Clinical Component

Navigating the Clinical Component

The Practice of Comprehensive Inpatient Medicine

Imagine practicing hospitalist medicine where you actually have time to think through complex cases, where your daily census allows for thoughtful decision-making rather than algorithmic urgency, and where strong subspecialty support means you can provide truly comprehensive care without feeling isolated. At Good Shepherd, your typical day involves caring for 12–14 patients—your share of the 25–28 total inpatient census split between two daytime hospitalists. This is medicine at a human scale, where you can remember details about each patient without consulting your note from that morning, where you can sit at the bedside rather than rush through encounters, and where the satisfaction of practicing good medicine isn't crushed under impossible volume demands.

Your patient population represents the full spectrum of adult inpatient medicine—the elderly farmer with exacerbated COPD and heart failure, the middle-aged construction worker with chest pain requiring rule-out MI protocol, the diabetic patient with sepsis from a foot infection, the stroke patient stabilized in the ED and needing admission for further management. You'll see the breadth of internal medicine and family practice, from straightforward cases to genuinely complex multi-system disease, but you'll practice with the safety net of readily available consultants who actually want to be involved in challenging cases rather than viewing consults as interruptions.

Patient Population and Volume:

  • Census: 25–28 total inpatients divided between 2 daytime hospitalists (12–14 patients per provider)
  • Daily admissions: 3–7 patients per day split between hospitalists during day shift
  • Night admissions: 2–6 patients admitted by dedicated nocturnist NPs (presented to you in the morning)
  • Daily discharges: 1–5 patients per provider, allowing for comprehensive discharge planning
  • Patient demographics: Adult population (18+) from Umatilla County and Northeastern Oregon
  • Case mix: Full spectrum of adult inpatient medicine including cardiology, pulmonology, infectious disease, endocrinology, nephrology, and general medical conditions

Your Admitting Responsibilities and Workflow

As a Good Shepherd hospitalist, you'll admit all patients from the emergency department, providing that crucial bridge from acute stabilization to comprehensive inpatient management. The ED physicians—two per shift with APP support in the Fast Track—handle initial evaluation and stabilization, then you take over for admission and ongoing care. With 70 patients daily passing through the ED (about 35% requiring true emergency medicine intervention), you'll receive a steady but manageable stream of admissions that keeps your practice engaging without becoming overwhelming.

You have direct admission authority to the six-bed ICU when patients require intensive-level care, working within an open ICU model that respects your clinical judgment while providing access to pulmonology, cardiology, and other specialist support for the most complex critically ill patients. Unlike closed ICU systems where you hand off care and lose continuity, or facilities where hospitalists manage ICU patients without adequate training or support, Good Shepherd's model strikes the right balance—you can admit directly when appropriate, involve intensivist-trained consultants when needed, and maintain involvement in your patients' care trajectories.

Admitting Model and ICU:

  • Admissions: Hospitalists admit all patients from the emergency department
  • ICU access: Direct admission authority to 6-bed open ICU
  • ICU census: Typically 3–4 patients; capacity for 6 ICU-level patients
  • ICU support: Pulmonology and cardiology consultants available; anesthesia backup for airway management
  • Step-down capability: 8 observation beds provide intermediate-level monitoring
  • Med/Surg beds: 19 dedicated medical-surgical beds (hospital typically at or near capacity)
  • Patient flow: Coordinated discharge planning maintains appropriate census levels

Procedures and Code Response

Your procedural responsibilities at Good Shepherd are refreshingly straightforward: procedures are helpful but not required. If you enjoy performing central lines, thoracentesis, paracentesis, or lumbar punctures, the opportunity is there. If you prefer to focus on diagnostic reasoning and medical management while colleagues in emergency medicine and anesthesia handle procedures, that's equally acceptable. This flexibility means you can practice to your training and comfort level without feeling pressured to perform procedures you haven't done since residency or declining procedures you'd like to maintain in your skill set.

When a code is called, you'll lead the resuscitation as the hospitalist, but you won't be alone. The emergency department physicians and the CRNA team (nine CRNAs providing 24/7 anesthesia coverage) are immediately available for airway management and intubations. You direct the code, make critical decisions about medications and interventions, and coordinate care, but when you need an expert airway secured quickly, you have skilled colleagues at your side within moments.

