Does a Hospitalist Get Any Kind of Special Training?

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At this point, it's mostly the same. So, most of them do their training in general internal medicines. Some of them do family medicine and some of them do pediatrics and do the same taking care of sick kids in hospitals. So most of them that is their training and in fact their training is better suited for them to become hospitalist than what most of them in the old days ended up doing which was to become primary care doctor.

So, my training in internal medicine back in 80s, I really trained to be a hospitalist. 80% of my training time was spend in hospitals and the fact that most of my colleagues who had that training ended up doing primary care. That was the mismatch, we didn't train them very well for what their practice was going to be, which was going to be largely and meet these days Medicaids is completely aguratory in the clinic.

For an increasing number of people that want to be hospitalists, they recognize that there is a core skill set that were beginning to train people in but we are still not great at and that is close from a mantra that I developed for the hospitals field. And my mantra is that a hospital has two sick patients.

One is the person that he or she's taking care of and the other is the building that they are working at. And the notion here is what we sometimes use a shorthand and call system thinking. The real [XX] for us has been quality is not very good, safety is not very good and the reason is not that the doctor is not smart enough or careful enough but the systems that we work in are dysfunctional.

And that in order to make those systems better, if the doctor says that's not what I do for a living, I'm a doctor, all I do is I take care of individual patient. Fixing the system, developing check list, improving the information technology system, that's some job for a hospital administrator.

That's a huge cope out because in fact when the hospital administrators tried to take that on and the doctors don't buy into it and don't participate then, the result doesn't work because we really need the deep knowledge of the clinicians of the way the system works. And so, then we mourn about it.

We say oh! they don't really understand our work but we made our bed, we weren't involved. It's my believe and I think increasingly a core belief in internal in medicine generally, that the doctor of the future, the great doctor of the future has to embrace this notion of systems that came.

Has to appreciate the fact that if their job is to deliver the best care at the lowest cost. I believe is their job, that we need to be experts and not only traditional doctoring, but also in systems engineering. And one of the fun things for us about the hospitals field was here with this new specialty emerging fifteen years ago, in an era where it was being starting becoming quite clear that the system was broke and needed to be improved and doctors needed to get involved.

So one of the things we really did was position the field as being not just a new specialty, but a new type of specialty where the physicians saw their role as having this duality to it. So for hospitalists who were training to be hospitalists many of them are doing an additional year or two of fellowship.

We run one, there many around the country, and they are actually not learning very much more clinical hospital medicine. They've finished their training and they are pretty good at taking care of patients with septic shock, or severe infections, or gas, or intestinal breading. What they don't know enough about is leadership, systems thinking, team work, building information technology systems and we believe that these are absolete core competencies not just for hospitals for all the doctors in the future.