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Whether obligatory or voluntary, service on committees is a reality for most hospitalists. “The 2005-2006 SHM Survey: State of the Hospital Medicine Movement” found that, for 92% of respondents, committee participation topped the list of non-clinical activities.1 Hospital medicine group leaders, consultants, and administrators interviewed for this article say time-pressed hospitalists must become more effective committee participants.
Civic Duty or Career Advancement?
Because of growing presence at the hospital and their knowledge of hospital operations, hospitalists are a logical choice for committee assignments. These can range from committees dedicated to care delivery (e.g., pharmacy and therapeutics) to the hospital board’s governance committees.
“Hospitalists, with their perspective of hospital operations and clinical care, could be a great part of broadening the perspective of the board, informing their decision-making and helping them to formulate policies,” says John Combes, MD, president of the Center for Healthcare Governance in Chicago, a subsidiary committee of the American Hospital Association.
Mark V. Williams, MD, professor of medicine and director, Emory Hospital Medicine Unit in Atlanta, and editor in chief of the Journal of Hospital Medicine, does not consider committee participation optional.
“I strongly encourage—if not almost require—all of the hospitalists in our group to be involved in at least one committee,” says Dr. Williams. “My belief is that hospitalists are integral to the functioning of the hospital, and as part of their responsibility, they need to be actively involved in committee work to move projects forward.”
Leslie Flores, MHA, co-principal of Nelson/Flores Associates, LLC, agrees. “It’s in the hospitalists’ best interest to be involved in committees,” she says. “Hospitalists are often in the best position to see what needs to be fixed, and they have the potential to have a significant impact on how effectively their hospital operates, which can make their own jobs easier.”
Further, she points out, “If the hospital, which is financially supporting them, is more successful and effective, there’s likely to be less financial pressure on their practice.”
Hospitalists’ perceptions about committee participation can be influenced by each hospitalist’s employment model. If one is working directly for the hospital and giving 110% to that employer, being asked to volunteer additional time to serve on a committee might be viewed as a burden. On the other hand, an independent hospital medicine group (HMG) contracting with the hospital to deliver services may view committee participation as an avenue for ensuring the group’s success. Whatever the employment model, and whatever the career goals of individual hospitalists, it often pays to target one’s participation in committees.
—John Combes, MD, president of the Center for Healthcare Governance, a subsidiary committee of the American Hospital Association.
Make Participation Count
Hospitalists will be playing more key roles in medical staff leadership, according to William D. Atchley Jr., MD, medical director of the Division of Hospital Medicine for Sentara Medical Group in Hampton, Va. His concern is that hospitalists will be asked to serve on more than one or two committees. He advises younger hospitalists to notify the president of the medical staff of which committees they would be interested in working on. Dr. Atchley is also a member of the SHM Board of Directors.
“It could be peer review, performance improvement, or ad hoc committees focused on developing evidence-based order sets, improving through-put or disaster preparedness,” says Dr. Atchley. Whatever the pick, “it should be something that they’re going to find enjoyable and that they feel will advance their stature within the hospital.”
To be an effective member of a hospital board committee, a hospitalist must represent the greater interests of all stakeholders—not just his or her own self-interest, cautions Dr. Combes. However, “as physicians become more stressed and production-oriented, giving up clinical time to participate in governance activities becomes more and more difficult,” he concedes. Hospitalists should choose committee assignments based on their interests and expertise.
Dr. Williams encourages hospitalists in his group to pick one committee—preferably one focused on care delivery (quality improvement, pharmacy and therapeutics, utilization review) and take an active role. “Then, over time, I encourage them to try to chair committees to obtain leadership experience,” he says.
Taking on too many extracurricular committee tasks can be counterproductive. To avoid this, Flores advises younger hospitalists to ask themselves the following:
- What will my committee participation do to support the goals of the committee and the organization?
- By participating in this committee, can I expand my own knowledge or understanding of the culture and politics of the organization?
- Can I become more comfortable interacting on an organizational level?
- Can I network and get to know people I wouldn’t otherwise encounter, who can be helpful to me personally?
In addition, Dr. Atchley believes rotating committee assignments is also beneficial, especially for the younger hospitalist. In his tenure as a hospitalist, Dr. Atchley has served as chairman of the Department of Medicine’s credentials and quality assurance committees, and as vice president of the medical staff. Each committee furnishes hospitalists with a different perspective about how the hospital functions.
“I think hospitalists should understand the medical staff bylaws and procedures,” says Dr. Atchley. “Each hospital medicine staff has this governance structure, and I have found it beneficial in resolving conflicts about patient care and interaction between physicians.”
Mary A. Dallas, MD, has seen the committee situation from both sides of the fence. She is medical information officer for Presbyterian Healthcare Services, an integrated healthcare delivery network in Albuquerque, N.M., but served as medical director of Presbyterian’s hospitalist group for five years before that.
“Hospitalists have a vested interest in making sure their work area is protected, so they need to plant some people in strategic places for the governance and medical staff,” says Dr. Dallas. “In order to be effective in the governance of the hospital, you have to be part of that medical substructure and get involved.”
For instance, as medical director, she sat on the hospital’s credential committee and found it allowed her to keep tabs on new HMG hires going through the credentialing process. “This [the hospital] is your work environment,” she explains. “You are here day in and day out, and you should shape that environment, have a say in policies and rules, so that you can make your job more successful and make patient care better.”
The Quandary over Compensation
Many hospitalists feel frustrated when committee obligations impinge on clinical duties. Is compensation the answer for filling committee slots? Opinions are mixed.
