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A primer on hospitalists

By J. Court Stephens, M.D.
Special to Reminder Publications

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 PCPs 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 PCPs 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 PCP. 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 PCPs 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.


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