"Poster Child" for Hospitalist Movement Changes Career Track: Confessions of an X-Hospitalist

The author of the blog In My Humble Opinion shares his rational behind a career change:

"I was once a hospitalist. In fact I was even featured in an article about hospitalists. Yep…that's me. Horrendous picture though… isn’t it? The patient I was taking care of was 97. She died about a year later in a nursing home. How do I know that? Because at the time I was transitioning to outpatient medicine. I became her primary care physician. So why did I make the change? And how much of a change was it for me? Recently I saw two patients discharged from hospitalist services. I think these cases illustrate the problems with this type of system."

The hospitalist system as a whole appears to be both viable and beneficial though. At least according to a recent NEJM study and the news about the planned IPO of one of the largest private hospitalist companies -- IPC The Hospitalist Co. ups deal size for IPO. According to MarketWatch: "The North Hollywood, Calif. provider of inpatient care raised $83 million by offering 5.2 million shares in the middle of its $15-$17 price range. In a sign of health, the company increased the size of the offering from 4.7 million shares."


Riding the Hospitalist Boom to an IPO. WSJ.

References:
Confessions of an X-Hospitalist. In My Humble Opinion.
What the Heck is a Hospitalist? North Shore Magazine.
Today’s New England Journal Hospitalist Study. Wachter's World.
Outcomes of Care by Hospitalists, General Internists, and Family Physicians. NEJM.
Image source: sxc.hu

Related:
Being a good hospitalist includes talking with the patient and the outpatient physician. DB’s Medical Rants, 01/2008.
A List of Hospitalist Blogs
Another Study Questions the Value of Hospitalists
Definition of "Hospitalist" Added to Merriam-Webster Dictionary
What I Learned from Making the Website of the Cleveland Clinic Hospitalists
SHM Annual Meeting and Cleveland Clinic Hospitalist Section
Audio: Hospitalist Medicine. One of the executives of IPC, Glen Applebaum, discusses hospitalist medicine as a career. Podcasting Project for the UT Internal Medicine Residency Program.

Updated: 03/31/2008

Dr. RW Shares His Impression of 4th annual Mayo Clinic Update in Hospital Medicine

Notes from Dr. RW is one of the hospitalist blogs I subscribe to. The posts listed below are definitely worth-reading if you organize a CME course or you think of attending one:

Thoughts and impressions on hospital medicine CME

Alternative medicine promoted to hospitalists attending CME course

Fondaparinux and HIT---the bubble has burst

Random observations from the hospital medicine CME conference

More clinical pearls from the hospital medicine CME conference

Hospital medicine CME conference: final reflections

References:
A List of Hospitalist Blogs
Using Web Services to Enhance a Medical Education Course

A List of Hospitalist Blogs

Below is the list of a few prominent (and not so prominent but still interesting) blogs authored by hospitalists:

Wachter's World. Author: Robert M. Wachter, MD is Professor and Associate Chairman of the Department of Medicine at the University of California, San Francisco. The term "hospitalist" was first coined by him in 1996 in the NEJM article The Emerging Role of "Hospitalists" in the American Health Care System.

DB’s Medical Rants. Author: Robert M. Centor, MD, Chief, Division of GIM
University of Alabama at Birmingham and President of SGIM.

Notes from Dr. RW. Author: R. W. Donnell, a hospitalist in Northwest Arkansas.

The Hospitalist Blog. Author: Adam D. Singer, MD, Chairman, CEO and founder of IPC, one of the nation’s largest private practice hospitalist companies.

Fat Doctor. Author: Anonymous, DO.

The Happy Hospitalist. Author: Anonymous, MD.

RangelMD.com. Author: Chris Rangel, MD, a hospitalist in Texas.

Clinical Cases and Images - Blog (the blog you are reading now)

Please feel free to add any other notable hospitalist blogs in the comments section below.


Riding the Hospitalist Boom to an IPO. WSJ.

Related:
Definition of "Hospitalist" Added to Merriam-Webster Dictionary, 11/17/2005.
SHM Annual Meeting and Cleveland Clinic Hospitalist Section, 5/31/2007.
What I Learned from Making the Website of the Cleveland Clinic Hospitalists, 8/11/2006.
Bob's Favorite Links: Robert Wachter shares his own list of favorite blogs. I am happy that CasesBlog tops the list currently as of 11/21/2007.
Image source: sxc.hu

Updated: 03/31/2008

A Hospitalist Night On Call

FatDoctor (her choice of pseudonym, not mine) is a hospitalist who had an eventful night on call and post-call day but she liked it. Here is the summary:

15 hours worked
1 direct admit
1 consult
9 ER admissions
38 calls from nurses
5 problems that needed immediate attention
13 moments of laughter with nursing staff
0 code
0 rapid responses
1 “stat medical consult” as I was on way out to parking lot

Read the rest in But, Who’s Counting? by FatDoctor.org. She also writes: "My work at urgent care and as a hospitalist is like the Jiffy Lube of healthcare. We can change your oil, but for real care, better see your PCP."

Further reading:
Practicing cost-effective medicine. One clinician's top 10 tips. Robert M. ACP Hospitalist, 2007.
Achilles Heel. FatDoctor.org.
Lube Job. FatDoctor.org.
Some Tips from a Hospitalist. FatDoctor.org.
In the Fatosphere, Big Is in, or at Least Accepted. NYTimes, 01/2008.

