Primary care physicians and hospitalists on care quality

When a primary care physician’s patient is admitted to the hospital, that patient’s care is quite often provided by hospital staff, including a hospitalist. As the term implies, a hospitalist is an internal medicine physician who practices in a hospital setting only. The hospitalist specialty is relatively new, having been initiated just over a decade ago.

A hospitalist has several differences over the primary care physician when caring for a patient who has been admitted to the hospital. The hospitalist has established hours to care for patients in the hospital and does not have to be called in from an independent practice when a patient needs care. The hospitalist is trained in hospital procedures and serves as the point of contact between nurses and other hospital staff and the patients’ primary care physician.

However, a recent study published in JAMA Internal Medicine found that the primary care physician’s familiarity with the patient’s medical history and prior established relationship with that patient may have a more significant impact on the level of care quality provided to the patient in the hospital.

The study, which involved over 560,000 Medicare patients, found that “patients cared for during a hospitalization by their own primary care physicians had slightly longer lengths of stay, were more likely to be discharged to home, and were less likely to die within 30 days compared with those cared for by hospitalists.” In addition, patients cared for by their primary care physicians while in the hospital had a slightly lower readmission rate than those who were cared for by a hospitalist.

The primary care physician may have an advantage in providing higher quality care, given the prior relationship and knowledge of the patient’s medical history. The hospitalist has some advantages in regard to being more familiar with hospital operations and being able to communicate more effectively with hospital staff. Hospitalists, in the study, tended to discharge patients earlier and to another healthcare facility, whereas the patient’s primary care physician was more likely to discharge patients to their own home.