Hooray for hospitalists

Hooray for hospitalistsHospitalists, physicians who practice internal medicine solely within the inpatient setting, are profiled in today's Boston Globe. One of the weirder things about hospitals is there usually aren't many doctors around. Primary care physicians tend to round in the early hours of the day, and then patients are left with nursing and administrative staff the rest of the time. Hospitalists address that deficiency by actually being in the hospital most of the day.The article profiles Dr. Faisal Hamada, who runs the hospitalist program at Brockton's Caritas Good Samaritan Medical Center. He's actually employed by Cogent Healthcare, an Irvine, CA --not Philadelphia as the article states-- based provider of turnkey hospitalist programs. Cogent provides the hospitalists, support staff, protocols and IT systems. The company generates a return on investment for its clients by improving the quality and efficiency of the hospital. Because hospitalists are around they can make adjustments in a patient's schedule during the course of a day, something a primary care is unlikely to do after rounds . That kind of intervention tends to improve length of stay.Good hospitalists develop a rapport with community physicians, which is essential so that those physicians don't feel like the hospitalists are stealing their patients. I'm not surprised that Dr. Hamada is complimentary to the community physicians, but it's also a fact that hospitalists tend to be more competent working in the hospital than their community-based colleagues. Hospitalized patients tend to be very sick --sicker than office-based physicians are used to seeing. Hospitals also have their policies, procedures, and informal ways of getting things done. It's easier for a hospitalist to be good at this part of the job than someone who is only in the hospital occasionally.One of the common complaints about hospitalists, also echoed in this article, is that there is a gap in communication between the hospitalist and the primary care physician, so that patients can get in trouble in between the time they are discharged and the time they see their community doc again. But that actually shouldn't be such a problem in Brockton. Unlike most hospitalist programs, Cogent has its own call center to follow up with discharged patients, and has specific protocols for communicating with community physicians. In addition, Brockton is one of the three Massachusetts communities that is being wired up with a health information exchange as part of the Massachusetts eHealth Collaborative. That should make it much more straightforward for hospital-based and community-based physicians to stay in touch. Patients will benefit.