The Hospitalist Will See You Now

The Hospitalist Will See You Now

Rising costs and increasing federal regulations have spawned a new kind of inpatient care.

By Beth Milligan

Less than 20 years ago, the term to describe the career path of Dr. David Friar hadn't yet been coined in the medical field.

Today, Friar is CEO of Hospitalists of Northern Michigan (HNM), a firm of more than 100 providers and a dozen administrative staff focused on one of the fastest growing fields in healthcare: hospitalist medicine.

Before hospitalists – whose job is the care of hospitalized patients – doctors like Friar often went back and forth from their practice to the hospital, juggling hospital visits with office appointments.

Since patients requiring hospitalization relied on their family physician to oversee the details of their treatment, this arrangement often left them at the mercy of their physician's schedule.

Enter hospitalists. These specialized practitioners virtually eliminate the need for hospital visits by primary physicians. By acting as a coordinator between the patient and their care, hospitalists manage every aspect of a patient's stay – as well as ensure primary physicians are kept apprised of patient care (a process significantly streamlined by the evolution of electronic medical records.)

"Hospital visits have become very complicated; there are no easy patients anymore," said Dr. David McGreaham, Vice President of Medical Affairs at Munson Medical Center. "If you have a group of physicians dedicated solely to hospital care and managing the processes surrounding patients, you'll be able to create systems that are safe, efficient and effective – both for the hospital and the patient."

Munson first began utilizing hospitalists in 1993 (though that term was not officially coined until 1996, in a New England Journal of Medicine article) to assist with admissions at night, when primary care physicians were most difficult to reach. Munson later expanded the program to include 24-hour coverage in 1997.

Just four years later, Friar and his fellow hospitalists working at Munson left to form HNM, an independent, physician-owned group that now contracts with Munson and five other hospitals throughout northern Michigan to provide hospitalist services. (Most Munson practitioners are contracted in such a manner, including anesthesiologists, emergency-room doctors, and surgeons.)

Dr. Sara Roth is the co-founder of Patient Care Specialists (PCS), the second of the two groups providing hospitalist services to Munson. Unlike HNM, which by contract focuses heavily on admissions and a generalized range of patient treatment, PCS is primarily focused on servicing the needs of specialty patients, like cardiology.

PCS employs just shy of a dozen staff, including mid-level providers.

"I have actually always wanted to be a hospitalist," said Roth. "I enjoy the diversity and acuity of care that we have in the hospital. Hospitalists are very much involved in improving patient safety and quality. We're able to respond in real time to patient needs … which isn't always true when you're a primary care physician."

Primary care physicians still play a crucial role in patient treatment, and the close relationships they develop with patients over time is often cited as one of the major advantages of their profession over hospitalists – an advantage both Roth and Friar acknowledge, but say is outweighed by the hospitalist model's benefits.

"I do think one of the negative things patients express is that they want to see a primary care doctor," said Roth. "Those [doctors] know everything about their history; who they are. But one of the things we try really hard to do as hospitalists is introduce ourselves as their primary care doctors while they're in the hospital … doctors who are available 24/7."

Friar said that the loss of the in-office relationship is outweighed by the benefits of having a dedicated hospital-based physician.

"What made me pause the longest before becoming a hospitalist [was the loss of those relationships]," he said. "But there are so many other advantages. We've come into communities where hospitalists haven't existed before … and have heard resistance at first, but then people quickly come to understand [the benefits of] what you're doing."

Both Roth and Friar say the demand for hospitalists has grown at such an accelerated rate in recent years that it now outpaces supply. While Friar says part of that imbalance remains the lure to providers of the perceived calmer pace and independence of a private practice, he believes the realities of the medical field – particularly as it evolves under the Affordable Care Act – make it increasingly likely physicians will come under the fold of larger institutions, such as hospitals.

"With the rising costs of [medical technology] it's becoming virtually impossible to be a mom-and-pop office hanging up a shingle like the old days," he said. "Hospitals are also becoming responsible for every aspect of a patient's care, which means they need to control every aspect of a patient's care. The only way they can do that is if they employ or contract with every provider."

Large hospitalist groups such as HNM are also uniquely poised to help guide the medical institutions they serve – particularly those of smaller scale or limited resources – through the rapidly changing medical landscape brought on by the industry's morphing regulations.

"We spend a lot of time attending national conferences and workshops, studying trends and advising hospitals on what systems they should use," Friar said. "Being a healthcare institution used to be like being a library – nothing ever changed. Now, just like libraries, everything is changing at such an incredible speed that it's hard for hospitals to keep up. That's where we can help."