“Also, they’re extremely helpful when the practice is in an expansion mode,” Dr. Simone says. “If they want to bring in two or three more referring providers’ practices, you can utilize the part-timers to help with the extra work so you don’t overwork your staff.”
Though it’s less common these days, a new hospitalist program may meet with resistance from local doctors. Offering those doctors part-time shifts can help ease the transition.
“They’re worried about what’s going to happen to their inpatient skills, what their patients may think, and their income,” says Steven Nahm, vice president of the Camden Group, a hospitalist consultancy and management company with offices in Chicago and El Segundo, Calif. As part-timers, these doctors keep current with inpatient care and can gauge the impact of the program on their practices.
A respected local physician who comes in part-time also lends credibility and gives medical staff a greater sense of confidence in the program, Nahm says. Dr. Simone calls these part-timers ambassadors.
One Example
The hospitalist program at Hudson Valley Hospital Center in Cortlandt Manor, N.Y., began in July 2005 at the request of local doctors. The program, Hospital Medicine Associates, contracts with the hospital and has its own billing system. It has eight full-time hospitalists, and as of about six months ago, four hospitalists sharing two full-time positions. They even share malpractice insurance because New York state law allows for half-policies. The part-timers work under pro-rated policies because they work fewer hours.
Allowing doctors to job-share seemed like common sense, says Richard Becker, MD, who leads the program.
“If you have good physicians, you want to keep them,” he says. “Having two doctors share shifts gives you flexibility. If one is sick or ill or on vacation, the other can come in and take care of it. You never have to worry about that position.”
While most programs have a few part-time physicians, it’s rare to see a program fully staffed by part-timers or job-sharers, Nahm says.
“Generally, they’re transition steps toward a program staffed by full-time hospitalists,” he says.
It can take more than a year to staff a program, especially for medical centers that aren’t in a city with a medical school. Now that more hospitals want to start hospitalist programs—and quickly—it helps to bring in part-timers to support an incomplete team, says Betty Abbott, chief operating officer of Eagle Hospital Physicians in Atlanta, Ga., a hospitalist consultancy that serves the southeast and Atlantic states.
“It used to be you had three to nine months to start a program, and now many people are saying, ‘We’d like to have it next Monday,’ ” Abbott says.
Some smaller or rural hospitals run part-time-only hospitalist programs because it’s the only option that makes economic sense, or because they have trouble recruiting full-time hospitalists. In these cases, part-timers can give a much-needed boost to admissions.
“The doctors typically in the community don’t want to work on weekends,” says Alan Himmelstein, FACMPE, president of Hospital Care Consultants Inc. (HCC) in San Antonio, Texas. “So if they see a patient in their office on a Thursday that has pneumonia, they will opt to either transfer to a bigger city, or treat the patient in an outpatient setting, which is not optimal. With the hospitalist there, the hospital can take that patient.”
Competition, Commitment
Two of the major concerns about part-time and job-sharing hospitalists are that they won’t be as committed to the program as other hospitalists, or that they’ll attract patients to their own private practice—away from referring physicians.