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

I have argued that hospitalist programs were developed to ease the strain on hospitals and doctors. Dr Samoil seems to concede as much. He cites traffic, paperwork, inpatient-averse locums, efficiency protocols, and committee meetings as reasons—they are important concerns, but at some remove from the bedside. He concludes by declaring that “there is a substantial advantage to the inpatient system [my emphasis] because of hospitalist care.”

I’m pleased for the system, but what happens when those patients go home? The corollary to hospitalist recruits becoming acute care experts, unfortunately, is skill atrophy on the part of those who no longer come in. In most industrialized countries community GPs were long ago excluded from the hospital. My colleagues from the United Kingdom tell me their daily interaction with consultants in their local hospitals has made them better doctors. General practitioners from France to New Zealand poignantly describe being regarded as marginal participants. Will that be our fate? What a needless, tragic loss for our patients and our professional selves.

As Dr Samoil correctly suggests, when family doctors resigned their privileges in large numbers something had to be done. Providing inpatient primary care in isolation was one option. A healthier alternative, in my respectful submission, would be to effectively address the concerns that drove GPs away with a view to bringing them back. In several communities in British Columbia, serious discussions in this regard are already under way. My colleagues and I will do what we can to help these succeed, for the sake of a more robust vision for primary care than simply optimizing the “inpatient system.”

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