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Ever think there has to be a better way to update your group’s 100-plus-page program manual? The HM group at Beth Israel Deaconess Medical Center in Boston offers a solution: Post all of the information on a secure wiki page.
That’s what hospitalist Roger Yu, MD, did a few months ago. He transferred his group’s manual to a wiki that allows members to access, add, and edit information about referring physicians, schedules, and more.
Dr. Yu says the page, hosted by Microsoft’s SharePoint platform, allows the 33-hospitalist group to stay up to date on new policies without forcing them to sift through a barrage of e-mails. “We probably have at least eight to 10 clinical rotations,” Dr. Yu says. “The hospital policy is always changing, the way we do our work constantly changes, and [using a wiki platform] is a way of getting this information across.”
The program was especially helpful, he adds, when his group recently developed a new referral relationship with a large, multispecialty group that had some unique needs. “There are specific ways they want us to consult their specialists, and they have different pager numbers and contact people, so we were able to post all of that in a page on the wiki,” Dr. Yu explains, adding any member of his group can add or edit information on the wiki.
Dr. Yu says his group hopes to eventually use the wiki to post calendar events and share teaching materials.
Joe Li, MD, director of the Beth Israel HM program, who tasked Dr. Yu with developing the wiki, says the program has, for the most part, run smoothly: “I wouldn’t say there have been glitches, per se, but I think people in the group have different levels of willingness to adopt new technology,” says Dr. Li, SHM’s president-elect. “Some [of our] people have accessed it less than others.”
Dr. Yu says that while creating a wiki doesn’t require extensive HTML knowledge or even computer savviness, it does involve some initial planning. “I would say if you’re going to start it up, it’s more about thinking about how to organize the table of contents,” he says. Once the table of contents is created, he says, expect to spend a few hours a day plugging in the information. It took him about three days to input the 120-plus-page manual.
For more tips on how to create your own wiki, visit Microsoft's help page.
Ever think there has to be a better way to update your group’s 100-plus-page program manual? The HM group at Beth Israel Deaconess Medical Center in Boston offers a solution: Post all of the information on a secure wiki page.
That’s what hospitalist Roger Yu, MD, did a few months ago. He transferred his group’s manual to a wiki that allows members to access, add, and edit information about referring physicians, schedules, and more.
Dr. Yu says the page, hosted by Microsoft’s SharePoint platform, allows the 33-hospitalist group to stay up to date on new policies without forcing them to sift through a barrage of e-mails. “We probably have at least eight to 10 clinical rotations,” Dr. Yu says. “The hospital policy is always changing, the way we do our work constantly changes, and [using a wiki platform] is a way of getting this information across.”
The program was especially helpful, he adds, when his group recently developed a new referral relationship with a large, multispecialty group that had some unique needs. “There are specific ways they want us to consult their specialists, and they have different pager numbers and contact people, so we were able to post all of that in a page on the wiki,” Dr. Yu explains, adding any member of his group can add or edit information on the wiki.
Dr. Yu says his group hopes to eventually use the wiki to post calendar events and share teaching materials.
Joe Li, MD, director of the Beth Israel HM program, who tasked Dr. Yu with developing the wiki, says the program has, for the most part, run smoothly: “I wouldn’t say there have been glitches, per se, but I think people in the group have different levels of willingness to adopt new technology,” says Dr. Li, SHM’s president-elect. “Some [of our] people have accessed it less than others.”
Dr. Yu says that while creating a wiki doesn’t require extensive HTML knowledge or even computer savviness, it does involve some initial planning. “I would say if you’re going to start it up, it’s more about thinking about how to organize the table of contents,” he says. Once the table of contents is created, he says, expect to spend a few hours a day plugging in the information. It took him about three days to input the 120-plus-page manual.
For more tips on how to create your own wiki, visit Microsoft's help page.
Ever think there has to be a better way to update your group’s 100-plus-page program manual? The HM group at Beth Israel Deaconess Medical Center in Boston offers a solution: Post all of the information on a secure wiki page.
That’s what hospitalist Roger Yu, MD, did a few months ago. He transferred his group’s manual to a wiki that allows members to access, add, and edit information about referring physicians, schedules, and more.
Dr. Yu says the page, hosted by Microsoft’s SharePoint platform, allows the 33-hospitalist group to stay up to date on new policies without forcing them to sift through a barrage of e-mails. “We probably have at least eight to 10 clinical rotations,” Dr. Yu says. “The hospital policy is always changing, the way we do our work constantly changes, and [using a wiki platform] is a way of getting this information across.”
The program was especially helpful, he adds, when his group recently developed a new referral relationship with a large, multispecialty group that had some unique needs. “There are specific ways they want us to consult their specialists, and they have different pager numbers and contact people, so we were able to post all of that in a page on the wiki,” Dr. Yu explains, adding any member of his group can add or edit information on the wiki.
Dr. Yu says his group hopes to eventually use the wiki to post calendar events and share teaching materials.
Joe Li, MD, director of the Beth Israel HM program, who tasked Dr. Yu with developing the wiki, says the program has, for the most part, run smoothly: “I wouldn’t say there have been glitches, per se, but I think people in the group have different levels of willingness to adopt new technology,” says Dr. Li, SHM’s president-elect. “Some [of our] people have accessed it less than others.”
Dr. Yu says that while creating a wiki doesn’t require extensive HTML knowledge or even computer savviness, it does involve some initial planning. “I would say if you’re going to start it up, it’s more about thinking about how to organize the table of contents,” he says. Once the table of contents is created, he says, expect to spend a few hours a day plugging in the information. It took him about three days to input the 120-plus-page manual.
For more tips on how to create your own wiki, visit Microsoft's help page.
Legislative Agenda
Eric Siegal, MD, SFHM, is not an SHM newbie. Since becoming a member in 1999, he has served on the awards and annual meeting committees, and he is the current chair of the Public Policy Committee. So when he learned he was elected to a three-year term as SHM’s newest board member, he says, he was excited about the opportunity to continue to work with “old friends.”
Dr. Siegal is a Critical Care Fellow at the University of Wisconsin School of Medicine and Public Health, and previously served as regional medical director for Brentwood, Tenn.-based Cogent Healthcare. TH eWire caught up with him just as he finished attending his first board meeting at HM10.
What unique perspective do you bring to the board?
I think I have a pretty varied experience. I ran both community and academic hospitalist programs. And I obviously have the policy bent, which, with all that is going with healthcare policy reform, I think it will be important to have someone on the board who has a fair degree of fluency with that. Although I will also say that two other board members come from the policy committee, so I’m by no means alone.
What kind of issues do you look forward to getting involved in?
The two areas that interest me most are healthcare policy and how hospitalists are going to interface with the critical-care environment. We know there is a large percentage, if not a majority, of hospitalists practicing critical-care medicine, some of whom may be appropriately trained to do so and others who are not. I think there are opportunities to figure out how hospitalists can and should participate in the critical care of patients. Hopefully, we can pair up with critical-care societies to figure out how we’re going to address the massive and growing shortage of critical-care physicians in the U.S.
Where do you see SHM in 10 years?
I would like to see us recognized as part of the solution to making healthcare better. We have worked very hard up to now to demonstrate to legislators, insurers, and people in the quality world that SHM [that] although we do advocate for members, we also advocate for healthcare reform. I think, unfortunately, that many professional societies start and end primarily with what is in the best financial interest of their membership. We have gone to great lengths not to be that: to be seen as an organization that is part of the solution to healthcare, not part of the problem. … I would hope that in 10 years that would not only be widely accepted throughout the healthcare community, but that when Congress or [the Centers for Medicaid and Medicare Services] looks around and thinks about who are the people who they can work with to make things better, hospital medicine is at the top of the list.
