Leadership in Hospital Medicine

Organizations which grow rapidly often fall behind on managers. Those embarking in unchartered waters especially need to keep pace with the management skills, financial realities and the language of numbers. Hospitalists as an organization have grown rapidly, recruiting unsuspecting physicians who get intimidated by the mere mention of numbers and figures. The Society of Hospital Medicine (SHM) conducts a survey of hospitalist group leaders every two years, which collects data about salaries, work hours, hospital support, etc. It was shocking to note how many hospitalist group “leaders” did not follow figures around their cash flow, revenue, or margin; the basics of any business. It is intimidating for many hospitalist group leaders to walk into a chief finance officers den, be presented with charts, numbers and figures, and have intelligent and meaningful discussions on their groups’ financial health.

The Society of Hospital Medicine has done an amicable job in organizing a leadership academy, which meets twice every year. The academy’s popularity is a proxy of everything I mentioned above. Hospitalists are willing to pay hefty sums to learn the tools of this trade, which are not covered in any medicine curriculum. Walking in the Society’s foot steps are the likes of EmCare, Team Health and Cogent, multistate management companies that have arranged their own leadership training camps. While these boot camps have definitely armed the leaders with people skills, provided clues about management proficiency, and helped with scheduling and team building, they fall short of educating them how to navigate the maze of healthcare finance.

After the success of leadership academy 1, the Society of Hospital Medicine has now incorporated a second part in the academy. This part 2, however, presented more of the same, rather than addressing what was lacking. The Society has done its job in training group leaders, but has failed to provide them with the necessary financial jargon and vocabulary. The next step is the revision of part 2 of the academy curriculum to provide more training in numbers and finances. Physicians who have learned the basic management skills in part 1 can then round off their skills with financial training in part 2. So we don’t get surprised by group leaders asking about the difference between RVU and work RVU.

With the organization now more than 20,000 members rich, there is also need for developing a level beyond leadership academies 1 and 2 to train leaders managing at regional and national levels. The hospitalists are still a new group, trying to find and develop processes, bargaining rates and services, defining roles, and fighting for their own board and reimbursement. There needs to be a better trained leadership, equipped with bargaining techniques, familiar with advocacy and Washington ways.