hospitalists

From “The Garden of Earthly Delights,” by Hieronymous Bosch.

Jeff Goldsmith,  president of Health Futures Inc. and associate professor of public health sciences at the University of Virginia, writes in Hospitals & Health Networks:

“I have believed for years that healthcare management programs have underprepared their graduates for the complexities of even understanding, let alone managing, medical professionals,” who are, he half-jokingly says,  different species.

He suggests that hospital executives learn this about the new class of physicians:

“For their entire training, they’ve been supervised by other physicians: the faculty ‘officer corps’ and the ‘noncoms,’ i.e., senior residents and fellows. They saw folks in suits in the halls {such as hospital executives}, but had the dimmest notion what the ‘suits’ actually did for a living. ”

And:

Younger physicians ”remain fiercely competitive and empirical.”
 
”They actually care about the people they are taking care of.”

”{W}with the possible exception of the pediatricians, they will never (a word I don’t use often) care about the people they are not seeing as much as they do about the patients in front of them. They will work hard to help their patients understand their role in their own health. But your physicians have been trained to take care of patients, not the rest of the community.” {Translation: Don’t get your hopes too high about physicians embracing population health.}
 
”They have learned a lot from watching their elders. There is a lot of discussion in medicine right now about how Generation Y doctors are different from their workaholic elders. Most younger physicians don’t want to practice 100 hours a week. …. Striving for work-life balance looks like wisdom derived from closely studying their {burned out} elders.”

”Don’t expect the best of them to stick around if you cannot adequately support their practices.”

“Don’t expect a lot of help reducing patient care costs.”

”If we expected employed physicians to actually reduce the cost of care, we’re learning sadly that their training has pointed them in a very different direction. Even younger hospitalists and intensivists have had trouble with more resource-sparing clinical decision-making. They will need to be retrained, and that will happen only with effective physician leadership.”

”Younger physicians are, however, team players, and far more comfortable practicing as part of a team than all but a handful of their elders. This bodes well for their willingness to adopt and practice evidence-based, protocol-driven medicine….But don’t expect them to practice protocol-driven medicine unless they feel the outcome is defensible based on available science.”