Is the integration of urgent, emergent, inpatient and
care of patients with
acute medical conditions.
By Amina Martel, MD
Dr. Martel is the Medical Director of a Galen site in San Jose, California. She holds a BA in Biology from Boston University and an MD from St. George’s University School of Medicine. She completed her Internal Medicine residency at Cook County Hospital. Dr. Martel joined Galen in 2004.
When I started working as a hospitalist in 1998, there were only a handful of such jobs available in the country. Hospitals were either thinking about starting a hospitalist medicine program or trying to decide if they even needed one. I started working as a hospitalist right out of my residency at Cook County Hospital outside of Chicago (which was an experience in itself). I was full of energy and knowledge, as I had just taken my ABIM boards, and thought I could handle anything. Well, my first few years were very humbling. I found out I had a lot to learn about medicine and life. It was a challenge to try to navigate patients’ end of life issues while figuring out if I really even wanted to be a hospitalist for the next 20+ years.
I used to get comments from the PCPs that the hospitalist was just a highly paid resident, because if you were a real physician, you would take care of the patients in the clinic as well as when they were in the hospital. Or that a hospitalist was just a temporary phenomenon that would not last. And there was always the comment that hospitalists could not know a patient they were seeing for the first time as well as a PCP who had taken care of the same patient for years.
While I thought that was a valid point, I also knew from experience that a hospitalist familiar with acute care medicine and hospital procedures can establish a rewarding and meaningful relationship in a short amount of time with patients and their families. In addition, I observed that having hospitalists available 24/7—unlike PCPs who have to be consulted or called in—is very comforting to both the patients and the medical staff, and can save lives in emergencies. I learned that patients who are sick or in pain did not care who was taking care of them, as long as they were given good care and treated with respect.
It is gratifying to see that there are over 30,000 hospitalists today, and that this surge of hospital medicine is continuing across the country. I sense more physicians are realizing that hospitalists are here to stay and that a career in hospitalist medicine is a long-term choice rather than the fad it was once thought to be. In this sense, it is following the trajectory of emergency medicine as it was becoming a specialty.
Did I make the right choice in becoming a career hospitalist? You bet.
My sense is that hospital based medicine, particularly in Internal Medicine and the specialties, requires a different set of skills than office based practice. Some, by experience can master both. The scope has become so large that hospital versus clinic has become a more effective way to deliver care. What is often missing is meaningful and efficient transfer of information between the two. This is best accomplished through technology: seamless transfer of information from hospital to office based clinician similar to what Kaiser does so well. In reality, this is sorely missing in most other models and may explain problems we currently have: duplication of services, poor compliance, failure to follow up on critical results, large number of readmissions
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