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What is a GI hospitalist?
A GI hospitalist is a gastroenterologist that primarily provides inpatient care. Their main professional focus is the acute management of gastrointestinal conditions occurring in the hospital setting.
How prevalent are subspecialty hospitalists?
The rise of hospitalists has changed the landscape of medicine. The hospitalist is now the central inpatient provider responsible for patient care and day-to-day housestaff education. From 1995 to 2016, the number of hospitalists increased from 500 to over 50,000.1 While the majority of hospitalists are generalists from the fields of internal medicine, pediatrics, and obstetrics/gynecology, some come in the form of specialists. In a recent survey, up to 10% of internal medicine subspecialists already consider themselves “hospitalists.”2 However, most of these self-described hospitalists only do so part of the time. For example, many group practices have one of their members manage all the hospitalized patients for the group for certain periods of time. It is rare to find full-time subspecialist hospitalists, but there has been an emergence in this new model of GI practice. Many people are unaware of this system of care nor understand how it may influence hospital-based care.
What is the role of a GI hospitalist?
While my primary responsibility is to care for inpatients whom require GI consults, I have outpatient and administrative responsibilities. Generally speaking, I am the de facto consult attending for the year.
How did you decide to become a GI hospitalist?
Upon graduation from my GI fellowship, I wanted an academic job where I could work closely with fellows and manage a wide breadth of complex, high-acuity patients. During fellowship, I enjoyed all areas of gastroenterology and hepatology and did not “sub-subspecialize.” As such, I wanted a job where I would see the full spectrum of GI and liver disease. Additionally, I enjoyed seeing the sickest patients, because I felt I could make the most dramatic differences with my care.
When I was searching for jobs, I spoke with the chief of GI at the hospital where I completed my residency about how I could fill a niche. We conceived of a model that would merge my personal interests and help the division provide consistent teaching for fellows and increase inpatient billing. Prior to my arrival, attendings that staffed the consult service were expected to continue their research and outpatient clinical workload while finding time to come to the hospital. Not surprisingly, attending rounds was erratic. The fellows were left to manage patients independently, scrambled to run cases by whomever happened to be around, or waited until they could reach the attending the next day. Unsurprisingly, billing by attendings was sparse.
What is a typical day like in your life as a GI hospitalist?
My day starts at 7:30 a.m. either with my outpatient office hours, endoscopy session, or GI Grand Rounds. Each week, I have two morning outpatient office sessions, one morning endoscopy session, and one morning session supervising fellows’ endoscopy.
At noon, I round with a team of GI fellows, medical students, and housestaff rotators for 2 hours. After we see the new consults, the remainder of my afternoon is spent seeing the follow-up patients. For two afternoons throughout the week, I have outpatient endoscopy sessions. I typically conclude my day at 5 p.m.
For night coverage, I take emergency calls for my own patients, and share general call duties with the other members of my division. On average, I take calls for one weekday a month and five weekends per year.
Typically, GI hospitalists only cover inpatients during the daytime. All nights and weekends are covered by partners and nonemergent overnight consults are saved until the next day. They have no office work.
What is the most challenging part of being a GI hospitalist?
As the perpetual “GI Consult Attending,” there is the threat of burnout when confronted with a high volume of sick, complex patients. Many of the patients have multiple comorbidities and require a multidisciplinary approach. On average, we have five new consults a day and the number of active follow-up patients is 10. Nonetheless, the nature of the inpatient service makes the volume of work unpredictable. When the service is busy and the census swells, the numbers of patients requiring staffing and notes can become overwhelming.
Importantly, for those without an outpatient practice, one loses the opportunity to develop longitudinal relationships with patients. Additionally, one also loses the ability to provide integrated, comprehensive care for individual patients once they leave the hospital.
How are you paid?
My compensation is based on a base salary with an incentivized system based on my RVUs and collections. For the dedicated hospitalist for a group practice, there is typically a base salary and productivity-based income. Additionally, there should be a path to partnership. Lastly, in balancing the ledger, the diminished inpatient revenue stream is offset by the lack of overhead.
What are the benefits of a GI hospitalist system?
Our system benefits the workflow for the GI fellows. Since I have started, the GI consultation rounds start at a consistent time. During these rounds, we discuss relevant GI literature and make timely plans on all patients. Oftentimes, I am able to supervise the fellows so they can fit in a scope before the end of the workday. Ultimately, the fellows know they can find me and discuss patients throughout the day. The fellows consistently have told me that the since the implementation of the hospitalist system, there has been a dramatic difference. Collectively, they feel both their education and patient care have improved.