Dr. Williams says he is “a little uncomfortable with the concept of people getting paid every time they attend a committee meeting. For hospitalists who receive funding from the hospital to support their programs, it’s important for the leader [of the HMG] to ensure that they’re collaborating with hospital administration. The hospital has the expectation that, as part of our salary structure, we will be members of committees. That needs to be part of the job.”
Dr. Dallas agrees: “Regardless of whether you’re getting paid or not, this is your work environment. I think it’s very important to be involved, so that your voice is heard and so that you can help make the [hospital] structure better.”
Compensating physicians for their time does communicate that their time is valued and respected, says Dr. Combes, but payment does not necessarily guarantee a high level of committee members’ engagement. In addition, he says, if physicians are being compensated directly by the hospital for serving on committees, “this can threaten the perception of their objectivity, in terms of bringing an independent perspective to the board.” A better solution might be for the hospital medicine group to build its own compensation structure for non-clinical work so members retain independence when voicing opinions to the hospital board.
Dr. Atchley admits it’s sometimes a struggle to find people willing to serve on medical staff committees. He advocates compensation for those duties on a per-meeting or hourly basis. His hospital meets attendance requirements by giving credit to doctors who participate on selected medical staff committees.
Through her consulting assignments, Flores has observed that in some organizations where hospitalists are paid based on productivity, committee participation can be assigned a relative value unit so hospitalists are compensated on the same basis as for clinical work.
Flores concurs with Drs. Dallas and Williams: “In most organizations, a certain minimum level of participation in medical staff activities is expected of all staff members. I think that hospitalists should expect to do that to the same degree as other medical staff members, on a voluntary basis.
“If hospitalists truly want to impact how the medical staff and the hospital operate, and to be considered for high-level leadership positions, then their best way of becoming known and respected in the medical community is by participating on committees.” TH
Gretchen Henkel writes frequently for The Hospitalist.
Reference
- SHM’s “2005-2006 Survey: State of the Hospital Medicine Movement, 2006.” Available online at www.hospitalmedicine.org Last accessed April 5, 2007.
Whether obligatory or voluntary, service on committees is a reality for most hospitalists. “The 2005-2006 SHM Survey: State of the Hospital Medicine Movement” found that, for 92% of respondents, committee participation topped the list of non-clinical activities.1 Hospital medicine group leaders, consultants, and administrators interviewed for this article say time-pressed hospitalists must become more effective committee participants.
Civic Duty or Career Advancement?
Because of growing presence at the hospital and their knowledge of hospital operations, hospitalists are a logical choice for committee assignments. These can range from committees dedicated to care delivery (e.g., pharmacy and therapeutics) to the hospital board’s governance committees.
“Hospitalists, with their perspective of hospital operations and clinical care, could be a great part of broadening the perspective of the board, informing their decision-making and helping them to formulate policies,” says John Combes, MD, president of the Center for Healthcare Governance in Chicago, a subsidiary committee of the American Hospital Association.
Mark V. Williams, MD, professor of medicine and director, Emory Hospital Medicine Unit in Atlanta, and editor in chief of the Journal of Hospital Medicine, does not consider committee participation optional.
“I strongly encourage—if not almost require—all of the hospitalists in our group to be involved in at least one committee,” says Dr. Williams. “My belief is that hospitalists are integral to the functioning of the hospital, and as part of their responsibility, they need to be actively involved in committee work to move projects forward.”
Leslie Flores, MHA, co-principal of Nelson/Flores Associates, LLC, agrees. “It’s in the hospitalists’ best interest to be involved in committees,” she says. “Hospitalists are often in the best position to see what needs to be fixed, and they have the potential to have a significant impact on how effectively their hospital operates, which can make their own jobs easier.”
Further, she points out, “If the hospital, which is financially supporting them, is more successful and effective, there’s likely to be less financial pressure on their practice.”
Hospitalists’ perceptions about committee participation can be influenced by each hospitalist’s employment model. If one is working directly for the hospital and giving 110% to that employer, being asked to volunteer additional time to serve on a committee might be viewed as a burden. On the other hand, an independent hospital medicine group (HMG) contracting with the hospital to deliver services may view committee participation as an avenue for ensuring the group’s success. Whatever the employment model, and whatever the career goals of individual hospitalists, it often pays to target one’s participation in committees.
—John Combes, MD, president of the Center for Healthcare Governance, a subsidiary committee of the American Hospital Association.
Make Participation Count
Hospitalists will be playing more key roles in medical staff leadership, according to William D. Atchley Jr., MD, medical director of the Division of Hospital Medicine for Sentara Medical Group in Hampton, Va. His concern is that hospitalists will be asked to serve on more than one or two committees. He advises younger hospitalists to notify the president of the medical staff of which committees they would be interested in working on. Dr. Atchley is also a member of the SHM Board of Directors.
“It could be peer review, performance improvement, or ad hoc committees focused on developing evidence-based order sets, improving through-put or disaster preparedness,” says Dr. Atchley. Whatever the pick, “it should be something that they’re going to find enjoyable and that they feel will advance their stature within the hospital.”
To be an effective member of a hospital board committee, a hospitalist must represent the greater interests of all stakeholders—not just his or her own self-interest, cautions Dr. Combes. However, “as physicians become more stressed and production-oriented, giving up clinical time to participate in governance activities becomes more and more difficult,” he concedes. Hospitalists should choose committee assignments based on their interests and expertise.
Dr. Williams encourages hospitalists in his group to pick one committee—preferably one focused on care delivery (quality improvement, pharmacy and therapeutics, utilization review) and take an active role. “Then, over time, I encourage them to try to chair committees to obtain leadership experience,” he says.
