Melding these groups of physicians with disparate interests and responsibilities is the next challenge for hospital leadership. It is a challenge fraught with potential pitfalls. As Dr. Wellikson explains, “The biggest obstacle is that physicians don’t do change very well.”
Administrators will turn to their institution’s hospitalists (both hospital-employed and contracted) to effect these changes and ensure overall standards and efficiency.
“I think hospitalists are in a position to bridge the gap between administrators and medical staff,” says David Yu, MD, medical director of hospitalist services at Decatur Memorial Hospital in Illinois. “I think that’s why there will be more and more hospitalists in leadership positions. That’s why hospitalists are unique: they have their feet in both worlds.”
Dr. Wellikson believes the home team will step up to the plate and take over many of the leadership duties of the new hospital.
Kenneth Patrick, MD, the ICU director of Chestnut Hill Hospital in Philadelphia, sounds a more cautionary note. Dr. Patrick, a trained hospitalist and intensivist, believes the demise of the old “hospital privilege” model is dissolving ties between physicians and their workplace. “I think younger physicians will be much more transient and more concerned with their position, work hours, and pay,” he says.
He sees a young workforce—whether hospital or office-based—as more disengaged than physicians used to be. “They will meet hospital standards, but not be actively involved in developing them,” he believes. That will be left to a small group of hospital-based physicians “who will voluntarily come forward because it is their civic responsibility. It would be nice if more physicians would work on committees, but they look at them like jury duty and they don’t want to serve.”
“The question everyone asks is ‘What’s in it for me?’” Dr. Yu says. He notes a common sticking point: the requirement for increased documentation, which often means more work for doctors. “I think administrators are going to be in shock if they think practitioners are going to line up and say, ‘Well that’s great for the hospital.’”
The key to cooperation, says Dr. Yu, is the linking of changes to mutual benefit and patient welfare: “The administrators have to communicate that in the long run everyone will gain and it will ultimately lead to better patient care. You have to share your vision, inspire, motivate, and develop a culture of providing quality care. It’s easier said than done, but it’s the essence of medical care.”
What about patients? How do they react when a group of strangers takes over their hospital care rather than the primary care physician they often have gotten to know and trust for years? “Wanting your doctor present is counterbalanced by not having your doctor in the house,” Dr. Axon says. “Now you can see a physician anytime during the day.” And most patients are glad for the tradeoff. Dr. Yu has found the same dynamic with his patients at Decatur Memorial Hospital. “I can just count on one hand patients who were not happy the primary care physician wasn’t there,” he says. “Patients are more concerned with having their problems solved than with who is solving them.” And he makes sure his hospitalist staff never undermines the office based physicians. “We always say we are not better physicians, we are just more available.”
While they may have left the hospital, office-based physicians still will be a large presence in it by advocating for their patients. “If my whole currency is, ‘Do I have hospital privileges?’ then all my decisions are based on that,” Dr. Wellikson says.