MMS Physician Focus: August 2009
By J. Court Stephens, M.D.
Hospitalist care is rapidly emerging across the nation, but it's
still not widely understood. A hospitalist is a physician,
generally board-certified in internal medicine, who serves as the
main physician contact for a patient during a hospital stay. As
"quarterbacks" of a healthcare team, they coordinate care with
other healthcare professionals throughout the stay, keeping the
patient's primary care provider informed all along the way. When
your primary care physician (PCP) chooses to participate in the
program or if you don't have a physician with hospital privileges,
hospitalists provide dedicated care around the clock, every day of
the year.
Employed by a hospital, hospitalists have a range of
responsibilities. They admit patients, often in the emergency
department, discuss treatment options, answer questions, monitor
test results, respond to changes in the patient's condition, and
consult with primary care physicians and specialists while the
patient is in the hospital. Upon discharge, the patient's primary
care provider resumes responsibility for care.
Hospitalists present a favorable situation for both patients and
primary care physicians: they ensure patients receive the care they
require in the hospital and free primary care physicians from
hospital rounds, allowing them to see more patients in the
office.
The specialty has seen dramatic growth: fewer than 1,000
practiced in the U.S. in the mid-1990s, and as many as 30,000 are
expected by 2010. This growth has been pushed by the changing
healthcare landscape: healthcare costs have continued to rise, and
the demands on primary care have continued to increase. Primary
care physicians are often challenged to find enough time to see
patients in their offices and enough time to make bedside visits to
their patients at hospitals. This situation has become more acute
with the growing shortages of primary care physicians here in
Massachusetts and across the country.
Hospitalists typically care for a number of inpatients daily,
are able to treat a wide range of conditions, and coordinate care
with other key members of the hospital's patient care team,
including nursing, case management, radiology, pharmacy, and
others.
Using hospitalists provides benefits.
- Knowing the workings of the hospital, they can accelerate
response time to patients, providing quick follow-up on tests,
timely interventions, and facilitation of
discharge.
- Physicians who focus on caring for inpatients provide prompt
and efficient treatment, leading to quicker recovery and reduced
need for sub-specialty consultation.
- The hospitalist model can decrease a hospital stay by half a
day or more, without compromising quality or safety. As a result,
hospital costs are decreased.
- Patients and their families tend to have high rates of
satisfaction due to increased access to and communication with the
physician during hospital stays.
Cautions and concerns have existed with such programs, however,
as hospitalist programs are still in their early stages. A major
concern initially was that patients might be reluctant to entrust a
"stranger" with their care rather than their own primary care
physician. Yet education and positive results have mitigated this
concern.
Hospitals were also wary that such programs would add another
layer in the flow of care. Experience has shown this not to be a
problem, and systems have been established to prevent disruption.
Hospitals were also concerned about outcomes and implications for
the bottom-line, but this, too, has been eased with education.
Finally, some physicians worried about a 'closed system' that would
exclude primary care physicians from hospital inpatient practice.
In response, many hospitals have adopted a voluntary hospitalist
system that primary care physicians are welcome to accept. With the
continuing need to contain costs, the use of hospitalists will
likely be even more attractive.
While hospitalist programs are becoming well-established, if you
as a patient still have concerns when admitted to a hospital, talk
with your primary care physician and the hospital staff. They
should be able to address all your questions and concerns. For more
information on hospitalists, visit the Society of Hospital Medicine
at www.hospitalmedicine.org
J. Court Stephens, M.D. is Medical Director of the
Hospitalist Program at Harrington Memorial Hospital in Southbridge,
Mass. Physician Focus is a public service of the Massachusetts
Medical Society. Readers should use their own judgment when seeking
medical care and consult their personal physician for
treatment.
