Care Physician

Hospitals, practices using locum tenens physicians more often

Wed, 04 Jun 2008 06:59:56 -0400

In what some deem a troubling sign that the primary care physician shortage is getting worse, a growing number of hospitals and practices are working through temp agencies to get their staffing needs met. As has always been the case, physicians are choosing the locum tenens option for their own reasons, including the flexibility of not having to maintain their own office, the ability to experiment with different regions and facilities, and the ability to limit how many hours they work.

However, hospitals and medical practices seem to be facing a new squeeze forcing them to change their habits. According to a survey by doctor temp-agency Staff Care, spending on temp doctors across the U.S. has more than doubled since 2001, and the number of days worked by physicians as temps has grown by 20 percent between 2006 and 2007 alone. Observers say a growing demand for primary care physicians is helping to fuel this boom.

To learn more about this trend:
- read this Chicago Tribune piece

Why EDs need urgent care services

Fri, 30 May 2008 06:59:59 -0400

Today, EDs are crowded at levels they've never been before, and there's few if any signs the problem can be made better. Sure, smart hospitals can improve patient flow by investing in IT that tracks them efficiently. And there's always ways to make better use of time when patients are waiting--for example, I've heard of some that take blood samples and do an EKG while patients was boarding in the hallway.

But I'd argue that the answer isn't necessarily getting them in and through the system as quickly as possible--out the door or into beds--isn't necessarily the best way to think about dealing with this flood of patients.

After all, just because a patient isn't dying (and doesn't need to be admitted at that moment) doesn't mean that they're a) not just a bit too acute to be lightly sent home to bed, b) might benefit from palliative meds to tide them over until specialists can see them, or c) in need of more information to better self-manage their condition than the more or less useless handouts EDs typically provide. And that argues strongly for establishing at least some kind of primary/urgent stepdown presence in the ED for patients who still need help once it's been determined that they're not in immediate danger.

For one thing, a primary care-minded staff member such as a nurse practitioner can do much to help coordinate care between the ED and on-call staff at primary care practices. He or she can also ask a few probing questions of the primary care physician to see if there's tests or issues the patient might not have mentioned, something that ED physicians seldom has time to do.

What's more, an NP can help develop a slightly more robust care plan for moving forward than "here's a referral," which all many non-critical patients get. Such help not only improves outcomes overall, it also builds relationships with patients who may have a need to return to your ED someday.

On top of everything else, if hospitals place an urgent care person within the ED, that could serve as a funnel to future relationships with the patient and his or her family which could include ambulatory surgery referrals, relationships with affiliated primary care practices, physical therapy and more. In other words, while health systems may not get an admission out of that visit, but they could develop a longer-term relationship that proves fruitful for both sides.

So, folks, what do you think? Am I on base here? Is there something I'm missing? Write to me and tell me what you think. -Anne

Physicians now have many choices

Fri, 11 Apr 2008 06:59:59 -0400

A few weeks ago, I called to schedule a visit with my family's primary care doctor, and was surprised to learn that he had left the group. My doctor, a young man in his first few years as a practicing physician, already has moved to a concierge practice--in this case, one affiliated with Virginia-based PartnerMD.

This incident brought home for me something I've been watching emerge over my career as a healthcare editor (nearly 20 years). Of course, over the past decades, managed care has greatly restricted physicians' freedom to practice as they see fit, not to mention subjecting them to huge patient loads, in most cases. But particularly in the last five years or so, it's been striking how many new options have been emerging for physicians that didn't exist, or weren't realistic choices, when I began covering this industry in the early 1990s.

For one thing, my wonderful, dedicated primary care physician could have become a hospitalist rather than working solely in a traditional family practice, something that didn't exist when I started out. He could be a supervising physician for the explosively growing retail clinic market, or in one of the hybrid retail clinic/urgent care clinic models that have sprung up. Before long, I think there also will be a new "medical home" specialty of some kind that re-defines the family care role.

Specialists, meanwhile, increasingly are succeeding by building ambulatory surgery centers. A small handful are becoming telemedicine specialists, a job category that is likely to see a great deal of growth in coming years--especially for cardiologists and critical care specialists--if my research is any indication.

Not only that, for those who are cyber-friendly, a small but growing number of doctors are choosing to conduct some or all of their practice online. Insurance companies increasingly are paying for e-visits, and web technology has advanced to the point where coordination of care, patient charting, practice management and even real-time monitoring of patient care data can be done remotely... sometimes with just a smartphone.

While some of these trends may create health system imbalances for a time (my doctor's decision took one more PCP out of the traditional primary care business, for example), I believe that they will work themselves out in the long run. Hospitals may have a role here, as they certainly can lend their creativity to providing doctors with new, valuable outlets for their talents. And of course, managed care companies can think outside the box in rewarding and motivating physicians, too. (I guess pay-for-performance has some potential there, though it's not exactly a showstopper of an innovation.)

In the mean time, it's great to think that physicians like my ex-primary care doctor don't have to put decades into an unsatisfying practice model just to do what they were trained to do. Let's hear it for medical innovation. - Anne