Brown Clinic’s New Hospitalist Program Improves Care, Boosts Physician Productivity

At Brown Clinic, an ICSI member in Watertown, SD, inpatient obligations at the local hospital were creating significant work-life balance challenges for physicians. The group of 18 primary care doctors provided ambulatory care in a very busy clinic setting while sharing responsibility for call management of 20+ hospital inpatients. Clinic commitments, physician age, and patient volumes were all contributing to the situation. When two physicians decided to leave the practice, it seemed to be time for a change.

The clinic’s leadership team decided to develop a hospital-based physician program, where ‘hospitalists’ provide ongoing and immediate care, consult with the primary care provider during a patient’s hospitalization and help ensure a smooth transition back to the primary physician after discharge. Hospital-based physician programs are associated with better outcomes for patients and higher rates of satisfaction for providers.

To make this new delivery model a success, leadership knew they needed buy-in and commitment from each provider. They did their research, including visits to similar clinics using this model to hear about their challenges and successes, and used the information to develop a program that would work for them.

“We did have several challenges and had to go ‘back to the drawing board’ several times, but there was never any finger pointing or assigning blame,” commented Dr. Catherine Gerrish, chairman of the clinic’s Quality Committee. “The attitude was, ‘this isn’t working as well as we would like, what do we need to do to fix it?’ Once we had a clear understanding of the issues, we came up with new ideas to try. The program is now running quite smoothly.”

Dr. Gerrish also addressed a concern that patients would be upset that their own physician was not seeing them at the hospital and clinic as before. While this was an issue with some, she noted that the majority of patients and their families are happy that they have physicians at the hospital that can quickly deal with issues as they arise.

“After we made the decision to start the program, the primary challenge was finding physicians to plug into the schedule,” added Jim Vachal, the clinic’s chief administrative officer. “A deeply entrenched primary care culture changed seemingly overnight. It was a textbook example of how a rigid culture can change rapidly, once the crisis is recognized.”

Smiling docs tend to be more productive

The clinic has limited metrics to date, but Vachal says physicians have adjusted well and find it much less stressful because they are either at the clinic or at the hospital and don’t have to go back and forth several times a day. As a result, their productivity has increased. And while he hasn’t figured out a foolproof way to measure work/life balance, Vachal says physicians’ attitudes speak volumes. “Smiling docs tend to be more productive.”