In terms of consult efficiency, one study demonstrated that the transition to a GI hospitalist system resulted in a mean decrease in consult to urgent esophagogastroduodenoscopy (EGD) time from approximately 24 to 14 hours.3 However, this occurred in the context of a lower inpatient consult volume and only covered 2 months. Furthermore, the time from admission to EGD did not change. Nonetheless, further studies are needed to examine the impact of this model shift.
In terms of a financial benefit, at our institution the total gross inpatient charges increased more than $850,000 for the year. This was largely attributable to the 79% increase in the gross charges from follow-up notes.
For group practices, the hospitalist system makes more efficient use of physician’s time. Physicians can either focus on outpatients or inpatients without worrying about going between the office, ambulatory surgical center, and the hospital. In general, inpatients require a disproportionate amount of time relative to the revenue collected. Furthermore, by eliminating the need for group physicians to go to the hospital, they can carve out 1-2 hours of office time to increase billing.
When there is one point-person whom handles all inpatient GI, communication is facilitated among primary teams and other services. The GI hospitalist develops working relationships with surgeons, radiologists, anesthesiologists, intensivists, etc. Teams can often just text or call me directly, instead of looking for the covering attending or going through the office phone service.
What are drawbacks to the GI hospitalist model?
Since there is only one gastroenterologist in the hospitalist model, if that person is not doing a good job, it affects the management of GI conditions for the entire hospital.
There is a loss of continuity-of-care. When GI patients get admitted, the gastroenterologists responsible for their care will not be the person with whom they have a long-term relationship. Furthermore, when the patient gets discharged, the primary gastroenterologists will not be fully aware of the inpatient course.
Also, when outpatient and inpatient gastroenterologists become segregated based on hospital setting, they each lose out of learning the intricacies of managing patients in a different context.
What do you like most about being a GI hospitalist?
The GI hospitalist position creates a great opportunity for gastroenterologists to make a remarkable, immediate impact on interesting, high acuity patients. The nature of the job also has the advantage of providing reasonable hours. This may be attractive to many whom want a better work-life balance.
Dr. Wan is assistant professor of medicine, associate program director, GI Fellowship Program, New York Presbyterian/Weill Cornell Medical Center, New York, N.Y.
References
1. Wachter R.M., Goldman L. Zero to 50,000 – The 20th Anniversary of the Hospitalist. N Engl J Med. 2016 Sep 15;375[11]:1009-11.
2. Estimating the Number and Characteristics of Hospitalist Physicians in the United States and Their Possible Workforce Implications. Analysis in Brief. Available at: https://www.aamc.org/download/300620/data/aibvol12_no3-hospitalist.pdf. Accessed May 1st, 2016.
3. Mahadev S., Lebwohl B., Ramirez I., Garcia-Carrasquillo R.J., Freedberg, D.E. Transition to a GI Hospitalist System is Associated with Expedited Upper Endoscopy. Gastroenterology. 2016;150[4]:S639-40.
What is a GI hospitalist?
A GI hospitalist is a gastroenterologist that primarily provides inpatient care. Their main professional focus is the acute management of gastrointestinal conditions occurring in the hospital setting.
How prevalent are subspecialty hospitalists?
The rise of hospitalists has changed the landscape of medicine. The hospitalist is now the central inpatient provider responsible for patient care and day-to-day housestaff education. From 1995 to 2016, the number of hospitalists increased from 500 to over 50,000.1 While the majority of hospitalists are generalists from the fields of internal medicine, pediatrics, and obstetrics/gynecology, some come in the form of specialists. In a recent survey, up to 10% of internal medicine subspecialists already consider themselves “hospitalists.”2 However, most of these self-described hospitalists only do so part of the time. For example, many group practices have one of their members manage all the hospitalized patients for the group for certain periods of time. It is rare to find full-time subspecialist hospitalists, but there has been an emergence in this new model of GI practice. Many people are unaware of this system of care nor understand how it may influence hospital-based care.
What is the role of a GI hospitalist?
While my primary responsibility is to care for inpatients whom require GI consults, I have outpatient and administrative responsibilities. Generally speaking, I am the de facto consult attending for the year.
How did you decide to become a GI hospitalist?
Upon graduation from my GI fellowship, I wanted an academic job where I could work closely with fellows and manage a wide breadth of complex, high-acuity patients. During fellowship, I enjoyed all areas of gastroenterology and hepatology and did not “sub-subspecialize.” As such, I wanted a job where I would see the full spectrum of GI and liver disease. Additionally, I enjoyed seeing the sickest patients, because I felt I could make the most dramatic differences with my care.
