Unfortunately, until we address the true problem, which is how we get paid by the government and private insurers, this is the way it is likely going to stay. I routinely hear the comments which tend to insinuate the hospitalists’ selfish motives of more money and a better lifestyle. However, I disagree that the notion of sacrificing my family, my education and basically my life to hold on to an ideology is somehow more noble than providing quality care to inpatients. It is much easier for the “comprehensivist” with 8 partners to make this argument than many of us who are in small practices (and I do realize that many making these arguments are in the smaller practices).

I would go back to a traditional practice in a heartbeat if the pay was equitable and I would be able to make a living, pay overhead and have a somewhat normal lifestyle. But, as the house calls of Marcus Welby’s day have gone by the wayside, unless something changes the way doctors are paid, so will the traditional medical practices (unless of course, they choose retainer medicine).

I would also disagree with the assumption that just because the primary physician is not rounding that there is always fragmented care. As in any situation, your program is only as good as the integrity of the physician delivering the care. I don’t profess to know my inpatients as well as their primary physicians but I make it my job to review every available old record, call the primary physician for information, and upon discharge, make darn sure that the primary physician receives a discharge summary before the patient follows up. If a summary is not possible prior to their visit, a phone call to the doctor is in order. If you take pride in your work, you can have a superior delivery system.

With the way we are paid and the way I had to run patients through my office like cattle, I felt as though the only way to provide quality care (in my particular geographic area as I am one of only a few internists), have a decent lifestyle and also the only way for me to maintain the internal medicine education I have worked so hard to attain, I had to choose inpatient medicine. Maybe it’s because I’m just not that smart, but I have to have time to read and study about my patients in order to keep up.

Let me finish by saying how much I admire the physicians who are committed to practicing traditional medicine. My hat’s off to you!

On the flip side, I was recently talking to one of our internists. He is burned out and finds having to worry about hospitalized patients that are “crumping” inhibiting his ability to focus on the clinic, and if he can’t focus on clinic, he can’t have the through put that he needs to generate a profit. He is considering going the hospitalist route because he feels that he wont’ be working as hard and the compensation will be better. THAT will be a loss to our community. As someone who works both in and out patient services, it IS difficult and feels that no one is receiving the best care when a patient is “crumping” and one is trapped in clinic. I don’t think there is good answer.