Hospitalists treat most patients at metro-east hospitals

Belleville resident Marsha Benson is recovering from a shoulder-replacement surgery she had a few weeks ago at Memorial Hospital in Belleville. Benson praised the treatment she received from a hospitalist during her five-day hospital stay.

“I had a very bad complication with my heart,” Benson said, “and she (hospitalist Dr. Jemila Crawford) was really on top of it. ... She would come by the bed, and she would hold my hand while she was talking. I liked that kind of touch.”

Patients admitted to metro-east hospitals are most often treated by in-house doctors, referred to as hospitalists, rather than their primary care physicians. Some patients who haven’t been admitted to the hospital in the last few years may be surprised to find out their family doctors for the most part no longer treat them. However, hospitalists do remain in contact with a patient’s primary care physician.

Benson, 66, was already familiar with hospitalists, as she was treated by one during her two-day stay at St. Elizabeth’s Hospital in Belleville in September for a bleeding ulcer.

“It was really scary,” Benson said, “but she (the hospitalist Dr. Usha Muthyala) came in and explained to me what was going on and what was going to be done. ... She really thoroughly explained everything.”

Benson said she appreciated the hospitalist coming to see her twice a day during her hospital stay — once in the morning and once in the late afternoon. She also commended the hospitalists for their thoroughness and friendliness.

St. Elizabeth’s Hospital in Belleville currently has 10 hospitalists, but hospital officials hope to add two more soon. Memorial Hospital in Belleville has 18 hospitalists, and currently, there are two at Memorial East in Shiloh, which opened on Tuesday. When the new hospital is fully operational, there will be nine hospitalists at Memorial East, according to Mike McManus, chief operating officer at Memorial. Anderson Hospital in Maryville has 11 hospitalists.

What hospitalists do

A hospitalist is a board-certified doctor whose primary job is to care for patients admitted to a hospital. A hospitalist works closely with a patient’s primary care physician and specialists at the hospital. Patients treated at area hospitals by hospitalists surveyed by the News-Democrat had mixed reactions.

Dr. Naveen Krishna, the lead hospitalist at St. Elizabeth’s, said his job is to “give a good experience to a patient while they are here. Hospitalists provide a comprehensive healthcare delivery to acutely ill patients who come to the hospital.”

Krishna, who lives in St. Louis, oversees the team of hospitalists at St. Elizabeth’s and serves as medical director for inpatient services for the Hospital Sisters Health System’s Southern Illinois Division, which includes St. Elizabeth’s Hospital, St. Joseph’s Hospital in Highland and St. Joseph’s Hospital in Breese.

When treated by a hospitalist, Krishna said, there is no delay in patient care so patients often have shorter hospital stays, which reduces healthcare costs.

About 70 primary-care physicians in the metro-east no longer see their patients at the hospital but rather have them treated by hospitalists, Krishna said. “They are focusing on their clinic patients totally and their productivity has improved and our productivity has improved as well.”

Hospitalists on staff at St. Elizabeth’s have a weekday meeting at which patient care is discussed in collaboration with other hospital departments including pastoral care, nursing and hospice, among others.

“Everybody sits across the table and decides what needs to be done next” for a patient’s treatment plan, Krishna said.

A St. Elizabeth’s hospitalist typically treats between 12 and 16 patients a day. “If you overwork a hospitalist, they are not going to be as thorough and they are going to be tired.” said Dr. Loren Hughes, president of the HSHS medical group.

McManus said hospitalists cover a majority of the patients admitted to the hospital.

“The hospitalist physicians cover all the patients who come into the ER,” McManus said. “They probably manage 65 percent — the vast majority — of patients in the hospital.”

At Memorial, a hospitalist treats about 15 patients a day, said Dr. Joshua Niebruegge, a hospitalist at Memorial.

“Hospitalists are physicians who specialize in the care of patients at a hospital,” said Niebruegge, who lives in O’Fallon. “We act like the primary care doctors for the patients inside the hospital.”

St. Elizabeth’s Hospital spokeswoman Kelly Barbeau said patients will receive two bills — one for hospital services and one for the professional services of the hospitalist.

“Most insurances cover hospitalist care but a difference in the bill may be seen depending if the physician group is ‘in-network’ of that patient’s plan or not,” Barbeau said.

Fast-growing specialty

The term hospitalist was first used 20 years ago in a New England Journal of Medicine article.

Mark Turner, president and CEO of Memorial Hospital, said Memorial employed it’s first hospitalist in 2005.

“It’s meeting a need on a number of fronts. It’s providing a service to patients. It’s providing a service to the admitting physicians, typically primary-care physicians,” he said. “As health care has changed over the last several decades, the industry or health care in general has recognized the demands placed on primary care physicians and the need to really develop the hospitalist service or inpatient medicine service.”

Hughes said hospitalist service is “one of the fastest growing specialties” in all of medicine.

When Krishna started four years ago, he was one of four hospitalists at St. Elizabeth’s. “This is expanding astronomically,” Krishna said.

