Sunday, June 1, 2008

Of Hospitalists, Intensivists, Criticalists, Proceduralists Surgicalists, Obstetrianists, Locumtenenists, and Nocturnalists

hospitals and doctors, hospitals, physicians and busienss ideas - These days, every time you turn around, you run across new name for a new medical specialist, who is almost always hospital-based.

What’s behind this compulsion to create new specialists? It goes against traditional wisdom -- that we have too many specialists and too few generalists. The hidden reason may be that generalists want to become specialists and the road to that ambition goes through hospitals.

The creation of new specialists hinges on five trends;

1) The drive by hospitals to assure greater control, safety, and efficiency through hospital-based specialists. The movement towards hospitalists, intensivists, and criticalists has been going on for ten years. Having these specialists on site to respond to emergencies and other needs of patients make sense in many ways. On-site physicians can respond quickly in more standardized ways to problems and, as a bonus can shorten hospital stays. Another side benefit is that practicing physicians and other members of the hospital staff generally accept these new specialists. They offer relief from night and weekend calls, and doctors can have confidence their patients are in good hands.

2) Proceduralists are a refinement and spin-off of hospitalists – a subspecialty. They ensure safety and efficiency because they grow adept at doing common hospital procedures – lumbar punctures, central vascular.access cut-downs, tracheostomies, parancenteses and thorancenteses. They perform them repeatedly and well – and more safely than an inexperienced resident might..

3) “Nocurnists”are the new kid on the hospital specialist block, and the latest development, on the hospital safety front. Within the last two weeks, articles in the New England Journal and the Wall Street Journal, have commented on the work of David Shulkin, M.D., president and CEO of New York’s Beth Israel Medical Center , who observed that many critical cases are admitted at night, that these patients tend to have poorer outcomes, and that the hospital staff is at its lowest level at night. The outgrowth of his concerns was the creation of full-time physician “nocturnists,” who work only at night as a career. In some ways, “nocturnists” are mature versions of residents, who now work fewer hours because of new laws restricting them to an 80 hour week or less.


4) Then there is the physician shortage. It is now acknowledged that a physician shortage is upon us. To assure continuity of care and coverage, hospitals are increasingly turning to locum tenens, or locumtenensmists, and physicians, in their turn, turning to the locum field to escape the hassles of private practice, to work regular hours, and to have their medical practice premiums paid.

5) Finally, there is the new generation of young physicians. Most are trained in hospitals, and most feel comfortable in that setting. These young physicians seek a balanced life style, time-off, vacations, other fringe benefits, and professional support – all of which may be hard to come by in private practice.


References

1. D.J. Shulkin, MD, “Like Night and Day – Shedding Light on Off-Hours Care, New Englnad Journal of Medicine, pages 2091-2093, May 15, 2008.

2. Laura Landro, “Hospitals Move to Reduce Risk of Night Shift, ‘Nocturnists Fight Dangers Patients Face on Off-Hours, “ Wall Street Journal, May 28, 2008

35 comments:

Toni Brayer, MD said...

Equalize the payment for these "procedurists" and "specialists" with primary care and watch the interest fade. Really...who decides to be a doctor because they LOVE anesthesia or radiology? Students learn quickly who has the most free time, earns the most and gets the goodies. It ain't the one caring for the patients long term.

Dino William Ramzi said...

Not every niche should be a specialty. Maybe we should take a page out of the lawyers' playbook: the only recognized specialty is intellectual property. Everyone else is just a lawyer, even though each gets recognition in their area of choice.

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Nocturnalist is the most annoying work in this world ! without any doubt.

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