Inpatient vs Outpatient Care;: Can Doctors Do Both?

Five years ago, I left hospital wards and emergency rooms behind and entered a new & improved medical practice model, at least for me. Since then, I only see patients for office consultations and procedures. Office medicine is a very different trade than hospital practice each having very distinct skill sets. If I were to return to the hospital now to see patients, it would be uncomfortable for me (and them) having not used these skills for years. Similarly, hospital-based doctors might find transitioning to an office practice to be clumsy and uncomfortable.

While it might seem that a gastroenterologist or any medical specialist should be able to see patients in any location, this is not the case for most of us. Hospital medical issues are quite different from office medical complaints. Physicians, as in so many other occupations, need repetition in order to maintain high competency levels. There’s a reason, for example, that airline pilots need to maintain specified flying hours. Athletes, musicians, heart surgeons, comedians, police officers, paramedics or therapists all need a certain volume of clients and customers to maintain their professional edges. Consider an example to illustrate this point. If you needed to have a cardiac catheterization, would you favor a cardiologist who performs the procedure several times each week or three times yearly? (Hint: this is an easy question.)

Airline pilots need frequent flying to stay sharp.

If I were thrown back into the hospital now to see gastro patients, I would be confronting issues that I have not seen for years. There are likely new diagnostic and therapeutic strategies in place. Medications have changed. I might very well be both out of practice and out of date. While I could probably muddle through, I think that patients are entitled to a higher medical standard than muddling.

I recall years ago, I gave up performing an advanced endoscopic procedure. I recognized that my low volume of cases was not sufficient to maintain a high-quality level. So, I eliminated the procedure from my clinical repertoire and have since referred these patients to more expert practitioners. All professionals and tradesmen should know their limitations and disclose them freely to their customers. I have yet to hear a patient complain when I remark that I am referring the patient to a more capable or experienced physician.

My current office medical skills are sharp and current. The outpatient arena has become my lane of comfort and competence. At the end of this road will be my retirement. I hope that I will have the necessary skills for that occupation.

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