New type of specialists take care of patients

Mary Lou Peterson is from Eureka and was hospitalized 50 miles away in Whitefish with a swollen, infected leg.

The elderly woman likes her doctor in Eureka. But a long trip is a bit much for him to check on her daily at North Valley Hospital.

"It's busy as the dickens out there," she said.

But Peterson still saw the same doctor regularly - first Dr. Suzanne Daniell, and then Dr. Betty Kuffel.

"I'm seeing a doctor every day. … I know each of these ladies has spent plenty of time reading my charts. … They knew all about me - where I lived, when I came in, not just what was on the charts," Peterson said.

This continuity comes from a program that North Valley has dabbled with for a year and kicked in full time on March 1.

It's part of the evolution of a new type of specialty - the "hospitalist."

The term was coined in 1996 and covers physicians who spend all their time at hospitals with admitted patients independent of emergency room doctors and surgeons.

Traditionally when a patient ends up in a hospital, his or her private physician is still the primary caregiver, checking in whenever his or her practice allows.

That complicates and lengthens the day of a private doctor. And a patient sees that physician at irregular times.

Consequently, hospitals nationwide have been staffing themselves 24/7 with hospitalists, whose sole job is the general medical care of admitted patients. Kalispell Regional Medical Center began its own hospitalist program more than two years ago.

"The specialty is poised not only to continue its meteoric growth, but make inroads into U.S. hospitals," said a 2006 article by Edward Doyle, editor of Today's Hospitalist.

About 82 percent of hospitalists are trained in some form of internal medicine, according to Wikipedia. Most of the rest are trained as family practitioners or pediatricians, with about 5 percent being non-doctors, such as nurse practitioners and physician assistants.

According to Wikipedia, hospitalists materialized because:

. States and various medical associations put limits on staff duty hours, including those by interns and resident doctors.

. Numerous primary-care doctors are playing shrinking roles in hospitals, mainly because their revenues improve as they stay more at their offices.

. Insurance applies pressure to decrease admitting patients with lesser problems. That means admitted patients now usually have major health problems requiring longer stays with needs for better continuity of care. And office-based physicians have problems ensuring that continuity.

In Whitefish, the town's private-practice internal medicine doctors - Daniell and Dr. Beth White - found themselves stretched too thin between their office and the hospital, said Kuffel, who coordinates North Valley's five hospitalists. Kuffel's specialty is internal medicine.

Consequently, North Valley began a hospitalist program for weekends and then expanded to a full-time program in March.

The five hospitalists are Kuffel, Daniell, White, Dr. Patrick Madigan (a cardiologist who still does some limited private practice) and Dr. Ken McFadden, who splits his duties between the emergency room and being a hospitalist.

Kuffel and Madigan are the only full-time hospitalists at North Valley. While the other three have other responsibilities - White and Daniell have kept their private practice - when a hospitalist is on duty, that doctor concentrates solely on that job.

The number of consecutive 24-hour shifts varies. Sometimes they can last up to four days, with the doctors being on call at night.

"This provides better continuity of patient care," Kuffel said.

Coordination is a major key to this type of program.

"Continuity of care - think hand-offs and discharges - is still the 800-pound gorilla that looms over the specialty," Doyle wrote.

North Valley hospitalists always pass a patient from one doctor to another in person.

The same cell phone is passed along to the North Valley hospitalist on duty so nurses have only one number to dial to get that doctor.

North Valley also is working on ways to measure the program's effectiveness over time, Kuffel said.

Doyle's Today Hospitalist article said this specialty faces some future changes, such as:

. Hospitalists eventually having to get a certification tailored to their specialty.

. Possible changes in the scope of the hospitalist specialty, which is dominated by internal medicine practitioners. Problems such as broken bones, some obstetrics and co-managing surgical patients might be formally added to a hospitalist's responsibilities.

. How and if insurance companies, Medicare and other institutions pay for work done by hospitalists.

Reporter John Stang may be reached at 758-4429 or by e-mail at jstang@dailyinterlake.com