The practice of hospital medicine doctors supervising the care of other physicians' patients during their hospital stays is the fastest-growing specialty in the profession.
EUGENE — In the olden days of medicine, which in this case means pre-1996, nobody had ever heard of a "hospitalist." Today, the practice of hospital medicine doctors supervising the care of other physicians' patients during their hospital stays is the fastest-growing specialty in the profession.
Frank Littell, a doctor of internal medicine and medical director of the hospitalist program at Sacred Heart Medical Center at RiverBend, says 30,000 physicians in this country have trained specifically for the specialty since the phrase was coined 14 years ago. And there still aren't nearly enough hospitalists to go around.
"Right now, there are probably from five to eight slots open for every hospitalist that's available; it's really good if you're looking for a job," Littell said. "Hospital medicine represents a whole change in the model of care.
"Part of the incentive was, 'Gee, if a doctor doesn't have to drive to the hospital, park, see one or two patients, then drive back to the office for regular office hours and still be on call for hospitalized patients it would save everyone a lot of time, money and frustration.'"
The concept has proved successful for patients as well as physicians, he said. RiverBend now has the equivalent of 31 full-time hospitalists on staff, not counting pediatrics, which runs its own program.
Every day, there are 17 hospitalists on duty. They fill three shifts around the clock at Sacred Heart's RiverBend and University District hospitals, Littell said.
The hospitalist program in the children's arena at RiverBend works differently, said pediatrician Paul Bouressa, who serves as the unit's inpatient medical director.
"We do a hybrid' version here in pediatrics," Bouressa said. "All of our hospitalists here have their own outside practices, where they spend most of their time.
"But we have a rotation where each of us works a 12-hour shift for four days either all day or all night about once every eight weeks. It really provides a lot of continuity for patients."
Under the old way of doing things, hospitalized patients often saw their doctors only very early in the morning or late in the afternoon or even in the evening, before or after regular clinic hours.
That meant sudden changes in medical condition couldn't be addressed unless the physician either could be reached for telephone consultation or called away from the regular practice to the hospital, leaving other patients sitting in the waiting room.
The previous system also often meant hours of delay for patients waiting to be discharged before their physicians arrived to sign their release orders.
But with a hospitalist always on duty, none of that happens. Desiree Delsied, mother of 3-year-old Max, pronounced herself happy with the attention her little boy received during a recent overnight hospitalization with asthma.
"We went to the clinic first, and after the doctor there looked at him for a minute, we were told he needed to go to the hospital," Delsied said.
"It has been really good to have (a hospitalist) here, because one time when they tested his breathing it was OK, and 15 minutes later, his lungs were full.
"If there wasn't a doctor around all the time, he couldn't have been checked as often, and he might have had to stay longer."
Tammi Dillon felt the same way about the treatment her 4-year-old daughter, Dylan Dillon, received after a sudden onset of pyelonephritis, a form of kidney infection.
"The (hospitalist) came right to the emergency room when they decided to admit her," Dillon said. "It was good, because we didn't have to wait for someone else to be called in" to begin treatment.
Having hospitalists on hand around the clock has reduced the number of children who have to be transported to Oregon Health and Science University's state-of-the-art Doernbecher Children's Hospital in Portland by at least a third, Bouressa said.
"If we have a child with a more critical illness, there's always someone on hand to monitor them, where before a doctor would not have been available, so they might have been transported," he said. "This is so much better for families.
"And we also have a two-way camera setup with Doernbecher, so we can get consultation on many of the kids in our care without them having to be taken to Portland to be seen."
The local pediatricians who take turns watching over kids at RiverBend like the way they handle their hospital duties, "but we realize that our system is about where many other hospitalist programs were 10 years ago," Bouressa said. "Most of us didn't want to give up our outpatient practices, so for now this is the way we want to handle it."
On the hospital's adult side, a fledgling hospitalist program has been in place in the Eugene-Springfield area since the late 1990s, Littell said.
"It started with groups of primary care physicians — both Oregon Medical Group and PeaceHealth — who each (hired) a physician to take care of hospitalized patients in their groups so the primary care physicians didn't have to spend so much time making hospital rounds or responding to inpatient emergencies," he said. "It's changed in a relatively short time to the formalized hospital care system we have now."
Hospitalists at Sacred Heart's medical centers work seven days on, followed by seven days off the clock, Littell said.
"That's a very attractive schedule for many physicians. And compared with a private practice, the paperwork is negligible, which is another plus."
About 95 percent of hospitalist physicians come out of the internal medicine emphasis, and the popularity of the new specialty has contributed to a recent downward trend in the number of practicing primary care physicians, Littell said.
The necessity for a hospitalist to be conversant with all types of maladies and procedures suffered by hospital patients creates a different and steep learning curve, Littell admits.
A hospitalist might start a shift with an elderly person who sustained injuries from a fall, followed by a person in intensive care with septic shock and then a drug abuse patient with a related skin infection.
"We currently cover every ward in the hospital; across the board, there's an expectation that every hospitalist will know about everything from cerebral hemorrhage to stroke to heart failure," he said.
"To be honest, this pushes the limits. I've learned to do many things I never did in training.
"It can be rather stressful, but it's also exciting."