‘Hospitalists’ growing in popularity New breed of internists make life easier for primary care doctors, patients

PORTLAND – Hospital patients who once expected to see their primary care physician at their bedside may find themselves talking to a “hospitalist” instead.

Hospitalists are a new breed of internists who work at a hospital full time, examining patients, ordering tests, meeting with families, consulting with specialists and doing other things a primary care doctor ordinarily would do during a hospitalization.

Maine Medical Center in Portland introduced the service this summer.

Other places in Maine that offer hospitalist programs include St. Joseph Hospital in Bangor, Eastern Maine Medical Center in Bangor, Southern Maine Medical Center in Biddeford, Franklin Memorial Hospital in Farmington and Redington-Fairview Hospital in Skowhegan.

In an era of managed care, the hospitalist system can save money by providing faster, more efficient care. Hospitalists can order tests immediately, and track down the results more quickly. In an emergency, they can be at the bedside in a flash.

Despite some initial skepticism toward strangers in white coats, families have come to appreciate the easy access to a doctor that a hospitalist service provides, says Dr. Larry Wellikson, executive director of the National Association of Inpatient Physicians.

“What the patients notice is ‘Boy, I’m getting seen a lot by this doctor,'” Wellikson said.

Nationally, he said, there are about 5,000 hospitalists and the demand is growing.

While some primary care physicians worry that hospitalists could make the medical system more impersonal and damage continuity of care, others are delighted because they find they have more time to spend with their office patients or their own families.

“I think everywhere hospitalist systems have been set up, there initially was skepticism,” said Dr. Ben Cowan, associate director of the Maine Hospitalist Service at Maine Medical Center. “But as people come to be comfortable with the system, they tend to come to the realization that we are actually on their side and that we’re working with them rather than against them.”

At St. Joseph Hospital, where the hospitalist program began in 1996 with just three doctors, the service now employs 10 hospitalists, one nurse practitioner and a physician’s assistant.

“We cover for 65 providers now and we have people banging down our doors, pleading with us to take care of their patients,” said Dr. Laura Matones, clinical director of the program.

“The quality of life improves for the primary practice person. They don’t have to take calls, they don’t have to come in on weekends, they don’t have to make rounds at 6 o’clock in the morning before they start their outpatient day.”

Dr. August Valenti, who advocated for the service in Portland, said that at a time when hospitalized patients generally are sicker and require more attention, it makes sense to allow someone who specializes in acute care to manage their cases.

“It’s unrealistic to think that people can be adept at all recent developments in acute care medicine as well as outpatient medicine,” he said.