Use of Hospitalists Rises

Doctors are relying increasingly on hospitalists — a relatively new specialty of physician who takes over the care of critically ill patients once they are admitted to a hospital. Keith Seinfeld of member station KPLU reports.

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RENEE MONTAGNE, host:

A story now about new kind of specialty which may mean fewer hospital patients will see their regular doctors. Keith Seinfeld of member station KPLU introduces us to the hospitalist.

KEITH SEINFELD reporting:

When a hospitalist walks in wearing his white coat and stethoscope, the first thing he has to do is explain.

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Dr. DAVE KNOPFLER(ph) (Hospitalist, Overlake Medical Center): We frequently get asked questions by patients--where's my doctor?--as soon as I walk in the door. Where's my doctor?

SEINFELD: Dave Knopfler is a hospitalist at Overlake Medical Center in Bellevue, Washington.

(Soundbite of crowd)

Dr. KNOPFLER: Usually, I try to be very diplomatic and I say, `You may not have been aware, but at Overlake Hospital we have a doctor called the hospitalist and that's who I am, and I specialize in hospital care.' And I will stress the fact that their regular physician is the one who made the choice to have us care for their patients.

SEINFELD: Knopfler's making his rounds. He checks on a woman named Roberta Brady(ph).

Dr. KNOPFLER: Now, Ms. Brady, do you remember me coming by earlier this morning.

Ms. BRADY (Patient): Yeah.

Dr. KNOPFLER: OK. Can I peek at your legs...

Ms. BRADY: Sure.

Dr. KNOPFLER: ...and see how they look?

SEINFELD: Mrs. Brady's been in and out of the hospital with a heart condition.

Dr. KNOPFLER: Now your regular doctor--is it still Dr. Raskin(ph)? Correct?

Ms. BRADY: Yes.

Dr. KNOPFLER: Yeah. Now did you see him since we sent you out of the hospital just--no? When's the last time you saw him?

Ms. BRADY: About a month ago.

SEINFELD: Knopfler's one of 11 hospitalists on staff here. A decade ago there were just 100 or so nationwide. Now there are more than 12,000. Many, like Knopfler, are employed by the hospital itself, others work with outside medical groups that contract directly with the hospital. For Knopfler, becoming a hospitalist was a welcome relief from his original specialty, internal medicine.

Dr. KNOPFLER: I was forced to see patients on a very regimented schedule who essentially ignore problems at times to play games with billing and insurers and Medicare and everyone else because only certain things are allowed on the same day.

SEINFELD: On the other hand, he loved working in the hospital. Now his job is to be a patient's primary doctor only when they're in the hospital. That's a typical story for thousands of doctors who've become hospitalists. It's the fastest growing medical specialty in America. It's got its own organization, the Society for Hospital Medicine, which predicts they'll soon outnumber cardiologists. Bob Wachter came up with the name hospitalist. He's a doctor and professor at the University of California, San Francisco. In the mid-1990s, he began hearing about doctors taking on a new role.

Dr. BOB WACHTER (Professor, University of California San Francisco): I think what we recognized then was this was happening all over the county in little drips and drabs and nobody recognized that there really was a trend there.

SEINFELD: He wrote about it in the New England Journal of Medicine. To his eyes, the trend made a lot of sense for two reasons: time and efficiency. Hospital stays are shorter than they used to be, so the average doctor has fewer patients to go visit. Meanwhile, more medical care is delivered on an outpatient basis, so doctors are heavily scheduled back at their offices. Wachter says the days are gone when you could be like TV's Marcus Welby.

Dr. WACHTER: The problem is you are so busy in the office that, in fact, if you are the patient's physician of record in the hospital, a huge vacuum exists and the patient, in fact, has no one looking after them for eight or 10 hours a day.

SEINFELD: A hospitalist can keep checking on the patient all day long. In theory, that would allow a hospitalist to catch problems more quickly. And Dr. Wachter says they're also more familiar with the kinds of things that could go wrong in the hospital, leading to better quality care.

But are you also giving something up? Critics, like family practitioner Dave Schumer(ph), from Auburn, Washington, think you are.

Dr. DAVE SCHUMER (Family Practitioner): They want you to see a stranger each time, and a different stranger each time you go to the hospital, each time you need someone. They're good people. They're nice people, but they don't have the relationship.

SEINFELD: How important is that relationship? Dr. Schumer and some prominent family doctors across the country say it's about things that may not be in your medical chart, such as knowing what you'd want.

Dr. SCHUMER: Things happen in the hospital. People have strokes. People have heart attacks. People get tubes put down them. You know, people get surgery. People get put on breathing machines. Someone's got to be there who knows you, who knows what the family wants.

SEINFELD: It's not clear how families and patients feel about the hospitalist trend. Surveys show they don't feel strongly one way or another. Among family doctors and internists, their national organizations are officially neutral. But you can see acceptance is growing by the simple fact that more and more doctors are using the service. For NPR News, I'm Keith Seinfeld in Seattle.

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