One of the most important factors in the intricate calculus of U.S. health care is the number of physicians who provide ambulatory primary care, and a recent policy brief spotlighted a trend that may be driving that figure down.
Authors of the brief,(jabfm.org) which was published in the September-October issue of the Journal of the American Board of Family Medicine, reviewed the 2016 Family Medicine National Graduate Survey that was administered to all board-certified family physicians who had completed residency three years earlier. They found that 8.9 percent of the 2,034 respondents who were active in patient care self-identified principally as hospitalists and did not provide outpatient continuity care.
These physicians said they worked longer hours, made more money and experienced greater job satisfaction than their non-hospitalist peers.
"If these findings are generalizable, interest in hospital medicine among family physicians may grow beyond the almost 9 percent seen in this survey," the authors wrote.
The policy brief, which came from the Robert Graham Center for Policy Studies in Family Medicine and Primary Care, suggests that increased interest in hospitalist practice among new family physicians could come at the expense of community-based primary care.
"If a larger proportion of family physicians become hospitalists, primary care physician shortages might be exacerbated," the authors wrote.
An accompanying commentary(www.jabfm.org) echoed this concern, with particular attention paid to family medicine's burnout rate.
"Work-life integration, salary and opportunity for further professional growth seem to be important components in this (career) choice and reflect what a hospitalist career can offer," wrote Ramon Cancino, M.D., M.Sc., and Brian Jack, M.D. "These issues also influence a workforce's well-being and resilience."
The commentary notes that FP hospitalists three years out of residency rated their satisfaction as 92.3 percent compared to 84.3 percent for non-hospitalist FPs, but -- looking at another specialty -- that burnout is more common among internal medicine hospitalists compared to outpatient general internists.
The commentary points out the importance of getting the components of career choice right so more physicians will choose to practice ambulatory primary care. "Despite ample evidence that well-trained family physicians practicing in a community setting contribute greatly to that community's health, recruitment of physicians into office-based family medicine is challenging, an unfortunate reality given that recent estimates predict a shortage of 52,000 ambulatory primary care physicians by 2025."
Similar to the need for ambulatory primary care, demand for hospitalists continues to outstrip supply,(www.medscape.com) even as some 30 hospitals a year vanish.(www.bloomberg.com) About 75 percent of U.S. hospitals employed hospitalists(www.nejm.org) in 2016.
Authors of the policy brief found that FPs who identified as hospitalists logged more working hours than their non-hospitalist colleagues (64.2 versus 53.6 hours per week on average). But the hospitalists also reported higher median income -- $250,000 versus $185,000. The difference is meaningful, the authors wrote, considering that half of graduating family medicine residents report more than $150,000 in educational debt.(jabfm.org) Hospitalist FPs also reported greater satisfaction with their principal practice than did the non-hospitalists (92.8 percent versus 84.3 percent), and they were more than twice as likely to be men.
The AAFP has endorsed the inclusion of family physicians among hospitalists' ranks, particularly when a cross-disciplinary approach can help address the needs of underserved or rural areas. Authors of a 2014 study(www.stfm.org) published in Family Medicine noted that "hospitalists have a significant educational role in family medicine resident training," and they called for further research into how hospitalists and family medicine faculty could most effectively collaborate as residency teachers.
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