hospitalists in hospitals

Trauma Columnist · Nov 29, 2007

Hi there and welcome. I am a mid-level provider in a large nephrology practice. I make rounds in a total of five hospitals, 4 of which have MD hospitalists. These four also have "closed" ICUs meaning only the intensivist(MD) admits to the ICU. I like this concept in that we are consulted as are other specialists but the hospitalist/intensivist (MD) remains the "Capt of the Ship." This is very important for the care of the patient - to ensure that there is one person who KNOWS what is going on with the pt and who coordinates the specialty care.

I know of mid-levels that work for the hospitalists and they do see pts but certainly the MD must see the pt. Billing and just ethical patient care demand that.

Also - I am going to move your post to the general nursing forum in order to get you more answers.

ASSEDO · Nov 29, 2007

Our hospitalists are MD's.

CraigB-RN, MSN, RN · Nov 29, 2007

Our hospital is starting in the near future to use mid-level practitioners as "hospitalists". These mid-level practitioners will be able to do rounds on patients and write discharge orders without these patients having seen the doctor. I hear the wave of the future are "hospitalists". If this is the wave of the future, are MDs going to be obsolete in 20 or 30 years. Why go to school for an MD if you can become a hospitalist? What do you guys think. Are hospitalist a good idea?

The term hospitalist can be a generic one. MD or midlevel. Most places I've seent that use midlevels as hospitalist/intivist use them to spread around the time of the MD. There may be more contact going on with the mD's than you are aware of. In the majority of facilities hospitalist are internal medicine docs who choose t work in a hospital setting rather than have the "troubles" of a private practice.

MikeyJ, RN · Nov 29, 2007

Our hospital is starting in the near future to use mid-level practitioners as "hospitalists". These mid-level practitioners will be able to do rounds on patients and write discharge orders without these patients having seen the doctor. I hear the wave of the future are "hospitalists". If this is the wave of the future, are MDs going to be obsolete in 20 or 30 years. Why go to school for an MD if you can become a hospitalist? What do you guys think. Are hospitalist a good idea?

As others have said, hospitalist is a general term that basically refers to an MD/DO or mid-level hired by the hospital to care for in-patients. Most hospitals have hospitalists or internists. From the hospitalists I have spoken to, apparently 20 years ago, hospitalist positions were very popular. However, over the last 20 years, sub-specialities became more popular and primary care doctors were on the decline and many hospitals stopped hiring hospitalists. However, over the last 5 years, many more physicians are choosing to go into the primary care field (family, internal medicine, pediatrics, ob/gyn) because of the lifestyle and thus hospitals are again starting to hire hospitalists/internists.

And to answer your second question, MD's will never ever be obsolete. NP's cannot take the place of a physician -- and in fact, in all states they either need to work in a supervisory role with the physician or a collaborative role. Our healthcare system needs physicians -- you need individuals in the healthcare field who have spent 4 years in medical school and 4+ years in residency. I would be frieghtened if physicians became obsolete.

YellowFinchFan · Nov 29, 2007

Our hospitalists are MD's.

We have several hospitalists at our hospital-they are all MDs too. I didn't know they could be anything else but an MD.

mgababyko · Nov 29, 2007

We have hospitalists too, called "rounders". They usually have on-call and clinic time as well. All are MDs.

SarasotaRN2b · Nov 29, 2007

Our hospitalists are MD's.

DITTO!

RNsRWe, ASN, RN · Nov 29, 2007

We have a staff of hospitalists (all MDs) who see patients that either don't have primary healthcare providers OR whose primaries don't have privileges in our hospital OR whose primaries don't WANT to go to the hospital to see the patients.

As for the last part, if my healthcare provider didn't want to take the time to come see me in the hospital, they can FORGET about having me as a patient for the rest of my life. I'm floored that some people think it's fine that the hospitalist "consult" with their doctor, because the doctor won't go to the hospital. Sorry, doesn't fly with me.

But enough venting . For those without primary care providers, a hospitalist is a great system: someone to follow your care throughout your stay. OTOH, and it's a BIG "other hand", the huge huge majority of our hospitalists' patients are also without insurance, so the stays are freebies on us, or they have Medicare or Medicaid (also meaning that the majority of the stay is a freebie, on us). So having hospitalists admit large numbers of patients isn't exactly a wonderful thing from the hospital's standpoint: the hospitalists justify their employment with the hospital by providing care for sometimes ridiculous caseloads of patients, when SO much of their patient load is inflated. By that, I mean patients who frequently DON'T have to be admitted (think frequent-flyer drug seekers), but are anyway. And are kept for days or even weeks longer than any other doctor would keep them in the hospital, running thousands of dollars on more and more tests and giving more and more narcotics, only to send them back onto the street to be admitted another day.

So yeah, I think they're a good idea for the normal person who for some reason doesn't have a primary care provider and has a hospitalist in charge of their care for a normal duration of a normal hospitalized illness. But for the most part, I see the system as crap.

MikeyJ, RN · Nov 29, 2007

What I have never understood about the hospital I work at is that we are a teaching hospital and affiliated with a medical school, thus we have residents... but yet we still have hospitalists that work with internal medicine. Never understood why the hospitalist takes some cases and the residents take some.

Retired R.N. · Nov 29, 2007

We have a staff of hospitalists (all MDs) who see patients that either don't have primary healthcare providers OR whose primaries don't have privileges in our hospital OR whose primaries don't WANT to go to the hospital to see the patients.
As for the last part, if my healthcare provider didn't want to take the time to come see me in the hospital, they can FORGET about having me as a patient for the rest of my life. I'm floored that some people think it's fine that the hospitalist "consult" with their doctor, because the doctor won't go to the hospital. Sorry, doesn't fly with me.[ENDQUOTE]
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I have had very good experiences as a patient with a primary care physician who does not do hospital calls, but collaborates with hospitalists and the appropriate specialists whenever I need to be admitted. The hospitalists I have known were all experienced MDs well-versed in cooperation and coordination among all the members of the health team. I plain English, that translates to the fact that no matter what time of day or night, I had a well-rested physician in charge of my care, instead of one so fatigued that (s)he could barely push one foot ahead of the other one. All the nurses in the hospital loved the system because it was so easy for them to get a quick response from a physician when one was necessary. They didn't have to spend needless time waiting for a call-back from a physician or surgeon who really needed to be asleep to prepare for the coming day.

MikeyJ, RN · Nov 29, 2007

As for the last part, if my healthcare provider didn't want to take the time to come see me in the hospital, they can FORGET about having me as a patient for the rest of my life. I'm floored that some people think it's fine that the hospitalist "consult" with their doctor, because the doctor won't go to the hospital. Sorry, doesn't fly with me.

You must not forget though that some private physicians don't maintain their privleges at all the local hospitals. There are some patients admitted to our ped's floor that are picked up by the attendings and residents because their pediatrician doesn't have privleges at our hospital.