High-Value and Patient Focused

21 Mar

Is it high-value and patient focused or is it disruptive and lawsuit prone?

Twenty years ago, physicians who chose a career in primary care did not imagine a professional life restricted to the outpatient setting.  Primary care physicians were trained to care for patients in the inpatient and outpatient settings, encompassing care for the healthy, acutely ill, and chronically ill patients.  These physicians could not imagine transferring their patients to other doctors for a limited period of time when they were admitted to a hospital or to a nursing home.  Physicians would not have envisioned temporarily transferring the care of their patients to another unaffiliated doctorat a time when these patients were the sickest and vulnerable and in most need of someone who knows them, their health problems, and their preferences for care.  It did not make sense to these physicians that a patient would want to see them when they were well, but be transferred to another doctor whom they did not know when they got sick.
The trend toward hospitalists caring for inpatients has grown exponentially over the last 20 years.  In 1990, there were about 7000 hospitalists in the United States and in 2011, there are approximately 30,000.  Hospitalists are said to improve both the efficiency of care, mostly through reducing length of stay, and its quality.  Primary care physicians initially resisted this change in professional responsibilities, but now prefer the new system because they perceive that hospital visits were not efficient use of their time.

Among the forces that ignited and sustained the rapid growth of hospitalist care was the birth of managed care, which put pressure on primary care physicians to see more patients in the outpatient setting and on hospitals to shorten the length of stay.  Declining reimbursements for non-procedural services put additional pressure on the primary care physician to see more patients to maintain their income.  Additionally, the interest of younger physicians in careers with controllable lifestyles contributed to the emergence of a new clinical specialty focused on hospital medicine…Read more

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