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Q: We are considering launching a hospitalist program to reduce the burden of ED call. Are there any drawbacks?

Hospitalist Leadership Connection, November 17, 2009

A: Although hospitalist programs can be  helpful in reducing on-call burden, they are not a panacea.

First, the money spent on hospitalist programs prompts some specialists to accuse the hospital of unfairness. These specialists may view these large payments as relief of burden for PCPs but no relief for specialists from call.

Second, aggressive hospitalist programs sometimes disrupt traditional referral patterns, leading to a small number of “preferred” specialists who get the lion’s share of the referrals. Sometimes, it also leads to a net reduction in referrals and loss of revenue to specialists.

Finally, the shortage of hospitalists nationwide leads to overburdened hospitalist programs that cannot adequately meet all the demands placed on them. Hospitalist job satisfaction may be poor when they are perceived as glorified house staff, ultimately undermining hospitalist recruitment and retention in a tight job market. If hospitalists take on excessive volume, they aren’t able to see new admissions in a timely manner. This leaves the specialists to be the first to see the patient, often causing the specialty to provide more time-consuming and comprehensive care than initially intended. And, if specialists assume the hospitalists are taking care of the general medical care, but the hospitalists aren’t seeing patients soon enough, delays in care can contribute to less-than-optimal outcomes and greater liability for everyone.

The above excerpt is adapted from Emergency Department On-call Strategies: Solutions for Physician-hospital alignment, 2nd edition, by Jonathan H. Burroughs, MD, MBA, FAPE, CMSL; Martin B. Buser, MPH, FACHE; Roger A. Heroux, MHA, PhD, FACHE; Richard A. Sheff, MD, CMSL; published by HCPro, Inc., Marblehead, MA.

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