Who are hospitalists? - Pharmaceutical Representative

You know how busy your primary care physicians are. You know how busy your specialist customers are. How do you know this? Because they have little to no time to see you. In fact, they barely have enough time to see their patients -- about 10 to 15 minutes for each visit, if they are lucky. What do they do when they need to admit a patient to the hospital? How do they find time to make bedside visits? In a growing number of cases, they don't have to anymore.

Enter the hospitalist -- one of the fastest-growing physician specialties today. Hospitalists, also called inpatient physicians, are doctors who work exclusively within the hospital setting. They pick up patient cases upon admittance and organize the care of those patients until they are discharged. According to the Philadelphia-based Society of Hospital Medicine, between 10,000 and 12,000 hospitalists practice in the United States today. That number is up from an estimated 8,000 in 2003, according to a study done by the Washington-based Center for Studying Health System Change. Moreover, the SHM forecasts a further increase in the number of hospitalists to as many as 25,000 to 30,000 by the year 2010.

What's driving the increase? Beyond today's PCPs' and specialists' overloaded schedules, cost savings and quality improvements are the main factors. A 2002 study published in the Annals of Internal Medicine (vol. 137, no. 11) shows that on average, hospitalists are able to: reduce patient length of stay by one day, save an average of $700 per case and improve patient satisfaction.

What do all these numbers mean for you? They mean you need to start calling on hospitalists. To call on hospitalists and hospitalists-in-training, you first need to have some basic background information on them, such as where they are trained, who they work for, what they do on an average day and -- perhaps most important -- what they care about when it comes to interacting with pharmaceutical sales representatives.

Hospitalist training

About 83% of hospitalists are trained in internal medicine, about 5% are subspecialists, about 3% are in family practice and about 9% are pediatric hospitalists who are trained in general pediatrics. Many hospitalists practicing today did not complete a hospitalist-focused residency or fellowship because no such programs existed until a few years ago. With the growing need for these physicians, however, several academic centers have developed hospitalist-focused training programs.

Hospitalist tracks tend to be rolled into internal medicine residency programs or fellowships. Regardless of how hospitalist programs are delivered, most aim to provide participants with exposure to clinical and institutional issues relevant to hospital-based practices. Such clinical issues may include palliative care, pain management, antibiotic resistance and nosocomial (hospital-acquired) infections. Other hospital-system issues may include billing, coding, malpractice, medical errors and patient safety. In addition to clinical and hospital-system training, the hospitalist training track at the University of Colorado Hospital, the Denver VA Medical Center and the Denver Health Medical Center provides hospitalist fellows with guidance on how to develop an effective résumé as well as strategies for successful interviewing and contract negotiations.

Hospitalist employers

Most hospitalists work directly for a hospital, are sole contractors to one or more hospitals, are part of a medical group practice of hospitalists, or work for a hospital-based management company. Hospitalist management companies, such as the Canton, OH-based Hospitalists Management Group and North Hollywood, CA-based IPC -- The Hospitalist Company, hire hospitalists and provide them on a contractual basis to hospitals.

To find out which hospitals and medical groups offer hospitalist services in your territory, look to the Society of Hospital Medicine, which provides a member directory of practice profiles. The 2003 Practice Profile book is available online at: www.hospitalmedicine.org/Content/NavigationMenu/Publications/PracticeProfiles/Practice_Profiles.htm.

By reviewing these profiles of hospitalist services, you can identify several key facts about each program, such as the year it started, the number of practitioners, hospital demographics, relevant awards and several other specifics. For example, a review of Brigham and Women's Hospital/Faulkner Hospital in Boston reveals that its hospitalists are salaried members of the hospital with no additional incentives for compensation. Meanwhile, Beth Israel Deaconess Medical Center, also in Boston, pays salaries to hospitalists but also provides incentives that are tied to clinical volumes (the number of patients they provide care to). These pieces of information are just a sampling of the variety of information that can be gleaned by reviewing profiles of hospitalist services.

How can all this profiling information help you? Just understanding who employs the hospitalists you call on and how those hospitalists are compensated, for example, can help you direct your business-related sales messages appropriately. Just think -- if you know that a hospitalist receives a bonus for increasing the number of patients he manages, then shortening length of stay and increasing patient turnover may be of interest to that physician. If you have data that show your drug can shorten length of stay, then you might want to think about educating such a practitioner about that benefit of your product.

A day in the life of a hospitalist

Some may argue that there is no "average day" for hospitalists. What a hospitalist does on an average day really depends on the particular hospitalist and where that physician is working. That said, it is clear that a typical day for a hospitalist generally involves providing care to a variety of inpatients and coordinating that care with several members of the hospital staff, including nurses, other physician specialists, physical therapists, occupational therapists, radiologists, case managers and social workers.

Danielle Scheurer, an associate physician and hospitalist at Brigham and Women's Hospital in Boston, says, "I usually spend most of the morning rounding on established patients. Late morning and early afternoon are spent discussing the patients with the residents and teaching them either at the bedside or in didactic lectures." Scheurer adds that she spends her late afternoons preparing new lectures, seeing new patients, talking with families and primary care physicians, and doing paperwork and billing.

What hospitalists don't do on an average day is run an office, either inside or outside the hospital. By working only with inpatients, they forego managing employees, paying rent, purchasing and maintaining equipment, etc. Scheurer notes that her favorite thing about being a hospitalist is the flexibility it allows her in her day and the amount of teaching she gets to do with the hospital staff. However, the flip side is that she is on call all the time. "We are expected to be available 24/7 for most of our patients, so our pagers are always on," Scheurer says.

Hospitalist sales calls

Calling on hospitalists is somewhat different from calling on office-based physicians. For example, hospitalists tend not to be as concerned with medications used for prevention or steady chronic illnesses, Scheurer says. She notes that her main concerns include antimicrobials, antihypertension and cardiac medications, and antithrombotic agents.

However, like most physicians, hospitalists want to know what your product does, see proof of how well it works, and be informed about any precautions and warnings associated with its use. Scheurer says the three things she wishes sales representatives would not do are:

* Make product claims that are not supported in the literature.
* List what other doctors in the area are prescribing as a reason to use a drug.
* Spend more than five to 10 minutes discussing a product.

What should you focus on during hospitalist sales calls? First, make sure you have literature to back up your claims. Second, don't rely on anecdotal, local practice patterns to support utilization of your product. Third, keep your discussion focused.

In addition to these three strategies, Scheurer says it is important for representatives to provide hospital-specific data relevant to hospitalists. She suggests that representatives should know what is on the hospital formulary and, if appropriate, what the antimicrobial resistance patterns are in the hospital. In fact, the most memorable and helpful sales call she ever had was one in which the representative provided data on the incidence of use of antimicrobials in the hospital and the hospital's specific resistance patterns.

Succeeding with hospitalists

Succeeding with hospitalists requires that you know your product's relevance to what hospitalists do. Identifying this crossover means understanding their patient populations, their professional goals, the hospitals in which they work, applicable formulary restrictions, and who pays them, among other things. Once you identify the main intersections between your world and theirs, you will be on the road to building strong relationships with these important customers.

About the Author

Gwen McLean