Time to return primary care docs to ‘quarterback of patient care’ role—in and out of hospitals

Hospital entance
Primary care physicians should be involved in the care of hospitalized patients, argue two doctors.

There’s one big problem when the care of hospitalized patients is turned over exclusively to hospitalists, according to two physicians.

“At a time when the patient most wants and needs the comfort of a long-time trusted professional friend, the patient instead is confronted with a stranger at the helm,” write Stephen C. Schimpff, M.D., a semi-retired internist and former CEO of the University of Maryland Medical Center, and Harry A. Oken, M.D., a primary care physician in private practice who still cares for his patients when they are hospitalized, in a blog post on Medical Economics.

It’s time to bring primary care physicians back into the picture to work with hospitalists to care for patients when they are admitted to the hospital, the two doctors argue.

Related: Embrace 'hospital medicine' approach to improve quality

While hospitalists are expert in what they do, they often have to care for a large number of patients who are quite ill. But they don’t know the patient, the way his or her primary care doctor does and patients may have multiple hospitalists caring for them over the course of an admission. Hospitalists may order redundant tests and unneeded consultations with specialists, which drives up healthcare costs, according to Schimpff and Oken.

Related: VIPs: Hospital clinicians feel the pressure when elite patients demand special attention, care

Rather than disparaging hospitalists, the two advocate for a collaborative process. “Returning the PCP to his or her positon as the quarterback of patient care is good medicine—it means greater quality, a more satisfied patient, less frustrated physicians—yet much lower total costs of care,” they write.

Meanwhile, some small and cash-strapped hospitals are turning to nurses to fill the hospitalist role. Rusk County Memorial Hospital, a 25-bed hospital in Ladysmith, Wisconsin, lost half of its primary care physicians. When patient satisfaction and outcome rates dropped, it implemented a program that employs three nurse practitioners in rotating hospitalist shifts to take some of the burden off of the remaining primary care docs and emergency physicians.

Related: In some hospitals, nurses are taking on a hospitalist role

Overall, admissions have risen by 23% since 2014 and 85% of patients are now likely to recommend care from Rusk.

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