The Hospitalist Model – Pros and Cons

123RF.com/Tyler Olson

The term “hospitalist” became mainstream in the 1990s, as a new model of caring for inpatients began to gain popularity in the US. A hospitalist is a physician whose entire patient population are inpatients assigned to a given area of a hospital. This is a great career option for internal medicine or family medicine residents who are looking to continue working exclusively within a hospital system and whose priority is the management of sick patients.

Pros:

• Handoff: One of the main reasons this model for care was developed in the first place is so the transition between teams managing a patient can go more smoothly and prioritize safety. Previously, patients would be admitted to a hospital, and their community-based PCP would be the physician caring for them. This would lead to miscommunication since this physician would be toggling between ambulatory responsibilities and care for inpatients. Having a team of doctors strictly concerned with the course of admitted patients helps to alleviate community physicians and enables a culture of safer handoffs between teams at shift-changes.

• Knowledge of the “system”: When patients are admitted to or discharged from a hospital, oftentimes a team of both doctors and allied health professionals becomes involved in their care. For example, any additional specialty consultations, social work, case management, rehab, and step-down or skilled nursing facility staff could be called upon. Hospitalists have the unique knowledge of how to best facilitate the use of all of these teams and provide a consistent center point around which the other teams can work.

• Availability: Unlike community physicians who have to balance outpatient appointments and inpatient care, hospitalists are exclusively working with patients in the hospital, in real time, throughout patients’ hospital stay. This allows for greater availability for patients and their families and is a great improvement in patient satisfaction. Hospitalists are usually available or present 24 hours a day. Typically, jobs that involve overnight shifts pay slightly higher than those which exclusively schedule during the day.

• Teamwork with residents, fellows: In academic centers, hospitalists are the preceptors for teams of learning doctors that care for inpatients. This is a great opportunity for those going into internal medicine fields who would like to incorporate education into their daily workflow.

• No “well patient” care: For the most part, people who are admitted to hospitals are unwell. Oftentimes they have dynamic or tenuous conditions that require daily reassessment and planning from their medical team. This is appealing to many, particularly newer physicians, because it allows for a large volume of more complex patients. A hospitalist typically won’t be dealing with “run of the mill” issues like colds, belly aches, rashes, and other issues for which patients visit ambulatory care. This is a great advantage for some.

• Billing/coding: Many ambulatory care physicians spend large amounts of time on the computer, billing and coding for patient visits. Maximizing revenue, especially for smaller practices, is a huge burden that falls most often on the doctors, in addition to the nuts and bolts of practicing as a physician. Hospitalists do not have to bother with this kind of work, since their procedures and time spent with patients are billed-for by the hospital billing departments and extracted from the EMR.

Cons:

• Inpatient vs outpatient experience: As mentioned earlier, the work of a hospitalist involves rounding on and crafting plans for patients who are admitted as inpatients to hospital. Oftentimes they can be quite ill, but there are also a good number of patients who are “long termers” or “repeat offenders.” The care for these patients can be tedious to some and drag out over a long period of time. There can also be the frustration of continually working with a patient who has chronic conditions with chronic exacerbations, who never really improves. The decision to take on a hospitalist role must also involve the acknowledgement that “well patient” visits will not be part of their repertoire.

• Continuity: Patients will come and go within a hospital system, but for the vast majority of patients, their hospital stay is a one-time occurrence. There is no outpatient follow-up or continuity of care for hospitalists. This can be frustrating for those who prefer to see a patient through with a particular condition, and to check-in with them periodically. Those who value continuity would probably be best suited for ambulatory medicine.

• Shiftwork: As mentioned, hospitalists are expected to be in the hospital 24 hours a day. That means some shifts will need to be assigned at night. Usually a contract involves 14-16 shifts / month, which can be divided into 12 or 24-hour shifts. Due to the nature of shift work within a hospital, the schedule may change on a monthly basis, which could be challenging for those with children or in households where both spouses are medical professionals.

As you can see, there is much to consider when weighing your options between in-hospital and community-based positions. The hospitalist model has proven to be advantageous for both patients and doctors, and many other specialties are beginning to adopt this approach to fit their departments’ needs. To view and learn more about the particularities of any specific hospitalist position, feel free to browse the jobs advertised on our site here.