FP Report -- March 1999
Task force finds variety of views about hospitalists
AAFP President-elect Bruce Bagley, M.D., chaired the 1998 Task Force on Hospitalists.
Bagley"We found we couldn't be for the hospitalist idea or against it," said Bagley, of Albany, N.Y.
He said about 20 percent of AAFP members use hospitalists, about 55 percent are neutral on the hospitalist concept and about 25 percent believe going to the hospital is part of being a complete family physician. The latter group, said Bagley, wonders, "How could the AAFP consider letting anyone be a hospitalist?!"
In Bagley's practice, physicians take weekly turns doing hospital rounds in the morning and then -- usually over lunch -- update other physicians on the patients. "We've done this for 22 years," said Bagley. "I don't know why, all of a sudden, it needs a label."
Even though the percentage of family physicians with hospital admitting privileges sank from 91.1 percent in 1988 to 85.8 percent in 1998, only about 4 percent of physicians throughout those 11 years felt their privileges were unduly restricted.
"Most family physicians who dropped their privileges did so voluntarily, and they're not upset about it," said Bagley.
He acknowledged, however, "The potential is there for a managed care organization to say, ÔWe'll take care of your hospitalized patients.' People are afraid of involuntary exclusion from the hospital. We all should be concerned about that."
The AAFP Congress of Delegates approved several task force policy recommendations, including:
- The opportunity to serve as a hospitalist must be open to all interested, qualified physicians.
- The decision of who should care for a family physician's hospitalized patients should be made by the patient and the family physician.
- Family physicians should consider the mid- and long-range implications for their practices before they relinquish hospital privileges.
Many physicians who talked with task force members stressed the importance of communication between the hospitalist and the primary care physician. "The concern has always been lack of continuity," said Bagley.
So the task force developed "Guidelines for Interaction in 'Hospitalist' Models."
The guidelines are attached to a report to the Congress of Delegates, "Hospitalist Models for Inpatient Care."
The report and guidelines are available at http://www.aafp.org/x19805.xml or may be ordered free as item #R708 from the AAFP order department at (800) 944-0000. They are also available as document #8001 on the AAFP Express fax service (see page 2).
AAFP commissions are continuing to monitor the hospitalist trend.
FP Report is published by the AAFP News Department. Copyright © 1999 by American Academy of Family Physicians.
FP Report | Headlines |AAFP Home | Search