Latest news with #hospitalist
Medscape
5 days ago
- Health
- Medscape
Key Challenges Faced by Today's Hospitalists
On any given day, Andrea Braden, MD, must make quick clinical decisions about hospital patients who require emergency care. Her biggest challenge as a hospitalist is 'the anxiety around never knowing what is going to come in the door that day,' said Braden, who is also an OB/GYN and lead clinical educator for TeamHealth in Atlanta. 'There is no way to predict whether your day will be calm or disastrous. I think having to be prepared for both scenarios at all times is what keeps us hospitalists on edge. It's also what makes us great at our jobs — the ability to take control of emergencies and guide our teams appropriately.' Braden and other hospitalists share their most common day-to-day challenges with Medscape Medical News . Healthcare Funding and Insurance The role of a hospitalist doesn't end at discharge, said Monique Nugent, MD, a hospitalist at South Shore Hospital in Weymouth, Massachusetts. Nugent said her biggest challenge is the ever-changing landscape of healthcare funding and what insurance companies will cover, such as medical services and devices that help her ensure the continued health of her patients after they leave the hospital. 'It affects the care I can give people and affects their long-term prognosis,' she said. While Nugent is thankful for the work of her case management team, she said she still spends a lot of time working around what insurance will pay for patients' healthcare needs. 'I have to make sure I prescribe meds they can get,' Nugent said. 'Can they get into rehab or long-term care? Can they safely be at home? Are they able to access specialists after discharge?' If a patient qualifies for certain services, such as hospital-at-home, the next step would be to ensure that service is available in their area, Nugent said. For instance, someone who lives in a rural community may come to a Boston-area hospital for a stroke. After discharge, however, a patient may not have access to certain rehabilitation services, or their insurance may not cover services to ensure they continue to improve once they are released from the hospital, she said. Another example: If a patient prefers hospice care at home, will their insurance cover what's needed for this? 'How can I help navigate that so that they will be supported?' Nugent said. Balancing Act Ethan Molitch-Hou, MD, cited time constraints as a primary challenge for hospitalists. 'We have limited time to care for complex patients who are only getting sicker as we move more care to outside of the hospital,' said Molitch-Hou, who is an assistant professor of medicine and director of the Hospital Medicine Sub-Internship at the University of Chicago Medicine, Chicago. 'There is a constant battle to balance handling your sickest patients who need your focus and time to get the correct diagnosis and treatment, while the push for an early discharge or assuring your patient who is unhappy about events in the hospital (that may be out of your control) is also cared for,' he said. 'Conversations that you know require time and nuance can be interrupted by a page about something that, at the moment feels, less consequential, such as a stool softener when in the middle of a rapid response for a hypotensive patient.' Despite the time constraints, Molitch-Hou said hospitalists need to clearly communicate their care plans to their patients and families to ensure compliance. He said hospital physicians need to remember the reason they went into medicine and focus on the positives. Those are keys to having a long career in hospital medicine, he said, 'and for me, having variety in my week-to-week responsibilities has kept the job fresh.' Between Empathy and Burnout As a hospitalist working in a cancer hospital for the last 9 years, Nikhil Sood, MD, said one of his most persistent challenges is 'managing clinical uncertainty amid high emotional intensity.' 'On particularly tough days, when I feel mentally and physically drained after a difficult conversation about prognosis and care goals with a family, it becomes harder to be fully present, listen intentionally, or provide the high level of care I expect of myself,' said Sood, an internist and hospitalist at Banner Gateway Medical Center in Gilbert, Arizona. Unlike in general medicine, the symptoms of his patients tend to be specific to the individual and don't always align with typical textbook patterns, Sood said. 'Each decision comes with substantial weight and little margin for mistakes,' he said. Many oncology patients are immunocompromised, and complications may escalate quickly from seemingly benign symptoms, such as a low-grade fever or vague abdominal pain, he said. 'Symptoms frequently represent a delicate balance between disease progression, treatment side effects, and secondary issues, such as infections, thromboses, or metabolic imbalances,' he said. Lab results can be ambiguous with imaging yielding inconclusive findings. 'Layers of uncertainty often obscure the 'right' answer,' said Sood. 'As a hospitalist, I am expected to swiftly navigate these gray areas, assimilating comprehensive oncologic histories and making urgent choices in the absence of perfect information, all while ensuring compassionate communication with patients and their families.' Meanwhile, many of his patients and their families are knowledgeable, highly engaged, and expect informed answers, he said. 'Delivering bad news is a routine part of my work, yet it never feels ordinary. Compassion fatigue is a genuine concern, and I continuously navigate the fine line between empathy and burnout.' Sood said he's grateful to his employer for understanding the intense challenges of oncology care and offering social outings, regular wellness initiatives, and 'a culture that prioritizes mental health and self-care.' Despite the challenges, Sood finds his role 'profoundly meaningful and rewarding,' he said. 'The privilege of being part of a patient's most vulnerable moments — whether filled with hope or heartbreak — is something I always value.'