Eric Siegal, MD, SFHM, is not an SHM newbie. Since becoming a member in 1999, he has served on the awards and annual meeting committees, and he is the current chair of the Public Policy Committee. So when he learned he was elected to a three-year term as SHM’s newest board member, he says, he was excited about the opportunity to continue to work with “old friends.”
Dr. Siegal is a Critical Care Fellow at the University of Wisconsin School of Medicine and Public Health, and previously served as regional medical director for Brentwood, Tenn.-based Cogent Healthcare. TH eWire caught up with him just as he finished attending his first board meeting at HM10.
What unique perspective do you bring to the board?
I think I have a pretty varied experience. I ran both community and academic hospitalist programs. And I obviously have the policy bent, which, with all that is going with healthcare policy reform, I think it will be important to have someone on the board who has a fair degree of fluency with that. Although I will also say that two other board members come from the policy committee, so I’m by no means alone.
What kind of issues do you look forward to getting involved in?
The two areas that interest me most are healthcare policy and how hospitalists are going to interface with the critical-care environment. We know there is a large percentage, if not a majority, of hospitalists practicing critical-care medicine, some of whom may be appropriately trained to do so and others who are not. I think there are opportunities to figure out how hospitalists can and should participate in the critical care of patients. Hopefully, we can pair up with critical-care societies to figure out how we’re going to address the massive and growing shortage of critical-care physicians in the U.S.
Where do you see SHM in 10 years?
I would like to see us recognized as part of the solution to making healthcare better. We have worked very hard up to now to demonstrate to legislators, insurers, and people in the quality world that SHM [that] although we do advocate for members, we also advocate for healthcare reform. I think, unfortunately, that many professional societies start and end primarily with what is in the best financial interest of their membership. We have gone to great lengths not to be that: to be seen as an organization that is part of the solution to healthcare, not part of the problem. … I would hope that in 10 years that would not only be widely accepted throughout the healthcare community, but that when Congress or [the Centers for Medicaid and Medicare Services] looks around and thinks about who are the people who they can work with to make things better, hospital medicine is at the top of the list.
Eric Siegal, MD, SFHM, is not an SHM newbie. Since becoming a member in 1999, he has served on the awards and annual meeting committees, and he is the current chair of the Public Policy Committee. So when he learned he was elected to a three-year term as SHM’s newest board member, he says, he was excited about the opportunity to continue to work with “old friends.”
Dr. Siegal is a Critical Care Fellow at the University of Wisconsin School of Medicine and Public Health, and previously served as regional medical director for Brentwood, Tenn.-based Cogent Healthcare. TH eWire caught up with him just as he finished attending his first board meeting at HM10.
What unique perspective do you bring to the board?
I think I have a pretty varied experience. I ran both community and academic hospitalist programs. And I obviously have the policy bent, which, with all that is going with healthcare policy reform, I think it will be important to have someone on the board who has a fair degree of fluency with that. Although I will also say that two other board members come from the policy committee, so I’m by no means alone.
What kind of issues do you look forward to getting involved in?
The two areas that interest me most are healthcare policy and how hospitalists are going to interface with the critical-care environment. We know there is a large percentage, if not a majority, of hospitalists practicing critical-care medicine, some of whom may be appropriately trained to do so and others who are not. I think there are opportunities to figure out how hospitalists can and should participate in the critical care of patients. Hopefully, we can pair up with critical-care societies to figure out how we’re going to address the massive and growing shortage of critical-care physicians in the U.S.
Where do you see SHM in 10 years?
I would like to see us recognized as part of the solution to making healthcare better. We have worked very hard up to now to demonstrate to legislators, insurers, and people in the quality world that SHM [that] although we do advocate for members, we also advocate for healthcare reform. I think, unfortunately, that many professional societies start and end primarily with what is in the best financial interest of their membership. We have gone to great lengths not to be that: to be seen as an organization that is part of the solution to healthcare, not part of the problem. … I would hope that in 10 years that would not only be widely accepted throughout the healthcare community, but that when Congress or [the Centers for Medicaid and Medicare Services] looks around and thinks about who are the people who they can work with to make things better, hospital medicine is at the top of the list.
Conventional Wisdom: When New Isn’t Better
Ever wonder whether a new drug is as good as the one you’ve been prescribing for years? Alec B. O'Connor, MD, MPH, wonders all the time. In a commentary published in the March 1 issue of the Journal of the American Medical Association, Dr. O’Connor calls on the FDA to help physicians answer such questions.
Dr. O’Connor, associate medicine residency program director for inpatient services at the University of Rochester Medical Center in Rochester, N.Y., says that as part of the drug-approval process, the FDA should require pharmaceutical companies to submit data comparing the efficacy and safety of a new drug to an established first-line drug.
TH eWire recently asked Dr. O’Connor about his proposal.
Question: What propelled you to write this editorial?
Answer: I’ve observed that physician tendencies and patient tendencies are to try new drugs, regardless of what they were taking before the new drug came out. … When new drugs come to market, they are compared only against placebo and, in reality, that is not a comparison. What I need to see is how the new drug compares to what I’m already using to treat the patient for the same indication. … For all we know, if we stop using the old drug and prescribe the new drug, we may be harming the patient, in addition to increasing drug costs.
Q: Is it possible these requirements could increase drug development costs?
A: [The increase] will likely be quite small because there are so many drug development costs that happen before you get to the trial. I think the bigger risk would just be that they would get to the end of the drug development process and discover they have a drug that can’t be approved because it’s not as good as what we are currently using. … The flip side is that if that happens, then we prevent the drug from coming to market and replacing a current treatment with a drug that was shown to be inferior. I think companies would find that if they get to that point, they can find niches for the drug where it’s added to an existing treatment. They can also determine what patient population the drug makes the most sense for and do a trial that shows it does have a clinical effect that is just as good as what is already out there. So they’ll still have a drug they can sell.
Q: Will the policy incentivize pharmaceutical companies to develop orphan drugs or new classes of drugs?
A: It might. They would see it as a potentially less-risky development. Unfortunately, drug companies have to invest a lot of money in a potential new drug before they get to the Phase III trials where they are comparing them. It’s possible that drug companies might strategize about choosing more orphan indications, where all they would have to do is compare the drug to placebo, because there is no other treatment option.
Ever wonder whether a new drug is as good as the one you’ve been prescribing for years? Alec B. O'Connor, MD, MPH, wonders all the time. In a commentary published in the March 1 issue of the Journal of the American Medical Association, Dr. O’Connor calls on the FDA to help physicians answer such questions.
Dr. O’Connor, associate medicine residency program director for inpatient services at the University of Rochester Medical Center in Rochester, N.Y., says that as part of the drug-approval process, the FDA should require pharmaceutical companies to submit data comparing the efficacy and safety of a new drug to an established first-line drug.
TH eWire recently asked Dr. O’Connor about his proposal.
Question: What propelled you to write this editorial?
Answer: I’ve observed that physician tendencies and patient tendencies are to try new drugs, regardless of what they were taking before the new drug came out. … When new drugs come to market, they are compared only against placebo and, in reality, that is not a comparison. What I need to see is how the new drug compares to what I’m already using to treat the patient for the same indication. … For all we know, if we stop using the old drug and prescribe the new drug, we may be harming the patient, in addition to increasing drug costs.
Q: Is it possible these requirements could increase drug development costs?
A: [The increase] will likely be quite small because there are so many drug development costs that happen before you get to the trial. I think the bigger risk would just be that they would get to the end of the drug development process and discover they have a drug that can’t be approved because it’s not as good as what we are currently using. … The flip side is that if that happens, then we prevent the drug from coming to market and replacing a current treatment with a drug that was shown to be inferior. I think companies would find that if they get to that point, they can find niches for the drug where it’s added to an existing treatment. They can also determine what patient population the drug makes the most sense for and do a trial that shows it does have a clinical effect that is just as good as what is already out there. So they’ll still have a drug they can sell.
