Having a primary care physician (PCP) care for their own patients in hospital settings may result in meaningful differences in care patterns and patient outcomes, according to a new JAMA study.
The study found that patients cared for by their PCP had slightly longer lengths of hospital stay, but were more likely to be discharged home and less likely to die within 30 days compared to patients cared for by hospitalists and other generalists.
The study authors suggested models of care that integrate PCPs with their patients’ hospital care may “yield substantial benefits in outcomes that are meaningful to patients.”
The study explored whether the type of generalist caring for a hospitalized patient affects the patient's outcomes both in and out of the hospital. Researchers studied more than 560,000 admissions of Medicare beneficiaries in 2013. The study analyzed admissions data involving hospitalists, PCPs and generalists for the 20 most common medical diagnoses among elderly fee-for-service Medicare patients.
The researchers found patients cared for by their PCP during hospitalization had better overall results. The authors suggested that a physician’s prior experience with a patient “may be associated with resource use and patient outcomes in the hospital and during the postdischarge period.”
Integrating PCPs in a patient’s hospitalization shows promise. However, if that’s to become the norm, hospitals will need to figure out a way to not add to PCPs’ workload or contribute to burnout.
The report also found that other generalists, who don’t work in a hospital setting and didn't know the patient before admission, had the worst outcomes. “Our results show that patients cared for by these physicians had worse readmission and mortality outcomes relative to those cared for by hospitalists. We found that most of the PCPs who cared for their own patients in the hospital also cared for other patients, suggesting that at least some of these physicians practice in group arrangements that involve cross-coverage.”
Meanwhile, hospitalists, a model created in the 1990s as a more efficient way to deliver care, experienced the second best outcomes in the study overall. Hospitalists are seen as a way to reduce the need for PCPs in hospitals, which reduces physician workload and burnout and could resolve possible doctor shortages.
Despite the introduction of hospitalists, physicians are still feeling overloaded, but that’s for myriad reasons, including workload and EHRs. On the horizon, the healthcare industry may face a dwindling workforce, too.
A recent Federation of State Medical Boards report found that the number of actively licensed physicians at the end of 2016 increased 12% since 2010. The U.S. physician-to-population ratio increased in that time from 277 physicians per 100,000 people to 295 per 100,000. However, that increase may not keep up as the country ages.
Physician shortages could become a problem, especially in California. A recent report from the Healthforce Center at the University of California, San Francisco suggested that the Golden State won’t have enough PCPs by 2030. To help with demand, the report suggested that half of the state’s full-time equivalent primary care clinicians will be nurse practitioners and physician assistants by 2030.
Of course, predicting the future is an inexact science. However, the aging U.S. population and the fact that 10,000 people a day become eligible for Medicare point to a growing need for healthcare physicians in the coming years.