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According to the Society of Hospital Medicine (SHM), the number of hospitalists has increased from approximately 5,000 hospitaists in 2005 to more than 30,000 hospitalists in 2010. Despite this explosive growth and the fact that the majority of hospitals now have hospitalist programs, not all of them have been successful in establishing a thriving organization with staying power. The need for financial support of hospitalist programs and overextension of services coupled with recruitment issues, turnover, and leave of absences may lead to excessive workloads and possibly burnout. The overall annual turnover percentage of hospitalists is high, approximately 22% nationwide, despite opportunities to improve retention of physicians within a practice (SHM data). None of these issues are unique to Hospital Medicine and have been experienced by other geographically localized specialties including emergency medicine and critical care.

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Patients and their families continue to express confusion about the role of hospitalists in their care and may misconstrue the term “hospitalists” for “hospice.” Too often, hospitalists assume patients understand their presence at the bedside and neglect to take the time to explain their role as the internal medicine physician or family medicine physician responsible for patient care, assuming responsibility for everything from admission to discharge, including making patient rounds and ordering all needed tests and procedures. This failure in communication may leave patients and families feeling that their primary care provider has abandoned them, which may erode the patient-hospitalist and patient-primary care provider relationship.

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This chapter will explore the specific components essential to building, growing, and managing a thriving hospitalist practice with staying power.

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It is important to have a strategic plan for the practice around growth and the types of hospitals and programs best aligned with agreed upon goals and objectives. For example, strategic planning may require not aligning with all groups requesting support of the hospitalist team. If a group does not fit your strategic profile or geography, it may be best to decline the opportunity to manage a program. Depending on the goals of the practice, certain approaches may not promote patient satisfaction or continuity of care goals, as for example, when a hospital simply wants your team to cover admissions during the “off hours” that residents are not covering and then transfer patients to residents or surgeons during “peak hours.” Obstacles of geographic distance requiring a day of travel of the core management team present an additional burden that make it best to pass up the opportunity without key management team members in place. Therefore, each hospitalist group should critically evaluate whether the growth into a new hospital makes sense based on the values and goals of the organization.

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Before starting a practice it is critical to determine what factors predict the success or failure of strategic plans and those that the group defines as the business and financial motivators that impact on the decision to build, expand, and manage a hospitalist service.

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