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Growing Up Fast

Hospital medicine comes into its own

by Kimberly McGhee

Doctor Michael M. HawkinsDr. Michael M. Hawkins

The rapid growth in the number of hospitalists over the past two decades — from a few hundred in 1996 to more than 50,000 in 2016 — was fueled by managed care’s demands for greater efficiency and by a concern over the high rates of medical errors at hospitals. From its origins, hospital medicine has been dedicated to making hospitals more efficient and safer places. The fastest growing medical specialty, hospital medicine now has its own society, boards and fellowships.

“Hospital medicine is here to stay. We have demonstrated improvements across the nation in patient safety, throughput, increased quality at decreased cost, and it’s a very good thing that is happening to the world of medicine,” says Michael M. Hawkins, M.D., who joined MUSC Health in May 2016 as associate chief medical officer for hospital medicine services. “But I’ll say that with a caveat: It is only good if there is meticulous communication built around it.”

Hawkins’ caveat is an important one. A hospitalist, as the name suggests, focuses exclusively on the care of hospitalized patients. Hospital medicine is a departure from the traditional model of care, in which patients’ own primary care physicians traveled to the hospital to care for them. Initially, some critics feared that the new specialty could damage the bedrock of good patient care — the physician-patient relationship.

That concern can be addressed, Hawkins believes, with proper communication. “I explain to the patient that I have been on the computer and have all of their records,” says Hawkins. “As long as you have that communication and you are in touch with their physician and can round on them multiple times, people really begin to appreciate the increased availability that a hospitalist provides.”

Since his arrival in May, Hawkins has been very impressed with the dedication and camaraderie of his hospitalist team and how well they have aligned themselves with the institution’s goals.

“I am coming into an already really, really good hospitalist team,” says Hawkins. “My role is to go from good to great.”

Hawkins has already made changes to improve workflow efficiency and the patient experience. For instance, he added a second private hospitalist team at the Ashley River Tower (ART) to handle referrals from the chest pain center, preventing unnecessary patient transfers from ART to another MUSC hospital.

He has also been hard at work building his team, a challenge given that hospitalists are in such high demand. He is particularly proud to have recruited three of MUSC’s top internal medicine graduates as hospitalists for his team.

“When people who are training here and who are in the trenches day in and day out like what they are seeing enough to stay here after graduation, that’s a good sign,” says Hawkins. He hopes to educate more medical students and residents about the new specialty and encourage them to stay on as hospitalists at MUSC Health. He also plans to add a fellowship in hospital medicine.

Hawkins is confident that the robust team of hospitalists he is building will help the institution meet its quality metrics while also creating an even safer, more welcoming environment for patients.

Hawkins smiles at the prospect. “When you can change a system to increase efficiency and decrease costs and improve quality, that’s a good place to be.”