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This doctor sees inpatients only

New 'hospitalists' help ease the burdens on physicians

A new breed of doctor who treats patients only when they are hospitalized is becoming more prevalent in Boston-area hospitals, according to a study published yesterday.

The doctors, known as hospitalists, are rapidly increasing in numbers around the country, but have become especially prominent in Boston-area institutions as primary care physicians spend less time seeing patients in hospitals, said Dr. Hoangmai H. Pham. A senior health researcher at the Center for Studying Health System Change in Washington, D.C., he was principal author of the study.

''We found that hospitalists are emerging as a more prominent source of inpatient care, but it's happening for a variety of reasons," Pham said. ''In Boston, primary care physicians are under a lot of revenue pressure. Their revenues are not keeping up with their costs. The hospitals in Boston felt compelled to provide hospitalist care as a support for their primary care physicians."

Hospitalists are members of a new medical specialty focused on providing care only to patients in hospitals, whereas primary care physicians split their time between their offices and hospitals.

The hospitalists ensure that patients receive proper, timely care and are protected from hazards such as hospital-borne infections. In addition, hospitalists play an increasing role in intensive care units and in care for nursing home patients on brief hospital stays.

They also keep hospital costs down.

The problem for primary care physicians, Pham said, is that they receive the same fee whether they see a patient in their own office or have to travel to the hospital. Hospitalists help to ease some of that burden by reducing the number of trips to the hospital by primary care physicians.

''Boston is one of the extreme markets where physicians have historically been underpaid, given their high cost of living," she said.

The prevalence of hospitalists in Boston has little to do with the concentration of teaching hospitals, said Pham, and more to do with the economics of medical practice.

Dr. John Beamis, chairman of the Division of Internal Medicine at Lahey Clinic in Burlington, said he plans to double the number of hospitalists to six by July. Hospitalists are needed because ''the patients in the hospital now are sicker than they used to be, they're in for a shorter period of time, and they demand more care," he said. ''They need dedicated care by people used to doing it all the time in the hospital environment."

For instance, he said, a hospitalist might see a patient and order tests early in the morning, while the patient's primary care physician might not visit the patient until later in the day.

The Society for Hospital Medicine, which represents the new specialty, said the number of hospitalists grew from several hundred in the mid-1990s to more than 8,000 in 2003, the latest data available, according to the study.

Dr. Joseph Li, director of hospital medicine at Beth Israel Deaconess Medical Center, said his staff of physicians plays an increasing role in the training of residents, the newly minted doctors who perform rotations at hospitals to learn different medical specialties.

For instance, he said, a hospitalist would oversee residents performing bedside procedures such as spinal taps, ensuring that the novices perform the procedure properly.

With the oversight, he said, ''You're likely to be better at performing the procedure, and that will increase patient safety. The primary teachers in patient wards are hospitalists."

The study said that hospitalists may need more training as their role continues to expand.

''Because most hospitalists are internists, internal medicine training programs may want to consider ways to provide elective supplmental training for graduates interested in hospitalist careers," the study said.

Jeffrey Krasner can be reached at

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