Hospitalists and family physicians: Understanding opportunities and risks

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Original Research

Hospitalists and family physicians: Understanding opportunities and risks

J Fam Pract. 2004 June;53(6):473-481

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References

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This study additionally questioned whether hospitalist care is truly of better quality and lowers costs. Findings of higher costs associated with subspecialist vs generalist hospitalist care also warrant further investigation in larger studies. Also, because many recent studies have examined only length of stay and in-hospital costs, it is still unknown whether the hospitalist model produces costs savings for the health system overall.¹²

Opportunities to further study hospitalists and their impact

Research has focused largely on quantitative values related to hospitalist care. Yet the emergence of this new provider type introduces issues to be studied that encompass more than effects on length of stay and mortality.

In particular, questions remain about issues surrounding the patient–physician relationship, including patient perceptions of how hospitalists affect communication, continuity of care, and trust.¹⁶ Similarly, studies have investigated primary care physicians’ attitudes regarding desired communication with hospitalists,¹⁴ but none have studied the changing role of primary care hysicians who no longer perform inpatient care, or have questioned family physicians about career satisfaction.

Further, published studies have not been large enough to consider the influence of multiple independent variables such as hospital type, hospital location, or patient factors such as insurance status, disease classification, or psychosocial issues. Table 4 shows some of the many opportunities to formally study the effect of hospitalists on family practice, considering both the areas of existing research focus and new areas that can be explored.

TABLE 4
Opportunities to study impact of hospitalists on family practice

Existing research focus on hospitalists
Satisfaction of patient, hospitalist, primary care provider
Quality of hospital care
Effects on hospital length of stay
In-hospital mortality
Readmission rates
Hospital cost savings opportunities
Hospitalist productivity, workload
New areas for family practice-focused research
Family practitioner experience, satisfaction
Perceptions of family practitioners, other primary care providers regarding disruption of patient care relationships,⁴⁰ continuity of care issues
Outpatient costs, follow-up care costs
Economic impact of alternative compensation arrangements
Evaluation of economic and noneconomic benefits of continuity of care
Integration with nonhospitalist physicians, nonphysician workers
Qualitative perspectives of different stakeholders
Distinction between urban and rural practice settings
Distinction between community-based and academic practices
Family practitioner productivity, workload

Conclusions

Given that the goal of hospitalists is to affect the hospital sector of the US market—associated with around $430 billion in expenditures for 2000^54,55 —the potential to decrease costs while preserving quality of care is undeniably attractive. However, research evidence does not show uniformly positive results from the introduction of hospitalist programs.

A primary concern is that the purposeful discontinuity of care introduced by the hospitalist can affect quality of care, resulting in medical errors and poor outcomes for patients.³² In addition, more attention must be given to compensation and reimbursement so that family physicians are not discouraged from providing inpatient care for purely financial reasons.

Although a number of publications have discussed the implications of hospitalists, the specific effect of the hospitalist model on family practice remains largely unknown. Knowledge of such effects can be increased by performing well-designed research involving family physicians and by including both qualitative and quantitative approaches. Answers to clinical and managerial questions such as how to best manage communications, how to facilitate the crucial transitions between outpatient and inpatient care, and how to maintain clinical relationships given the introduction of a new provider type can help family physicians preserve and enhance relationships with hospitals, inpatient providers, and patients.

Acknowledgments

The author is very grateful to Kelly Kelleher, MD, MPH, and to the editors of this Journal for thoughtful review and suggestions to improve this report. The author has no conflict of interest to report.

Correspondence
Ann Scheck McAlearney, ScD, Division of Health Services Management and Policy, Ohio State University, School of Public Health, 1583 Perry Street, Atwell Hall 246, Columbus, OH 43210-1234. E-mail:mcalearney.1@osu.edu.