Updated: 01/21/2008

Salary Stories: Hospitalist

Salary Stories Blog has an interview with Frank L. Urbano, MD, FACP who is also the author of several case studies on PrimeInc.org:

"I typically see between 20 to 30 patients per day, and that allows me to have a generous hospitalist compensation package. Hospitalist practices generally have very small overhead compared to outpatient offices, so hospitalist salaries can be higher."

Another hospitalist by the blog name of FatDoctor writes: "My work at urgent care and as a hospitalist is like the Jiffy Lube of healthcare. We can change your oil, but for real care, better see your PCP."

Related:
Definition of "Hospitalist" Added to Merriam-Webster Dictionary
Another Study Questions the Value of Hospitalists
Physician Assistant Salaries: A Day in the Life of a Physician Assistant. Salary Stories.
Lube Job. FatDoctor.

Updated: 10/02/2007

Medicare Will Not Pay for Hospital Errors -- How Do You Define a Hospital Error?

According to KidneyNotes:

"Look for the definition of an "error" to be expanded dramatically... Central line infection? C. difficile colitis? Ventilator associated pneumonia?"

The initial six conditions on the Medicare list are:

1. pressure ulcers
2. catheter-associated urinary tract infections
3. Staphylococcus aureus (shown above) septicemia
4. air embolism
5. blood incompatibility
6. object left behind in surgical patient

Number 2 and 3 are hospital-acquired infections and numbers 4-6 were to be called "never events." Besides those on the list for 2008, seven more conditions are under consideration for 2009, according to AMNews.

Further reading:
Medicare Says It Won’t Cover ‘Preventable’ Hospital Errors. NYTimes, 08/2007.
Medicare plans to stop paying for 6 hospital-acquired conditions. AMNews staff, June 18, 2007.
Medicare No Longer Willing to Pay Hospitals for Preventable Medical Errors. MSSPNexus Blog, 08/2007.
Medicare won’t pay for mistakes? Notes from Dr. RW, 08/2007.
An Inexact Science. Musings of a Dinosaur, 08/2008.
Preventable medical errors, from Wikipedia, the free encyclopedia.
Let Me Sprinkle Some Fairy Dust On My Patient. The Happy Hospitalist, 01/2008.
Image source: Wikipedia, CDC.

Updated: 01/15/2008

Using a Blog to Build an Educational Portfolio in Academic Medicine

What is an "educational portfolio"?

Let me explain. I am an academic hospitalist at the Cleveland Clinic. The goal of our section is to be the best academic hospitalist group in country. "Academic" means that we devote a significant amount of our time to research and teaching. This time has to be accounted for and for that purpose each of us builds an educational portfolio -- a collection of research ideas, projects, presentations, manuscripts and published articles. A blog can be the perfect solution to building an electronic educational portfolio.

Collecting your research ideas (and asking for feedback) is actually a very valuable exercise not dependent on your current position -- a medical student, resident, academic or private practice physician. Medicine is all about life-long learning, isn't it?

How to use a blog to build an educational portfolio?

All blogs place a time stamp on the posts and are in a reverse chronological order, thus placing the newest ideas on top. Reading a recent Scoble post, I realized that Google makes it really easy to find what you have written weeks or even months ago: just search for a particular topic adding your blog name to it: example. Scoble's example is naturally not related to medicine at all but the idea is what is important there:

One of the first things I learned about blogging back in 2000 was it is an awesome way to stick things into Google. If you find a new restaurant, for instance, and they don’t yet exist in Google, if you write about it on your blog invariably it’ll be there within a week.

I regularly write about things for the SOLE purpose of putting them on Google. Same thing with my link blog.

It’s very easy to pull them back out, too. Just add your blog’s name to a Google search.

For instance, I remember I wrote about a coffee place in Redmond. Forget the name? Just ask Google for it back out. This works consistently well.

You can choose whether to make you blog accessible to everyone (recommended, since it invites feedback) or confidential. Currently, the best and easiest service to start a blog seems to be Blogger.com, owned by Google.

Related reading:

"One of the best decisions I’ve made in my career was to start a blog and a wiki, leaving a paper trail of ideas" http://bit.ly/GX7Z6C
The power of blogging on Google. Scobleizer.
Blogs Are Increasingly Venues for Scholarship. Open Medicine Blog, 01/2008.
Developing a virtual personal network. BMJ Career Focus 2007;334:13-15.
Web 2.0 in Medicine 2006-2007 (PowerPoint file).
Feature: 5 Reasons to Use WordPress as CMS. BloggingPro, 2007.
How To Use Your Blog To Make 2008 Your Best Year Ever! LifeHack.org.
Video presentations: Novel concepts and easy-to-use web tools for researchers. European Molecular Biology Laboratory, 2006.

Blogs as Web-Based Portfolios Part 2. Thinking Stick, 2010.

Blogs as Web-Based Educational Portfolios - free eBook PDF http://goo.gl/BXCF

As A Busy Physician, Why Do I Even Bother Blogging? http://goo.gl/fSF3 - Excellent summary.
Beautiful example of how blogs can disseminate medical information much more efficiently than journals, NEJM included (http://goo.gl/rOvNq).

Note: After working at the Cleveland Clinic and Case Western Reserve University as a Clinical Assistant Professor for Medicine for 3 years, I moved to Creighton University to complete an Allergy and Immunology fellowship. I now work as an Allergist/Immunologist and Assistant Professor of Medicine and Pediatrics at the University of Chicago. This blog post was written during my work at the Cleveland Clinic.