I’ve been a practicing physician for 30 years. I was a Primary Care Physician (PCP) for 19 years, and have been a Hospitalist for the past 11 years.
I always have enjoyed the hospital setting. I really looked forward to my time in the hospital when it was my week to round for my group practice. My partners almost dreaded their hospital week, so I guess it was a natural progression for me to eventually become a Hospitalist.
Hospitalists are Internal Medicine physicians, or Family Practitioners, who have limited their practice solely to the hospital setting.
Compare this to Primary Care Physicians who have chosen to limit their practice to only seeing outpatients. Almost all the PCPs in Augusta and mostly across the country no longer go to the hospital.
There is a common misperception that PCPs are not permitted to come to the hospital. This is simply not true. PCPs are welcome in the hospital and their input is certainly appreciated. The truth is, it is impractical for them to come to the hospital any longer. I will elaborate further.
Being a PCP is not an easy endeavor. The hours are long and the challenges are many. There is a significant shortage of PCPs across the country. Most PCPs are fully subscribed, and their schedules are packed.
So imagine the stress of having a full office and receiving a phone call that your hospitalized patient is having a crisis? Or working hard in the office all day and driving back to the hospital while your family waits?
But there’s more to this than just the personal burden of being a PCP. The worlds of Primary Care and Hospital Medicine continue to diverge.
Hospital Medicine has evolved into its own specialty. Certainly there is overlap, but I would have to retool considerably to be a PCP again. Likewise for a PCP who hasn’t been in the hospital setting for some time.
I fully understand the respect patients have for their PCP. I understand I must earn the trust of both patients and PCPs before I can expect to care for these patients. I’ve seen how some of my outpatient colleagues have struggled with the decision to forgo their hospital practice to better serve their ambulatory patients.
I approach this matter of trust in a solemn manner. When my colleague’s patient is in my care, I celebrate the good outcomes and grieve the bad ones. I expect no less of my Hospitalist colleagues.
I hear folks say, “The Hospitalist doesn’t know anything about me.”
Do I know you can fix a grandfather clock or that you grow the most beautiful roses in Augusta? No. But I can learn a wealth of information about your health history by scanning your medical records, and I’m a very quick study.
I’ve seen your exact problem dozens, if not hundreds, of times. I’m highly versed in its latest treatments, likely benefits and potential pitfalls. And I’ll engage a consultant if there’s any question about how to proceed.
I’m a whiz at navigating the convoluted health care system and I’ll be a resource for you if you need to make difficult decisions. My partners and I will be there for you if your condition changes. I’ll be truthful with you about what’s going on with your health situation, even if I ever have to give you bad news.
When it comes time for you to go home, I’ll try hard to make sure your PCP has everything he or she needs to take care of you going forward. And I think it’s really cool you can fix a clock and maybe when you’re feeling a little better you can tell me why my yellow roses never do as well as the red ones.
Are Hospitalists a good thing or a bad thing? I guess it depends on whom you ask.
I’m passionate about what I do, and I have high expectations of my colleagues. I can certainly understand how the development of the hospitalist movement has been a hard change for many seniors. By the same token, many younger patients arrive and just assume somebody will be there to care for them.
I know our Hospitalist practice has made a very positive impact on the quality of care we provide at University Hospital. Our goal is to continue to earn the community’s trust and resolve to provide the best care we can every day.
The writer is medical director of University Hospitalists, University Health Care System.