Listen to Moof comment on the hospitalist movement

I am a neuroradiologist at a busy suburban hospital. I get a wonderful lateral view of health care at my hospital. I can tell you which doctors are good, which are top notch (the ones I send my family to), and which are in neither category.
We have some excellent internists and surgeons. Unfortunately, the hospitalists are a notch below, although with a few bright exceptions.
Why did this happen? Try looking at the most powerful motivator, money. What is the reimbursement for inpatient care? Certainly not in the league with surgical fees, outpatient visits, cardiac testing, or endoscopy fees.
If there were a groundswell of support to have internists and surgical specialists provide hospital care to their own patients, and not farm it out to hospitalists (or even PA’s), this could be done with regulations, evil as they are. Increase the fee for inpatient care (unlikely to happen in this cost-cutting age), or tie the fees for more expensive procedures to the admnistration of inpatient care. I don’t know exactly how to implement this.
I will say that most family docs are far removed from providing inpatient care, but then, by the time the patient is in hospital, usually a specialist is on board.
By the way, we don’t see any pediatric hospitalists, do we. ALL of the local pediatricians provide inpatient care to their patients when the rare hospitalizations occur. and they seem good at it. Appropriate specialists are consulted, such as pulmonologists or surgeons, but you always see the pediatrician follow the patient, as well. What a great relief for the parents.

why are hospitalists becoming so common?

it is the same reason why physicians choose not to work in primary care.

it is economics.

did you know that the large majority of hospitalist were working as primary care docs
but quit outpatient care due to the frustration of having to see people on a 10 minute allotment?

hospitalists are paid much more per hour than primary care docs are. so why the surprise?

did you know that there is a huge drop in the numbers of doc’s training to become primary care docs?

why? economics.

it is the same reason why doc’s choose to become specialists such as Gastroenterologists, cardiologists, pulmonologists, radiologists,dermatologists etc….

no mystery here.

About a decade ago, when they introduced the hospitalist concept into our group, it was optional. I was vehemently against participating, feeling that it would interfere with my relationship with my patients. I feared that I would lose something w/o directly experienceing the admissions. And, in many cases, I was proved right.

However, when faced with the strong possibility of a third miscarriage in little over a year, I abdicated. My patients were important, but so was my unborn child. Shortly thereafter, the HMOs with which we worked made it mandatory, for the HMO patients at least. We had some say (but not a lot) over the choice of hospitalist. For the patients not governed by those HMOs, we cobbled together various constellatins of coverage. Some were in house docs, taking a week off to round in the hospital. That was usually good, albiet uneven. For a while, we had a hospitalist who took loving care of my patients. She treated them so well, that my patients fell in love with her. She was quoted from the altar at the funeral of one of my patients. But, she burned out. It is very hard to find someone who takes the care of my patients as I would.

So why don’t I sign up to be a hospitalist? Because a) I value my office practice & my patients and b) I have a husband & small kids and they need me too. And, sad to say, I’ve gotten rusty. Hospital care is something you have to practice to remain sharp at, same as any other job. When you don’t use those muscles for a few years, you are not as efficient and constantly fearful that you’ve forgotten something.

To make this work welll, there has to be some communication between the in-house & out-house docs. I try to see my folks while in the hospial, to at least reassure them that I’m in the loop. And they are reassured that I’m in on it. It has worked to my satisfaction, when the hospitalist calls me daily & we work as a team. It fails dismally when the hosptalist doesn’t bother to call & gives only the bare-bones info.

It is not perfect. But, boy is it the fashoinable thing to do!!!!

Wm H-

I’m a little surprised to hear you say that, most people I know have been very happy with the improvements made by VA over the last several years. How long had it been since you went there?