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PREFER INPATIENT CARE? A NEW SPECIALTY BECKONS.
Some primary-care physicians enjoy treating hospital patients-and some don't. You can't blame the ones who don't; commuting to the hospital to see a patient or two takes time that could be used to see a half-dozen or more office patients. Still, because cases in the hospital tend to be more complex, some doctors feel they're more interesting than those they see in the office. If you count yourself in this group, opportunity may be knocking at your door.
A new breed of specialist is gaining ground: They're hospitalists-primary-care physicians who manage inpatient care for a hospital's, IPA's, or group practice's hospitalized patients.* These doctors coordinate diagnosis and treatment, ensure that patients receive optimal, cost-conscious care, and get them out of the hospital as quickly as possible. Inpatients respond well to a hospitalist, because they see the doctor each day, and thus receive more attention than an office-based physician can give them.
One reason this new specialty is alluring for doctors who practice it full time is that it offers regular hours. When they're off, they're off, so they can have a life away from the job. That's a big plus for doctor parents who enjoy the challenge of hospital care, but still need predictable blocks of time to spend with their kids.
Opportunities for hospitalists are growing dramatically. While doctors employed by ER-staffing companies such as Spectrum Healthcare Services have been serving as hospitalists for years without a formal title, the field is just coming into its own as a specialty. (The National Association of Inpatient Physicians, a specialty organization formed last year, estimates there are currently 2,000 to 3,000 practicing hospitalists. But membership includes physicians who are hospitalists only part time. The organization defines hospitalists as physicians who spend more than 25 percent of their time caring for the inpatients of other doctors.) At our firm, we're getting regular requests from clients asking us to recruit full-time hospitalists. We expect such requests to grow in the months to come.
What qualifications do you need?
Prospective hospitalists tend to be general internists skilled in caring for hospitalized patients, with some critical-care-unit experience. But since many inpatients are older adults, it certainly won't hurt your chances if you have a specific interest or training in geriatrics.
Because FPs generally receive less inpatient training than general internists, their prospects for becoming hospitalists depend on how much critical-care experience they have. A family physician who spends a lot of time treating inpatients has a good shot; in fact, a growing minority of FPs have already entered the new field.
We're also starting to see demand by pediatric and multispecialty groups for hospitalists to work strictly with children. Some experts feel that the need for pediatric hospitalists will eventually rival demand for adult-inpatient specialists.
At present, there's no hospitalist board to award certification in the new specialty. But to compete for available positions, you should be certified in a primary-care field.
You'll also need a solid track record with managed-care patients. Hospitalists are most in demand by hospitals and doctor groups that have global capitation contracts. In this set-up, full risk is assumed for all patient care-including costly hospital stays. For such contracts to be profitable, inpatients must receive optimal care for the least cost. Your responsibility as a hospitalist is to plan strategies for making that happen.
Finally, you'll need excellent communication skills and a flair for diplomacy. You'll work with each patient's primary-care physician as well as with hospital-based specialists to assure continuity of care. But if the primary wants to pursue protocol A, a specialist recommends protocol B, and you favor protocol C, you'll call the shots-and take the heat.
It will also be your job to see that the primary doctor is kept in the loop, and that the patient and family members understand why you're pursuing one course of action and not another. And, of course, you'll deal with your bosses, who keep an eye on the bottom line.
Pay, Perks, And Tips For Job Shopping And Interviewing
While you needn't look only among hospitals or mega-groups for a hospitalist opening, you do need to look for an organization with enough inpatient volume to support you. Generally, that means groups with at least 15 physicians-although a smaller group might sensibly hire a hospitalist if it treats mainly Medicare patients.
When you go on interviews, ask about the number of patients you'd be responsible for. An office-based primary-care physician with an active panel will have an average of 2,200 patients, of which one or two will be hospitalized at a given time. Thus, a 15-physician primary-care group with a broad mix of patients will routinely have 15 to 30 of them in the hospital, a load a competent hospitalist should find manageable.
The greatest appeal of a hospitalist career lies in those predictable hours and in the interesting work. The pay is decent, but money isn't a major incentive to become a hospitalist. The job doesn't pay substantially more than other primary-care positions do. If you don't mind putting in extra hours, you could potentially earn &$180,000 a year, but you might do that well in many primary-care positions. Incentive plans for hospitalists are next to impossible to find.
A savvy interviewer will probably choose a couple of tough inpatient scenarios and ask how you'd manage them. So be savvy yourself: Pick two or three inpatient cases you've handled that were particularly difficult, and explain how you resolved them. Cite data that demonstrate how your solutions were not only medically but fiscally sound, and you'll make a strong argument for being hired.
This article was published by Cejka Search and originally appeared in Medical Economics Magazine. Copyright by Medical Economics Company Inc. at Montvale, NJ 07645. All rights reserved.