Taking on too many extracurricular committee tasks can be counterproductive. To avoid this, Flores advises younger hospitalists to ask themselves the following:
- What will my committee participation do to support the goals of the committee and the organization?
- By participating in this committee, can I expand my own knowledge or understanding of the culture and politics of the organization?
- Can I become more comfortable interacting on an organizational level?
- Can I network and get to know people I wouldn’t otherwise encounter, who can be helpful to me personally?
In addition, Dr. Atchley believes rotating committee assignments is also beneficial, especially for the younger hospitalist. In his tenure as a hospitalist, Dr. Atchley has served as chairman of the Department of Medicine’s credentials and quality assurance committees, and as vice president of the medical staff. Each committee furnishes hospitalists with a different perspective about how the hospital functions.
“I think hospitalists should understand the medical staff bylaws and procedures,” says Dr. Atchley. “Each hospital medicine staff has this governance structure, and I have found it beneficial in resolving conflicts about patient care and interaction between physicians.”
Mary A. Dallas, MD, has seen the committee situation from both sides of the fence. She is medical information officer for Presbyterian Healthcare Services, an integrated healthcare delivery network in Albuquerque, N.M., but served as medical director of Presbyterian’s hospitalist group for five years before that.
“Hospitalists have a vested interest in making sure their work area is protected, so they need to plant some people in strategic places for the governance and medical staff,” says Dr. Dallas. “In order to be effective in the governance of the hospital, you have to be part of that medical substructure and get involved.”
For instance, as medical director, she sat on the hospital’s credential committee and found it allowed her to keep tabs on new HMG hires going through the credentialing process. “This [the hospital] is your work environment,” she explains. “You are here day in and day out, and you should shape that environment, have a say in policies and rules, so that you can make your job more successful and make patient care better.”
The Quandary over Compensation
Many hospitalists feel frustrated when committee obligations impinge on clinical duties. Is compensation the answer for filling committee slots? Opinions are mixed.
Dr. Williams says he is “a little uncomfortable with the concept of people getting paid every time they attend a committee meeting. For hospitalists who receive funding from the hospital to support their programs, it’s important for the leader [of the HMG] to ensure that they’re collaborating with hospital administration. The hospital has the expectation that, as part of our salary structure, we will be members of committees. That needs to be part of the job.”
Dr. Dallas agrees: “Regardless of whether you’re getting paid or not, this is your work environment. I think it’s very important to be involved, so that your voice is heard and so that you can help make the [hospital] structure better.”
Compensating physicians for their time does communicate that their time is valued and respected, says Dr. Combes, but payment does not necessarily guarantee a high level of committee members’ engagement. In addition, he says, if physicians are being compensated directly by the hospital for serving on committees, “this can threaten the perception of their objectivity, in terms of bringing an independent perspective to the board.” A better solution might be for the hospital medicine group to build its own compensation structure for non-clinical work so members retain independence when voicing opinions to the hospital board.
Dr. Atchley admits it’s sometimes a struggle to find people willing to serve on medical staff committees. He advocates compensation for those duties on a per-meeting or hourly basis. His hospital meets attendance requirements by giving credit to doctors who participate on selected medical staff committees.
Through her consulting assignments, Flores has observed that in some organizations where hospitalists are paid based on productivity, committee participation can be assigned a relative value unit so hospitalists are compensated on the same basis as for clinical work.
Flores concurs with Drs. Dallas and Williams: “In most organizations, a certain minimum level of participation in medical staff activities is expected of all staff members. I think that hospitalists should expect to do that to the same degree as other medical staff members, on a voluntary basis.
“If hospitalists truly want to impact how the medical staff and the hospital operate, and to be considered for high-level leadership positions, then their best way of becoming known and respected in the medical community is by participating on committees.” TH
Gretchen Henkel writes frequently for The Hospitalist.
Reference
- SHM’s “2005-2006 Survey: State of the Hospital Medicine Movement, 2006.” Available online at www.hospitalmedicine.org Last accessed April 5, 2007.
Whether obligatory or voluntary, service on committees is a reality for most hospitalists. “The 2005-2006 SHM Survey: State of the Hospital Medicine Movement” found that, for 92% of respondents, committee participation topped the list of non-clinical activities.1 Hospital medicine group leaders, consultants, and administrators interviewed for this article say time-pressed hospitalists must become more effective committee participants.
Civic Duty or Career Advancement?
Because of growing presence at the hospital and their knowledge of hospital operations, hospitalists are a logical choice for committee assignments. These can range from committees dedicated to care delivery (e.g., pharmacy and therapeutics) to the hospital board’s governance committees.
“Hospitalists, with their perspective of hospital operations and clinical care, could be a great part of broadening the perspective of the board, informing their decision-making and helping them to formulate policies,” says John Combes, MD, president of the Center for Healthcare Governance in Chicago, a subsidiary committee of the American Hospital Association.
Mark V. Williams, MD, professor of medicine and director, Emory Hospital Medicine Unit in Atlanta, and editor in chief of the Journal of Hospital Medicine, does not consider committee participation optional.
“I strongly encourage—if not almost require—all of the hospitalists in our group to be involved in at least one committee,” says Dr. Williams. “My belief is that hospitalists are integral to the functioning of the hospital, and as part of their responsibility, they need to be actively involved in committee work to move projects forward.”
Leslie Flores, MHA, co-principal of Nelson/Flores Associates, LLC, agrees. “It’s in the hospitalists’ best interest to be involved in committees,” she says. “Hospitalists are often in the best position to see what needs to be fixed, and they have the potential to have a significant impact on how effectively their hospital operates, which can make their own jobs easier.”
