Are you thinking about starting a rural hospitalist program?

The Happy Hospitalist is a board certified internist who works in the hospital and writes regularly on several blogs, including The Happy Hospitalist.

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A reader asked me the question: Do you have advice for a small rural hospital that wants to start a hospitalist program?

The most important component to a successful hospitalist program, whether rural or big city, is to have a strong backing by administration. An administration that understands more than revenue in = revenue out. In Happy’s neck of the woods there are major big city hospital systems that have been trying to get hospitalists up and running for almost 10 years and have failed miserably. Why?

Because administration believes, and continues to believe that the only way to run a program is to look at front door revenue generation (physician billing) as the only parameter to determine success or failure of a program. These are the programs which are based only on revenue generation targets. And they will almost always fail because revenue comes at the expense of efficiency and value in every other aspect of the value tree.

The most successful programs are those in which the administration understands the vast tentacles of value that hospitalists bring to their medical system, independent of physician billing. Tangible and intangible parameters that can make or break the fiscal health of the institution as a whole.

Many hospitalist programs are doomed to failure because administration fails to understand the dynamics of hospitalist medicine. They fail to staff appropriately. And when hospitalists leave for greener pasteurs, they are left with a high likelihood of burnout by those remaining.

Rural has it even harder because it is hard to staff. Nobody wants to do rural. Here’s my advice

1. Only administrations that appreciate physician billing as a small component of determining success of a program will survive. If your administration believes that physician billing is the most important sign of success and they make their decisions accordingly, the program is doomed to failure.
2. Don’t under staff. Many programs try to skimp by. When one doc leaves (and they will), it puts the others on the road to burnout real quick. If you can’t fully staff with enough physicians plus buffer for growing pains and the quitters, then start the program part time. Perhaps no weekends or no nights. Whatever, if you don’t have enough physicians to run the program, it’s doomed to failure from the start.
3. Be flexible. The larger your pool of candidates, the more successful you will be in starting the program.
4. Keep lines of communication open between docs and administration. Hospitalist jobs are everywhere. Administration in rural America must understand that they don’t run the show, the docs do. Why? because the docs can leave and land a job just about anywhere they want. It’s a buyers market for hospitalist medicine. It will be for quite some time. We are only getting started.
5. You’re going to have to pay more than you think. It’s rural. And it’s hospitalist. Think big.