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Most European nations long ago delegated inpatient care to hospital-based physicians, so-called hospitalists, with primary care physicians (PCPs) providing only outpatient care. The United States, where patients have always counted on having their own PCPs at their hospital bedside, is following suit. PCPs are being pushed out of U.S. hospitals by hospitalists, physicians employed by managed care organizations and hospitals to care for hospitalized patients in a more efficient way. Despite initial concerns about problems with continuity of care and doctor-patient communication, most California PCPs felt that hospitalists had a positive effect on patients and on their own practice satisfaction in 1998.
This was true especially in voluntary hospitalist systems that decreased the workload of PCPs and did not threaten their income. However, California PCPs, particularly internists, were less accepting of mandatory hospitalist systems, according to a study supported by the Agency for Healthcare Research and Quality (HS09557). Doctors don't like to be forced to hand over their patients at the hospital door, explains principal investigator Andrew B. Bindman, M.D., of the University of California, San Francisco.
The researchers mailed a survey to randomly selected general internists, general pediatricians, and family practitioners in California who had experience with hospitalists to ask the physicians about their views of hospitalists. Of the 524 responding physicians, 64 percent had hospitalists available to them, and 23 percent were required to use hospitalists for all admissions.
Physicians perceived hospitalists as increasing (41 percent) or not changing (44 percent) the overall
quality of care. Sixty-nine percent reported that hospitalists did not affect their income, and about half said that hospitalists increased their practice satisfaction (50 percent) and decreased their workload (53 percent). On the other hand, 28 percent of PCPs believed that hospitalists decreased the quality of the doctor-patient relationship. Internists, physicians who attributed loss of income to hospitalists, and those in mandatory hospitalist systems viewed hospitalists least favorably.
For more details, see "Friend or foe? How primary care physicians perceive hospitalists," by Alicia Fernandez, M.D., Kevin Grumbach, M.D., Lara Goitein, M.D., and others, in the October 23, 2000 Archives of Internal Medicine 160, pp. 2902-2908.
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