Since last July, ob-gyn hospitalists have delivered hundreds of babies at Bellevue Woman's Center in Schenectady County, N.Y. One of these doctors is always on duty—day and night.
"We're basically there to coordinate a team approach to the care that enhances patient safety and patients' peace of mind," says Nicholas Kulbida, M.D., chief of obstetrics and gynecology at Ellis Medicine, the health system that owns the hospital.
Ob-gyn isn't alone. Anecdotal evidence suggests that the hospitalist movement is sweeping through clinical specialities—from general surgery to neurology. The trend is being driven by multiple factors, not the least of which is ensuring coverage at a time when it is increasingly difficult to get physicians to be on call.
"The center of gravity for [private] practice has, to some degree, been moving away from the hospital" and toward outpatient settings, says John Nelson, M.D., a hospitalist consultant in Bellevue, Wash., who co-founded the Society of Hospital Medicine in 1997.
"In general, today's hospitalized patients are sicker than those seen in years past, older, and, consequently, more fragile," says Andrew N. Wilner, M.D., recently a neurohospitalist in New London, Conn., and now a medical volunteer in the Philippines. When treatment decisions must be made quickly for patients with acute stroke, continuous seizures or meningitis, "the presence of a neurologist can significantly enhance quality of care," he says.
But executives must tread carefully so as not to disrupt the already delicate balance between hospitals and physicians, especially specialists.
"While there was initial resistance to the program's introduction, with time this dissipated, and over the years actually evolved into the opposite," says John Maa, M.D., a gastrointestinal surgeon overseeing the five-year-old surgical hospitalists program at the University of California–San Francisco Medical Center. Most general surgeons were relieved to abandon call schedules and pleased to focus on elective patient care, research and education. Still, "the possibility for concerns of tension with other providers and turf battles are real and must be addressed," he cautions.
Adam Singer, M.D., CEO and chief medical officer of IPC: The Hospitalist Company Inc., says the staffing firm tries to avoid those conflicts and instead focuses on areas with physician shortages.
The initial transition to a hospitalist model is often the most trying time, particularly in obstetrics because women prefer that their personal physicians perform deliveries. "There are patient satisfaction challenges," says Patrice M. Weiss, M.D., ob-gyn chair at Carilion Clinic in Roanoke, Va., and head of the patient safety and quality improvement committee at the
American Congress of Obstetricians and Gynecologists.
Last summer, the committee issued an opinion supporting the hospitalist trend. "It has to be appropriately introduced to patients of the practice and patients of the community," Weiss cautions, "so they know what to expect when they go to labor and delivery."