Q: Will the policy incentivize pharmaceutical companies to develop orphan drugs or new classes of drugs?
A: It might. They would see it as a potentially less-risky development. Unfortunately, drug companies have to invest a lot of money in a potential new drug before they get to the Phase III trials where they are comparing them. It’s possible that drug companies might strategize about choosing more orphan indications, where all they would have to do is compare the drug to placebo, because there is no other treatment option.
Ever wonder whether a new drug is as good as the one you’ve been prescribing for years? Alec B. O'Connor, MD, MPH, wonders all the time. In a commentary published in the March 1 issue of the Journal of the American Medical Association, Dr. O’Connor calls on the FDA to help physicians answer such questions.
Dr. O’Connor, associate medicine residency program director for inpatient services at the University of Rochester Medical Center in Rochester, N.Y., says that as part of the drug-approval process, the FDA should require pharmaceutical companies to submit data comparing the efficacy and safety of a new drug to an established first-line drug.
TH eWire recently asked Dr. O’Connor about his proposal.
Question: What propelled you to write this editorial?
Answer: I’ve observed that physician tendencies and patient tendencies are to try new drugs, regardless of what they were taking before the new drug came out. … When new drugs come to market, they are compared only against placebo and, in reality, that is not a comparison. What I need to see is how the new drug compares to what I’m already using to treat the patient for the same indication. … For all we know, if we stop using the old drug and prescribe the new drug, we may be harming the patient, in addition to increasing drug costs.
Q: Is it possible these requirements could increase drug development costs?
A: [The increase] will likely be quite small because there are so many drug development costs that happen before you get to the trial. I think the bigger risk would just be that they would get to the end of the drug development process and discover they have a drug that can’t be approved because it’s not as good as what we are currently using. … The flip side is that if that happens, then we prevent the drug from coming to market and replacing a current treatment with a drug that was shown to be inferior. I think companies would find that if they get to that point, they can find niches for the drug where it’s added to an existing treatment. They can also determine what patient population the drug makes the most sense for and do a trial that shows it does have a clinical effect that is just as good as what is already out there. So they’ll still have a drug they can sell.
Q: Will the policy incentivize pharmaceutical companies to develop orphan drugs or new classes of drugs?
A: It might. They would see it as a potentially less-risky development. Unfortunately, drug companies have to invest a lot of money in a potential new drug before they get to the Phase III trials where they are comparing them. It’s possible that drug companies might strategize about choosing more orphan indications, where all they would have to do is compare the drug to placebo, because there is no other treatment option.
Independent Partnership
While spending a summer taking care of her mother-in-law, who was ill with colon cancer, Lynne Allen, MN, ARNP, heard her calling loud and clear. “I thought, ‘Wow, I can do this,’ ” she says. “A lot of people can’t do this.”
Allen had completed a year of nursing school right after high school but never finished. So she decided to go back to school and earn a nursing degree. She graduated from the University of Washington’s Adult Acute Care Nurse Practitioner Program in 2001 and later landed a job at Columbia Basin Hematology and Oncology, a private practice in Kennewick, Wash.
At the time, a then-burgeoning hospitalist group based in Brentwood, Tenn., was looking to recruit nurses. Cogent Healthcare made Allen an offer. The idea of working in a hospital where doctors would be available 24 hours a day, seven days a week, intrigued Allen. “I was a house supervisor in grad school and always remember thinking, ‘If only I had a physician in here, I could take care of this problem in two minutes,’ ” she says.
Allen accepted the offer and went to work in Cogent’s nonphysician clinical development program. Last year, she returned to Columbia Basin, where she makes hospitalist rounds four times a week at Kadlec Regional Medical Center in Richland, Wash. Allen, the newest member of Team Hospitalist, recently spoke with The Hospitalist about the unique perspective nurse practitioners (NPs) offer HM.
Question: What do you like about working with hospitalists?
Answer: I like the teamwork involved. I really like going in the morning and seeing that the nurses cared for the patients all night and know what is going on. I like knowing that they can feel comfortable calling me about what they need and making a difference. In terms of hospital medicine, just because [a patient] stays a long time doesn’t mean they are getting the quality of care they need. There are other issues involved with that, especially in cancer patients. They are afraid to go home, afraid of dying. If you have a patient with cancer or COPD [chronic obstructive pulmonary disease] and they are probably not going to live as long as they would normally, you begin to talk to them about their goals for themselves, in terms of quality of life.
Q: How do you initiate that conversation?
A: Medicare has made it very easy, because every patient that comes in should be asked if they have a living will, so you bring that subject up. Most people, when they are dying, they know it. The rest of the family is surprised, but the patient knows it. Sometimes you just bring it up point-blank.
Q: Why does HM present an opportunity for NPs?
A: I think workforce is one of the issues. I think there are a lot of nurses out there who have worked in a hospital and love that acute-care environment. It is very different than working in a clinic. I do both right now, and there is such a difference in what you need to know about your patients and how you treat them.
Q: How is it different?
A: When you are in an outpatient center, [patients] are there and you are probably giving them meds if they are getting chemotherapy and need some support. In an inpatient setting, they are there all the time. It’s a 24/7 need for support. I see this as another special area NPs can take. It’s in the stage of infancy, and it will grow.
Q: Do you think your background in nursing has helped you interact better with patients?
A: Yes. It is part of “who” nurses are. I really enjoy being able to take care of the patients that need the open communication, because it does help them.
Q: What unique perspective do NPs bring to HM?
A: I think nurses are taught to look at the whole patient. We are not taught to specifically say, “This patient has these symptoms, this disease process, this treatment.” … They have family. They have social issues. They have spiritual issues. [It all plays] into their disease process and their treatment process.
Q: What’s the one thing about NPs that most hospitalists don’t get?
A: We are trained to practice independently. In my state, Washington, I can be a completely independent practitioner. We are also taught to know when to consult or collaborate with a physician. I think sometimes physicians don’t recognize that or understand that. They think that we just want to be more independent. HM is a team effort, and we are willing to be part of the team with an equal partnership.
Q: What are some of the issues that come up between NPs and hospitalists?
A: Physicians are not trained to delegate. They are trained that you are in control, you are the one in charge of this patient’s care, you will dictate what goes on with this patient. Medicare and Medicaid require an attending physician, so for a physician to put [his or her] name on there and trust someone else to assess and develop a care plan is hard for them. And I can’t blame them.
Give it a chance, work together, and develop that relationship. Don’t expect it to be there right at day one. And it might not even be six months, but you need to be open-minded and willing to work with someone who is willing to work with you, and not just think it is about giving orders.
Q: What qualities should hospitalists look for in hiring NPs?
A: They should look for someone who has actually worked in a hospital, who is interested in working on a team, who is interested in developing their own capacity or intellectual ability to take care of patients—and recognize that there is going to be a learning curve there. They should also look for someone who is pleasant and who seems to fit in with the team. TH
Stephanie Cajigal is associate editor of The Hospitalist.
While spending a summer taking care of her mother-in-law, who was ill with colon cancer, Lynne Allen, MN, ARNP, heard her calling loud and clear. “I thought, ‘Wow, I can do this,’ ” she says. “A lot of people can’t do this.”
Allen had completed a year of nursing school right after high school but never finished. So she decided to go back to school and earn a nursing degree. She graduated from the University of Washington’s Adult Acute Care Nurse Practitioner Program in 2001 and later landed a job at Columbia Basin Hematology and Oncology, a private practice in Kennewick, Wash.
At the time, a then-burgeoning hospitalist group based in Brentwood, Tenn., was looking to recruit nurses. Cogent Healthcare made Allen an offer. The idea of working in a hospital where doctors would be available 24 hours a day, seven days a week, intrigued Allen. “I was a house supervisor in grad school and always remember thinking, ‘If only I had a physician in here, I could take care of this problem in two minutes,’ ” she says.
