Published in the December 2010 issue of Today’s Hospitalist
IT’S WELL KNOWN THAT HOSPITALISTS are taking on a growing number of admissions in the hospitals where they work. But how do they distribute those admissions, and how many are acting as attendings for complex diagnoses? The 2010 Today’s Hospitalist Compensation & Career Survey shed light on hospitalists’ roles in admissions and as primary attendings.
What percentage of your hospital’s admissions do you care for?
When we asked hospitalists how many of their facility’s admissions they cared for, the mean number for all respondents was 56.3%. Seven percent of respondents said that they care for all patients in their hospitals, and 17.5% said they cared for 20% or less.
The number of admissions cared for by hospitalists was slightly lower for hospitalists working at universities/medical schools (52.4%) and multispecialty/primary care groups (52.9%). Those figures were slightly higher for hospitalists working for hospitals/hospital corporations (60%).
Perhaps it’s no surprise that the number of admissions cared for by hospitalists was lower among physicians who work days and cover nights by beeper (48.9%). The number of admissions cared for by hospitalists was also lower for physicians paid via pure productivity (42.5%).
How does your hospitalist group handle admissions?
More than half of hospitalists (64.3%) said that their groups randomly rotate admissions among physicians. Relatively few hospitalists said their group assigns admissions by unit or floor (8.8%), and even fewer (6%) say they assign admissions by primary care groupings.
The number of groups that rotate admissions randomly is higher for adult hospitalists (69.5%), but it’s under 45% for pediatric hospitalists.
How admissions are rotated by type of patient seen
What kinds of differences are there in how admissions are rotated by employer type? For one, a larger number of hospitalists working at national hospitalist management companies (77.1%) say they rotate admissions randomly. On the low end, 57.8% of hospitalists working at universities/medical schools say they randomly rotate admissions, but that’s at least in part because more of those hospitalists (14.1%) assign admissions based on the location of units and floors.
One finding that’s hard to ignore is the relatively large number of hospitalists who say they use some other system to distribute admissions. Among all respondents, nearly one-quarter (23.7%) said that they don’t assign admissions randomly, geographically (by unit or floor), or by primary care groups.
Several respondents who chose "other" pointed out that there’s only one of them on at any given time, so the distribution of patients is simple: The hospitalist on duty takes all comers. Hospitalists in teaching hospitals noted that admissions can be rotated by resident teams.
Interestingly, several respondents said they distribute admissions by patient age, while others said they took admissions for limited periods of time during their shifts, like in four-hour blocks.
For which diagnoses do you serve as the primary attending?
Once patients are admitted, hospitalists are acting as the primary attending for patients with complex diagnoses. The number of hospitalists who say they act as primary attending is highest for conditions like COPD (95.7%) and lowest for trauma patients (20.6%)
For the most part, there were no major differences in how many hospitalists served as primary attending based on factors like age or employment type. There were, however, some significant differences in primary attending status by diagnosis between hospitalists who see adults and who see children.
Want more data? Go to the 2010 survey results online at www.todayshospitalist.com and look for the "Survey Results" button on the left side of the page.
