“The nature of our job is such that it’s fairly easy to coordinate that,” says Daniel J. Brotman, MD, FACP, director of the hospitalist program there. “It creates sort of auxiliary staffing.”
The hospitalist program at Johns Hopkins started in 2002. Part-timers tend to work nights and weekends and get a lot of flexibility; they sign up for shifts instead of working a guaranteed schedule. Continuity of care is rarely an issue because full-time staff provides that, Dr. Brotman says.
“We divide labor into somebody who’s doing admissions and someone who’s taking care of the patients day to day,” he says. “The person who’s doing admissions can be anybody who’s competent to do so and doesn’t need to be someone who’s available the next day to take care of the patients.”
So far, hand-offs have been smooth, Dr. Brotman says, partly because the transfer of information about Hopkins’ complex tertiary-care patients is thorough by necessity. While good communication is important for all hospitalists, it’s especially important for part-timers and job-sharers, Dr. Simone says. In addition to requiring thorough notes and communication, he suggests finding out ahead of time whether a part-timer will be available to answer questions during off hours.
“Are they flexible so they can come in a heartbeat if you need them?” Dr. Simone says. By the same token, referring physicians have to commit to doing a verbal hand-off to the hospitalists, and hospitalists have to commit to sending a report when the patients are handed back, Abbott says.
When HCC tried establishing a hospitalist program that covered only weekend shifts, Himmelstein says, tight turnarounds on Monday mornings and spotty cell phone service in rural areas made it too hard to coordinate hand-offs.
Other Issues
There are other factors to consider before bringing in full-time hospitalists or job-shares, such as billing.
“They’re working as a hospitalist for a week, and one of their private patients comes in to be admitted,” Nahm says. “Are they seeing that patient as a hospitalist or are they seeing that patient outside of the program, as their own patient?”
The same issue can come up with a pulmonary or infectious disease specialist, for example. If she consults on other patients during her shift, is she doing so as a hospitalist or in her private practice?
“I find it best if you just take the philosophy that you’re buying this physician’s time, and anything this physician does on the clock for you is considered a service of the hospitalist group—and all billing and collection and revenue, in other words, go back to the hospitalist group,” Nahm says.
Also, a part-time hospitalist may face competing demands for his or her time.
“Sometimes they come in and they’re lacking focus because they’re tired—they’ve been up all night moonlighting in the ED,” Dr. Simone says. “Or they pace themselves because they know tomorrow and for the next four days, they’re on call for their private practice.”
Despite the practical issues part-timers bring, Dr. Simone points out, they tend to increase a program’s flexibility and efficiency, allow the hospital to offer more value, lower burnout, and increase job satisfaction.
Dr. Gupte wants more programs to start hiring part-time hospitalists—especially to help families like hers, where both parents are busy physicians.
“I think that makes a big difference in family care,” she says. “People sometimes think that we won’t be as intense or as focused when you’re doing the part-time thing. I don’t think that’s true.” TH
Liz Tascio is a freelance journalist based in New York City.