Sunday, May 17, 2009

Hasta Luego Chicago

So, I am finishing up the Society of Hospital Medicine 2009 meeting. I walk away with mixed feelings.

For one, it was refreshing to hear that many of the struggles that our hospitalist program has are not unique. On the other, it's clear that a lot of places "get it" and are light years ahead of my program when it comes to clearly defining the limits and scope of what a program of a certain size can/should do. As a Med/Peds physician, the special interest group was mostly cathartic, but did give me renewed purpose in trying to effect positive changes.

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. 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.

I thought the discussions on Quality Initiatives summed up the issues very succinctly, and I especially enjoyed the fact that SHM convinced one of Satan's Minions from United HealthCare to weigh in. I thought Dr. Susan Freeman (of the Jedi Knights) was exceptional. Watching her counterpointing Steven Stern was tremendous. But at the end of the session, it had the feel of two warriors shaking hands, knowing that the real war was about to begin.

I didn't hear anyone bring up the fact that "bundled payments" in 2009-2010 has very different implications than it did the last time it was tried. A shit-ton more of us are employed by hospitals now. When trying to divvy up the breadcrumbs, and as "not-for-profit" hospitals guard their profit margins, what's the place of the hospital-employed physician at the table?

The discussion of readmission rates and post-hospitalization care was important, but I was quite disturbed at the murmurs of suggesting that hospitalists now take over some of those outpatient duties post-discharge. Hospitalist medicine emerged because primary care doctors could no longer effectively do clinic AND inpatient medicine. In our community, the primary care doctors that we started admitting for immediately boosted their clinic schedules. And that's fine... unless we can't get your damn inpatients to follow up with you. I think that this is an area where the onus does fall back on the primary care doctors. In our community, they used to be responsible for all the unassigned admissions AND their follow up. I just bristle at the suggestion that the job of the hospitalist needs to start morphing back into the very profession we all found so dissatisfying.

Finally, as someone who drives a fair distance to serve a rural-esque population, it struck me at the "Exhibition Hall" how disingenuous recruiters are when trying to convince physicians in a hot market to give up major aspects of what make a location desirable in exchange for promises of cash. I almost wish they would be banned from the whole enterprise next year. I realize they represent a significant revenue stream for SHM, but can we at least separate the people who have clinical information for us from the snake oil vendors? We're not stupid. A hunting/fishing "paradise" that's less than an hour (55 minutes at 85mph) from a regional airport makes lofty compensation promises that always always come with strings attached.

I really wish they would just say, "This place sucks, but here's what we're going to offer you in terms of compensation/work schedule that we hope makes up for it." Instead of pictures of babbling brooks and fields of wildlife, those booths need to read like an offer letter. Just a suggestion.

All in all, it was a great experience, and I look forward to next year. But for the love of god, get more chairs.

1 comment:

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