cbrons

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well, I was reading this article: http://healthfieldmedicare.suite101.com/article.cfm/what_is_a_hospitalist_

and then some of the comments, like this one:

Doesn't this defeat the purpose of going through the research necessary to choose a qualified physician to be your primary care doctor. At the time you need your PCP most they fluff you off to some one else who could care less if you walk or crawl home.

Your PCP knows your meds, and your history, and should be more qualified to oversee any treatments or medications you are receiving in the hospital. If I understand the paragraph above, it is up to us to make some other staff member aware of what our history is, what meds we are on, what our family history is, what we are alergic to, etc., etc..

Someone else mentioned that "this is a very bad idea". Actually it is an abomination, and a wholly unjustifiable defiance of the patients' interests and welfare.

I have spent the past year and three quarters undergoing chemotherapy and radiation ending in a bone marrow transplant, at the same time making sure that my oncology team kept my primary care Physician in the loop at all times concerning my treatment and overall health. I am just learning now that my PCP started this "hospitalist" BS about six months ago, and having a reason to visit his office today, read a note on his door telling his patients about this "hospitalist" garbage, ending his note with a statement saying if his patients didn't like it -- they could find another physician who would see patients that were hospitalized (providing of course if those MDs were taking new patients). What a bunch of BS. I guess they need more time to play golf or take vacations that their patients and their insurance companies pay for.

Get real --- These MDs in private practice just don't care for their patients, and like most politicians, are in the game for the money and freebies.
This goes out to all of you who think primary care doctors are still highly respected and revered. Its sad, because I know (in my rural township) that all the family practice doctors work over 70 hours per week and attend to patients in the hospital. Why can't people just let the guy take a little bit of the load off so he can see his kids?

I was also surprised that many primary care practices are hiring hospitalists to do additional things, like handle their on-call responsibilities. It can't be cheap and with primary care physicians salaries sinking they still find it worth it to pay all this money so they can lighten their burdens a little. I guess I'm not surprised that a huge percentage (there was some other thread about this) of primary care doctors would switch careers if they could.
 

nevercold

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You will see this over and over again in the healthcare field. People are not willing to take responsibility for their own healthcare. They don't know their own medicines or allergies or medical history and expect someone else to know it for them. I've frequently seen patients in urgent care or the ER who respond to every question with, "Oh it should be in my chart." People not taking responsibility for their own lives is, of course, nothing new, but is becoming more of an issue in healthcare as the volume is increasing and the compensation tightening, forcing even primary care physicians to compartmentalize their scope of practice and rely more on others to assist in a patient's care (such as in the hospital). If you have to see patients 8am to 5pm and do all of your medical record work and continuing education outside of that because you have to see these patients every 15 minutes, you don't have time to also round in the hospital.
 

group_theory

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I was also surprised that many primary care practices are hiring hospitalists to do additional things, like handle their on-call responsibilities. It can't be cheap and with primary care physicians salaries sinking they still find it worth it to pay all this money so they can lighten their burdens a little. I guess I'm not surprised that a huge percentage (there was some other thread about this) of primary care doctors would switch careers if they could.
That patient, if hospitalized, would probably want to personally speak to his PCP during the day time too (and get angry that the PCP can only spend 10-15 minutes a day with him in the hospital before he/she runs back to the office to see patients - or to play golf since the insurance payment is soooooo high for primary care physicians :laugh:)

In reality, the reason why hospitalists are doing well is that it benefits 3 groups of people

1. PCP - they can spend more time in office seeing patients (and thus making money). If you have 3 patients hospitalized, you have to go to the hospital, see the patients, write orders, go back to your office, and follow-up with any studies/labs/consults that you placed that morning. In that entire time, you get to bill for 3 inpatient hospitalization. The PCP can probably make more money seeing patients in his outpatient office in the same time it takes to travel, see the 3 patients, write notes/order labs, drive back to the office, and follow-up on labs. Plus with hospitalists, the nurses won't call the office multiple times during the day for orders, clarifications, or if the patient is SICK, require the PCP to cancel several appointments so that he/she can go back to the hospital to attend to a patient who is going downhill. Seeing fewers patient = less income.

2. Hospitalists - you do shiftwork. You get paid a base salary plus productivity. You're not in a hurry to go anywhere. You're not filling out social security disability forms, driver license forms, work permit, etc. Instead you're filling out equally mindless hospital forms

3. Hospital - hospitalists are more efficient at turnovers since they actually spend time in the hospitals and can follow-up labs/consults/results MUCH faster than a PCP from his outpatient office - and can get the patient discharged faster because of it. Plus with new medicare guidelines and core measurements, you want someone who is up-to-date with billing and coding requirements (so that the hospital gets paid more money). Instead of Heart Failure, if you write Acute on Chronic Left systolic Heart Failure, the hospital gets paid thousands of dollars more. If you don't properly document why the patient isn't on certain heart failure medication, the hospital gets dinged for non-compliance. Good luck getting a PCP who spends 30 minutes a day in the hospital (and some days, don't even come in if none of his/her practice patients are admitted) to be up to date on the latest documentation requirements mandated by medicare/medicaid/insurance companies along with how to effectively and correctly bill for services rendered.


and I would argue patients benefit too. If you're in the ICU, would you want your office PCP to take care of you, or would you want a critical care doctor? Why? If you are sick enough to warrant hospitalization, would you want your office PCP to take care of you, or someone who specializes in inpatient hospital medicine?

The patient may want his or her own PCP as the hospitalist - which is fine - but that patient must be aware that if that is the type of care he/she wants, the PCP will visit early in the morning, late in the afternoon, or quickly for lunch ... and won't be availabe during the day for a quick "chat" or "update on your progress" since the PCP will be in office seeing patients (and not playing golf due to the handsome payments that patients and insurance companies give to primary care doctors)

If the patient wants an old-fashion doctor - he better pay for an old-fashion doctor. Paying for an insurance company doesn't mean anything since they are trying to maximize profit by making it difficult for doctors to be paid. The doctor will see very little of that insurance payments
 

Raryn

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If I'm hospitalized I'd rather have a hospitalist... They spend all day dealing with the ins-and-outs of hospitalized patients, and experience is always valuable.

I may be biased though. My mother is a hospitalist....
 

Dirt

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Patient benefits are simple. Hospital medicine is a special niche in the medical world nowadays. Hospitalists are specialists at it. Nobody complains about their PCP when they send them to a cardiologist. This is no different.
 

Just Joshin

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Are there hospitalists in peds or psych? And if so, how much is pay? I like the idea of shift work.
 

Just Joshin

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Yes, there are.
Can you expand on that a little? Do they get paid about what they would in private practice or less? Yes, I am concerned about the money because of the loans I'll be taking out. Any idea if the shifts are like ER shifts where you can arrange to work nights or something?
 

Raryn

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Are there hospitalists in peds or psych? And if so, how much is pay? I like the idea of shift work.
There are psychiatrists who work only inpatient, which is pretty much the equivalent to a hospitalist. Not sure about pedes....
 

oldbearprofessor

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The pediatric hospitalist movement is rapidly increasing for the same reason as happened in other fields. There are some pedi hospitalist fellowships available and some positions include (or are exclusively) neonatology, others are more focused on general in-patient ward management. Many of the current folks working as hospitalists did not do any type of fellowship, but it is likely to become more fellowship-oriented in the future, at least in major academic pediatric hospitals.

Salaries are too variable to make any specific comment - depends if you are doing in-house night-call, the location, your training, etc. Generally consistent with or a bit above general out-patient pediatrics.