By Nikki Jhutti

Three years ago, Providence Care Hospital’s Complex Medical Management program was facing a physician staffing crisis.

Two of the three part time physicians in the unit were retiring.

Recruitment had been a challenge for the hospital in the past, so filling those roles was easier says than done.

But that wasn’t the only concern.

“The model we had in place was not able to keep up with the growing needs of our organization or our patient population,” says Kathleen Fitzpatrick, outgoing Medical Administration Director at Providence Care.

“We needed to revolutionize our physician staffing model.”

Fitzpatrick knew a change of this magnitude required help.

That’s why the hospital partnered with Queen’s University Department of Family Medicine and the Southeastern Ontario Academic Medical Organization (SEAMO) for the transformation.

The makeover included replacing the old specialist-based physician staffing model with a new one focusing on hospital medicine.

One of the fastest growing medical specialties in North America, hospital medicine features hospitalists who are dedicated inpatient physicians who work exclusively in a hospital setting.

“What we’ve seen over the years is the medical complexity of patients has increased and specialists aren’t necessarily able to focus on all the clinical needs of a patient,” Fitzpatrick explained.

“People are living longer with more complex, chronic conditions and so we need a more holistic approach in terms of treatment.  A hospitalist is able to look at all the needs of a patient and work with the team to create a care plan to meet those needs.”

The group spent years researching, planning and recruiting.

Fast forward to October 2019, and the trio has established the first academic Division of Hospital Medicine in Canada. Dr. Ammar Rashid is the chair of the division. “Patient safety and evidence based medicine is our highest priority,” he says. “I’m excited to be in this position because we are making history by establishing this division and this is the largest care providing division at Providence Care Hospital.”

The division features 11 hospitalists who help support care across 230 hospital beds. The Department of Family Medicine oversees the entire operation.  Queen’s is the first Canadian university to have a division like this and acknowledge hospital medicine as its own specialty.

“While many family medicine departments offer inpatient hospital based care as part of their training program, family physicians in this division will focus a significant portion, and in some cases all of their time, on hospital medicine,” explains Dr. Michael Green, Department of Family Medicine Head.

SEAMO manages an alternative funding plan agreement with the Ministries of Health and Long-Term Care, as well as the Ontario Medical Association. “Our role included pulling together the three disparate services into a single, unified program under the leadership of the Department of Family Medicine,” says Danielle Claus, SEAMO Executive Director. “By working together I think we create a stronger unit of service because people are providing consistent care under common leadership.”

There are four main goals for the division: enhancing patient care, improving physician wellness, training future hospitalists, and raising the awareness of hospital medicine.

Patient care

Providence Care is Southeastern Ontario’s leading provider of specialized care in aging, mental health and rehabilitation. The division brings together many of the services the hospital offers into one group.

“It allows for better continuity of care, cross coverage and the opportunity to collaborate when certain services need more assistance. That’s something we haven’t had in the past,” says Fitzpatrick. “Now we have a consistent group of people who are able to learn from each other and work together which is a huge benefit to our patients.”

Not only will the hospitalists be able to create care plans that focus on addressing all the clinical needs of patients, but Fitzpatrick adds the division will also help decrease wait times.

Physician wellness

The division is not only looking out for patients, but also physicians. Rashid says creating a team atmosphere for hospitalists helps combat issues such as physician fatigue or burnout. “Everyone is striving to have that healthy work/life balance. Physicians are no different,” says Rashid. “Being in a team not only increases morale but you also have back up to cover when people are on vacation for example.”

And the more people in the division, the less time physicians spend on call.

“When the Complex Medical Management program was run by three part time physicians, they were providing on call services once every three weeks. Now with this division, each physician is on call for one week out of every nine weeks. That’s a big difference,” says Fitzpatrick.

Academic mandate

The division may be up and running but the group is now working on the next phase; developing a fellowship program for third year family medicine residents, specifically dedicated to hospital medicine.

“With the aging population there will be more and more complex patients with significant sub-acute care or rehabilitation needs.  This division provides a great opportunity for medical learners to improve their skills in those areas,” says Green.

“The program is new and unique because physicians will also have a mandate to innovate in developing hospital medicine learning opportunities and conduct academic work related to hospital medicine from a family medicine perspective.”

“We wanted to put some time and energy into helping the province and the entire country solve the issue around the lack of physicians available for hospitalist positions,” adds Fitzpatrick.

“It’s actually one of the things I’m most proud of. Not only are we solving our own problem, but we also want to train people to help solve problems beyond the walls of Providence Care Hospital.”

Advocacy

While already a staple in a number of healthcare facilities south of the border, Rashid says hospital medicine continues to grow in Canada. “We want to be that voice to help advocate for more hospital medicine divisions across the country,” Rashid says. “My long term goal is to develop a collaborative network of hospital medicine divisions amongst all Canadian universities. Through that network we could work together to develop a hospital medicine curriculum and eventually advocate for it to be added as a certified competence through the College of Family Physicians of Canada.”

And while it may take some time before that happens, the fully staffed division is already making a difference by providing the best possible care for patients and clients at Providence Care Hospital.

Nikki Jhutti is a Communications Officer at Providence Care.