“I can intervene earlier,” he says. “And, as a result, patients don’t spin out of control.”
Dr. O’Brien likes the challenge of the complex cases he encounters. But he also likes the flexibility he enjoys. “It’s a good arrangement for me,” he says. “On the nights you’re off, you’re really off.”
As with other specialties, hospitals enjoy the arrangement as well. “Hospitals are much happier having physician employees that they can train and support more fully because they know them better,” observes Dr. O’Brien. “They also like the consistency of a physician who knows the staff and can respond quickly to problems, as well as patient and family questions. The doctor is part of the family, rather than an outsider,” which benefits both the facility and the practitioner.
KIDS TAKE CENTER STAGE
Mary Ottolini, MD, MPH, medical director, Hospitalist Services, at Children’s National Medical Center in Washington, D.C., was a pediatric hospitalist even before the job had a name.
“I was providing inpatient pediatric care, and I really loved it,” she says. “About that time, the hospitalist movement started, and I finally could attach a name to what I was doing.”
Everyone loves the arrangement, says Dr. Ottolini. Attending and referring physicians have the security of knowing that their patients are being cared for by specialists 24 hours a day.
“This removes a lot of stress and burden from them,” she notes. At the same time, parents “feel that there is someone taking ultimate responsibility for their child and looking after the whole child.”
Even when the prognosis is poor, “it is good to be there for families and help them through a difficult time,” continues Dr. Ottolini, who adds that it “is gratifying to work with an excellent team of experts to help a gravely ill child.”
HOSPITAL NEED FOR DERMATOLOGY: MORE THAN SKIN DEEP?
The need for a dermatologic hospitalist seems questionable. “Traditionally, dermatologists came to the hospital so infrequently,” recalls Dr. Wellikson. “There were few dermatologic emergencies.”
Even Rokea el-Azhary, MD, a dermatologic hospitalist at the Mayo Clinic in Rochester, Minn., admits, “There are so many medications to treat dermatologic conditions on an outpatient basis. This has influenced a downward trend in hospital dermatology over the years.”
Nonetheless, Dr. el-Azhary and her colleagues keep busy addressing severe medication-related and other rashes. They’re able to provide fast relief, which is important for patients with painful, uncomfortable conditions.
“If someone comes into the hospital with fever and a rash, aches, pain, neuralgia, and skin that shows vasculitis, we can make a diagnosis quickly and promptly begin treatment,” she explains.
PASSING FAD OR GROWING TREND?
Ask hospital-based specialists or their administrators if they think this trend is here to stay, and they are emphatic that it is.
“I think the hospitalist movement in general is reminiscent of the era when hospitals began hiring emergency room physicians,” suggests Dr. Marton. “These hadn’t existed previously; then overnight they were a common part of the hospital staff.”
Dr. Wellikson agrees. “Traditionally, hospitals have not been in the business of hiring physicians,” he says. “But now they are in the position of assembling a team with physicians as part of that.”
With the growth of hospital medicine overall, the variety of hospitalists will increase as well. The specialties will continue to transition into hospitalist programs and grow. They’re also expected to include such areas as orthopedic surgery. Specifically, Dr. Marton suggests that the next hot specialty for hospitalists can be predicted by identifying fields where there are high volumes of potential shortages. Still, he notes, some specialties, such as plastic surgery and neurosurgery, are unlikely to become hospital-based.