Different physician roles in the hospital

[ajaykumaragarwalusa]

Hello All,

Can somebody please shed light on what is the difference between attending physician vs admitting physician vs hospitalist? What role does each one of them play in pt's care at the hospital?

[smf0903]

We have hospitalists so they are also the admitting physician. Our other docs, such as surgeons, we consider the attending.

Our hospitalists are who who decides who is admitted and who is inpatient or observation. They perform the physical and provide the H&P, put in the orders. We always have at least one hospitalist in the hospital 24/7. Attendings show up usually in the morning to check on patients and then are off to office visits or procedures.

The attending also also puts in orders, and their orders trump those of the hospitalists. Fun times ensue when one set of orders goes against another

[Double-Helix, BSN, RN]

Admitting physicians and hospitalists are both attending physicians. An attending physician is any doctor who has completed their training and been granted privileges to practice independently within the hospital. This distinguishes them from residents and fellows, who require supervision from the attending physician.

A hospitalist is a doctor who only cares for patients while they are in the hospital, and does not provide outpatient or primary care. Once the patient is discharged, the dr/pt relationship with the hospitalist ends. When the patient is discharged, they follow up with an outpatient clinic or their primary doctor.

The admitting physician, also know as the attending of record” is the physician under who's service the patient is admitted. This is typically the attending on service at the time that the patient is admitted to the hospital. This designation is primarily for billing purposes. Any physicians from the same group as the admitting physician who see the patient on subsequent days must bill under the same service.

Examples: A child is admitted to the general pediatrics floor for RSV. Dr. A. is the attending on service when the patient is admitted and completes the admission documentation. The child stays in the hospital for 2 days, and it also cared for by Dr. B, who works for the same group as Dr. A. The child is also evaluated by the pulmonologist, Dr. C. When the patient is discharged, he goes to his primary pediatrician for follow up. Dr. A is the admitting physician- he completed the admission evaluation. Dr. A and Dr. B are both hospitalists- they only see the patient during the hospitalization. Dr. C is also an attending physician of the pulmonology specialty- she practices independently as a physician in the hospital.

[ajaykumaragarwalusa]

Thanks for your input.

So let me make sure I understand this correct. I'll take a simple scenario. Patient walks to ED complaining of chest pain. ED physician who will take care of the patient is listed as Attending Physician, correct?

Now, if ED physician feels patient needs to be Admitted to Medsurg/ICU, he would coordinate that with pt's PCP or the Hospitalist on call? My understanding is,

Scenario A- If patient's PCP (Dr Gary Smith) has admitting privileges at the hospital, then he would be listed as Attending and Admitting in pt's profile/during registration? If yes, where does Hospitalist come into picture and how is he listed on pt's profile? Can you have multiple attendings listed?

Scenario B- If PCP doesn't have admitting privileges at the Hospital, then Hospitalist on call(Dr Jones) would be listed as admitting and attending, correct?

If patient stayed in the hospital for 5 days (Monday to Friday), then in Scenario A, Dr Gary Smith (pcp) is listed as attending and admitting, and that doesn't change during the course of pt's stay, correct? Under what circumstance would hospitalist take care of that patient? And how would Hospitalist be listed under pt's profile? If there are multiple Hospitalists that belongs to same group as Dr Jones, and Dr Jones covered on Mon and Tue, Dr Barry from Wed to Friday, how in pt's profile their name appears? If patient were to be consulted to a cardiologist (Dr Cardio) then Dr Cardio would be listed under "consulting physician, correct?

In Scenario B, if on Monday Dr Jones is listed as admitting and attending, from Wed to Fri would Dr Barry would be listed as attending?