Irish Medical News -
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Published on: 7/6/2006
Last Visited: 7/6/2006
Dr John Kellett, consultant general physician, Nenagh Hospital, Co Tipperary, says hospitalists, and in the UK, acute hospital physicians, are both very similar concepts with regard to the type of training required.
In essence, this is the idea of having a consultant general medical physician in the hospital, or on-call offsite depending on circumstances, looking after patients, particularly acute admissions.
"At the moment the new contract is making a big issue of having consultants available 24 hours a day seven days a week.This seems a little silly to me - since no one needs, for example, a dermatologist to be available 24/7."
Dr Kellett says that American medicine envisages a need in future for only four specialists working in hospitals at night: emergency medicine consultants, hospitalists, intensivists, and anaesthetists.
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"The core four specialities should be extremely well paid since their job will be particularly onerous and demanding, and they should have regular CME etc. and should be able to retire at around 50 years of age if they want to," Dr Kellett told IMN.
He says historically, most general physicians - who provide offsite on-call emergency night cover - have a subspecialty interest, which they tend to be more interested in rather than general medicine.
While in the past, this was probably sufficient, he says there are now more acutely sick patients presenting to hospitals, and it is difficult to train both in a subspecialty and in general medicine at the same time.
In the US, and indeed elsewhere, night work has become more intensive, as has the pressure to get the patient safely discharged in a shorter period, and hospitalists are trained for such scenarios.
With the closure of hospitals and tighter admission protocols, it had become incredibly difficult for American physicians to cover multiple far-flung hospital sites, leading to the hospitalist emerging in the US in the late 1990s, he says.
Dr Kellett believes it would make sense to incentivise and train doctors interested in this work and reward them for the stress and responsibility, as opposed to forcing all doctors to do some amount of acute work.
Dr Kellett, who raised the issue at this year's Spring Meeting of the Irish Association of Internal Medicine, said both the US and UK terms may be a new term for the declining pool of Irish general physicians.
In Ireland, he says, there is little appetite for more general physicians, but only for more "ologists".
By contrast, he says the NHS in the UK is developing acute hospital medicine, where the idea of leaving sicker than ever patients under the care of inexperienced junior doctors or a consultant pursuing a subspecialty did not make sense any more.
Dr Kellett says he sent a considerable submission on the concept to the Hanly hospital reform working group.
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In terms of lifesaving skills, Dr Kellett says the most important thing is your general medical competence."General medical competence is often assumed, and I don't think that is right.It is reasonable when people are being interviewed that the most important attributes are general medical skills, that you are safe to practice acute general medicine in the middle of the night."
He points to a study in the BMJ from some years back which found that UK trainee doctors, many of whom had just completed medical training, had significant gaps in basic but potentially life-saving care.
Dr Kellett says all doctors need help to maintain their skills in dealing with acute emergencies.
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