But is this not the trend with primary care and other health care also? Organizational forces that see primary care doctors, generalists, etc. simply as tools.

I remember at Harvard when I was there there were new MBA types who wanted to put orthopods into strategic places in Harvard hospitals since they saw them as heavy indebted and desirous of being profit centers.

Bohdan A. Oryshkevich, MD, MPH

The danger…is that many hospital administrators see hospitalists as valuable…as utilities.

I am a nurse employed by a large for-profit hospital corporation, where ill patients requiring complex care are reduced to standardizable, predictable units of production with one-size-fits-all solutions. Business concepts of efficiencies and productivity determine health care priorities. Managing costs rather than managing care, when it comes to dealing with the complex care of ill patients, deteriorating working conditions, and poor patient care, trump compassion and quality of care.

Where I work, hospitalists are valued by administration as utilities to managing costs rather than as valuable assets to providing high quality care to patients.

Ill patients and their families do not make perfect customers. When patient satisfaction surveys plummeted, staff was asked to identify dissatisfied patients, so that they could be excluded from post hospital surveys, and to identify “extremely satisfied” patients, so they would be targeted for the surveys. Making dissatisfied patients and families disappear. “You juke the stats.” Improved patient satisfaction scores are now being heralded. Managers become assistant vice presidents, assistant vice presidents become executive vice presidents, taking what is not progress and what is not valid, and glossing it up, saying “We’re doing a great job.”

I’m sensing some whining here.
As a general surgeon, I want a series of 38 year old 117 lb. self employed women with biliary colic and Blue Cross to operate on. For every one of those, I am asked to see a series of morbidly obese noncompliant unfunded diabetics with cellulitis that is just not getting better and the hospitalist wants “surgical input” just to make sure he’s not missing something. In every specialty, there are “good cases” and bad cases. You will revel in the great case of Type 4 RTA that you just picked up, or the Con’’s syndrome, or any other of the once in a career diagnoses that you make, but the fact of the matter is that practicing medicine, in any specialty, is a job. It may be a calling, or an obsession, or even a lifestyle, but it’s also a job we are paid to do because it’s important that it gets done and nobody will do it for free. Like it or not, the routine admission that you feel is demeaning or not worth your expertise is as alien to the orthopod as an infected bunion would be to you. An otherwise healthy orthopedic patient’s admission and discharge should be adequately managed by a PA or NP, but there is tremendous resistance in many internist/hospitalist blogs to using extenders as part of the hospitalist team.

It’s a job, one for which hospitalists are well compensated, and get to punch out at the end of the shift, not having to be concerned about running an office, making payroll, the insurance status of the patient, or any of the dozens of other details that are such a challenge for the self employed physician. If what happens between sign-in and sign-out is truly intolerable, then you are in the wrong field, or the wrong position, but please, don’t take it as a personal affront if you are asked to do some work that doesn’t rate a feature article in the New England Journal of Medicine.