Dr. Jill Waldman”™s office is a tiny one at Phelps Memorial Hospital Center in Sleepy Hollow. Its size belies the growing role she and the staff physicians under her direction have assumed in hospital care.
It is also her only office. Her work days begin and end at the hospital, as they also do for the six full-time physicians she directs. Waldman is a hospitalist, a new breed of physician directly employed by hospitals whose fast-growing ranks could serve to make the doctor”™s visits to hospitalized patients about as rare as the doctor”™s house call.
“This is our sole focus,” said Waldman, director of the adult hospitalist service at Phelps since August 2010. “This is also our base of operations. We don”™t have an office practice that we”™re running to. We don”™t have clinic hours that we”™re late for ”¦ It”™s a clear benefit for the patient to have a physician whose sole focus is inpatient management. You no longer have physicians trying to straddle two fences at the same time.”
Hospitalists can more quickly get emergency room patients admitted to the hospital and coordinate surgeries in cases where prompt treatment is crucial. They can quickly order lab and diagnostic tests for patients. They can discharge patients at any time of the day and night, eliminating the expensive wait for one”™s primary physician to sign discharge papers during morning rounds at the hospital.
”˜Massive changes”™ in delivery of care
Looking to expand and improve the hospital”™s 10-year-old hospitalist program, Phelps administrators recruited Waldman from Nyack Hospital, where she held the same post. Waldman in turn brought several young doctors from her Nyack staff to Sleepy Hollow. In addition to overseeing patient care on a 24-hour basis, “The hospitalists will be very helpful in the education and mentoring of residents” in the family medicine residency program that Phelps Memorial expects to launch in 2012 with New York Medical College, said Daniel Blum, senior vice president at Phelps Memorial.
The term “hospitalist” was coined in 1996 by authors of an article published in the New England Journal of Medicine. “Over the last five years, hospitalists have become much more commonplace in this region,” said Blum. The growth of the hospitalist practice is “a phenomenon of some very massive changes in the delivery of health care in this country,” he said.
Blum said the service has been driven in part by a need to eliminate excessive lengths of stay for patients to protect them from infections contracted in hospitals and because of increased demand for hospital beds in a state and region in which the number of hospital beds has dramatically decreased.
Blum said the nature of inpatient care has changed to become “almost a subspecialty of medicine.” Hospitalists, he said, can better assure that hospitals achieve the quality measurements and keep up with new and ever-evolving standards of inpatient care.
”˜The best job in the world”™
As employees of the hospital rather than self-employed physicians, “We”™re able to practice with a virtually blind eye to a patient”™s insurance status,” Waldman said. “We don”™t need to tell anybody that, ”˜I”™m sorry, we don”™t take Medicaid, you can”™t come to our office.”™”
Insurance coverage “is just not relevant to our patients usually until discharge,” when a hospitalist might review a patient”™s prescription coverage when prescribing medications, for example.
At Phelps Memorial, said Blum, “We tend to provide these physicians as a way of providing additional resources to the medical staff.” Especially with lower reimbursement rates for their services, doctors “need to spend as much time in the office seeing as many patients as they can,” he said. Leaving the office for emergency calls to hospitalized patients can be a costly diversion for doctors, both he and Waldman said.
Blum said the hospitalist service at Phelps has lowered the average patient length of stay by approximately one day. “That”™s dramatic,” he said. The average daily census of patients in the hospitalist service has grown, he said, another measure of the program”™s success and its acceptance by primary-care physicians.
“It”™s the best job in the world,” said Waldman. The variety of cases seen by hospitalists “is very intellectually stimulating,” she said.
“I think the fact that you get to work with patients when they are at their most vulnerable and scared is a privilege.”
Helping them “through the medical milieu and quagmires,” said Waldman, “is what makes this job fantastic.”
