​Hospitalists just starting their careers may need more support than more experienced hospitalists to ensure optimal outcomes for their patients, concludes a study from the February 2018 JAMA Internal Medicine. The study examined data of Medicare patients treated by 3,860 hospitalists over a four-year period, starting with the physicians' first year as hospitalists. The researchers found a significant association between hospitalist experience and patient mortality for physicians just starting their careers. The observed 30-day mortality rate for patients of first-year hospitalists was 10.50% compared with 9.97% for patients of second-year hospitalists. Additionally, the mortality odds for patients of second-year hospitalists was 0.90 compared with patients of first-year hospitalists. After the second year, there was little change in either the 30-day or hospital mortality between the second year and subsequent years of experience for hospitalists. Additional studies are needed to determine whether other factors, such as unfamiliarity with the work environment, affect hospitalists' performance in their first year. Nevertheless, the authors conclude that their findings "should prompt interventions to bolster support systems for new hospitalists such as mentoring or coaching programs." First-year hospitalists may also benefit from reduced caseloads, the authors also said.

HRC Recommends: Effective interdisciplinary teamwork is essential in a hospitalist program because hospitalists are responsible for coordinating all of the care that admitted patients receive. Risk managers should encourage hospitalist program directors to evaluate strategies and tools designed to improve interdisciplinary teamwork so that a model that best suits the needs and goals of the hospitalist program is implemented. Consideration should be given to strategies to help first-year hospitalists effectively transition from graduate medical training to the organization's hospitalist program.