Background: As the field of HM continues to evolve, many hospital medicine groups (HMGs) are expanding their scope of practice outside of the care of the hospitalized patient. Our HMG, a 120-physician team working at 2 tertiary care hospitals in the New York Metropolitan area, is no exception. Over the past 3 years, our HMG has increased in size, owed to expansion of clinical services and presence into the fields of research & education.
Purpose: With a rapid expansion and evolving focus we have made an effort to maintain and expand the tripartite mission (excellence in clinical care, education, and research) while adding a 4th dimension of wellness.
Description: Our HMG has introduced initiatives to achieve this mission. In the clinical domain, we have established accountable care units to help standardize clinical care, throughput, & readmission prevention. These efforts have shown improvement in operational metrics (decreased LOS, increased early discharges) and clinical outcomes (unchanged mortality rates from 2018 to 2019 despite increased CMI, 2% increase in patient satisfaction scores from 2017 to 2019, decreased readmission rate from 2018 to 2019). Additionally, we have completed faculty development programs focusing on the changing landscape of our clinical care (geriatrics, surgical co-management & critical care) which have led to improved comfort levels in these areas. In the education domain, we have promoted development for teaching faculty with weekly “teaching tips” emails from residency leadership, monthly teaching hospitalist meetings focused on faculty development, & an annual “Teaching Hospitalist Boot Camp” for new hires. These efforts have helped maintain our HMG’s teaching evaluation scores above the Department of Medicine average. In the research domain we have developed a “Scholars Program” designed to nurture faculty with an interest in research, providing them mentorship and the skills to develop research projects. Our initial cohort in this program has three well-developed research projects ahead of schedule for manuscript submission. Additionally, with an increased focus on giving hospitalists time and mentorship to thrive in the area of research, we have an increased academic output (from 2018 to 2019, 20% increase in SHM abstracts; 10% increase in manuscript publications in high impact journals) and academic promotion in our group (3 hospitalists promoted to Associate Professor in 2019). In the physician wellness domain, we have adapted increased scheduling flexibility in our hybrid schedule with the addition of 7 on/7 off rotations based on hospitalist input. We have implemented an automated scheduling system which has led to increased scheduling satisfaction in the HMG (increase in scheduling satisfaction from 54% to 67%) We have started highlighting a “Hospitalist of the Month” at our monthly division meeting. We have appointed a “social chair” at each site to organize social events for our group. Additionally, the implementation of our accountable care units, each with a physician lead, has lead to leadership opportunities in our HMG, promoting our hospitalists and providing a sense of achievement for our physicians. These efforts have led to high levels of retention and above average physician engagement and alignment scores as compared to peer groups.
Conclusions: During our rapid expansion over the last three years, we have seen our HMG blossom in multiple domains. By providing support and starting innovative programs we have made great strides towards our academic mission.