Further, she points out, “If the hospital, which is financially supporting them, is more successful and effective, there’s likely to be less financial pressure on their practice.”
Hospitalists’ perceptions about committee participation can be influenced by each hospitalist’s employment model. If one is working directly for the hospital and giving 110% to that employer, being asked to volunteer additional time to serve on a committee might be viewed as a burden. On the other hand, an independent hospital medicine group (HMG) contracting with the hospital to deliver services may view committee participation as an avenue for ensuring the group’s success. Whatever the employment model, and whatever the career goals of individual hospitalists, it often pays to target one’s participation in committees.
—John Combes, MD, president of the Center for Healthcare Governance, a subsidiary committee of the American Hospital Association.
Make Participation Count
Hospitalists will be playing more key roles in medical staff leadership, according to William D. Atchley Jr., MD, medical director of the Division of Hospital Medicine for Sentara Medical Group in Hampton, Va. His concern is that hospitalists will be asked to serve on more than one or two committees. He advises younger hospitalists to notify the president of the medical staff of which committees they would be interested in working on. Dr. Atchley is also a member of the SHM Board of Directors.
“It could be peer review, performance improvement, or ad hoc committees focused on developing evidence-based order sets, improving through-put or disaster preparedness,” says Dr. Atchley. Whatever the pick, “it should be something that they’re going to find enjoyable and that they feel will advance their stature within the hospital.”
To be an effective member of a hospital board committee, a hospitalist must represent the greater interests of all stakeholders—not just his or her own self-interest, cautions Dr. Combes. However, “as physicians become more stressed and production-oriented, giving up clinical time to participate in governance activities becomes more and more difficult,” he concedes. Hospitalists should choose committee assignments based on their interests and expertise.
Dr. Williams encourages hospitalists in his group to pick one committee—preferably one focused on care delivery (quality improvement, pharmacy and therapeutics, utilization review) and take an active role. “Then, over time, I encourage them to try to chair committees to obtain leadership experience,” he says.
Taking on too many extracurricular committee tasks can be counterproductive. To avoid this, Flores advises younger hospitalists to ask themselves the following:
- What will my committee participation do to support the goals of the committee and the organization?
- By participating in this committee, can I expand my own knowledge or understanding of the culture and politics of the organization?
- Can I become more comfortable interacting on an organizational level?
- Can I network and get to know people I wouldn’t otherwise encounter, who can be helpful to me personally?
In addition, Dr. Atchley believes rotating committee assignments is also beneficial, especially for the younger hospitalist. In his tenure as a hospitalist, Dr. Atchley has served as chairman of the Department of Medicine’s credentials and quality assurance committees, and as vice president of the medical staff. Each committee furnishes hospitalists with a different perspective about how the hospital functions.
“I think hospitalists should understand the medical staff bylaws and procedures,” says Dr. Atchley. “Each hospital medicine staff has this governance structure, and I have found it beneficial in resolving conflicts about patient care and interaction between physicians.”
Mary A. Dallas, MD, has seen the committee situation from both sides of the fence. She is medical information officer for Presbyterian Healthcare Services, an integrated healthcare delivery network in Albuquerque, N.M., but served as medical director of Presbyterian’s hospitalist group for five years before that.
“Hospitalists have a vested interest in making sure their work area is protected, so they need to plant some people in strategic places for the governance and medical staff,” says Dr. Dallas. “In order to be effective in the governance of the hospital, you have to be part of that medical substructure and get involved.”
For instance, as medical director, she sat on the hospital’s credential committee and found it allowed her to keep tabs on new HMG hires going through the credentialing process. “This [the hospital] is your work environment,” she explains. “You are here day in and day out, and you should shape that environment, have a say in policies and rules, so that you can make your job more successful and make patient care better.”
The Quandary over Compensation
Many hospitalists feel frustrated when committee obligations impinge on clinical duties. Is compensation the answer for filling committee slots? Opinions are mixed.
Dr. Williams says he is “a little uncomfortable with the concept of people getting paid every time they attend a committee meeting. For hospitalists who receive funding from the hospital to support their programs, it’s important for the leader [of the HMG] to ensure that they’re collaborating with hospital administration. The hospital has the expectation that, as part of our salary structure, we will be members of committees. That needs to be part of the job.”
Dr. Dallas agrees: “Regardless of whether you’re getting paid or not, this is your work environment. I think it’s very important to be involved, so that your voice is heard and so that you can help make the [hospital] structure better.”
Compensating physicians for their time does communicate that their time is valued and respected, says Dr. Combes, but payment does not necessarily guarantee a high level of committee members’ engagement. In addition, he says, if physicians are being compensated directly by the hospital for serving on committees, “this can threaten the perception of their objectivity, in terms of bringing an independent perspective to the board.” A better solution might be for the hospital medicine group to build its own compensation structure for non-clinical work so members retain independence when voicing opinions to the hospital board.
Dr. Atchley admits it’s sometimes a struggle to find people willing to serve on medical staff committees. He advocates compensation for those duties on a per-meeting or hourly basis. His hospital meets attendance requirements by giving credit to doctors who participate on selected medical staff committees.
Through her consulting assignments, Flores has observed that in some organizations where hospitalists are paid based on productivity, committee participation can be assigned a relative value unit so hospitalists are compensated on the same basis as for clinical work.
Flores concurs with Drs. Dallas and Williams: “In most organizations, a certain minimum level of participation in medical staff activities is expected of all staff members. I think that hospitalists should expect to do that to the same degree as other medical staff members, on a voluntary basis.
