Hospitalist

Non-teaching services: A threat to medical education?

Dr. Wes writes on hospitalist-run non-teaching services, and how they threaten medical education:

I see many, many more patients shunted to in-hospital hospitalist services that are productivity-driven. These eager inpatient attendants to health care are a formidable challenge to managing inpatient teaching services: patients are seen quickly, decisions expedited, and lengths of stay minimized, making a powerful inducement for hospital systems to employ these services. Teaching services are rarely …

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Most hospitalist programs are "in big trouble"

Mostly because they are expanding too quickly and biting off more they can chew. Here are some red flags. (via Dr. RW)

That’s some flexible hospitalist position

Couz talks about the hospitalist position she took in Canada:

But then the same little hospital that had been courting me to work in emerg presented another option– they are currently desperate for hospitalist coverage. I can come in for as long as I want, as many days a week as I want and they’ll pay me $130/hr to see as many inpatients as I can. They don’t seem …

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Internal medicine versus the ER

ER docs sometimes lament hospitalists asking for a complete workup. Well, The Angry Doctor fires back:

So it’s just as easy for me to make disparaging remarks about the ER’s complete lack of motivation to diagnose (DISPO DISPO DISPO… the mantra goes, right?) as it is for these ER heads to lament how lazy primary care docs have become. Why all the intellectual; dishonesty? We all know the …

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Declining generalists and job security in the ER

Hospitalists demanding complete workups before admission? 911DOC has some strong words about that:

By insisting on this level of completeness from me the hospitalists, internists, and many surgeons have aced themselves out of caring for the critically ill and are losing their clinical judgement and skills for lack of use. In the meantime my skill and knowledge base is increasing. Hell, internists in my town don’t even manage the …

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Hospital employment

It’s back in style, writes Richard Reece:

Today, it is specialists and sub-specialists and hospitalists, who are hot when it comes to physician employment. For hospitals, salaried specialists fill a void ““ in-house patient coverage, ER coverage, and prestige in the community.

For the physician, other factors are at work ““ a predictable 40 hour week, which fits the life styles of young or burnt-out physicians, a refuge …

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Hospitalists: Good in theory

Aggravated DocSurg talks about how his hospitalist program is too disorganized, leaving many peri-operative complications to the surgeon.

In theory, hospitalist programs should be well-staffed, and internists available for consults. The reality is that many of these programs are in their infancy, and recruitment to smaller community hospitals are a problem. Combined with the high turnover rate inherent in this specialty, many programs are in a …

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Virginia Tech: A call for gun control?

Hospitalist Chris Rangel looks at both sides, as well as a take-home message unrelated to whether guns are regulated or not:

Unfortunately, the best lesson to come out of this is for law enforcement and first responders. Don’t automatically assume that multiple homicides in normally peaceful communities where the killer(s) is still a large are isolated incidents in which a rational murderer is attempting to flee and has no interest …

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Doctors as interchangeable commodities

Dr. Wes says that as doctors practice more at satellite offices, patients are increasingly being seen by their colleagues.

Of course, the concept of interchangeable doctors is already in full force with the hospitalist movement.

Why do we have hospitalists anyway?

retired doc explains:

I am leaning to the conclusion that this is the result of physician fees price controls put into place in 1992 for Medicare patients and the controls placed on hospital charges for Medicare patients in efforts to control the rising cost of medical care for the elderly.

Also love this quote:

It has been so long since I functioned as a officist and a hospitalist – …

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How are hospitalists doing?

Very well, thank you very much.

Not happy with internal medicine’s direction

Dr. RW says that there’s nothing to differentiate general internal medicine from FPs:

Worse yet, the proposals are another failure of the ACP to reclaim the identity of internal medicine. In defining the way internists fill the primary care role the proposals make no distinction from family practice. Is it any wonder there is a growing perception that the only way to be an internist is to be a …

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Hospitalists: The last true internal medicine physicians?

Looks to be that way, says retired doc:

Hospitalists do seem to spend most of their work day doing what many of us wanted to do when we decided to become internists and I hate to think the only avenue for the Oslerian type internist to travel is that of the hospitalist but that may be the reality though we have not quite arrived at that point yet.

Hospitalists: Get used to it, part 2

More controversy about hospitalists. Some patients aren’t happy:

“If I’m in the hospital, I want my doctor to come and visit me. You better believe it,” said Hill, 78, who is retired. “That’s part of his job.”

Well Mr. Hill, welcome to the world of decreasing reimbursement, pressuring office physicians to see more patients in the clinic. If you’re not happy about this arrangement, I suggest getting involved …

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Hospitalists: The must-have recruiting selling point

It’s a buyer’s market for physician jobs. Hospitals not having a hospitalist program are at a disadvantage:

Doctors are satisfied with Coweta’s patient base and current hospital facilities, but some are reluctant to make a commitment to Coweta because of Newnan Hospital’s lack of a “hospitalist” program, according to Bass . . .

. . . A lack of financial resources has so far prevented Newnan from establishing …

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Hospitalists: Better get used to it

This reader wants to go back to the “old way”:

I’m sorry, but when I chose my primary care doctor that is who I want on my team looking out for me, not someone I don’t know. As the hospitalists will be talking to the surgeon, my primary care doctor should be involved in my care. When they give the medications, maybe your primary care doctor would have done it …

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Arguing against hospitalists

This writer wants life to go back to the old (pre-hospitalist) days:

Somewhat reduced length of hospital stays and lower costs are touted by the hospital and health insurance industries–but hospitalists with subspecialties actually raise costs, and I am aware of no studies of overall costs or number of readmissions after the initial hospital stay.

In-house hospitalist programs do not typically pay their own way, and we needn’t …

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Blame the ivory tower for the demise of internal medicine

retired doc points to an article from the Annals:

Academic medicine is the carpenter that fashioned the coffin of internal medicine. Instead of reengineering internal medicine to accommodate changes, it cannibalized the discipline by reducing its worth, creating the hospitalist and ambulatory care internist. These were both nails that helped seal the coffin; the former reduced the influence of the internist in the acute care environment and the latter …

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Liability is driving out board-certified ER docs, allowing internal medicine physicians to benefit:

Ironically, he credits the state’s years of high malpractice insurance premiums and fears of litigation with driving out the competition: board-certified emergency medicine physicians who, although they may live in Pennsylvania, commute across the river to work in New Jersey.

“As an ER doctor, I can make more money than I can as a hospitalist, more …

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There goes the neighborhood

Thanks to Kevin for trusting us and letting us play on his blog while he is (hopefully) on vacation. With any luck, we wont trash the joint. It’s hard to imagine how an oncologist, nephrologist, ER/hospitalist, psychiatrist, pathologist (in a former life I think Dr. Bottles was a pathologist), and obstetrician could get into any trouble….guess, we’ll see.

I’m all in favor of umbilical cord blood banking …

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