by Jen Jenkins
There was a time not long ago, circa the mid-1990s, when the term “hospitalist” did not exist. Doctors worked in hospitals only periodically, attending to their patients when necessary. It wasn’t until economic pressures and a push for efficiency in healthcare created “the hospitalist boom” that we started seeing doctors working in hospitals full-time. It became clear that having doctors based at every hospital was significantly better for both efficiency and for hospital profits. According to this article in the New York Times, the discipline grew rapidly from 2003-2011, jumping from 11,000 hospitalists nationwide to 50,000 respectively. Doctors began enjoying the additional time they were now afforded to spend with their patients and for a time hospitals were so happy with the advantages in efficiency that it all seemed too good to be true. And sure enough, the initial advantages began to wear off. A huge consequence of the constantly changing healthcare market is the necessity for more and more efficiency. In yet another shift, doctors began having their quality time with patients limited due to a push for a focus on metrics, documentation, and hospital management.
Dr. Rajeev Alexander is a hospitalist at PeaceHealth Sacred Heart Medical Center in Springfield, OR. In his practice, Dr. Alexander believes in taking the time to go through every minute detail with his patients and he dislikes the style of medicine so carelessly flaunted in pop culture television. “Real life is all about the narrative,” he said. “It’s sitting down and talking about bowel movements with a 79-year-old woman for 45 minutes. It’s not that interesting, but that’s where it happens.” His method of treating patients happened to be negatively juxtaposed against the new direction his hospital wanted to take. In 2014, Sacred Heart announced that they planned on requesting bids to outsource their hospitalists to a management company. Outsourcing has recently become more popular across the country as hospitals realize it may be an excellent way for them to measure quality without being responsible for the complicated data collection that is involved. Working in our modern hospitals means being preoccupied with money constantly; this new shift was targeting that bottom line.
Here, the overarching problem for Dr. Alexander’s group is that hospitalists are not a “profit center” for hospitals. Dr. Alexander and his colleagues at Sacred Heart were outraged by the very idea of outsourcing, convinced that this would mean seeing many more patients per shift in the interest of profits. They did not want to lose their jobs by resisting this change but they also knew that it would be the patients that were significantly affected. Then, the idea of unionizing was brought up. It is rare, but there are hospitals around the country whose doctors are unionized, although no union is composed of a single group of specialists. Feeling increasingly bitter after seeing no better options, the group shed their doubts and held a union election. The decision to form a union was voted in overwhelmingly. They had won a battle but not the war. Although the industry has seen a retreat in outsourcing for the time being, that does not mean that hospitals aren’t still keen on getting more out of their doctors. Just how they do so, we shall continue to see.