A need for call coverage and the boom in outpatient care are driving health systems to develop hospitalist models for medical specialties not traditionally associated with hospitalists, including gastroenterology.
Clearwater, Fla.-based BayCare Health System, which operates 16 hospitals, is one system hopping on this trend. Sowmya Viswanathan, MD, BayCare’s chief physician executive, told Becker’s the shift is being driven by complexity and volume.
The traditional hospitalist model
Hospitalists typically focus exclusively on inpatient care, managing hospitalized patients throughout their stay rather than maintaining outpatient clinics.
Hospital medicine is a specialty tailored for acutely ill, hospitalized patients. Known as hospitalists or laborists, most of this workforce completed residencies in internal medicine, general pediatrics or family practice, according to the Society of Hospital Medicine. Other physician specialties are increasingly included in hospitalist models, including neurology, oncology and OB-GYN.
The hospitalist model was partly borne out of a need to split focus between inpatient and outpatient settings. For example, obstetricians usually choose one setting because it is difficult to balance the inpatient setting’s on-call burden with the outpatient setting’s high-risk case load, according to Dr. Viswanathan.
She noted a trend Becker’s has heard from other clinical executives across the U.S.: Some employees are framing on-call coverage as a burden and asking for flexibility. In response, systems are establishing new hospitalist models.
“Whether we call it a hospitalist or not, every specialty is looking at, ‘When we have really complex patients, do we need to create a team that takes care of them?’ They’re all looking at it, they’re just calling it different names,” Dr. Viswanathan said.
At BayCare, for example, has an advanced heart failure group for patients requiring quaternary care, such as those needing ventricular assist devices or extracorporeal membrane oxygenation. Although not officially categorized as hospitalists, this group functions within that framework.
BayCare’s approach
BayCare has formal hospitalist models in internal medicine, palliative, obstetrics and neurology. The system is exploring similar models for other high-volume specialties, including oncology, gastroenterology and orthopedics.
Physicians in gastroenterology and orthopedics approached BayCare in search of a hospitalist model.
When volume rises, “it almost becomes unsustainable for a regular gastroenterologist or an oncologist to take care of them,” Dr. Viswanathan said. “You have to carve out the hospitalist model because the volume is so high. It completely depends on how much volume of those high-end cases [you are] getting — that requires you to have a hospitalist in the hospital taking care of these patients.”
So far, the process has been trial-and-error.
There is no “cookie cutter” formula for creating new specialty hospitalist models, according to Dr. Viswanathan. Two key variables are call coverage and compensation structure.
To determine these, health systems must consider several factors. “The types of consults they get, the hours in which they are asked to come in, the number of hours they have to work at one stretch is very different based on the specialty and the types of services that specialty caters to,” Dr. Viswanathan said.
There is also more variance in the complexity of cases managed by different specialties, requiring different call schedules for obstetric versus neuro hospitalists at BayCare.
“Neuro hospitalists, a lot of times, can go one week on, one week off, easily, whereas an OB hospitalist, we have to constantly think about their schedule,” Dr. Viswanathan said. “If they have had absolutely no sleep at all, we need to make sure that we have reinforced more staffing … so that they are able to go home and take a good night’s rest.”
One advantage of developing new specialty hospitalist models is flexible call coverage. A schedule of one week on, one week off may contribute to burnout, so Dr. Viswanathan recommended systems experiment with more adjustable call coverage schedules.
