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TRENDWATCH: The Specialization of Hospital Medicine

Many experts are not surprised by the rise of hospital-based specialists. Dr. Neilson points out that, in 2003, Louis Weinstein, MD, chair of the department of obstetrics and gynecology, Jefferson Medical College, Philadelphia, said that only about 10 hospitals had obstetric hospitalists, but that he expected this number to increase to several hundred in a few years.

“Weinstein proposed the idea of ‘laborists’ as a solution to the problems many hospitals had getting community obstetricians to handle patients besides their own,” recalls Dr. Neilson (see also, “What is a Laborist?” p. 6). “In fact, he felt it would evolve to a point where these laborists would handle the majority of hospital deliveries.”

RESEARCH SAYS …

Practitioners and administrators state anecdotally that hospital-based specialists make a positive difference in patient care, and research is just beginning to support these claims. For example, one study showed that pediatric hospitalists improve critical care outcomes. The authors concluded that patients treated by pediatric hospitalists were discharged nearly a full day sooner and were almost three times more likely to survive that stay after the pediatric intensive care unit switched after-hours coverage from residents to hospitalists.1

Clearly, more studies are needed regarding the effect of specialist hospitalists on outcomes, patient satisfaction, costs, and other aspects of hospital care. However, such research is likely to become more common as hospital-based specialists continue to gain popularity.

According to physicians who are hospital-based specialists, these studies will show that their services not only improve outcomes, but have a positive effect on practitioner lifestyle, hospital quality improvement efforts, and patient satisfaction.

“I think a few years ago this was a trend,” says Dr. Ottolini. “Now it’s not at all unusual to see specialists working as hospitalists.” TH

Writer Joanne Kaldy, who is based in Maryland, has covered healthcare issues for more than 10 years.

REFERENCE

  1. Ottolini M, Pollack M. Pediatric hospitalists improve critical care outcomes. Crit Care Med. 2003;31(3):986-987.

A Day in the Life …

What’s a typical workday like for specialist hospitalists? TAKE A LOOK:

While specialist hospitalists’ days are busy, challenging, and demanding, Dr. Ottolini notes that they see interesting cases, get to hone their expert skills in their specific practice area, and enjoy the camaraderie of a professional clinical team. They also have the luxury of set shifts and the knowledge that they can go home and really be off the clock. Here’s a sample of various specialists’ schedules.

Mary Ottolini, MD, MPH (pediatric hospitalist): “I start my morning by examining new admits and patients likely to go home that day. Then I round with my resident and student teams. I review films taken in the last 24 hours, and then I conduct patient examinations and talk to family members. My afternoons often involve giving talks to residents and students. Also, because I’m a division chief, I talk with my staff and handle paperwork and other administrative duties.”

Rokea el-Azhary, MD (dermatologic hospitalist): “First, I round on the inpatient unit, then I do the same on the outpatient unit. I also consult at two Mayo-affiliated hospitals.

Sometimes, I will follow up on patients who I see in the clinics—patients who were discharged and I need to know how they’re doing. Throughout the day, I answer emergency room questions about anything with skin involvement—from poison ivy and sunburn to pressure ulcers and dermatitis.”

Thomas O’Brien, MD (psychiatric hospitalist): “First of all, I have to establish a relationship with the patients, but I only have a short time to do this—not weeks or months like I did in outpatient practice. However, I make it clear to my patients that the quicker I get to know them and understand the problems, the better I’ll be able to help them. It’s amazing how they’ll open up and respond. I’m in charge of behavioral health services in three hospitals, and I spend a lot of time responding to urgent situations and questions. These units gauge success by how quickly they can move cases and issues off their desks. Generally, I provide acute stabilization so that people can leave the hospital and go back to their outpatient therapist and treatments.”

Duncan Neilson, MD (obstetric hospitalist): “Rounding starts the day here. I review all labor patients and serve as physician on record for them until their physician of choice comes on deck. I deliver some patients, particularly those on the high-risk service. I usually only deliver private patients if their physician is tied up elsewhere for some reason. Most often, the attendings will deliver their own patients. However, I will assist as needed, and I am available to address any problems or emergencies that arise. I also do labor triage and oversee all labor activities.”—JK

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