Medical Memoirs: Q & A on being a hospitalist in this fast-growing subspecialty

The projected demand for hospitalists is increasing, so we asked Dr. Alex Viegas, a hospitalist at Winter Haven’s Gessler Clinic and Polk County Medical Association member, what it means to work in this relatively new subspecialty.

Central Florida Doctor (CFDr): What is a hospitalist?
Dr. Alex Viegas: Hospitalists are physicians who practice solely in the field of inpatient care. They are usually internal medicine doctors who after residency focus on hospitalized patients. Eighty percent of hospitalists are internal medicine MDs, while the remaining are family practice, critical care or nephrology [doctors].

CFDr: What are the advantages of being a hospitalist vs. being an internal medicine practitioner?
Dr. Viegas: The origin of Hospitalist Medicine came from the increasing complexity of inpatient care, which put tremendous pressure on the traditional internist not able to juggle both practices. The advantage of being a hospitalist is the flexibility […] to pick the amount of time they can, or need, to spend with each patient as opposed to 15-minute slots in the office. Also, it allows them flexibility in when they can start and finish their days (in most instances). It allows them to practice higher intensity medicine, which is usually what newer graduates want. The newer block schedules allow for younger individuals to pursue an active lifestyle during their blocks off.

CFDr: Are there any disadvantages to being a hospitalist, or to being seen by a hospitalist? (For example, do they suffer from lack of first-hand background with the patient’s medical history, lack of patient trust, being forced to be more of a general practitioner than they might have to be in private practice, etc.)
Dr. Viegas: Hospitalists are at a slight disadvantage when they see a patient on the first day. But once they get to know you, it is smooth sailing thereafter. The biggest disadvantage of the hospitalist movement lies in the handoff or transition of care to outpatient. If this is not properly coordinated, there can be serious ramifications to patient care. Another big disadvantage to being a hospitalist is burnout from the high intensity work environment, [and a current] annual attrition rate of 25 percent.

CFDr: Will hospitalists eventually replace some internal medicine practices?
Dr. Viegas: The hospitalist is a complement to the outpatient MD and is not meant to replace them.

CFDr: Is this a new trend in hospital care? Please elaborate on the need for hospitalists.
Dr. Viegas: Hospitalist medicine started in 1995 and has really taken off. It is the fastest growing subspecialty in medicine with a projected need of 25,000 hospitalists by 2020.

CFDr: What kind of special services do hospitalists provide for patients?
Dr Viegas: Hospitalists provide the same care that other MDs provide, but are able to do so more efficiently. This is because of their availability round the clock. It allows them to assess patient care issues first hand rather than order tests over the phone. They are able to control costs, shorten length of stay, and greatly influence positive outcomes. They are attuned to the working of the institution and contribute to quality improvement. They are able to facilitate a better flow of patients through hospitals for all [of the] above-mentioned reasons.

More and more hospitals are hiring their own hospitalists in an effort to control costs, length of stay and patient flow. Even though hospitalists usually are not able to generate their own salary, the hospitals more than make up for the salary subsidization because of the above mentioned reasons.

CFDr: Is any special training involved besides the internal medicine background?
Dr. Viegas: The American Board of Internal Medicine (ABIM) and Society of Hospital Medicine (SHM) have recently started inpatient care-focused certification examinations that hospitalists can take in addition to their residency-based certification exams.

CFDr: Are their services limited to those times when a person is hospitalized, or can they continue to offer service through outpatient clinics run by the hospital?
Dr. Viegas: Most hospitalists are limited to inpatient care. However in Winter Haven many hospitalists go to nursing homes and follow their inpatients there and this makes a tremendous impact on continuity of care.

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