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Hospitalists

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10 years 4 months ago #57343 by DocM
Where I live in the Pacific Northwest, the vast majority of hospitalistsat my community hospital are internists who do strictly in patient medicine.

The hospitalist model is beginning to expand here to include other specialities - surgery and Ob ( as laborists). We also have a neurologist hospitalist to manage the acute strokes inparticular, and have a pediatric hospitalist to do mostly the newborn care and manage the small peds unit ( we do not have a PICU and only a small NICU). Pediatric critical care is pretty much a hospital only field too. The adult pulmonary critical care people here have pretty much divided themselves into those who do inpt medicine - manage all the ICU patients and see the inptpulmonary consults, and those who do outpt pulmonary/sleep lab stuff.

I haven't seen any other medical subspecialties divide up this way yet - no cardiac hospitalists,GI hospitalists, heme onc hospitalists. However, many practices in these specialities are increasingly having their patients managed by hospitalists while in pt ( unless electively admitted for say a procedure or for chemo), serving only to "consult" on them - meaning they don't get paged with everything - the hospitalist does. Some practices also schedule it so that one doc in the group, GI for instance, will do a whole week of inpatient work - all the consults, all the inpatient procedures - doing nothing outpt until the folllowing week.

In my opinion it is a useful model because medicine is getting so broad and complicated that outpatient work is often very different than inpt work. It also does provide a better lifestyle with more predictable hours for everyone involved and ideally better treatment for the patients. Ultimately the quality of care delivered depends however on good communication between the PCP, any involved specialists and the hospitalists - without that it can't work.

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10 years 3 months ago #57344 by kpzr/9145
Like everything else in medicine these days, this leads to less continuity of care.

My large pediatric practice has just started using a pediatric hospitalist service for our inpatients which is GREAT for me and I think better for the patients, in that they receive more up to date medical care. However, we still round on these patients in a social sense which takes every bit as long and sometimes even longer. I know the patients like it but it is totally unreimbursed time and frustrating for me, it often takes just as long to round as it used to. If it were up to me, I would only pay a social call to a personal patient of mine or in special circumstances.

kpzr

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10 years 3 months ago #57345 by efex101
Where I work there are "no social" visits unless the doc happens to be at the hospital. Is this mandatory at your place? I mean that somewhat defeats the purpose of having a hospitalist service available. Sure, patients love it, but at some point the line has to be drawn. You could also call you patient while in the hospital, let them know you are aware/concerned and see them once they get discharged.

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10 years 3 months ago #57346 by LauraMD
I love my hospitalist service! I think they do a great job.

I do 'social rounds' on pts with whom I have a good relationship (the pt who only saw me once 3 years ago is not as needing of this visit as the one I've seen every month for a year.)

If it weren't for my hospitalists, I would be much more stressed and hurried with my pts, both in-house and in clinic. For example, it is a nightmare when you are in the middle of a clinic day and you get a page from the hospital that the little old man you admitted with pneumonia is now having 10/10 abdominal pain. It's hard to drop everything and run to the hospital. Hospitalists do a specific job, and they are generally good at it.

I have friends who are hospitalists, and they tend to like the flexibility, though sometimes they work really hard on their shifts (heck, I do too!). It's all a matter of what suits your personality, I think.

And when they carve my stone, all they need to write on it is, "Once lived a man who got all he ever wanted..." --Ty Herndon

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10 years 3 months ago #57347 by Doc201X
Personally, I think it takes a special kinda Doc to want to be a Hospitalist in the same vein as I see people who become Nurses.

My Scientist/Physician Journey
www.Doc201X.blogspot.com

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10 years 3 months ago #57348 by Popcorn
Not sure what you mean by that... it was quickly becoming the default option at the IM residency at the hospital where I trained (for those IM'ers who didn't land a fellowship.)

I'd argue that it's a special kind of doc who wants to run a practice and still admit all her own patients.

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