Comments on: How hospitalists can provide high quality patient care at the lowest possible cost

By: TrenchDoc

TrenchDoc — Mon, 07 Sep 2009 00:53:31 +0000

I am on call this weekend and there have been 8 calls. The most serious was from a patient who had been exposed the H1N1. Last year when our group was still covering the hospital I would have made rounds on 30 to 60 patients at 2 hospitals and would have answered 40 to 50 pages. Now it would take a lot more money than I will ever get from CMS or Obama to get me to go back to being an intern for specialists.

By: ninguem

ninguem — Sun, 06 Sep 2009 19:06:54 +0000

TrenchDoc – “…..The Iron Docs have left the building…..”
Or maybe Atlas Shrugged.

By: ninguem

ninguem — Sun, 06 Sep 2009 19:05:15 +0000

jsmith – “…..So, I should go to college for 4 years, med school for 4 years, then residency in medicine or family medicine for 3 years. Then I should become a hospitalist and put my professional life in the hands of the local hospital administrator……”

Indeed. Beats me why anyone would want to become an intern for a lifetime. But to each his own. I’m not impressed with the overall performance of hospitalists. Marginal improvements at best. Fix some problems, create new ones. But basically, no one else wants to do that work. You find some primary care practices willing to admit their own patients at most. But to be on the hook for drying out every drunk in the county, a target for every personal injury lawyer in town. No thanks.

By: Pitdoc

Pitdoc — Fri, 04 Sep 2009 19:46:40 +0000

The real problem is the lack of incentive for taking care of sick patients in the hospital. No one wants to do this anymore. Hospitals have no choice but to hire hospitalists. Most physicians realize they can see more patients in the office for more reward and less hassles. If the baby boomers think they have it rough now, just wait. The whole system is a mess. God help the truly sick patients because it is becoming more and more difficult to find someone to care for them. Of course, their hip fracture or nuclear stress test can still be taken care of – but someone else will need to admit the patient.

By: TrenchDoc

TrenchDoc — Fri, 04 Sep 2009 17:10:28 +0000

Cougar
Excellent point. I gave up my hospital practice after 32 years and my life has been dramatically improved. No more 2:30 pm calls for problems that the nurse forgot to ask me on my 7 am rounds. No more 2am phone calls for sleeping meds, fall out of bed and something for constipation. My income is the same and I work 2 hours a day less and always get a good nights sleep. The Iron Docs have left the building.

By: Bonedoc

Bonedoc — Fri, 04 Sep 2009 16:13:48 +0000

I find that in the three community hospitals in which I practice, the financial incentive for both the hospitalist and the hospitals is to admit almost everyone who presents to the ER for an overnight stay, particularly for conditions which were formerly managed on an outpatient basis. As a result, the bed occupancy rates have skyrocketed, and the hospital’s bottom line has improved…. but is that the goal?

As for the “netherworld of doctor-owned clinics and surgi-centers,” just try to find an employed physician for an urgent but not emergent issue at 5pm on a Friday before Labor Day. As a fee-for-service doc, I will be in my office with the phone lines open and will tell the patient to hurry in. I won’t direct them to the ER to see the hospitalist. Take a look at the number of cases and turnover times in physician owned surgi-centers vs. hospital OR’s and tell me, objectively… if that is possible for an academic doc (we all have our palms greased by someone)…, which is more efficient and cost-effective.

By: Cougar

Cougar — Fri, 04 Sep 2009 11:43:01 +0000

Hospitalist medicine is a result of poor remuniration to family physicians and out-patient internists. The PCP loses money by managing the in-patient because they could see 5 in clinic in the same time to see the 1 in-patient. Thus, their patients get admitted to the hospitalist.

Ideally, the PCP admits to the hospital. They know the recent studies, medical problems, and life story. This can save money and hospital length.

Hospitalist medicine is just a patch to a broken system. There is a better way, but the incentives aren’t there.

By: Happy Hospitalist

Happy Hospitalist — Thu, 03 Sep 2009 23:02:28 +0000

What the Mayo doctors don’t make in salary, they more than make up in private ventures, board of directorships, hawking drugs for easy money for big pharma and showing up at CME events to get paid 1000s to give a one hour talk.

I’m sure the Mayo docs ain’t hurtin. It’s just that if you are going to pay all doctors to go give lectures and sit on board of directorships, that’s like having 100% of your population on food stamps.

There isn’t enough money to fund the non salary benefits these guys enjoy if every doctor ate from the trough

By: alex

alex — Thu, 03 Sep 2009 22:43:59 +0000

Mayo does not pay particularly well, nor does it give that much autonomy. It also has a large pool of cash only patients from overseas to fund less profitable areas. It’s like how Hopkins sometimes offers far less than market starting salaries because of the hospital name.

There is a subset of doctors (not very large, I suspect, given the lack of stampede into Mayo-like systems) for whom the prestige of being a “Mayo clinic doctor” and perceived benefits of an integrated system outweigh the lack of autonomy and pay. I actually think a substantial portion of the reason such places perform abnormally well is because of this; the 5 or 10% of doctors attracted to such a culture are probably well above average in most respects. I bet forcing everyone else into Mayo clones won’t do anything like what the “incentivizers” (I’m really starting to hate the prefix incent) think.

By: jsmith

jsmith — Thu, 03 Sep 2009 22:27:14 +0000

So, I should go to college for 4 years, med school for 4 years, then residency in medicine or family medicine for 3 years. Then I should become a hospitalist and put my professional life in the hands of the local hospital administrator. Give me an independent medical group or give me death.