Sudheer Koyagura always wanted to be a doctor so he could help sick people regain their health.
When Koyagura was serving his medical residency in Huntsville, Alabama, he learned of hospitalist programs that allowed doctors to practice their crafts almost solely in hospitals. After finishing a fellowship in geriatric medicine at the University of Arkansas for Medical Sciences, Koyagura took a job as a hospitalist with Northwest Health System five years ago.
“I always wanted to be a doctor treating sick patients,” said Koyagura who works at the system’s hospitals in Springdale and Bentonville. “A hospitalist is fulfilling my satisfaction. At the end of the day, I get more satisfied from treating sick patients and seeing them go home.”
Hospital physicians are a growing trend in the United States. The Society of Hospital Medicine estimated that there are 44,000 practicing hospitalists in the country, approximately quadruple the number in 2003, and nearly 75 percent of hospitals have some type of hospitalist program.
“I would almost be willing to bet that there’s not a hospital in Arkansas that doesn’t have a hospitalist program or doesn’t want one,” said Tom Cummins, the chief medical officer for CHI St. Vincent Health System.
Sharif Omar, the CEO of Northwest Health System, said Northwest has approximately 14 hospitalists, while Cummins said CHI St. Vincent had about two dozen, although he didn’t have an exact number. Most hospitalists are internal medicine physicians, but Cummins and Omar said there are other specialties growing in popularity, such as OB-GYN and surgical.
Cummins was a traditional internal medicine doctor for many years in Batesville before he took the leap and became a hospitalist at White River Medical Center in 2009. He joined CHI St. Vincent as an executive in 2013.
“I loved hospital medicine,” Cummins said. “For internal medicine doctors, in particular, that’s how we were trained. Most of our training is hospital-based [with] the urgency, the immediacy of what you’re doing with internal medicine in the hospital as opposed to some of the day-to-day stuff. Some of the stuff people who come into the clinic with is stuff that just wasn’t intellectually challenging.”
Cummins said when he was chief medical officer at White River and interviewed general practitioners for positions with the group, they all wanted to know if White River had a hospitalist program. If there wasn’t one, they didn’t want to come because they weren’t interested in dividing their time between hospital and clinic.
Cummins understood because he once had the same conflict. As a clinic doctor with hospital responsibilities, he would divide the day between hospital rounds and clinic appointments, which caused blocks of lost time even though his clinic was across the street from the hospital.
“My attention wasn’t solely on my hospital patients or solely on my clinic patients; it was torn,” Cummins said. “Hospitalists’ only job is to take care of the patients while they are in the hospital. They’re more attentive to what’s going on; they can follow up on tests more quickly; they can address emergencies or changes in condition much more rapidly. Hospitalists are designed to be in the building attending to the day-to-day, hour-to-hour needs of the hospitalized patient.”
Improved Efficiency Cited
Omar said studies have shown that hospitalist programs greatly improve the efficiency and effectiveness of inpatient care, while also improving results for general practitioners, who are able to see more patients without hospital distractions.
There is a financial benefit to the hospitals, of course. Yes, paying hospitalists salaries can be quite the expense — median income is estimated to be more than $250,000 — but shorter hospital stays mean more profit for hospitals.
Cummins said the benefits far outweigh physician costs.
“It’s good for us if people are moved through efficiently, effectively and appropriately,” Cummins said. “We don’t want people sent home too soon, but we don’t want them here longer than they need to be. We want our patients to get the best care and we want them to get timely care.”
Omar said the most important metric is improved patient care. It’s why people in medicine, such as Cummins and Koyagura, became doctors in the first place.
“It allows us to have someone in-house always caring for the patient, which allows us to provide more consistent and more attentive care,” Omar said. “That translates usually into better care. The better we can care for a patient and get them back home, the better it is for the patient, the better it is for the hospital, the better it is for everyone.”
The Society of Hospital Medicine said hospitalist programs can reduce a patient’s length of stay by 30 percent. Koyagura said having a doctor on site ordering and then reviewing test results can shorten hospital stays significantly.
“It’s taking care of inpatients most of the time,” Koyagura said. “It’s comprehensive medical care. We follow the tests immediately. Most of the time, the patients are discharged on the same day.”
Communication Key
Patients surely must appreciate the improved and quicker care, but what about those patients who miss seeing their doctor when they are hospitalized? Omar said the community has become more accepting of hospitalists, and strong communication between hospital doctor and clinic doctor can make treatment seamless.
“Patients in communities understand it better now,” Omar said. “With technology and electronic records now, there’s still a good communication path. Essentially, the hospitalist is an extension of that physician’s practice. As long as you have great communication between the primary care physician and the hospitalist, there is nothing that falls through the cracks.”
Koyagura said availability is a big positive with hospitalist programs. If a patient needs attention, the doctor is there; if a family member needs an update, the doctor is there.
“We are always available to the patients for 24 hours in the hospital,” Koyagura said. “If the family comes and wants to talk to the doctor, we are available to them.”
Hospitalists are growing in popularity with doctors fresh out of residency, and Cummins said that’s because the work is challenging work while the hours are better. Koyagura said he works from 7 a.m. to 7 p.m. seven days a week with seven days off after.
“It’s much like ER: You come in and work your 10-12 hours and then you’re off,” Cummins said. “There is some lifestyle appeal. That’s not why I did it. I just love hospital medicine.
“I like taking care of sicker people. Even now, I like being in the know with how things are going with those critically ill people.”
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