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Am Fam Physician. 2008;78(10):1130

Author disclosure: Nothing to disclose.

Original Article: Quality and Cost of Care by Family Physicians vs. Hospitalists (Tips from Other Journals)

Issue: July 15, 2008

to the editor: Our practice cares for all its hospitalized patients (adults and children), so I have been dismayed that many family physicians and generalists have given up hospital-based care. This movement has occurred despite high-quality evidence demonstrating no improvement in outcomes or cost savings from specialists in hospital medicine. I was pleased to read the “Tips from Other Journals” by Dr. Kripke that reviewed the study from the New England Journal of Medicine.1 This study showed that family physicians provide inpatient care on par or superior to that of general internists and hospitalists.1 In this study, the small reduction in length of stay (0.4 days) in patients cared for by hospitalists actually translated to zero cost improvement compared with hospitalized patients cared for by family physicians. Surprisingly, the closing line in that study stated that “there remains a need to understand how hospitalist systems should be structured in order to improve the quality and outcomes of care.”1 Rather than pushing to improve an expensive system that distances us from our patients, I would have phrased the take-home lesson quite differently: given that family physicians provide care that is equal to or better than that of hospitalists, there is a need to re-integrate the primary care physician into hospital care of their patients, and structure payment systems accordingly.

There is growing concern over primary care physicians feeling distanced from their patients because of a lack of involvement in their care,2,3 which results in physician dissatisfaction and may also impact patient safety.4 The only sure way of improving this situation is to align ourselves with the goal of excellent care of our patients, in and out of the hospital. It is time for leaders in family medicine and primary care to review the evidence and advocate for changes in reimbursement, which could once again make it possible for all family physicians to practice as we were trained.

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

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