Hospitalists fill in for general practitioners

By Monetta M. Harr – Jackson Citizen Patriot

Change is just about the only constant in medicine, but some patients are surprised when an unfamiliar doctor stops by their room at Foote Hospital.

Increasingly, it is not their general practitioner. Instead, it is a physician known as a hospitalist.

“Our biggest challenge is explaining to patients what we do,” said Dr. Noel Lucas, director of Foote’s hospitalist program.

Hospitalists are physicians who work regular shifts caring only for patients who are hospitalized. Their role can take the place of a patient’s general practitioner during a hospital stay, or supplement it.

Foote, part of Allegiance Health, joined this rapidly growing national trend three years ago.

Some call it a win-win situation. A win for patients because a physician is always available to handle everything from an emergency to talking to the patient’s family. A win for general practitioners who have more freedom outside regular work hours because they don’t have to make rounds or be on-call.

On the other hand, some patients are startled, or even distraught, if their primary-care physician isn’t the one visiting them in the hospital, explaining test results and making plans for more treatment or discharge for home.

“Initially it seemed strange not to have my family doctor visiting, but I realized the hospitalists are familiar with my case and my family doctor is probably double-booked at the office,” Foote patient Alexis Keppeler said Tuesday afternoon.

Keppeler said he was introduced to hospitalists in March, during a different stay. Tuesday, he discussed with Lucas a CT scan performed on his head the previous night. The CT scan was fine and, together, Keppeler and Lucas decided the knee — which was sore from the fall — didn’t need further examination.

New medicine

Foote, which started its hospitalist practice with three doctors, today employs 11 physicians and two nurse practitioners who see between 50 and 70 patients a day. Ninety percent of these patients are admitted through the emergency room, Lucas said.

The term “hospitalist” was coined in 1996 in an article in the New England Journal of Medicine. It is such a new form of medicine that the National Association of Inpatient Physicians was only created in 1998; its name was changed in 2003 to Society of Hospital Medicine.

“We checked into this idea for a year or two,” said Jerry Grannan, executive director of physician integration at Foote.

It is going so well, he said, that Foote expects to start a pediatric hospitalist practice this year.

Grannan said hospitalists save on average a half-day of a patient’s stay, which trims expenses such as nursing care for a patient awaiting discharge. Hospitals, which are paid a flat fee for a diagnosis and generally don’t profit from a patient staying longer, want patients to check out as soon as is medically prudent.

He said Foote pays hospitalists a competitive salary, but declined to offer specifics. The Society of Hospital Medicine said the median total compensation package for a hospitalist is $168,000.

Dr. Scott Flanders, director of the hospitalist program at University of Michigan Hospital since 2003 and president-elect of the Society of Hospital Medicine, said nearly 20,000 U.S. hospitals use hospitalists.

A huge benefit, he said, is a time savings for doctors and patients. Traditionally, general practitioners have driven back and forth from their office to the hospital, sometimes leaving a backlog of office patients.

UM Hospital and Mott Children’s Hospital have 40 hospitalists who work full- or part-time.

“We need to create schedules and jobs that allow for balance and for a life outside the hospital,” Flanders said.

There is a “big shortage” in primary-care physicians because of the hours those practices demand, he said.

However, none of Foote’s hospitalists lives in Jackson County, said Lucas, which means they spend some time commuting.

“As a general rule, we like our physicians to live in the community, but we understand the real-estate market is hampering that,” Grannan said. “A hospitalist is shift-oriented, so they don’t have to respond to emergencies or carry a beeper.”

Foote hospitalists work 15 shifts per month. Shifts last 12 hours. One doctor works overnight, and three or four work each day. Lucas, the director, modeled it after a similar program at Covenant HealthCare, a 700-bed hospital in Saginaw.

Great opportunity

Lucas, 37, and his wife have two young children. He spent many hours working as a traditional internist in an office with adult patients, first in the St. John Health System in Detroit, then in Saginaw. When Covenant started a hospitalist program, he jumped at the opportunity.

“I like working in the hospital setting. I’m an adrenaline junkie,” said Lucas, who is looking to move to Jackson from Saginaw.

Tuesday at Foote, Hermaok Howard ate her lunch while her daughter and granddaughter kept her company.

Howard’s daughter, Dixie Foster of Jackson, said she encountered the hospitalist practice two years ago when her husband was at Foote. Her mother was being treated by Lucas and would be discharged later that afternoon.

“It is nice to have a doctor you can talk to,” she said about the convenience of them working right in the hospital.

According to Grannan, 37 of Jackson County’s 69 family-practice doctors and internists participate in the hospitalist program. Money is not an issue — the hospital doesn’t charge doctors for the service — but some doctors struggle with the decision.

Dr. Jon Lake, Foote’s chief of staff who works at Allegiance Family Medicine-Townsend, 400 Hinckley Blvd., said he is among a few of the nine physicians in the practice who are not using hospitalists.

“I like doing rounds, the interaction with patients and with my peers. It’s a way to connect and learn,” said Lake, a family practitioner.

He said that when he has questions on a case, he often consults with a specialist while on rounds.

“They tell me what is new in their field that I can apply to my patient, and I’ve learned something as well as helped my patient.”

For Lake, it is about not wanting to “give up my patient.”

“There is a funny irony when I get a call in the middle of the night to call on a patient in the hospital. I drive in, fix or stabilize the patient and I feel good driving home,” he said.

On the other hand, Dr. Mike Burgess with Centreok for Family Medicine, 1401 W. North St., has used the hospitalist practice since it started. Before that, he used a local internal medicine/pulmonary group in the hospitalist function.

“It’s time management. There are only so many hours in a day,” said Burgess, who is in practice with Dr. Brian Adamczyk.

“We were a little nervous at first, but early on and happily, the hospital physicians provided high quality care and reduced the length of stay of patients,” Burgess said.

Burgess said hospitalists “do a better job than primary-care physicians because they are trained to order only appropriate tests and consultations. A primary-care physician may (order) various consultations that may not be medically necessary.”

This increases the patient’s bill.

Burgess said he still makes rounds, but he calls them ”social rounds” and doesn’t bill patients. He views this as an opportunity to chat with patients when he is at the hospital.

Daily routine

Foote’s hospitalists meet daily at 7 a.m. in their office in the Anderson Building. The day physicians talk to the overnight physicians about cases. A computer printout of patients who need to be seen is distributed and divided equally among the day shift. At 8 a.m. they meet with case managers for more patient review, then at 8:30 a.m. start their rounds.

Having his staff making rounds, instead of a primary-care physician, is invaluable, Lucas said, because patients may have “multiple medical issues. They just don’t have a broken hip, they have diabetes, hypertension (high blood pressure), and we can consider all that.”

They can access that patient’s medical records because all tests and charts from the last decade and more are recorded on Foote’s computer system. This prevents ordering duplicate — and expensive — tests.

Before a patient is discharged, Lucas said his team makes a follow-up appointment with the patient’s primary care physician. If the patient doesn’t have a regular physician, they make an appointment with the Center for Family Health, a free clinic.

“I love what I’m doing,” Lucas said. “We expected it to take longer than it has to add this many physicians, but it’s all about patient satisfaction.”

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