Although most hospitalists have internal medicine as their medical specialty, a new breed of practitioners is gaining popularity. Hospitalists from obstetrics, pediatrics, psychiatry, dermatology, orthopedic surgery, and other fields bring the knowledge and experience of their specialties to hospital-based positions. In doing so, they gain many benefits they didn’t have as private practitioners. It’s a win-win situation that has the trend toward hospital-based specialists growing and receiving praise from physicians, administrators, and patients alike.
According to SHM CEO Larry Wellikson, MD, the demand for specialist hospitalists “is driven by hospitals’ needs to have these specialists available to them on a regular basis.”
HOSPITAL-BASED CARE DELIVERS FOR OBSTETRICIANS
Addressing a problem in their communities is one reason specialists join hospital teams. “The introduction of a new hospital in our small community, which previously only had one, created a challenge for small OB/GYN groups who didn’t have enough personnel to cover calls at two facilities,” says obstetric hospitalist Duncan Neilson, MD, chief of women’s services for Legacy Health System in Portland, Ore.
The ultimate question, Dr. Neilson says, was how to provide adequate OB/GYN and high-risk services and back up the community without having to hire “a lot” of physicians. “We solved both problems with hospitalists,” he explains.
Keith Marton, MD, FACP, chief medical officer/senior vice president at Legacy, adds that a key driver for the move to obstetric hospitalists was the desire to mitigate the facility’s liability risk.
“We saw hospitalists as providing continuity, more predictable physician presence to work with nurses to improve delivery outcomes,” he explains. Another important driver, Dr. Marton emphasizes, was his facility’s neonatal intensive care unit and the need for the perinatal specialists there to work with obstetricians they know and trust.
“We have seen from other communities that you don’t go out and ask community obstetricians to fill this role,” he says, adding that hospitalists are a better option. “This would improve care, increase our volume and revenues, and decrease costs.”
Being a hospital-based obstetrician has both business and lifestyle advantages. “In a typical OB/GYN practice, physicians often have to be in two places at once,” says Dr. Neilson. “When you’re with a laboring patient, you can’t be with patients in your office. You feel torn.”
There is no such split in hospital-based practice. “You’re free to concentrate on the care of laboring patients,” he says.
This is appealing for practitioners who especially like handling labor and deliveries because that’s the focus of their work. At the same time overhead and malpractice insurance are managed by the hospital, enabling specialty hospitalists to provide the best possible care with the least amount of hassle.
As for lifestyle, “you come to the hospital in the morning, you work your shift, you go home, and you are done,” explains Dr. Neilson.
Patients also benefit from having obstetric hospitalists involved in their care. “Patient safety is improved. A physician is onsite 24 hours a day to address problems,” says Dr. Neilson, who notes that this situation enables patients to stay with their own practitioner while having access to the hospital-based labor expert.
Are there disadvantages to being or hiring a hospital-based obstetrician? “It’s kind of hard to think of any,” admits Dr. Neilson. He suggests that physicians who like the variety of handling obstetrics and gynecology “might not like being a hospital-based specialist.”
PSYCHIATRIC HOSPITALISTS ANALYZE NEW OPPORTUNITIES
Obstetricians aren’t the only specialists enjoying lives as hospitalists. A growing number of psychiatrists are finding new and exciting opportunities as hospital-based practitioners. (See “The Doctor Is In,” p. 30.) For example, Thomas O’Brien, MD, a psychiatric hospitalist at Swedish Medical Center in Seattle, was drawn to hospital-based practice by his love of this setting and for treating acutely ill patients.