Two recent health care episodes have sharpened my conviction that every practicing physician should be affiliated with a hospital.
In December I was admitted to the hospital for one night for observation. My care was managed by my gastroenterologist and my primary care physician, both of whom I have been with for almost twenty years. There coordination was perfection, I was fully informed, and all worked out well.
While I have been on the faculty of Mount Sinai medical school in New York City for forty+ years, over time, with the exception of my urologist, all my physicians (PCP, GI, orthopedics, ophthalmologist, and dermatologist) now practice near where I live in Hoboken, are on the same hospital medical staff, and know each other well.
Recently I was at physician’s office for a routine periodic screening. A Family Practice resident was shadowing my doctor and when we chatted he said it was not necessarily his plan to be on a hospital medical staff after he finished his training. I was flabbergasted that the GME program had not emphasized that as an “automatic”.
More and more primary care physicians are in full time office practice and hand patients off to hospitalists for inpatient care. Not to be confused with Intensivists: A physician who specializes in the care of critically ill patients, usually in an intensive care unit (ICU). (4)
The American Academy of Family Physicians defines a PRIMARY CARE PHYSICIAN as follows:
A primary care physician is a specialist in Family Medicine, Internal Medicine or Pediatrics who provides definitive care to the undifferentiated patient at the point of first contact, and takes continuing responsibility for providing the patient’s comprehensive care. This care may include chronic, preventive and acute care in both inpatient and outpatient settings. Such a physician must be specifically trained to provide comprehensive primary care services through residency or fellowship training in acute and chronic care settings.”
“All physicians should obtain hospital privileges in accordance with their individual qualifications, i.e., documented training and/or experience, demonstrated abilities, and current competence.” (1)
A Hospitalist is: ”A hospital-based general physician. Hospitalists assume the care of hospitalized patients in the place of patients’ primary care physicians.” (2) *The trend toward full time, salaried hospitalists is driven by “….convenience, efficiency, financial strains on primary care doctors, patient safety, cost-effectiveness for hospitals, and need for more specialized and coordinated care for hospitalized patients.” (3)
Well, I am not convinced!
Why develop a relationship with a PCP only to be treated by a “stranger” team of hospitalists?
Even if you are admitted to the service of a hospitalist or specialist (e.g., neurologist for evaluation for Parkinson’s disease) don’t you want your PCP by your side as well, even if it is not as the primary diagnostician?
If PCPs don’t participate in the care of sick patients don’t their diagnostic skills diminish by what they no longer see and do?
You don’t get to pick you hospitalist. These physicians work in shifts and you are likely to be cared for by multiple hospitalists during a hospital stay.
In my mind the solution is that every practicing physician should be required to have hospital privileges. Every hospital medical staff develops criteria to maintain privileges in the context of accreditation, licensure and other compliance requirements.
The key ones have to do, for example, with attending departmental conferences and serving on clinical committees.
The most important reality is that being on a hospital medical staff subjects each physician to interaction with other physicians on best practices and now many hospitals have physician quality metrics. And it is a safety valve to make sure impaired physicians are identified and helped, and “senior” physicians do not practice outside the scope of their capabilities.
But mostly it is to remember the importance of “continuity of care” (apparently now out of favor) and respect for the patient who must not be handed off to a stranger when serious illness strikes.
Note: This blog shares general information about understanding and navigating the health care system. For specific medical advice about your own problems, issues and options talk to your personal physician.