Among the hospital-based medical specialists, first there was the pathologist. Then there was the radiologist, followed by the hospitalist/intensivist, and now the surgicalist. Pathologists gravitated to hospitals because that's where diseased tissues were frequently removed and the surgeons needed someone to tell them what they had taken out. Radiologists initially established their practices in hospitals because their imaging equipment was expensive and bulky, as it is today, and because the sickest patients gravitated to hospitals.
I encountered an article entitled Not On Call that discusses the emergence of the latest iteration of the "ist" specialist -- the surgicalist. Below is an excerpt from it (boldface emphasis mine):
The hospitalist concept, despite early resistance from admitting physicians, has become so common that many of those same doubting doctors now rely on hospitalists as a key piece of their patients’ continuum of care. In fact, it’s worked so well that some hospitals, fed up with the high costs and inefficiencies associated with call coverage, are extending the concept to their surgeons. Now, so-called “surgicalists” are rapidly gaining popularity among some forward-thinking hospitals that are facing mounting pressure to pay physicians ever-higher amounts for call coverage....But many hospitals and surgical groups are finding that employing a few general surgeons within a multispecialty group to handle call cases is increasing throughput at the hospital and increasing the quality of life for the rest of the physician group practice—at little detriment to the income of the remaining physicians. [One surgical group practice] employs 35 surgeons from a range of specialties, including 18 general surgeons. Eight of those surgeons are involved in [a hospital's] surgical hospitalist program. At least one surgicalist is at the facility 24 hours a day, seven days a week, which helps the hospital free up beds more efficiently and schedule emergency surgeries almost immediately. The result is less waiting for patients in pain from vascular, colon and appendix problems, for example, while the hospital is able to increase patient throughput.
The reasons for the emergence of the surgicalist cited in this article are interesting and based largely on hospital budgetary reasons. They include the escalating cost for hospitals of paying physicians for on-call coverage and the need for more efficient bed management and greater patient throughput. Quality issues associated with the change are also cited including less waiting time for urgent surgical procedures.
The emergence of an increasing large cadre of hospital-based medical specialists, I suspect, works to the advantage of lab and pathology professionals who can then develop a closer working relationship with such colleagues who are readily available for consultation. However, it does seem that the trend creates an even greater physical and cultural gap between office-based and hospital-based physicians. The trend also creates a greater schism between the clinical information contained in office EMRs and hospital EMRs and thus an even greater need for interoperability between these two islands of clinical information.
I'd like to know more about the level of luxury offered by the hospital to these live-in docs. Do they have room for a wife and kids?
Also, do they get secretarial help with their everyday needs? How can they go to the bank, buy clothes, etc?
Sound very difficult to apply in real life.
Posted by: EM | December 11, 2006 at 12:54 PM