More Money, More Problems


Hospitalists should be mindful that President Obama's half-billion-dollar commitment to new funding for community health centers (CHCs) could translate into unexpected compensation and burnout issues in the coming years, according to an SHM Public Policy Committee member.

Felix Aguirre, MD, FHM, vice president of medical affairs for IPC: The Hospitalist Company, says that until long-term healthcare reform is implemented, Obama’s $493 million in CHC grants "should be a wash."

Dr. Aguirre cautions that American Recovery and Reinvestment Act funding could have unintended consequences. For example, some clinics might raise compensation standards to retain or recruit hospitalists in order to deal with increased patient census. That increase could force local bidding wars for hospitalists at a time when supply is short.

“They will have a bit more money to attract those hospitalists,” Dr. Aguirre says.

In San Antonio, where Dr. Aguirre works, the effect could be even more pronounced, as one in four Texans are uninsured and more likely to take advantage of federally qualified health centers. In fact, 2007 federal data show roughly 40% of CHC patients were uninsured.

U.S. Health and Human Services officials say the stimulus money will provide care to nearly 3 million additional patients in the next two years, including roughly 1 million people without insurance. The added workload could cause burnout in hospitalists serving those institutions but who specialize in HM in part for the quality of life and scheduling perks that it affords.

"The ones that work with the CHCs would have more volume, but less chance of collecting on it, unless they have some arrangement to collect on that," Dr. Aguirre says. "There will be stress with increased volume."

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