Hospitalists have proven their worth
I was aware as I started at King Edward VII Memorial that there had been a number of concerns raised about the introduction of hospitalists, and the perception that community physicians had been ‘shut out’.
The introduction of the hospitalist service on the medical wards some five years previously was accomplished without finesse and appropriate communication, leaving many community physicians feeling disenfranchised from the hospital.
There is a huge body of evidence now, however, which attests to the value of a hospitalist service to cost reduction, reduction in length of stay, and improvements in quality. To get optimum benefit, however, there must be strict adherence to communication protocols from community physician to hospitalist and vice versa so that patients can move seamlessly from doctor’s care to hospital and home again.
With regards to hospitalists, the goal should be to improve overall standards of care, and, in my view, extending the hospitalist cover would help. For example, at present, there are insufficient numbers of hospitalists to provide in-house, 24/7 coverage on the medical service. Round-the-clock coverage is provided by a cadre of medical officers, assigned to all of the services. This use of medical officers existed prior to the hospitalist service, when community physicians oversaw the medical officers remotely.
Whereas the hospitalists are uniformly trained, board-eligible or board-certified internists who have completed accredited residency programmes, the medical officers are drawn from a diverse pool of fairly recent medical-school graduates who have either not sought or withdrawn from further training, or are preparing themselves to migrate to training opportunities in other countries.
The Chief of Medicine, and the Director of Hospitalists, interview them through Skype, and once on-site have a 90-day evaluation. Should a candidate prove to be unsuitable during this period, and appropriate remedial intervention is unlikely to succeed, that candidate is dismissed. The medical officers must also demonstrate they have the skills to provide safe and appropriate care autonomously before being allowed to cover the hospital at night.
The Chief of Medicine, and the Director of Hospitalists, are unyielding in their adherence to standards that assure such levels of performance. I unreservedly endorse the process for evaluation of medical officers, as patient-safety concerns must take precedence.
On the medicine service, the medical officers come under the supervision of the hospitalists, who are either present or easily available. On the other services, there are no hospitalists, so the supervision of medical officers is not as close. It would be desirable to have one standard of care for all services, and all of the medical officers should be directly supervised by a senior physician and have that physician readily available to them. The greatest exposure is on the surgical service, as there are no hospital-employed surgeons, and the Chief of Surgery is part time, committed to only eight hours a week.
I certainly hope that my tenure at BHB these last eight months has been as rewarding to BHB as it has been for me. There is a great opportunity for Bermuda to establish a model health system with BHB at its core, connected to all other service deliverers via an electronic health record, thus assuring the communication, coordination and continuity of care. The challenge will be to have the stakeholders currently on divergent courses to collectively embrace the concept as a common goal.
* Dr Scott joined BHB in August 2012, and worked as Interim Chief of Staff until March 2013.