“If hospitalists truly want to impact how the medical staff and the hospital operate, and to be considered for high-level leadership positions, then their best way of becoming known and respected in the medical community is by participating on committees.” TH
Gretchen Henkel writes frequently for The Hospitalist.
Reference
- SHM’s “2005-2006 Survey: State of the Hospital Medicine Movement, 2006.” Available online at www.hospitalmedicine.org Last accessed April 5, 2007.
Hard Work Pays Off
This is the second in a series on the four pillars of career satisfaction. Part 1 appeared on p. 14 in the June issue of The Hospitalist.
How can hospitalists work long days often packed from beginning to end and still remain happy with their jobs? One answer can be found in “A Challenge for a New Specialty: A White Paper on Hospitalist Career Satisfaction” (available online at www.hospitalmedicine.org), a comprehensive document by SHM’s Career Satisfaction Task Force (CSTF). This white paper can be used by hospitalists and hospital medicine practices as a toolkit for improving job satisfaction. It outlines the four pillars of career satisfaction.
The Second Pillar: Workload/Schedule
The workload/schedule pillar refers to the type, volume, and intensity of a hospitalist’s work as well as time pressures, variability of work, and number of interruptions. A hospitalist schedule must take all these factors into consideration.
CSTF Co-Chairperson Winthrop Whitcomb, MD, Mercy Medical Center, Springfield, Mass., maintains that this pillar is supported by the other three—autonomy/control, reward/recognition, and community/environment—but most closely with reward/recognition.
“There needs to be a reward system in place no matter what the workload,” says Dr. Whitcomb. “You can’t really talk about workload without addressing rewards. It’s human nature that in order to work hard, you need to be rewarded in some meaningful way.”
But many people—not just physicians but workers from all fields—may have separate concerns about heavy workload and just rewards.
An Example of Workload Issues
You probably know from your own experience as a hospitalist how workload can affect career satisfaction. Here is a fictional example of a hospitalist struggling with an increased patient load:
The director of my community-based hospital medicine program has mandated that each hospitalist see 15 to 20 patients each weekday, and 20 to 30 patients a day over weekends. I know this workload is too heavy to allow good quality of care. Under the pressure of seeing my quota of patients, I’m afraid I might make a mistake or miss something.
“There are physicians out there who can and do handle this type of workload, and they do it happily and well,” Dr. Whitcomb points out. “But this is only true if there is an appropriate reward system in place, and there clearly needs to be a good support system in order to provide quality of care” under this example.
CSTF says this individual should take the following steps:
Step 1: Go on a fact-finding mission. Find out whether hospitalist workload, responsibilities, and schedule at this facility are the norm. “[The hospitalist] should get an idea of what’s happening at other hospital medicine groups; he should understand the national picture,” says Dr. Whitcomb. “He might then realize that hospitalists in his group are only working 187 days a year, and that over a course of a year they’re not really working any harder than others who work more days,” says Dr. Whitcomb. “This might get him thinking a little bit differently about the workload.”
Step 2: Undertake organizational strategies. A hospitalist can find out how he or she has a voice in workload issues.“Figure out how hospitalists are represented in the structure of the group,” advises Dr. Whitcomb. “If a director is mandating how much [hospitalists] work, there has to be some mechanism for the physicians to be able to provide feedback. This often takes the shape of a compensation committee; this group is not just about compensation but about budget and sustainability for both the hospital and the hospitalists.” Physician representation—having a say in workload and schedule—is important to maintain a good balance within a hospital medicine program.
Step 3: Consider recommendations to ease workload. “You can try to change the workload through justifying adding staff or through putting systems in place that allow you to see more patients,” says Dr. Whitcomb. But what if the hospitalist considers or takes these steps and still finds his patient load to be unsustainable long term? “In terms of feeling like you’re not able to provide safe care,” says Dr. Whitcomb, “once you’ve suggested changes to the leadership and no changes are made, this may become a deal-breaker.”
Workload Leans on Other Pillars
The interesting thing about the workload/schedule pillar of job satisfaction is that, if you are unhappy with your workload, the other three pillars can sustain you and make you generally satisfied.
Dr. Whitcomb points to a 2002 article published in the Journal of Health and Social Behavior.1 The study examined a national survey of hospitalists and found that job burnout and intent to remain in the career are more meaningfully associated with favorable “community” relations than with negative experiences such as reduced autonomy.
“Workload is not a predictor of burnout as long as the other three pillars are intact,” summarizes Dr. Whitcomb.
Jane Jerrard has written for The Hospitalist since 2005.
Reference
- Hoff T, Whitcomb WF, Nelson JR. Thriving and surviving in a new medical career: the case of hospitalist physicians. J Health Social Behav. 2002 Mar;43(1):72-91
This is the second in a series on the four pillars of career satisfaction. Part 1 appeared on p. 14 in the June issue of The Hospitalist.
How can hospitalists work long days often packed from beginning to end and still remain happy with their jobs? One answer can be found in “A Challenge for a New Specialty: A White Paper on Hospitalist Career Satisfaction” (available online at www.hospitalmedicine.org), a comprehensive document by SHM’s Career Satisfaction Task Force (CSTF). This white paper can be used by hospitalists and hospital medicine practices as a toolkit for improving job satisfaction. It outlines the four pillars of career satisfaction.
The Second Pillar: Workload/Schedule
The workload/schedule pillar refers to the type, volume, and intensity of a hospitalist’s work as well as time pressures, variability of work, and number of interruptions. A hospitalist schedule must take all these factors into consideration.
CSTF Co-Chairperson Winthrop Whitcomb, MD, Mercy Medical Center, Springfield, Mass., maintains that this pillar is supported by the other three—autonomy/control, reward/recognition, and community/environment—but most closely with reward/recognition.
