Will hospitalists continue as a loss-leader, attractive service to the docs who do not want to do hospital work, and the “no-doc” patients?

I’ve worked in hospitals where being on call put us at risk for ER admits of patients who had no doctor. Meaning the drunks, drug addicts, psych patients who needed medical problems treated first. You know the story. That was the majority of my hospital work; my own patients were the minority.

Needless to say, I left the place, for another hospital where I’m not at risk for those patients because of hospitalists. I admit my own patients. Even with four, five patients a day to my name in the hospital, my days are still quite. I have an office practice and a life. That all changes when you’re at risk for every sociopath who walks into the ER.

If I had a choice between hospital “A” with hospitalists, and hospital “B” without, I’d go on staff at hospital “A”.

Plus clinic practices often hospital-run, where the docs get a big Medicaid load. Again, I’d take the job for a 9-5 M-F clinic, but if I were on-call for the admits from such a clinic, I’d quit. Some hospitals run hospitalist programs in order to keep their outreach clinics staffed.

I may be a lone dissenting voice but a do not think hospitalists as a movement will succeed for the following reasons:

1) it does not pay for itself; in fact, most porgrams are subsidized by sponsoring hospitals

2) it is by far not easy work. I think a lot of doctors are attracted to it as an alternative to private practice; however, it has its own frustrations and burnout is a problem

3) Despite the hype, there is no conclusive study showing improved quality or decreased cost.

I acknowledge my own bias: as a family practitioner I continue to do hospital work because there is no substitute for the patient’s regular doctor when the patient is sickest, in the hospital.