Hospitalists are doctors who manage inpatient care
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Dr. Hernandez talks with Anderson about his case. Hernandez is a hospitalist, a new type of doctor who manages the care of patients while they are in a hospital.
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Dr. Juan Hernandez listens to the lungs of Robert Anderson, a patient at Mercy Hospital and Trauma Center, Janesville, who had been admitted with pneumonia.
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Dr. Christopher Wistrom, left, and Dr. Kate Templeton, medical director of St. Mary’s Janesville Hospital hospitalist program, confer about a patient who returned to the hospital with a number of surprising symptoms, but all tests came back negative.
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Dr. Juan Hernandez, center, leads a morning meeting at Mercy Hospital and Trauma Center with specialists . They discuss all patients for the day, including those being discharged.
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.
Jan 9, 2013 at 1:10 a.m.
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Where in this article does it say hospitalists are good for the patient? I find it difficult to believe that 3 to 4 hospitalists on a shift can deliver quality care to every patient in an entire hospital. I've experienced hospitalists and I can't say I like them. My experiences were not in Janesville. It's not a personal dislike. It's knowing that 10 minutes after he/she leaves the room I am just a unit on a production line; patient #00355 Gall Bladder Room #1234. It is a totally clinical experience. They don't know me and I don't know them. They release me and make follow up appointments with my primary. My primary asks me another litany of questions. If he/she took care of me in the first place, he/she wouldn't have to ask and I wouldn't have to repeat and repeat, etc. There is a real disconnect with this type of care; it is a business deal and not a doctor-patient relationship, you probably will never see this hospitalist again. You had no say in the matter, they were assigned to you BY THEIR EMPLOYER. You are no longer the employer and have no idea if they are good doctors or not. Bring your notebook and write everything down so you or your survivors have the notes needed for your lawyer. Business squabbles are best settled by lawyers.
Nov 29, 2012 at 2:55 p.m.
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My family and I have had superior care at Mercy Hospital and Trauma Center.One of relatives had a heart attack recently and thanks to the Janesville paramedics, the Mercy trauma doctors, heart doctors, AND later during his stay at Mercy the hospitalists, my Uncle survived. From the time his wife called 911 to the time he was in the operating room for cardiac surgery was 35 minutes. That is what saved his life! I still can't believe the quick and professional response.
Our community is very fortunate to have all the specialists at Mercy - right in our own hometown at a seconds notice. Unlike St Mary's who consistently sends patients to Madison if they need any kind of specialized care. My Uncle would have died if he would have been taken to St.Mary's. In fact, the paramedics don't even take heart patients to St. Mary's because they don't have the specialists located there.
So hats off to Mercy's medical professionals for a job well done!
Nov 27, 2012 at 10:59 p.m.
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I have read the posts here,not for one second did i doubt my friends wife in telling me what happened the other day at Mercy Trauma Unit!!
My friend got in an accident with head injuries,has been a long process,he goes in and out with knowing what's going on,he has made great improvements,but this one Doctor said the other day that my friend should be taken to Mendota,my friends wife heard him say it twice,then all hell broke out,i just wonder how qualified this person is,obviously he didn't know anything about bed side manners!!
Nov 27, 2012 at 4:36 p.m.
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Hospitals that use hospitalists *must* supply patient advocates to follow every single admission. Absent a professional advocate, patients might reasonably refuse to go to those hospitals.
Nov 27, 2012 at 4:31 p.m.
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"assembly line approach and maximizing their profit." "profit driven baloney." Possibly.
Nov 27, 2012 at 4:24 p.m.
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This development means that patients, now more than ever, will need a patient advocate by their side every minute they are hospitalized.
Nov 27, 2012 at 4:21 p.m.
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Hospitalists are additional staff members who have to be paid. This is going to raise the cost of hospitalization. How about saving money by avoiding the hospital as much as possible through coordinating care between a primary care physician and visiting nurses who would care for the patient at home.
Nov 27, 2012 at 3:33 p.m.
