Hospitalist programs take many shapes, and the organizational flowchart typically depends on the number and makeup of the physicians, the hospital, the patients, and the community. Adequately covering the needs of inpatient units can be especially frustrating in rural communities, some hospitalists say.
“There are only five physicians total in our town,” says Gary Ensz, MD, a partner in the Auburn Family Health Center in Auburn, Neb. “In addition to being family practitioners, we are our own hospitalists. Covering the emergency room, seeing patients in clinic, and following hospitalized patients is a big burden.”
To address these issues, Dr. Ensz and his partners developed the Physician Extender Emergency Room Hospitalist (PEERist) program. They utilize physician assistants (PAs) to serve many hospitalist functions under their supervision.
“We hired PAs to work in the hospital and the emergency room,” Dr. Ensz explains. “They do not work in the clinic and then take call. Their only responsibilities are to the hospital and ER.”
The demands of ER call force people to retire. Now we have someone at the hospital highly trained and, as they get more experience, actually do some work better simply because they are there all the time.
—Gary Ensz, MD, partner, Auburn (Neb.) Family Health Center
PEERists work under protocols addressing treatment concerns and give guidance on when physicians should be called. On-call doctors round in the morning with the PA. The physicians like this approach, Dr. Ensz says, because they see the PEERist when it is convenient for them; before, they would leave clinic patients to attend to concerns at the hospital.
Impact of ER Call
“For most of us practicing in rural situations, the demands of ER call force people to retire,” Dr. Ensz says. “Now we have someone at the hospital highly trained and, as they get more experience, actually do some work better simply because they are there all the time. At worst, you now have two sets of hands working on the patient.”
PAs work a rotating schedule of up to 72 hours with as many as nine days off in a row. PAs can be recruited from a much larger area; in fact, one commutes four hours each way. PEERists say the time off makes it easier to do things with their families or work another job.
In addition to pluses associated with the practice, Dr. Ensz is seeing other benefits, such as closer working relationships with the nurses. He also stresses that his hospital now has 24/7 in-house coverage, something almost unheard of in small rural hospitals.
One of the more subtle improvements might have been in getting people to the hospital quicker. “It wasn’t unusual for someone to come to clinic with symptoms they had for a while,” Dr. Ensz says. “The PEERists being in-house all the time have done away with these concerns.”