- James O'Callaghan
1. You initially studied chemical engineering—how did you end up being a pediatric hospitalist? What do you like most about your job?
I enjoyed mathematics and science in high school, and my father was an electrical engineer, so naturally I was encouraged to pursue a career in engineering. However, although I excelled at the subject matter, I found the career aspirations lacking in social interactions and service to others, key qualities that I have discovered growing up as a Boy Scout. At the college I attended, there was an accelerated combined BS-MD program. I became friends with some of these students, and from discussions with them, I realized that a career in medicine might be able to combine my love of science with my passion to help others. And I am happy to say that my early assumptions proved correct—I love my job as a pediatric hospitalist! My favorite part of the job is easily interacting with my patients. I am the one who can most often be found carrying patients on my shoulders or pushing them down the hall in swivel chairs (just don’t tell hospital administration!)
2. As a pediatric hospitalist in Seattle, you have been on the front lines with the COVID-19 pandemic. What are some lessons you are taking away from this experience?
When the pandemic arrived in early 2020, I had just completed a 2-year term as President of the Medical Staff at the community hospital where I spend the majority of my clinical time, EvergreenHealth Hospital, in Kirkland, Washington. As Immediate Past President, I still have another 2 years to actively work with the CEO and the administrative team at EvergreenHealth. Some of the biggest lessons I learned have come from this role. As front line clinicians, we tend to think about and put our patients first. That is of course not a bad thing, but this pandemic taught me to think about the big picture—how to creatively redesign hospital wards to accommodate an increase in ventilated patients, how clinical decisions hinge on the ability of logistics and supply chain to meet demand, how decisions in one part of the health care system can have profound effects on patients across the entire system. This pandemic has greatly enhanced my education on health systems and population management.
3. You were the RVU Chairperson of the AAP SOHM Executive Committee from October 2010 to April 2016—tell us more about RVU in hospital medicine and how they can be used correctly/effectively.
RVU stands for Relative Value Unit. It is a number, used by CMS and insurers, that is assigned to a CPT code. It is a measure of “how much” work a physician or provider had to do with a particular patient. In theory, the more complex a patient, and the more work one does, then the higher the number of RVUs generated by that patient encounter. RVUs can then be used as proxy for work or productivity. However, some of the work performed by a pediatric hospitalist may not necessarily be captured in RVUs. For example, working on improving an order set or conducting lectures for medical learners or driving into the hospital repeatedly while on home call will not likely be captured in the RVUs generated. Hospital groups will likely have to get creative to account for and track all of this “non-RVU” work, in order to adequately and correctly gauge the true work of pediatric hospitalists.
4. You were inpatient lead on Seattle Children’s Acute Gastroenteritis Guideline Committee (2009 to 2016) and Community Acquired Pneumonia Guideline Committee (2012 to 2016). How did you get involved, and what advice do you have for young hospitalists who want to get more involved with committees at their hospitals?
I first got involved with clinical standard work at my community hospital. Early in my career, there was a request to update the hyperbilirubinemia order set. I quickly realized that as the lead pediatric hospitalist, I could work to get all members of my group to practice in a similar, evidenced-based manner, or I could update the clinical pathway and influence the behavior of all clinicians who used it, even members outside my immediate hospital medicine group. A few years later, when Seattle Children’s Hospital began to roll out their Clinical Standard Work pathways, I jumped at the chance to get involved for similar reasons. For early career hospitalists looking to get more involved and make similar impacts, most of the time you just have to step forward and say, “yes!” I would start by asking more senior members in your group, the nursing managers for the units that you round on, and even the CMO (Chief Medical Officer). It seems as if there is a never-ending list of non-clinical work for physicians, so one last piece of advice: once you get good at saying “yes” to this work, you also need to learn to say “no,” so you don’t become overwhelmed or burnt out!
