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Q&A: Do specialty hospitalists have a future in practice or will the trend fade out?

Hospitalist Leadership Connection, September 1, 2009

A: Yes, as emergency department (ED) call panel stipends reach high enough levels, hospitals are taking a page from internal medicine hospitalist programs and applying it to other specialties on call. Stipend payments are escalating beyond belief, and it is common to find hospitals paying $8 million to $10 million per year for ED call coverage stipends. Now, a new breed of specialist is in the ranks of internal medicine:

• Pediatric hospitalists
• OB laborists
• General surgical hospitalists (or surgicalists)
• Orthopedic hospitalists (or traumatologists)
• Psychiatry hospitalists
• Neurology hospitalists
• Gastronology hospitalists
• Intensivists

In the author’s experience, hospitals found many advantages with the addition of specialty hospitalist programs for orthopedic, general surgery, and OB departments. These specialty programs provide effective coverage for the ED unassigned patients in the specialties with the highest patient volumes. The hospitalist programs provide full-time leadership for the orthopedic, general surgery, and OB specialists, as well as backup to other subspecialties.

Overall, the hospitalist programs increase physician satisfaction by enhancing their quality of life, while also improving their practice revenue by freeing time to treat additional private patients. They also provide medical and administrative leadership through the appointment of a full-time medical director for each program. The programs assist in the recruitment and retention of private practice orthopedic, general surgery, and OB specialists. In addition, they reduce the variation of practice within the hospital, allowing achievement of core standards for the Centers for Medicare & Medicaid Services and The Joint Commission. The hospitalist programs develop a cost-effective, long-term solution to help hospitals achieve a positive ROI, and potential increases in private surgeries will help increase hospitals’ contribution margins.

The above excerpt is adapted from the Emergency Department On-Call Strategies: Solutions for Physician-Hospital Alignment, Second Edition, by Jonathan H. Burroughs, MD, MBA, FACPE, CMSL; Martin B. Buser, MPH, FACHE; Roger A. Heroux, MHA, PhD, FACHE; and Richard A. Sheff, MD, CMSL, published by HCPro, Inc., Marblehead, MA.

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