When Myrna M was admitted to
hospital with pneumonia last month, she expected her longtime
GP would treat her. Instead a complete stranger —
a physician working as a hospitalist — looked after
her while she was an inpatient. Myrna wasn't exactly thrilled
at first. But after a while she bonded with her new doc
and was sorry to say goodbye to him when she was discharged.
In hospitals across Canada, hospitalists
are becoming a more and more common sight, on hand to
look after inpatients of doctors who, for one reason
or another, don't have hospital privileges. Hospitalists
come from all walks of physician life — retired
docs who want to keep a foot in the door, or younger
doctors not ready to commit to a permanent practice.
"In Peterborough, many of our current
hospitalists are physicians who are part time hospitalists,
part time primary care still," says Dr Renwick Mann,
secretary treasure of the Peterborough County Medical
Society and an anesthetist at Peterborough Regional
Health Centre who works with a lot of hospitalists.
"But a lot of hospitalists here gave up their community
practice." He adds, "The whole issue is a spin-off of
the medical manpower human resource problem that we're
in at the moment."
He says there are many reasons
hospitals employ hospitalists, and as many reasons doctors
decide to become hospitalists. "There's no question
the hospitalist model has provided more consistent access
for physicians to care for patients while they're in
hospital. Hospitalists can see patients through from
start to finish, until they are discharged," he explains.
"Also the salary structure and the workload in terms
of time commitment is such that for many the hospitalist
role was quite appealing."
We spoke to one family medicine
specialist, Dr Joshua Tepper, who works as a hospitalist
at Kirkland Lake Regional Hospital, to find out what
he does and why he does it.
National Review of Medicine:
Why are you working as a hospitalist? Why not just open
a family practice?
Dr Joshua Tepper: I'm pragmatic to the degree
that I'm not ready to open a longterm family practice
until my wife is done with her training (in psychiatry).
There isn't the same initial investment and ongoing
monthly investment as there would be for a family doctor
starting a practice. Plus there's currently a strong
need for hospitalists for people who don't have a family
doctor or whose family doctor does not participate in
hospital-based care.
NRM: How do you like the
work?
Dr Tepper: Most of the time I'm working in teams,
with a social worker and physiotherapist and discharge
planners. I really enjoy the teamwork and the focus
on the patient. I work with nurses on the ward almost
around the clock. And I like that collegiality with
other doctors, trying to solve problems. I get to deal
with patients and their families in a very direct way,
because usually when someone is in hospital they're
very sick. I really enjoy that family contact.
NRM: But as a hospitalist,
can you establish a longterm relationship with a patient?
Dr Tepper: I see that patient every day until
they're discharged, and we may involve a specialist
as well. Hospitalists practise very good medicine with
some very sick patients — the skills we have shouldn't
be underestimated.
NRM: Do you think the presence
of hospitalists encourages doctors to give up their
hospital privileges?
Dr Tepper: I think it's the other way around:
the absence of family doctors in hospitals is encouraging
more doctors to become hospitalists. Because family
doctors are making the decision to not to be as involved
in hospital care, it may have created a vacuum that
hospitalists are filling.
On the other hand, I don't think
the presence of hospitalists is keeping doctors away
from hospitals. Because I'm there doesn't stop a family
doctor from looking after their patients. In some larger
urban settings, I understand there have been rules and
regulations that limit the role of family doctors in
hospitals, and those situations seem unfortunate.
We also need to do more to encourage
family doctors to either get back into hospitals or
stay in hospitals. Having family physicians involved
in family settings is important.
NRM: Why do you think doctors
choose to become hospitalists?
Dr Tepper: They may find that lifestyle more
suited to what they're interested in. To some degree,
they'll have more defined hours. They can be long hours
including night-time responsibility, but it might be
more predictable and not necessarily as long term a
commitment as an individual in family practice. It's
very different from family practice where you're responsible
for patients for a longterm basis.
NRM: How do you see the
hospitalist's role evolving?
Dr Tepper: This will depend. In a small community
that might be having a huge shortage of family doctors,
you may simply see hospitalists looking after patients
who have to be admitted but have no family doctor.
In a more urban area, it might
be unreasonable to expect family doctors to do in-hospital
care when their patients are spread across five or six
hospitals. In this case, the doctor might have privileges
in one hospital and hospitalists could look after their
patients in other hospitals. This is the type of scenario
where you'll really see hospitalists and family doctors
working closely together.
The hospitalist's role could also
evolve as the coordinator between several doctors. I
had one patient this weekend who was under the care
of three or more specialists, and it was my job to coordinate
this patient's care. Normally, this would have been
the family doctor's role.
Interviews conducted by Marjo
Johne
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