“There needs to be a reward system in place no matter what the workload,” says Dr. Whitcomb. “You can’t really talk about workload without addressing rewards. It’s human nature that in order to work hard, you need to be rewarded in some meaningful way.”
But many people—not just physicians but workers from all fields—may have separate concerns about heavy workload and just rewards.
An Example of Workload Issues
You probably know from your own experience as a hospitalist how workload can affect career satisfaction. Here is a fictional example of a hospitalist struggling with an increased patient load:
The director of my community-based hospital medicine program has mandated that each hospitalist see 15 to 20 patients each weekday, and 20 to 30 patients a day over weekends. I know this workload is too heavy to allow good quality of care. Under the pressure of seeing my quota of patients, I’m afraid I might make a mistake or miss something.
“There are physicians out there who can and do handle this type of workload, and they do it happily and well,” Dr. Whitcomb points out. “But this is only true if there is an appropriate reward system in place, and there clearly needs to be a good support system in order to provide quality of care” under this example.
CSTF says this individual should take the following steps:
Step 1: Go on a fact-finding mission. Find out whether hospitalist workload, responsibilities, and schedule at this facility are the norm. “[The hospitalist] should get an idea of what’s happening at other hospital medicine groups; he should understand the national picture,” says Dr. Whitcomb. “He might then realize that hospitalists in his group are only working 187 days a year, and that over a course of a year they’re not really working any harder than others who work more days,” says Dr. Whitcomb. “This might get him thinking a little bit differently about the workload.”
Step 2: Undertake organizational strategies. A hospitalist can find out how he or she has a voice in workload issues.“Figure out how hospitalists are represented in the structure of the group,” advises Dr. Whitcomb. “If a director is mandating how much [hospitalists] work, there has to be some mechanism for the physicians to be able to provide feedback. This often takes the shape of a compensation committee; this group is not just about compensation but about budget and sustainability for both the hospital and the hospitalists.” Physician representation—having a say in workload and schedule—is important to maintain a good balance within a hospital medicine program.
Step 3: Consider recommendations to ease workload. “You can try to change the workload through justifying adding staff or through putting systems in place that allow you to see more patients,” says Dr. Whitcomb. But what if the hospitalist considers or takes these steps and still finds his patient load to be unsustainable long term? “In terms of feeling like you’re not able to provide safe care,” says Dr. Whitcomb, “once you’ve suggested changes to the leadership and no changes are made, this may become a deal-breaker.”
Workload Leans on Other Pillars
The interesting thing about the workload/schedule pillar of job satisfaction is that, if you are unhappy with your workload, the other three pillars can sustain you and make you generally satisfied.
Dr. Whitcomb points to a 2002 article published in the Journal of Health and Social Behavior.1 The study examined a national survey of hospitalists and found that job burnout and intent to remain in the career are more meaningfully associated with favorable “community” relations than with negative experiences such as reduced autonomy.
“Workload is not a predictor of burnout as long as the other three pillars are intact,” summarizes Dr. Whitcomb.
Jane Jerrard has written for The Hospitalist since 2005.
Reference
- Hoff T, Whitcomb WF, Nelson JR. Thriving and surviving in a new medical career: the case of hospitalist physicians. J Health Social Behav. 2002 Mar;43(1):72-91
This is the second in a series on the four pillars of career satisfaction. Part 1 appeared on p. 14 in the June issue of The Hospitalist.
How can hospitalists work long days often packed from beginning to end and still remain happy with their jobs? One answer can be found in “A Challenge for a New Specialty: A White Paper on Hospitalist Career Satisfaction” (available online at www.hospitalmedicine.org), a comprehensive document by SHM’s Career Satisfaction Task Force (CSTF). This white paper can be used by hospitalists and hospital medicine practices as a toolkit for improving job satisfaction. It outlines the four pillars of career satisfaction.
The Second Pillar: Workload/Schedule
The workload/schedule pillar refers to the type, volume, and intensity of a hospitalist’s work as well as time pressures, variability of work, and number of interruptions. A hospitalist schedule must take all these factors into consideration.
CSTF Co-Chairperson Winthrop Whitcomb, MD, Mercy Medical Center, Springfield, Mass., maintains that this pillar is supported by the other three—autonomy/control, reward/recognition, and community/environment—but most closely with reward/recognition.
“There needs to be a reward system in place no matter what the workload,” says Dr. Whitcomb. “You can’t really talk about workload without addressing rewards. It’s human nature that in order to work hard, you need to be rewarded in some meaningful way.”
But many people—not just physicians but workers from all fields—may have separate concerns about heavy workload and just rewards.
An Example of Workload Issues
You probably know from your own experience as a hospitalist how workload can affect career satisfaction. Here is a fictional example of a hospitalist struggling with an increased patient load:
The director of my community-based hospital medicine program has mandated that each hospitalist see 15 to 20 patients each weekday, and 20 to 30 patients a day over weekends. I know this workload is too heavy to allow good quality of care. Under the pressure of seeing my quota of patients, I’m afraid I might make a mistake or miss something.
“There are physicians out there who can and do handle this type of workload, and they do it happily and well,” Dr. Whitcomb points out. “But this is only true if there is an appropriate reward system in place, and there clearly needs to be a good support system in order to provide quality of care” under this example.
