MCMC: Trends driving hospitalist model


As in communities all over the United States, the Mid-Columbia region is struggling to attract and keep enough doctors to provide the first line of care to a growing population of patients.

“The United States is in the midst of a health care crisis that is expected to worsen over the next several years,” according to a report this spring by the American College of Physicians.

The facts are startling:

• 21% of doctors who were certified to practice internal medicine in the early 1990s have left the practice.
• Only 20% of physicians in the last year of medical residency programs say they plan to practice internal medicine, a decline of 63% in the last seven years.
• The Council on Graduate Medical Education forecasts a shortage of at least 65,000 physicians – and possibly as many as 150,000 – by the year 2020.
• By 2020, internal medicine doctors will spend 25% more time – about 40% of total time – with patients age 65 and above.

People in The Dalles aren’t immune to the effects of these changes.

“We’ve lost five internists in the last eight months,” says Dr. Thom Nichol. “People were unhappy for various reasons.”

Lifestyle choices drove several of those departures. In particular, physicians want predictable, regular hours. Many are even choosing to work part time, so they can have more time for other personal interests.

Under the traditional model of care, a physician would see patients in the office, and also when they went into the hospital. Typically, a doctor would respond to urgent needs of their hospitalized patients during the day. After hours, however, they would share that duty with other doctors. The greater the pool of doctors, the less frequent any individual doctor would have to wear a beeper that might yank them out of bed at 3 a.m. to attend a patient in hospital.

All that is changing. A dwindling pool of internists has increased the frequency of “call” duty for those who remain, and that has boosted disruptions to office hours, and personal time. More disruptions equals higher stress equals greater pressure to consider professional change.

“No way they’re taking call every other night,” is how Dr. Gretchen Blair summed up the attitude of an increasing number of physicians.

In response to this situation, Mid-Columbia Medical Center and its affiliated physician practices have adopted several innovations intended to ensure that everyone gets the care they need:

• Creation of hospitalist teams to provide all hospital care to patients admitted by internal medicine doctors (see sidebar). This frees internal medicine doctors from working “on call,” and lets them focus on patients in the office setting.
• Creation of a “Convenience Care Clinic” to serve pressing care needs of patients who have no regular doctor, or who can’t find time on their doctor’s schedule (see sidebar).
• Hiring of a full-time physician recruiter to focus on hiring physicians both for the hospitalist teams, and to assume care of patients in the office setting (see sidebar).
• Adoption of an advanced electronic medical records system that, when fully implemented, will link everyone providing care – in the doctor’s office, or in the hospital – to full and current information about each patient (see sidebar).

“This is an effort to minimize turnover,” says Mark Ackley, director of the Mid-Columbia Medical Group, which provides business services to the majority of internal medicine and family practice physicians in The Dalles.

“We’re being responsive to a changing health care model.”