When I was searching for jobs, I spoke with the chief of GI at the hospital where I completed my residency about how I could fill a niche. We conceived of a model that would merge my personal interests and help the division provide consistent teaching for fellows and increase inpatient billing. Prior to my arrival, attendings that staffed the consult service were expected to continue their research and outpatient clinical workload while finding time to come to the hospital. Not surprisingly, attending rounds was erratic. The fellows were left to manage patients independently, scrambled to run cases by whomever happened to be around, or waited until they could reach the attending the next day. Unsurprisingly, billing by attendings was sparse.
What is a typical day like in your life as a GI hospitalist?
My day starts at 7:30 a.m. either with my outpatient office hours, endoscopy session, or GI Grand Rounds. Each week, I have two morning outpatient office sessions, one morning endoscopy session, and one morning session supervising fellows’ endoscopy.
At noon, I round with a team of GI fellows, medical students, and housestaff rotators for 2 hours. After we see the new consults, the remainder of my afternoon is spent seeing the follow-up patients. For two afternoons throughout the week, I have outpatient endoscopy sessions. I typically conclude my day at 5 p.m.
For night coverage, I take emergency calls for my own patients, and share general call duties with the other members of my division. On average, I take calls for one weekday a month and five weekends per year.
Typically, GI hospitalists only cover inpatients during the daytime. All nights and weekends are covered by partners and nonemergent overnight consults are saved until the next day. They have no office work.
What is the most challenging part of being a GI hospitalist?
As the perpetual “GI Consult Attending,” there is the threat of burnout when confronted with a high volume of sick, complex patients. Many of the patients have multiple comorbidities and require a multidisciplinary approach. On average, we have five new consults a day and the number of active follow-up patients is 10. Nonetheless, the nature of the inpatient service makes the volume of work unpredictable. When the service is busy and the census swells, the numbers of patients requiring staffing and notes can become overwhelming.
Importantly, for those without an outpatient practice, one loses the opportunity to develop longitudinal relationships with patients. Additionally, one also loses the ability to provide integrated, comprehensive care for individual patients once they leave the hospital.
How are you paid?
My compensation is based on a base salary with an incentivized system based on my RVUs and collections. For the dedicated hospitalist for a group practice, there is typically a base salary and productivity-based income. Additionally, there should be a path to partnership. Lastly, in balancing the ledger, the diminished inpatient revenue stream is offset by the lack of overhead.
What are the benefits of a GI hospitalist system?
Our system benefits the workflow for the GI fellows. Since I have started, the GI consultation rounds start at a consistent time. During these rounds, we discuss relevant GI literature and make timely plans on all patients. Oftentimes, I am able to supervise the fellows so they can fit in a scope before the end of the workday. Ultimately, the fellows know they can find me and discuss patients throughout the day. The fellows consistently have told me that the since the implementation of the hospitalist system, there has been a dramatic difference. Collectively, they feel both their education and patient care have improved.
In terms of consult efficiency, one study demonstrated that the transition to a GI hospitalist system resulted in a mean decrease in consult to urgent esophagogastroduodenoscopy (EGD) time from approximately 24 to 14 hours.3 However, this occurred in the context of a lower inpatient consult volume and only covered 2 months. Furthermore, the time from admission to EGD did not change. Nonetheless, further studies are needed to examine the impact of this model shift.
In terms of a financial benefit, at our institution the total gross inpatient charges increased more than $850,000 for the year. This was largely attributable to the 79% increase in the gross charges from follow-up notes.
For group practices, the hospitalist system makes more efficient use of physician’s time. Physicians can either focus on outpatients or inpatients without worrying about going between the office, ambulatory surgical center, and the hospital. In general, inpatients require a disproportionate amount of time relative to the revenue collected. Furthermore, by eliminating the need for group physicians to go to the hospital, they can carve out 1-2 hours of office time to increase billing.
When there is one point-person whom handles all inpatient GI, communication is facilitated among primary teams and other services. The GI hospitalist develops working relationships with surgeons, radiologists, anesthesiologists, intensivists, etc. Teams can often just text or call me directly, instead of looking for the covering attending or going through the office phone service.
What are drawbacks to the GI hospitalist model?
Since there is only one gastroenterologist in the hospitalist model, if that person is not doing a good job, it affects the management of GI conditions for the entire hospital.
