Primary care engagement
Increased isolation with growth of hospitalist model
Physicians used to all be at the hospital in the mornings, both primary care providers and specialists. This was a key time to establish and maintain collegial relationships. The rise of hospitalists means that primary care doctors are no longer at the hospital and seem to have become more isolated. This is also starting to happen to specialties that are adopting the “hospitalist” model. The concern is that this is leading to a less engaged medical staff and more physician burnout. We have tried other social activities but it is hard to replicate the daily interactions that used to occur in the hospital. I don’t think the hospitalist model is going away and will likely grow, how can we replace what has been lost in terms of staff interactions.
time to bring back a physician lounge, which in some institutions has disappeared, as a focal meeting point where colleagues can engage in discussions, take a break, and socialize.
We experience the same issue but one thing that has helped at our system is to do conferences centered on specific topics by specialty. We just did one on Advance Care Planning and Palliative Care. This has allowed us to bring physicians from all across the continuum together to discuss pertinent issues. Often times breakfast will be served and there is time for networking. This gives all of the providers a reason to be there (the conference) but gives them time to get to know each other, discuss patients, etc.
I think using video calls meetings in the morning might still be visible so the primary care physicians can still be in touch with other doctors in the hospital on daily basis. also the primary care physicians can still come to the hospital “not all of them everyday” on a prescheduled plan to attend the morning gatherings” few of them very day”.
I suggest we acknowledge that times are changing and will never be the same. Don’t spend too much time trying to bring it back, but focus on how to make the current and future environments more optimal for everyone. We’ve moved all of our PC docs to 100% outpatient and employ a full hospitalist model, plus ED, adding Ortho and maybe Laborists in the near future. Allowing providers to focus in one area should be beneficial to them and the patients, if you have you right resources,structure and tools in place to promote the same, or better communication than the days of old. As scale continues to change the market and communities continue to grow outward from any centrally located hospital, we must encourage and design technology and programs that narrow the time and distance challenges of the new markets. Population health strategies are already driving these demands and it’s gaining momentum.
Keys for us include:
– Optimization of EHR
– Usage of portals and secure messaging tools for providers
– Quartely provider socials, away from work
– Regular MD leadership events for edcuating and aligning
– Monthly Section Head meetings that inlcude inpatient and outpatient MD leaders
I agree this is a problem. Here are a few things we are currently doing with some success. To start, our medical staff changed the rules and allowed different categories of membership. If you are a primary care provider who doesn’t come to the hospital any longer but still part of the system, you can stay active with a nominal fee but not required to have all the annual requirements to be a full time member. This will allow you to receive updates from the health system and attend our quarterly medical staff meetings. Secondly, we began utilizing our business development team to meet with our specialists and PCPs in the community. They aren’t necessarily part of our health system but refer their patients to our facility. When issues arise, we send out someone from administration along with medical director of the hospitalist. We try to correct the problem immediately which the PCPs then feel involved. Lastly, our specialists constantly go to community events to educate other specialists and PCPs about the latest technology and how we can partner to deliver better care.
I agree that this is a challenge. It also doesn’t seem that the isolation of primary care from hospital and specialty medicine will reverse.
We have had a number of social events with limited help. Many people say they are too busy to attend.
Service level agreements between PC and specialties have been some help.
We are transparent with financial performance of the group and that has helped drive internal referral rates and, indirectly, communication.
Combined Leadership Council with primary, specialty and hospital medicine has been a helpful forum to bring issues forward and then arrange the appropriate conversations.
Within the hospital, we have worked to increase communication between hospitalists and other providers. This involves collaboration on service agreements. Recently, we have worked on improving progress notes to make hospitalists ability to provide effective patient care easier. Our physicians lounge in the hospital remains a busy place with much interaction between inpatient physicians. Connection to the outpatient world is more difficult and the barriers may be increasing. Not sure this can be impacted.