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Neal R. Axon, MD
Ed note: This article is the second in a series of interviews with members of Team Hospitalist: 12 hospital medicine experts who are serving a two-year term as special editorial consultants to our magazine.
Ever consider working as an academic hospitalist? Here to give you the scoop on what it’s like is “Team Hospitalist” member R. Neal Axon, MD, assistant professor of internal medicine and pediatrics at the Medical University of South Carolina (MUSC) in Charleston.
Dr. Axon completed his residency at Duke University Medical Center and received his medical degree from the University of Alabama School of Medicine in 2000.
Why is it important to conduct research in hospital medicine?
We haven’t perfected medicine just yet, and until we do we have to work to make it better. Even though hospital medicine research is different from clinical medicine, we need to have people who are working to make the systems of care better.
What attracted you to academic medicine?
I love teaching residents and medical students, and I missed doing it when I entered in private practice. I just completed my master’s at MUSC in clinical research. My department was very supportive and even paid my tuition.
Is it difficult to balance research work with shift work?
It’s definitely a challenge. Fortunately for me, my group does not have shift work in the traditional sense. We do have a night shift, but it’s something we do on an infrequent basis. It would be extremely difficult to do in a seven-on, seven-off schedule that most hospitalists have.
What type of research are you working on?
I’m currently doing some work with hypertension. One of the projects is doing survey work where we access the attitudes of providers (doctors and house staff) on what to do with patients who have hypertension. My observation has been that, in many cases, when patients are admitted to a hospital, they also have high blood pressure that may equate with hypertension in the outpatient setting. It’s not clear when that should be addressed--or how. This survey would help us understand that.
What do you like about what you do?
I worry more about what the department chief thinks than what the CEO of the hospital thinks. At community and non-teaching hospitals, the focus is much more on the bottom line.
So is it impossible to do research if you work at a non-teaching hospital?
I think it’s likely to be more difficult--in that setting--to be a pure clinical researcher, but I do think there are opportunities out there for every day hospitalists to participate in research. This is one of the things I’m currently working on as a member of the SHM Research Committee. One deliverable we’re excited about is the fact that there will be sessions at the [2009] annual meeting in Chicago that will specifically address how hospitalists can do research.
Another thing I hope can evolve is practice-based research networks, which exist in the primary care setting, but not so much in hospital medicine. These networks include groups of community doctors who band together to do clinical research projects. Central leadership helps the members of the group come up with research questions. This is something I’m working on in my state to develop, but this type of setup does exist in other areas.
What advice do you have for hospitalists who are interested in research?
The most important piece of advice is to find a good mentor.
The second thing is that most medical schools have master’s degree programs that teach you the skills that will get you started in clinical research. I went to medical school, but didn’t learn anything about biostatistics or trial design. TH
Ed note: This article is the second in a series of interviews with members of Team Hospitalist: 12 hospital medicine experts who are serving a two-year term as special editorial consultants to our magazine.
Ever consider working as an academic hospitalist? Here to give you the scoop on what it’s like is “Team Hospitalist” member R. Neal Axon, MD, assistant professor of internal medicine and pediatrics at the Medical University of South Carolina (MUSC) in Charleston.
Dr. Axon completed his residency at Duke University Medical Center and received his medical degree from the University of Alabama School of Medicine in 2000.
Why is it important to conduct research in hospital medicine?
We haven’t perfected medicine just yet, and until we do we have to work to make it better. Even though hospital medicine research is different from clinical medicine, we need to have people who are working to make the systems of care better.
What attracted you to academic medicine?
I love teaching residents and medical students, and I missed doing it when I entered in private practice. I just completed my master’s at MUSC in clinical research. My department was very supportive and even paid my tuition.
Is it difficult to balance research work with shift work?
It’s definitely a challenge. Fortunately for me, my group does not have shift work in the traditional sense. We do have a night shift, but it’s something we do on an infrequent basis. It would be extremely difficult to do in a seven-on, seven-off schedule that most hospitalists have.
What type of research are you working on?
I’m currently doing some work with hypertension. One of the projects is doing survey work where we access the attitudes of providers (doctors and house staff) on what to do with patients who have hypertension. My observation has been that, in many cases, when patients are admitted to a hospital, they also have high blood pressure that may equate with hypertension in the outpatient setting. It’s not clear when that should be addressed--or how. This survey would help us understand that.
What do you like about what you do?
