Across town at Scottish Rite, a nonprofit hospital, the hospitalists cope with the demands of a steady influx of new Atlantans. David Hall, MD, is Scottish Rite’s medical director. He was a former Egleston hospitalist and a private practitioner for 10 years in Baltimore before he relocated to Atlanta.
“We don’t have house officers, and there is a resident on call only one night a week,” says Dr. Hall. “Pediatricians in the community need to have their patients admitted 24/7, and we also have to admit from the emergency department at night. With our hospitalists taking calls at night and working all the next day, sometimes they would be on for 36 hours straight. As our service has grown, we’ve realized that this model was not sustainable.”
To reduce the burnout from their growing patient loads, the hospitalists changed their model. As of August 1, 2005, hospitalists at Scottish Rite began working either eight- or 12-hour shifts.
“Until we gain some experience with the shift system, we know we will struggle with continuity and handoffs,” adds Dr. Hall. Scottish Rite is also increasing its complement of moonlighting private practice pediatricians who want to keep their hospital skills current by covering the heavy workload.
Dr. Hall says recruiting new hospitalists isn’t a problem. Many local physicians want to do this work—especially right after residency. Comparing being a hospitalist with his 10 years in private practice, he says, “In my office practice I’d be sitting 20 feet away from a colleague, and there wasn’t much interaction. Now I’m learning something new every day and discussing interesting patients with other doctors. Building these ongoing relationships is great.”
Benefits, Culture, and More
The compensation and benefits packages at Egleston and Scottish Rite reflect that they are two separate hospitals in one system. Egleston’s hospitalists are employed by the medical school and receive a straight salary, with no incentive or at risk components. Scottish Rite’s hospitalists are hospital employees and have 20% of their salary at risk with productivity, quality improvement, and patient satisfaction incentives.
Although the different compensation systems may lead to discrepancies in pay, Dr. Berkelhamer explains that the policy of Children’s Hospital of Atlanta is to offer market-based salaries to all hospitalists. “Part of my job is to ensure that Dr. Snitzer and Dr. Hall are empowered to hire the physicians they want,” he says.
The hospitals have different corporate cultures as well. “The Scottish Rite group is very comfortable with lots of hands-on work while those at Egleston like to spend more time teaching,” says Dr. Berkelhamer.
Dr. Taylor, who trained with Dr. Snitzer and had a private practice in Atlanta for five years before becoming a full-time Egleston hospitalist in 1993, also acknowledges the different cultures at Egleston and Scottish Rite.
“We are two hospitals that come to the table and work together,” she observes. “Although we are in separate locations and may approach things differently, we practice the same type of medicine.”
Dr. Berkelhamer, who works with both sets of hospitalists, reinforces the observation that their clinical practices are consistent: “Surveys on patient and community physician satisfaction are the same, as are outcomes and productivity data.”
Special Issues for Both Hospitals
As part of a growing medical specialty in a dynamic region of the country, hospitalists at Children’s Hospital of Atlanta must confront a number of issues—some unique to them, others that reflect national trends. With different compensation and productivity systems, the two sets of hospitalists must collaborate to practice one brand of medicine.