The hospitalist model of care has spread like wildfire since its introduction 20 years ago. In the mid-1990s, there were fewer than 1,000 hospitalists practicing in the United States; today, there are more than 44,000 in approximately 72 percent of U.S. hospitals. Hospitalist programs have been shown to more than pay for themselves by improving outcomes, reducing length of stay and enhancing hospital efficiency. Primary care physicians like them because hospitalists reduce their rounding responsibilities, and patients like them because they receive greater focus and attention during their hospital stays.
This model has proven so effective that it has sparked another trend: the rise of other “-ists.” Laborists, for example, are obstetrician/gynecologist physicians who work full-time in a hospital, delivering babies, rather than seeing patients in an office setting like a traditional OB/GYN.
In a 2011 survey by Today’s Hospitalist, more than 75 percent of the hospitalists interviewed said they worked in hospitals exclusively, but there was a significant segment that branched out into other settings such as skilled nursing facilities (SNFs), long-term acute care (LTAC) and hospice/palliative care services. In particular, transitionalists as they’re known—hospitalists who work part of the time outside of acute care in LTAC or SNFs—are drawing attention for their potential not only to help hospitals improve patient care, but also to help them reduce length of stay and avoid financial penalties for preventable readmissions.1 Subspecialties in neurology, orthopedics, and general surgery are other areas in which the hospitalist model is being applied beyond the role of primary care.
Not only does this trend offer patients more focused physician attention in new areas of the healthcare continuum, but it also offers healthcare facilities an opportunity to provide less segmented, more consistent quality care. And it offers new opportunities for physicians who want to work on a locum tenens (i.e. temporary) basis in various subspecialty areas.
However, along with the opportunities, come challenges. The rise of the “-ists” requires placement firms to have a greater understanding of how the various subspecialties integrate along the continuum of care, how they work together in a hospital environment or beyond it so the right candidate is chosen and placed. Just as healthcare is evolving, so is the locum tenens industry. The days of “one-off,” “placeholder” assignments are over as locum tenens staffing firms need to have greater clinical healthcare expertise than ever before.
The bottom line is that new opportunities are opening for physicians who want to distinguish their medical careers in a particular niche that goes beyond general practice or the traditional role of a hospitalist. And those opportunities are opening for physicians who want to work on a locum tenens basis, as well.
Place Physicians into a System of Care, Don’t Just Plug an Open Spot
Innovative locum tenens firms continue to examine how “-ists” can be maximized in temporary placement scenarios. The game has changed. Clinical management experience is critical in locum tenens physician placement today. And, with the growth of “-ist” subspecialties, working with a firm that has a “system of care” perspective is essential. Successful locum tenens placements have become so much more than just plugging any physician into an open spot with minimum qualifications.
The savviest firms understand what happens in the healthcare continuum, how to manage it and how to place subspecialties into it to avoid segmentation, to integrate with the system and with other providers to yield the greatest benefit.
Placing temporary hospitalists and “-ist” subspecialties is a complex undertaking. That’s why it makes sense for a locum tenens firm to have clinical experience. There is a lot to these positions, more than just doing an exam and ordering a drug. The need for collaboration and communication, for integration with the healthcare system and other providers is substantial.
“-ists” Will Play a Big Part in the Future Healthcare Landscape
Telemedicine is an adjunct to the foundation of healthcare, and “-ist” subspecialties will have their place there, too. As the physician shortage continues to reduce the number of primary care physicians and their availability to patients, these new creative approaches help fill the gap.
Take for example, transitionalists—physicians who would be able to make home visits and keep patients from having to be readmitted to the hospital after a hospital stay, or from having to visit the Emergency Room at the local hospital because they couldn’t get an appointment with their family physician or wait for an urgent care provider to see them. Transitionalist care, when used at the appropriate time and place, can make a significant contribution to community health and well-being. These types of scenarios ensure the “-ist” movement will absolutely be part of healthcare’s future landscape.
1. Katz, Paula S. Walking the walk in transitional care. Today’s Hospitalist, February 2012. Retrieved from
http://www.todayshospitalist.com/index.php?b=articles_read&cnt=1435 on April 28, 2015.
2. Carris, Jason. HM leaders highlight benefits of specialty hospitalist programs. The Hospitalist, August 28, 2012. Retrieved from http://www.the-hospitalist.org/article/hm-leaders-highlight-benefits-of-specialty-hospitalist-programs/ on April 28, 2015.
Joseph Turner is Vice President of Locum Connections. For more information, visit www.locumconnections.com.