Dr. Wes writes on hospitalist-run non-teaching services, and how they threaten medical education:
I see many, many more patients shunted to in-hospital hospitalist services that are productivity-driven. These eager inpatient attendants to health care are a formidable challenge to managing inpatient teaching services: patients are seen quickly, decisions expedited, and lengths of stay minimized, making a powerful inducement for hospital systems to employ these services. Teaching services are rarely as efficient since teaching takes time and, regrettably, time is money.
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{ 3 comments }
Isn’t this a re-hash of age old HAVEs [those who go into hospitalist service] and HAVE-NOTs [those that are in the teaching service]. The latter maybe assigned to attendings who are so busy trying to see enormous numbers of patients with minimal to no compensation?
Teaching services can never be as efficient at utilization as those run by mature clinicians, if they are optimal teaching experiences. Good training requires that residents be given leeway to make clinical judgement which means they have to have responsibility for making decisions without a lot of interference and find their clinical comfort level–sometimes that takes and extra day or two in the hospital.
This is garbage.
First off, the patients assigned to the Non teaching service typically arent spearated by insurance status. They are just in a queue with the on call residents and the ER just doles em out.
Secondly, the real danger is that all the non teaching cases are probably lower acuity, so the few “easy ones” that interns and residentts (and their attendings) get are plucked away in favor of those that are sick as hell. So the floor team gets crushed. Its just like with mid level run clinics.
NO WAY would hospitals get rid of residency programs, if Medicare gives the hospital 150K per resident for GME, then the hospital would be pissing away MILLIONS of dollars.
These non teaching prgrams are a byproduct of JCAHO 405 regulations (in NYC anyway) that put caps on resident admissions and census. Administrators are in constant jeopardy of being cited by JCAHO so they are desperate to ease the burden on the housestaff placed there by the ever increasing use of the ER/hospital as a primary care source and hotel.
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