Medscape
06-05-2025
- Health
- Medscape
FAQs About Working as a Hospitalist
Hospitalists serve a unique role in patient care. Rather than focus on a specific organ system or disease, hospitalists specialize in the comprehensive care of hospitalized patients. They see patients of all ages and backgrounds dealing with chronic and acute illnesses, emergencies, surgeries, and a range of other causes that have put them in the hospital. A 2022 report from the Society of Hospital Medicine determined that there were around 44,000 hospitalists in the United States, and those numbers were only climbing. For medical students seeking a better understanding of what it means to pursue a career in hospital medicine, we turned to Heather Nye, MD, professor of medicine at the University of California San Francisco and associate chief of medicine at San Francisco VA Health Care System, San Francisco. She also serves on the Board of Directors of the Society of Hospital Medicine. Medscape Medical News asked Nye to share five key aspects about working as a hospitalist. Her responses are given below: At what point did you decide to become a hospitalist and why? 'I decided to become a hospitalist near the beginning of the movement in the late 1990s. I worked with brilliant hospitalists as a resident and learned about their jobs, their ability to teach residents and make quick, high-impact decisions for sick inpatients. It seemed fun and not at all mundane. It's been a thrill to watch the field grow into many different niches in need of experts, such as skilled nursing facilities, palliative medicine, perioperative medicine, addiction medicine, etc. We are problem solvers with a broad lens and our impact continues to grow. Hospitalists are now the healthcare system experts — often serving in C-suite roles, quality and patient safety leadership roles, and many other critical operational areas. [Hospitalists are] well-poised to address the rapidly changing landscape of medicine today.' What are work-related challenges that may be unique to hospitalists compared with other specialists? 'Hospitals never close. As a result, hours and schedules for hospitalists can be intrusive — and regularly include nights, weekends, and holidays. While the spry and youthful hospitalist just out of residency is accustomed to this work schedule, as family responsibilities grow — and as we enter mid-to-late career — the 7 days on, 7 days off or other common schedules can be grueling. Another challenge is the breadth of our practice. Like outpatient primary care physicians, our ground covers every organ system, psychosocial issues, and everything in between. In a patient with heart failure, acute coronary syndrome, kidney failure, and out of control diabetes, the fourth left toe pain is still under your purview and may be a meaningful sign of underlying process that must be addressed.' What are keys to effective communication with patients? 'I've always believed that hospitalists are the consummate interpreters. We synthesize loads of complex information coming from specialists, diagnostic studies, and knowledge of procedures and treatments and must simply describe options, connect the dots between systems, and help patients make decisions around treatment options. This is a heavy lift, and my favorite part of being a hospitalist. Creating an 'aha' moment for a patient by drawing a simple figure on a piece of paper — for example, the kidneys and bladder and how urinary obstruction causes problems — is a very effective strategy. Writing out on a whiteboard pain regimen options available to patients or discussing medications and indications for each is often eye-opening and not done nearly enough for patients. Sitting at the bedside has been shown to be effective time and again for making patients feel heard and promoting good communication.' What's a typical schedule for a hospitalist? 'Many hospitals employ 7 days on, 7 days off strategy with 8- to 12-hour shifts for days and 8- to 12-hour shifts for nights. Academic centers, like my own, have a number of different services — such as resident ward teams, hospitalist ward teams, surgical comanagement, and consults — each of which may have a different stretch of time covered. In systems with resident inpatient teams, a hospitalist attending physician will often be on for 1-2 weeks at a time. At my facility, we do sporadic weekend and evening shifts to ensure a hospitalist is available 24/7 for admitting, resident supervision, and hospital emergencies.' What's a common misconception about hospitalists? 'One misconception might be that hospitalists are glorified residents and do not have a specific skillset or knowledge base required for practice. This couldn't be further from the truth. First of all, acute care medicine is very different than primary care and requires procedural skills, quick synthesis of information, and knowledge of appropriate diagnostic studies. The syntheses of multi-organ illnesses is also a unique area in which hospitalists excel. Secondly, understanding and mastering hospital systems is sometimes as important as clinical knowledge in caring for patients admitted to the hospital. Navigating these systems swiftly and effectively can be critical for optimal outcomes, and most especially, transitions back to the community. I like to say hospital medicine is 'full service' medicine — bedside to home.'
