With the publication of a recent observational study published in the NEJM which seems to indicate that hospitalists save a little money ( read the latest by the Happy Hospitalist and you just might conclude it is more than a little money- see below for link) and do not seem to have proven harm to the patients,several prominent medical bloggers ( Dr. Wes, The Happy Hospitalist, and Dr. Wachter) all seem to agree that we have a win-win situation. It is win-win at least as far as the doctors now known as hospitalists ( and sometimes noturnists) and the hospitals are concerned and sometimes for the internists and family docs who now no longer manage their patient's care when they are hospitalized. There is always at least one sour note.
In this posting, Dr. Rob expresses no little dissatisfaction that he can't find out in anything like a timely fashion what the heck the hospitalists et al did with his patient in the hospital.Further, I am becoming more and more of the opinion that patients tend to be in the win column as well except when they go back to their primary care doc to find out what happened to them in the hospital. I hasten to point out that this is not be case with every hospitalist-patient-PCP encounter set but obviously sometimes it does happen.
Dr. Wes points out that when we go to the hospital we now have the doctor rather than our doctor. That is ,the primary care doctor who attends the patient when he is not in the hospital hands off the patients to the hospitalist who in the course of the patient's stay in the hospital may himself hand off the patient a number of times. The recurrent discontinuity of care at least so far has not been proven to cost anything in terms of cost to the hospital or morbidity of mortality of the patients. One might argue that the loss of one aspect doctor-patient relationship could be lost but no dollar value is typically assigned to that. And as Dr. Happy Hospitalist points out , there was no shortage of hand offs on weekends between docs in the same group anyway, so what's different now.
As Dr. Wes states and as the Happy Hospitalist has explained clearly the current economics of medical care is such that the dichotomy of "officist" and hospitalist makes sense and the former practice of an internist playing both roles perhaps was only possible in a long gone economic environment.
I chafed against the concept of a hospitalist and mourned the apparent terminal condition of the type of internist that I enjoyed being for a number of years but now if I were just entering into a medical life as a general internist I believe I would have to take the road of either the hospitalist or the physician with a retainer practice. As pointed out by DB the retainer doc can have the time to do a good job in the office .We all know that the time pressured doc is a prefect recipe for missed diagnoses, poor judgment calls, pride and sometimes ethical damage to the physician and loss of respect of the patient. The retainer doctor has the time and the hospitalist practice -as least of the type that Dr Happy Hospitalist lives- does also.I think as far as general internists are concerned. Mr. Dylan's advice might be heeded.
..you better start swimming or you'll sink like a stone.For the times they are a changing