CSTF says this individual should take the following steps:
Step 1: Go on a fact-finding mission. Find out whether hospitalist workload, responsibilities, and schedule at this facility are the norm. “[The hospitalist] should get an idea of what’s happening at other hospital medicine groups; he should understand the national picture,” says Dr. Whitcomb. “He might then realize that hospitalists in his group are only working 187 days a year, and that over a course of a year they’re not really working any harder than others who work more days,” says Dr. Whitcomb. “This might get him thinking a little bit differently about the workload.”
Step 2: Undertake organizational strategies. A hospitalist can find out how he or she has a voice in workload issues.“Figure out how hospitalists are represented in the structure of the group,” advises Dr. Whitcomb. “If a director is mandating how much [hospitalists] work, there has to be some mechanism for the physicians to be able to provide feedback. This often takes the shape of a compensation committee; this group is not just about compensation but about budget and sustainability for both the hospital and the hospitalists.” Physician representation—having a say in workload and schedule—is important to maintain a good balance within a hospital medicine program.
Step 3: Consider recommendations to ease workload. “You can try to change the workload through justifying adding staff or through putting systems in place that allow you to see more patients,” says Dr. Whitcomb. But what if the hospitalist considers or takes these steps and still finds his patient load to be unsustainable long term? “In terms of feeling like you’re not able to provide safe care,” says Dr. Whitcomb, “once you’ve suggested changes to the leadership and no changes are made, this may become a deal-breaker.”
Workload Leans on Other Pillars
The interesting thing about the workload/schedule pillar of job satisfaction is that, if you are unhappy with your workload, the other three pillars can sustain you and make you generally satisfied.
Dr. Whitcomb points to a 2002 article published in the Journal of Health and Social Behavior.1 The study examined a national survey of hospitalists and found that job burnout and intent to remain in the career are more meaningfully associated with favorable “community” relations than with negative experiences such as reduced autonomy.
“Workload is not a predictor of burnout as long as the other three pillars are intact,” summarizes Dr. Whitcomb.
Jane Jerrard has written for The Hospitalist since 2005.
Reference
- Hoff T, Whitcomb WF, Nelson JR. Thriving and surviving in a new medical career: the case of hospitalist physicians. J Health Social Behav. 2002 Mar;43(1):72-91
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Want a bonus check? CMS has a program for you
Quality measures are reported on the CMS claim form just as any other service would be, except that no charge is billed for the reported measure. The time frame established for the reporting of these measures is July 1 through December 31 of this year. Although there are plans to continue the program in 2008, it is unclear whether funds will be available for a bonus in 2009, and the measures for 2008 will be different from those used in 2007.
To calculate the potential bonus amount when at least 3 measures are successfully reported, use your total Medicare income for the past 6 months. If you received $60,000 for treating Medicare patients from January 1 through May 31, for example, and Medicare income has been steady, expect a lump sum bonus of $900 in mid-2008.
How do I report an intervention?
Good news: You do not have to register to participate in PQRI; you need only report the selected quality measures each time you submit a claim for the patient service to which the quality measure applies. Criteria for reporting (and then receiving the bonus in mid-2008) for these quality measures are as follows:
- Select the quality measures that apply most often to your practice (see the TABLE)
- Enter the PQRI codes on block 24D of the CMS 1500 claim form with a $0.00 dollar amount; if your system does not allow this amount to be entered, change it to $0.01
- There must be a match between the acceptable CPT or ICD-9 code reported for the overall service with a CPT Category II or HCPCS “G” code designated as the quality measure, as listed in the Medicare specifications file (www.cms.hhs.gov/PQRI/15_MeasuresCodes.asp#TopOfPage)
- Apply any applicable allowed modifier that explains why the quality measure was not assessed:
- Measure title
- Description
- Instructions on reporting, including frequency, time frames, and applicability
- Numerator coding
- Definition of terms
- Coding instructions
The numerator part of the measure is represented by a CPT Category II code with or without a modifier. CPT code 1090F (presence or absence of urinary stress incontinence assessed) would be reported if the presence or absence of urinary incontinence was assessed, but a modifier 1P is placed in box 24E of the claim form if you have documented a medical reason why this was not assessed, or modifier 8P if it was not assessed but the reason was not documented.
TABLE
The Physician Quality Reporting Initiative: 10 measures may apply to ObGyn practice in 2007
| MEASURE | CONSTRAINTS AND COMMENTS | ||
|---|---|---|---|
| #20 Perioperative care: Timing of antibiotic prophylaxis—ordering physician |
| ||
| #21 Perioperative care: Selection of prophylactic antibiotic—first- or second-generation cephalosporin |
| ||
| #22 Perioperative care: Discontinuation of prophylactic antibiotic (non-cardiac procedures) |
| ||
| #23 Perioperative care: venous thromboembolism prophylaxis (when indicated in all patients) |
| ||
| #39 Screening or therapy for osteoporosis for women 65 years and older |
| ||
| #41 Osteoporosis: Pharmacotherapy |
| ||
| #42 Osteoporosis: Counseling for vitamin D and calcium intake, and exercise |
| ||
| #48 Assessment of presence or absence of urinary incontinence in women aged 65 years and older |
| ||
| #49 Characterization of urinary incontinence in women aged 65 years and older |
| ||
| #50 Plan of care for urinary incontinence in women aged 65 years and older |
| ||
Quality measures are reported on the CMS claim form just as any other service would be, except that no charge is billed for the reported measure. The time frame established for the reporting of these measures is July 1 through December 31 of this year. Although there are plans to continue the program in 2008, it is unclear whether funds will be available for a bonus in 2009, and the measures for 2008 will be different from those used in 2007.
To calculate the potential bonus amount when at least 3 measures are successfully reported, use your total Medicare income for the past 6 months. If you received $60,000 for treating Medicare patients from January 1 through May 31, for example, and Medicare income has been steady, expect a lump sum bonus of $900 in mid-2008.
