Published in the July 2010 issue of Today’s Hospitalist
IN THIS MONTH’S COVER STORY, we tackle an issue that gets lots of attention among hospitalists, and for good reason: the ability “or inability “of hospitalists to work with midlevels.
The topic of midlevels is so critical because there simply aren’t enough hospitalists to go around. But despite that reality, many hospitalist groups are struggling with how to succeed with NPs and PAs on board.
One problem is that primary care physicians, who’ve just gotten comfortable turning their inpatients over to hospitalists, may not be ready to have those patients treated by someone who isn’t a doctor. And medical specialists who rely on midlevels in their own practice may not extend that same level of confidence to NPs and PAs working with the hospitalist service.
There are also problems that arise from midlevels’ varying levels of training and experience, and what that means for their ability to work independently. The hospitalists at the University of Michigan Health System in Ann Arbor, for instance, terminated their four-year-old experiment with midlevels, in large part because of concerns about the oversight hospitalists needed to exercise to help midlevels care for very complex patients. (You can find more information on this in our March 2010 issue.)
But programs struggle with an even more fundamental problem: the expectations of their own physicians. While some hospitalists say they’re willing to accept midlevels, they refuse to see that NPs and PAs may evolve past discharge planning roles.
Our cover story highlights groups that are capitalizing on midlevels to substantially boost productivity and extend their leadership within hospitals. But those success stories make it clear that there are no shortcuts that time-strapped groups can take in terms of training or oversight.
Making greater use of midlevel providers may solve a lot of problems, but I’m not sure how many hospitalists are ready to take the plunge.
Editor & Publisher