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).
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.
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.
I still see my patients in the hospital!
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.