Q&A - Hospitalists at DRMC

"Q&A: Doctors talk about Danville Regional's hospitalist program"
Danville Register & Bee Saturday, November 10, 2007

A national trend in hospital care is being expanded at Danville Regional Medical Center. Dr. Fran DeChurch was hired last week to start working at the hospital as the director of the hospitalist program.
Hospitalists are hospital-based doctors who care for patients while they are at the hospital, instead of a patient’s regular doctor. When the patient is released from the hospital, he or she returns to the care of the pre-admission doctor. DeChurch and Dr. Michael Caplan, a local physician who helped develop Danville Regional’shospitalist program, recently shed some light on the role of hospitalists in Danville and throughout the nation.

What is a hospitalist?
Caplan: Hospitalists are fully trained doctors who have completed medical school and residency training and graduated with degrees in internal medicine or family practice. Most, but not all, are young university-trained doctors who have recently completed and are very familiar with hospital-based care. Others are doctors who have been in traditional-based medical practices who decide to change to hospital-based care exclusively. They undergo additional training as hospitalistsoften in coordination with the companies that contract their services to hospitals around the nation.
DeChurch: Hospital medicine has become its own specialty. Programs are developing specifically for hospital medicine, much like geriatric medicine evolved as a specialty.
How many hospitalists does Danville Regional have?
DeChurch: With me, there will be four full-time hospitalists and eight to 10 part-time. We will be recruiting four more full-timehospitalists.
How did hospitalist programs begin? (DeChurch was actually in on the ground floor of hospitalist programs beginning in the U.S.)
DeChurch: When I finished my residency in 1990-91, the government was looking at how many hours interns could work. They saw there were going to be limits on the patient loads and hours on interns coming down the road, and wondered how they were going to handle all those patients.We developed a ‘chief service’ to take care of the unassigned patients. Lo and behold, that was the beginning of the hospitalists, although the term was not coined until the mid-1990s. It’s kind of neat to know I was in on the ground floor.
How did the hospitalist program begin at Danville Regional?
Caplan: The impetus for developing a hospitalist program started in early 2004 when a request was made from the medical staff to the administration of Danville Regional. A special committee was formed to research national hospitalist organizations and recommend companies through which these contract services could be provided. The conversion to a hospitalist-based care plan at the hospital was driven by a national trend that has existed for many years in other hospitals across the country as well as neighboring cities in the region. The hospital implemented its hospitalist program contracted through Em-Care in April of 2006 and has now changed services providers to Cogent. Both of these companies were highly recommended by the initial search committee and medical staff advisors.
What are the benefits of having hospitalists?
Caplan: The Emergency Department likes hospitalists because there is a doctor available in the hospital to see ED patients throughout the day and night. The alternative is to call a doctor out of his home or office practice, which can result in a delay in patient care, longer ER wait times and reduced patient satisfaction. The benefits of a well-run and staffed hospital service is having full-time inpatient care services, less variability in patient care, more timely discharges, improved documentation and more prompt inpatient consultation services. The traditional practice of medicine in this community without a hospitalist service results in some doctors working in excess of 110 hours a week.
Why do doctors become hospitalists?
DeChurch: I enjoy it; it’s a different type of medicine. It is more intense. To be in the hospital anymore, you have to be pretty sick. (A hospitalist) can truly help people.
Caplan: Doctors become hospitalists because they enjoy the challenges and intensity of hospitalized patients. They are highly trained and familiar with this patient type. Becoming a hospitalist removes a doctor from the obligation of running a private practice outside a hospital setting and provides good work hours and an improved lifestyle. The salary is also competitive compared to the traditional medical-based practice. Hospitalists generally work four 12-hour shifts a week or 16 total shifts a month.
How has the hospitalist program been accepted by the staff and patients at Danville Regional?
Caplan: The program has been accepted by most, but not all of the medical staff. (But) this is the trend throughout the country and not unique to Danville Regional. There are many doctors who use or want to use the hospital service as it grows to accommodate their hospitalized patients. These physicians are under personal, lifestyle, financial and practice pressure to focus their time to either hospital inpatient or clinical outpatient care but not both. (Caplan said patients initially had a reluctance to see a hospitalist, which he does not think is unusual because they have grown accustomed to the traditional care of seeing the same doctor inside and outside the hospital setting.) Sometimes the reluctance has come from a lack of understanding of what a hospitalist is or what role a hospitalist plays in the delivery of health care in coordination with their private doctor. Patients, however, come to realize that they still get good care, have access to specialists and stay only three to four days in the hospital with an average admission before being discharged. They also come to realize that they have much greater access to their private doctors outside the hospital due to the time that is freed up by the hospitalist.
Who are the patients the hospitalists see?
DeChurch: We admit all unassigned patients through the emergency room and those are without community physicians. From the time it is determined that the patient will be hospitalized, that patient becomes our responsibility as attending physicians. (Recently, the physicians with Internal Medicine Associates and Piedmont Internal Medicine decided to turn their inpatient care over to the hospitalists.)
What if a patient needs a specialist?
DeChurch: There will always be specialists available, such as surgeons, orthopedists and cardiology. A hospitalist is like a cruise director, making sure everything and everyone is where they need to be. We use consultants if a patient needs one.
How widespread is the use of hospitalists?
DeChurch: Hospitalists are found everywhere now. We interviewed someone (Monday) who is a hospitalist in a 25-bed hospital.
Caplan: The needs for hospitalists are greatly exceeded by the supply. Current statistics put the need for new hospitalists to serve the current national demand at 15,000 more doctors than are now available (with) need growing each year.
Who is DeChurch, and what hospitalist experience does she have?
Caplan: She is a nationally known and respected hospitalist leader with more than 15 years of hospitalist experience and eight years of experience as a hospitalist program director. Her leadership will add a great deal of quality and depth to the overall program. Her husband is Dr. Hugh Fraser, the medical director of the hospital’s blood donor center. She said she accepted the job at Danville Regional because “there is a certain atmosphere other hospitals don’t have, and the physicians were happy.” Dr. Frances DeChurch, was the Hospitalist Service Director at Annie Penn Hospital before coming to Danville.
What will she do first?
DeChurch: My main focus will be recruiting. Then come back in six months and see what I will fix. My job will be making sure we have a cohesive team and interfacing with the community, physicians and departments so people won’t think their doctors have abandoned them.