Voices that Transform: Dr. Jensa Morris
Jensa Morris, MD, is a practicing hospitalist and Director of the Smilow Hospitalist Service at Yale New Haven Hospital. Dr. Morris has a strong interest in quality improvement, education and team-building in inpatient medical services.
She serves as Chair of the ABIM Hospital Medicine Longitudinal Knowledge Assessment (LKA®) Approval Committee.
You were one of the first at Yale to specialize in the field of hospital medicine. How has your work as a hospitalist evolved through the years?
I started as a hospitalist at Yale, straight out of residency in Boston. Hospitalists really didn’t exist yet at Yale New Haven Hospital, so there were three of us taking care of a large service of general medicine patients; for months we worked all the time because there was no other staff to do it. We saw general medicine, cardiology, oncology, sickle cell patients—everything. And then there were some dramatic changes to the ACGME guidelines and suddenly this whole new profession of hospital medicine exploded. At Yale, we went from three hospitalists in 2002, to more than 100 full-time equivalent hospitalists now. With that explosion over the years, there have been tons of opportunities. I have done general medicine, orthopedic and neurosurgery co-management, COVID-19 and now oncology.
About ten years ago, co-management programs were just being explored and I was asked to work with the orthopedic surgeons to help manage hip fracture patients. We built a really robust co-management program for hip fractures that reduced 30-day mortality in patients with hip fractures, reduced medical complications such as pneumonia, sepsis and delirium, and created a really great partnership with the surgeons.
Later, when we saw that complicated elective arthroplasty patients with multiple co-morbidities had longer inpatient lengths of stay, we started a co-management program for these high-risk arthroplasty patients. Then we expanded to co-manage high-risk neurosurgery patients. Next, we delved in further and created a preoperative optimization program where we worked with nurse navigators to reduce ED visits and readmissions post-operatively.
And then COVID hit. I felt a very strong loyalty to my medical team so I left surgical co-management and I spent a year and a half just seeing COVID patients. Much of the hospital was transformed into dedicated COVID units. At Yale, we were hit hard.
When COVID eased up, I was approached with the idea of bringing co-management to oncology. I was intrigued. We created a small pilot program that was successful in its first year, lowering length of stay while maintaining high quality care. With our initial success, we expanded and now we cover all of solid tumor oncology and about half of inpatient hematology. In July 2023, we will expand again to care for sickle cell patients. We even have one doctor who is bone marrow transplant-trained and is doing some bone marrow transplant work. It’s been interesting to see how this has evolved.
What is the key to the success of co-management programs?
Mutual respect is key. There’s absolutely no question about it. Understanding that you can’t possibly know it all and working as a team is important. I’m constantly in text, email and phone conversations with the patients’ primary oncologists. Interestingly, I think what they were expecting—like maybe a really good resident—was not what they got. They were surprised how much a hospitalist brings to the table and have now realized that hospitalists have a unique skill set. It’s been rewarding to see other specialties recognize the value of hospitalists.
Did you have to provide additional training to the hospitalists who work with medical oncologists? I imagine there are a lot more end-of-life issues to manage.
There are many end-of-life discussions with bad news to deliver. The first year we did specific end-of-life communications training because it’s not a standard communication skill. These are really difficult conversations. The first few times, I think I was as emotionally devastated as the patient and the family, and it was hard to get the words out clearly. Now I have these conversations every single day, and I have learned that providing clear medical information with clear expectations is a gift that I can give the family. Even though I can’t cure the cancer, I can certainly make the whole process a little less scary.
It seems like it’s a very creative field. Do you think that being flexible is important for hospitalists?
I think it’s absolutely important if you want to keep learning and growing. I have had the opportunity to do many different things over my career at Yale. Each was an opportunity to learn and grow as a physician. Who knew that I would do general medicine and then orthopedics and then COVID and then oncology? No one ever plans to do any of that, so it’s important to be flexible and open to learning new things. Then your career can take you in many fascinating directions.
What advice do you have for women who are in medical school and considering a career in hospital medicine?
I love medicine; it is such a fulfilling career. I would give the advice that someone once gave me and that is, you can do it all, you just can’t do it all at once. I think that’s such good advice, because even in those times when I had young children and I was watching all of these people around me excel and I was thinking that my career was going nowhere because I was spending half my time at home and half my time at the hospital and I didn’t particularly feel like a good mom or a good doctor—even during those times, I could remember that a career is long and that this was my phase where I was balancing work and raising my children. Now I’m working full time and I’m really enjoying both the patient care and the leadership and the mentoring of younger doctors.
There’s a time for everything.
