Look at hospitalists and you’ll find more gray hair, crow’s feet, and accumulated wisdom than you might expect. While many hospitalists are physicians fresh from residency, the average age of a hospitalist is actually 40—in part because some hospitalist are docs who have left office practices in favor of hospital work.
These docs, who we’ll call “mid-career hospitalists,” take diverse paths to this change. Some miss the adrenaline rush of acute care. Others have become weary of the flat reimbursements and high patient volumes needed to maintain office practices today. Whatever their paths, they’re an interesting lot.
The most common scenario by which mid-career hospitalists make a transition is when hospital administrators recruit their own. That’s how Robert Brannon, MD, an Ob/Gyn in private practice since 1968, became a hospitalist at Presbyterian Hospital of Dallas in July 2005. Shrinking reimbursements, the costs of running an office, having to cover night call, and a national request for proposal (RFP) by the hospital precipitated Dr. Brannon’s career move.
He and nine other Ob/Gyns submitted a proposal in response to the RFP; hospital administrators awarded the group, OB on Call, LLP, a contract to start a hospitalist service for a largely indigent population in a hospital with more than 7,000 births annually.
I had already started to phase out the office practice and was working in a Medicaid clinic and an osteoporosis clinic when the hospital decided it had to do better with its indigent patients, particularly the 80 to 90 each month who came in with no prenatal care,” says Dr. Brannon. “The medical staff knew that resident work rules precluded their work off hours, so patient needs indicated that full-time hospitalists were in order.”
Now Dr. Brannon has the camaraderie of working with other hospitalists and neonatologists, delivering many babies, but still eliminating on-call obligations when he’s off duty.
“I’m doing more significant obstetrics work, re-honing my skills, and doing high-risk deliveries,” he says. “I’m doing what I love without the administrative hassles of a private practice.”
Jeffrey Frank, MD, had an even bigger nut to crack when he switched from an office-based practice to start a hospitalist medicine service at Doctors Medical Center (DMC) in San Pablo, Calif. The 45-year-old internist graduated from medical school in 1987 and worked in a four-person medical group in the area he describes as “very industrial, with oil refineries all around and the home base of the Hells Angels.”
—Scott Oxenhandler, MD
Helping to cover hospitalized patients for five HMOs precipitated his career change. “That was a mini-hospitalist assignment, and I felt I could adapt to full-time,” says Dr. Frank.
On DMC’s medical staff for years, Dr. Frank saw the hospital go from first in market share to a distant second after entrepreneurial doctors built a newer hospital north of town. Dr. Frank’s patients were aging and the prospects for improving the office practice were poor. Then there was Dr. Frank’s 800-pound gorilla: Kaiser-Permanente, a giant with 45% market share, with plans geared to younger patients, and physician salaries that his group couldn’t match. DMC continued slowly downhill, with closure a real risk.
In 2004, with his family’s acceptance of the long hours that launching a hospitalist program would take, Dr. Frank initiated discussions with hospital administrators to become its first chief hospitalist. Rather than leaving the office practice and launching a hospitalist service simultaneously, Dr. Frank approached established vendors for help. He chose IPC for its technology infrastructure and electronic medical records, competitive salaries, and the hope of attracting more physicians, whom Dr. Frank eventually recruited locally.