Damn, I gotta get back to the office! by Pat Conrad MD


Years ago, a med student asked me, “What is a hospitalist?” I answered that a hospitalist was the answer to an economic question. The lead editorial in the current issue of Medical Economics is titled “Transitional care: the unintended consequence of hospitalists’ rise.” It’s author Mary Ann Bauman, MD makes valid – if rather delayed – points. Dr. Bauman describes that after being discharged from the hospital, patients are often called to check on their status and after-care, and that said call is made by a nurse manager, care coordinator, or insurance company rep – always a stranger. To which I say, “Yep, what did you expect?”

She describes how her own group practice switched several years ago to using hospitalists, with the immediate attendant improvement in the quality of life for the primary care docs. She regrets the loss of familiarity with the treating physician(s) that hospitalized patients must now experience. Dr. Bauman says, “The hospitalist system emerged because care was often more expensive and time-delayed when doctors were not in-house 24/7…”, which I think is only a partial explanation. I’ve always thought that another significant component in the rise of hospitalists was that any time spent in the hospital took time and energy otherwise needed in a busy office practice. Rounding early in the morning before a full clinic day made for a much longer day; rounding during the day took away time that could be applied to seeing more patients or taking a needed lunch break. As office reimbursements flatlined and administrative requirements and overhead rose, the need to see more patients faster became more urgent, and the day got shorter. In this context, a finite amount of time, energy, and interest had to be applied where it would generate the greatest return.

In my last year in the clinic before I fled to the ED, I gave away my emergency call and rounding to a neighboring practice. The time it took to round before office hours, the aggravation of calls in the wee hours, and the lousy, delayed pay for my efforts made it an easy choice. It is a sad irony that a society which increasingly has tried to pay for everyone’s daily care with someone else’s money has unwittingly, killed the very care it was seeking. Marcus Welby, MD is dead, (and if he wasn’t he would retire before his MOC expired).

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  4 comments for “Damn, I gotta get back to the office! by Pat Conrad MD

  1. mamadoc
    July 28, 2016 at 10:02 pm

    We saw our patients in the hospital for 30 long years and for the last 7 they did their level best to push us out of there. The hassling finally got too much. We heard all about how high costs were and how inefficient we were. Now care is fragmented and nobody arrives at the SNF before 4 or 5 pm (which causes a whole other set of heartburn). When we rounded they were always there by noon, because we saw them early and got the process in motion. They have since hired two hospitalists to replace our little group of three and one of them didn’t last but 6 months, Inefficient? I’ll tell you who’s efficient, it’s the person who has to be in the office a t 9:00 AM, that’s who.

  2. Kurt
    July 27, 2016 at 6:39 pm

    Yeah, And nobody knows what the hell is going on with the patient. No way in h*ll is one going to
    make $250k in the office alone without some sort of “gimmick”. I agree, hospital care is going to the hospitalists and FP is going to the NP’s and LELT’s.

  3. Russell Brunet
    July 26, 2016 at 10:40 am

    I still see my patients in the hospital!

  4. Perry
    July 26, 2016 at 8:56 am

    Marcus Welby is rolling over in his grave as he sees what’s happening to medicine, especially primary care. I think he’s glad he’s not around to deal with it.

Comments are closed.