How to Integrate Yourself Into Hospital Practice

Committees are involved in virtually every area of hospital governance and decision making – from patient care and safety to operations and credentials. An executive committee oversees the work of numerous standing committees, and ad hoc committees are formed to focus on particular issues.

"As young emergency physicians, it is critical for us to begin to develop leadership roles by serving on hospital committees. It allows others to know us as thoughtful leaders with an understanding of the bigger picture, as committed individuals who can lead and offer insight," said Cherri Hobgood, MD, Director of Education, Department of Emergency Medicine, University of North Carolina School of Medicine. Dr. Hobgood, a past president of EMRA, is the current president of the North Carolina College of Emergency Physicians.

Serving on a hospital committee provides a young physician with the opportunity to influence decisions that affect patient care, demonstrate clinical knowledge, hone leadership skills, represent the emergency medicine group, and become known by physicians throughout the hospital.

Getting to Know Medical Staff

"Hospital committees are a natural fit for emergency physicians because we’re hospital based. We’re dependent on the hospital and the medical staff for our practice," said Rebecca Parker, MD, attending physician for Centegra Health Systems, McHenry and Woodstock, Illinois, and Assistant Professor of Emergency Medicine at Texas Tech, El Paso. Dr. Parker is also chair-elect of ACEP’s Young Physicians Section.

Since emergency physicians work different hours from the rest of the medical staff, they don’t have as many opportunities to interact with other physicians. Through committee work, a young physician can develop contacts outside the clinical arena. "It’s an opportunity to demonstrate knowledge outside of the ED setting and the context of an individual patient. It allows for the development of meaningful rapport and can affect job stability and professional development," said Dr. Hobgood.

Dr. Parker agrees: "Working on a committee is a good way to meet and get to know other physicians. Especially in private practice, the medical staff depend on you and need to be able to trust you to be their eyes and ears in patient care. It’s good to be known and recognized by the attendings. Also, emergency physicians tend to change jobs a lot. When the medical staff sees you as part of the overall hospital practice it strengthens your relationships and gives you more job security. Medical staff have a lot of power with regard to credentialling."

Improving Patient Care

As emergency physicians, we seek to improve patient care and committee participation is a very viable way of doing it," said Dr. Hobgood.

The skills involved in being in charge of a team in the clinical setting are skills that are highly valued on hospital committees. "We know how to get things accomplished. Young emergency physicians need to understand that that in itself is a skill," said Dr. Hobgood. "Emergency physicians are able to rapidly assimilate information and make decisions. We know how to develop consensus because we work with physicians and other staff and the patient and family to create a care plan. We also have a certain degree of comfort with not knowing every last bit of detail before making a decision. We can be detail oriented, but can also give a ranking to the amount of detail needed to make a decision."

Since emergency physicians have a practice paradigm that is different from other specialties, they can identify for a committee any proposed changes that would not be effective for the ED and explain why a different approach might be needed.

One example of this, notes Dr. Parker, is the quality improvement committee, which deals with cross-disciplinary issues that affect patient care. "It’s important for emergency physicians to be represented on this committee because our work crosses all departments—we work with everyone. So we want to be in on the discussion and the decision-making process," Dr. Parker said.

Demonstrating Knowledge

A committee is a good place to demonstrate expertise as you support your statements and positions, said Dr. Parker. "You can learn a lot in the process of presenting your case and it also enhances your credibility," she said. "Your participation in a committee gives you opportunities in terms of professional development. You do literature searches, develop interpersonal skills, learn how to run meetings. It helps the hospital. It helps you. It’s a great way to be part of the community."

In addition, practice styles can vary greatly and a committee is a good place to learn about the practice styles of other physicians, some of whom may have been in practice 30 years or more, notes Dr. Parker. "It’s good to get a feel for different practice styles, some of which may not be familiar to you as a young physician. Committees offer an opportunity to understand others’ practice styles in more detail and give you an opportunity to have some dialog in an environment where there is not a patient involved," she said.

Benefiting the Group

"Your director or clinical chair may have suggestions as to where you could serve on a committee. They often see attributes in you that you might not identify in yourself. It allows you the opportunity to help the department and also expand your own horizons," said Dr. Hobgood.

An individual physician’s work on a hospital committee can benefit the entire emergency medicine group. "For example, if you know and understand billing or want to do so, volunteer for the committee that deals with that (often the practice management committee). You’ll learn a lot about the economics of the practice and the hospital, which can go a long way to helping your group maintain a revenue stream," said Dr. Hobgood.

"As another example, the clinical policies and procedures committee may make decisions about what emergency physicians can and cannot do, so you can have a positive influence there. Participation on that committee allows you to become an asset to your group because you can be protective of your group’s influence and right to practice in certain ways, as well as their revenue stream," notes Dr. Hobgood.

Joining a Committee

"Most committee members are appointed. However, committee leaders are often looking for people interested in a particular area—those who can bring a level of enthusiasm, interest and expertise," said Dr. Hobgood. "If you’re interested in a particular committee, make your wishes known through your department head or clinical director," she advises. "Which committee you volunteer for depends on your area of interest. Ask yourself: What do I like to do? What do I like to read about? What special expertise do I have? For example, young emergency physicians often have experience with very advanced informatics systems, knowledge which could be helpful to a hospital committee."

Another approach would be to indicate your interest in serving on a committee and let your ED medical director decide where you’re needed most, suggests Dr. Parker. "My advice is to just get started, almost all committees relate to us in emergency medicine. For example, the infectious disease committee and the trauma committee are good committees for young emergency physicians to get started on. The other committee members will value your knowledge and your experience with trauma." Or, the pharmacy committee, which works on new drug approval and what will be included in the pharmacy, is a good place to learn how things work in your hospital, and to start to meet people and get to know the hospital systems, said Dr. Parker.

"I think emergency physicians should be interspersed throughout the entire committee structure of the hospital," said Dr. Hobgood. "The emergency department is integral. A tremendous number of patients enter the hospital through the emergency department and our physicians interface with all aspects of the hospital."