The “best” medical outcomes result from the right intervention, at the right time for the right person. Increasing expectations from patients, third-party payers, and hospitals demand from physicians almost super-human expertise, faster response times, and safety measures that surpass those of the airlines. Responding to these rising expectations, medicine has become more specialized. We now have breast specialists, voice specialists, colon/rectal specialists, child abuse specialists, hand surgeons, and cytologists (pathologists who only look at single cells), to name but a few.
While a narrower focus of knowledge and skills defines most specialties, the range of tasks continues to bind doctors to working in the office seeing patients, in the hospital making rounds, in the OR doing surgery, in the labor and delivery room delivering new babies, and in the emergency department sewing up lacerations. Well, this non-division of labor is being challenged as the “best” way to deliver the “best” healthcare. Is it still possible for a single physician—even with partners or physician “extenders”—to “manage” increasingly complex patients in an increasingly complex environment with increasing expectations, while paying attention to their own and the hospital’s bottom line—great patient care at the lowest possible cost? Probably not.
When I was a resident at Montefiore Medical Center in the Bronx in the early 1980s, the medical residents had a call system that used “night floats”—residents whose only responsibilities were to cover patients at night. Every resident did this for one month a year. Some nights, medical residents went home at 10 pm and reported back at 7 am for morning rounds after a good night’s sleep. We surgical residents scoffed at these “softies.” Every other or every third night—now that was a schedule that grew hair on your chest!
Over these last 30 years, I have come to see that seeds of change grow and bear fruit that tastes good enough that some people are willing to take a bite. New medical specialties are not only becoming more common but are also being defined in new ways—such as point of care for the patient. My emergency medicine colleagues would be quick to point out that the specialty of emergency medicine has been around for almost 40 years. True but now it’s accelerating (like everything else) and finding its way into other specialties. Medical hospitalists for pediatricians and internists, laborists for obstetricians, trauma surgeons, intensivists, and more.
Even in surgery, compartmentalization is taking off with specialists in acute care and surgical hospitalists. This new breed is filling the rising demands for more predictable and flexible schedules for surgeons and more rapid, team-based responses for the hospitals and patients they serve. Doctors are not called away during office hours leaving patients to wait or reschedule. Patients are not left in the hospital for hours and hours waiting for their doctor to round or come to the emergency department while the appendix becomes increasingly painful and inflamed, maybe bursting. With improved communications, team building, and recruitment of different skill sets and knowledge, this paradigm is making sense to more and more people. It’s a win-win-win!
It is simply inevitable that change will occur. And women who are leading the way toward flexibility and predictability are at the vanguard of a movement that is already taking place. Get ready to take advantage of the need to redefine how doctors work. Enter into creative collaborations with healthcare organizations and institutions and become happier, more productive doctors with better patient outcomes. Everyone, come on board!
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