Sunday, March 30, 2014

Hospitalists Improve Quality of Care

Hospitalists are now firmly planted in the medical landscape.  These doctors have no office practices and earn their living exclusively by managing hospitalized patients.  These guys and gals are either hospital employees or are private groups who are under contract by hospitals.  The market and the profession were hungry for this new specialty, which has exploded across the country.   The advantages to patients and to practicing physicians are enormous.  Are there drawbacks?  Of course, but you’ll have to wait a week to read about them.

Hospitalists Pro or Con?  Which side has more weight?

When these hospital physicians first appeared on the hospital scene, there was buzz that patients would push back against these stranger-docs wanting their own office doctors to attend to them instead.   This never materialized.    Patients no longer had the expectation that their own doc would be available to them 7 days a week.  Indeed, medical physician groups and institutions had on-call rosters such that it was likely that the doctor available was not the patient’s actual physician.  So, the heavy lifting had already been done.
Once patients and their families recognized the high quality of care that hospitalists provide, whatever doubts that may have existed evaporated.

Here’s the upside.
  • Hospitalists provide superior hospital care because of their training and experience.   It is probably true that a physician who treats 75 heart attack patients each year is more skilled at doing so than is a family doctor who does this quarterly.  In general, higher volume translates to higher quality.
  • Hospitalists are there around the clock.  They are available to check on patients throughout the day and night.  Can anyone argue that this is not superior to the prior system of the attending physician seeing the patient once daily?  Go ahead.   Make your case.
  • Hospitalists allow primary care physicians to stay clear of the hospital so they can focus on their out-patient practices, where their skills are better matched.   Additionally, it is very inefficient for a primary care physician to come each day to the hospital to see a patient or two.  For these reasons, the vast majority of primary care physicians refer their hospitalized patients to hospitalists for care and treatment.
  • Internists enjoy a higher quality of life as they no longer have to stagger in at 3 a.m. to admit one of their patients.
Next week, I’ll offer my view of the downside of hospital medicine.  Yes, I know the suspense is killing you.  I can only hope that if I write it, that you will come.

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