Increase in hospital care specialists has some worried
BY SHANNON MUCHMORE World Staff Writer
Tuesday, May 08, 2012
5/08/12 at 7:59 AM
The number of doctors who specialize in hospital care is increasing in Tulsa and around the country, leaving some concerned the trend will worsen the already lacking number of primary-care physicians.
A flexible schedule and good paycheck are enticing medical students and outpatient doctors to choose to work for a hospital, seeing only admitted patients, as what is called a "hospitalist."
Hospitalists have been shown to reduce readmission rates and health care costs at hospitals, but their growing number could make Oklahomans' access to care even more limited.
Oklahoma has consistently ranked among the worst states in primary-care providers per capita.
There are about 30,000 hospitalists in the country and nearly 90 percent of hospitals with more than 200 beds employ them, according to the Society of Hospitalist Medicine.
From 2003 to 2009, the number of hospitals with hospital medicine groups increased from 29 percent to 58 percent. For hospitals with more than 200 beds, it increased from 55 percent to 89 percent, according to the society.
The hospitalist movement began in the early 1990s, replacing the model of primary-care doctors visiting their patients in the hospital.
Now, few doctors do so, and that care is performed by hospitalists. They typically have about 20 patients at a time and also perform tasks like admission and discharge.
John Schumann, a professor and the associate program director of the internal medicine residency at the University of Oklahoma School of Community Medicine, understands why medical students choose to become hospitalists but laments the decreasing number of doctors and patients who have long-term relationships.
"I do think something's lost," he said.
He is also concerned that fewer and fewer new doctors are going into primary care or setting up their own offices.
A hospitalist typically works seven days on and seven days off, including some nights and weekends. Their average pay is about $200,000, which is more than what a person doing outpatient care usually receives.
Dr. Jan Finer recently chose to become a hospitalist after 23 years as an outpatient doctor.
She made the decision because she wanted to get away from long hours and increases in patient demand. At her old job, she could only devote about 10 minutes to each patient, she said.
She would work an extra two hours at night to get caught up with paperwork.
"I realized that for me to have any sort of balance, I had to walk away," she said.
It was a hard decision to make because she enjoyed outpatient care. But better pay, better hours and time off that could actually be taken enticed her, she said.
She has known other doctors who have made the same decision and sees lots of medical students choosing the hospitalist path. She worries that could result in more and more patients not having access to primary care, she said.
"It's going to be a huge issue," she said.
Kay Cudnoski, a resident from the OU School of Community Medicine, is choosing to become a hospitalist because she wants to raise children.
"The hours are really conducive to family," she said.
She has considered doing primary care but feels more prepared for hospital work. She's not enjoying her clinic rounds as much, she said.
She volunteers at the Dream Center and her new hours will allow her to keep doing so, she said.
"That's something that's fulfilling to me and that I plan to continue," she said.
Ivette Acosta also said she is best prepared for work in a hospital.
"It's almost identical to what we're doing now (as residents)," she said.
Setting up an individual practice involves risk and lots of time. There is rarely a moment when the doctor is not on call.
Also, medical students aren't taught how to run a business, which involves reams of paperwork and dealing with insurance companies, the residents said.
Dr. Ziad Sous, president of Tulsa Hospitalists, said the hospitalist movement has improved health care by making it more efficient and by saving money.
"(The traditional method) became really time consuming and they weren't providing good care in the hospital," he said.
Tulsa Hospitalists began in 1998 with a handful of people and now includes 45 health-care providers, he said.
Hospitalists decrease the length of stay and costs of care, partly because the doctors can order tests and look at results throughout the day, instead of just visiting the hospital once every day, Sous said.
Several studies have shown that length of stay is typically decreased by a hospitalist, but results from studies on hospitalists' effect on cost of care have been mixed.
Hospitalists operate like a support system for the hospital and allow specialists to focus on their specialty, instead of other parts of patient care, Sous said.
"Hospitalists become the backbone of any hospital," he said.
30,000 hospitalists work in the country.
Source: Society of Hospitalist Medicine
- 3,300 hospitals employ hospitalists.
- 89 percent of hospitals with more than 200 beds employ hospitalists.
- 82 percent of hospitalists are trained in general internal medicine.
Original Print Headline: Increase in hospital care doctors has some worried
Shannon Muchmore 918-581-8306
Hospitalist Dr. Julie Nahar takes a phone call at the Oklahoma Heart Institute in Tulsa on Friday. MATT BARNARD / Tulsa World
More medical students and outpatient doctors are choosing to work for a hospital as what is called a "hospitalist," like Dr. Julie Nahar. MATT BARNARD / Tulsa World