Comments on: How will the economy affect hospitalist salaries?

By: Sharon

Sharon — Wed, 04 Mar 2009 04:54:00 +0000

Happy, with all respect to your program, I think it’s far from the majority. I think it’s great that you can show that your own hospitalist program has results in your particular community setting, but when we look overall, we really don’t find the evidence to be there. Meanwhile hospitals are hiring hospitalists left and right, on the assumption (based on some smaller studies) that they will save money. Another thing that I do not think these studies look at enough is patient satisfaction, doing tests again that may have been done before, (one might argue that cost of stay is a proxy indicator of this, but given the way hospital stays are reimbursed I don’t think it’s an appropriate measure), exposing patients to radiation, etc. Obviously all of this would be very hard to tease apart, but I think the hospitalist movement does not have the ammunition to back up its claims that it leads to cost savings.

That being said, I would be very interested to know more about the data you’ve collected at your institution, because in the end I’m in favor of the most efficient, safe, and affordable ways to take care of patients.

By: Anonymous

Anonymous — Tue, 03 Mar 2009 22:23:00 +0000

JB,

You forget that the cost of the extra day is the opportunity cost of the admit that got turned away. That's the important value an efficient inpatient (primary care or hospitalist) physician brings to the hospital's budget.

It's becoming a moot point whether hospitalists are more efficient. As primary care slowly dies , our inpatient skils are being abandoned in hopes of keeping the office solvent a little longer. Many primary care docs couldn't return to the hospital at this point. It sucks but the alternative for many of us is to go bankrupt.

By: jb

jb — Tue, 03 Mar 2009 21:46:00 +0000

Good. Fast. Cheap.
Pick any two.
That’s been true in medicine forever.
Hospitalists can be worth their salaries because good and fast can equal cheap, if they don’t cost too much to keep on staff.
If their salaries go up further, they won’t be cheap (i.e., cost effective), no matter how good they are, or how much time they save. In my experience, there are some good and fast ones, and Happy very likely is one of them (to hear him say it, in any event), but many are good but not fast, or fast but not good. A few are neither, but they don’t get rehired.
It will also get realized at some point that the cost of an extra day in the hospital is not as high as the UR people and administrators seem to think. When an extra day is tacked on to a stay, the cost is meals and meds and 1/6 of a nurse. It’s not a trivial cost, but hiring a crew of hospitalists at $250K can add up in a hurry also.

By: The Happy Hospitalist

The Happy Hospitalist — Tue, 03 Mar 2009 14:07:00 +0000

Sharon. My Hospitalist program blows those numbers out of the water. Perhaps there are few well run hospitalist programs, at the least ones being researched.

By: Sharon

Sharon — Tue, 03 Mar 2009 12:42:00 +0000

Why do people keep holding on to the idea that hospitalists are cost-effective despite a large study that does not support this conclusion? If you look at the confidence intervals in this study, you find that the evidence is simply not there.

http://www.ahrq.gov/research/may08/0508RA17.htm

By: Anonymous

Anonymous — Tue, 03 Mar 2009 07:17:00 +0000

I do admit my own patients. My experience with hospitalists includes the following:

1) when my patients are admitted to a neighboring hospital. I NEVER hear from the hospitalists when this happens, neither upon admission nor discharge.

2) in my own hospital, I receive, and resist, pressure from administration to utilize the hospitalists.

3) I have to endure the false mantra that hospitalists decrease costs and improve quality. As I requested in another response, please show me the data. I know that some studies may have shown this, but many others have not.

In summary, just as we regret the day that the first doctor agreed to accept payment from the first HMO, therefore opening the pandora's box of third party payment, we will rue the day that primary care doctors gave up caring for their sick patients, under the illusion that it was neither profitable nor "quality." The less we do, the more easily replaced we are.

A family practitioner

By: Anonymous

Anonymous — Tue, 03 Mar 2009 04:46:00 +0000

In my neck of the woods, I never see a family practitioner actually admit their own patients.

By: Slightly Disgruntled Hospitalist (but becoming less so)

Slightly Disgruntled Hospitalist (but becoming less so) — Tue, 03 Mar 2009 01:40:00 +0000

to the family practitioner who has only bad experiences with hospitalists: If you admit your own patients, you shouldn’t have to deal with hospitalists at all. Just admit your own and the occasional un-doctored and you never have to speak to us. Where I work, some of the community docs do just that. Many do not. And the number that don’t admit is increasing all the time. If all of a sudden, they decided to reapply for priveleges, I would be out of a job. But that doesn’t seem to be happening anytime soon.

But, as you have said before – communication is key. Do you have an EMR that works with the hospitals? Can the hospitalist get information from you on nights and weekends? That is my biggest frustration in admitting some doctors’ patients – I can’t get any info. Almost all of the PCPs I call though are happy to hear from me and say the hospitalists never call them. That is sad…

By: Anonymous

Anonymous — Mon, 02 Mar 2009 22:19:00 +0000

Happy:

In my neck of the woods, the phrase "well-run hospitalist program" is an oxymoron.

Family practitioner

By: The Happy Hospitalist

The Happy Hospitalist — Mon, 02 Mar 2009 21:12:00 +0000

Anon. Remember, I said a well run hospitalist program. Bad programs are expendable because they bring no intrinsic or intangible value. I work in a well run hospitalist program. The day my value runs out is the day I move on.