Tuesday, December 2, 2008
Hospitalists - They are Here
I was kind of surprised tonight as I sat at a Hospital Board Meeting and we needed to approve a contract for a Hospitalist Group. Although these were highly informed, medically savvy board members, they did not know what a "hospitalist" was. I thought everyone knew about the changes in medical care that have swept hospitals across the country in the past ten years. And "hospitalists" are a change that are here to stay.
For readers who wonder what I am talking about...a hospitalist is a doctor, usually trained in Internal Medicine, who does not have a practice or office but becomes the attending physician for a hospitalized patient. The Hospitalist manages all the patient's diagnosis, testing, treatment and coordination but will probably never see the patient again after they are discharged...unless they come back to the hospital. Most hospitalists are part of a "group" that covers the hospital 24/7.
Many of these patients have their own doctor "outside" of the hospital who resumes their care when they are discharged. Many other patients have no doctor "outside" of the hospital because all the doctors are becoming hospitalists instead of practicing primary care.
The hospitalist movement started out slowly, but over the past decade just about every hospital now has them and fewer and fewer family medicine and internal medicine doctors take care of hospital patients...they turn the care over to hospitalists. One reason for the shortage of primary care doctors across the nation is that young physicians are choosing to become hospitalists rather than "office" docs.
Why? Well, hospitalists have no overhead, no practice expenses, no employees to manage, they make better money, have more time off, no call, a defined start and stop time and they have the support of the entire hospital staff.
Hospitals pay the hospitalists more money than they could possibly make billing Medicare or even insurance companies for patient care. It is a win for the hospitals because they have guaranteed coverage in the emergency department, better standardized protocols of care, ability to move patients out and home sooner (called Reduced Length of Stay...worth millions on Medicare and Medicaid patients).
I read several "hospitalist blogs", like the Happy Hospitalist, Fat Doctor and Rural Doc. I've learned that nothing stays the same and the emergence of the hospitalist is a prime example of how the world of medicine continues to change and evolve. Unfortunately other evolutionary changes point to the fact that primary care physicians are soon to be extinct.
Addendum: For another take on what goes on inside the hospital between hospitalists and other specialists, check out ER Stories.
Posted by Toni Brayer, MD at 9:40 PM