The truth is that neurosurgeons are trained to manage these patients, and the bottom line is that no one wants to get out of bed. What you call a “paradigm shift” in your December 2009 cover story, I call “turf.”
I resent this shift, but I think it will be transient. With cost and reimbursement cutbacks, payers are NOT going to continue to pay two doctors when only one is needed. Hospitalists will not be paid to manage hypertension in an ICH patient when the appropriate admitting doctor (the neurosurgeon) has for years been capable of doing so.
We are often seen as little more than glorified housestaff as we admit patients more appropriately admitted by a specialist. The only thing we accomplish is to improve specialists’ lifestyle—at the expense of providing appropriate, timely care.