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.


tracy said...

Hospitalists are "Happy". :)

(They also tend to "borrow" your pics and stories...!)

ERP said...

And soon there will be more "Labourists" and "Surgicalists" who are OB's and Surgeons who just practise in the hospital. However, I don't think the lure of more money and less overhead, etc. will drive all internists out of primary care. Most internal med docs I talk to really like the outpatient side of medicine and the relationships they have with patients. In fact, at our hospital, three of our new hospitalists are only doing it for a year or two while they decide what to do next. One is waiting to hear if he got a Nephrology fellowship.

The Happy Hospitalist said...

Hey doc. That's crazy that the hospital board didn't know what a hospitalist was. Where have they been for the last 10 years?

I agree that change is constant. Where will we be in 10 years? What will hospital based medicine look like if the proposed bundling of physician and hospital payment is realized?

Talk about a boxing match of the century.

Anonymous said...

I was talking to a nurse today that used to work at a Hospital in San Francisco who said along time ago there were hospitalists but they were called and known as house doctors who were employed by the hospital to work in the hospital.

Anonymous said...

The Costa Rica "cats" look like ant eaters. Are they civits?
Your cat is cuter.

Anonymous said...

The one thing that I'm not sure is as good for the patient compared to a primary care doctor as the attending physician. Last year when
my boyfriend's mother was in the hospital for an infected gall baldder and surgery for a week because it was summer with vacations and
days off she had three different hospitalists that family had to tell each one the
same information all over again. Even though there are chart notes it didn't
seem like there was continuity of care in knowing what was going on in her case. There
were four of us family visiting each day that had to keep informing them of things. It was also confusing to the patient just out of surgery on strong pain meds.

I do know another situation where it went more smoothly with hospitalists when it was a consistant one and can be better for the primary care physician not to have to run into the hospital at all hours of the night and day.

Barbara K. said...

Do you think that this trend means that what we think of as primary care will cease to exist outside of the hospital? Is this already happening?

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tracy said...

Dr. Jordan ("In My Humble Opinion"), is a "Prehospitalist"!

Bolina Stretta said...

So, are we going to have a health care system with no PCP, and just wait until something gets so bad that we go to the ER ? That's terrible.
What happened to preventive medicine ? I am shopping for health insurance and noticed that a lot (way too many) either do not cover, or barely cover any routine preventive visits. Are these people insane or what ?
Anyway, have a great week.