As hospitals make advances in hospital safety, including eliminating infections, and reducing medication errors, they are also working toward cutting costs.
To gain better control over the many people who make decisions in hospitals, some that affect patient care in the hospital, and others that affect costs, there are some job titles that may be new to patients. Knowing who these people are will help you navigate your own hospital experience more successfully. They are unique to hospitals, and are supposed to provide benefits to patients, although not all patients will agree that encountering them has improved their experience in the hospitals.
Hospitalists
First defined in the New England Journal of Medicine in 1996, the hospitalist is a physician who is employed by the hospital to care directly for patients who are admitted by another doctor. They are typically generalists such as primary care physicians or internists, and they stand in for the doctor who admitted the patient.
From the point of view of the patient, hospitalists are a mixed blessing. Since a hospitalist is always available on the premises, patients and their caretakers (nurses, advocates) have quicker access to the doctor should a problem arise with the patient . They are able to keep an eye on the big picture of the patient's health, balancing the tendency of specialists to focus on the body system they know. On the other hand, the presence of a hospitalist means the patient's usual doctor, the one who knows the patient and his medical situation, does not come to call at the hospital. This can be frustrating to patients who feel comforted by the familiarity of their usual doctor.
From the point of view of the patient's regular doctor, knowing someone else can make the hospital calls frees him up to keep his office hours more regularly, allowing him to see more patients during the day. In addition, the doctor does not have to be on call 24/7 and is assured his patient will be seen in a timely manner should a problem arise.
From the point of view of the hospital, the presence of a hospitalist can reduce errors, and provides another income stream since the hospitalist will bill each patient for the time he spends with her.
Hospitalist is now a designation of doctor, accepted by medical graduate schools, in demand by hospitals, and defined with job descriptions in hospital human resource departments. The Society of Hospital Medicine was founded to help the public understand about this designation, and improve the education of hospitalists.
Proceduralists
Henry Ford's assembly line may have influenced development of the job called "proceduralist."
Recognizing that many medical procedures require a high level of skill, but are reimbursed at low levels by health insurance, the first Procedure Center was built at Cedars-Sinai Hospital in Los Angeles. Now they are found at academic medical centers throughout the country.
A proceduralist will be a doctor who does the same 3-5 procedures every day on as many patients as can be accommodated. Spinal taps, central-line insertions, and other less recognized procedures are performed this way.
Patients benefit by the skill level of the proceduralist. Most doctors or surgeons don't have the opportunity to refine their skills so sharply. The hospital benefits by the numbers of patients who are able to undergo the procedure, the reduced risk of complications, and therefore better opportunities for their financial bottom line.
Intensivists
To address the need for knowledge of the special aspects of critical care in hospital intensive care units (ICUs), the title of intensivist was created and is embraced by organizations interested in patient safety and quality improvement.
Intensivists have specialized knowledge of working with patients who are near death, but may be able to be medically ministered to survive. Beyond their general knowledge of body systems and the reasons patients are admitted to ICUs to begin with, intensivists specialize in taking care of critically ill patients, which often includes managing medications to increase blood pressure, and mechanical ventilators, skills which general internists may not routinely use.
Patients benefit because studies say more of them survive the ICU experience.
