Use of Hospitalists and Office-Based Primary Care Physicians’ Productivity

Abstract

BACKGROUND: Growth in the care of hospitalized patients by hospitalists has the potential to increase the productivity of office-based primary care physicians (PCPs) by allowing them to focus on outpatient practice. OBJECTIVE: Our aim was to examine the association between utilization of hospitalists and the productivity of office-based PCPs. DESIGN/PARTICIPANTS: The cross-sectional study was conducted using the 2008 Health Tracking Physician Survey Restricted Use File linked to the Area Resource File. We analyzed a total of 1,158 office-based PCPs representing a weighted total of 97,355 physicians. MAIN MEASURES: Utilization of hospitalists was defined as the percentage of a PCP's hospitalized patients treated by a hospitalist. The measures of PCPs' productivity were: (1) number of hospital visits per week, (2) number of office and outpatient clinic visits per week, and (3) direct patient care time per visit. KEY RESULTS: We found that the use of hospitalists was significantly associated with a decreased number of hospital visits. The use of hospitalists was also associated with an increased number of office visits, but this was only significant for high users. Physicians who used hospitalists for more than three-quarters of their hospitalized patients had an extra 8.8 office visits per week on average (p=0.05), which was equivalent to a 10 % increase in productivity over the predicted mean of 87 visits for physicians who did not use hospitalists. We did not find any significant differences in direct patient care time per visit. CONCLUSIONS: Our study demonstrates that the increase in productivity for the one-third of PCPs who use hospitalists extensively may not be sufficient to offset the current loss of PCP workforce. However, our findings provide cautious optimism that if more PCPs effectively and efficiently used hospitalists, this could help mitigate a PCP shortage and improve access to primary care services.KEY WORDS: hospitalists; primary care physician shortage; productivity.

Biased Technical Change in Hospital Care and the Demand for Physicians

“…Whereas it has been demonstrated in the literature that the use of mid-level practitioners enhances physician productivity, Park & Jones (2015) found that the increased use of hospitalists (physicians who solely work with inpatients), there was an increase in primary care providers' surgery-visit productivity by approximately 10%. This increase in surgery visits also translated to fewer hospital visits, primarily due to higher quality primary care.…”

Biased technical change in hospital care and the demand for physicians

“…Whereas it has been demonstrated in the literature that the use of mid-level practitioners enhances physician productivity, Park and Jones [9] found that in the increased use of hospitalists (physicians who solely work with inpatients), there was an increase in primary care providers' surgery-visit productivity by approximately 10%. This increase in surgery visits also translated to fewer hospital visits, primarily due to higher quality primary care.…”

PA job availability in primary care during 2014 and 2016

“…Having more hospitalists reduces the amount of primary care physician time required for hospital rounds, freeing up time to see more patients in ambulatory settings; the increase in primary care productivity might not offset the loss of primary care providers to the hospitalist workforce, however. 23,24 Hospitals will not hire more hospitalists than are needed. Hence, as with many relatively young professions, a shift has been taking place that is not being captured by the workforce simulation model.…”