Health care studies are far too limited in scope. There are important consequences of the rapid increase to 30,000 hospitalists in the United States. Savings to hospitals has been the focus in a national reimbursement design that favors services needed by few that are delivered in a very few locations at greater reward.
The first consequence of the hospitalist workforce is the loss of 20,000 primary care physicians. Hostpitalists are those younger for even greater future losses of primary care.
The second is responsibilities for care moved from high resourced hospitals to low resourced outpatient care. This responsibility is often forced upon primary care physicians who assume responsibilities for the outcome with no control over the care (such as anticoaguation errors or those dumped before stability). Primary care nurses are caught in two crossfires. They must gather the information from this fragmentation. Also they are the ones that have to arrange care.
Hospitals have not been doing well in key areas. Errors such as 20% readmission for cardiac care that should be 10% or less with appropriate care. Primary care nurses are no small component since they outnumber primary care physicians with over 270,000 as compared to 220,000 to 230,000 primary care physicians (100,000 FM, 55,000 PD, and 65,000 – 75,000 IM) As with primary care physicians, practitioners, and team members, the RN component is paid less and often has greater complexity in the job description and what the job requires.
Hospitalist workforce is a worse case scenario for primary care. The bullseye hit internal medicine primary care, a key workforce for the elderly, right when the nation was doubling the elderly 2010 to 2030. The elderly also have two to three times the primary care need. The bullseye hit primary care nurses, one of the most important components.
Also this consequence was not in isolation. Resident work hours restrictions left a vacuum that was filled with tens of thousands of nurse practitioners and physician assistants moving from primary care to teaching hospitals.
Those focused on hospital, subspecialty, and academic interests rarely see the consequences of their actions – that result in less basic health access overall for the United States, less primary care per primary care graduate, and less workforce where the nation most needs workforce – in the primary care dependent 30,000 zip codes with 65% of the population.
Robert C. Bowman, M.D. http://www.basichealthaccess.blogspot.com
