A trial period of changes in hospital coverage: and now for something completely different!

Short story:

Starting Monday July 13th, for a trial period through the end of October, my call group will have patients admitted and cared for by the hospital's hospital-based doctors for 3 weeks on and 3 weeks off. We will care for our patients for 3 weeks off and 3 weeks on, alternating with the hospital-based docs.

At the end of this trial period, we'll see how it's been working out for everyone, including our patients to see if we all want to continue on in this 3 weeks on/3weeks off cycle.

Long story:

Physicians used to be on-call for the needs of their patients 24/7/365. Naturally, that gets old pretty quickly since you can never be away from a phone our out of the area.

A few decades ago, a common practice developed where different doctors would agree to share coverage on evenings, weekends and holidays. When you are on-call you're on for the group, but when you're off you're all the way off (as in you can go fishing or skiing, leave town, catch a movie with your kids...).

In the past 5 or so years, a nationwide trend which Marshall adopted is one in which family doctors only see patients in the office, and the hospital hires doctors who only see patients in the hospital (such doctors are referred to as hospitalists). Supposedly, the patients get better care as they are seen by doctors who only ever treat hospitalizably ill people. Also, supposedly this is more profitable for both the family docs and the hospital.

So far, no one including Marshall can demonstrate a difference in hospitalist versus family doctor care in terms of the complexity of the patients, how well they do and how long they have to stay in the hospital.

Unfortunately, one outcome of this is that there are only 7 primary care docs in Western El Dorado County who still see patients in the office and also in the ER and in the hospital. Marshall's own doctors backed out of the hospital about 5 years ago and can't come back.

I share call with Drs. Keith Boston, Leanne Camisa and Dave Ramos. This means if you have to be in the hospital after hours, one of us will be admitting you and I will see you first thing in the morning (or on Monday AM, if it's a weekend).

Thing is, Camisa and Ramos are married and have two young children. As you can imagine, they are finding it increasingly difficult for one or the other of them to be on-call literally half of their lives.

Bottom Line:

For my call group to continue to function, we needed to come up with some form of relief.

We still feel the best care you are going to get if you get really sick is going to come from a doctor who already knows you well.

We think the hospital docs are excellent docs, but would prefer to take care of our own patients because it's important to us.

However, the times are changing around us and there aren't many of us left doing the full range of practice.

So, we want to try out a system where we're each on-call every fourth night and weekend for 3 weeks in a row, and then 3 weeks off.

During this 3-week off period, the hospital docs will be informed as to your medical history, surgeries and your medications.

Please let me know how you feel about this, and please let me know if you are in the hospital but feel that you would rather that I was seeing you there.

Again, this is a trial period from mid-July for about 3 months. At the end of it, we'll be seeing how it's working out for everyone involved especially our patients.