New specialists are ready to help -- inpatients, that is

Hospital patients expecting to get a bedside visit from their primary care doctor are increasingly likely to get a visit from someone like Dr. Faisal Hamada , instead.

Hamada, who makes the rounds at Caritas Good Samaritan Medical Center in Brockton, is among the rapidly growing number of "hospitalists" in Massachusetts and across the country who are transforming the inpatient experience.

Hospitalists are members of the fastest-growing medical specialty in the country. They work exclusively in the hospital and do not have their own community or family practices outside the hospital walls.

The job of these dedicated inpatient physicians is to make sure patients are getting the right treatment and tests, help patients and families understand what is happening, and make sure patients do not stay in the hospital longer than necessary.

Those may sound like obvious goals. But in traditional hospital care models, in which busy primary care physicians travel to the hospital and make rounds once a day, usually early in the morning, patients are frequently frustrated because they can't find out what is going on with their care.

The problem has only grown as primary care physicians -- squeezed economically by declining insurance reimbursements -- increase their daily office visit load to keep up.

"The problem with the primary care physician is they don't have enough time now to visit with their patient in the hospital," Hamada said. "We are available to them any time."

With hospitalists, administrators are finding that patient satisfaction rises. Care is more easily standardized. And the institutions are saving money by cutting down on needlessly long hospital stays.

The use of dedicated inpatient hospitalists nationally is "exploding," said Joseph A. Miller, a Needham resident who is senior vice president of the Society of Hospital Medicine , a nonprofit medical association headquartered in Philadelphia.

In 1996, when the hospitalist specialty was established, there were about 500 hospitalists, he said. There are about 15,000 now, and the Society of Hospital Medicine projects there will be 30,000 by 2010.

The programs started in teaching hospitals and are spreading quickly to community hospitals like Good Samaritan in Brockton. In Massachusetts, which has 75 acute-care hospitals, there were four hospitalist programs in 1996. Now there are more than 50, run by hospitals and large physician group practices, Miller said.

Miller said the popularity of these programs has been fueled by a desire to save money, as well as a demand for standardization and accountability by insurance companies and regulators.

"The evidence is beginning to show they are having superior outcomes," he said. "These are young doctors -- the average age is 37 years old -- and they are very comfortable with folks looking over their shoulder and saying they should be practicing a certain way, as opposed to community docs, who feel threatened."

Good Samaritan contracts with Cogent Healthcare of Philadelphia, which provides Hamada's services and about a half-dozen other hospitalists. Other hospitals hire their own hospitalists.

Because of improved communication, the proportion of patients rating their experience as "very satisfactory" at Good Samaritan moved to a high of 78 percent in 2006 from a low of 28 percent in 2003, said James A. Berghelli , who supervises the hospitalist program as the hospital's director of clinical integration.

The hospital also has more control over how patients are cared for, because hospitalists can be given guidelines to treat certain conditions for every patient.

"The decrease in variation is what gives that higher standard of care and decreased length of stay," Berghelli said.

There is a downside to hospitalist programs: the potential for lapses in communication and care after the patient leaves the hospital and returns to the care of the primary care doctor. The American Academy of Family Physicians , which represents primary care doctors, supports the use of hospitalists but has issued a set of communications protocols to help make sure hospitalists are telling primary care physicians about what happened to their patients in the hospital.

Hamada said some patients are surprised to see a hospital doctor instead of their own primary care physician. But he said he carefully reviews a patient's medical records before he walks into the room, which makes all the difference.

"They think their primary care physician has known them for a long time, and it is a concern," he said. "But once they see they are treated well, and you know their history, they start being more comfortable with you."

Christopher Rowland can be reached at crowland@globe.com.

(Correction: Because of a reporting error, a story in yesterday's Business section about the growing use of hospitalists in healthcare gave a wrong location for the headquarters of Cogent Healthcare. The company is based in Irvine, Calif.)