In 2002, when I began my first hospitalist job, I was a dyed-in-the-wool hospital medicine convert, convinced that the transfer of inpatient care to true specialists in hospital medicine (hospitalists) would dramatically improve the quality and efficiency of inpatient care, increase patient satisfaction and decrease costs. By 2008, I had developed serious doubts, which prompted me to publish an editorial in the Journal of Hospital Medicine, entitled “The Expanding or Shrinking ...

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Consider this hypothetical addendum to a hospital discharge summary: ”ADDENDUM @10:56 a.m: In considering the accurate billable discharge time involved in this case (as I have recently been instructed by hospital coders that I must record the exact time required for a patient discharge, rather than simply “greater than 30 minutes” or “less than 30 minutes”), I feel I have stumbled upon a troubling quandary, having failed to note the exact ...

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The practice of medicine in the United States is almost entirely based on national guidelines and regulations. Minor, inconsequential differences may exist from state to state, but nothing significant enough to justify the current requirement of comprehensive, redundant licensing of physicians in each individual state in which they practice. Notably, in an uncommon example of federal common sense, physicians can work at any Veterans Administration facility, in any state, with any ...

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San Diego, Tucson, Orlando, and Dallas. Those are a few of the modest destinations to which I have traveled, as a hospitalist, to attend CME conferences, using the pre-tax CME benefit from my employer, including paid days off. As a young professional, my yearly CME trips gave me a mildly magical sense of privilege: “Really? They’re going to pay for all of this?” Browsing through various CME conference options and dreaming ...

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