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International Concern: Hospitalists around the globe face similar issues, seek answers in U.S.


They hailed from such places as Germany, Bermuda, and Brazil, yet they were searching for the same answers as their American counterparts. How do I improve our better discharge process? How can we work better with administrators or primary-care physicians (PCPs)? How can we recruit better clinicians or see more patients in a day?

Nearly 20 international hospitalists gathered to discuss ideas, exchange business cards, and report on the growth of the hospitalist model in their countries at a Special Interest Forum at HM12 in April in San Diego.

“I’m here to get together with hospitalists, colleagues in the same field. We have a new program, and I thought I could learn from meeting people already in the field,” said David McGowan, MD, a hospitalist at the only HM group in Bermuda.

Dr. McGowan, attending his first SHM annual meeting, focused his attention on practice management, leadership and quality-initiative (QI) topics. His four-doctor HM group is relatively new, and he planned to “take some stuff back to my group.”

HM in USA proved we can reduce the costs, and proved we influence the length of stay. That’s interesting to medical directors.

—Rafaela Komorowski Dal Molin, hospitalist, Hospital Mae de Deus, Porto Alegre, Brazil, scientific director, Brazilian Society of Hospital Medicine

Bermuda has one hospital, in the capital city of Hamilton, for the entire island of nearly 65,000 residents. Administration has been very supportive of the HM model, according to Dr. McGowan, although the group has faced challenges in the community.

“The system is new and people are used to their primary-care physicians being in the hospital,” he said. “We have been working on that through public relations, providing good care, and ramping up our communication with the primary-care physicians in the community.

“We set the standard for the island, and I think we are making progress. The quality of care is better. … I think the potential is there for things to be better, and outcomes are going to [get] better.”

Euro Development

Not so new to the HM model of care was Stefan Reinecke, MBA, chief of the division of general internal medicine at St. Mary’s Hospital in Stuttgart, Germany. HM12 marked the third time he’d traveled to the U.S. for an HM-focused meeting, and, as before, his areas of focus were on practice management and quality.

“I think there is a need for well-trained physicians in internal medicine, with a high knowledge of quality, methods of quality measurement, and outcome measurement,” said Dr. Reinecke, whose division has 35 inpatient physicians and 20 residents.

As in the U.S., a hospitalist model requires upfront costs to the German healthcare system, and Dr. Reinecke said he and other group leaders are feeling “strong financial pressures” from administration. He said he hoped to build new quality- and systems-improvement structures into his division, and “to do it daily,” he said.

South America

One way to validate a hospitalist service is to demonstrate improvements in quality and cost of care. That’s exactly what Rafaela Komorowski Dal Molin’s group at Hospital Mae de Deus in Porto Alegre, Brazil, has done─and her chief medical officer noticed.

“Our HM service reduced length of stay,” she said, noting hospitals and payors in her country are “thinking more and more about costs of care.”

She also said administrators are learning why the HM model of care is important. “HM in USA proved we can reduce the costs, and proved we influence the length of stay,” she said. “That’s interesting to medical directors.”

Dr. Dal Molin’s six-hospitalist group began in 2009 and includes an intensivist and pulmonologist. Starting this summer, the group will begin training four residents in an HM-focused program.

Dr. Dal Molin admitted Brazil’s healthcare system is just learning about the HM model, and groups face myriad clinical, financial, and professional issues. “HM in Brazil is not recognized as a specialty yet,” she said. “We’re working on it. I’m thinking maybe in the next two years it will be recognized.”

As scientific director of the Brazilian Society of Hospital Medicine, Dr. Dal Molin was one of a small contingency of hospitalists from the Southern Hemisphere at HM12. The group is planning its second Brazilian Congress of HM Nov. 15-16 in Sao Paulo.

Richard Quinn is a freelance writer based in New Jersey.

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