Hospitalist Program Bridges the Gap

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P>Dr. Brent Elsey is pumped. The family physician, and Chief of Medical Staff at Barrie’s Royal Victoria Hospital, has just started the first day of his regular shift as hospitalist. For the next seven days, Elsey will leave his Stroud family practice in the hands of his colleagues, wear his pager 24-hours-a-day and work at a hectic pace, seeing as many as 30 patients in one day.

And he loves it.

“You actually sign your life away for a week, but it is fascinating,” said Elsey. “This is real doctoring. It is exciting family medicine…tough stuff – but, as chief of staff, it also gives me an intimate frontline view of how this hospital runs. Sometimes when you sit in the ivory tower you lose touch.”The hospitalist program, along with the creation of a Prenatal Walk-in Clinic, are ways RVH is coping with the national doctor shortage. While recruitment of family physicians is a high priority at RVH, medical staff also know the reality of the situation and have put these programs in place to meet the immediate needs of the community.

During one seven-day shift Elsey will see the gamut of medical conditions in the patients he will meet. On this day, he’s got a full list of 39 people, which includes six of his own patients currently in hospital. He’ll see a 28-year-old woman with possible colitis, an 80-year-old special-needs man from a group home with pneumonia and a 31-year-old woman with depression, just to name a few.

And no one is more pleased to see Dr. Elsey than orphan patient Jeannie McColligan. The 79-year-old frail woman with a delightful Scottish accent, explains her condition as she shows Dr. Elsey her red and swollen feet. She believes it is a result of complications from her chemotherapy.

McColligan would have preferred to see a doctor she’s more familiar with, but since moving to Barrie a few years ago she hasn’t been able to find one.

“It’s hard, especially when you have to always deal with doctors who don’t know you,” said McColligan.

Royal Victoria Hospital put its hospitalist program in place in November 2001 to meet the needs of patients just like McColligan.

It is estimated that 25,000 to 30,000 – almost a quarter of the population – of Barrie residents have no family doctor – but Elsey suspects the numbers are actually higher. These orphan patients rely on the care of walk-in clinic physicians and emergency doctors. Currently designated an underserviced area, Barrie is in desperate need of 17 family doctors. The hospitalists also care for patients whose family doctor does not have hospital privileges and those in the area for travel reasons.

Prior to this program, people admitted to hospital would be seen by the doctor on call. Often the doctors would change and the continuity of care would be broken. Now with the program in place, and a commitment from 11 family doctors, patients admitted to RVH will be under the care of perhaps two hospitalists during their stay.

To compensate doctors for this huge commitment, a weekly payment of $5,000, plus OHIP billing, was established. In its initial stages the program featured a pool of 65 doctors, each paid a $100 per patient. Eventually, doctors began dropping out of the program. After investigating other programs in the province, Elsey and a group of colleagues took the best from each and created RVH’s hospitalist program.

And with the trickle of medical graduates, the high cost of setting up a family practice, the lure of specializing in a field and the ailing baby boomer population, Elsey doubts the doctor shortage will come to an end any time soon, nor his shifts as hospitalist.

“Probably not in my lifetime,” he said.

Dr. Laura Crook echoes Elsey’s sentiments. As a Barrie family physician and RVH’s Clinical Director of Women’s Health, Crook was concerned that expectant mothers without a family doctor were being put at risk. Knowing the doctor shortage would not be solved anytime soon; Crook helped to establish the Prenatal Walk-in clinic.

“This clinical program was opened to serve women in the community unable to find a doctor as well as women whose family doctors are no longer doing prenatal care. Our aim was to fill the gap for those women and ensure they get the highest quality prenatal care,” said Crook.

Since the clinic opened last May, 120 women have registered and there is now a five-week waiting list. The doctors at the clinic deal with woman from conception to 28 weeks into their pregnancy; at that point their care is transferred to an obstetrician. Eight family doctors have agreed to work in the clinic one morning a month using the OHIP billing schedule.

“Financially it is a sacrifice for the physicians and the hospital is providing the service as a community service,” said Crook. “What we really need to do is work on using our skill pool to the best advantage for the community. There are lots of areas where a nurse practitioner can work alongside a doctor in prenatal care. Right now we are really robbing Peter to pay Paul in the way medical services are being delivered.”With this in mind Crook and Elsie, as well as a committed group of medical professionals, are looking at alternative ways to bridge this gap. One way, they believe, is to set up a clinic the orphans patients can call their own. The proposed clinic, staffed by the hospitalists, geriatric programs and nurse practitioners, will provide medical care on a consistent basis. It will be a place that offers prenatal care right to palliative care. The clinic, currently in proposal form with the Ministry of Health, will ensure all people in Barrie receive the same quality and continuity in their health care.

“Right now, in Barrie, we have a two-tiered health system. There are those who have a family doctor and those who don’t,” said Elsey.

The proposed clinic will level the playing field and give every resident access to their ‘own’ doctor. It could prove to be the proposal that cures what ails our community’s orphan patients.