Difference Between Hospitalist And Attending Physician

Specialties Med-Surg Nursing Q/A

Specializes in Med/Surg, Tele, PCU.

In my 2 short years as a nurse I've been so bogged down trying to learn the ropes, that I haven't had the opportunity to pin someone down and ask what the difference is between the hospitalist and the attending physician. There are so many times that I am going to call the attending to get orders or give results or just about anything related to a patient's care. Then either a charge nurse or another nurse will tell me, no call the hospitalist such and such person is the hospitalist today.

Can someone out there clarify this? Thanks a gazillion!:yeah:

9 Answers

Specializes in Med/Surg.

In my teaching hospital the hospitalist is the attending physician-sometimes they will have interns but generally take their own call. Hospitalists are internal med doctors. For other patients with different diagnoses they will be under an attending for pulmonary, ortho, etc. THat attending doc will have interns and residents and you go through the chain of command for questions.

Attending MD: Patient's primary doctor, or if self pay the covering service doctor in ER that day - may not be present in hospital at all times.

Hospitalist - In house doctor - must always be present in the hospital, during the night shift for example if patient codes or rapid response activated Hospitalist will respond they will also answer basic meds questions by nurses

The idea behind the hospitalist is that they can coordinate a person's inpatient needs better than an attending MD. Yes, the primary care doc knows the patient's history, but many people have more than one doc, and covering all their needs can become complicated.

For example, if someone goes in for a gall bladder surgery, they may need their cardiac and diabetes meds while they're inpatient along with any other home meds they take. Their primary doc will not be the one admitting them. The surgeon will. So who orders all the stuff not related to the surgery? The hospitalist. Who will come to see the patient for anything not pertaining to the GI situation? The hospitalist.

The hospitalist team is generally available 24/7. They can call any of the patient's docs if a consult is needed. And they'll get through more easily and have their calls returned quicker than the patient would.

Many specialists tend to have tunnel vision for their area. A hospitalist is supposed to be looking at the big picture and providing coverage for the whole person, not just the area of concern at the moment.

I have a relative who periodically goes in for complex ortho or neuro-surgery. Do you think the orthopod or the neurosurgeon wants to order his laxitives and his asthma meds? They will if need be, but they will only order what he's already on. If something new crops up during his stay, they just want to refer to someone else. The hospitalists now cover the situation, and it's a whole lot easier to get things accomplished.

Someone else in my family also had surgery a while back for a broken ankle. The surgeons did not want to be responsible for ordering diabetic meds and were actually going to send this person home a day early because they didn't want to prescribe the wrong things. The hospitalist saved the day and took care of both patient and docs.

In my experience, hospitalists are a great innovation that can spare the docs some headaches and get patients what they need in a timely manner. They also know their way around the hospital and can make things happen in a way a typical attending can't usually do.

You have to know the protocol for your facility. Some routinely use the hospitalist team. Others offer it as an option. On my unit (postpartum), there isn't much need for their services, so I'm not entirely sure what determines when the hospitalists are involved.

Your best bet would be to ask your co-workers how they do it. Other nurses should be able to clue you in as to what makes the distinction and how you can figure it out if it's not readily apparent.

If someone specifically tells you to call the hospitalist, I'd go ahead and give it a try. They should know when something you're asking for "belongs" to the admitting doc.

I think you will like this option once you become a little more familiar with it. Having a doc on call all the time can be a real blessing.

Specializes in Home Health.

In my hospital, the hospitalist is the doctor for the patients who have no doctor or for the ones who have a doctor but that doctor doesn't have admitting priviledges. If a pt. has a problem we call the doctor they are admitted to. Sometimes that is a doctor that also sees patients in a clinic somewhere and sometimes that it the hospitalist on duty.

Specializes in Medical, Surgical, Pediatrics.

