Hospitalists a growing trend

More hospitals add in-house doctors, benefiting patients

More hospitals add in-house doctors, benefiting patients

November 14, 2005|by JULIE E. GREENE

Earlier this year Washington County Hospital joined a growing number of hospitals that are adding in-house doctors, a trend some officials say benefits patients, hospitals and primary-care physicians.

The traditional American system in hospitals calls for a patient's primary-care doctor to go to the hospital if that person needs to be admitted or hospitalized, says Kelsey Wilkes, Washington County Hospital's director of integrated patient support services.

Primary-care doctors take care of their patients wherever they are, whether it's at the clinic, a nursing home or in the hospital, says Dr. Konrad Nau, a family medicine doctor involved in a program at Jefferson Memorial Hospital that is a hybrid of a hospitalist program.


Hospitalist programs came about from the way things are done in Europe, where there are doctors who work only in hospitals and doctors who only work in outpatient clinics, Nau says.

Hospitalists are physicians, usually internists, who treat hospitalized patients of other physicians so those other physicians don't have to go to the hospital every time one of their patients is hospitalized, officials say. They only work in the hospital.

The movement toward hospitalist programs or medicine began in the early 1990s from "growing concerns about patient safety and rising costs, meeting the demands of the Balanced Budget Act, increasing demands on primary-care physicians to spend more time at their offices and the lack of any single hospital-based individual to coordinate the entire care of a hospitalized patient," according to a history provided at the Society of Hospital Medicine's Web site.

Renewed focus

Hospitalist programs can help reduce patients' hospital stays and allow primary-care doctors to focus on the people in the outpatient clinics or offices, says Dr. Mark Baran, one of eight full-time hospitalists at Washington County Hospital. Baran is employed by Dallas-based EmCare Inc., which was contracted to provide hospitalist service at the hospital.

Because hospitalists work solely in the hospital, they have a familiarity with the hospital's policies and personnel, Baran says. That kind of familiarity can make things happen quicker.

The program began in March and so far the hospital's hospitalist program has partnered with nine physicians' practices, encompassing 26 doctors in Washington County or 59 percent of internal medicine and family practices in the county, Wilkes says.

Primary-care doctors who are not partnered with the hospitalist program still have to leave their office, where they might have patients waiting, to go into the hospital to care for their patients when they become hospitalized, Baran says.

That's what the doctors at Walnut Street Community Health Center in Hagerstown used to do until they partnered with the hospitalist program in April, says Dr. Laura B. Asher, medical director at the health center.

Contracting with the program has provided better continuity of care for the health center's hospitalized patients and allowed the health center's doctors to focus on patients at the clinic, Asher says.

Hospitalists also have referred many unattached patients to the health center to receive care once they are discharged from the hospital, Asher says.

Wilkes says hospitalists also treat unattached patients, those without a primary-care physician or who are not from the local area so their doctor can't just come over and admit them.

Easier scheduling

Washington County Hospital officials considered starting a hospitalist program because there were some processes at the hospital "that were actually hindered by needing to work around primary physicians' schedules," Wilkes says.

For example, a hospitalist can order a lab test, get the results and decide what to do, she says.

A primary-care doctor might not be in the hospital when the lab results come back and a nurse could end up playing phone tag with the doctor, who might not be able to return to the hospital until the evening to address the test results, Wilkes says.

Having in-house doctors gets things done more efficiently and often helps patients get treated and discharged more quickly, she says.

Data is being collected concerning the length of stay for a patient treated by a hospitalist versus a primary-care doctor, Wilkes says. So far that stay is slightly shorter for the hospitalists' patients, but it's not statistically significant, she says.

Hospital officials also are tracking charges to see if the hospitalist program is more cost effective.

According to information at the Society of Hospital Medicine's Web site (, patients seen by hospitalists have lower costs, shorter lengths of stay and better medical outcomes, including higher survival rates.

Growing trend

There are more than 12,000 hospitalists in North America today and it's the fastest growing medical specialty in the nation, according to the group.

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