Hospitalists Could Be One Solution to Physician-Hospital Conflicts, According to Commentary

"Many hospitals ... are seeking to eliminate conflicts" between physicians and hospital administrators "by hiring or contracting with hospitalists, physicians who see patients only in the hospital setting," Manoj Jain, an infectious disease physician and a medical director for Medicare's quality improvement organization in Tennessee, writes in a Washington Post commentary.

Jain cites an eight-year-long "standoff" between physicians and administrators at the hospital in which he works over increased reimbursements for extra on-call responsibilities. According to Jain, the "frightening possibility" arose that a patient would need emergency surgery and "no surgeon would arrive." Jain writes that although such a situation never happened, "the dispute made one thing clear: The disagreement might be between the doctors and the hospital, but the party most at risk was the patient."

According to Jain, physicians are earning less because of decreasing reimbursements from health insurers, more uninsured patients, the high costs of medical liability insurance and increasing costs of running a private practice. In addition, many physicians prefer to make decisions on care on a patient-to-patient basis, not on evidence-based guidelines. Meanwhile, hospital administrators also "face their own budgetary problems" and "push doctors to be aware of cost when ordering tests and to reduce the length of hospital stays." There currently are more than 20,000 hospitalists nationwide, up from a few hundred 10 years ago, according to Jain.

He writes, "Having a salaried staff of doctors gives administrators better control over physician quality measures and length of stay" and also "shifts more of the focus of private physicians to the outpatient setting." He continues, "Unfortunately for the patient, this means two primary care doctors: one for when they are in the hospital, the other for the rest of the time." Jain concludes, "Quick and easy solutions to conflicts may not be on the horizon," but "they have to be reached, because doctors need hospitals and hospitals need doctors. And patients need both" (Jain, Washington Post, 9/16).