Thinking about starting a rural hospitalist program?

Here’s my advice:

1. Only administrations that appreciate physician billing as a small component of determining success of a program will survive. If your administration believes that physician billing is the most important sign of success and they make their decisions accordingly, the program is doomed to failure.
2. Don’t under staff. Many programs try to skimp by. When one doc leaves (and they will), it puts the others on the road to burnout real quick. If you can’t fully staff with enough physicians plus buffer for growing pains and the quitters, then start the program part time. Perhaps no weekends or no nights. Whatever, if you don’t have enough physicians to run the program, it’s doomed to failure from the start.
3. Be flexible. The larger your pool of candidates, the more successful you will be in starting the program.
4. Keep lines of communication open between docs and administration. Hospitalist jobs are everywhere. Administration in rural America must understand that they don’t run the show, the docs do. Why? because the docs can leave and land a job just about anywhere they want. It’s a buyers market for hospitalist medicine. It will be for quite some time. We are only getting started.
5. You’re going to have to pay more than you think. It’s rural. And it’s hospitalist. Think big.

From the Happy Hospitalist.

A Hospitalist’s Lament

Notes from Dr. RW...

"...[B]ecause the [hospitalist] role has not been carefully defined it is morphing into that of a jack-of-all-trades house doctor, a career few of us signed up for.

"Uncritical enthusiasm for some nebulous notion of 'comanagement' has blurred the boundaries of responsibility among hospitalists and other specialists and forced hospitalists into clinical encounters way beyond the scope of their training, pushing them out of their comfort zones and creating liability concerns.

"Under the rubric of comanagement some hospitalist programs are being made to function as H&P and discharge planning services in which they perform the clerical scut work on surgical and subspecialty patients who have no need of their clinical expertise.

"Hospitalists are increasingly coming to be viewed as administrative and business solutions more than clinicians. Not exactly what a candidate looks for in a career.

"These factors may increase the risk of burnout, increase turnover in hospitalist programs and exacerbate the shortage in the work force."

Continued...