Meanwhile, HM has made his office-based practice more flexible and more accessible. “In my medical group, a number of my partners actually start seeing patients [in the office] as early as seven in the morning,” Dr. Stream says. “They can commit to being there for patients at that early hour.”
He points out that handoffs to and from primary-care doctors and hospitalists has improved, but it’s still a work in progress. “I think it’s gotten better over time,” he says. “I think there’s recognition—on both sides of those handoffs—that things could be improved. I think the commitment is there both for the ambulatory physicians, the primary-care doctor, the family doctor, and the hospitalist taking care of them.”
Although hospitalists generally are better compensation than family doctors, Dr. Stream says he isn’t aware of “any friction” from family physicians. “Our academy, our members, family physicians, believe that the work that [we] do is undervalued in our current healthcare system. But that doesn’t mean that we have to compare ourselves to hospitalists,” he says.
Even as fragmentation of medical care has increased, the emergence of the hospitalist has helped to streamline care, says Joanne Disch, PhD, RN, president-elect of the American Academy of Nursing and clinical professor at the University of Minnesota School of Nursing in Minneapolis.
“There has become such increasing fragmentation of who is the team around the patient,” she says. But, she notes, “the hospitalist really provided a mechanism to promote continuity of care.”
Nurses, she says, have found hospitalists to be “somebody who can cover your back.” “When the system works right, the nurses do not have to seek out a physician and hope that they can either grab somebody or somebody makes rounds,” Disch says, noting a general frustration amongst her peers as to a lack of clarity in regard to who’s in charge. “What hospitalists inherently do, structurally, is provide a main physician who will be the accountable one in the hospital setting. You have a named person that the nurse knows, ‘Ah, this is who I need to go to.’ ”
Although most nurses welcomed hospitalists from the very beginning, she continues, the addition of MDs into the hospital setting did cause confusion, most notably over the roles of PCPs, referring physicians, and hospitalists.
“It wasn’t clear the extent of this individual’s responsibility and how to use them effectively, but over time my sense is that people … really find this helpful,” she says.
An area that might have room for improvement is hospitalist-nurse communication, with more “huddling” and discussions at shift change. Better communication with patients’ families also could be improved, she says. “[It] gets a little confusing sometimes,” she says. “Either everybody, or nobody, is talking with the patient and the family.”
The reaction of Craig Becker, a member of the American Hospital Association board and president of the Tennessee Hospital Association, was, at first, fairly dismissive. An idea being discussed in the industry—inpatient physicians working full-time in hospitals—would not be worth it, he thought. He couldn’t get past the notion that such an arrangement would be “a waste of money,” and that if someone tried it, it would just be in the clinical-care units.
Once a couple of hospitals started hospitalist services, he was more inclined to listen. “I was getting feedback from them, and they were saying: ‘Boy, this has made a big difference, both in patient care and financially,’ ” Becker explains. Once he noticed HM programs popping up in small, rural hospitals, Becker knew “this was a movement whose time had come.”