Hospitalists: A plus for patient care
Dr. Anthony Smith, a hospitalist, examines patient Delois Hart of Greenville. Smith is one of four new physicians who work with referring physicians to care for hospitalized patients at PCMH. Photo by Cliff Hollis
(Nov. 1, 2001)
On a recent Monday, Dr. Anthony Smith was caring for 36 patients. That's about an average patient load on a typical day at the office. Smith's office, however, is Pitt County Memorial Hospital.
Smith is one of four hospitalists who began work at PCMH last month. In addition to Smith, they are Drs. Kevin Gaylord and Erik Summers, all graduates of the internal medicine residency program at University Health Systems of Eastern Carolina, and Dr. Sanvir Singh, who also spent time at the medical school studying gerontology. Also, D.J. Nelson, a family nurse practitioner and former PCMH emergency department nurse, works for the hospitalist program.
Gaylord, Smith and Summers are employed by the Brody School of Medicine at East Carolina University and have faculty appointments; Singh and Nelson are employed by Physicians East. PCMH contracts for the service. All the hospitalists are internists, and their patients have a wide range of illnesses, but all are adults.
The ECU Department of Pediatrics began its own hospitalist program a year or so ago.
Put simply, hospitalists are doctors who see patients in hospitals. The term first appeared in a 1996 article in the New England Journal of Medicine by Dr. Robert Wachter of the University of California-San Francisco. At PCMH, the hospitalist program arose from discussions that began a year or two ago among leaders of PCMH, Physicians East, and the Brody School of Medicine at ECU. The physicians needed help with inpatient coverage. The medical school needed extra physicians when patient volume became too great for residents to handle. PCMH needed to do more to free up beds for patients waiting to be admitted, said Dr. Clyde Brooks, medical director for quality at PCMH and leader of the hospitalist program.
After months of negotiations and planning, the program is a reality. It began Oct. 15, and as soon as the service opened for business it received 32 patients from local referring physicians.
Two hospitalists work each week, one from 7 a.m.-7 p.m. for seven days, and the other from 7 p.m. to 7 a.m. They then have the next seven days off while the other pair of hospitalists work. Nelson works roughly 8 a.m. to 5 p.m. Monday through Friday. "She provides the glue that ties the program together," Brooks said, adding that Nelson works closely with referring physicians' offices and often begins the patient work-ups for the hospitalists.
"It has its ups and downs," Smith said while working on 2-South. "There's always something going on." As he perused patient charts, he added, "It's a wonderful opportunity, being one of the first (hospitalists) here at UHS, breaking new ground."
Dr. Richard Pippen, an internist at the Physicians East Farmville office, is one of 23 local physicians who have subscribed to the hospitalist service. "The first few days are going very well," Pippen said. Not having to make so many trips to PCMH means he can extend his office hours and see more patients there, Pippen said. It makes recruiting new physicians easier, since they know the call schedule won't be so brutal. It also means he and his colleagues can be better doctors.
"When you're up all night (on call), you're not as effective the next day," Pippen said.
In addition to freeing time that physicians would normally spend making rounds, hospitalists have also been shown to improve patient care. The National Association of Inpatient Physicians in Philadelphia estimates that using hospitalists can reduce costs to hospitals and lengths of stay by 15 percent.
However, surrendering hospital visits means the average primary care doctor gives up about $25,000 in annual revenue, according to IPC-The Hospitalist Co., which provides hospitalist services to physician groups, hospitals and insurers. But the costs of traveling to hospitals can cost a physician about $75,000, including paying other doctors