Another advantage is that a hospitalist is likely to have seen a patient before a procedure is needed. Dr. Soni believes it’s not as frightening for a patient to have a procedure done at bedside by someone they have met. “And we can educate patients about the procedure and answer follow-up questions because we are there,” he notes.
However, physicians doing procedures may not agree that hospitalists should take over the service. In some institutions the idea of establishing a proceduralist service or center has met roadblocks from physicians who see proceduralists an interlopers.
At Cedars-Sinai this hasn’t been a problem. “Our interventional radiologists and surgeons have been supportive because they have as much as they can handle,” Dr. Rosen explains. “They are content to focus on the more complicated procedures.”
Hospitalists specializing in procedures say it adds variety to their usual routines. “It takes a different mentality and different skills,” Dr. Rosen explains. “It’s much like surgery. You get a feeling of accomplishment when you’re done and then you go on to something else. It’s very satisfying,”
From a revenue standpoint, hospitalists can bill for the procedures they perform, although reimbursement for the typical procedure is not “jaw-dropping,” Dr. Rosen says.
For hospitalists, developing procedure skills may lead to career advancement. “The more you have to offer, the more valuable you are,” Dr. Soni advises. “By becoming a proceduralist you generate money for the hospital instead of being just an expense.”
Training and Standards
Whether hospitalists or other physicians do procedures, most of them agree there is a need for training and certifying of proceduralists. “Currently there are no standards for mastery in performing procedures,” Dr. Li says. “We measure mastery by personal belief. You ask me if I feel comfortable doing a certain procedure, and I say ‘Yes’ or ‘No.’ ”
SHM has identified performing procedures as one of the skills all hospitalists should be able to demonstrate, according to Dr. Li. To that end, an advanced procedures training course will be held at Hospital Medicine 2008, SHM’s Annual Meeting in April. For the first time, procedure experts will train hospitalists using different simulators, portable ultrasound, and other equipment.
“The future growth of proceduralist services and centers will come from being closely associated with and staffed by hospitalists,” Dr. Rosen says. He believes it’s an opportunity for hospitalists to supply another value-added service and have more variety in their work. TH
Barbara Dillard is a medical journalist based in Chicago.