Comments on: Are patients refusing doctors who no longer do hospital work?

By: Dr. Mary Johnson

Dr. Mary Johnson — Thu, 30 Jul 2009 23:29:59 +0000

By then, “Bad Medicine”, a good many of us on these threads will be over and done – our careers/hopes/dreams eaten up by this mess.

By: Bad Medicine, Good Solutions

Bad Medicine, Good Solutions — Thu, 30 Jul 2009 21:50:16 +0000

Once the system collapses as the government realizes they can’t afford healthcare, and services level out to their true market value, people will be clamoring to take ownership of patients once again. Hospitalists will cease to exist faster than they came into play. Health care reform will only expediate this process – comical really.

By: Mary Pat Whaley

Mary Pat Whaley — Thu, 30 Jul 2009 13:17:02 +0000

As a manager of both out-patient practices and a hospitalist practice, my job is to develop processes to bridge the differences between hospital protocols and ambulatory care needs. When the processes work perfectly, it works for the patients, the nurses, and the physicians. When a glitch appears, it takes a lot of communication to find out where the process broke down and repair it. The model is working in this small town where the patients appreciate getting seen more quickly than they did when their PCPs worked in the hospital, and they are slowly getting accustomed to the hospitalists.

By: Aftercancer

Aftercancer — Thu, 30 Jul 2009 13:03:13 +0000

I have a primary physician who is a former hospitalist and does not have admitting privileges. Any hospitalization I have is likely to be covered by one of the far too many specialists in my life.

The benefit is that when I am at my primary care office I am seen on time and have the full attention of my physician. I’ll take the risk.

By: David

David — Wed, 29 Jul 2009 21:50:05 +0000

I am a neurologist and I split my time equally between hospital coverage and outpatient. It is clear to me that with the development of new drugs, new discoveries about disease treatment, and new processes in the hospital – it is hard to keep up with both. At some point I will probably have to do hospital only.

The hospital is a unique world and it seems obvious to me that those who are very familiar with it will become more efficient at using it and probably more effective. They know who to call under what circumstances. They are more familiar with the diagnosis and treatment of acute diseases. They make the hospital run more smoothly by seeing patients in a timely manner and by fielding follow up questions quickly. (Can you image the frustration of the nurses who have to continually try to get in touch with the busy office-based primary care physician? It can be a nightmare!)

We are perfectly accepting of the fact that there are cardiologists (or even EP specialists), neo-natologists, and intensivists. All of these fields offer the patient greater levels of expertise, because there is simply so much more to know. For the very same reasons, we how have hospitalists.

By: Happy Hospitalist

Happy Hospitalist — Wed, 29 Jul 2009 21:41:47 +0000

Most businesses are not in the business of paying for something they do not value. If the value of hospitalist medicine decreases, the value of the subsidy will as well. If the administrators have the wool pulled over their eyes, I suppose hospitalist medicine would be the greatest scam in the history of medicine.

Until then, the market is telling you that hospitalists hold a greater value to inpatient medicine than do the outpatient internists/family medicine docs.

Let me know when the hospitals start paying the outpatient internists and family medicine docs 100K a year in subsidies to round on their patients.

By: family practitioner

family practitioner — Wed, 29 Jul 2009 19:27:30 +0000

Methinks happy is a little defensive.
The hospitalist movement is a flawed solution to a flawed system; right now you may have value worthy of your subsidy, but they will start squeezing you more and more, and it will never be enough. Eventually, you will be eschewed in favor of an even more “cost effective” solution. But that’s ok, we can use primary care doctors, be they internists or family physicians, in my community.

By: ninguem

ninguem — Wed, 29 Jul 2009 18:16:49 +0000

@ Donald Green MD – do you have a link to that Scripps study, I’d like to give it a look.

By: Donald Green MD

Donald Green MD — Wed, 29 Jul 2009 17:04:59 +0000

Time will tell. The hyperbole of “indispensability” is a bit much. If you read the original Scripps study on hospitalists you will see that the most efficient care was from community physicians who were directly responsible for their patients. You have been sold a bill of goods.

By: Happy Hospitalist

Happy Hospitalist — Wed, 29 Jul 2009 16:30:42 +0000

I can’t believe what I’m reading here.

Hospitalist medicine is WIN-WIN-WIN-WIN-WIN-WIN. There is a reason why hospitals subsidize hospitalists on aver age of100K per hospitalist per year. Because the service they provide is indispensable to all the parties involved. Including patients.