A t 77, Robert Eddy, MD, is a busy fellow. As a hospitalist at the 278-bed Brantford General Hospital in Brantford, Ontario, Canada, he works an average of 70 hours a week.
What keeps him going?
“After a long day at work I really look forward to my gin and tonic,” he says. “I have a picture of it in my mind when I’m driving home.”
On a more serious note, Dr. Eddy attributes his career longevity to good health, good genes, never smoking, and not overdoing the booze.
“I’m very lucky,” he says. “As a doctor you can keep going as long as you don’t have major health problems. My dad died in his 90s, so longevity runs in my family.”
Dr. Eddy rises early to do paperwork at his home office, then drives 20 minutes to the hospital and performs his hospitalist duties five mornings a week, Monday through Friday. On an average day he sees 12 inpatients, completes his charts, then grabs a quick lunch before heading out to see patients in a shared office practice in Burford, about nine miles away.
Scheduling around his hospitalist work and the office practice, he also makes house calls and nursing home visits to his sickest and frailest patients. He covers for his community-based colleagues and hospitalists, and twice a month organizes CME meetings for family physicians. From March to July he adds a temporary assignment at St. Joseph’s Villa in Dundas, tending to 70 patients at that retirement community.
Janice Legere, MD, medical director of the hospitalist program of Brantford General Hospital, calls him “a country guy with a very dry sense of humor. The other hospitalists look up to him because he is the real deal as a doctor.”
Not bad for a gentleman born in the same year and month as the beginning of the Great Depression—October 1929. In his sixth decade of medicine, Dr. Eddy may be the oldest practicing hospitalist.
—Sandra Eddy, wife of Robert Eddy, MD, hospitalist at Brantford General Hospital in Ontario, Canada
No Sign of Slowing
Although he has practiced medicine for more than 52 years, retirement is not on his agenda.
“I closed my solo practice in 1999 because I didn’t want to work so hard, but I’m busier than ever now,” he says.
While Dr. Eddy and his second wife, Sandra, seriously discuss the possibility of his retirement every year, they have reupped for the hospitalist work, office practice, and house/nursing home visits at least through 2008. As they describe it, the overburdened Canadian healthcare system needs every qualified pair of physician hands it can get.
Ontario’s healthcare system can ill afford to lose someone of Dr. Eddy’s commitment, knowledge, and experience.
“I love medicine and am very lucky to have the energy and the stamina to keep going,” Dr. Eddy says. “I enjoy seeing hospitalized patients because I have as much time as I need to do a general assessment of their medical condition. I get my mind around the whole patient.”
His wife affirms Dr. Eddy’s commitment.
“We have been together for 28 years, and we have a good marriage,” she says. ‘‘But he is on call 24/7, and medicine always comes first. Then there’s us.”
But Dr. Eddy’s not just a nose-to-the-grindstone type of guy—he and Sandra do relax together. Along with his nightly after-work gin and tonic and an annual week’s trip to Las Vegas, they enjoy outings to the local casino, golf, dinners with friends, and frequent visits from three grandchildren.
“I enjoy the variety in my career as a physician and the quality of my life,” he concludes.
The New Hospitalist
Becoming a hospitalist seemed a logical step for Dr. Eddy when he opted to leave full-time office practice in 1999. Brantford General Hospital, where he had admitting privileges, covered a catchment area of 80,000 people.
When the only two other hospitals in the area were closed, Brantford General was overwhelmed. Adding to the systemic distress, 80% of community doctors had given up their hospital privileges. Hospitalists were urgently needed to pick up the slack. Dr. Eddy went for it.
In Canada, hospital throughput isn’t a priority. The system lacks enough sub-acute and rehab beds to discharge patients from hospitals in a timely fashion, leaving patients hospitalized longer compared with similar care in the United States. The average length of stay for heart failure is 6.1 days in the U.S. versus 8.5 days in Canada; for aortic aneurysm repair it’s seven days (U.S.) versus nine days (Canada), according to the Journal of Cardiology.
Those bottlenecks lead to hospitalized patients ready for a less acute level of care occupying beds needed for acute patients. For example, patients wait months for knee replacement surgery, then spend three to four weeks on the rehab ward in the hospital. A step-down facility would probably be ideal but doesn’t exist. “There are people lying in the ER overnight, people who need to be in palliative care units who are in acute care beds,” Dr. Eddy notes. “It is very tough.”
As a family physician, Dr. Eddy favored a hospitalist career because he would have the time to do a general assessment—a whole-patient, complete check-up. He doesn’t admit patients or work in the ED (“Not my forte; I’m not looking for more stress,” he says), but works on the general medical units.
According to Dr. Legere, the septuagenarian physician works approximately 75% of full-time hospitalist hours. He puts in at least 40 weeks a year and covers at least 10 weekends for the hospitalist service.
Hospitalist Larry Kramer, MD, who has worked side by side with Dr. Eddy since 2002, calls him a compassionate, sensitive physician attuned to the small kindnesses patients and family appreciate, such as remembering everyone’s name.
“He’s an excellent team member, always open to referrals and consultations,” says Dr. Kramer, who’s also impressed with Dr. Eddy’s interest in mastering a Palm Pilot when he discovered how much easier and faster it was to access clinical and pharmaceutical information. “He didn’t grow up with computers, but he sure learned how to use his Palm,” adds Dr. Kramer.
The Office Practice
When he started his hospitalist career, Dr. Eddy fully intended to relinquish the office practice to another family physician. It didn’t happen that way—there were about 200 patients he couldn’t give up.
“They are elderly, and I make house calls if it’s too much of a burden for them to come to the office,” he says. “I also see them in nursing homes or retirement homes.” He also covers the office practice for the month of August so his practice partner can have the month off.
His wife, who fields home office phone calls, attends to the issues of 200 special patients and also tries to guide those looking for a primary care doctor to someone else willing to take them.
“My wife works very hard at managing my private practice,” says Dr. Eddy. “She’s a people person but is not soft-minded at all. She helps a lot of patients find primary care physicians who will take them on as well as fielding calls from my private patients.”
The Ontario Health Insurance Plan (OHIP) pays him on a fee-for-service basis. In 2000, when bureaucrats tried to avoid reimbursing him for making house calls by stipulating that at least 50% had to be for palliative care, he made a list of all 200 patients. He made his case for palliative care—“they’ll all die within four years.” The medical establishment accepted it, and he continues making house calls—for which he says the health authorities are relaxing the regulations.
As if the hospitalist and office practice weren’t enough, Dr. Eddy runs a small group practice CME program sponsored by McMaster University and the College of Family Physicians of Canada. “Six of us family physicians get together to discuss three cases based on handouts and a fact section” he says. The CME group meets twice a month for eight months of the year.
In short, Dr. Eddy describes himself as having energy to burn. His hospitalist colleague Dr. Kramer seconds that.
“The amount of work he does is phenomenal,” Dr. Kramer says. “He is very thorough, and it’s remarkable to see how much he still loves practicing medicine. It’s hard to believe that when he’s finished with his hospitalist job he heads off to his office practice, house calls, and nursing home work.”
And what does Dr. Eddy think of his colleagues?
“They seem quite young,” he says of Brantford’s cadre of six full-time and six part-time hospitalists. “But come to think of it most are in their 40s, and some in their 50s and 60s. Maybe they aren’t so young.” TH
Marlene Piturro is a frequent contributor to The Hospitalist.