PCPs have seen their overhead costs rise dramatically along with insurer mandated paperwork and government mandated electronic medical record (EMR) time requirements. This means the PCP must see more and more patients for shorter and shorter periods to cover overheads and reserve time for the nonclinical requirements. The average visit time is now 15 minutes with only 8 to 10 minutes of "face time". It also means that most – but definitely not all – PCPs no longer attend their patients in the hospital, leaving that function to the hospitalist
In our experience hospitalists are a heterogeneous group, many are just out of an internal medicine residency; some are working part-time because of childcare obligations. Many are contemplating a fellowship but want to catch up on loan obligations. Some hospitalists anticipate at a future point to become PCP’s. Still others intend to make a career as a fulltime hospitalist.
Frequently employed by the hospital, they still must meet productivity standards in order to earn their salary. Often this means caring for a large number of patients, most of them quite ill. Although they are expert in what they do, they do not have the years of interaction with the patient that the PCP has. And so they did not know the patient before the hospital event and are not likely to know him or her after. Each patient is an individual with his or her unique family, social, economic and of course medical background. The patient today may well have multiple chronic illnesses such as diabetes, congestive heart failure or chronic lung disease and now enters the hospital with a new problem or an exacerbation of an old one. The hospitalist can deal well with the reason for admission. Nevertheless they will not be cognizant of the fine balance of personality and medication that has otherwise maintained the patient as independently living in the community. It also unlikely that they know what studies have been done prior to the admission.
The PCP was always the backbone of American medicine. He or she not only cared for patients in the office but also collaborated with the emergency room physician and attended to hospitalized patients, seeking specialist consultation as needed. Today, only a few PCPs even visit their hospitalized patients, relying entirely on the hospitalist and the emergency medicine physician.
Although most PCPs do not visit their patients in the hospital today, some do and they are committed to give the patient the expert care that the patient requires. But for these physicians some community hospitals for various reasons have determined that only the hospitalist may have privileges to care for the patient. That’s right; hospital managements are discouraging primary care doctors from coming to the hospital and in many cases have prohibited them from having active admitting privileges. Somehow, they discount the possibility that the primary care doctor knows the patient best and can work effectively and collaboratively with the hospitalist for the patient’s benefit. Erroneously, hospitals in many cases believe that primary care doctors diminish quality and increase the length of stay. We have discussed this very issue with a retired board member from a large Maryland insurer and confirmed that a huge uncontrollable expense to the hospital bill is over consulting with specialists and redundancy of procedures and testing ordered by hospitalists.