Comments on: The Battle of the Century - The Hospitalists vs The Specialists.

By: SVM

SVM — Thu, 09 Apr 2009 17:47:20 +0000

This seems like a very tunneled vision/view.
The sub specialists are likely sub standard at your hospital.
Sub specialists do help (and again not everyone is created equal) in timely diagnosis and sometimes in quicker discharges, ultimately to the patient’s benefit. I work as a sub-specialist and as an hosptialist and YES there are times (when a PCP consults me) that I do order more tests (if I think appropriate), however that helps me pick something up that either fixes the prob or convinces me that the patient can be discharged with further out-pt follow up. This is not as black or white to me, the hosp vs sub-specialist arguement.

By: Patient Directed, I Mean Demanded Care

Patient Directed, I Mean Demanded Care — Tue, 09 Dec 2008 11:34:33 +0000

[…] for an argument, she had insurance, so I figured I might be able to get one to see her as a “feed the Bulldog” […]

By: ERP

ERP — Thu, 04 Dec 2008 14:47:35 +0000

Well, RN, you are right, if the hospitalist does not know what he or she is doing, the point of their existance is moot. Ours happen to be very good luckily.

By: RN in a rural hospital

RN in a rural hospital — Thu, 04 Dec 2008 12:42:20 +0000

Alo t depends on the quality of the hospitalist, ours can’t seem to function independently, basically they need someone to blow their noses for them. The patient waits for the specialist to consult prior to treatment at times, or the hospitalist not knowing what to do orders a lot of unnecessary test practicing preventive ( litigation) medicine. There is a big disconnect with our hospitalist program. They spin trying to figure out what is going on with the patient, can’t complete a task and write orders constantly contriadicting each other. They don’t want the nurses to bother them, thus leaving patients again waiting for care.
This may work in large hospitals but it is a failure at ours.

By: Trifling Jester

Trifling Jester — Thu, 04 Dec 2008 04:42:00 +0000

It has always been my understanding that you will pay much more for an inpatient test than an outpatient test.

By: ERP

ERP — Thu, 04 Dec 2008 03:47:55 +0000

The point of my post was that specialists tend to order lots of tests - that specifically pertain to their subspeciality. This includes things like Echos, PFT’s, Small Bowel Series, CT’s, Thalium Scans, MRI’s, etc. These tests can often be done as an outpatient and are thus less expensive. This is in addition to the billing that the specialists do for their consult. Internists/Hospitalists that manage a case by themselves tend to order less. In my opinion, if the outcomes of the patients are the same (ie, they do just as well), it is better to order less and save money.

By: anonymous

anonymous — Thu, 04 Dec 2008 03:40:33 +0000

the original post posited that one way money would be saved is by fewer echo’s or pft’s being ordered. i simply raised the question of whether that was true or not. whether you ordered it, or the specialist ordered it, or an outpatient doc ordered it, if the test was ordered, there would be no savings.
the specialists leaving comment is not ridiculous. you may not have seen it, but that does not make it true. that does not imply that the hospitalists ‘had better’ consult the specialists for easy cases, just that there are multiple consequences for the decisions we make.

By: The Happy Hospitalist

The Happy Hospitalist — Thu, 04 Dec 2008 01:51:00 +0000

to the anon just above. I order an echo if I think I need an echo to manage a patient, which is far less often than a cardiologist, I’m sure. If the echo suggests the need for a cardiologist I get a cardiologist involved. I don’t need a cardiology consult to order an echo. Any more than I need a pulmonologist to order PFT’s. Any more than I need a gastroenterologist to order a small bowel series. I am capable of interpreting the results of these tests in the context of clinical medicine.

Internists, shocking to some, are trained to manage many organ system diseases that stake claim to a specialty. The rational that hospitalists had better consult the specialists for the bull dog cases or they will leave the hospital is ridiculous. Too many cooks lead to a pile of burned wasted expensive pasta.

By: anonymous

anonymous — Wed, 03 Dec 2008 21:15:36 +0000

do you avoid echo’s, or are they just done outpatient? i suspect the latter. in that case, you just made things less convenient for the patient, and potentially more expensive for them.
in any case, you will probably see contraction of specialists if the volume of consults drop enough. specialty groups will ally themselves with one hospital in exchange for guarantees of work volumes. that may mean less availability of docs for the sicker patients as well.
no free lunch here.

By: The Happy Hospitalist

The Happy Hospitalist — Wed, 03 Dec 2008 15:42:27 +0000

This also relates to my post a couple days ago about how doctors are retreating to their office work and outpatient surgical cases that are generally easier to manage, quick, pay well and are easy to scale on volume. Hospital work? The patients are sicker and you don’t get paid more for taking care of sick people.

By: Toni Brayer, MD

Toni Brayer, MD — Wed, 03 Dec 2008 06:39:06 +0000

What a great and insightful post and so so true. I am going back and linking it on a blog I just this moment finished on “hospitalists”.

By: The Happy Hospitalist

The Happy Hospitalist — Wed, 03 Dec 2008 00:39:28 +0000

I agree with everything you said.