There is a loss of continuity-of-care. When GI patients get admitted, the gastroenterologists responsible for their care will not be the person with whom they have a long-term relationship. Furthermore, when the patient gets discharged, the primary gastroenterologists will not be fully aware of the inpatient course.
Also, when outpatient and inpatient gastroenterologists become segregated based on hospital setting, they each lose out of learning the intricacies of managing patients in a different context.
What do you like most about being a GI hospitalist?
The GI hospitalist position creates a great opportunity for gastroenterologists to make a remarkable, immediate impact on interesting, high acuity patients. The nature of the job also has the advantage of providing reasonable hours. This may be attractive to many whom want a better work-life balance.
Dr. Wan is assistant professor of medicine, associate program director, GI Fellowship Program, New York Presbyterian/Weill Cornell Medical Center, New York, N.Y.
References
1. Wachter R.M., Goldman L. Zero to 50,000 – The 20th Anniversary of the Hospitalist. N Engl J Med. 2016 Sep 15;375[11]:1009-11.
2. Estimating the Number and Characteristics of Hospitalist Physicians in the United States and Their Possible Workforce Implications. Analysis in Brief. Available at: https://www.aamc.org/download/300620/data/aibvol12_no3-hospitalist.pdf. Accessed May 1st, 2016.
3. Mahadev S., Lebwohl B., Ramirez I., Garcia-Carrasquillo R.J., Freedberg, D.E. Transition to a GI Hospitalist System is Associated with Expedited Upper Endoscopy. Gastroenterology. 2016;150[4]:S639-40.
What is a GI hospitalist?
A GI hospitalist is a gastroenterologist that primarily provides inpatient care. Their main professional focus is the acute management of gastrointestinal conditions occurring in the hospital setting.
How prevalent are subspecialty hospitalists?
The rise of hospitalists has changed the landscape of medicine. The hospitalist is now the central inpatient provider responsible for patient care and day-to-day housestaff education. From 1995 to 2016, the number of hospitalists increased from 500 to over 50,000.1 While the majority of hospitalists are generalists from the fields of internal medicine, pediatrics, and obstetrics/gynecology, some come in the form of specialists. In a recent survey, up to 10% of internal medicine subspecialists already consider themselves “hospitalists.”2 However, most of these self-described hospitalists only do so part of the time. For example, many group practices have one of their members manage all the hospitalized patients for the group for certain periods of time. It is rare to find full-time subspecialist hospitalists, but there has been an emergence in this new model of GI practice. Many people are unaware of this system of care nor understand how it may influence hospital-based care.
What is the role of a GI hospitalist?
While my primary responsibility is to care for inpatients whom require GI consults, I have outpatient and administrative responsibilities. Generally speaking, I am the de facto consult attending for the year.
How did you decide to become a GI hospitalist?
Upon graduation from my GI fellowship, I wanted an academic job where I could work closely with fellows and manage a wide breadth of complex, high-acuity patients. During fellowship, I enjoyed all areas of gastroenterology and hepatology and did not “sub-subspecialize.” As such, I wanted a job where I would see the full spectrum of GI and liver disease. Additionally, I enjoyed seeing the sickest patients, because I felt I could make the most dramatic differences with my care.
When I was searching for jobs, I spoke with the chief of GI at the hospital where I completed my residency about how I could fill a niche. We conceived of a model that would merge my personal interests and help the division provide consistent teaching for fellows and increase inpatient billing. Prior to my arrival, attendings that staffed the consult service were expected to continue their research and outpatient clinical workload while finding time to come to the hospital. Not surprisingly, attending rounds was erratic. The fellows were left to manage patients independently, scrambled to run cases by whomever happened to be around, or waited until they could reach the attending the next day. Unsurprisingly, billing by attendings was sparse.
What is a typical day like in your life as a GI hospitalist?
My day starts at 7:30 a.m. either with my outpatient office hours, endoscopy session, or GI Grand Rounds. Each week, I have two morning outpatient office sessions, one morning endoscopy session, and one morning session supervising fellows’ endoscopy.
At noon, I round with a team of GI fellows, medical students, and housestaff rotators for 2 hours. After we see the new consults, the remainder of my afternoon is spent seeing the follow-up patients. For two afternoons throughout the week, I have outpatient endoscopy sessions. I typically conclude my day at 5 p.m.
For night coverage, I take emergency calls for my own patients, and share general call duties with the other members of my division. On average, I take calls for one weekday a month and five weekends per year.
Typically, GI hospitalists only cover inpatients during the daytime. All nights and weekends are covered by partners and nonemergent overnight consults are saved until the next day. They have no office work.
