Comments on: Listen to Moof comment on the hospitalist movement

By: All Blogged Up: A Moof’s Tale / Hospitalists - This Patient’s Take

All Blogged Up: A Moof’s Tale / Hospitalists - This Patient’s Take — Sat, 13 Oct 2007 20:41:09 +0000

[...] checked to see who had just posted … it was Dr. Centor … and here was the title: “Listen to Moof comment on the hospitalist movement.” There was my entire comment – as a post. – Oh my. Caught! Red faced. – So much for a low [...]

By: cp

cp — Mon, 24 Jul 2006 06:44:22 +0000

I am a hospitalist, i’ve been in this profession for almost a decade so I believe I can give an accurate insight to this discussion.
Why are less PCPs seeing patients in the hospital? I agree its partially economics, the time spent seeing just a few patients in the hospital takes alot of precious time away from the office. Its more efficient, less stressful and profitable to hand off your hospitalized patients and squeeze a few more appointments in. Is this such a bad thing? These days patients are not admitted to the hospital unless they are very sick. (Its simply too expensive.) Thus the hospitalized patient usually requires someone to be available at any moment in case they have an emergency. Primary care physicians can’t just drop their office appointments to run in to see a crashing patient. Also, often emergencies happen in the middle of the night, a hospitalist physician group often has coverage to allow a physician in their group to sleep in the hospital every night thus if a patient gets worse they can easily go and evaluate and treat the patient firsthand. Your primary care physician isn’t superman/woman and can’t provide this level of service every night. When they get the page at 3 am they are sleepily giving orders over the phone.
Also, hospitalists tend to get very good at taking care of hospitalized patients which is very different from caring for office patients. The care you receive is usually very up to date and appropriate. I disagree that hospitalists are notch below, in my group I would say we are a notch above the average community internist. I know that my years of experience have served patients well. I and my partners have made many diagnoses that were missed by their primary care docs. I want to add that our hospitalist programs are completely voluntary. Physicians have the option of referring to us or seeing patients themselves. After seeing the quality of care provided they kind of see us as a partner in their practice. We discuss the patients with them and send them detailed discharge summaries. Regardless of whether you love or hate the hospitalist, they are here to stay.

By: Anne, NREMT-P

Anne, NREMT-P — Sun, 05 Feb 2006 14:59:03 +0000

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?

By: Wm H

Wm H — Sat, 04 Feb 2006 04:38:13 +0000

“almost all of them are foreign, and I can barely understand them when they talk.” Moof, this is why I stopped going to the Vetrans Hospital for care. The VA budget cuts have driven away most good physician, I have chosen to do without health care rather then beg for medication with someone I can not understand and who obviously has no interest in providing Military Vetrans with treatment.

By: V

Sat, 04 Feb 2006 01:34:07 +0000

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!!!!

By: Dr. Kranky

Dr. Kranky — Sat, 04 Feb 2006 01:30:54 +0000

With respect to the first comment by AKS: I have a good deal of experience working with PEDIATRIC hospitalists. I can assure you they are alive and well. Based on my interactions with both adult and pediatric hospitalists, I have to say that I am much more satisfied with the care rendered to my pediatric patients. I find the hospital based internists all too ready to hand off responsibility for the patient to whoever is the easiet target. The pediatricians on the other hand take a great deal of pride in owning their little patients and championing their cause to any and all specialists they call in to assist in the management of these children. This discrepancy has not been explained away to my satisfaction. This has been my admittedly limited experience in two large community hospitals over the course of some 15 years. My observations may not hold true in other settings.

By: primary care doc

primary care doc — Sat, 04 Feb 2006 00:45:50 +0000

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.

By: CMS

CMS — Fri, 03 Feb 2006 21:46:27 +0000

I agree that a hospitalist is not my first choice of who will see me in the hospital. I am an RN and appreciate the hospitalists for what they do for nursing staff and the primary MD’s. However, I had a small stroke and was in the hospital overnight and had this person, who was at best impersonal and in a great hurry, deal with me and he was not a great help to me at all “see your primary when you leave”. No referral to neurologist, no referral to Physical therapy,and after I asked, he offered a OT referral. (I could not handle my fork with my right hand.) I felt he was very dismissive of what for me was a traumatic event. I have permanent disability, an went through a period of severe depression which is very common. It would have been nice to have his perspective on what I could expect. Instead, in his d/c summary he wrote that I was very anxious. Well, after 3 mds, 2 ers and 38 hours after my stroke, someone finally believed me that I was having a stroke (when they were able to see the actual damage on a head CT….). I think he would have been anxious too!

By: AKS

AKS — Fri, 03 Feb 2006 20:27:25 +0000

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.