Another challenge concerns the effect of a hospitalist program on primary care physicians who practice outside the hospital setting, such as family physicians. “Will they lift those doctors from the community to work in the hospital, or will they employ full-time hospitalists?” asks Dr. Jamieson. “A new program is easiest to administer when you have full-time people on rotation, but it robs the community of some primary care physicians. In Calgary, we have a mix, so as not to deplete the community of those doctors.”
More concrete challenges concern funding streams and convincing hospital and, in a single-payer system, governmental authorities that hospitalists are worth the investment. “Demonstrating value is the first step,” says Dr. Jamieson, who helped develop the hospitalist program in Calgary.
The timely sharing of records is also critical, so electronic medical records or sophisticated faxing systems should be in place as well. “The hospital should send the patient’s records to the office doctor by the end of the day on which that patient is discharged,” explains Dr. Nelson. “If it takes two weeks for the community doctor to get the records, that’s going to be a problem.”
In general, he advises Australian hospitalists to listen well but make their needs and interests clear. “I would tell them to be frank about what they are looking for and how they want their practices to go. I encourage them to develop an ongoing dialogue with North American hospitalists: we can learn from each other.” TH
Norra MacReady is a regular contributor to The Hospitalist.
References
- Hillman K. The changing role of acute-care hospitals. Med J Aust. 1999 Apr 5;170(7):325-328.
- Murray RB, Wronski I. When the tide goes out: health workforce in rural, remote and indigenous communities. Med J Aust. 2006 Jul 3;185(1):37-38.
- Hore CT, Lancashire W, Roberts JB, et al. Integrated critical care: an approach to specialist cover for critical care in the rural setting. Med J Aust. 2003 Nov 3;179(9):95-97.
- Egan JM, Webber MG, King MR, et al. The hospitalist: a third alternative. Med J Aust. 2000 Apr 3;172(7):335-338.
- Hatzistergos J. Health care work force innovations. Address before the Parliament of New South Wales, published in NSW Legislative Council Hansard, August 31, 2006, page 1221. Available at: www.parliament.nsw.gov.au/prod/PARLMENT/hansArt.nsf/V3Key/LC20060831012. Last accessed October 10, 2006.