Teaming up for better hospital medicine

Abstract

FigureFigurePhysician assistants (PAs) are a valuable part of the hospitalist team, and the Society of Hospital Medicine (SHM) has recognized that by expanding its popular Fellows program to include PAs. Hospital medicine is the fastest growing specialty in the history of American medicine. The forces that have fueled this rapid growth include the pursuit of higher-quality patient care among a higher acuity patient population, hospitals' realization of the financial advantages of hospitalists managing their patients, and the relative decrease in resident workforce as a result of duty hour restrictions by the Accreditation Council on Graduate Medical Education. These are not likely to abate soon, so the demand for practitioners of hospital medicine will intensify. PAs are and will continue to be called upon in increasing numbers to fulfill this growing need. Conceptually, PA-based teams have a lot to offer the field of hospital medicine, which has embraced the value of a team-based approach in caring for complex and severely ill patients. A variety of models for the hospitalist physician-PA team has emerged, each adapted to the unique requirements and characteristics of the clinical environment. This nascent landscape of PA-based hospitalist teams brings with it challenges and opportunities-–two sides of the same coin. A rigorous evaluation urgently is needed to quantify the promise of the synergistic addition of value to patient care by PA-based teams. The various models of these teams need to be described and best practices established to guide their deployment. Simultaneously, PAs must become active in hospital medicine program leadership and design. In November 2012, we at SHM expanded the eligibility for our Fellow in Hospital Medicine (FHM) program to include PAs, NPs, and hospital medicine practice administrators. The program, which has inducted more than 1,100 Fellows and Senior Fellows since 2009, is designed to recognize clinicians who have demonstrated a commitment to hospital medicine, the Society's Core Competencies, system change, and quality improvement principles.1 The expansion of the program exemplifies SHM's philosophy that team-based collaboration is a cornerstone of quality healthcare. In the words of SHM Immediate Past President Shaun Frost, MD, SFHM, “The standards by which SHM Fellows are measured promote the highest quality of patient care and system efficiency. And they can be equally applied to physicians, PAs, NPs, and administrators within the hospital medicine specialty.” Candidates for the SHM Fellows designation submit applications that demonstrate experience, organizational teamwork and leadership, and a dedication to lifelong learning. The most recent Fellow in Hospital Medicine (FHM) and Senior Fellow in Hospital Medicine (SFHM) classes were inducted at SHM's 2013 Annual Meeting last May. This group included the inaugural class of PA Fellows. SHM has long aspired to be a “big tent” society, and this extension of Fellow recognition, unique among medical professional organizations, proves that we are serious about it. For more information about the program and qualifications for candidacy, visit http://www.hospitalmedicine.org/fellow.