I've become somewhat disgusted with a new "vision" for hospitalists at our institution, and I wanted to get some feedback.
Just prior to the Society of Hospitalist Medicine meeting in Chicago, I read a post from another hospitalist blogger lamenting the push to degrade hospitalist medicine from a specialized clinical field of internal medicine into a "jack-of-all-trades" utility that provides a "convenience factor" for proceduralists. He called for strong leadership from SHM to voice disapproval of this dangerous trend. I didn't hear anything as definitive as I would have liked.
It seems that some hospital administrators have the misguided goal of having hospitalists admit 100% of the patients in order to allow all of the specialists (read: obscenely well-compensated proceduralists) to perform as "technicians".
At first, I thought the push to get a very small hospitalist program to start doing pre-operative medical evaluations was noble... until I realized we were only doing them for highly-lucrative elective procedures for surgeons already making 7 figures.
But that wasn't enough. Now the proceduralist/technicians want to maximize the number of procedures (which are supposed to include a global 90-day period of post-op care) without having to deal with all that pesky time-consuming post-op management. Hospitals that make money off the backs of these guys salivate at the notion of boosting their procedure output. What's the new en vogue way to achieve this? By turning over all of that post-op care to the hospitalist. We are being shamelessly used to construct the assembly line that plucks the money off the Medicare (and occasionally privately-insured) tree.
Now, at our institution, it's a total crapshoot whether or not the hip fractures wind up on medicine with an ortho consult, or ortho with a medicine consult. In either case, our surgeons do typically leave daily notes on their patients (but I use the word "note" quite loosely). I have rarely seen a shred of "management" being provided ("plan: per hospitalist"). But one doesn't have to look far to see where this is going -- the hospitalists are being used as bargaining chips to pacify the proceduralist/technicians... especially those that can uproot and take trauma-center status with them.
And so the slow march to shove inappropriate patients down the hospitalists' throat ensues. Epidural abscesses are admitted to medicine because an infection is a medical problem. Prisoners with jaw fractures are admitted to medicine because they're on psych drugs. Otherwise healthy 30-somethings with appendicitis are admitted to medicine because... well... does it really matter?
Make no mistake, I plan to exit stage left the moment it's in the cards, but is this a pervasive problem in the field of hospitalist medicine? Am I going to have to ask every potential future hospital to what degree they try to manipulate the Medicare National Bank at the expense of the hospitalists? Do you know how much money is wasted for me to do an H&P at 3am on a patient that I will literally be making absolutely no medical decisions for? With all the other bullshit hoops we have to jump through to get paid for our work, why is this not Medicare fraud?
For the moment, our proceduralist/technicians are having a field day with the administrative support for dumping on the hospitalists. I, for one, am ready to cease using the prefix "Doctor" for someone who wants to be treated like a glorified mechanic (even though I've long thought of interventional cardiologists as slightly-better-educated plumbers). You want to be a technician? Then maybe it's about time you were paid like one.