Procedural and Code Responsibilities:

  • Procedures: Helpful but not required; ED and anesthesia available for support
  • Common procedures available: Central lines, thoracentesis, paracentesis, lumbar punctures, arthrocentesis
  • Code leadership: Hospitalists lead code responses
  • Airway management: CRNAs or ED physicians handle intubations during codes
  • Anesthesia support: 9 CRNAs providing 24/7 coverage for emergent airways and procedural sedation
  • Emergency backup: ED physicians (2 per shift) available for acute situations

Specialty Consultation and Collaborative Care

One of the most satisfying aspects of practicing at Good Shepherd is the genuine collaborative environment with subspecialists. As the hospital expands its specialty lines in cardiology, pulmonology, nephrology, rheumatology, and neurology, you'll work alongside physicians who view hospitalists as colleagues rather than competitors or referral sources to be guarded.

You'll also work closely with a strong surgical team—three general surgeons, six OB/GYNs, a gastroenterologist, a urologist, and a podiatrist—who understand that good perioperative care requires collaboration. With six orthopedic surgeons in the Orthopedic Center of Excellence, you'll see your share of post-operative orthopedic patients, but always with clear expectations and appropriate surgical backup.

Available Specialty Consultants:

  • Cardiology: Available for acute coronary syndrome, heart failure, arrhythmias, and complex cardiac cases
  • Pulmonology: Support for respiratory failure, COPD exacerbations, and critical care consultation
  • Nephrology: Consultation for acute kidney injury, electrolyte disturbances, and dialysis considerations
  • Rheumatology: Available for inflammatory conditions and complex autoimmune cases
  • Neurology: Support for stroke, seizures, and neurological emergencies (telestroke service available)
  • General Surgery: 3 surgeons providing GI, trauma, and general surgical care
  • Orthopedics: 6 surgeons at the Orthopedic Center of Excellence
  • OB/GYN: 6 providers for obstetric and gynecological emergencies
  • Gastroenterology: Available for GI bleeding, liver disease, and endoscopic procedures
  • Urology: Consultation for genitourinary emergencies and complex urological issues

Technology and Clinical Support

You'll work within Epic, the gold standard electronic medical record that you likely already know. No fighting with clunky interfaces—just Epic's familiar workflows, comprehensive integration, and robust clinical decision support. The system connects seamlessly with radiology, lab, pharmacy, and documentation, letting you focus on medicine rather than tech issues.

Diagnostic imaging is readily available onsite—MRI, CT, and X-ray—with optional reads for CTA, echo, and nuclear studies. The radiology team understands timely imaging drives decision-making. For telestroke evaluation, neurology support is always available through telemedicine, even during overnight hours.

Technology and Support Systems:

  • EMR: Epic electronic medical record with comprehensive integration
  • Imaging: Onsite MRI, CT, and X-ray; optional reads for CTA, echo, and nuclear studies
  • Laboratory: Full-service lab with rapid turnaround for critical values
  • Pharmacy: 24/7 pharmacy support with clinical pharmacists available for consultation
  • Telestroke: Remote neurology evaluation available for acute stroke patients
  • Robotics: DaVinci Xi, DaVinci DB5, and Mako robotic surgical systems
  • Infusion center: 7-bed infusion center for complex medication administration
  • Emergency capabilities: Level III Trauma Center managing STEMI, stroke, and PE cases

Call Coverage That Respects Your Time

You'll be on call for nights, backing up three full-time nocturnist NPs who manage overnight issues and admissions. In the past two years, hospitalists have been called in overnight only once. The NP team is well-trained, and they know when a situation needs physician backup versus phone consultation.

When you're off, you're truly off. No constant calls or being pulled in unnecessarily. The system protects your time and respects your need for rest and recovery—something that sets this program apart.

Call and Coverage Structure:

  • Night coverage: Three full-time nocturnist NPs handle all overnight admissions and floor care
  • Physician call: Hospitalist on call as backup for NP team
  • Call frequency: Rarely called in—once in the past two years
  • Phone triage: NPs manage routine issues independently, contact physician for complex decisions
  • Weekend coverage: Included in your 5-on/10-off rotation (no separate weekend call)
  • Backup system: Clear protocols for when physician presence is needed
  • Daytime APP support: 2 full-time physician assistants support daytime operations
  • PRN coverage: 5 regular PRN physicians plus 2 additional PRN physicians plus 1 PRN NP provide schedule flexibility

The Satisfaction of Comprehensive Medicine

At Good Shepherd, you'll practice the kind of hospitalist medicine that drew you to the specialty in the first place—comprehensive care for diverse patients, collaboration with skilled specialists, intellectual challenge balanced with manageable volume, and the satisfaction of being genuinely valued by your community.

You'll manage acute coronary syndromes, respiratory failure, sepsis, and complex multi-system disease—with appropriate support and reasonable expectations. This is hospitalist medicine done right.

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