Allen accepted the offer and went to work in Cogent’s nonphysician clinical development program. Last year, she returned to Columbia Basin, where she makes hospitalist rounds four times a week at Kadlec Regional Medical Center in Richland, Wash. Allen, the newest member of Team Hospitalist, recently spoke with The Hospitalist about the unique perspective nurse practitioners (NPs) offer HM.
Question: What do you like about working with hospitalists?
Answer: I like the teamwork involved. I really like going in the morning and seeing that the nurses cared for the patients all night and know what is going on. I like knowing that they can feel comfortable calling me about what they need and making a difference. In terms of hospital medicine, just because [a patient] stays a long time doesn’t mean they are getting the quality of care they need. There are other issues involved with that, especially in cancer patients. They are afraid to go home, afraid of dying. If you have a patient with cancer or COPD [chronic obstructive pulmonary disease] and they are probably not going to live as long as they would normally, you begin to talk to them about their goals for themselves, in terms of quality of life.
Q: How do you initiate that conversation?
A: Medicare has made it very easy, because every patient that comes in should be asked if they have a living will, so you bring that subject up. Most people, when they are dying, they know it. The rest of the family is surprised, but the patient knows it. Sometimes you just bring it up point-blank.
Q: Why does HM present an opportunity for NPs?
A: I think workforce is one of the issues. I think there are a lot of nurses out there who have worked in a hospital and love that acute-care environment. It is very different than working in a clinic. I do both right now, and there is such a difference in what you need to know about your patients and how you treat them.
Q: How is it different?
A: When you are in an outpatient center, [patients] are there and you are probably giving them meds if they are getting chemotherapy and need some support. In an inpatient setting, they are there all the time. It’s a 24/7 need for support. I see this as another special area NPs can take. It’s in the stage of infancy, and it will grow.
Q: Do you think your background in nursing has helped you interact better with patients?
A: Yes. It is part of “who” nurses are. I really enjoy being able to take care of the patients that need the open communication, because it does help them.
Q: What unique perspective do NPs bring to HM?
A: I think nurses are taught to look at the whole patient. We are not taught to specifically say, “This patient has these symptoms, this disease process, this treatment.” … They have family. They have social issues. They have spiritual issues. [It all plays] into their disease process and their treatment process.
Q: What’s the one thing about NPs that most hospitalists don’t get?
A: We are trained to practice independently. In my state, Washington, I can be a completely independent practitioner. We are also taught to know when to consult or collaborate with a physician. I think sometimes physicians don’t recognize that or understand that. They think that we just want to be more independent. HM is a team effort, and we are willing to be part of the team with an equal partnership.
Q: What are some of the issues that come up between NPs and hospitalists?
A: Physicians are not trained to delegate. They are trained that you are in control, you are the one in charge of this patient’s care, you will dictate what goes on with this patient. Medicare and Medicaid require an attending physician, so for a physician to put [his or her] name on there and trust someone else to assess and develop a care plan is hard for them. And I can’t blame them.
Give it a chance, work together, and develop that relationship. Don’t expect it to be there right at day one. And it might not even be six months, but you need to be open-minded and willing to work with someone who is willing to work with you, and not just think it is about giving orders.
Q: What qualities should hospitalists look for in hiring NPs?
A: They should look for someone who has actually worked in a hospital, who is interested in working on a team, who is interested in developing their own capacity or intellectual ability to take care of patients—and recognize that there is going to be a learning curve there. They should also look for someone who is pleasant and who seems to fit in with the team. TH
Stephanie Cajigal is associate editor of The Hospitalist.
While spending a summer taking care of her mother-in-law, who was ill with colon cancer, Lynne Allen, MN, ARNP, heard her calling loud and clear. “I thought, ‘Wow, I can do this,’ ” she says. “A lot of people can’t do this.”
Allen had completed a year of nursing school right after high school but never finished. So she decided to go back to school and earn a nursing degree. She graduated from the University of Washington’s Adult Acute Care Nurse Practitioner Program in 2001 and later landed a job at Columbia Basin Hematology and Oncology, a private practice in Kennewick, Wash.
At the time, a then-burgeoning hospitalist group based in Brentwood, Tenn., was looking to recruit nurses. Cogent Healthcare made Allen an offer. The idea of working in a hospital where doctors would be available 24 hours a day, seven days a week, intrigued Allen. “I was a house supervisor in grad school and always remember thinking, ‘If only I had a physician in here, I could take care of this problem in two minutes,’ ” she says.
Allen accepted the offer and went to work in Cogent’s nonphysician clinical development program. Last year, she returned to Columbia Basin, where she makes hospitalist rounds four times a week at Kadlec Regional Medical Center in Richland, Wash. Allen, the newest member of Team Hospitalist, recently spoke with The Hospitalist about the unique perspective nurse practitioners (NPs) offer HM.
Question: What do you like about working with hospitalists?
Answer: I like the teamwork involved. I really like going in the morning and seeing that the nurses cared for the patients all night and know what is going on. I like knowing that they can feel comfortable calling me about what they need and making a difference. In terms of hospital medicine, just because [a patient] stays a long time doesn’t mean they are getting the quality of care they need. There are other issues involved with that, especially in cancer patients. They are afraid to go home, afraid of dying. If you have a patient with cancer or COPD [chronic obstructive pulmonary disease] and they are probably not going to live as long as they would normally, you begin to talk to them about their goals for themselves, in terms of quality of life.
Q: How do you initiate that conversation?
A: Medicare has made it very easy, because every patient that comes in should be asked if they have a living will, so you bring that subject up. Most people, when they are dying, they know it. The rest of the family is surprised, but the patient knows it. Sometimes you just bring it up point-blank.
Q: Why does HM present an opportunity for NPs?
A: I think workforce is one of the issues. I think there are a lot of nurses out there who have worked in a hospital and love that acute-care environment. It is very different than working in a clinic. I do both right now, and there is such a difference in what you need to know about your patients and how you treat them.
Q: How is it different?
A: When you are in an outpatient center, [patients] are there and you are probably giving them meds if they are getting chemotherapy and need some support. In an inpatient setting, they are there all the time. It’s a 24/7 need for support. I see this as another special area NPs can take. It’s in the stage of infancy, and it will grow.
Q: Do you think your background in nursing has helped you interact better with patients?
A: Yes. It is part of “who” nurses are. I really enjoy being able to take care of the patients that need the open communication, because it does help them.
Q: What unique perspective do NPs bring to HM?
A: I think nurses are taught to look at the whole patient. We are not taught to specifically say, “This patient has these symptoms, this disease process, this treatment.” … They have family. They have social issues. They have spiritual issues. [It all plays] into their disease process and their treatment process.
Q: What’s the one thing about NPs that most hospitalists don’t get?
A: We are trained to practice independently. In my state, Washington, I can be a completely independent practitioner. We are also taught to know when to consult or collaborate with a physician. I think sometimes physicians don’t recognize that or understand that. They think that we just want to be more independent. HM is a team effort, and we are willing to be part of the team with an equal partnership.
Q: What are some of the issues that come up between NPs and hospitalists?
A: Physicians are not trained to delegate. They are trained that you are in control, you are the one in charge of this patient’s care, you will dictate what goes on with this patient. Medicare and Medicaid require an attending physician, so for a physician to put [his or her] name on there and trust someone else to assess and develop a care plan is hard for them. And I can’t blame them.
Give it a chance, work together, and develop that relationship. Don’t expect it to be there right at day one. And it might not even be six months, but you need to be open-minded and willing to work with someone who is willing to work with you, and not just think it is about giving orders.
Q: What qualities should hospitalists look for in hiring NPs?
