he says. “I also got very attached to my patients, and in oncology, that’s not always a good thing. It became very trying emotionally.”

Dr. Holder spent the next five years practicing internal medicine at Community Health Improvement Center in Decatur. In 2005, he joined the hospitalist program at Decatur Memorial Hospital. Last year, he became medical director of hospitalist services, chief medical informatics officer (CMIO), and medical director of information systems.

Although he has found a new niche, his philosophy remains the same.

“Everything I do comes down to the fact I still love taking care of patients,” says Dr. Holder, one of six new members of Team Hospitalist. “That’s why I became a doctor. It’s very rewarding, and I never want to give that up.”

As a physician, I still find [clinical work] extremely rewarding. As medical director, I need to be in the trenches to know what the hospitalists are going through and what problems they are having. As CMIO, it’s very important that I use the system I’m in charge of trying to optimize.

Question: You left oncology partly because you became attached to your patients. Does that approach help you as a hospitalist?

Answer: Definitely. I try to teach younger hospitalists the value of developing a rapport with patients. I enjoy building that emotional or intellectual attachment. I’m a big believer in the human aspect of what we do, and it’s one of the aspects of my job I love the most.

Q: Did you join Decatur Memorial with aspirations of leading its hospitalist program?

A: No. My plan was to focus on giving good patient care, get involved on the quality side, and become the CMIO for the hospital. When the medical director role opened up, it seemed to be sitting there waiting to be filled. I structured it so I could continue to see patients and split my administrative time between being the medical director of the hospitalists and being the CMIO.

Q: Why is it so important for you to still see patients?

A: As a physician, I still find it extremely rewarding. As medical director, I need to be in the trenches to know what the hospitalists are going through and what problems they are having. As CMIO, it’s very important that I use the system I’m in charge of trying to optimize.

Q: What advice would you give to a physician who is about to become leader of a program?

A: You need to anticipate growth. I was caught off guard by how fast our program continued to grow, and how quickly we reached the point where we needed more hospitalists. In retrospect, I should have immediately started looking to recruit. I also was not prepared for the financial aspect. If you don’t have a financial background, I would very quickly get training in that area.

Q: What is your biggest challenge as medical director?

A: Getting others in the hospital to accept change, even when all indications are it’s for the better.

Q: Have you identified a strategy that helps make that process easier?

A: The first step is to establish a sense of urgency. Then I try to get people who will be involved in the process or people who don’t oppose change to help set up a vision for the project and communicate that vision. Once you get empowerment to do the project, go for a short, early win that shows the concept is viable and can make it.

Q: How did you develop your interest in information systems?

A: I’ve always been interested in computers and how we can use computerization and informatic systems to improve patient care. When I became a hospitalist, I got much more involved. Decatur Memorial implemented computer physician order entry (CPOE). I became the physician champion for that, and my interest grew from there. I’m fortunate our administration is very good at pushing to improve our information systems.

Q: Does that interest fit with your approach toward medicine?

A: Absolutely. I’m a big believer in evidenced-based medicine. I think computer systems complement that very well.

Q: You were a finalist for McKesson’s Distinguished Achieve-ment Award and received an award this year from the Association of Medical Directors of Information Systems. What were those honors for?

A: We did a complete cultural change with nurses and physicians in terms of how they deal with diabetes. As part of that project, I developed a CPOE order set that automatically calculated the basal, nutritional, and correctional insulin dosage for the physician based on the patient’s weight and height. It made the right thing to do the easy thing to do. The concept involved the use of evidence-based medicine, project improvement with the Six Sigma process, and the high-level use of informatics.

Q: Has that improved patient care?

A: I was able to demonstrate a statistically significant improvement in glucose control without a change in hypoglycemia, so I did demonstrate an improved clinical outcome.

Q: What’s next for you professionally?

A: I have no intention of changing jobs, but I will continue to be very involved in quality projects. The biggest long-term project is developing more patient- and family-centered care at our hospital. I went to a national conference in February, and a big component was patient-centered care. I was very intrigued by it and brought the vision back to our hospital.

Q: Where does the effort stand?

A: I thought our hospitalist group would be a good group to do an initial component of the project. It went over really well, and people started asking me to present it to others. It took on a life of its own, and I wound up on a bit of a lecture series. It has since become an official Six Sigma project. We got the charter for it and it’s going in the hospital’s strategic plan, which I’m very pleased about.

Q: You earned FHM designation earlier this year. What does that mean to you?

A: It means a great deal. It’s tremendous recognition for the work I’ve done, the quality improvement projects I’ve been involved with, and the leadership roles I’ve taken on. At the same time, when you are able to show a national society views your work as important, I think it gives me even more credibility with the administration and the support staff.

Mark Leiser is a freelance writer based in New Jersey.