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
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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