A: They should look for someone who has actually worked in a hospital, who is interested in working on a team, who is interested in developing their own capacity or intellectual ability to take care of patients—and recognize that there is going to be a learning curve there. They should also look for someone who is pleasant and who seems to fit in with the team. TH
Stephanie Cajigal is associate editor of The Hospitalist.
Summer Camp
Nurse practitioners (NPs) and physician assistants (PAs) are expected to help fill the HM ranks in the coming years, and more than 200 of them showed their dedication to the field by attending the first Adult Hospitalist Physician Assistant and Nurse Practitioner Boot Camp last week in Chantilly, Va.
Sponsored by SHM, the American Academy of Physician Assistants, and the American Academy of Nurse Practitioners, the soldout event provided intense training in such clinical areas as cardiac neurologic care, as well as infection control. Attendees also learned valuable practice management tips and learned how to report Physician Quality Reporting Initiative (PQRI) measures.
"The NPP bootcamp was a success; participants were happy with the content," says Jeanette Kalupa, MSN, ACNP-BC, APNP, an acute-care NP with Cogent Healthcare of Wisconsin in Milwaukee. "The faculty, who were a mix of MDs, NPs, and PAs, were terrific. The NPs and PAs who attended were a mix of experience levels and knowledge levels, in regards to hospital medicine."
Photo credit: Jay Westcott
Nurse practitioners (NPs) and physician assistants (PAs) are expected to help fill the HM ranks in the coming years, and more than 200 of them showed their dedication to the field by attending the first Adult Hospitalist Physician Assistant and Nurse Practitioner Boot Camp last week in Chantilly, Va.
Sponsored by SHM, the American Academy of Physician Assistants, and the American Academy of Nurse Practitioners, the soldout event provided intense training in such clinical areas as cardiac neurologic care, as well as infection control. Attendees also learned valuable practice management tips and learned how to report Physician Quality Reporting Initiative (PQRI) measures.
"The NPP bootcamp was a success; participants were happy with the content," says Jeanette Kalupa, MSN, ACNP-BC, APNP, an acute-care NP with Cogent Healthcare of Wisconsin in Milwaukee. "The faculty, who were a mix of MDs, NPs, and PAs, were terrific. The NPs and PAs who attended were a mix of experience levels and knowledge levels, in regards to hospital medicine."
Photo credit: Jay Westcott
Nurse practitioners (NPs) and physician assistants (PAs) are expected to help fill the HM ranks in the coming years, and more than 200 of them showed their dedication to the field by attending the first Adult Hospitalist Physician Assistant and Nurse Practitioner Boot Camp last week in Chantilly, Va.
Sponsored by SHM, the American Academy of Physician Assistants, and the American Academy of Nurse Practitioners, the soldout event provided intense training in such clinical areas as cardiac neurologic care, as well as infection control. Attendees also learned valuable practice management tips and learned how to report Physician Quality Reporting Initiative (PQRI) measures.
"The NPP bootcamp was a success; participants were happy with the content," says Jeanette Kalupa, MSN, ACNP-BC, APNP, an acute-care NP with Cogent Healthcare of Wisconsin in Milwaukee. "The faculty, who were a mix of MDs, NPs, and PAs, were terrific. The NPs and PAs who attended were a mix of experience levels and knowledge levels, in regards to hospital medicine."
Photo credit: Jay Westcott
The Blog Rounds
2008-09 apparently was a good time to find a job in HM. The Wall Street Journal’s Health Blog cites a new report from Merritt Hawkins & Associates (download PDF) that shows from April 2008 to March 2009, 85% of searches offered signing bonuses averaging $24,850. That’s in contrast to 46% of searches in 2005-2006, when the average bonus was $14,030.
The report also included average salaries for HM, which was the third-most-requested search assignment following family medicine and general internal medicine. The average salary for HM during that time period, excluding benefits or productivity bonuses, was $201,000, according to the report. It represents a 14.8% increase since 2005-2006, when the annual average annual salary for a hospitalist was $175,000, according to the report.
Fun & Games
On his blog, Running a Hospital, Paul Levy, president and CEO of Beth Israel Deaconess Medical Center in Boston, offers physicians a game to help them better understand the value of standardized medicine. Interestingly, the game involves drawing a pig. For instructions, visit http://runningahospital.blogspot.com/2009/06/pig-part-1.html.
Work-Life Balance
In her Well blog, New York Times writer Tara Parker Pope cites a recent article from Times columnist Pauline Chen, MD, in which Dr. Chen recalls the toll her intense medical training took on her temperament and personal relationships.
Doctors responded to the post with a variety of viewpoints. Here’s what one old-timer had to say:
“I am from the era of 120-hour weeks, every second or third night on call. No ‘cap’ on the numbers of patients we admitted or carried on our service. I remember still being in the hospital at 10 p.m. after a night on call (40 hours straight). I learned how to manage the sickest patients through the entire course of their hospitalization. My residency and fellowship after medical school was seven years in duration, and I loved it. The ONLY regret I have after all these years is reading the NYT comments and blogs about all the doctor-haters and disgruntled patients who think that medicine is an easy path to riches.”
2008-09 apparently was a good time to find a job in HM. The Wall Street Journal’s Health Blog cites a new report from Merritt Hawkins & Associates (download PDF) that shows from April 2008 to March 2009, 85% of searches offered signing bonuses averaging $24,850. That’s in contrast to 46% of searches in 2005-2006, when the average bonus was $14,030.
The report also included average salaries for HM, which was the third-most-requested search assignment following family medicine and general internal medicine. The average salary for HM during that time period, excluding benefits or productivity bonuses, was $201,000, according to the report. It represents a 14.8% increase since 2005-2006, when the annual average annual salary for a hospitalist was $175,000, according to the report.
Fun & Games
On his blog, Running a Hospital, Paul Levy, president and CEO of Beth Israel Deaconess Medical Center in Boston, offers physicians a game to help them better understand the value of standardized medicine. Interestingly, the game involves drawing a pig. For instructions, visit http://runningahospital.blogspot.com/2009/06/pig-part-1.html.
Work-Life Balance
In her Well blog, New York Times writer Tara Parker Pope cites a recent article from Times columnist Pauline Chen, MD, in which Dr. Chen recalls the toll her intense medical training took on her temperament and personal relationships.
Doctors responded to the post with a variety of viewpoints. Here’s what one old-timer had to say:
“I am from the era of 120-hour weeks, every second or third night on call. No ‘cap’ on the numbers of patients we admitted or carried on our service. I remember still being in the hospital at 10 p.m. after a night on call (40 hours straight). I learned how to manage the sickest patients through the entire course of their hospitalization. My residency and fellowship after medical school was seven years in duration, and I loved it. The ONLY regret I have after all these years is reading the NYT comments and blogs about all the doctor-haters and disgruntled patients who think that medicine is an easy path to riches.”
2008-09 apparently was a good time to find a job in HM. The Wall Street Journal’s Health Blog cites a new report from Merritt Hawkins & Associates (download PDF) that shows from April 2008 to March 2009, 85% of searches offered signing bonuses averaging $24,850. That’s in contrast to 46% of searches in 2005-2006, when the average bonus was $14,030.
The report also included average salaries for HM, which was the third-most-requested search assignment following family medicine and general internal medicine. The average salary for HM during that time period, excluding benefits or productivity bonuses, was $201,000, according to the report. It represents a 14.8% increase since 2005-2006, when the annual average annual salary for a hospitalist was $175,000, according to the report.
Fun & Games
On his blog, Running a Hospital, Paul Levy, president and CEO of Beth Israel Deaconess Medical Center in Boston, offers physicians a game to help them better understand the value of standardized medicine. Interestingly, the game involves drawing a pig. For instructions, visit http://runningahospital.blogspot.com/2009/06/pig-part-1.html.
