Hospitalists have more time
for patients and their family

Hospitalists - A Growing Specialty - Improve Patient Care

June 20, 2006
by Michael Johns, Project Manager
As reported on, by Ed Green from Business First of Louisville:

Ask Dr. Glenn Gabbard what distinguishes him from other physicians at Baptist Hospital East or other local health care facilities, and he will say that he doesn't feel rushed -- something he could not have said four years ago.

For the past three-and-a-half years, Gabbard has been a member of a growing specialty in medicine known as hospitalists. As a result, he's been able to give up the daily grind that for many physicians means long, unpredictable hours with dozens of patients at the office, along with visits to the hospital to check on more patients.

For Gabbard, 36, that often meant working early mornings, late nights and some weekends to make sure he was taking enough time to guide the care of his patients.

"I don't like to be hurried. ... For me, it was a lifestyle issue," he said, describing his decision to give up his family practice and join Nikorb Medical Services LLC to work full-time with patients in hospitals.

"I had a private practice for four years, and I never saw my family," he said.

Nikorb is a Louisville physicians practice with nine doctors who see patients at Baptist Hospital East or Norton Suburban Hospital for more than 100 traditional physician practices.

The Nikorb group receives referrals from the primary-care physicians and other family practitioners to follow the care of patients while they are in a hospital and receives payments from insurance companies or government agencies for coordinating the patients' care.

Generally, primary-care physicians choose to work with individual hospitalists or practices so they do not need to visit patients at the hospital. In some cases, patients admitted through a hospital emergency room are assigned a hospitalist to follow their care if they do not have a primary-care physician who will visit the hospital.

In a best-case scenario, a patient's primary-care physician explains in advance that the patient will be seen by a hospital-based physician, Gabbard said.

But in some cases, patients are surprised that they will not be seen by their regular physician. In the latter case, Gabbard explains the hospitalist process to the patient on the first day of his or her stay.

Dr. Hoangmai Pham, a senior health researcher for the Center for Studying Health System Change in Washington, D.C., who has studied the national trend toward using hospitalists, said some early studies showed that patients did not like having hospitalists treat them, especially if they were unfamiliar with the concept.

But more recent data show that most patients accept the practice and understand that their physicians will not see them in the hospital, Pham said.

There is similar data to show that patient care has improved as hospitalists become more experienced caring for patients in the hospital, she added.

"I think part of it is a moving target," Pham said. "As time has evolved, it has become clear that this is not a system that is going to disappear. It will only grow in influence ... and patients have become accustomed to it."

Gabbard, who is board certified in internal medicine, said a drawback for physicians is not getting to know patients as well and following their care over a number of years. But he still enjoys getting to meet people and caring for them during their hospital stays, he said.

"I enjoyed (having a practice) and would still like to do both" inpatient and outpatient care, he says. "But, then again, it's hard to do either really well when you have to do both. And I really like what I am doing now."
A growing field

Gabbard still works about 12 hours per day about 20 days per month, seeing more than 20 patients each day, he said.

But his schedule now is more predictable because he and the other physicians work shifts to share the patient load.

He said he also can concentrate more on patients who need the most care and "see them in a timely manner," and he has gained a better understanding for complex medical conditions presented by patients in a hospital setting.

When necessary, Gabbard talks with a patient's regular physician to discuss decisions about their care. Otherwise, the doctors exchange information through patient charts and medical records that Gabbard reviews before and after seeing each patient.

Dr. Lynn Simon, chief medical officer for Jewish Hospital and St. Mary's HealthCare Inc., said that before hospitalist practices began, patients "either waited all day to see their doctor, or they had to wait for (the physician) to call in an order" or discharge patients.

"They would see them usually once a day," she said. "Now, they see somebody who can stay longer" and who will come back if necessary.

But in the early 1990s, many doctors began to take the approach that Gabbard has with a primary focus on hospital care.

According to information from the Society of Hospital Medicine, a Philadelphia-based nonprofit group that represents hospital-based physicians, the number of hospitalists practicing in North America has grown rapidly since the mid-1990s and has more than doubled since 2002 to about 15,000.

The number of hospitalists is expected to double again within four years, rising to about 30,000 by 2010, making the field about the size of cardiology, according to the organization.

During the past five years, the number of hospitalists on staff at Jewish and St. Mary's hospitals has nearly doubled, to about 20, Simon said.

And the five hospitalist practices that treat patients at the company's two Louisville hospitals are recruiting more physicians, she said, adding that details about the number of patients the hospitalists see are not available.

Officials with other Louisville health care organizations have seen similar growth trends but said they do not have firm data to show the growth because they don't track the number of hospitalists on their staffs.
Trend good for doctors and hospitals

The fact that most family physicians need more patients to keep their practices profitable seems to be one of the primary factors that is driving the growth of hospitalists, Simon said.

And hospitals welcome the change, she added, because patients who have a hospitalist following their care generally get faster responses to their needs.

Dr. Tami Secor, a primary-care physician with Baptist Medical Associates, said she likes referring all of her hospital patients to Gabbard's Nikorb group for a number of reasons.

One benefit is that she doesn't have to rush to the hospital when her patients need something. She also believes her patients need someone who is more knowledgeable about the needs of patients in a hospital setting.

"Medicine in general is getting more complex," she said. "It is hard to be an expert in everything that someone will need. Inpatient medicine is not an exception. If you are dealing with it all the time, you may recognize something faster than someone who is not as familiar (with a complex condition). It is not necessarily that the training is different, it is really just what you do every day."

Simon likened the growth in the use of hospitalists to the trend more than a decade ago of having physicians specialize in emergency medicine. She said both specialties require physicians to hone different skills that improve patient care.
Patient satisfied with care

Simon said officials with Jewish Hospital and St. Mary's HealthCare also find that patients enjoy having someone more concentrated on their care in an inpatient setting.

One of Gabbard's patients, Robert Hickey, 64, said that because his No. 1 priority was getting out of the hospital, he appreciated the extra attention he received by having someone at the hospital working full-time to follow his care and attend to his needs while he was at the hospital.

Hickey, who came to the emergency room as a result of unexplained bleeding, said that when he previously stayed at Baptist East, he was visited by a family physician.

But his physician stopped coming to the hospital and referred him to the Nikorb group for inpatient care.

Hickey said he saw Gabbard at least once per day, and the physician seemed to "have a good handle" on his condition.

What patients such as Hickey don't see is that after Gabbard spends five to 10 minutes with a patient, he spends another 20 to 30 minutes per patient at the nurses' station, coordinating care with specialty physicians or surgeons, ordering tests and studying patients' charts.

And Gabbard's practice has established a telephone-based system that allows him to dictate notes when a patient is discharged so the notes can be transcribed and later sent to the patient's primary-care physicians.

That took longer than I wanted," Gabbard said after a being held up while waiting for Hickey's surgeon to return a phone call so Gabbard could write an order to release the patient from the hospital.

"Nobody sees this part of it. Most of them don't know how long all of this takes."

For the original story, go here: At home in the hospital: A growing number of physicians focus their practices on treating acute-care hospital patients

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