Academic Hospitalists

 View Only

  • 1.  Teaching Shift versus Direct Care Shift

    Posted 09-06-2024 14:39

    Hello everyone,

    I hope this message finds you well. I have a question regarding how clinical service is counted toward annual requirements in your programs. In our GIM division, we have long been dualist physicians, but I'm encountering some pushback from leadership regarding how hospital service with residents is viewed. Specifically, they suggest that service with residents may be considered less intense than shifts with direct patient care, and therefore may not count the same toward clinical service weeks.

    I'm interested in understanding how other programs handle this distinction. Do you count hospitalist service with residents differently than direct care when calculating clinical service weeks?

    Thank you in advance for your insights.

    Best regards,
    David



    ------------------------------
    David E. Willens, MD MPH FACP (He/Him)
    Vice Chair for Quality and Safety
    Division Head, General Internal Medicine
    Department of Medicine
    Henry Ford Hospital and Medical Group
    Detroit, Michigan
    ------------------------------


  • 2.  RE: Teaching Shift versus Direct Care Shift

    Posted 09-09-2024 11:30

    Our direct care attendings carry fewer patients (max 12) than our teaching teams (target 16, max 20), so we consider them equivalent.



    ------------------------------
    Randy Goldberg, MD MPH FACP FHM
    Westchester Medical Center
    Valhalla, NY
    randy.goldberg@wmchealth.org
    ------------------------------



  • 3.  RE: Teaching Shift versus Direct Care Shift

    Posted 09-10-2024 08:12
    Hello—

    Our traditional teaching service weeks count for less money than direct care weeks. They are considered less time-intensive than direct care weeks. Although certainly there is an argument to be made they are quite intense in other ways.

    There is also frankly a supply and demand component. Teaching services tend to be quite desirable.

    Elizabeth




    Sent from my iPhone


    Original Message


  • 4.  RE: Teaching Shift versus Direct Care Shift

    Posted 09-09-2024 12:17

    David

    As we are moving to introduce non-teaching teams, I have been struggling with how to do this also.
    As Randy stated, I envision the direct care teams to have fewer patients, so that kind of offsets the patient workload.

    The challenge for me is coverage. A direct patient care team needs someone in the building 24/7, whereas the teaching teams, the attendings can sneak out early as the residents are the ones in the building 24/7.  Direct patient care may have a lower census, but they are there for longer hours.
    Instead of thinking of it in terms of clinical service weeks, I'd like to define it as salary per effort.
    I am trying to get to 24 weeks total for our hospitalist faculty, and use that as 80% clinical, 100% full time for everyone.
    Then figure out how much service on direct care vs teaching and translate that into percent effort terms: 12 weeks teaching = 40%, + 12 weeks direct 40%, then the 20% admin.
    I am going to propose a base salary differential based on that.

    I got this idea from Jennifer Scmidt at Wash U and expanded on it.




     



    ------------------------------
    Sunil Sahai
    Division Chief, General Medicine
    University of Texas Medical Branch School of Medicine
    Galveston TX
    ------------------------------



  • 5.  RE: Teaching Shift versus Direct Care Shift

    Posted 09-09-2024 12:38

    FYI, we have three nocturnists - one admitting, one covering the non-teaching service (who is a PA about 60% of the nights), and one covering Neuroscience and emergent overnight consults. Maximum coverage gap is 30 minutes in the morning (nocturnists sign off at 0700, day team signs on at 0730) and 60 minutes at night (nocturnists sign on at 1900 but day team is allowed to leave at 1800 if not busy).



    ------------------------------
    Randy Goldberg, MD MPH FACP FHM
    Westchester Medical Center
    Valhalla, NY
    randy.goldberg@wmchealth.org
    ------------------------------

    Original Message


  • 6.  RE: Teaching Shift versus Direct Care Shift

    Posted 09-09-2024 13:19
    Hello all,
    We've done both since our inception.
    Time on counts the same in our group and no differential for teaching v. Direct care as often while there is coverage the time involved amounts to about the same (notes, teaching, continued pages from nursing/staff as they don't differentiate once they know you're teaching and not direct care,etc) as well as plain simplicity.
    Our schedule is 185 times on the schedule/year so 24 weeks is fabulous! Our schedule includes nights, evening/swing shifts/daytime/admitters,etc)
    We run a call based model so that if folks are done with their day they can answer calls from home/orders remotely, etc but someone is physically in the hospital to respond to issues if need be-this eliminates the need to stay longer in the hospital for no added value on the direct care services. This is especially nice on weekends when the hospital is less responsive to testing and the ability to move patients through:)
    Happy to share however it helps
    Peace
    Nate



    Original Message