Hospitalists and Primary Care Physicians: A delicate balance

One physician quote: He tells patients, "The way the insurance is now, I can't afford to make hospital rounds. I think this is bottom line all the way around...$$....one more good analytical article from Medical Economics...BD

Jeffrey K. Pearson, a family physician in San Marco, CA, has to send his managed care patients to a hospitalist because his IPA, which contracts with a hospitalist group, won't pay him extra to round on HMO patients. He doesn't have to refer his other patients to hospitalists—yet he does.
"I love hospital work," Pearson explains. "But it got to the point where I just didn't have the time. If I got an admission during the day, I couldn't leave my office; if it was at night, I'd be at the hospital for five hours. I was just getting beaten down."
There are now about 20,000 hospitalists, four times as many as there were in 2002. Nearly half of all US hospitals have them, and the percentage tops 70 percent among larger institutions. According to internist Robert Wachter, who heads the hospitalist program at the University of California, San Francisco, the only thing that's preventing the field from growing even faster is a shortage of qualified candidates.
But several doctors told us they'd been given this choice: Either use hospitalists for all of a particular plan's or a hospital's patients, or not at all.
Five years ago, many of the physicians whom Medical Economics talked to about hospitalists said they could earn more by seeing patients in the office than by following them in the hospital. Now, it seems, doctors aren't so sure.
Take FP Joel Dickerman, who finds that the extra amount he's able to earn by seeing more patients in the office is counterbalanced by the additional overhead he's incurring. "For every hour you spend in your office, 50 percent of what you bring in goes to overhead," he says, noting that more patient visits mean more clinical staff. "When you're in the hospital, you keep 90 percent of what you collect, and only 10 percent goes to overhead."