Work-Life Balance
In her Well blog, New York Times writer Tara Parker Pope cites a recent article from Times columnist Pauline Chen, MD, in which Dr. Chen recalls the toll her intense medical training took on her temperament and personal relationships.
Doctors responded to the post with a variety of viewpoints. Here’s what one old-timer had to say:
“I am from the era of 120-hour weeks, every second or third night on call. No ‘cap’ on the numbers of patients we admitted or carried on our service. I remember still being in the hospital at 10 p.m. after a night on call (40 hours straight). I learned how to manage the sickest patients through the entire course of their hospitalization. My residency and fellowship after medical school was seven years in duration, and I loved it. The ONLY regret I have after all these years is reading the NYT comments and blogs about all the doctor-haters and disgruntled patients who think that medicine is an easy path to riches.”
The Blog Rounds
With thousands of hospitalists returning to work after the whirlwind that was HM09, many are contemplating lessons learned from the meeting. Here are a couple of interesting reads:
A Loss for Patients?
John Nelson, MD, FHM, FACP, a principal in the national hospitalist practice management consulting firm Nelson/Flores Associates and a columnist for The Hospitalist, says the annual meeting made him reminisce about how many hospitalists have given up full-time patient care since he and Winthrop F. Whitcomb, MD, FHM, a hospitalist at Mercy Medical Center in Springfield, Mass., founded the society in 1996.
“The longtime regulars were full-time patient caregivers way back when but now have other roles and now see patients only part of their time or not at all,” he writes in "The Hospitalist Leader" blog. “For a variety of reasons, these people have taken on roles other than patient care. I’m in that category, too, since I currently provide direct patient care only about 30% as much as the full-time hospitalists in the practice I’m in.”
Dr. Nelson says he worries patients are losing out on the unique, patient-centered care that hospitalists provide. "Hopefully, in their administrative roles, these hospitalists can do good things for even more patients than they could through bedside care," he writes. "We just need to make sure we aren't sucking the best doctors away from patient care simply because we've failed to create a sustainable and rewarding career in patient care."
Job Satisfaction
HM09 seems to have affirmed the career choice of "The Hospitalist Refugee", a hospitalist who blogs in the rural Midwest.
"While my current job is decidedly NOT where I want to practice (geographically or operationally), hospitalist medicine IS the environment I want to stay in," he writes. "I'm hopeful that when it comes time for me to find the next hospitalist job, our profession will have matured (with hopefully the leadership of SHM) enough that there is consistency and stability in the market."
Meeting Madness
Team Hospitalist member Randy Ferrance, DC, MD, FHM, was thoroughly impressed with the HM09 effort. Dr. Ferrance, a hospitalist at Riverside Tappahanock Hospital, a rural, 67-bed facility in Tappahannock, Va., offered his thoughts on the "HM09" blog.
"The sheer breadth and width of talent that SHM manages to attract—both in lecturers and attendees—is nothing short of impressive. This morning I was able to catch up on practice management ("What Have You Done for Me Lately") and medical management ("Heme/Onc Emergencies/Urgencies and Updates in Diagnosis and Management of CAD"), and soon I'll hear from Bob Wachter on managing accountability in a no-blame environment."
With thousands of hospitalists returning to work after the whirlwind that was HM09, many are contemplating lessons learned from the meeting. Here are a couple of interesting reads:
A Loss for Patients?
John Nelson, MD, FHM, FACP, a principal in the national hospitalist practice management consulting firm Nelson/Flores Associates and a columnist for The Hospitalist, says the annual meeting made him reminisce about how many hospitalists have given up full-time patient care since he and Winthrop F. Whitcomb, MD, FHM, a hospitalist at Mercy Medical Center in Springfield, Mass., founded the society in 1996.
“The longtime regulars were full-time patient caregivers way back when but now have other roles and now see patients only part of their time or not at all,” he writes in "The Hospitalist Leader" blog. “For a variety of reasons, these people have taken on roles other than patient care. I’m in that category, too, since I currently provide direct patient care only about 30% as much as the full-time hospitalists in the practice I’m in.”
Dr. Nelson says he worries patients are losing out on the unique, patient-centered care that hospitalists provide. "Hopefully, in their administrative roles, these hospitalists can do good things for even more patients than they could through bedside care," he writes. "We just need to make sure we aren't sucking the best doctors away from patient care simply because we've failed to create a sustainable and rewarding career in patient care."
Job Satisfaction
HM09 seems to have affirmed the career choice of "The Hospitalist Refugee", a hospitalist who blogs in the rural Midwest.
"While my current job is decidedly NOT where I want to practice (geographically or operationally), hospitalist medicine IS the environment I want to stay in," he writes. "I'm hopeful that when it comes time for me to find the next hospitalist job, our profession will have matured (with hopefully the leadership of SHM) enough that there is consistency and stability in the market."
Meeting Madness
Team Hospitalist member Randy Ferrance, DC, MD, FHM, was thoroughly impressed with the HM09 effort. Dr. Ferrance, a hospitalist at Riverside Tappahanock Hospital, a rural, 67-bed facility in Tappahannock, Va., offered his thoughts on the "HM09" blog.
"The sheer breadth and width of talent that SHM manages to attract—both in lecturers and attendees—is nothing short of impressive. This morning I was able to catch up on practice management ("What Have You Done for Me Lately") and medical management ("Heme/Onc Emergencies/Urgencies and Updates in Diagnosis and Management of CAD"), and soon I'll hear from Bob Wachter on managing accountability in a no-blame environment."
With thousands of hospitalists returning to work after the whirlwind that was HM09, many are contemplating lessons learned from the meeting. Here are a couple of interesting reads:
A Loss for Patients?
John Nelson, MD, FHM, FACP, a principal in the national hospitalist practice management consulting firm Nelson/Flores Associates and a columnist for The Hospitalist, says the annual meeting made him reminisce about how many hospitalists have given up full-time patient care since he and Winthrop F. Whitcomb, MD, FHM, a hospitalist at Mercy Medical Center in Springfield, Mass., founded the society in 1996.
“The longtime regulars were full-time patient caregivers way back when but now have other roles and now see patients only part of their time or not at all,” he writes in "The Hospitalist Leader" blog. “For a variety of reasons, these people have taken on roles other than patient care. I’m in that category, too, since I currently provide direct patient care only about 30% as much as the full-time hospitalists in the practice I’m in.”
Dr. Nelson says he worries patients are losing out on the unique, patient-centered care that hospitalists provide. "Hopefully, in their administrative roles, these hospitalists can do good things for even more patients than they could through bedside care," he writes. "We just need to make sure we aren't sucking the best doctors away from patient care simply because we've failed to create a sustainable and rewarding career in patient care."
Job Satisfaction
HM09 seems to have affirmed the career choice of "The Hospitalist Refugee", a hospitalist who blogs in the rural Midwest.
"While my current job is decidedly NOT where I want to practice (geographically or operationally), hospitalist medicine IS the environment I want to stay in," he writes. "I'm hopeful that when it comes time for me to find the next hospitalist job, our profession will have matured (with hopefully the leadership of SHM) enough that there is consistency and stability in the market."
Meeting Madness
Team Hospitalist member Randy Ferrance, DC, MD, FHM, was thoroughly impressed with the HM09 effort. Dr. Ferrance, a hospitalist at Riverside Tappahanock Hospital, a rural, 67-bed facility in Tappahannock, Va., offered his thoughts on the "HM09" blog.
"The sheer breadth and width of talent that SHM manages to attract—both in lecturers and attendees—is nothing short of impressive. This morning I was able to catch up on practice management ("What Have You Done for Me Lately") and medical management ("Heme/Onc Emergencies/Urgencies and Updates in Diagnosis and Management of CAD"), and soon I'll hear from Bob Wachter on managing accountability in a no-blame environment."
