Hospitalist Bradley Rosen, MD, has become something of a celebrity lately. Dr. Rosen, assistant director of the Procedures Center at Cedars-Sinai Medical Center in Los Angeles, is making news as the prime example of physicians carving new turf by becoming experts in performing medical procedures.
But it’s his center’s eye-popping statistics that are generating interest from patient safety groups and hospitals around the country. Dr. Rosen has documented a complication rate of less than 1% for procedures performed at the center. Published data for similar procedures done elsewhere sets the rate at between 3% and 5%.
The statistics don’t surprise Dr. Rosen. “The more you do something, the better you are going to be at it, and the better you are able to deal with the unexpected,” he explains.
Stories on proceduralists have also generated interest from hospitalists, who wonder if becoming experts in procedures can make them a more valuable part of the healthcare team and make their jobs more varied.
—Bradley Rosen, MD, assistant director, Procedures Center, Cedars-Sinai Medical Center, Los Angeles
The evolution of proceduralists is first and foremost a patient safety measure. Many internists have given up doing procedures, concerned that they don’t do enough of them to stay proficient. In a study published in The Annals of Internal Medicine, internists reported that they do 50% fewer procedures today than they did 18 years ago. And the American Board of Internal Medicine has reduced the number of procedures required for certification, saying internists should focus on core procedures they are likely to do frequently. Proceduralists are moving in to fill the void.
Also driving the proceduralist movement is concern that residents don’t get enough experience in doing today’s more complicated procedures and are being trained by other residents.
“Unfortunately, training in procedures hasn’t progressed much from when I was a resident,” says Joseph Li, MD, director of the hospital medicine program at Beth Israel Deaconess Medical Center in Boston and assistant professor of medicine at the Harvard Medical School. “When I had to do a thoracentesis, for example, a junior resident was teaching me, and we would get three or four kits because I knew that I would screw up. We had no notion of cost, and although I felt bad sticking a patient a bunch of times, it was the way it worked in the teaching hospital. Unfortunately that is still the way it’s done in the overwhelming majority of medical schools today.”