The Society of Hospital Medicine has about 40,000 members. Hospital medicine is becoming it’s own specialty.

Hospitalists at Memorial Hospital work for an outside agency called CEP America. Hospitalists at St. Elizabeth’s work for HSHS Medical Group.

When Dr. Christopher Farrar started as a hospitalist at Anderson Hospital in 2005, he was the only one on staff. Now, he’s one of 11 — seven hospitalists and four mid-level physicians who work as hospitalists.

At Anderson, the hospitalist program started as voluntary, Farrar said, where primary-care physicians could choose to have their patients treated by a hospitalist or not.

“By providing good care, good follow-up and good feedback, they have grown to trust us with their patients’ care,” he said. “It’s been more of a collaborative agreement based on trust, respect and good quality care.”

Now, Farrar said, hospitalists treat a majority of the patients at Anderson. He estimated hospitalists, who work 12-hour shifts, see between 15 and 20 patients a day.

Hospitalists are available whenever a patient or his family wants to speak to one.

“We are more versed at what our capabilities are at the hospital and how we can move people through the hospital in a safer way and more efficient,” Farrar said. “We order tests in the morning, get the results back at 10 a.m. and move forward in a more efficient way.”

Why be a hospitalist?

About 89 percent of hospitalists are trained internal medicine doctors, Krishna said. “Internal medicine is the training program that trains you to be a hospitalist,” he said.

Prior to becoming a hospitalist at St. Elizabeth’s two years ago, Dr. Pankaj Kaul of St. Louis was a primary-care physician in Chicago. Why make the switch? “This is what we have been trained (to do), and this is what we like as internist,” he said.

Dr. Farhanaz Chowdhury, a hospitalist at St. Elizabeth’s, enjoys treating acute patients. “Acute patients are more challenging,” she said.

Chowdhury also likes being able to frequently monitor all her patients during her 12-hour shift and checking to see if test results have come back. “You can see how the whole day she is doing, and you can see the treatment outcomes,” she said.

Farrar at Anderson also enjoys the challenge of being a hospitalist. “I like the new variety of it everyday,” he said. “You are tackling problems everyday in terms of different medical issues that requires you to research and figure out what’s going on.”

Dr. Umesh Gandhi, of St. Louis, has been working as a hospitalist the last six years. He currently works at St. Elizabeth’s. “I started right after my residency,” Gandhi said. “The life of a hospitalist is quite demanding.”

He describes himself as a “type A” personality who enjoys the challenges that come with being a hospitalist.

“The best thing I enjoy is taking care of patients who are acutely ill,” Gandhi said. “The moment they start feeling better they have that gratitude in their eyes and their sincere thanks.”

Dr. Adrian Barcus of Belleville, a hospitalist at Memorial, said his schedule as a primary care doctor was “pretty brutal” with weeks when he didn’t see his children or eat dinner with his family.

“Now I get to see my kids fairly often,” he said. “I take them to school sometimes. I actually get to be a dad to some degree. It’s really nice to have a work-life balance.”

Hospitalists typically work shifts. At St. Elizabeth’s, a hospitalist works from 7 a.m. to 7 p.m. or 7 p.m. to 7 a.m. seven days in a row, then are off the following seven days.

“This is a hectic time. When you are on, you are on,” Krishna said. “Our beeper goes off every three minutes, every five minutes.”

Gandhi likes the schedule of a hospitalist. “When you are working seven days on, you are totally into the seven days,” he said. “The seven days off is basically recuperating.”

The salary of a hospitalist is often higher than a family physician’s. According to data from the U.S. Bureau of Labor Statistics, a general internist in Illinois earned on average $172,900 a year in May 2014 while a family-practice doctor in Illinois earned on average $162,890 a year. The bureau doesn’t track the hospitalist profession specifically.

McManus, chief operating officer at Memorial, said hospitalists are “highly-trained physicians” who are compensated accordingly. However, he wouldn’t provide any specific salary figures.

Krishna said he enjoys the lifestyle of a hospitalist, the compensation as well as the satisfaction of treating patients. The most challenging aspect of the job, he said, is being able to connect to the patients.

“They would have seen their primary care for like 10 years, 15 years, and they build trust,” Krishna said. “When they see a new doctor taking care of them, they will be slightly apprehensive, but we try to overcome that by saying that ‘you are in the best hands and we partner with your physician.’”

Gandhi agrees with Krishna. “Primary care physicians have a unique bond with their patient, which we don’t,” Gandhi said. “We have to really work hard to build up that trust with the patient so at least they can trust us with their information, what’s been going on and why did they end up in the hospital.”

Dr. Tex Pardo, of O’Fallon, a hospitalist at Memorial, described hospitalist-patient interaction as a “blind date.”

“You do have to try to develop that relationship,” he said.

This story was originally published April 16, 2016 at 6:52 AM with the headline "Hospitalists treat most patients at metro-east hospitals."