Monday, April 30, 2007

The DocSurg is aggravated with the hospitalist movement

At my place of work surgeons and hospitalists enjoy a mutually respectful and beneficial relationship. So, I was surprised to read this rant from Aggravated DocSurg, a general surgeon and one of my favorite medical bloggers. He’s underwhelmed with the hospitalists who came to fill the vacuum in his community resulting from all the internists giving up hospital medicine. These hosptialists don’t provide him the help he needs. Consequently he’s having to “tune up” his surgical patients and manage their post operative medical complications. In short he’s functioning as a flea (a pejorative term for Internist) and, thanks to global surgical fees, not getting reimbursed for it.

He writes “How can a middle aged guy who has spent the last 19 years training and then working as a general surgeon be a flea underneath his scrubs? I am afraid that it is because the economics of medicine, and the lifestyle choices of (many) physicians, have foisted the hospitalist era upon us.” He laments that the hospitalist program at his institution is inefficient and that other surgeons he networks with across the country feel the same way. Citing several possible reasons for this he notes, concerning hospitalists “…but in my experience they are folks who did not flourish in the world of office practice seemingly due to an inability to address patient problems in a time efficient manner.” Ouch. He goes on with “Additionally, one of the unspoken problems with the hospitalist system is that many patients are so P.O.ed at not being able to see their ‘real’ doctor that they develop an intense animosity towards the hospitalists called in to see them....and then fire them.” Yikes. And finally “I manage a whole host of perioperative medical problems because I can now do it more expediently, more safely, and with a better degree of success than my patients could get the same care through the system that has been handed to us. When cardiac problems get out of my league, I call a cardiologist ---- just like the hospitalists do. Ditto for pulmonary issues.” Blistering.

What about the generalizability of DocSurg’s experience? He no doubt could provide a collection of anecdotes to back up his impressions, but these do not equal evidence. The evidence regarding the hospitalist movement right now is mixed. DB recently pointed out that there will be good hospitalists and not so good hospitalists. Moreover, from an organizational point of view there are good and not so good hospitalist programs. DocSurg has pointed out some quality concerns that hospitalist leaders need to address. I hope they’re tuned in.

Kevin weighs in here.

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