An Offer You Can Refuse
What is the main reason women make less money than men in identical positions? A lack of negotiation skills, says Rachel George, MD, MBA, FHM, regional medical director and vice president of operations for Brentwood, Tenn.-based Cogent Healthcare.
“Women aren’t as comfortable negotiating as men are,” Dr. George says. “The fact is, individuals who ask for more generally get more.”
Dr. George offers women the following negotiation tips:
1. Investigate. Research average salaries for the position you are applying for, the region you live in, and the company you’d be working for. One place to start: the 2007-2008 SHM Bi-annual Survey on the State of the Hospital Medicine Movement.
2. Set goals. Define how much you want to make and ask for that amount. “You try harder when you set a goal,” Dr. George says.
3. Create BATNA. This concept, from the book “Getting to Yes: Negotiating Agreements Without Giving In”, is about the Best Alternative To a Negotiated Agreement (BATNA). Ask yourself: Do you have other positions lined up in case the one you’re applying for doesn’t work out?
4. Be realistic. Ridiculous offers will get you nowhere. Don’t ask for higher than the 95th percentile of the average salary for the position you’re applying for.
5. Look beyond salary. If your potential employer won’t budge on salary, consider other forms of compensation: CME money, PTO time, fewer work hours. “All these things can be negotiated to achieve the right package for you,” Dr. George says.
6. Practice, practice, practice. Negotiation is a learned trait; try role-playing with someone you trust.
7. Be persistent. Women tend to give up sooner than men. “Bargaining doesn’t end at the first conversation or transaction,” she says.
What is the main reason women make less money than men in identical positions? A lack of negotiation skills, says Rachel George, MD, MBA, FHM, regional medical director and vice president of operations for Brentwood, Tenn.-based Cogent Healthcare.
“Women aren’t as comfortable negotiating as men are,” Dr. George says. “The fact is, individuals who ask for more generally get more.”
Dr. George offers women the following negotiation tips:
1. Investigate. Research average salaries for the position you are applying for, the region you live in, and the company you’d be working for. One place to start: the 2007-2008 SHM Bi-annual Survey on the State of the Hospital Medicine Movement.
2. Set goals. Define how much you want to make and ask for that amount. “You try harder when you set a goal,” Dr. George says.
3. Create BATNA. This concept, from the book “Getting to Yes: Negotiating Agreements Without Giving In”, is about the Best Alternative To a Negotiated Agreement (BATNA). Ask yourself: Do you have other positions lined up in case the one you’re applying for doesn’t work out?
4. Be realistic. Ridiculous offers will get you nowhere. Don’t ask for higher than the 95th percentile of the average salary for the position you’re applying for.
5. Look beyond salary. If your potential employer won’t budge on salary, consider other forms of compensation: CME money, PTO time, fewer work hours. “All these things can be negotiated to achieve the right package for you,” Dr. George says.
6. Practice, practice, practice. Negotiation is a learned trait; try role-playing with someone you trust.
7. Be persistent. Women tend to give up sooner than men. “Bargaining doesn’t end at the first conversation or transaction,” she says.
What is the main reason women make less money than men in identical positions? A lack of negotiation skills, says Rachel George, MD, MBA, FHM, regional medical director and vice president of operations for Brentwood, Tenn.-based Cogent Healthcare.
“Women aren’t as comfortable negotiating as men are,” Dr. George says. “The fact is, individuals who ask for more generally get more.”
Dr. George offers women the following negotiation tips:
1. Investigate. Research average salaries for the position you are applying for, the region you live in, and the company you’d be working for. One place to start: the 2007-2008 SHM Bi-annual Survey on the State of the Hospital Medicine Movement.
2. Set goals. Define how much you want to make and ask for that amount. “You try harder when you set a goal,” Dr. George says.
3. Create BATNA. This concept, from the book “Getting to Yes: Negotiating Agreements Without Giving In”, is about the Best Alternative To a Negotiated Agreement (BATNA). Ask yourself: Do you have other positions lined up in case the one you’re applying for doesn’t work out?
4. Be realistic. Ridiculous offers will get you nowhere. Don’t ask for higher than the 95th percentile of the average salary for the position you’re applying for.
5. Look beyond salary. If your potential employer won’t budge on salary, consider other forms of compensation: CME money, PTO time, fewer work hours. “All these things can be negotiated to achieve the right package for you,” Dr. George says.
6. Practice, practice, practice. Negotiation is a learned trait; try role-playing with someone you trust.
7. Be persistent. Women tend to give up sooner than men. “Bargaining doesn’t end at the first conversation or transaction,” she says.
Leaders of the Pack
Who is better at decreasing mortality and length of stay: intensivists or hospitalists? Neither, researchers at Emory University in Atlanta report.
The group, led by Kristin Wise, MD, assistant professor of medicine at Emory, sought to answer this question at a time when an increasing number of hospitals are turning to hospitalists to fill manpower gaps in ICUs. For its timely research, the group is being honored: The Emory team's abstract was one of three chosen as HM09's Best of Research, Innovations, and Clinical Vignettes (RIV). The presenting abstracts received the highest scores; 409 abstracts were submitted for this year's RIV competition.
Emory's prospective, cohort study of 1,084 patients showed no statistically significant difference in mortality rate between patients treated by the intensivist team and the hospitalist ICU team. "It definitely shows hospitalists can provide high-quality ICU staffing … and can help address future critical-care needs as we’re facing an intensivist shortage," Dr. Wise says.
New Communication Tool
University of Michigan (UM) hospitalists Vineet I. Chopra, MBBS, MD, FACP, and Prasanth Gogineni, MD, together with a team of engineering students at UM, won the best of innovations award for their work on a Web site and iPhone application meant to replace the pager system healthcare teams currently use to communicate.
Using the application, known as MComm, hospitalists and other members of healthcare teams can delegate tasks to other physicians, as well as acknowledge when their own tasks are completed." Medical communication is fundamental to inpatient safety, quality, and cost of care," says Dr. Chopra, clinical assistant professor of medicine at UM. "We believe MComm represents a technological breakthrough in medical communication and the process of improving workflow. The use of electronic technology that organizes patients according to team and priority is unprecedented."
Inspirational Case
Twylla Tassava, MS, MD, administrator of academic consult service at Saint Joseph Mercy Hospital in Ann Arbor, Mich., described a novel way to treat intracranial pressure in patients with diabetes insipidus.
A 17-year-old female whose car was hit by a truck traveling 50 mph presented with a Glasgow coma score of 4 and multiple traumatic injuries. The hospitalist team was consulted on day two, when the patient released 1,790 cc of urine in one hour, an indication of diabetes insipudis (DI). When DI occurs within the first three days of brain injury, research shows the mortality rate to be 86%. Dr. Tassava’s team proposed using permissive hypernatremia to control the patient’s intracranial pressure.
The result: The patient recovered and is now a healthy 18-year-old college student with superior intellectual skills, normal motor function, and only mild memory impairment.
Who is better at decreasing mortality and length of stay: intensivists or hospitalists? Neither, researchers at Emory University in Atlanta report.
The group, led by Kristin Wise, MD, assistant professor of medicine at Emory, sought to answer this question at a time when an increasing number of hospitals are turning to hospitalists to fill manpower gaps in ICUs. For its timely research, the group is being honored: The Emory team's abstract was one of three chosen as HM09's Best of Research, Innovations, and Clinical Vignettes (RIV). The presenting abstracts received the highest scores; 409 abstracts were submitted for this year's RIV competition.
Emory's prospective, cohort study of 1,084 patients showed no statistically significant difference in mortality rate between patients treated by the intensivist team and the hospitalist ICU team. "It definitely shows hospitalists can provide high-quality ICU staffing … and can help address future critical-care needs as we’re facing an intensivist shortage," Dr. Wise says.