What is the most challenging part of being a GI hospitalist?
As the perpetual “GI Consult Attending,” there is the threat of burnout when confronted with a high volume of sick, complex patients. Many of the patients have multiple comorbidities and require a multidisciplinary approach. On average, we have five new consults a day and the number of active follow-up patients is 10. Nonetheless, the nature of the inpatient service makes the volume of work unpredictable. When the service is busy and the census swells, the numbers of patients requiring staffing and notes can become overwhelming.
Importantly, for those without an outpatient practice, one loses the opportunity to develop longitudinal relationships with patients. Additionally, one also loses the ability to provide integrated, comprehensive care for individual patients once they leave the hospital.
How are you paid?
My compensation is based on a base salary with an incentivized system based on my RVUs and collections. For the dedicated hospitalist for a group practice, there is typically a base salary and productivity-based income. Additionally, there should be a path to partnership. Lastly, in balancing the ledger, the diminished inpatient revenue stream is offset by the lack of overhead.
What are the benefits of a GI hospitalist system?
Our system benefits the workflow for the GI fellows. Since I have started, the GI consultation rounds start at a consistent time. During these rounds, we discuss relevant GI literature and make timely plans on all patients. Oftentimes, I am able to supervise the fellows so they can fit in a scope before the end of the workday. Ultimately, the fellows know they can find me and discuss patients throughout the day. The fellows consistently have told me that the since the implementation of the hospitalist system, there has been a dramatic difference. Collectively, they feel both their education and patient care have improved.
In terms of consult efficiency, one study demonstrated that the transition to a GI hospitalist system resulted in a mean decrease in consult to urgent esophagogastroduodenoscopy (EGD) time from approximately 24 to 14 hours.3 However, this occurred in the context of a lower inpatient consult volume and only covered 2 months. Furthermore, the time from admission to EGD did not change. Nonetheless, further studies are needed to examine the impact of this model shift.
In terms of a financial benefit, at our institution the total gross inpatient charges increased more than $850,000 for the year. This was largely attributable to the 79% increase in the gross charges from follow-up notes.
For group practices, the hospitalist system makes more efficient use of physician’s time. Physicians can either focus on outpatients or inpatients without worrying about going between the office, ambulatory surgical center, and the hospital. In general, inpatients require a disproportionate amount of time relative to the revenue collected. Furthermore, by eliminating the need for group physicians to go to the hospital, they can carve out 1-2 hours of office time to increase billing.
When there is one point-person whom handles all inpatient GI, communication is facilitated among primary teams and other services. The GI hospitalist develops working relationships with surgeons, radiologists, anesthesiologists, intensivists, etc. Teams can often just text or call me directly, instead of looking for the covering attending or going through the office phone service.
What are drawbacks to the GI hospitalist model?
Since there is only one gastroenterologist in the hospitalist model, if that person is not doing a good job, it affects the management of GI conditions for the entire hospital.
There is a loss of continuity-of-care. When GI patients get admitted, the gastroenterologists responsible for their care will not be the person with whom they have a long-term relationship. Furthermore, when the patient gets discharged, the primary gastroenterologists will not be fully aware of the inpatient course.
Also, when outpatient and inpatient gastroenterologists become segregated based on hospital setting, they each lose out of learning the intricacies of managing patients in a different context.
What do you like most about being a GI hospitalist?
The GI hospitalist position creates a great opportunity for gastroenterologists to make a remarkable, immediate impact on interesting, high acuity patients. The nature of the job also has the advantage of providing reasonable hours. This may be attractive to many whom want a better work-life balance.
Dr. Wan is assistant professor of medicine, associate program director, GI Fellowship Program, New York Presbyterian/Weill Cornell Medical Center, New York, N.Y.
References
1. Wachter R.M., Goldman L. Zero to 50,000 – The 20th Anniversary of the Hospitalist. N Engl J Med. 2016 Sep 15;375[11]:1009-11.
2. Estimating the Number and Characteristics of Hospitalist Physicians in the United States and Their Possible Workforce Implications. Analysis in Brief. Available at: https://www.aamc.org/download/300620/data/aibvol12_no3-hospitalist.pdf. Accessed May 1st, 2016.
3. Mahadev S., Lebwohl B., Ramirez I., Garcia-Carrasquillo R.J., Freedberg, D.E. Transition to a GI Hospitalist System is Associated with Expedited Upper Endoscopy. Gastroenterology. 2016;150[4]:S639-40.
