The study was limited to care by only one hospitalist group, prompting Elliott to caution that one study in one healthcare system is not enough to dictate policy. It should, however, "spur people to look at this in other settings."
Data to Push Back
Elliott's finding "changes the nature of negotiations between hospitals and hospitalists," says Robert Wachter, MD, associate chairman of the department of medicine at the University of California, San Francisco. He is an internal medicine specialist who is regarded as a leader of the hospitalist movement.
"If market dynamics create a census of 20 (patients per hospitalist) that may affect the hospital's cost, and now hospitalists have the ability to argue there's a return on investment calculation that needs to be made," he says.
"Yes, it may cost the hospital a few more dollars to allow us to keep a census at 15 or 16 (patients per hospitalist, rather than 20 or 25,) but those dollars may pay off in terms of throughput and lower hospital cost. We need to change the nature of this conversation, and that conversation happens in every hospital in the country that has hospitalists."
In the past, Wachter says, hospitalists may have believed they were overworked, "but they didn't have the data to push back, to tell [hospital administrators], 'You're shooting yourself in the foot when you make us run this fast on the treadmill.' "