5. The letters SFHM follow MD and FAAP in your signature—what do they stand for and how did you earn those letters?
I am especially proud of earning those credentials. SFHM stands for Senior Fellow in Hospital Medicine. This Fellow designation was bestowed upon me by the Society of Hospital Medicine, a professional association much like the AAP, that I have been a member of since 2004. As Jack Percelay once described it to me, whereas the AAP is made up of ‘all pediatricians all the time,” SHM is made up of “all hospitalists all the time.” SHM is predominately made up of hospitalists who care for adult patients, but there is a strong and active group of us who identify as pediatric hospitalists. In order to meet the criteria for SFHM, one has to demonstrate a commitment to hospital medicine: at least 5 years in the field, attendance at multiple national meetings, and dedication and performance in either quality improvement or leadership, as well as endorsement by at least 2 current members of SHM.
6. You were co-author on “Choosing wisely in adult hospital medicine” in 2013; what do you think should be on a Choosing Wisely list for pediatrics in 2020?
Ha! I feel like this is a teaser question. Yes, I was involved in the first installment of the SHM - Adult Hospital Medicine Choosing Wisely campaign back in 2013. However, I am one of the SHM representatives to the 2020 Choosing Wisely campaign for pediatric hospital medicine! This work group, a joint effort between the AAP, SHM, and the APA (Academic Pediatric Association) has been working tirelessly over the past 18 months to formulate a second Choosing Wisely list for pediatric hospital medicine. We have finalized this new list of 5 recommendations and are currently in the process of seeking approval from all 3 professional organizations, so you will have to wait just a bit longer to find out what they are!
7. Jack Percelay often ends his list-serve commentary with the phrase “that’s just my 2 pennies.” What are your two cents?
Wow, that’s a tough one. As I look back at the first part of my career, as outlined above, one might think that my career has always been my number one priority. While my career has always been an important part of my life, it is always just that…a part. Now, more than ever, physicians need to remember to grow and nurture all parts of their life, and that would include health, family life, love life, friends, etc. With all of the recent attention to work-life balance and career burnout, I hope folks can craft a career that is fulfilling to them, while at the same time balancing that with all of the other roles we assume.
I enjoyed mathematics and science in high school, and my father was an electrical engineer, so naturally I was encouraged to pursue a career in engineering. However, although I excelled at the subject matter, I found the career aspirations lacking in social interactions and service to others, key qualities that I have discovered growing up as a Boy Scout. At the college I attended, there was an accelerated combined BS-MD program. I became friends with some of these students, and from discussions with them, I realized that a career in medicine might be able to combine my love of science with my passion to help others. And I am happy to say that my early assumptions proved correct—I love my job as a pediatric hospitalist! My favorite part of the job is easily interacting with my patients. I am the one who can most often be found carrying patients on my shoulders or pushing them down the hall in swivel chairs (just don’t tell hospital administration!)
2. As a pediatric hospitalist in Seattle, you have been on the front lines with the COVID-19 pandemic. What are some lessons you are taking away from this experience?
When the pandemic arrived in early 2020, I had just completed a 2-year term as President of the Medical Staff at the community hospital where I spend the majority of my clinical time, EvergreenHealth Hospital, in Kirkland, Washington. As Immediate Past President, I still have another 2 years to actively work with the CEO and the administrative team at EvergreenHealth. Some of the biggest lessons I learned have come from this role. As front line clinicians, we tend to think about and put our patients first. That is of course not a bad thing, but this pandemic taught me to think about the big picture—how to creatively redesign hospital wards to accommodate an increase in ventilated patients, how clinical decisions hinge on the ability of logistics and supply chain to meet demand, how decisions in one part of the health care system can have profound effects on patients across the entire system. This pandemic has greatly enhanced my education on health systems and population management.
3. You were the RVU Chairperson of the AAP SOHM Executive Committee from October 2010 to April 2016—tell us more about RVU in hospital medicine and how they can be used correctly/effectively.
