Structure of the Hospitalist Program
The “Hospitalist Service” or "PA service" is the non-teaching service and comprises the core of the Hospitalist program's clinical activity. Each team consists of an attending and a physician assistant (PA). PAs are expected to assist the primary attending in almost all aspects of clinical care, including direct patient care, family interactions, interdisciplinary team mobilization, documentation, and dictations. Attendings are ultimately responsible for their patients' medical care and disposition, including documentation and billing. Each attending is also expected to take an active role in the clinical development of the PAs while working with them. When the pace of clinical activities allows, there is no predetermined service size cap. However, each team is expected to be able to manage a service of about 12 patients.
Senior Medicine Rotation
The unique team structure is a streamlined unit, incorporating a Hospitalist attending, two third-year residents, and up to two fourth-year medical student sub-interns. A Hospitalist psychiatry attending also works closely with resident teams either by joining daily rounds or by providing timely psychiatric consultations to those patients with psychiatric co-morbidities. There are no interns or third-year medical student clerks on the service, allowing the focus of teaching to remain at the senior resident level. Given the team structure and the nature of the hospitalists' role in the hospital, residents are afforded the opportunity to interact more closely with their supervising attendings than in traditional general medicine rotations. Without an intern, residents manage their patients as a private attending would manage patients in an “off-service” setting. This is intended to provide a higher degree of ownership of the patients. Hospitalists also lead weekly educational sessions with the residents, focusing on topics pertinent to Hospital Medicine as well as Internal Medicine boards review.
Medical Consult Rotation
A Hospitalist attending teaches and supervises the medical consultation service. The attending also helps facilitate the transfer of patients from non-medical services to medicine when appropriate. Four senior resident rotate on this service per block and Attending rounds occur daily - usually in the early afternoon. Senior residents perform general medical consults as well as comprehensive perioperative risk assessments. They are called to consult on patients from a wide variety of services such as Orthopedics, Neurosurgery, Psychiatry, OB/GYN, and Rehabilitation Medicine. Residents learn how to interact with and effectively communicate with other clinical services and to provide outstanding and efficient care to medically ill patients on non-medical services.
General Medicine Rotation
A Hospitalist attending teaches and supervises on one of the traditional general medicine housestaff teams throughout the year. Each team takes advantage of the "two-attending system" by pairing attendings from complimentary backgrounds, usually a generalist and a sub-specialist. The Gen Med II service has the unique feature of having dedicated time during rounds with a third attending from the Hepatology/Liver Transplant service.