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Am Fam Physician. 2000;61(3):647

to the editor: I read with interest the letter on the role of the family physician as a hospitalist.1 I joined a practice in Washington, N.J., in 1984, but well before that, this group of physicians had been rotating hospital care of patients on a weekly basis. The rotation continues, and the physician on hospital duty has only the hospital as the primary responsibility for that assigned week. We do not have the inherently disjointed coverage problems because we do not share on-call arrangements with other practices. The physician on call handles all the admissions for that week, as well as all the calls for the practice at large. At the office, we have extended hours of operation that include Saturday hours, so the calls generally do not become onerous.

I could not agree more with Drs. Guyn. As a rule, our patients are pleased with their inpatient care. The on-call rotation exposes our patients to other members of our practice. This improves our outpatient care by increasing patient identification with the group and not just with one physician. It also reminds the physicians that this is a group practice—continuity is preserved.

The hospitalist movement has appeared under the shadow of managed care. Attempting to reach goals of hospital days per 1,000 insured lives of less than 200 days per year brings with it concern for the present process of inpatient care. Decreasing use of hospital services will increase outpatient care. In the future, who will feel adequately trained and experienced to handle the smaller number of patients on our inpatient services? The future may reveal a shared physician caring for the inpatients of several practices.

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This series is coordinated by Kenny Lin, MD, MPH, deputy editor.

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