LYNNE JETER

Drive down the busy Highway 98 corridor in Hattiesburg, Miss., and a new high-tech billboard touts the latest addition to the medical staff at Hattiesburg Clinic.

A neurosurgeon? A cardiologist? A nephrologist?

No, a hospitalist, representing the fastest-growing medical specialty in the United States.

“We’ve been in existence for 10 years and have 19 hospitalists,” said Dr. Steven E. Farrell, medical director of the hospitalist program at Hattiesburg Clinic, which is linked to Forrest General Hospital. “We have four dedicated night docs (nocturnists) and two dedicated hospitalists to manage ESRD patients. We have been very successful in managing our length of stay, patient satisfaction, core measure for CMS and other metrics.”

Just 10 years ago, only a few hundred hospitalists were practicing in the United States. Today, there are 20,000 hospitalists, nearly as many as gastroenterologists or neurologists. Most hospitalists are internists, though a growing percentage represents pediatrics.

By 2010, the Society of Hospital Medicine (SHM) predicts 30,000 hospitalists will be practicing in the United States.

And they’re earning their keep. According to the most comprehensive hospitalist study to date, presented at the 2007 SHM annual meeting, Dr. Peter Lindenauer, associate professor of medicine at Tufts University School of Medicine, said hospital stays are a half-day shorter if managed by a hospitalist, with mortality and readmission risks comparable to those of family physicians or general internists.

“Some physicians didn’t like it at first because they felt they were losing control,” said Rob Anderson, vice president for Dallas-based TKG Med Staff, a division of Medical Edge, a physician-owned practice management group employing more than 800 healthcare providers. “But when they realized they actually made more money by having hospitalists in that role so they could spend more time in the office, their quality of life improved. Once they got a taste of that type of system, they wondered how they ever got along without it.”

Northwest Texas Healthcare, a 489-bed medical facility in Amarillo, Texas, contacted Anderson in 2006 to recruit a medical director and to establish a hospitalist program. Just a few months after the hospitalist program was put in place, hospital patient satisfaction jumped from 37 percent to 67 percent.

“The original game plan was to start off with three hospitalists,” recalled Anderson. “And once they had three in place, they wanted to go to four. Then when they got to four, the primary care physicians on call for the hospital saw the program was doing very well — the quality and continuum of care was there — and the program basically doubled. Now we’re looking to have eight on staff before too long.”

The majority of hospitalist programs look at revenues generated by billings and collections to determine the success of the program. Additionally, the hospital evaluates other factors relating to the value of the program:

• Reduction in length of stay.
• Reduction in cost per case.
• Reduction in readmission rate.
• Retention or attraction of primary care physicians to the medical staff.
• Increased primary care physician and specialist satisfaction.
• Increased patient satisfaction.
• Reduction in mortality rate.
• Reduction in complication rate.
• Reduced congestion in emergency department.
• Solution to care of unassigned patients.
• Improved management of observation unit.

“An increasing number of smaller towns throughout the country are seeing the value in starting hospitalist programs,” said Anderson. “Rural communities have discovered that many of the primary care physicians they are trying to recruit for private practice are not interested in doing in-patient medicine.”

Unfortunately, as the hospitalist movement is gaining momentum, the availability pool is dwindling. As a result of the shortage, hospitalist groups are using a variety of scheduling models, including:

• Shift-only: “7-on, 7-off, or 5-on and 5-off schedules,” explained Anderson. Approximately 40 percent of hospitalist management groups use shift schedules.
• Call-only: About 25 percent of hospitalist programs are using a call-based schedule (150 days on call, with 15.7 hours per day on call).
• Hybrid: Approximately 35 percent of programs use a mix of shift and call: 1,833 shift hours (206 shifts, each 8.9 hours) and 1,139 call hours (82 days on call, 12.8 hours per day). The correct daily staffing ratio is about one physician to every 15 patient encounters.

“There has been a consistent need for hospitalists and a limited number of candidates, even though salaries have risen over the past three years,” said Anderson. “In 2003, the average hospitalist salary range was $130,000 to $150,000, depending on location and model. Now, the salary ranges have increased to $150,000 to $180,000 or more, again depending on location.”

Hospitals have embraced the new model, subsidizing roughly one-third of the average hospitalist’s salary, particularly in rural areas.”

Farrell, whose practice extends to a largely rural area, said the hospitalist program “has worked very well for us.”



November 2007