How do I report an intervention?
Good news: You do not have to register to participate in PQRI; you need only report the selected quality measures each time you submit a claim for the patient service to which the quality measure applies. Criteria for reporting (and then receiving the bonus in mid-2008) for these quality measures are as follows:
- Select the quality measures that apply most often to your practice (see the TABLE)
- Enter the PQRI codes on block 24D of the CMS 1500 claim form with a $0.00 dollar amount; if your system does not allow this amount to be entered, change it to $0.01
- There must be a match between the acceptable CPT or ICD-9 code reported for the overall service with a CPT Category II or HCPCS “G” code designated as the quality measure, as listed in the Medicare specifications file (www.cms.hhs.gov/PQRI/15_MeasuresCodes.asp#TopOfPage)
- Apply any applicable allowed modifier that explains why the quality measure was not assessed:
- Measure title
- Description
- Instructions on reporting, including frequency, time frames, and applicability
- Numerator coding
- Definition of terms
- Coding instructions
The numerator part of the measure is represented by a CPT Category II code with or without a modifier. CPT code 1090F (presence or absence of urinary stress incontinence assessed) would be reported if the presence or absence of urinary incontinence was assessed, but a modifier 1P is placed in box 24E of the claim form if you have documented a medical reason why this was not assessed, or modifier 8P if it was not assessed but the reason was not documented.
TABLE
The Physician Quality Reporting Initiative: 10 measures may apply to ObGyn practice in 2007
| MEASURE | CONSTRAINTS AND COMMENTS | ||
|---|---|---|---|
| #20 Perioperative care: Timing of antibiotic prophylaxis—ordering physician |
| ||
| #21 Perioperative care: Selection of prophylactic antibiotic—first- or second-generation cephalosporin |
| ||
| #22 Perioperative care: Discontinuation of prophylactic antibiotic (non-cardiac procedures) |
| ||
| #23 Perioperative care: venous thromboembolism prophylaxis (when indicated in all patients) |
| ||
| #39 Screening or therapy for osteoporosis for women 65 years and older |
| ||
| #41 Osteoporosis: Pharmacotherapy |
| ||
| #42 Osteoporosis: Counseling for vitamin D and calcium intake, and exercise |
| ||
| #48 Assessment of presence or absence of urinary incontinence in women aged 65 years and older |
| ||
| #49 Characterization of urinary incontinence in women aged 65 years and older |
| ||
| #50 Plan of care for urinary incontinence in women aged 65 years and older |
| ||
Quality measures are reported on the CMS claim form just as any other service would be, except that no charge is billed for the reported measure. The time frame established for the reporting of these measures is July 1 through December 31 of this year. Although there are plans to continue the program in 2008, it is unclear whether funds will be available for a bonus in 2009, and the measures for 2008 will be different from those used in 2007.
To calculate the potential bonus amount when at least 3 measures are successfully reported, use your total Medicare income for the past 6 months. If you received $60,000 for treating Medicare patients from January 1 through May 31, for example, and Medicare income has been steady, expect a lump sum bonus of $900 in mid-2008.
How do I report an intervention?
Good news: You do not have to register to participate in PQRI; you need only report the selected quality measures each time you submit a claim for the patient service to which the quality measure applies. Criteria for reporting (and then receiving the bonus in mid-2008) for these quality measures are as follows:
- Select the quality measures that apply most often to your practice (see the TABLE)
- Enter the PQRI codes on block 24D of the CMS 1500 claim form with a $0.00 dollar amount; if your system does not allow this amount to be entered, change it to $0.01
- There must be a match between the acceptable CPT or ICD-9 code reported for the overall service with a CPT Category II or HCPCS “G” code designated as the quality measure, as listed in the Medicare specifications file (www.cms.hhs.gov/PQRI/15_MeasuresCodes.asp#TopOfPage)
- Apply any applicable allowed modifier that explains why the quality measure was not assessed:
- Measure title
- Description
- Instructions on reporting, including frequency, time frames, and applicability
- Numerator coding
- Definition of terms
- Coding instructions
The numerator part of the measure is represented by a CPT Category II code with or without a modifier. CPT code 1090F (presence or absence of urinary stress incontinence assessed) would be reported if the presence or absence of urinary incontinence was assessed, but a modifier 1P is placed in box 24E of the claim form if you have documented a medical reason why this was not assessed, or modifier 8P if it was not assessed but the reason was not documented.
TABLE
The Physician Quality Reporting Initiative: 10 measures may apply to ObGyn practice in 2007
| MEASURE | CONSTRAINTS AND COMMENTS | ||
|---|---|---|---|
| #20 Perioperative care: Timing of antibiotic prophylaxis—ordering physician |
| ||
| #21 Perioperative care: Selection of prophylactic antibiotic—first- or second-generation cephalosporin |
| ||
| #22 Perioperative care: Discontinuation of prophylactic antibiotic (non-cardiac procedures) |
| ||
| #23 Perioperative care: venous thromboembolism prophylaxis (when indicated in all patients) |
| ||
| #39 Screening or therapy for osteoporosis for women 65 years and older |
| ||
| #41 Osteoporosis: Pharmacotherapy |
| ||
| #42 Osteoporosis: Counseling for vitamin D and calcium intake, and exercise |
| ||
| #48 Assessment of presence or absence of urinary incontinence in women aged 65 years and older |
| ||
| #49 Characterization of urinary incontinence in women aged 65 years and older |
| ||
| #50 Plan of care for urinary incontinence in women aged 65 years and older |
| ||