He built the hospitalist patient base by admitting all patients of the two largest medical groups. His entrepreneurial spirit intrigued both IPC and the hospital’s chief financial officer by reducing the average length of stay from 5.3 to 4.0 days, which improved the bottom line. Dr. Frank’s salary then increased by 30%. He says he loves doing acute care again and sees many of his former patients because the medical group has transferred hospital work to the hospitalists.
I was worried about being at the hospital all the time. I’m 45 years old, but energetic because there’s lots of work. I can keep up with three of the hospitalists just out of residency. Seeing my old patients also connects me to my old practice.
—Jeffrey Frank, MD
“I was worried about being at the hospital all the time,” says Dr. Frank. “I’m 45 years old, but energetic because there’s lots of work. I can keep up with three of the hospitalists just out of residency. Seeing my old patients also connects me to my old practice.”
Across the country in Hollywood, Fla., Scott Oxenhandler, MD, a geriatrician, couldn’t be happier with his mid-career change from office-based doctor to hospitalist. He left a thriving practice of eight physicians he helped start in 1987 to be chief hospitalist at Hollywood Memorial Regional Hospital (Fla.). Seeing five to eight hospitalized patients every day as their primary physician, he knew the hospital’s inner workings and how to start a hospitalist program—largely for unassigned patients.
“I wanted a free hand practicing acute care medicine, good compensation and benefits, lack of paperwork hassles, and a great schedule,” says Dr. Oxenhandler.
When he started in July 2004 Dr. Oxenhandler had no problem structuring a hospital medicine service that attracted physicians with competitive salaries and schedules to accommodate individual needs. He now has 21 full- and part-time hospitalists. They mostly work 8 a.m. to 5 p.m. with an average daily census of 12 to 15 and several consults. A nocturnist admits patients from 8 p.m. to 8 a.m., and 10 doctors handle 5 p.m. to 8 p.m. short call four times per month.
Overall, the transition for the 48-year-old veteran was surprisingly easy. “I was in the hospital all the time anyway, and the way internal medicine is evolving there have to be connections between inpatient and outpatient doctors,” says Dr. Oxenhandler. As the hospitalist leader he mentors young doctors, knows how to distribute the workload, and loves to share clinical insights.
Other Paths
For a doctor who finished residency at nearly 40, “mid-career change” takes on new meaning. Ron Jacobs, MD, internist, chief medical officer, and co-founder of PrimeDoc Management Services of Asheville, N.C., was a businessman in his 20s, then studied medicine and started an office practice in 1997. That practice—with four internists, a pulmonologist, and a cardiologist—was thriving. But Dr. Jacobs was bored. He missed the hospital’s intensity, was used to visiting six or eight hospitalized patients daily, and decided that seeing 16 or 18 patients without the office practice would suit him. So he co-founded PrimeDoc, which now has 100 hospitalists practicing in 15 programs throughout the Southeast and Mid-Atlantic.