I can’t imagine any reason why PCPs should be forced to hospitalists. I do know of a few places that require a pulm consult for a patient on a vent, and a few where only certain docs can admit to the ICU.

If someone wants to manage their own patient, they should be allowed to. There are enough docs who are OK with letting the hospitalists do the inpt stuff.

Even we hosptialists can’t prove we should be taking care of everyone in the hospital.

But we certainly should be availible for docs who want us to take care of their patients.

Just because Underpaid in New York likes inpt work (and is probably jsut as good or better than me at it) doens’t mean the rest of his outpt collegues feel the same way.

Hey, we hospitalists are here if you want us. That’s how it should be. – the decision belongs to the pt’s PCP (if the pt has one).

But 2:12 is right – no hospitalists means going back to the old days of “service admissions.”

There is no evidence proving that hospitalists shorten length of stay by 2 days; please quote your sources. Studies have shown at best a length of stay 1/2 day less; other studies have shown no significant differences.

As far as use of consultants, I do not know if this has been studied at all. However, I do not believe it. Anecdotally, I would say the opposite is true, but until it is studied, your opinion is as good as mine.

Regarding service admissions, you can have them, but please don’t tell me you do a better job of caring for my patients, because I just do not believe you.

Underpaid in New York

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?

The fact is we make even less at the hospital because we have staff and systems at the office to make us more efficient.

Of course patients prefer their own physician when admitted. When the shrinking margin between practice revenue and overhead wasn’t a major concern, I preferred the old system as well. However, only those patients and physicians brave or fortunate enough to leave the third party payers will likely get that in the future. In that market, a physician would want to keep inpatient skills to attract patients.

Yes, hospitals would dump their hospitalists as soon as they’re not needed but for now they need physicians to fill their inpatient beds while primary care slowly collapses. They also need to keep the revenue generating specialists happy by having hospitalists available to do the scut work for them.

A family doc

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