FP Report -- March 1999
Rural hospitalist gets nights, weekends free
FP Ross Ramey takes day shift in hospital for rural communities
PETERBOROUGH, N.H. -- Can the idea of a hospitalist, an inpatient physician, work in a rural area? Yes, thought family physician Ross Ramey, M.D., of Jaffrey, N.H.
He already did utilization review at Monadnock Community Hospital in nearby Peterborough, N.H.; assisted at surgeries; and performed procedures for FPs and internists.
A few physicians wanted to drop their daytime rounds and admissions at the hospital, which draws patients from the towns and farms nestled among southwest New Hampshire's pine-covered hills and mountains.
So Ramey left his part-time office practice last June and does hospital-based work full time, wearing several hats.
Ramey checks the progress of Christine Vose after her third hip surgery. "We agreed to do kind of a tradeoff," said family physician James Potter, M.D., of Jaffrey. "Ross already had a practice at the hospital, and he does hospital services during the day for me so I can open my practice earlier and add evening hours. My productivity has expanded. Besides, I always felt I was unfair to patients waiting to see me when I had to leave to admit someone during the day."
The equation has a plus for Ramey: His colleagues cover the off hours and OB care, so he has most nights and weekends free -- just what his wife and three children want.
"I needed a hospitalist after our kids hit their teen years, about three years ago," said his wife, family physician Lisa Ramey, M.D. "The kids were too old for a nanny but young enough so they shouldnÕt need to fix their own suppers and take care of each other."
Lacking a hospitalist, she turned over her OB cases and inpatient work to other physicians. "I always thought the kids would need us more when they were little, but they need us more now," she said.
Ross Ramey, M.D. (right), talks with the family of a patient who is dying in the ICU. Eventually, Ross and Lisa Ramey and about 18 colleagues in Monadnock Health Services answered three questions:
- Can we afford a hospitalist?
- Is there enough work for a hospitalist?
- What jobs could be combined with hospitalist for full-time hospital-based work?
Only four physicians and two nurse practitioners refer medical patients to Ramey as their hospitalist (his other colleagues still make admissions and rounds), and his pay as hospitalist comes from inpatient care and procedures. Through contracts with Monadnock Health Services, the hospital pays for two other hats Ramey wears: He is medical director of the emergency room and has transformed his utilization review work into a community-based continuum-of-care project that will encompass agencies, wellness activities, clinical guidelines, and inpatient and outpatient care.
Ramey and James Bennett, M.D., study the X-rays of a hospitalized patient and confer about treatment. "I can shift from one role to another without disturbing the structure of an office practice," said Ramey. He's reduced the length of stay for his patients to 2.89 days, compared to other medical patients' four-day average. "I'm familiar with community services and have time to contact them right away to set up assistance after hospitalization," he said.
Ramey has worked in the area 12 years. "Everybody knows Ross. This is a rural area, and everybody knows everybody," said his wife. "He isn't a locum tenens from California."
His advice to hospitalist wannabes: "Some years of service in a practice can prepare you to be a hospitalist. There's a certain amount of seasoning that's helpful."
FP Report is published by the AAFP News Department. Copyright © 1999 by American Academy of Family Physicians.
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