Hospitalists Can't Fly

When I was a kid growing up, I heard that scientists had conclusively proven that Bumblebees can’t fly. I thought that was hilarious. I felt like I had stumbled onto some cosmic truth, or that a secretive, hidden society's presence had just been revealed to me. I knew that some important universal principle on how things really worked lay just beyond my grasp.

I work as a half time Hospitalist and as a half time nursing home director. On the evening of February 20, after finishing my Hospitalist rotation, I needed to complete some overdue admissions at the nursing home. There, I ran into a former partner of mine, Andy, from my earlier private practice days. And Andy was very angry.

He began: "Are the Hospitalist any GOOD over there? They discharge patients too early, they never complete work ups. My patient had an out patient MRI scheduled for her chronic back pain, why couldn't they have taken care of that while they were treating her pneumonia? They never call me, like they should, and keep me informed on everyone’s progress. I never get the discharge dictations on the day they send people home. Nobody there cares. My patients don’t like them, they’re complete strangers. As far as I'm concerned, they should all be fired and replaced. Hell, they can close the whole hospital, for the quality of work that gets done there now."

"Well, funny you should bring that up, Andy. I just heard that they were planning on closing or severely cutting back the Hospitalist program." This was not true, but I was interested in testing a theory. "You know that Hospitalist programs loose about $90,000 on each Hospitalist, and our hospital is no different. The fees generated just doesn't cover the 24/7 coverage that’s needed. In fact, as our hospital has been bleeding red ink now for over two years, what with all the other cut backs, they're looking at the Hospitalist program closely. It’s costing them 1.5 million a year. They'll probably limit the hours, maybe limit coverage to daytime only, and drop nights, weekend, and holidays in order to maximize billing and save what they can".

Watching the adrenal kick in, the pupils dilate, the pitch of his voice rise slightly, Andy said: "Now wait a minute. They can’t do that. Since I stopped going to the hospital my life has gotten way better. I don’t work as hard, and I’m making more money. My hospital rounding used to generate, maybe, 20% of my income but 80% of my aggravation. They can't close the program. How they going to cover the patients?"

"Well, Andy, they’re still your patients. You rounded on them once, you covered them once, and you’ll just do it again."

"No way, I ..."

So, in summary, my N-of-one research project demonstrates the following truths on the provision of physician based care to hospitalized patients:

1 - Hospitalists are overpaid, not conscientious, practice medicine poorly, don't communicate well with PCPs, cost hospitals millions of dollars, and patients don't like them.

2 - PCP's like to sleep nights and enjoy their families on weekends and holidays.

Therefore, I conclude, that Hospitalists Can't Fly.

Q.E.D. - Quantum Est Demonstratum.

I find that hilarious as well.

alan berkenwald, md