RVU stands for Relative Value Unit. It is a number, used by CMS and insurers, that is assigned to a CPT code. It is a measure of “how much” work a physician or provider had to do with a particular patient. In theory, the more complex a patient, and the more work one does, then the higher the number of RVUs generated by that patient encounter. RVUs can then be used as proxy for work or productivity. However, some of the work performed by a pediatric hospitalist may not necessarily be captured in RVUs. For example, working on improving an order set or conducting lectures for medical learners or driving into the hospital repeatedly while on home call will not likely be captured in the RVUs generated. Hospital groups will likely have to get creative to account for and track all of this “non-RVU” work, in order to adequately and correctly gauge the true work of pediatric hospitalists.
4. You were inpatient lead on Seattle Children’s Acute Gastroenteritis Guideline Committee (2009 to 2016) and Community Acquired Pneumonia Guideline Committee (2012 to 2016). How did you get involved, and what advice do you have for young hospitalists who want to get more involved with committees at their hospitals?
I first got involved with clinical standard work at my community hospital. Early in my career, there was a request to update the hyperbilirubinemia order set. I quickly realized that as the lead pediatric hospitalist, I could work to get all members of my group to practice in a similar, evidenced-based manner, or I could update the clinical pathway and influence the behavior of all clinicians who used it, even members outside my immediate hospital medicine group. A few years later, when Seattle Children’s Hospital began to roll out their Clinical Standard Work pathways, I jumped at the chance to get involved for similar reasons. For early career hospitalists looking to get more involved and make similar impacts, most of the time you just have to step forward and say, “yes!” I would start by asking more senior members in your group, the nursing managers for the units that you round on, and even the CMO (Chief Medical Officer). It seems as if there is a never-ending list of non-clinical work for physicians, so one last piece of advice: once you get good at saying “yes” to this work, you also need to learn to say “no,” so you don’t become overwhelmed or burnt out!
5. The letters SFHM follow MD and FAAP in your signature—what do they stand for and how did you earn those letters?
I am especially proud of earning those credentials. SFHM stands for Senior Fellow in Hospital Medicine. This Fellow designation was bestowed upon me by the Society of Hospital Medicine, a professional association much like the AAP, that I have been a member of since 2004. As Jack Percelay once described it to me, whereas the AAP is made up of ‘all pediatricians all the time,” SHM is made up of “all hospitalists all the time.” SHM is predominately made up of hospitalists who care for adult patients, but there is a strong and active group of us who identify as pediatric hospitalists. In order to meet the criteria for SFHM, one has to demonstrate a commitment to hospital medicine: at least 5 years in the field, attendance at multiple national meetings, and dedication and performance in either quality improvement or leadership, as well as endorsement by at least 2 current members of SHM.
6. You were co-author on “Choosing wisely in adult hospital medicine” in 2013; what do you think should be on a Choosing Wisely list for pediatrics in 2020?
Ha! I feel like this is a teaser question. Yes, I was involved in the first installment of the SHM - Adult Hospital Medicine Choosing Wisely campaign back in 2013. However, I am one of the SHM representatives to the 2020 Choosing Wisely campaign for pediatric hospital medicine! This work group, a joint effort between the AAP, SHM, and the APA (Academic Pediatric Association) has been working tirelessly over the past 18 months to formulate a second Choosing Wisely list for pediatric hospital medicine. We have finalized this new list of 5 recommendations and are currently in the process of seeking approval from all 3 professional organizations, so you will have to wait just a bit longer to find out what they are!
7. Jack Percelay often ends his list-serve commentary with the phrase “that’s just my 2 pennies.” What are your two cents?
Wow, that’s a tough one. As I look back at the first part of my career, as outlined above, one might think that my career has always been my number one priority. While my career has always been an important part of my life, it is always just that…a part. Now, more than ever, physicians need to remember to grow and nurture all parts of their life, and that would include health, family life, love life, friends, etc. With all of the recent attention to work-life balance and career burnout, I hope folks can craft a career that is fulfilling to them, while at the same time balancing that with all of the other roles we assume.