Hospitalists ensure care is always just down the hall

Dr. Otto Velasquez doesn’t spend his days in a doctor’s office treating children with runny noses and sore throats.

Instead, the pediatrician is a mainstay at Edinburg Children’s Hospital, taking care of children with serious conditions, from pneumonia to severe asthma. He’s there to answer parents’ questions, then if problems arise, there to face the wildly different challenges that appear every day in a hospital.

“This is what I wanted to do,” Velasquez said of being in a hospital full time. “An office becomes very monotonous, but in the hospital, you’re seeing very sick patients with different situations and it’s challenging.”

Velasquez is a hospitalist — a doctor who works exclusively in hospitals, rather than dividing his time between a medical center and a doctor’s office. More and more hospitals, nationwide and in the Rio Grande Valley, have launched hospitalist programs, hoping to cut costs, shorten hospital stays and provide more consistent attention to sick patients, according to officials.

Historically, doctors in private practice have monitored their own patients in the hospital, making rounds before or after working in the office. Now, when patients enter the hospital, many community doctors are choosing to turn over their patients — temporarily — to a hospitalist, officials said.

The hospitalist alternative is becoming more appealing to doctors as their offices become more hectic, said Jim Summersett, CEO of Knapp Medical Center in Weslaco.

“With increased demands on doctors in their own private practices, as well as the growing complexity of hospital care … there’s a need for hospital-based doctors,” Summersett said. “I think in 10 years, we’ll see many more hospitalist programs across the country.”

Knapp started using hospitalists at the request of local doctors, Summersett said. The facility contracts with three hospitalist groups to provide inpatient care for adults, children and infants.

“It’s not because the hospitalists are better doctors. They’re just more available,” he said. “It helps to have doctors who are physically here all the time.”

Seven groups of hospitalists — four who specialize in adult medicine, one pediatric and two infant — cover many of the Valley’s hospitals, according to Velasquez. The hospitals contract with local physician groups to provide hospitalist services, similar to the contracts many hospitals have with emergency doctors.

The growth of hospital medicine

Hospital medicine is a fast-growing field in the United States, with about 20,000 hospitalists currently practicing, according to the Society of Hospital Medicine. The organization predicts that about 30,000 hospitalists will be in practice by 2010, surpassing the number of cardiologists in the country.

Hospital medicine isn’t yet recognized as a specialty, but the American Board of Internal Medicine has proposed making it a field within internal medicine.

“Eventually I think we’ll become a subspecialty, because the movement is so strong,” Velasquez said.

The profession is growing quickly for several reasons, according to the Society of Hospital

Medicine. More patients are being treated on an outpatient basis than in the past, leaving community doctors less time to tend to hospital patients, the organization says. Hospitals also are trying to reduce medical errors and minimize costs, and the presence of full-time doctors could help improve efficiency and reduce the risk of mistakes, the society says.

Summersett said that having hospitalists on staff offers several benefits.

“It allows us to reduce the length of stay and appropriately match our resources to the patients’ needs — resources like procedures and medications,” he said. “It helps us with aligning our compliance with (federal) standards … and helps us meet economic challenges.”

A recent study in the New England Journal of Medicine found that hospitalists reduce a patient’s length of stay by half a day, and those patients had slightly lower medical costs than patients cared for by general internists or family physicians. The quality of care stayed the same, according to the study.

Pros and cons of a new approach

Local hospitals don’t require primary doctors to refer their patients to a hospitalist when those patients enter the hospital. But more and more doctors are taking that option, said Dr. E. Chandler Deal, one of the hospitalists at Valley Baptist Medical Center-Harlingen.

“At this point in time, we have to turn away business,” Deal said. “Right now, our eight (hospitalists) are functioning at 102 percent of their abilities.”

Although some doctors are wary at first, they come to appreciate the help hospitalists can offer, Velasquez said.

“Little by little, they gain an understanding that we’re not here to take their patients away, but to extend a service,” he said. “They can spend more time in the office. When they close the office, they can go home, and they don’t get calls at 2 or 3 a.m. And their patients are taken care of. It’s a win-win situation.”

Some local doctors said they’re happy with the arrangement and with the care the hospitalists provide.

“They can respond to changes in a patient’s condition readily, can respond to reports from the lab, and make decisions more promptly,” said Dr. Stanley Fisch, a Harlingen pediatrician who refers patients to a pediatric-hospitalist group. “The patients do better as a result. In our experience, they’ve done a wonderful job, and we’ve been pleased.”

But the model only works as long as the hospitalist and primary-care physician communicate, said Dr. James King, president of the American Academy of Family Physicians. The academy has developed guidelines for interaction between family physicians and hospitalists, calling for the doctors to communicate frequently while the patient is in the hospital.

“Our concern is continuity of care,” King said. “The hospitalist needs to make sure information gets to the primary-care doctor, and the primary-care doctor should contact the hospitalist and share information.”

At Valley Baptist, primary doctors are kept informed in several ways, Deal said.

“We send them copies of our records. They also have access to the patient’s electronic medical record, or they can contact us. And upon discharge, we send them a summary very promptly, within 24 hours,” he said.

Fisch said he’s never felt in the dark about what’s going on with his patients while they’re in the hospital.

“It works pretty smoothly,” he said.

Patients have given Fisch positive feedback as well, he said.

“The parents come back saying they think the children had very good care and that the doctors were attentive,” he said.

Some local doctors, however, worry that referring patients to a hospitalist can have consequences.

“Family physicians who give up hospital work can lose their inpatient skills,” said Dr. Bruce Leibert, program director for Valley Baptist Family Practice Residency in Harlingen. “Also, you lose a connection with your patients at a crisis moment and it compromises trust … doctors should really think about what they’re giving up.”

To some local doctors, the hospitalist model offers the best of both worlds, they say.

“There’s a doctor in house all day long for patients, who can respond to their needs,” said Valley Baptist hospitalist Dr. James Castillo. “And the primary-care doctor can stay in the office, where they’re really needed.”

Although it might take time for patients to adjust to the new approach, in the end many of them seem to appreciate it, hospital officials said.

Parents of sick children, in particular, value having a readily accessible doctor in the hospital, said Christy Escandon, chief nursing officer of the children’s hospital and Edinburg Regional Medical Center.

“The hospitalists have more time to speak with them, they’re available for questions and concerns, and that’s appreciated,” Escandon said.

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Melissa McEver covers health and environment issues for Valley Freedom Newspapers. She is based in Harlingen and you can reach her at (956) 430-6252.