Does the use of hospitalists benefit physicians in primary care practice? (Pro & Con).

YES

As a solo general internist with over 2,000 managed care patients, I have found the services of hospitalists to be invaluable in enabling me to provide complete 24-hour care to my hospitalized patients with a degree of continuity that is not possible with my seven-person call group.

The hospitalist group that I utilize has become more familiar with some of my patients than many of the physicians in my call group. I tell my patients that now "there is someone in the hospital who has at least heard of you, 24 hours a day!"

This segment of my practice used to involve a tremendous time burden for me and my staff, mainly due to the many phone calls regarding hospitalized patients. A soloist could literally spend all day on the telephone answering queries from nursing stations, case managers, discharge planners, medical directors of health plans, and home health nurse--not to mention taking calls from pharmacies about noncovered medications and from other physicians' offices regarding referrals. And then there are the calls that must be made to health plans to get authorization for medications or durable medical equipment.

I used to accept such calls immediately during the day, thereby shortchanging my office patients. It is a relief not to be interrupted repeatedly during office visits.

Hospitalists can greatly improve the quality of life of primary care physicians by reducing the hours spent in the hospital and the office. I carefully reviewed the time I was spending away from my family and usually it was associated with hospital issues, such as making late-night calls or returning to the hospital in the evening. Also, 90% of my after-hours calls were from the hospital. Hospitalists have eliminated this annoyance.

Discontent with primary care as a specialty has been rising because of long hours and low reimbursement compared with other specialties. By using hospitalists, primary care physicians can focus on other income-producing activities and avoid the aggravation involved in making hospital rounds on three to six patients a day. Most of my admissions are elderly, seriously ill patients. Advances in technology mean that they need constant attention, sometimes around the clock. This is impossible for the soloist.