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Hospitalists must be ‘system engineers’ in the future

ORLANDO, Fla. – Despite significant disruptive forces in health care, hospital medicine “is positioned about as good as any specialty can be positioned,” Laurence Wellikson, MD, MHM, CEO of the Society of Hospital Medicine said here.

The dilemma is that the scope of the hospitalist “is going to expand as the institutions are changing,” he said at Hospital Medicine 2018.

Wellikson referred to consolidations of hospital/health systems and insurers; and hospital management companies – such as Fresenius’ acquisition of Sound and Cogent, and TeamHealth’s acquisition of IPC.

He said there are “new-fangled bedfellows” like CVS Health and Aetna, and Cigna’s purchase of Scripts; and “even more disruptive and curious is” Amazon-Berkshire Hathaway-JP Morgan “get together and look at their 1.1 million employees and say, ‘we think we can devise a better health care system.’”

“And these are just the beginning,” he said noting future, potential disruptors like Amazon and Apple who are expanding their scope in health care, and artificial intelligence.

“There are 61,000 hospitalists. What are you going to do when there is no more hospital care?” he is often asked.

New models are emerging such as hospital at home, microhospitals and the conversion of existing hospitals to specialty hospitals.

“This changing landscape is that hospitals are not going to be defined solely by acute care,” he said. “They already get more than 50% of their revenue from outpatient services. ... And hospitals are moving from being a revenue source to an expense. And the whole era of population management forces an institution like a hospital – the most expensive part of the health care continuum – to look at how they should do things differently.

“We have to decide what kind of specialty we want to be,” he said. “Are we going to lead or are we going to follow?

“We have to very quickly move to be a specialty where we are the system engineers. Where we are evaluating and improving systems in innovative ways. That as hospitals and health care evolves that we are central to that evolution.”

However, Wellikson warned that the skills learned in residency will not be enough and hospitalists will be asked to do more, particularly in post-acute care.

Additionally, hospitalists will expand their roles in perioperative care where they already play an integral role; and critical care and palliative care.

There are only 4,000 board-certified palliative care physicians. “This is an opportunity for hospitalists to up their game,” he said noting that the Society of Hospital Medicine is creating resources in palliative care and critical care.

The remainder of the hospitalist’s career will be an evolutionary process and there will no longer be a steady state, he said.

Hospitalists will win if they understand team-based care, evidence-based medicine, care transitions and become system engineers.

“I am absolutely as confident as I have ever been that hospitalists will be right in the middle of what is going to happen [and] that this country needs the skillset that hospitalists provide,” he said. – by Joan-Marie Stiglich, ELS

Reference:

Wellikson L. Future challenges for hospital medicine: A specialty in evolution. Presented at: Hospital Medicine 2018; April 9-11, 2018; Orlando.

Disclosure: Wellikson is the CEO of the Society of Hospital Medicine.