Monday, December 29, 2008

ACGME protects medical students & injures patients' safety

The Journal of General Medicine provided some insight into why hospitalists are "replacing" residents at teaching hospitals.

A major paradigm shift has recently occurred, one that has the opportunity of solidifying the role of hospitalists in teaching hospitals. As of July 1, 2003, the Accreditation Council for Graduate Medical Education (ACGME) has imposed new requirements restricting resident duty hours. As teaching hospitals have learned that not all members of their medical staffs are either interested in or capable of caring for patients without a resident buffer, they are turning toward hospitalists as the solution to the residency work duty problem. One approach is to “uncover” patients so that the hospitalist cares for the patient without resident involvement. In fact, the majority of hospitals listed as U.S. News and World Report's Best Hospitals either have developed or are developing such a “hospitalist-only” service.
These new opportunities for hospitalists are considerable but do not come without danger. As hospitalists are increasingly utilized to provide care for nonresident services in academic medical centers, the potential exists for these faculty members to be seen primarily as “superresidents.” In many academic centers, they will be the only faculty members who manage hospitalized patients without the assistance of either residents or fellows. If clinical care is the only tangible responsibility of hospitalists in the teaching hospital, we fear they will be perceived as second-class members of the academic community. Therefore, staffing a non-house staff service should not come at the expense of visible teaching roles.
The article continues:
Hospitalist involvement in several educational activities—such as didactic medical student education, hospitalist electives for fourth-year medical students, hospitalist residency tracks for internal medicine house officers, and training of allied health professionals—are compatible with also staffing a non-house staff service. Because hospitalists will ultimately be evaluated primarily by their contributions to medical education and inpatient-oriented research, emphasizing only efficient, non-house staff clinical care will likely result in an unfavorable judgment by the academic community. Indeed, the experience of other new specialties—such as emergency medicine and critical care—has revealed that in addition to filling a clinical niche, successful specialties also must develop robust training programs and research agendas.
It is my experience that Hospitalists (with or without the capital "H") are not involved in any aspect of research at a major teaching hospital (Duke University Medical in Durham, NC). The hospitalists at DUH are disrespectful of both the residents and the medical faculty. The hospitalists have told me this directly to my face.

DUH's hospitalists Dr. Hope Uronis and Dr. Ramiah are the most blatant examples of hospitalists who refuse to cooperation, communicate or coordinate with the attending or admitting Duke medical faculty member (Dr. Mark Easley and Dr. Michael Morse). Drs. Easley and Morse ordered treatments and a hospital resident, Uronis and Ramiah told me that they refused to follow through with the orders.

I am not surprised that the article's writers opine that many hospitalists will eventually move into hospital administration positions. The DUH breed of hospitalists have told me that their job is to be cost effective and save Duke University Hospital money.

Perhaps us patients should contact the Accreditation Council for Graduate medical Education.

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