Healthcare Delivery Providers, part of the Healthcare Marketplace Specialization. This is Module 2.1.4, Hospital Based Physicians. The learning outcomes for this lecture are that we will review the various hospital based physicians and also review some common specialties and sub-specialties. Again, recall MDs, or doctors of medicine, are physicians. ED is emergency department, hospital medicine service, ICU. The way I have divided up the hospital-based physicians is according to these four categories. Again, they do not cover all the physicians, but it's a good way to start understanding who works in the hospital. So emergency medicine, hospital medicine, and then the medical sub-specialties and the surgical sub-specialties. Let's start with emergency medicine. So remember, this is the emergency department where you need 24 x 7 availability of these specialized physicians, and these physicians are very adept at treating emergent patients, who are extremely sick and can have many different types of illnesses when they first come in. So one patient could have a big trauma. Another one could be in need of surgery, that needs to be transferred up to the operating room. Another one could just have a asthma attack. Another could have chest pain, which could be a heart attack. Another one could have a mental and behavioral health problem. So again, they are the center point of triaging, treating all of these diagnoses and conditions that show up in the emergency department. Hospitalists is a new category of physicians which has emerged over the last several years, and these are the hospital medicine physicians who specialize in treating hospitalized patients who need acute care. So these are physicians that only work in the hospital and do not work in clinics. Typically, they're available 24 x 7 for consultation with nurses and to see patients at the bedside. And a new type of schedule that has emerged for these special physicians is what's called 7on-7off. So they would work for seven days in a week, then be off for seven days and then work the next week again. And again, because of the 24 x 7 availability, they have shifts, 11 to 12 hours that one physician will cover and then another physician will come in at night. Let's talk about the medical sub-specialists now. So these are physicians that typically will not do large surgeries, although they could do some procedures. So these are the specialists that take care of heart or the kidneys or the GI tract which is the stomach and the intestines. These are the physician intensivists that work in the ICU. Neurologists take care of the brain and the spinal cord, and many, many others. So again, these are the medical sub-specialists. Let's do a short quiz now. Next large category of specialists are surgeons and proceduralists. So these are surgeons or other physicians that do procedures. So the surgeons can be divided up into either general surgeons or sub-specialty surgeons. And these, again, just like the medical sub-specialists, are divided up into various parts of the body or organ systems that they deal with. So heart and lungs, bones, ortho, brain or spine, neuro, obstetricians, moms and babies around childbirth, trauma, trauma surgeons, and many more. There are other providers that sometimes function almost similar to a physician, with some caveats. One of the types of providers is the advanced practice registered nurses, or APRNs. These providers are able to write prescriptions and the discussion around how much an APRN can do is actively taking place across the states in the United States. Another type of provider is called the physicians assistants, and these are providers that work in collaboration under the supervision of a physician, but are able to do quite a few things just like a physician does. So some of the key issues for physicians that practice in a hospital setting are how they're organized. And we've talked a little bit about the medical executive committee, so that's the structure within the hospital to oversee credentialing, to perform peer review, that is, review of each other's practice, and directly report up into the board of directors. Also for physicians, how are physicians going to oversee continuous quality improvement? That can happen through the medical executive committee structure or through a quality improvement division or department. We talked a little bit about the differences between employed versus independent practice and how those could be organized. Again, remember that employment and direct line authority does matter. So having the physicians from an independent practice come together with a hospital and have alignment in vision and culture is extremely important. And then there's a lot of legal and compliance issues around how hospitals can and cannot work with physicians. So in summary, hospitals have many specialized physicians that take care of patients across all the departments, right from the emergency department to the medical units, to the surgical suites and operating rooms. And the relationship between physicians and hospitals has been evolving for the last many decades and continues to evolve. The key to remember is that if we are going to do population health and be an accountable care organization, the physicians, the hospitals, the health systems, and all the other staff need to be aligned in culture, in vision, and in mission so that they all try to take care of the patients in the communities that they serve. And I can tell you from being in Minnesota, that does happen really, really well in this particular state.
