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HM groups should provide informational brochures to admitted patients

I am trying to find out two pieces of information. First, is there a national association of hospitalists that oversees and gives guidance to all of the regional and national hospitalists that are now in practice? If this defines your group, great. On to my second question: Is there an established policy or doctrine that is recommended for hospitals in regard to disclosure to patients that they are indeed a hospitalist type of hospital? If so, could you advise how I might obtain a written copy? Thank you.

C.G. Lemaire, Virginia

Dr. Hospitalist responds: According to the 2008 American Hospital Association survey, about half of the nation’s hospitals have hospitalists. In hospitals with 200 or more beds, 83% have hospitalists. The field has grown rapidly since its inception in the late 1990s. There are an estimated 28,000 hospitalists in the U.S.

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Do you have a problem or concern that you’d like Dr. Hospitalist to address? E-mail your questions to drhospit@wiley.com.

Most hospitalists recognize the Society of Hospital Medicine (SHM) as the professional society that represents their interests. I am not aware of any established SHM policy that mandates or suggests that a hospital disclose to patients the fact that hospitalists work there, nor do I believe that one is necessary. Hospitalists are medical doctors whose interest is the care of hospitalized patients. This is analogous to critical-care physicians, whose interest is care of the patients in hospital intensive-care units, or ED physicians, who care for patients in hospital emergency departments. There is neither a requirement nor expectation for hospitals to notify patients of the availability of these types of physicians working at a hospital.

I understand patient expectations can be different. Most patients expect to see ED physicians when they visit a hospital ED. But this was not always the case. Several decades ago, the field of emergency medicine was in its infancy, and most hospitals did not have ED physicians. I am certain most patients were surprised to see an ED physician instead of their primary-care physician (PCP). But patients came to realize ED physicians were trained specifically to care for ED patients and were available to care for them when their PCP was not available. I think patients will become familiar with hospitalists and expect to see one when they are hospitalized—but until that time arrives, I do think it is reasonable for everyone involved to help set that expectation for patients.

Ideally, HM programs should develop brochures explaining a hospitalist’s role in the care of hospitalized patients, as well as the relationship between hospitalists and PCPs (see “Satisfaction Scorecard,” January 2009, p. 57). These brochures should be distributed not only to hospitalized patients, but to outpatients in PCP offices. The primary-care clinic waiting room is a great place for these brochures.

PCPs should discuss the role of hospitalists when they send a patient to the hospital for admission. It is important for hospitalists and PCPs to know that patients are more likely to be accepting if they understand: 1) the PCP supports this model of care; 2) the hospitalist and PCP are communicating about the patient’s care; and 3) the hospitalist is available to the patient while the PCP is in their clinic.

SHM’s Web site also has a sample brochure, which can be used to introduce and inform patients about the hospitalists’ role in their care. Download the form at www.hospitalmedicine.org/samplebrochure.

Know your contract before signing the dotted line

My contract says that as a hospitalist, I will work 18 shifts a month, each being a nine-hour duration, and on average 2,000 hours per year. It does not add up to 2,000 hours. Does night call count toward the number of hours? Do weekends and holidays count toward the number of hours?

Anshu Sood, MD

Dr. Hospitalist responds: If I understand you correctly, you are working 1,944 hours annually (18 shifts per month x 12 months x nine hours per shift). You did not tell me whether your compensation is based on the number of hours you work or whether you collect a salary regardless of the number of hours you work. If you collect a salary, sounds like you are scheduled to work fewer hours than expected.

That being said, I also don’t know the other details of your employment agreement. Does your employment agreement include paid vacation and sick time? Perhaps that might explain the difference. Another plausible explanation is that your compensation includes payment for sign-out and sign-in time at the beginning and end of each shift (18 shifts/month x 12 months x 9.25 hours/shift = 1,998 hours). Regardless of the explanation, your question made me wonder: Why are the details of your job description unclear to you, and why are you asking me rather than your employer for clarification? I urge all hospitalists to clearly understand their employment agreements before accepting any job offer. Any differences should be resolved before signing the contract. It is worth the time and money to seek the advice of an attorney familiar with physician employment contracts. The attorney’s job is to review your agreement and explain the terms of the contract, as well as point out what is missing. TH

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