Patients on a hospitalist service may not see things the same way. My neighbor understood he was hospitalized for the purpose of open-heart surgery done by the MD. He looked at the perioperative care outside of the operation as a secondary issue.
Most medical admissions managed by hospitalists don’t have such clear marquee events in patients’ eyes. So it may be less natural for patients to feel OK about how the hospitalist and NPP divide up care responsibilities. Look at it this way: As hospitalists, we have limited face time with patients, and must make good use of it to establish trust and rapport. When we add an NPP to the care team, we ask patients to develop trust and rapport with two providers instead of just one.
Imagine a patient recently discharged from a hospitalist practice. Her friend asks how it went and which doctor she saw. The patient responds, “I couldn’t figure out who was really in charge of my care. Dr. Nelson’s name was on my armband, but I rarely saw him. Instead, I saw his assistant (the NPP) most of the time.” I suspect that patient will be much less likely to report high levels of satisfaction with her care than one who just saw a hospitalist.
Though I’m concerned that it might be more difficult to keep patients happy when NPPs are part of a hospitalist practice, most practices report this hasn’t been a problem. I’m not suggesting that concern about patient satisfaction means you shouldn’t use NPPs in your hospitalist practices. However, patient satisfaction is an issue to consider when organizing your practice—and an NPP’s role in it—to provide the greatest benefit to your patients. TH
Dr. Nelson has been a practicing hospitalist since 1988 and is co-founder and past president of SHM. He is a principal in Nelson/Flores Associates, a national hospitalist practice management consulting firm. He is also part of the faculty for SHM’s “Best Practices in Managing a Hospital Medicine Program” course. This column represents his views and is not intended to reflect an official position of SHM.