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Roofrack have you ever dealt with a hospitalist?
I have in fact dealt with Dr.Hernandez and in fact found him to be quite incompetent in caring for the patient which I was helping care for at the time. Not only did he NOT read the chart before opening his mouth to the patient, his "plan of treatment" was a 360 degree turn from that of the physician who had been treating her for the first week of her stay.
In another case, had the patients primary care physician been involved in the treatment/care while he experienced severe chest pain in excess of a week he might still be alive. But because his primary care physican,who was familiar with the patients medical history, was not involved the patient died, he was 37.
Nov 27, 2012 at 1 p.m.
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All of these comments boil down to a bunch of cry babies that are mad their primary doctor isn't there to feed them pain pills at will. Get over it people and let the doctors do their work.
Nov 27, 2012 at 12:18 p.m.
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Plain and simple hospitalists are not familiar with the patient, do not know the patients medical history; and quite frankly do not do patients any good. Mercy has done a huge disservice to their patients by preventing those who know the patient and his/her medical history to see their hospitalized patients. The use of hospitalists is likely to cause more misdiagnosis, deaths, and injuries to patients. Malpractice suits will increase as well, as they should when a physician makes a serious error.
Nov 27, 2012 at 11:30 a.m.
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The way things are getting in the medical profession I would rather die on the floor at home. I pretty much avoid all Drs. like the plague. Everyone I know that goes to Drs. ends up a screwed up mess living on bags of pills per day. Let's face it this is just the start of how bad things are going to get. Everyone will be just a number. No personal care at all.
Nov 27, 2012 at 10:45 a.m.
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This "trend" has not caught on in most places the way it has at Mercy. Here I think the use of Hospitalists has more to do with shutting out other Primary Care Providers as a way to not play nice with other competing providers.
Nov 27, 2012 at 9:41 a.m.
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Dr. Hernandez was my primary care Doctor when he worked in Beloit. He is an amazing Doctor and Mercy is very lucky to have him.
Nov 27, 2012 at 9:12 a.m.
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My last stay at the hospital, I was assigned a in house dr. at St. Mary hosp. here in JVL. My primery Dr. came once in 10 days and stayed about 3 minutes just to ask how I was doing. I knew nothing about the in house DR. but he took out my goul bladder which I question if this was needed. I was to sick and disoriented to ask any why.
Nov 27, 2012 at 9:01 a.m.
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This may be fine for people who don't have a "primary care physician" - but those of us who do would rather have our own doctor at a time of crisis - the doctor who knows us and knows our history - at a time when we need them the most. The hospitalist policy seems to treat both patients and physicians as just another number. Profits are apparently more important than patients. Surprise, surprise.
Nov 27, 2012 at 9 a.m.
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marciamike
I experienced the same thing with a family member. It seemed to me that the personal health information of the patient was not transferred to the hospitalist. Instead, they seemed to be focused on an "assembly line" approach and maximizing their profit. There definitely is NO personal touch in the treatment and care (IMO).
Nov 27, 2012 at 7:41 a.m.
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My wife was taken by ambulance to Mercy Hospital. While she was enroute, I called our long time physician. He informed me he would not be seeing her at the hospital, due to the hospitalist policy. The hospitalist assigned to us could barely speak English. None of our family of 5 could understand him. Late on the first day of her hospitalization, the hospitalist disappeared. He was not to be found the entire 2nd day, either. On the 3rd day, when I threatened to go to the hospital administration due to the lack of an overseeing doctor, a replacement hospitalist was assigned. I think this whole hospitalist idea is profit driven baloney. The bottom line is YOUR doctor is NOT AVAILABLE to you when you need him or her the most.
Nov 27, 2012 at 5:57 a.m.
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I find it hard to believe a doctor can work a 12 hour day 7 days in a row and still be effective when making decisions with life and death outcomes. Some of the benefits of a hospitalist are easy to see but overall, as a patient, I don't think it's a good idea.
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