I worry more about what the department chief thinks than what the CEO of the hospital thinks. At community and non-teaching hospitals, the focus is much more on the bottom line.
So is it impossible to do research if you work at a non-teaching hospital?
I think it’s likely to be more difficult--in that setting--to be a pure clinical researcher, but I do think there are opportunities out there for every day hospitalists to participate in research. This is one of the things I’m currently working on as a member of the SHM Research Committee. One deliverable we’re excited about is the fact that there will be sessions at the [2009] annual meeting in Chicago that will specifically address how hospitalists can do research.
Another thing I hope can evolve is practice-based research networks, which exist in the primary care setting, but not so much in hospital medicine. These networks include groups of community doctors who band together to do clinical research projects. Central leadership helps the members of the group come up with research questions. This is something I’m working on in my state to develop, but this type of setup does exist in other areas.
What advice do you have for hospitalists who are interested in research?
The most important piece of advice is to find a good mentor.
The second thing is that most medical schools have master’s degree programs that teach you the skills that will get you started in clinical research. I went to medical school, but didn’t learn anything about biostatistics or trial design. TH
Ed note: This article is the second in a series of interviews with members of Team Hospitalist: 12 hospital medicine experts who are serving a two-year term as special editorial consultants to our magazine.
Ever consider working as an academic hospitalist? Here to give you the scoop on what it’s like is “Team Hospitalist” member R. Neal Axon, MD, assistant professor of internal medicine and pediatrics at the Medical University of South Carolina (MUSC) in Charleston.
Dr. Axon completed his residency at Duke University Medical Center and received his medical degree from the University of Alabama School of Medicine in 2000.
Why is it important to conduct research in hospital medicine?
We haven’t perfected medicine just yet, and until we do we have to work to make it better. Even though hospital medicine research is different from clinical medicine, we need to have people who are working to make the systems of care better.
What attracted you to academic medicine?
I love teaching residents and medical students, and I missed doing it when I entered in private practice. I just completed my master’s at MUSC in clinical research. My department was very supportive and even paid my tuition.
Is it difficult to balance research work with shift work?
It’s definitely a challenge. Fortunately for me, my group does not have shift work in the traditional sense. We do have a night shift, but it’s something we do on an infrequent basis. It would be extremely difficult to do in a seven-on, seven-off schedule that most hospitalists have.
What type of research are you working on?
I’m currently doing some work with hypertension. One of the projects is doing survey work where we access the attitudes of providers (doctors and house staff) on what to do with patients who have hypertension. My observation has been that, in many cases, when patients are admitted to a hospital, they also have high blood pressure that may equate with hypertension in the outpatient setting. It’s not clear when that should be addressed--or how. This survey would help us understand that.
What do you like about what you do?
I worry more about what the department chief thinks than what the CEO of the hospital thinks. At community and non-teaching hospitals, the focus is much more on the bottom line.
So is it impossible to do research if you work at a non-teaching hospital?
I think it’s likely to be more difficult--in that setting--to be a pure clinical researcher, but I do think there are opportunities out there for every day hospitalists to participate in research. This is one of the things I’m currently working on as a member of the SHM Research Committee. One deliverable we’re excited about is the fact that there will be sessions at the [2009] annual meeting in Chicago that will specifically address how hospitalists can do research.
Another thing I hope can evolve is practice-based research networks, which exist in the primary care setting, but not so much in hospital medicine. These networks include groups of community doctors who band together to do clinical research projects. Central leadership helps the members of the group come up with research questions. This is something I’m working on in my state to develop, but this type of setup does exist in other areas.
What advice do you have for hospitalists who are interested in research?
The most important piece of advice is to find a good mentor.
The second thing is that most medical schools have master’s degree programs that teach you the skills that will get you started in clinical research. I went to medical school, but didn’t learn anything about biostatistics or trial design. TH
Raajev Alexander, MD
Ed note: This article is the first in a series of interviews with members of Team Hospitalist: 12 hospital medicine experts who are serving a two-year term as special editorial consultants to our magazine.
Raajev Alexander, MD, is one busy hospitalist. For the past three years, he has been the lead hospitalist for the Oregon Medical Group, a group that caters to McKenzie-Willamette Medical Center in Springfield, Ore., and Sacred Heart Medical Center in Eugene, Ore. In addition to seeing about 15 patients a day, Dr. Alexander’s expertise in systems development has made him an attractive local expert. He serves on about five hospital committees (“I’ve lost track.”) and often attends meetings on his days off.
