Innovations in the medical field and the steady growth and demand of hospitalists have brought a new paradigm about medical specialties and how doctors want to get involved with patient care. What does this mean for physicians and hospitals?
Hospital medicine has driven most of PCPs’ growth, and it’s no wonder that 500-bed and even 100-bed and rural facilities are overwhelmed by the demand for hospitalists. There are currently about 6,000 hospitalists practicing inpatient medicine in different practice settings, including children’s hospitals and nursing facilities. Experts project the growth of hospital medicine to increase to 19,000 plus within another decade. In 2001, for instance, one in every five members of the American Academy of Family Physicians uses hospitalists.
Lifestyle choices, reimbursement benefits and concern for continued care for patients have been factored in by doctors and administrators, and the growing importance of hospital medicine is encouraging the growth and demand. Healthcare groups that continue to utilize hospital medicine in addressing steady demand for inpatient care have seen the increased presence of hospitalists, so much so that even sub-specialized physicians have decided how they want to be involved in inpatient medicine. They can now be seen co-managing surgical patients, performing glycemic control, DVT prevention and antibiotics prescriptions, as well as evaluating elective surgical and pre-admission patients who would’ve otherwise seen cardiologists, endocrinologists, neurologists, intensivists, orthopedic doctors and emergency medicine physicians.
“Specialties like neurology, surgery, and even otolaryngology have begun to establish inpatient care based on the hospital medicine model,” said Craig Fowler, Pinnacle Health Group’s Vice President for Training and Recruitment.”Many of these hybrid specialties begin in the academic setting, but we’ve also seen these programs in community hospitals, military and Veterans Affairs facilities, and even psychiatric hospitals. We’ve also observed the steady demand of nearby community clinics and facilities for consulting with inpatient medicine specialties.”
Experts currently estimate that there are about 250 hybrid hospital medicine programs around the country. This number is projected to grow given that some of these programs, such as pediatric hospitalist programs, have reported enhanced efficiency and patient satisfaction, particularly in ambulatory care, emergency medicine and pediatric inpatient services.
Full-time neuro-hospitalists, or neurologists who practice hospital medicine, have accounted for at least 8% of the American Academy of Neurology’s members, while 73% of them listed inpatient neurology care as their main practice focus. “Administrators attribute the increased growth of neuro-hospitalists with impracticable inpatient neurological services,” added Fowler. “We’ve had physician searches and meetings with healthcare systems who wanted to take the pressure off of their outpatient neurologists or doctors that maintained offices or clinics in remote areas. Strokes require urgent care and it makes a lot more sense to have neuro-hospitalists cover the Emergency Department to cover those kinds of emergency consults. Moreover, hospitals benefit from having neuro-hospitalists cover their facilities by being certified as neuroscience centers.”
There is also a growing trend for psychiatric hospitalists. Psychiatrists sometimes veer away from inpatient settings mostly because of work coverage and lifestyle preferences, but psychiatric hospital medicine offers these physicians the opportunity to specialize in conducting assessments and treating patients with severe mental illnesses and psychopathologies that are inappropriate for outpatient practice environments.
A quaternary care center in San Francisco, California, meanwhile, reported increased demand for otolaryngology, with more and more of their otolaryngologists being required to cover operating rooms or ICUs. Complexities in otolaryngologic diseases, increased ambulatory care demand, and geographic issues have prompted them to hire a full-time otolaryngologic hospitalist whose main duty is to cover inpatient work.
At the same hospital, they have reported better response time for surgical consultations, faster waiting time for patients with acute appendicitis by up to 50% and increased billable consultations by up to 200% when they added a surgical hospitalist. The same could be said for a Miami-based facility, reporting positive support for their acute care geriatric programs from their hospitalists and gerontology nurse practitioners.
Orthropedic hospitalists are also seeing similar trends, with facilities in North Carolina having orthopedic hospitalists referring patients to other doctors, managing fracture care and starting patients with therapies when full-time orthopedists take elective cases. In obstetrics and gynecology, the Society of OB-GYN Hospitalists estimates that there are currently about 142 OB-GYN hospital medicine programs around the country, compared to just 15 in 2006. Obstetrics has a high malpractice rate, so healthcare facilities minimize litigation and settlement costs by bringing the right doctors who can cover and manage obstetric emergencies and deliveries.
Recruiters need to be cognizant of the expansion of facility-based specialists. The demand for these new specialists is likely to increase. With the increased scrutiny of outcome and the shift toward outcome based reimbursements, hospitals are going to increase the inpatient medicine recruitment in a number of these sub-specialties.