Hospitalistsphysicians who work full time inside hospitalsare in high demand both nationwide and in the Spokane area, where the current number of 18 such practitioners is expected to more than double in the next year.


The idea of having a doctor work exclusively within a hospital has been around this country for about 15 years and emerged in Spokane in 1997, when Group Health Cooperative hired six physicians here to focus solely on seeing patients while they were in the hospital. Proponents of the hospitalist model say such practitioners can reduce medical costs and provide better patient care than doctors who come into the hospital for brief periods.


Hospitalists these days are in even greater demand than nurses, says the Society of Hospital Medicine Journal. Dr. Bob Zurcher, who has launched a new venture to recruit hospitalists to Holy Family Hospital here, says there are 15,000 hospitalists nationwide now, but that number is expected to double in the next five years.


For every 10 hospitalist positions that are open, theres only one applicant, says Dr. Judy Benson, who coordinates the hospitalist program that Sacred Heart Medical Center launched in 2001. Benson, who also is director of the Internal Medicine Residency Spokane program, says that up to 75 percent of the new physicians who do their internal medicine residency there become hospitalists, and that percentage has been growing.


So far, only Sacred Heart and Group Health employ hospitalists here. Sacred Heart has five such practitioners in its main hospital and four more in its Childrens Hospital. Group Health employs nine hospitalists, who are based at Sacred Heart and Holy Family Hospital, which are two of the hospitals where the HMOs members receive hospital services. Empire Health Services, which owns Deaconess Medical Center and Spokane Valley Hospital & Medical Center, plans to add hospitalists to those two institutions staffs in the coming months, and Holy Family and Coeur dAlenes Kootenai Medical Center plan to hire hospitalists, too.


KMC expects to have its first three or four hospitalists on staff by July. Empire Health says it will hire six hospitalists at Deaconess and two at Valley Hospital in roughly the same time frame. Holy Family plans to have six hospitalists on board by October. Later this year, Empire Health hopes to add four more hospitalists, says Keith Baldwin, Empires vice president of medical relations.


Meanwhile, an institution that already has hospitalists on staff will add more of the practitioners. Sacred Heart Childrens Hospital plans to add two more hospitalists within the next year, says spokeswoman Danita Petek. Benson says that Sacred Heart Medical Center expects to add seven more hospitalists over the next two yearswhich could give the Spokane-Coeur dAlene area as many as 49 hospitalists by then. Group Health, however, has no immediate plans to add hospitalists.


A new model


Traditionally, hospital patients are seen by their primary-care physician or specialist, who likely sees patients in more than one hospital on a daily basis as they make their rounds. Hospitalists, in contrast, work only in a hospital setting. The idea, says Baldwin, originated about 20 years ago in other countries before catching on in the U.S. about five years later.


Seattle-based Group Health, which now has five clinics in the Spokane-Coeur dAlene area, says its hospitalists see both Group Health members and patients who arent insured through Group Health, such as Medicare patients and fee-for-service patients who pay for their own care, says spokesman Ray Summers. The latter group makes up about 20 percent of all patients seen at the HMOs clinics, he says.


Hospitalists for that private insurance nonprofit see Medicare patients because, statistically, they are the sickest patients in the hospital and require a disproportionate amount of a hospitalists time, says Dr. Tom Schaaf, who helped design the program there and headed it for eight years. Summers says fee-for-service patients may have been covered previously by Group Health or might have had prior relationships with physicians at any of its clinics.


Currently, about half of the hospitalists employed in the Spokane area are internists, which are doctors of internal medicine. The Childrens Hospitals hospitalists specialize in pediatric care, and half of Group Healths hospitalists are family doctors. Nearly all of the new hospitalists to be hired here in the next two years, however, will be internists.


At Group Health, We like to keep an equal balance of family doctors as hospitalists because they have so much more training in family dynamics and can better bridge the communication gap from outpatient to inpatient, and back to outpatient, says Schaaf.


Dr. Joseph Bujak, KMCs vice president of medical affairs, says, Hospitalists provide a huge advantage in how much better they are able to communicate with nurses and family members. A handful of doctors caring for a larger number of patients provides for better outcomes, because a smaller group is accountable.


Holy Familys Zurcher, who recently formed Hospital Specialists PLLC, of Spokane, formed to recruit and employ hospitalists at Holy Family, says, A hospitalist is always available to see a patient immediately, maybe as many as three or four times a day. They specialize in hospital medicine and get good at it.


Becky Swanson, Empire Healths vice president of marketing, says that Empire earlier instituted a 13-month, two-physician pilot hospitalist program at Deaconess that ended last October. She says doctors have been surveyed there to determine what they want in a hospitalist program, and the first three physicians hired to begin the new program will start this month.


Bujak says the lifestyle afforded by being a hospitalist is especially attractive to younger physicians, who tend to put more emphasis on working fewer hours than older doctors do. It gives them an opportunity to uncomplicate their lives, he says. Hospitalists generally know their work schedule in advance, and when youre off duty, youre off duty, Bujak says.


While the long hours a primary-care physician puts in seeing patients and being on call are legendary, the average hospitalist works about 50 hours a week, Sacred Hearts Benson says. She says its also easier for a doctor to work part time as a hospitalist than to do so as a primary-care physician.


Theres an economic advantage to being a hospitalist, those in the industry say.


Most hospitalists probably make a little more money than the average internist because the hospital absorbs the overhead costs that would otherwise go to any physician in private practice, Benson says.


Yet, there are drawbacks.


The pace is more intense in hospitals, says Dr. Karen Thykeson, who has been a hospitalist at Sacred Heart for less than a year. In the hospital, the patients are really sick.


Hospitalists here say they can effectively see from 12 to 15 patients a day, and often see a single patient as often as four times a day, says Benson.


She adds, In the hospital, there are a lot of end-of-life patients. Most of them are quite elderly, require a lot of medications, and their care is time intensive.


Says Schaaf, Its a tough schedule, and theres a lot higher potential for burnout in the hospital.


Benson says primary-care physicians initially had a hard time relinquishing care of their hospitalized patients to hospitalists.


Yet, the realization by primary-care physicians that much of a hospitalists job is to keep them informed about their patients care, and that those patients routinely return to their care after a hospitalization, has eased that concern, says Swanson.


Everybody wants a hospitalist now, Benson says.


Says Baldwin, Weve reached a point where the primary-care physician probably cant do it all anymore.


Attracting hospitalists


Zurcher, who runs the company that will provide Holy Family with its hospitalists, says it already has recruited six hospitalists who have committed verbally to come to Holy Family by October.


Empire Health has hired Atlanta-based On Compass Health Inc. to recruit and employ hospitalists for its new program at Deaconess and Valley Hospital, which Baldwin expects will have a dozen such doctors within the next year.


Cogent Health Care, of Los Angeles, will provide that service for KMC, says Bujak.


Cogent and Kootenai will jointly pick the hospitalists, with each one evaluated like any other physician joining our medical staff, he says.


Sacred Hearts hospitalists technically are employed by Sacred Heart Medical Center, and the Childrens Hospitals hospitalists are employees of an arm of parent Providence Health Services, called Providence Physician Services. Benson says doctors for both are recruited with the help of Providence Health Services.


Bujak foresees a very bright future for hospitalists.


My long-term expectation at Kootenai Medical Center is that the care for most of our 150 patients will be managed by hospitalists. If the program grows as I anticipate, it could become a program of six, eight, 10, or even 15 hospitalists.


Contact Rocky Wilson at (509) 344-1264 or via e-mail at rockyw@spokanejournal.com.