“There has been friction between GPs and hospitalists because GPs have felt themselves pushed out of the hospital sector,” he says, “and they felt that hospitalists were getting paid more for hospital work than they were.”
Hospitalists, on the other hand, contend GPs were abandoning hospital-based practice, which created a new opportunity for those specializing in inpatient service delivery.
“Hospitalists did not feel they were represented as well as they should have been with the last round of [MOH] negotiations,” Dr. Appleton says. “They feel that they have been undervalued from a BCMA point of view, we don’t like to see that kind of conflict. I think once hospitalists help their colleagues understand the services that they are providing, then some of that resistance can go away. I’m hoping that they’re happier with what we’ve been doing and that their sectional status has improved things for them.”
Others in British Columbia agree with Dr. Appleton’s prognosis. “I think we’ve got optimism,” says Wayne DeMott, MD, a hospitalist at Royal Jubilee Hospital in Victoria, B.C. and chief negotiator for the BCMA’s Section of Hospitalist Medicine. “I think we’re trying to seek a much better representation of our issues from our parent organization that has struggled with figuring out what the heck to do with hospitalists. I do sense that they are trying to accommodate us a bit better and that they’re going to look at how they will represent us in the future.”
Understandably, though, Dr. DeMott also expresses wariness: “We had to go on a pretty tough journey in 2006 and we still haven’t forgotten how we were treated two years ago. We’re definitely going to continue to advocate strongly for ourselves.”
U.S.-Canadian Similarities, Differences
As U.S. hospitalists observe the growing pains of hospitalists in the Canadian healthcare system, it might look like deja vu all over again.
“In many ways, Canadian hospitalists are following a similar arc [as our U.S. HM colleagues] in carving out their niche,” says Dr. Wilton. The void created when family practice physicians abandoned hospital care in the late 1980s and early ’90s has turned into an opportunity for hospitalists. In turn, family practice physicians who at first were resistant have become accepting as they begin to appreciate the service hospitalists provide.
Even though U.S. and Canadian healthcare delivery and reimbursement systems differ, hospitalists “have a similar scope of practice” in the two countries, says Echo- Marie Enns, MD, CCFP, a hospitalist in Calgary, Alberta, and the first president of the Canadian chapter of SHM. John Nelson, MD, medical director of the Hospitalist Practice at Overlake Hospital in Bellevue, WA, a consultant for hospitalist practices with Nelson/Flores Associates, and co-founder and past president of SHM, agrees. “Eighty to ninety percent of the issues with hospitalists would apply to both settings,” he says. “There are ways in which they differ, but in broad strokes, they’re almost identical.”
Hospitalists’ situations and reimbursement agreements do vary from province to province, Dr. Enns notes. She was the lead hospitalist when the Calgary program started in 1998. She also worked in B.C. for a time and noticed that the MOH can be adversarial toward physicians at times. On the other hand, hospitalists in Alberta say they are “very well treated,” and have reported high satisfaction levels overall.
“The hospitalists here admit greater than fifty percent of the patients to medical beds in the region. So, we are the admitting force for the hospital,” she says. “We have a very cooperative relationship with the administration and have been able to initiate a lot of excellent initiatives to improve patient flow in moving patients to the most appropriate bed at the right time. As a result, we’re also getting to be more well known amongst the public.”