New Communication Tool
University of Michigan (UM) hospitalists Vineet I. Chopra, MBBS, MD, FACP, and Prasanth Gogineni, MD, together with a team of engineering students at UM, won the best of innovations award for their work on a Web site and iPhone application meant to replace the pager system healthcare teams currently use to communicate.
Using the application, known as MComm, hospitalists and other members of healthcare teams can delegate tasks to other physicians, as well as acknowledge when their own tasks are completed." Medical communication is fundamental to inpatient safety, quality, and cost of care," says Dr. Chopra, clinical assistant professor of medicine at UM. "We believe MComm represents a technological breakthrough in medical communication and the process of improving workflow. The use of electronic technology that organizes patients according to team and priority is unprecedented."
Inspirational Case
Twylla Tassava, MS, MD, administrator of academic consult service at Saint Joseph Mercy Hospital in Ann Arbor, Mich., described a novel way to treat intracranial pressure in patients with diabetes insipidus.
A 17-year-old female whose car was hit by a truck traveling 50 mph presented with a Glasgow coma score of 4 and multiple traumatic injuries. The hospitalist team was consulted on day two, when the patient released 1,790 cc of urine in one hour, an indication of diabetes insipudis (DI). When DI occurs within the first three days of brain injury, research shows the mortality rate to be 86%. Dr. Tassava’s team proposed using permissive hypernatremia to control the patient’s intracranial pressure.
The result: The patient recovered and is now a healthy 18-year-old college student with superior intellectual skills, normal motor function, and only mild memory impairment.
Who is better at decreasing mortality and length of stay: intensivists or hospitalists? Neither, researchers at Emory University in Atlanta report.
The group, led by Kristin Wise, MD, assistant professor of medicine at Emory, sought to answer this question at a time when an increasing number of hospitals are turning to hospitalists to fill manpower gaps in ICUs. For its timely research, the group is being honored: The Emory team's abstract was one of three chosen as HM09's Best of Research, Innovations, and Clinical Vignettes (RIV). The presenting abstracts received the highest scores; 409 abstracts were submitted for this year's RIV competition.
Emory's prospective, cohort study of 1,084 patients showed no statistically significant difference in mortality rate between patients treated by the intensivist team and the hospitalist ICU team. "It definitely shows hospitalists can provide high-quality ICU staffing … and can help address future critical-care needs as we’re facing an intensivist shortage," Dr. Wise says.
New Communication Tool
University of Michigan (UM) hospitalists Vineet I. Chopra, MBBS, MD, FACP, and Prasanth Gogineni, MD, together with a team of engineering students at UM, won the best of innovations award for their work on a Web site and iPhone application meant to replace the pager system healthcare teams currently use to communicate.
Using the application, known as MComm, hospitalists and other members of healthcare teams can delegate tasks to other physicians, as well as acknowledge when their own tasks are completed." Medical communication is fundamental to inpatient safety, quality, and cost of care," says Dr. Chopra, clinical assistant professor of medicine at UM. "We believe MComm represents a technological breakthrough in medical communication and the process of improving workflow. The use of electronic technology that organizes patients according to team and priority is unprecedented."
Inspirational Case
Twylla Tassava, MS, MD, administrator of academic consult service at Saint Joseph Mercy Hospital in Ann Arbor, Mich., described a novel way to treat intracranial pressure in patients with diabetes insipidus.
A 17-year-old female whose car was hit by a truck traveling 50 mph presented with a Glasgow coma score of 4 and multiple traumatic injuries. The hospitalist team was consulted on day two, when the patient released 1,790 cc of urine in one hour, an indication of diabetes insipudis (DI). When DI occurs within the first three days of brain injury, research shows the mortality rate to be 86%. Dr. Tassava’s team proposed using permissive hypernatremia to control the patient’s intracranial pressure.
The result: The patient recovered and is now a healthy 18-year-old college student with superior intellectual skills, normal motor function, and only mild memory impairment.
Pleased to Meet You
HM09's exhibit hall was abuzz today as representatives from about 200 companies stood poised and ready to greet a steady stream of hospitalists making their way into the hall following this morning's plenary sessions.
The American College of Chest Physicians' (ACCP) booth, for example, was quickly enveloped by hospitalists trying out the society’s robotic patient stimulator. "We use [it] to train physicians at the variety of courses that the college offers," explains Chad Jackson, MS, RRT, CHT, senior manager of clinical skill and simulation education for the ACCP. "This robotic stimulator is very realistic: He breathes, he bleeds, he pees. We can shock him just like you do real patients."
This is Mark Jamieson's fourth SHM annual meeting. The regional vice president of PatientKeeper, an IT company based in Newton, Mass., says the feedback his company receives at annual meetings influences product development. "A lot of times you go to these shows and you talk to administrators and IT people," he says. "This is one of the very few shows where you talk to docs who are doing the work every day."
Jamieson, who expects to talk to more than 200 hospitalists today, says he's witnessed HM's growth firsthand. "Four years ago when we were in Chicago you'd talk to people and they'd say, 'Yea, we're starting a hospital group, there are four of us now and we're looking to get more.' Then you see those same people the next year and they say, 'There are five of us and we want one more.' The next year they'd say, 'There are 12 of us and we want to get to 20.' It's interesting to see this movement, this segment grow."
HM09's exhibit hall was abuzz today as representatives from about 200 companies stood poised and ready to greet a steady stream of hospitalists making their way into the hall following this morning's plenary sessions.
The American College of Chest Physicians' (ACCP) booth, for example, was quickly enveloped by hospitalists trying out the society’s robotic patient stimulator. "We use [it] to train physicians at the variety of courses that the college offers," explains Chad Jackson, MS, RRT, CHT, senior manager of clinical skill and simulation education for the ACCP. "This robotic stimulator is very realistic: He breathes, he bleeds, he pees. We can shock him just like you do real patients."
This is Mark Jamieson's fourth SHM annual meeting. The regional vice president of PatientKeeper, an IT company based in Newton, Mass., says the feedback his company receives at annual meetings influences product development. "A lot of times you go to these shows and you talk to administrators and IT people," he says. "This is one of the very few shows where you talk to docs who are doing the work every day."
Jamieson, who expects to talk to more than 200 hospitalists today, says he's witnessed HM's growth firsthand. "Four years ago when we were in Chicago you'd talk to people and they'd say, 'Yea, we're starting a hospital group, there are four of us now and we're looking to get more.' Then you see those same people the next year and they say, 'There are five of us and we want one more.' The next year they'd say, 'There are 12 of us and we want to get to 20.' It's interesting to see this movement, this segment grow."
HM09's exhibit hall was abuzz today as representatives from about 200 companies stood poised and ready to greet a steady stream of hospitalists making their way into the hall following this morning's plenary sessions.
The American College of Chest Physicians' (ACCP) booth, for example, was quickly enveloped by hospitalists trying out the society’s robotic patient stimulator. "We use [it] to train physicians at the variety of courses that the college offers," explains Chad Jackson, MS, RRT, CHT, senior manager of clinical skill and simulation education for the ACCP. "This robotic stimulator is very realistic: He breathes, he bleeds, he pees. We can shock him just like you do real patients."
This is Mark Jamieson's fourth SHM annual meeting. The regional vice president of PatientKeeper, an IT company based in Newton, Mass., says the feedback his company receives at annual meetings influences product development. "A lot of times you go to these shows and you talk to administrators and IT people," he says. "This is one of the very few shows where you talk to docs who are doing the work every day."
Jamieson, who expects to talk to more than 200 hospitalists today, says he's witnessed HM's growth firsthand. "Four years ago when we were in Chicago you'd talk to people and they'd say, 'Yea, we're starting a hospital group, there are four of us now and we're looking to get more.' Then you see those same people the next year and they say, 'There are five of us and we want one more.' The next year they'd say, 'There are 12 of us and we want to get to 20.' It's interesting to see this movement, this segment grow."