Otolaryngologist Pioneers New Practice Model: Dr. Russell heralds hospitalist role as others ponder the concept’s staying power

Robert Wachter, MD, MHM, professor, chief of hospital medicine and chief of the medical service at UCSF Medical Center, helped coin the term hospitalist in 1996 in a published paper titled “The Emerging Role of ‘Hospitalists’ in the American Health Care System” (N Engl J Med. 1996;335(7):514-517). Dr. Wachter believes the needs of otolaryngology present the same set of circumstances that allowed internal medicine-based hospital medicine to flourish.

“The forces,” Dr. Wachter wrote in January on his blog, “are the same: sick patients, highly specialized providers who may not be comfortable with all the issues that arise in the hospital, and the need to focus on system improvement.”

The flip side of the case for oto-hospitalists is whether using a board-certified otolaryngologist to handle more pedestrian encounters is the most economical use of a physician’s time. According to Dr. Seidman, NPs and PAs can be useful, handling less intensive cases and freeing experienced physicians to focus on larger issues.

“The favorite part of my practice, frankly, is being in the operating room,” Dr. Seidman said. “So if you just had a hospitalist seeing consults…we cover this all well already. We have residents who see these patients.”

An Alternative

Dr. Russell understands the reticence. He doesn’t expect that an oto-hospitalist model will be the right fit for all institutions, or even most. He suggests, however, that people focus less on the nomenclature of hospitalists and instead consider the idea that the hospital setting, completely devoid of a clinical service, can provide enough intrigue and opportunity for an otolaryngologist.

“It’s going to vary depending on the size of the institution, the complexity of the other clinical activities,” he said. “This may or may not be beneficial elsewhere. At our university, we have a lot of complex problems. Inevitably, some of those problems are going to involve the head and neck and will benefit from consultation with an otolaryngologist.” 

Hopkins’ Dr. Bhatti is more optimistic, particularly in the age of generational health care reform that pledges to increase medical access to more patients.

“I totally think this is the way of the future, especially if the increase in capacity that all hospitalists are trying to build infrastructure for actually happens,” Dr. Bhatti said. “I have no reason to believe it’s not going to happen.”