The new specialist

The complexity of modern medicine has long required many physicians to specialize in a particular area, while others remain general practitioners, handling the routine cases and referring complicated ones to the appropriate specialist.

There’s now a new type of specialist who deals with hospital in-patient care.

A hospitalist is a physician who focuses his or her time on the care of people that are hospitalized,” says Michael Brouthers, president and CEO of Cogent Healthcare, a company that sets up hospitalist programs for hospitals. “A couple of decades ago, there was no such thing as an emergency room physician; it was handled by the physicians on staff.”

Now, physicians can be board certified in emergency room care and that’s all they do.

Most general practice physicians focus most of their time on outpatients. A doctor might see 20 to 30 people at his office as outpatients, and only one or two in a hospital setting in any given day.

“The concept here is, if physicians focus and practice primarily or only on those hospitalized, they can do a better job than the doctor who either does it on the side or as an afterthought to the outpatient practice,” says Brouthers.

The hospitalist does not replace the family physician, but is considered another specialist a patient could be handed off to, the same way a patient would be sent to a cardiologist. When the specialist is no longer needed — in the hospitalist’s case, when the patient is discharged — all information and treatment records are sent back to the family physician. In emergency cases in which the hospital stay isn’t planned by the family physician, the hospitalist would notify the family physician so he or she is aware one of their patients is in the hospital.

Hospitalist programs have not only provided patients with more doctor attention and care, they have also proven to be money savers.

The doctors have more expertise on inpatient care than most general practitioners because they are dealing with diseases every day, rather than just a handful of times each year. The care is more efficient, so the hospital stay is shorter.

With the same team of doctors working at the same hospital, standards are developed that waste less money.

The only controversy hospitalist programs have run into comes from managed care companies which have tried to make hospitalist care mandatory in some areas. The last thing a physician wants is to have any mandatory rules governing the care of his or her patient. Brouthers agrees with the physicians who say the final decision on whether a patient should be handed off should belong to the family doctor.

“It is important for everyone to recognize the single biggest component of health care cost is paying for hospitalized patients,” says Brouthers. “The model of delivering care for them could not be any more inefficient. The doctor goes in on his spare time and takes care of a handful of patients. The variability is enormous, and so is the waste. If a hospitalist program is done well, it can bring tremendous efficiency to costs and improve people’s satisfaction and outcomes. It’s an improvement of care while saving money.”

How to reach: Cogent Healthcare,

Todd Shryock ([email protected]) is SBN’s special reports editor.