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).Tweet