Are inpatients’ needs better served by hospitalists than by their family doctors?

I welcomed and enjoyed the debate regarding the role of hospitalists in this month's issue of Canadian Family Physician. Between 1994 and 2001 I directed, attended and taught on a Family Medicine Inpatient unit at my hospital and as a result can see both sides of the problem debated by Drs. Sahoil and Wilson.

On the plus side of the equation, I enjoyed the challenge of looking after my own patients (and those of my colleagues) in hospital. The range and complexity of problems dealt with helped to maintain strong clinical skills and confidence. My colleagues and I were also able to maintain a high degree of continuity of care for our patients resulting in greater satisfaction for all involved. We also were able to show that residents who trained at our hospital were more likely to be involved in providing in-hospital care to their patients after graduation (1).

On the minus side, providing inpatient care while also trying to run a busy office, teach, and be an involved husband and a father at home was very difficult. Being on call one-in-three and every 2nd or 3rd weekend and having to run over to the hospital during already limited lunch breaks was becoming unsustainable. By the time I had reviewed inpatients at the end of the day, I often arrived home in time for the end of dinner. In addition, many of my colleagues, most of whom only attended on the service 2 months per year (I attended 12 months of the year as the Director) found it challenging and anxiety-provoking trying to maintain a necessary level of comfort and competence. Also, as noted by both authors, the age and complexity of patients became greater over the years and we were often faced with the increasing time demands of family meetings and the challenges of discharge planning. Oh, and did I mention the approximately $14 per day that we were reimbursed by OHIP for providing such care?

It was with mixed feelings on my part that our inpatient service closed due to a hospital merger in 2001. I missed the challenge, but not the increasingly long hours and complexity of providing comprehensive care from office to hospital and back again.

As primary care reform in Canada evolves, one way to approach the need for family physicians to be involved in hospital care may be to ensure that they are paid appropriately for such care. That way they might limit their office hours so that they can incorporate in-patient care into a reasonable working day. Alternatively, within a group practice, it may well be that some physicians will choose to make inpatient care a significant (but not the sole) part of their practice, providing care and continuity of care to their own patients as well as those of their colleagues.

References

1. Pimlott N, Holzapfel S, Cummings S. Short report: does training in a family practice inpatient service affect practice after graduation? Can Fam Physician 2001;47:983–985.