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Primary Care Practice dropping hospital admiting privileges...Talk us out of it...

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  • Primary Care Practice dropping hospital admiting privileges...Talk us out of it...

    Five doctor internal medicine practice recently made a decision to drop going to and taking care of patients as attending in local hospital as we have done since practice started over fifty years ago. Hospital administrator has said he will have to hire two additional hospitalists to cover our patients that require inpatient care.

    Here are the reasons:

    1) We are getting burnout of the nighttime and weekend hospital callls. The specialists will not admit their own patients but have hospitalists or primary care admit.....even if it is a complication of some prior procedure they have done.

    2) With more and more patients going to Medicare Advantage getting tired of case managers asking us to do peer to peer of hospital denials.

    3) Bundling of payments appear on the way and primary care will be low man on totem pole.

    4) For us senior docs seems to be a easy way to transition to retirement.

    5) Difficult to recruit young doctors to join practice since most do not want to do both office care and hospital care.

  • #2




    Five doctor internal medicine practice recently made a decision to drop going to and taking care of patients as attending in local hospital as we have done since practice started over fifty years ago. Hospital administrator has said he will have to hire two additional hospitalists to cover our patients that require inpatient care.

    Here are the reasons:

    1) We are getting burnout of the nighttime and weekend hospital callls. The specialists will not admit their own patients but have hospitalists or primary care admit…..even if it is a complication of some prior procedure they have done.

    2) With more and more patients going to Medicare Advantage getting tired of case managers asking us to do peer to peer of hospital denials.

    3) Bundling of payments appear on the way and primary care will be low man on totem pole.

    4) For us senior docs seems to be a easy way to transition to retirement.

    5) Difficult to recruit young doctors to join practice since most do not want to do both office care and hospital care.
    Click to expand...


    One more factor: Hospital going to paperless charts and hospital has a cumbersome EHR (Meditech). It's no a big deal for the hospitalists since they get paid by the hour but for the primary care doc who has to get back to office to see waiting patients it is.

    Comment


    • #3
      I'd drop it and do social rounds on your patients. Improve your quality of life, probably no change in compensation, and still be involved from a social aspect if possible.

      As a subspecialist, I hate admitting my own patients. One hospital is great and everything is admitted to primary or hospitalist. This way, when I fix their hip fx and they're still in the hospital 10 days later I'm not rounding everyday writing ortho stable for DC. The other hospital, their hospitalists refuse to admit, but only will consult...becomes a fight to transfer to their service after patient is just sitting in the floor with med problems.

      Comment


      • #4
        Wait... do you have to have hospital privileges for your malpractice insurance? If so,  we have a "outpatient medicine" privileges that are not required to come into the hospital. It still means you have to go to meetings, etc. but you get to keep your malpractice insurance. Just make sure....

        Comment


        • #5


          The other hospital, their hospitalists refuse to admit, but only will consult…becomes a fight to transfer to their service after patient is just sitting in the floor with med problems.
          Click to expand...


          I am not ortho (as you can tell by my name) but I thought there was evidence that in hip fractures over a certain age (55?) that they do better being admitted by the hospitalist? Take that evidence to that hospital and get that changed!

          Comment


          • #6
            you are a tiny dam in the way of raging waters.  i think nostalgia can only carry on for so long.  sad but you can still help the outpatients.  perhaps access will improve.

            good of you to keep fighting the good fight so long.

             

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            • #7
              Perspective from an ER doc -- I think primary docs admitting their patients is a very difficult model that often has major problems.

              Hospitalists are specialists in inpatient medicine and are physically present in house most of the time.

              I used to work at a shop where we had an complex flow chart of who admitted who and when, it sucked, it really sucked.

              Comment


              • #8
                The internal medicine guys at my hospital have slowly dropped out of coming into the hospital.  All who have done it have been happy about it.  Most have said their income went up due to being able to have a more consistent office schedule.

                From a cardiology perspective, I have mixed feelings about hospitalists.  I love that they will admit everyone.  And I would much rather have a hospitalist as the primary than a family practice outpatient doctor when there is a sick sepsis train wreck patient in the ICU.  However, the hospitalists don't care much about what happens to the patients after they leave--so hospital discharge instructions and transition of care is done much less carefully.  The hospitalist model also guarantees that most patients are admitted to the hospital with doctors they have never met before, and therefore have no pre-existing relationship and no trust.  This doesn't make for great end-of-life and other high level discussions.

                Comment


                • #9
                  This isn't 1960s anymore.  Heck; not even 2000.   There's simply sicker patients and more intensity in hospitals today than even last year.  It's not a simple procalcitonin level either.

                  OP - the hosp admin has been enjoying the relative free ride your group has been giving them.   Time to cut the cord and restore some balance to today's medicine

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                  • #10
                    Yea drop it and move on.

                    Comment


                    • #11
                      You came to the wrong place to talk you out of this decision.  As a member of the millennial physician generation, I can tell you that no one wants to do that anymore.  My residency/fellowship classmates and I look at practices that still do this and laugh.

                      Comment


                      • #12
                        I thought I would be doing hospital medicine along with my primary care job.  I really enjoyed it in training.  I think it is great for transition of care and we can take really good care of our own patients. The patients really do like it.  Except when uncle Joe from out of town shows up at 2pm and wants to have a family meeting.

                        However when I actually looked for jobs I found that it is that the only groups still running this model were quickly falling behind.  They had a hard time recruiting because not many people wanted to do it and did not want the call.  The jobs I looked at paid less then purely outpatient jobs.  There is a lot to keep up with in outpatient medicine as it is.  Not that it is impossible by any means to stay on top of both but it is harder.

                        What is worse then an EMR???  Having to know 2 EMRs!

                        Gone are the days where if you forgot to order a lab you could just call the floor and add on that CBC.  Now you have to log in, boot up the EMR, find the patient, order the test,  wait for them to call you back saying that you forgot to sign the order,  log back in, ND  sign the order.

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                        • #13
                          I'm downright shocked that there is any discussion at all.  The model is clear, your hospital administrator is woefully out of touch, even for a hospital administrator.

                          So, yeah, time to join the new century!

                          Comment


                          • #14
                            Drop it and never look back!!! My life and call got so much easier when I stopped doing inpatient work. There literally hasn’t been one second where I regretted the change.

                            Comment


                            • #15




                              Wait… do you have to have hospital privileges for your malpractice insurance? If so,  we have a “outpatient medicine” privileges that are not required to come into the hospital. It still means you have to go to meetings, etc. but you get to keep your malpractice insurance. Just make sure….
                              Click to expand...


                              Thanks. Will look into it.

                              BTW, did you get a lower rate on malpractice dropping going to,hospital?

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