Hospitalists are doctors who manage inpatient care
JANESVILLE Years ago, patients admitted to the hospital would be greeted and cared for by their primary care physicians.
Today, a doctor known as a hospitalist is the person primarily responsible for managing the care of those patients while in the hospital.
The hospital medicine specialty is the fastest growing specialty ever, said Randy Lebakken, administrative director of the hospitalists/intensivists at Mercy Hospital and Trauma Center. With medicine becoming more complex and the number of acutely ill patients increaseing, doctors say hospitalists can better coordinate care in a hospital setting.
"It's a real paradigm change," said Dr. Keith Konkol, associate medical director for Mercy Health System and a medical director of the hospitalist program. Konkol referred to the shift from when primary care physicians would visit patients at home, then in the hospital, and now someone new sees the patients in the hospital.
"The hospitalists are experts in hospital medicine and taking care of inpatients," he said. "So I think that's what's really important to know, is that the primary care physician is really consulting the hospitalist—the expert—in hospital medicine. The only purpose really is to provide better quality and more efficient health care."
The number of hospitalists has increased from a few hundred a decade ago to more than 30,000 in 2010, according to the Society of Hospital Medicine, the association for the new specialty. The organization anticipates there will be more than 40,000 hospitalists in the next few years.
Leaders of the hospitalist programs at St. Mary's Janesville Hospital and Mercy Hospital explained more about what a hospitalist does:
Q: What are hospitalists?
A: They are physicians whose primary focus is the general medical care of hospitalized patients, according to the Society of Hospital Medicine. The term "hospitalist" wasn't coined until 1996.
Hospitalists are different from other physicians in that they don't have an office-based practice—they practice full time within a hospital.
"The idea is to have a dedicated team of physicians who can focus all their activities and all of their attention on the people while they're inpatients," said Dr. Kate Templeton, medical director of St. Mary's Janesville hospitalist program. "We're physically based in the hospital. There's always one of us physically in the hospital 24/7."
When a patient is admitted to Mercy or St. Mary's, a hospitalist admits the patient, rather than the patient's primary care physician. The hospitalist manages the care of the patient during his or her hospital stay.
At Mercy, hospitalists work seven days on, seven days off, from 7 a.m. to 7 p.m., and nocturnists work the same schedule from 7 p.m. to 7 a.m. The hospital has three hospitalists on day shifts.
St. Mary's has about 11 hospitalists split into two teams that work 12-hour morning and night shifts.
Some patients still wonder where their regular doctors are, said Dr. Juan Hernandez, a hospitalist at Mercy. Some primary care physicians will still check in with their hospital patients, often through the computer thanks to electronic medical records, Hernandez said.
Q: What are the benefits of hospitalists, and how do they affect the rest of the system?
A: In the mid-1970s, the average general physician had about 10 patients in the hospital, each staying eight to 10 days, according to the Society of Hospital Medicine. The physicians then spent 30 to 40 percent of their day visiting inpatients.
The need for care in the hospitals increased as big health care systems served patients in outlying clinics 45 minutes to an hour away, Konkol said. It wasn't an efficient use of the physician's time to make a 90-minute trip to see one patient, he said.
"It's really helped our primary care doctors in the outpatient setting," he said. "They can start their clinics earlier so it improves access to care for outpatients. Before, they could not really start their clinic until 8:30 or 9."
Hospitalists are inpatient specialists, so they treat the same diseases over and over while a primary care physician wouldn't have that experience as frequently, Konkol said.
Studies also show that hospitalists can reduce patient lengths of stay by up to 30 percent and can reduce hospital costs by up to 20 percent, according to the Society of Hospital Medicine.
Such programs also act as a recruiting tool for hospital and clinic doctors, Lebakken said. For doctors coming out of school, they more likely expect a hospital to have a hospitalist program. It also creates a better quality of life for clinic physicians, who no longer get called to the hospital at 2 a.m., then have to see a full day of patients in their clinic.
The nursing staff often feels free to call a hospitalist because they know one is available, Templeton said. Nurses in the past tried to be respectful of clinic appointments and might have tried to avoid calling a doctor.
"I like to think one of the advantages is much greater accessibility throughout the day," she said.
Marjorie Needham, senior lifestyle coordinator of Morningstar Senior Services, is a senior advocate for clients. She didn't know what a hospitalist was until working with Templeton for two of her clients. She loved that she was able to talk to the physician managing the patient's care whenever she visited.
"She was always there," from the emergency room to the intensive care unit, Needham said. "That is very, very consoling, for anyone."
Q: What does a typical day entail?
A: Templeton generally spends the first hour of her day reviewing patients on the computer, looking at overnight notes from nurses and talking to overnight staff. At 8 a.m., she makes multidisciplinary bedside rounds to her patients, which can range from 10 to 15 minutes.
After a couple of hours of rounds, she does her charting—making notes, ordering new tests and talking with consultants. She does another set of bedside rounds at the end of the day, reviews test results and preps the night staff.
While making his rounds on a recent morning, Hernandez, checked in on pneumonia patient Robert Anderson, 81, of Evansville.
Hernandez checked Anderson's lungs and asked him how he was feeling.
"Would you agree if I sent a nurse to your home?" Hernandez asked as they discussed when Anderson could go home.
"My boss isn't here," Anderson joked.
"I know what you mean," said Hernandez, who said he would talk to Anderson's wife about in-home care.
Each morning at Mercy, hospitalists meet with their multidisciplinary team, which includes nurses and staff from the medical and surgical floors, physical and occupational therapy and social work. Doctors present their patients, and discharge care is coordinated.
By the time Hernandez tells a patient that he or she will be discharged, the team has arranged the nursing home or caretakers, physical therapy, medication and other required tasks, he said.
Q: Why did you become a hospitalist?
A: "I think it's my personality," Hernandez said.
Hernandez trained in the family practice residency program at Mercy South, then practiced at Mercy Beloit before moving to the hospital. He said he enjoys working in an environment where medicine is a matter of hours—"it's more critical," he said, dealing with heart attacks, strokes and pneumonia.
"I did both; I know both sides of the equation," he said.
After also practicing in a clinic, Templeton said she found she loved geriatrics because of patients' "fascinating life stories" and their wonderful perspectives on life.
"I have found caring for some of the older patients just a wonderful privilege," she said.