Dr. Alexander graduated from the University of Utah School of Medicine in 1995. After completing an internship and residency at Legacy Portland Hospital’s Internal Medicine program in 1998, he was recruited into the Oregon Medical Group.
He recently spoke with The Hospitalist about what he likes about his job, but why he also feels hospitalists should be compensated for the extra duties they undertake.
What attracted you to hospital medicine?
There is this kind of patient acuity where the sort of problems you’re solving seem important. Patients can have serious illnesses so you’re using your skills as an internist. I also like that there is a discreet arch to the hospitalization: There is the beginning of the hospitalization, the middle, the end, and then you’re sort of done. And I like that there is an interdisciplinary aspect; you work with nurses, care management, speech therapists, physical therapists, and ancillary therapists.
What are the challenges of leading a hospitalist group?
I do more than the full number of shifts per year. In addition to that, I go to meetings and deal with everything from a nurse calls and complaints about a hospitalist, to administration of the group. The CEO [of Oregon Medical Group] and I talk about staffing plans and how we can better serve the two hospitals in our area. I also sit on several hospital committees where I contribute my opinions on how to deploy pharmacists to how to redesign the case management program. My group finally decided to compensate me for certain meetings, but I still don’t get paid for half the meetings I go to.
Is this an issue other groups have?
I’m almost positive this is an ongoing issue for all hospitalist groups—at least I think it ought to be.
Hospitalists provide quality improvement on two different levels. One level is that, because we are in the hospital every day, we get to know the nurses, case managers, unit managers, lead respiratory therapists, and physical therapists. So, we effect change just by standing in the hallway.
The cross-education of pharmacists, nurses, and doctors is getting better every day. This is different from the way it used to be when a doctor had to run to the hospital at noon to see two patients, then run back to the office. Another way we improve quality is through committees. For all of the committees I sit on, the hospital gets get all my knowledge and ideas about systems, medications, and cross-reactions of drugs for free. But there isn’t enough time in my day to see patients, do nurse education and respiratory therapy education, to create protocols, and to sit on committees.
What’s the solution?
There are certain business models in hospital medicine that don’t make it possible to last as a hospitalist for 25 to 30 years. For example, there are some models where you get a bonus if you hit 18 to 20 patient encounters a day—even though those numbers are outside the SHM guidelines. If you’re seeing that many patients, you’re not providing optimal patient care.
A good business model is one where you can have 12 encounters per day and make a good living. Or see eight encounters per day and do administrative work, and still make a good living. The way to get there is for the specialty to better identify its mission and who its constituents are. TH
Ed note: This article is the first in a series of interviews with members of Team Hospitalist: 12 hospital medicine experts who are serving a two-year term as special editorial consultants to our magazine.
Raajev Alexander, MD, is one busy hospitalist. For the past three years, he has been the lead hospitalist for the Oregon Medical Group, a group that caters to McKenzie-Willamette Medical Center in Springfield, Ore., and Sacred Heart Medical Center in Eugene, Ore. In addition to seeing about 15 patients a day, Dr. Alexander’s expertise in systems development has made him an attractive local expert. He serves on about five hospital committees (“I’ve lost track.”) and often attends meetings on his days off.
Dr. Alexander graduated from the University of Utah School of Medicine in 1995. After completing an internship and residency at Legacy Portland Hospital’s Internal Medicine program in 1998, he was recruited into the Oregon Medical Group.
He recently spoke with The Hospitalist about what he likes about his job, but why he also feels hospitalists should be compensated for the extra duties they undertake.
What attracted you to hospital medicine?
There is this kind of patient acuity where the sort of problems you’re solving seem important. Patients can have serious illnesses so you’re using your skills as an internist. I also like that there is a discreet arch to the hospitalization: There is the beginning of the hospitalization, the middle, the end, and then you’re sort of done. And I like that there is an interdisciplinary aspect; you work with nurses, care management, speech therapists, physical therapists, and ancillary therapists.
What are the challenges of leading a hospitalist group?
I do more than the full number of shifts per year. In addition to that, I go to meetings and deal with everything from a nurse calls and complaints about a hospitalist, to administration of the group. The CEO [of Oregon Medical Group] and I talk about staffing plans and how we can better serve the two hospitals in our area. I also sit on several hospital committees where I contribute my opinions on how to deploy pharmacists to how to redesign the case management program. My group finally decided to compensate me for certain meetings, but I still don’t get paid for half the meetings I go to.
Is this an issue other groups have?
