Doctors specialize in hospital care

By Jaclyn Youhana
http://www.daily-journal.com

Andrea Bennett’s regular doctor is not Terrill Applewhite.
But when she goes to the hospital, that’s who she sees.

Applewhite is a hospitalist, a doctor who takes over for the primary physician once a patient enters the hospital.

That means when Bennett, 21, of Kankakee, needed a physical before her brain surgery at Riverside Medical Center last week, Applewhite took over.

When Mitzi Coash, Bennett’s mother, first learned her daughter’s main doctor wouldn’t care for Bennett prior to the surgery, she was worried.

“I wasn’t sure how much information my doctor would give Dr. Applewhite,” Coash said, “but it’s been working out very well,” partially because he is always at the hospital. During Bennett’s checkup, Applewhite seemed abreast of the situation with his temporary patient, and he had an easy rapport with both Bennett and Coash.

Hospitalists are a growing trend. They make it easier for primary care physicians to grow their practices because they don’t have to spend so much time at a hospital. Patients, meanwhile, benefit from a hospitalist’s expertise, as he sees more acute conditions like heart attack or stroke at a hospital than he would in a clinic.

How many are there nationally? When Dr. Bob Wachter coined the term “hospitalist” in the New England Journal of Medicine in 1996, there were 300 to 400 in the country. As of December 2006, that number increased fiftyfold. Projections indicate there will be 30,000 hospitalists by 2010.

Kankakee and Iroquois counties have: One, Applewhite.

What does he do? Applewhite has been the hospitalist at Riverside Medical Center in Kankakee for seven years. Applewhite starts his day around 6:30 a.m. or 7 a.m., he said, and he’ll typically care for 20 to 25 patients at a time, like Bennett.

Specializing in internal medicine, Applewhite often deals with acute care. This means he can diagnose serious problems more quickly than some doctors who don’t spend 100 percent of their time with such cases, he said. Applewhite will also clear patients for surgery and monitor them during their hospital stays. However, he will see patients for whatever reason they happen to be in the hospital.

Why aren’t there more? When Linda Berg, vice president of patient services at Iroquois Memorial Hospital, started working at the hospital in 2005, some hospitalists asked if their services were needed; they weren’t. Hospitalists are typically found in larger metropolitan areas where physicians are so busy, they are unable to visit patients in the hospital, Berg said. That wasn’t the case in a small town like hers.

While Applewhite named three Chicago universities with hospitalist programs — University of Chicago, Northwestern University and Illinois Masonic Medical Center — trends tend to filter to smaller communities slowly.

But Applewhite’s company, Five Apples/Inpatient Specialists, LLC, is working with Riverside to recruit more hospitalists — hopefully two more within the next two to three years, he said.

“There’s a demand from the physicians here on staff, and there’s also a benefit for the community to have doctors that are available that are hospital-based to help patients without hesitation,” Applewhite said.

Provena St. Mary’s expects to start its hospitalists program soon, said Dr. Gary Plundo, St. Mary’s chief medical officer. He hopes to have the first within four to six months.

Who’s affected? Patients and primary care physicians.

Will you see a hospitalist? Maybe. Not all area physicians work with Applewhite, who said he works with 10 to 20 primary care doctors on a regular basis, including physicians in Peotone and Watseka. Ask your doctor to be sure.

What’s the benefit? Hospitalists cut a patient’s hospital stay by 12 percent, found a December 2007 survey by the New England Journal of Medicine. That’s the equivalent of a four-day stay turning into a 3 1/2-day stay.

“I have consistently had length-of-stay numbers less than my peers,” he said. “We’re able to get patients in and manage them efficiently and free up hospital beds.”

Plus, hospitalists allow primary care physicians to grow their practices, Applewhite said. Physicians don’t have to spend so much time at the hospital with patients; they can stay at the clinic and see a greater volume of people.

Dr. Philip Zumwalt is a family physician at Watseka Family Practice who works with Applewhite. With training in obstetrics, Zumwalt estimates that he delivers 10 to 12 babies a month, so he can’t leave town often. His patients tend to like the hospitalist setup because they become familiar with Applewhite if they have to make multiple visits to the hospital, Zumwalt said.

Without the hospitalist, Zumwalt said, he would have to find another family practice doctor or internist who would perform his patients’ surgeries.

“Some of those doctors wouldn’t be too enthused about that because they wouldn’t be seeing (the patients) after surgery, where the hospitalist, that’s their job — to see the people in the hospital and to be not so involved afterward.”

Drawbacks: Some older patients tend to want their own doctors to care for them, Plundo said. And though Iroquois doesn’t have any hospitalists, Berg suspects the physicians and the patients wouldn’t like the set-up.

“I’m not sure how our patients would react to someone coming in and saying, “Hi, I’m Dr. X. Your doctor doesn’t make rounds. He’ll see you back in the clinic,” she said.
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