So what changed, that my personal doctor can’t take care of me in the hospital?
This honestly is a little complex. Over the past decade there has been significant pressure on your Family Doc. In our own community, we had difficulty getting Internal Medicine consultations, and were getting overloaded with being assigned patients from the Emergency Room, who had no doctors, who where very sick, and mostly didn’t pay any of their bills. Our hospital had trouble attracting physicians to take care of these needs. We decided to get help with a new movement – Hospitalists. The hospitalists group were willing to bring down needed doctors in our area, but they needed more than patients that got their care free, but also our own patients to make it worth their while. During this same time, articles came out showing Hospitalists cost less and saved the hospital money, reinforcing the Hospitalist roll (more recent studies have now shown an opposite trend, and showing huge problems with “transitions of care” – patients being discharged home or to nursing homes and medications/information not being transferred right to their Family Doc). Hospital policies managing doctors have rightly questioned a Family Doctor taking care of their patients in the hospital after 4-5 years not doing so. Would the doctors be rusty and in fact not provide up to date care? So policies were made to make sure these docs were safe, but now for me to resume taking care of patients in the hospital, I will essentially need to go back to a “residency” program for a year to be credentialed (away from my office and patients in an approved program in another city).
In addition during this time, due to the disparity in reimbursement between outpatient medicine and inpatient medicine for private practice, it is not economically feasible to take care of patients in the hospital. To cover the increasing overhead costs, when the office is open I need to be seeing patients in the office. The reimbursement for time invested is much less for an office-based physician seeing patients in the hospital and not in the office. To give a readily available example, I still do exercise treadmills at the hospital for my colleague’s and my patients. I am usually at the hospital for 20 minutes or more. I get paid less for that time, than I get for a ear wax removal my nurse does, or spirometry (breath measurement) my nurse performs and I can see another patient while they do those tests. With the margin so tight in private practice, there is an economic disincentive to following our patients in the hospital.
Our Hospitalists do very good work. We are happy with the work they do for our patients. They also make sure we have the discharge information before seeing you in follow up. Dr. Fick has done a superb job at managing this.
Economics and politics have made us into “outpatient” docs only.