I’m almost positive this is an ongoing issue for all hospitalist groups—at least I think it ought to be.
Hospitalists provide quality improvement on two different levels. One level is that, because we are in the hospital every day, we get to know the nurses, case managers, unit managers, lead respiratory therapists, and physical therapists. So, we effect change just by standing in the hallway.
The cross-education of pharmacists, nurses, and doctors is getting better every day. This is different from the way it used to be when a doctor had to run to the hospital at noon to see two patients, then run back to the office. Another way we improve quality is through committees. For all of the committees I sit on, the hospital gets get all my knowledge and ideas about systems, medications, and cross-reactions of drugs for free. But there isn’t enough time in my day to see patients, do nurse education and respiratory therapy education, to create protocols, and to sit on committees.
What’s the solution?
There are certain business models in hospital medicine that don’t make it possible to last as a hospitalist for 25 to 30 years. For example, there are some models where you get a bonus if you hit 18 to 20 patient encounters a day—even though those numbers are outside the SHM guidelines. If you’re seeing that many patients, you’re not providing optimal patient care.
A good business model is one where you can have 12 encounters per day and make a good living. Or see eight encounters per day and do administrative work, and still make a good living. The way to get there is for the specialty to better identify its mission and who its constituents are. TH
Ed note: This article is the first in a series of interviews with members of Team Hospitalist: 12 hospital medicine experts who are serving a two-year term as special editorial consultants to our magazine.
Raajev Alexander, MD, is one busy hospitalist. For the past three years, he has been the lead hospitalist for the Oregon Medical Group, a group that caters to McKenzie-Willamette Medical Center in Springfield, Ore., and Sacred Heart Medical Center in Eugene, Ore. In addition to seeing about 15 patients a day, Dr. Alexander’s expertise in systems development has made him an attractive local expert. He serves on about five hospital committees (“I’ve lost track.”) and often attends meetings on his days off.
Dr. Alexander graduated from the University of Utah School of Medicine in 1995. After completing an internship and residency at Legacy Portland Hospital’s Internal Medicine program in 1998, he was recruited into the Oregon Medical Group.
He recently spoke with The Hospitalist about what he likes about his job, but why he also feels hospitalists should be compensated for the extra duties they undertake.
What attracted you to hospital medicine?
There is this kind of patient acuity where the sort of problems you’re solving seem important. Patients can have serious illnesses so you’re using your skills as an internist. I also like that there is a discreet arch to the hospitalization: There is the beginning of the hospitalization, the middle, the end, and then you’re sort of done. And I like that there is an interdisciplinary aspect; you work with nurses, care management, speech therapists, physical therapists, and ancillary therapists.
What are the challenges of leading a hospitalist group?
I do more than the full number of shifts per year. In addition to that, I go to meetings and deal with everything from a nurse calls and complaints about a hospitalist, to administration of the group. The CEO [of Oregon Medical Group] and I talk about staffing plans and how we can better serve the two hospitals in our area. I also sit on several hospital committees where I contribute my opinions on how to deploy pharmacists to how to redesign the case management program. My group finally decided to compensate me for certain meetings, but I still don’t get paid for half the meetings I go to.
Is this an issue other groups have?
I’m almost positive this is an ongoing issue for all hospitalist groups—at least I think it ought to be.
Hospitalists provide quality improvement on two different levels. One level is that, because we are in the hospital every day, we get to know the nurses, case managers, unit managers, lead respiratory therapists, and physical therapists. So, we effect change just by standing in the hallway.
The cross-education of pharmacists, nurses, and doctors is getting better every day. This is different from the way it used to be when a doctor had to run to the hospital at noon to see two patients, then run back to the office. Another way we improve quality is through committees. For all of the committees I sit on, the hospital gets get all my knowledge and ideas about systems, medications, and cross-reactions of drugs for free. But there isn’t enough time in my day to see patients, do nurse education and respiratory therapy education, to create protocols, and to sit on committees.
What’s the solution?
There are certain business models in hospital medicine that don’t make it possible to last as a hospitalist for 25 to 30 years. For example, there are some models where you get a bonus if you hit 18 to 20 patient encounters a day—even though those numbers are outside the SHM guidelines. If you’re seeing that many patients, you’re not providing optimal patient care.
A good business model is one where you can have 12 encounters per day and make a good living. Or see eight encounters per day and do administrative work, and still make a good living. The way to get there is for the specialty to better identify its mission and who its constituents are. TH