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Goldsholl told the audience.

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While that can be managed, you need to understand the expectations of each group. For instance, how will the scope of practice of the local primary care physicians change when a hospitalist program comes in? Or does a highly productive surgeon want capital funding for a new cardiothoracic unit, forcing the hospital to decide where to put its money? Goldsholl defined as who is asking for what. Defining hospitalist roles One factor that will affect hospital politics is the role that hospitalists play in patient care.

Fail to address the expectations of around-the-clock coverage, she warned, and the environment will sour quickly. In many facilities, hospitalists started out as glorified house officers. Now, however, hospitalists are often essential inpatient managers, more central to hospital operations than the higher paid surgeons and procedurally oriented specialists.

As roles change, Dr. Goldsholl said, so do politics.

Strategies to help you survive hospital politics

What PCPs want Finding out what primary care physicians want is critical to managing expectations. As a result, hospitalists need to set up their program in such a way that there can be no opportunity for patient stealing. One solution, particularly for a start-up hospitalist group, can be a night admitting service, Dr. And what about primary care physicians who ask for only vacation and weekend coverage?

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Goldsholl said, by telling PCPs upfront that that is not how the program operates. To cover weekends and vacations, she explains, primary care physicians must give the program their regular business. What subspecialists want Common requests from subspecialists on the medical staff generally have to do with the scope of service that hospitalists can provide. Concerns can include using consultants equitably, allowing consultants to work with other consultants on your patients, co-managing surgical patients and handling transfers of care.

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While the larger group dominated the hospital, it was often too busy to give timely consults to the hospitalists. Members of the smaller group, on the other hand, were quick to respond, getting patients to the cath lab in a matter of hours, not days. As a result, the hospitalist group gave much of its business to the smaller group.

The hospitalists had to deal with the political ripples, going back to the primary care physicians who referred to the larger group and explaining why the hospitalists needed to make other referrals. Politics related to scope of practice and throughput also come into play between the hospitalists and the emergency department. Goldsholl said that specific questions usually are variations of the general question: Where does your job end and my job start?

Like many other asks that hospitalists have to field, she said, these are often best handled by defined rules of engagement and communication.


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She recommended regular monthly meetings between the medical directors of the hospital medicine and the ED programs. Medical director Another potential political minefield for hospitalist programs: Goldsholl said that exactly who is tapped to lead a program will have far-reaching consequences in determining how well the program copes with workplace politics. From her own experience, Dr. For one, she had no interest in moving to the rural community where the hospital was located.

Goldsholl said, she was clearly not the right match. The Business of Medical Practice. Developing a Taxpayer Compliance Program. The Physician as Manager. Solving the American Healthcare Crisis. Medical Group Management in Turbulent Times. Making Sense of Dental Practice Management.

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