Not On Call

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The hospitalist concept, despite early resistance from admitting physicians, has become so common that many of those same doubting doctors now rely on hospitalists as a key piece of their patients’ continuum of care. In fact, it’s worked so well that some hospitals, fed up with the high costs and inefficiencies associated with call coverage, are extending the concept to their surgeons.

Now, so-called “surgicalists” are rapidly gaining popularity among some forward-thinking hospitals that are facing mounting pressure to pay physicians ever-higher amounts for call coverage.

“This looks like something that’s going to be a solution for call-pay problems,” says Jennie L. Campbell, a shareholder with Pershing Yoakley & Associates, a Knoxville, Tenn.-based consultancy. “Subsidies are getting so voluminous now, it’s becoming an equal-value proposition to employ them and lose money.”

That is, lose money on a line-item basis. But many hospitals and surgical groups are finding that employing a few general surgeons within a multispecialty group to handle call cases is increasing throughput at the hospital and increasing the quality of life for the rest of the physician group practice—at little detriment to the income of the remaining physicians.

Richard H. Roettger, M.D., runs the three-year-old surgicalist program for Greenville (S.C.) Hospital System. He says the idea came about because there weren’t enough surgeons at the hospital-owned multispecialty surgical practice who wanted to cover the emergency department at the flagship 710-staffed-bed Greenville Memorial Hospital, both for traumatic and nontraumatic surgeries.

“General surgeons across the country have been squeezed from a revenue standpoint,” says Roettger. “They’ve gotten to the point where running into the ER has become a real drudgery, and something a lot of them aren’t interested in doing.”

Roettger’s practice employs 35 surgeons from a range of specialties, including 18 general surgeons. Eight of those surgeons are involved in Greenville Memorial’s surgical hospitalist program. At least one surgicalist is at the facility 24 hours a day, seven days a week, which helps the hospital free up beds more efficiently and schedule emergency surgeries almost immediately. The result is less waiting for patients in pain from vascular, colon and appendix problems, for example, while the hospital is able to increase patient throughput.

Although some surgeons were initially resistant to the idea, Roettger says, “with time everyone has grown to love it. They don’t get called with an abscess, for example, at two in the morning.”

Roettger, who is on the rotation himself, says the increased throughput allows other surgeons in the practice to be more efficient, allowing them to take on more paying cases and elective procedures, which they didn’t have time for in the past due to call obligations.

—Philip Betbeze




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