- The Washington Times - Tuesday, March 25, 2008

Oralia Maitland was adamant. Bedridden at Georgetown University Hospital with pressure wounds and other ills, she tightened her lips and firmly shook her head “no” at Dr. Amarin Sangkharat’s suggestion that she needed to go into a nursing home, where she would get 24/7 care.

He tried several times, ever so gently, reminding her how detrimental it would be to her health to be alone at night in her Southwest home, even with a health aide visiting during the day.

Pressure wounds can lead to amputation, he informed her. She also had abdominal pains and complained about her eyes. Overweight and suffering from diabetes, she was unlikely to get better without ongoing care. Dr. Sangkharat would not be responsible for her beyond her hospital stay. Outside of some low-key persuasion, he could do little more without her consent.

“The offer is always on the table,” he told her.

An internist, Dr. Sangkharat is also a hospitalist — someone charged with taking the place of a patient’s regular physician while that person undergoes treatment in the hospital. He consults with Ms. Maitland’s primary care doctor and writes up reports from his own daily rounds, but he would have no further relationship with her after her discharge.

The profession has grown in line with the changing demands of the health care system. Research has shown that hospitalists help reduce the length of a patient’s hospital stay and, hence, costs as well as the chance of a patient contracting a hospital-based infection.

Doctors have different motivations for tackling the job, and hospitals and medical centers have different programs and conditions under which the hospitalists work. All large hospitals and medical centers in the Greater Washington area have them, and depending on their specialty, hospitalists also may perform surgery or assist at surgical procedures.

Part of the job Dr. Sangkharat enjoys most is interacting with hospital residents and interns — the academic staff. “I couldn’t devote my life to one organ system; I think hospitalists like general medicine, all the different parts of medicine,” he says — another reason he chose to enter a profession barely a decade old.

“Patients need someone to interpret what is going on and be responsible for integrating hospital care — to lead the team,” says Dr. James Welch, a Georgetown resident with a doctorate in tumor biology who is considering becoming a hospitalist. “A hospitalist is an ER doctor on the ward.”

Plus, he notes, “It’s a good life.” Hospitalists work regular hours and often can choose their schedule. They also are not called from home in an emergency.

“Twenty years ago, if you got sick you went to the hospital, and a family doctor would come in. That model obviously has changed dramatically because of economic pressures,” says Dr. Gaurov V. Dayal, chief medical officer at Shady Grove Adventist Hospital in Rockville, who calls hospitalist the “fastest-growing medical specialty.” Family practitioners and others in managed care can’t afford to take time to see patients in a hospital that often is some distance from their offices.

Shady Grove has eight to 10 hospitalists in various specialties, so at least one pediatrician, obstetrician-gynecologist and surgeon always is available.

“In the older model, physicians would make rounds early and often return after 7 p.m., relying between on updates from a nursing staff,” Dr. Dayal says.

With improvements in technology and diagnostic capabilities, however, the turnaround time for treatment is faster and key decisions about care sometimes must be made on the spot, which is where a hospitalist comes in.

Anne Arundel Medical Center in Annapolis has hospitalists in four areas — primary care, surgical, pediatrics and obstetrics-gynecology. A typical “war story,” says Dr. Joseph Morris, 53, who spent his earlier career in private practice, is the pregnant woman with a child who was found unconscious at home, bleeding from a head injury.

“She had passed out, smacking her head and opening a large gash,” he recalls. “Her 6-year-old called 911. When the ambulance brought her in, she was in shock, semiconscious and had almost no blood. I took one look at her and had her in the operating room in five minutes.”

Though they are relieved of much of the administrative tedium associated with a private office, hospitalists sometimes still have to spend time cajoling insurance companies to pay for certain patient procedures. They are, however, relieved of paying directly for malpractice insurance, which can range “well over $100,000 a year,” according to Dr. Morris.

The pay is slightly higher than in outpatient physician practice, says Dr. Titus Abraham, the co-director of Anne Arundel’s hospitalist service.

Carmela Cole, 50, director of Washington Hospital Center’s hospitalist program, says competition has driven up annual salaries to $170,000 and $200,000 or more.

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