Intensivists and ICUs
Question: What is your opinion on a closed ICU that already has a hospitalist program but now has a new intensivist program? Certainly some patients should be cared for by critical care physicians. However I feel we play an important role throughout the hospital, including the ICU. As physicians who specialize in hospital care, I do not want to lose opportunities to care for patients in the ICU. Do you feel medicine may move toward that, especially in the larger hospitals? Or have you found a happy medium?
Eric Marsh, MD,
Carolinas Healthcare System,
Dr. Hospitalist responds: In many small and rural hospitals throughout the country, generalists remain the frontline providers for ICU patients.
There is a shortage of critical care physicians in this country. Many small and rural hospitals have a difficult time recruiting sufficient numbers of critical care physicians to their medical staffs. This is not the case in most academic tertiary care medical centers, where pulmonary/critical care providers routinely care for the ICU patients.
In fact, during the past two decades, many hospitals, particularly tertiary care medical centers, have “closed” their ICUs to generalists and now use specialty-trained physicians, such as pulmonary/critical care physicians, to care for ICU patients. The reason is quality. Evidence suggests intensivists provide higher-quality, more evidence-based care to ICU patients than generalists.
Quality organizations, such as the National Quality Forum and The Leapfrog Group have actively promoted the role of intensivists in the ICU and labeled them as a marker of quality care. Hospitals are under increasing scrutiny to increase the quality of care they give patients. Reimbursement is increasingly tied to performance and quality.
I expect to see more and more hospitals “close” their ICU to generalists. To be fair, the data comparing intensivists and generalists came out before the widespread role of hospitalists in our nation’s hospitals. It would be interesting to compare the care provided by hospitalists versus intensivists in the ICU. It may be we find hospitalists fare comparably to intensivists. Until that data exist, I agree with the quality organizations. Hospitals, and more importantly patients, should rely preferentially on physicians with additional critical care training to provide care for their ICU care.
If your hospitalists are interested in continuing to provide care for patients in the ICU, I suggest you speak with the leader of the intensivist group to see how your hospitalists can work with—not in lieu of—the intensivists in the care of ICU patients.
In Pursuit of More Pay
Question: I am writing to get your advice on how to go about negotiating base pay increases. I come from a four-physician hospitalist program at the New York Hospital of Queens that has tripled its annual number of discharges since 2005 without a commensurate increase in base pay and no bonus or incentive pay. If this keeps up, we’ll continue to have high turnover always manned by junior attendings. Also, what is reasonable pay for the director of a hospitalist program?
Anne Park, DO,
New York Hospital of Queens
Dr. Hospitalist responds: I am writing to you from the lovely Manchester Grand Hyatt in San Diego, where I am attending the SHM Annual Meeting. I am here with nearly 1,600 of my closest friends in hospital medicine.
Meeting attendees heard SHM Senior Vice President Joe Miller reveal the results of the latest “Society of Hospital Medicine 2007-08 Survey: The Authoritative Source on the State of the Hospitalist Movement.” I refer to this survey not only because I believe it is the latest, most accurate, and comprehensive data on hospitalist productivity and compensation, but also because I think it is the objective data you need before you start discussions about compensation for you and your hospitalist staff.