tag:blogger.com,1999:blog-11034229.post112204436841758209..comments2023-07-14T02:53:40.719-07:00Comments on retired doc's thoughts: Prominent academic hospitalist expects growth driven-in part-by desire for "through-put"james gaultehttp://www.blogger.com/profile/05537303135780186926noreply@blogger.comBlogger4125tag:blogger.com,1999:blog-11034229.post-1154535988521768352006-08-02T09:26:00.000-07:002006-08-02T09:26:00.000-07:00"The hospitalist may get the patient out of the ho..."The hospitalist may get the patient out of the hospital sooner because there is no incentive to worry about what happens after discharge. "<BR/><BR/> after doing primary care work, inpatient and outpatient, for several years and now just inpatient hospitalist work....I can see little difference in my style. I try not to send patients home or to a nursing home until I think they are ready medically. It does no good for the patient or myself to send some home too soon.<BR/><BR/>The worst scenario I had in primary care was usually in caring for the mandatory unattached hospital patients who I admitted on medical back-up call. It takes a lot of effort and time , away from my esttablished patinets, to care for patients who you meet for the first time in the Emergency department. Now , as a hospitalist about 50% of my patients have no physician and many after discharge will not be able to or care to find a physician.<BR/><BR/>The biggest difference I find in hospital vs primary care work is not the stress of work (both have their unique stressors) but rather the lack of stress when I am not working. In primary care I never felt like I had time off...always worrying about details and risks my patients might face especially when they presented with a problem that I could not readily solve. I tended to work in the office on the weekends or come back late at night or cut short vacation time so I could improve my patient care or slog through the mounds of paper work I needed to do on behalf of my patients. As a hospitalist... when I'm off, I can actually relax and enjoy life without worrying so much. It is this sentiment, repeated often times among my hospitalist colleagues ( who did primary care first) that seems to come up repeatedly.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-11034229.post-1122331099600454922005-07-25T15:38:00.000-07:002005-07-25T15:38:00.000-07:00As a private community physician who still manages...As a private community physician who still manages most of his hospitalized patients, here's my perspective. It is not terribly cost-effective for me to do hospital care. I have a personal economic incentive to get the patient out of the hospital as soon as possible. However I am also familiar with what goes on after hospital discharge. Many patients are discharged to nursing homes which are not staffed adequately to care for the ill, unstable patients sent there. Home care is available, but physician supervision is lacking because most doctors will not do house calls. If the patient is too weak or unstable to come to the doctor's office, there is no physician care. More and more it seems that hospital care is about doing less and less faster and faster and then dumping the patient on someone else's lap. The hospitalist may get the patient out of the hospital sooner because there is no incentive to worry about what happens after discharge.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-11034229.post-1122323706852138632005-07-25T13:35:00.000-07:002005-07-25T13:35:00.000-07:00Thanks for the heads up. I listened to Dr. Leach's...Thanks for the heads up. I listened to Dr. Leach's podcast and got a better sense of the degree to which residents are trained, at least in part, outside of academic centers.To the extent this happens the impact of the 80 hr. resident week on demand for hospitalists would be greater.I apologize for relying too much on observations in one large southern city with 2 medical schools and not doing a little more research into that point.james gaultehttps://www.blogger.com/profile/05537303135780186926noreply@blogger.comtag:blogger.com,1999:blog-11034229.post-1122320997203134812005-07-25T12:49:00.000-07:002005-07-25T12:49:00.000-07:00You are simply wrong to say that the eighty hour w...You are simply wrong to say that the eighty hour work week only affects academic hospitals. There are more residents working in community settings than in academic medical centers. You can hear an interview with David C. Leach, MD, the Executive Director of the ACGME where he addresses this point and many others about private doctors training the next generation of doctors at www.soundpractice.net.Anonymousnoreply@blogger.com