It's the same at my hospital, we have a group of hospitalists, however, they are not working in the hospital 24/7. Our group of hospitalists work for the hospital, meaning they are always there during the daytime and care for patients who do not have a physician, as well as the patient's whose doctors choose to sign their patients over to the hospitalist to care for when admitted to the hospital.

It seems that hospitalists can function in many different roles, depending on the facility in which you work. It is probably best for you to talk to your nurse manager to get a clear understanding of the hospitalist role where you work.

Specializes in Med/Surg, Tele, PCU.
SonorityGenius said:

Attending MD: Patient's primary doctor, or if self pay the covering service doctor in ER that day - may not be present in hospital at all times.

Hospitalist - In house doctor - must always be present in the hospital, during the night shift for example if patient codes or rapid response activated Hospitalist will respond they will also answer basic meds questions by nurses

Thanks Sonoritygenius. What I don't understand though is that I have been told to call the hospitalist go get orders instead of the attending physician. I would think the hospitalist does not know the patient as well as the patient's primary. How about the covering service ER doc? He/she probably doesn't know the patient that well either, I don't know...do you know of a good procedure to find out on your own who to call for orders? I could understand calling the hospitalist for a code or a rapid response but, otherwise...I don't get it.

Thanks a bunch for your help.:yeah:

Specializes in Med/Surg, Tele, PCU.
The idea behind the hospitalist is that they can coordinate a person's inpatient needs better than an attending MD. Yes, the primary care doc knows the patient's history, but many people have more than one doc, and covering all their needs can become complicated.

For example, if someone goes in for a gall bladder surgery, they may need their cardiac and diabetes meds while they're inpatient along with any other home meds they take. Their primary doc will not be the one admitting them. The surgeon will. So who orders all the stuff not related to the surgery? The hospitalist. Who will come to see the patient for anything not pertaining to the GI situation? The hospitalist.

The hospitalist team is generally available 24/7. They can call any of the patient's docs if a consult is needed. And they'll get through more easily and have their calls returned quicker than the patient would.

Many specialists tend to have tunnel vision for their area. A hospitalist is supposed to be looking at the big picture and providing coverage for the whole person, not just the area of concern at the moment.

I have a relative who periodically goes in for complex ortho or neuro-surgery. Do you think the orthopod or the neurosurgeon wants to order his laxitives and his asthma meds? They will if need be, but they will only order what he's already on. If something new crops up during his stay, they just want to refer to someone else. The hospitalists now cover the situation, and it's a whole lot easier to get things accomplished.

Someone else in my family also had surgery a while back for a broken ankle. The surgeons did not want to be responsible for ordering diabetic meds and were actually going to send this person home a day early because they didn't want to prescribe the wrong things. The hospitalist saved the day and took care of both patient and docs.

In my experience, hospitalists are a great innovation that can spare the docs some headaches and get patients what they need in a timely manner. They also know their way around the hospital and can make things happen in a way a typical attending can't usually do.

Awesome explanation rn/writer, I may be hitting a brick wall here so please bear with me and my ignorance. In the scenario of the gall bladdder surgery where the surgeon would not be prescribing meds for anything outside of what he/she is doing, is a surgeon ever placed as the official attending physician? Because if they are, then I could see where the hospitalist would be a better person to call for meds outside of the surgeon's scope of work. How do you personally determine who to call? This can get really confusing.:uhoh3:

Specializes in Med/Surg, Tele, PCU.
You have to know the protocol for your facility. Some routinely use the hospitalist team. Others offer it as an option. On my unit (postpartum), there isn't much need for their services, so I'm not entirely sure what determines when the hospitalists are involved.

Your best bet would be to ask your co-workers how they do it. Other nurses should be able to clue you in as to what makes the distinction and how you can figure it out if it's not readily apparent.

If someone specifically tells you to call the hospitalist, I'd go ahead and give it a try. They should know when something you're asking for "belongs" to the admitting doc.

I think you will like this option once you become a little more familiar with it. Having a doc on call all the time can be a real blessing.

Thanks so much! Will do!:yeah:

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