Growing up in an old mill town on the Jersey Shore, "fishing every day," James Snyder, MD, PhD, probably never envisioned that he would live inland far from the beach in Middle Tennessee and South America.

 

After graduating from Rutgers, the State University of New Jersey, with a degree in molecular biology, he stayed to receive a Ph.D. before heading across the Atlantic for two years at Cambridge University. While there, he got a post doctorate degree, worked with psych patients at a halfway house connected to his Bible study class, made international friends … and caught the travel bug.

 

Snyder and a Scottish buddy left England heading west to travel around the world with stops in the United States, the Philippines, and Asia before heading back to Europe.

 

"We missed Australia and South America," he admitted.

 

When Snyder came back to the states for a fellowship at Baylor College of Medicine in Houston, he decided to go to medical school. Enrolling at the University of Texas' Southwestern Medical School in Dallas, he received two degrees before he came to Nashville to do an internal medicine residency at Vanderbilt University Medical Center.

 

He had decided he really liked the region, and that significant cultural differences made the south a "much more civil" place to be. His move to Nashville in 2000 was the "best decision I ever made in my life."

 

At Vanderbilt, Snyder continued to travel as much as possible and included a tropical medicine fellowship at a university in Colombia, South America to his credentials.

 

He is now part of the Hospitalist Group at St. Thomas.

 

Almost unheard of a generation ago and not yet classified as a medical subspecialty, hospitalists are in one of the most rapidly growing areas of medical practice in the country and are on staff at more than half of the nations' community hospitals. This growth, to some extent, might be tied to the legal limits curtailing house staff duty hours and the shrinking role of primary care physicians in hospital care.

 

Robert Watcher, MD, first used the term "hospitalist" in a 1996 New England Journal of Medicine article to describe a physician whose practice is organized around the site of care (the hospital), as compared to an organ, disease or a patient's age. Snyder said he thinks another term could be "adultist."

 

The Hospitalist Group at St. Thomas is the largest group in Nashville, in Tennessee, and in the South, except for Emory University. It employs 40 physicians and 25 full-time equivalents, divided into 10 teams. To ensure a continuity of care, most physicians have schedules that are seven days on, seven days off. A day shift is 11 hours; night shifts are divided into an overnight shift and two separate 'swing shifts' or half night shifts.

 

"Together these nocturnal shifts allow for the equivalent of two physicians to be in-house at night to cover the approximately 130 patients on our service, as well as the 15-20 patients admitted overnight," Snyder explained. Night shifts pay extra for the resulting "circadian disruption."

 

Snyder said his group is "100 percent committed" to maintaining communication with local doctors while their patients are in the hospital. "One of our most important activities is being sure that the discharge summary for the physician is a thorough and complete record of the patient's stay."

 

Several years ago Snyder, frustrated by the "Evaluation and Management" coding requirements called for by CMS and the "sub average" training physicians received from coding consultants, decided to develop a better way for physicians to do E & M coding. He "became an expert on hospital coding and spent over a year or so working on understanding and writing computer programs."

 

The result? Snyder developed a simple program used with a handheld device to interpret and implement ambiguous E & M documentation guidelines in a consistent procedure.

 

Because of its truly algorithmic nature, Snyder's program, called Easy E & M, circumvents the problem of navigating several charts and checklists by facilitating implementation of risk-based coding and optimizes E & M coding in general.

 

Snyder said writing a 20,000 line computer program was "very satisfying." He "loved developing the program and learning to write the computer code. It turned out to be a wonderful way to combine art, teaching, math and logic."

 

Because he has the ability to alternate an intense work schedule with blocks of time off, Sndyer has continued to travel extensively and has remained close to the friends that he made in South America during his fellowship. He recently purchased a condo in Medellin, Colombia, and travels there, only a three hour flight from Miami, almost every month.

 

In the last quarter of the 20^th century, Medellin suffered as the headquarters of the infamous Pablo Escobar, terrorist leader of a vast criminal organization, but since Escobar's death the city has recovered its tranquil reputation and seen dynamic growth.

 

Snyder said, "I feel safe there — it's a very friendly place. It's similar to Nashville in many ways. I feel like an ambassador to both."

 

As an extension of his ambassadorial role, he started a stuffed animal "ministry" for sick children in the city.

 

"On a few trips to Colombia, I have brought down a very large suitcase filled with stuffed animals donated by my physician colleagues. With the help of my Colombian physician friends (one is an intensive car pediatrician), I bring them to the kids at one of the hospitals in Medellin. The kids show their appreciation with huge smiles, and I get repeated 'gracias' from the parents."

 

"I am hoping to expand the program to bring more toys with me when I travel to Medellin," he said. (Contact Snyder CredibleMed@yahoo.com if you have gently used teddies or dolls that can travel).

 

Both in Medellin and in Nashville, music is an important part of his life. Snyder loves collecting and playing the guitar –"strictly acoustic"– and relaxing to the full, lush, warm tones that the instrument offers.