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How Primary Care Physicians Perceive Hospitalists

Alicia Fernandez, MD; Kevin Grumbach, MD; Lara Goitein, MD; Karen Vranizan, MA; Dennis H. Osmond, PhD; Andrew B. Bindman, MD

Arch Intern Med. 2000;160:2902-2908.

Background  Increased use of hospitalists is redefining the role of primary care physicians. Whether primary care physicians welcome this transition is unknown. We examined primary care physicians' perceptions of how hospitalists affect their practices, their patient relationships, and overall patient care.

Methods  A mailed survey of randomly selected general internists, general pediatricians, and family practitioners with experience with hospitalists practicing in California.

Main Outcome Measures  Physicians' self-reports of hospitalists' effects on quality of patient care and on their own practices.

Results  Seven hundred eight physicians were eligible for this study, and there was a 74% response rate. Of the 524 physicians who responded, 34% were internists, 38% were family practitioners, and 29% were pediatricians. Of the 524 respondents, 335 (64%) had hospitalists available to them and 120 (23%) were required to use hospitalists for all admissions. Physicians perceived hospitalists as increasing (41%) or not changing (44%) the overall quality of care and perceived their practice style differences as neutral or beneficial. Twenty-eight percent of primary care physicians believed that the quality of the physician-patient relationship decreased; 69% reported that hospitalists did not affect their income; 53% believed that hospitalists decreased their workload; and 50% believed that hospitalists increased practice satisfaction. In a multivariate model predicting physician perceptions, internists, physicians who attributed loss of income to hospitalists, and physicians in mandatory hospitalist systems viewed hospitalists less favorably.

Conclusions  Practicing primary care physicians have generally favorable perceptions of hospitalists' effect on patients and on their own practice satisfaction, especially in voluntary hospitalist systems that decrease the workload of primary care physicians and do not threaten their income. Primary care physicians, particularly internists, are less accepting of mandatory hospitalist systems.

From the Primary Care Research Center (Drs Fernandez, Grumbach, Osmond, and Bindman and Ms Vranizan) and Division of General Internal Medicine (Drs Fernandez and Bindman and Ms Vranizan), San Francisco General Hospital, San Francisco, Calif; Departments of Medicine (Drs Fernandez, Osmond, and Bindman), Family and Community Medicine (Dr Grumbach), and Epidemiology and Biostatistics (Ms Vranizan and Drs Osmond and Bindman) and Center for California Health Workforce Studies (Drs Grumbach and Bindman and Ms Vranizan), University of California, San Francisco; and Department of Medicine, Massachusetts General Hospital, Boston (Dr Goitein).

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