The debate over whether hospitalists should admit pregnant patients is splitting some medical staffs and hospitalist groups, and not just in St. Cloud. Across the country, mission creep has meant that hospitalists are being asked to admit patients they may never have seen before, from hip fractures to cerebral hemorrhages. Pregnancy, in many hospitals, is the next frontier.
When confronted with these patients—usually from the emergency department in the middle of the night when in-house hospitalists are the easiest physicians to reach—hospitalist groups are reacting differently. Some are concluding that they can't admit pregnant patients for any reason. Others are negotiating policies with obstetricians and administrators to admit some pregnant patients, but not all. But in other hospitals, like Dr. McFarling's, compromise remains elusive, with both hospitalists and obstetricians standing pat—and feeling unfairly put upon.
Hospitalists are increasingly asked to be attending physicians for patients who are beyond their comfort level and the scope of their training. This is a confusing situation because there are no guidelines or standards hospitalist programs can invoke to just say no. How much longer will the Society of Hospital Medicine stand aside and allow this mission creep to continue?