In a first-of-its-kind program for the Island, beginning this spring the Martha’s Vineyard Hospital will hire a small team of specially trained doctors to manage inpatient clinical care.
Three hospitalists, doctors who are acute care specialists, will be hired along with two new nurse practitioners or physician assistants, hospital president and chief executive officer Timothy Walsh said in an interview last week. The new hospitalist program is intended to relieve primary care doctors from the rotating responsibility of hospital rounds, hopefully freeing them to take on new patients.
“It’s going to change our world,” Mr. Walsh said.
There is a perceived shortage of primary care physicians on the Vineyard, although due to the fluctuating nature of the Island population, which is highly seasonal, actual data on the subject is inconclusive. Nevertheless, many primary care doctors are not accepting new patients or have waiting lists that are months long.
Mr. Walsh said the problem is in part due to the fact that a core group of primary care physicians on staff at the hospital also shoulder the responsibility for managing inpatient care in the hospital’s 25-bed acute care department.
Currently nine primary care doctors who are employed by the hospital rotate responsibility for seeing patients who have been admitted for acute care treatment. The primary care physicians have hospital duty every eighth night and every eighth weekend. The added work burden can cause the doctors to more strictly limit the number of patients they take in their private practices, Mr. Walsh said.
By relieving the primary care doctors of their inpatient duties, Mr. Walsh said the doctors should be able to take on new patients. Mr. Walsh said about 15 to 20 per cent of the primary care doctors’ time is spent on inpatient business.
“The big plus for the community is we’re relieving the primary care doctors of all that inpatient work and that’s going to allow us to open the patients up so people who need a physician can come in and get one,” he said.
Mr. Walsh said the new program will also result in better quality and continuity of care.
“The physicians who do it can concentrate on just inpatient care and there will be better handling at the inpatient care level,” he said.
The hospitalist program will cost about $500,000, Mr. Walsh said. It is planned to begin in May. Emergency room director Dr. Jeffrey Zack will head the program.
“The [inpatient care] is so closely related to the emergency room because that’s where the patient is coming from,” Mr. Walsh said.
Decades ago family doctors followed their patients from office examining room to hospital to discharge, but that is no longer the case as the field of medicine has become highly specialized. Plus doctors, patients and hospitals must navigate a complicated maze of insurance rules that are constantly changing. The Vineyard hospital is a critical access hospital, a special designation that allows certain rural hospitals to receive a more generous reimbursement rate from state and federal health insurance regulators in recognition of higher costs associated with delivery of care.
Mr. Walsh said the hospital, whose parent company is Partners Health Care in Boston, also is in the process of changing over to an electronic medical record-keeping system for inpatient care. This will streamline the exchange of information between the hospital and primary care physicians, he said.
He called the hospitalist program a long-term investment in medical care on the Island that will help retain primary care doctors.
Without it, he said: “I’m sure that at some point I’m going to start losing my primary care doctors because it’s such a burden on them.”
The program is modeled on one used in the Fairview Hospital in Great Barrington, also a critical access hospital.
“They swear by it,” Mr. Walsh said.