Hospitalists a continuing trend in area hospitals

By Julie Fann
star staff

Practicing medicine isn't the same as it used to be. The body of knowledge doctors are expected to master on a regular basis has become so immense that specialization has become increasingly necessary so that physicians can remain competent within their chosen field.
   Dr. George Kehler is a hospitalist, a term coined in a 1996 article which appeared in the New England Journal of Medicine to stand for physicians who devote the majority of their time to inpatient care. "I was part of the program at St. Mary's Hospital in Knoxville in 1991. It was generated mainly to take care of indigent patients, but then we started getting more business from local doctors. We told them, 'We can just take care of this, and you can concentrate on office time.' "
   Kehler, who is a hospitalist for both Sycamore Shoals and Indian Path hospitals, said that it has become more difficult to make the traditional approach, where primary care doctors follow their hospitalized patients, work effectively. "A lot of that is due to the fact that people are living longer, and so the health problems we have to deal with are more complex and also more numerous," he said.
   Kehler said the drawback to hospitalist care is that patients are accustomed to having their regular doctor follow them once they are admitted into the hospital. "People sometimes feel more comfortable with that, but I haven't seen a big problem with it. As long as you're nice to the patient and act concerned about their welfare, most people are fine with it," he said.
   The trend for hospitalist care is a result of physicians who are seeking more predictable work schedules, mainly recent graduates, and doctors who want to be able to spend more time seeing patients in the office, where they can also study and devote energy toward educating themselves more.
   Kehler said approximately 20 to 25 patients are seen by a hospitalist physician at Sycamore Shoals, and 60 to 80 patients at JCMC are seen by them. Kehler said hospitalists are also around for consults if a patient's regular doctor is out of town.
   "Being a hospitalist is the only thing I've ever known. My schedule is predictable, and it also helps the emergency room flow better, to have hospitalists working there," Kehler said.
   Scott Williams, CEO of Sycamore Shoals Hospital, said that the use of a hospitalist is solely up to the doctor who is following that patient. It is not a mandatory requirement set out by the hospital. "Some physicians in our community elect to use hospitalists. The hospital does not force physicians to use them. Doctors elect to do that on their own, and they (the hospitalists) do a great job," Williams said.
   Physicians may also use a hospitalist only when they are on vacation, or in special circumstances, but many doctors still practice in the office and also come to the hospital, he said. "Doctors have different desires, so they may like practicing only hospital-based care, or they may like doing both."
   Dr. Scott Caudle is a physician who, at times, uses a hospitalist to care for his patients, depending on their health problems and his schedule. "Some doctors only want to practice in a clinical setting because, with hospital care, there is concern over liability, and time is also an issue," he said.
   According to an article published in American Medical News, surrendering hospital visits means the average primary care doctor gives up about $25,000 in annual revenue. However, the cost of traveling to hospitals can cost a physician about $75,000, including paying other doctors to cover calls, and the missed opportunities to schedule new patients.
   The article also reported that a hospitalist program implemented in 1993 in Downey, Calif., resulted in 20 percent fewer hospital readmissions. This is due to the fact that, with the average hospitalist seeing about 15 patients, they have to keep in touch with the primary care physician, the article said.