Should hospitalists or intensivists manage ICU patients?

Many hospitals prefer so-called “closed” intensive care units solely managed by intensive care specialists.

The reason being that specialists can supposedly better adhere to quality measures, and hence lower costs, which are goals that hospital administrators pine for.

The problem is, there aren’t enough intensivists to staff closed-ICUs for many medical centers across the country.

So, hospitalsts are stepping in as a “stop-gap” measure, and in some cases, become a more permanent solution to ICU staffing (via Dr. RW).

Already, primary care doctors are deferring hospital care to hospitalists, and now, ICUs are being increasingly staffed by them as well. It’s inevitable that hospitalists will become the primary managers for almost every hospitilized patient, with specialists being involved in a consultation role only.

That fact should keep internal medicine thriving well into the future, albeit focused on an increasingly inpatient capacity.

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  • The Happy Hospitalist

    I cost less to manage ICU patients.

  • Anonymous

    What is the point of being a hospitalist if you can’t take care of an ICU patient?

    The “turf wars” are rare outside of academia and very large hospitals where doctors actually talk to one another and can work together.

    There’s enough work for everyone and I know very few pulmonologists who want to manage DKA and GI bleeds in the middle of the night. A hospitalist who can’t manage an ICU patient shouldn’t be taking care of “floor pts” either – he won’t recognize when they are decompensating.

    Happy is right – in an ICU more than any place else, some one needs to coordinate care and keep everyone on the same page. ICU care costs more, but hospitalists can help decrease the costs as well.

  • shadowfax

    Hospitalists are the future of ICUs the same way that FPs are the future of ERs.

    As long as there is a market niche, yeah, there will be someone to fill it and IM hospitalists are the rational and capable people to provide that service. At any hospital that can support a closed unit (which depends more on volume than availability), there will be more and more pressure to move to a closed model. As the Leapfrog measures percolate through CMS and TJC, the incentive for hospitals to recruit critical care hospitalists will increase.

    We’ve got them — it rocks.

  • DocMac

    There are certainly benefits to having an intensivist available. I am the traditional internist with an office and hospital practice. We continue to manage our own patients in ICU. If they need a subspecialist then we consult the appropriate one. The internist remains the primary doc and is frequently the one to deal with family/patient questions etc.

    I agree that there is not enough intensivist to cover the needs of every major hospital ICU. At times it would be nice to have one individual we could consult that could help with multiple aspect of intensive care medicine, without having to consult multiple subspecialties to manage some of the most critically ill patients.

    I think hospitalist are the ideal choice for managing ICU patients with subspecialty consultation or an intensivist when indicated.

  • Anonymous

    Shadowfax is right on the money. Eventually every hospitalist group will have at least one or two docs certitified in critical care. The line between “intensivist” and “ICU hospitalist” will blur.

    Most hospitalists know when they need a pulmonologist (“intensivist”) and it’s much better for the patient to have too many docs than too few.

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