Hospitalists redux

First of all, my comments should not be taken personally, I have colleagues who are hospitalists, they are great doctors, communicate with patients well and take their mission as hospitalists quite seriously.

That being said, I am not in favor of hospitalists and will even go out on a limb and say the following: it won’t last. Why? Because it does not pay for itself. The article clearly states that most hositalists are subsidized.

Furthermore, the argument that quality is improved is quite weak. Studies may have shown a slight decrease in length of stay but the data is far from overwhelming.

Also, no one has bothered to ask what patients think. If posed the question: “If hospitalized, would you rather be cared for by your regular doctor or a hospitalist?”, the great majority would choose their regular doctor. If continuity is allegedly so important, why are we so quick to sacrifice it?

Another issue: although many hospitalists are good, many are not. I describe them as “driftwood”, having held many jobs. And communication from them, although occasionally occurring, can be quite lacking. It is not uncommon to see a patient for hospital follow up and I never even knew they were in the hosptial!

For those of us who are internists and fps who want to continue to care for our patients in the hospital, we need to continue to believe in the value of it. Stop believing the hype that “you can make more money in the office”; I spend a lot of time in the office and I ain’t making so much money.
We need to tell the powers that be that there is NO substitute for a primary care physician who will care for patients both inside and outside of the hospital.
If we let hospital care go, we further undermine our value to the medical system and increase the risk that we will be replaced by cheaper midlevels (I have nothing against midlevels either, but they shoould be physician extenders, not replacements).

Underpaid in New York

75% of our admissions are patients without any primary care doc. Who is going to admit them?

I don’t know anyone who wants to go back to the old days of “taking unassigned patients” in order to get rid of the hospitalists. Let’s see anyone admit 8 sick as stink patients (3 to the ICU), all with no health insurance, AND see people in the office. Can’t be done in this day and age.

Everyone forgets about those patients.

Ask the question a different way:

If you could see your own doctor:

* you will see 3 other doctors called consultants. You’ve never met them before but they will direct your care.

*you will be in the hospital for 6 days.

*if you acutely get worse, your doctor may or may not be availible to help, and you may be moved to the ICU where another new doctor takes over your care.

If you are admitted to a hospitalist:

you will stay in the hospital for 4 days.
You will have fewer consultants seeing you.
If you decompensate, someone from your doctor’s group is in the building 24 hours a day to help.

Which one do you think most pts will choose?

“Regarding service admissions, you can have them,….”
That is exactly the point being made underpaid. Where I worked PCP’s never take unassigned. They give it to the hospitalists (even when they are on unassigned)
I don’t have a problem with PCP’s managing their own patients. I just see it happening less and less as time goes on. We can argue whether it is better or worse for the patient (and underpaid, for every substandard hospitalist I have seen, I have seen a substandard officist) but the simple FACT is fewer and fewer office docs see their patient’s in the hospital. By the way underpaid, the last hospitalsit group I worked in was ALWAYS in the black (or I would not have recived a bonus).