Short Takes On News & Events

Patient Loads Often At Unsafe Levels, Hospitalist Survey Finds

By Alvin Tran

January 28th, 2013, 4:56 PM

Nearly forty percent of hospital-based general practitioners who are responsible for overseeing patients’ care say they juggle unsafe patient workloads at least once a week, according to a study published Monday as a research letter in JAMA Internal Medicine.

In the study, researchers at Johns Hopkins University invited nearly 900 attending physicians, known as hospitalists, to complete an online survey that measured various characteristics, including the number of patients they thought they could manage safely during a typical shift.  Hospitalists are the physicians who coordinate a patient’s care and medications among various specialists while they’re in the hospital and oversee their transition home.

Among the 506 doctors who completed the survey, forty percent reported that their patient workloads exceeded levels they deemed safe at least once a month. Thirty-six percent said they exceeded their own notions of safe workloads more than once a week.  And nearly a quarter believe their workloads negatively affected patient outcomes by preventing full discussion of treatments.

“We know that with increased pressures from the health care system, with decreased reimbursement, present restrictions on work hours, and a focus on patient flow, that there is the concern that attending physician workload has increased,” said Dr. Henry Michtalik, an assistant professor of medicine and the study’s first author.

Michtalik and his colleagues also found that more than 20 percent of survey respondents believe their workload likely resulted in negative outcomes for patients by contributing to patient transfers, complications and even death. Twenty-two percent said they’ve ordered unnecessary procedures, consultations, and other tests due to time constraints.

The study authors acknowledged, however, that the respondents were self-selected and they had no way of confirming whether the  doctors’ perceptions of risks correlated with actual risks.

“With an increased amount of patients into the health system, if there is an underlying issue with work load, we can expect it to get worse,” Michtalik added in an interview.

Though the findings don’t surprise Dr. Eugene Litvak, the president and chief executive officer of the Institute for Healthcare Optimization, a nonprofit research group, who said he thought the study was overdue. “It may be common sense, but it’s important to have data to support it,” he said in an interview.

According to Litvak, physicians at hospitals across the country are regularly subjected to highly fluctuating patient demand.  “Those peaks [in demand] are mostly artificial in nature … and are the result of our mismanaged patient flow. Smoothing those peaks is the only alternative to reducing physician workloads short of hiring more physicians.”

Michtalik said the health care system has typically responded to increased costs by trying to decrease reimbursements, “assuming that providers and health care systems will become more efficient.”

“In actuality,” he said, “we may be focusing on a pennywise strategy, where we’re actually causing pounds of increased cost because of additional unnecessary testing, decreased discussions, and a paradoxical increase in costs.”

7 Responses to “Patient Loads Often At Unsafe Levels, Hospitalist Survey Finds”

  1. Daisy says:

    As I read this article, I’m reminded that the Affordable Care Act (ACA) is the only thing we have that offers hope for the future. Without the ACA, we have no hope. Yet, Republicans would like to repeal the ACA and repeal the hope that the ACA offers and return us to a healthcare system where control is returned to corrupt profit motivated insurance companies and return us to the hopelessness of unsafe hospital patient levels. Republicans are certainly not the party of hope. Republicans are the party of stupid! If Republicans get a chance, the ACA is doomed and hope for healthcare reform and healthcare cost control is destroyed.

  2. Wendy says:

    We all had better get use to it. Healthcare in America is on the fast track to becoming a universal single-payer system. The healthcare industry has milked the cow and the cow is dry. The culture of fear that the healthcare industry has relied upon to bilk consumers out of trillions in profits simply does not work any longer because middle class Americans are running out of disposable cash. If you don’t have a job, healthcare insurance isn’t high on your list of priorities. The healthcare industry has killed the goose that lays the golden eggs. More and more people are simply giving up and getting “free” healthcare at the local emergency room. Do you blame them? Watching a recent healthcare forum, one of the guest speakers on the panel represented the healthcare insurance industry. The other panelists represented providers, employers and consumers and were trying to be polite but the focus kept coming back to the same question. Why do we need insurance companies? What benefit does the insurance industry offer our healthcare system? Why do we have a entity that performs absolutely no function except to take money from consumers and pass that money to providers and, while doing so, skims off a profit margin for themselves. The sooner we all realize that insurance companies serve no purpose except adding more cost to the system, the sooner we will begin to bend the cost curve.

  3. Clifford Kaye, M.D. says:

    I have issue with this statement from Dr Michtalik, “With an increased amount of patients into the health system, if there is an underlying issue with work load, we can expect it to get worse,”

    The “how will we handle the influx of new inpatients!” concept is a fallacy. The uninsured patients are already using the system… accessing it in the most expensive way. With no primary/preventative care they use the ED as a clinic and are admitted to the hospital when sick.

    Perhaps the quote was taken out of context. There will, hopefully, be a drastic rise in outpatient encounters as the ACA is further implemented. This will warrant a change in how we structure and reimburse the PCP world… we need to lure more talented young doctors to that arena.

  4. Marilyn Daniels, Ph.D says:

    Wendy, you’ve hit the nail on the head! There is no question the health care system is in crisis. A single-payer system is the best answer. The GAO has state that the “purpose of insurance” is to coordinate with other insurers! Employer-based insurance has become the primary obstacle to good, universal health care. It has been a major behind-the-scenes contributor to cost increases for decades.

  5. Li-hsia Wang, MD, FAAP says:

    Wendy and Marilyn, Thank you for good answers to the problem. Take out the insurance companies! That’s not the only answer to our problems providing adequate care, but it’s the critical beginning, when we can start rational planning while at the same time restoring the relationship between patient and provider, removing the insurance company from standing between us.

  6. Bob says:

    Medical students need to understand that healthcare is changing. The 1950′s Marcus Welby model is a thing of the past. A future where doctors will retire with millions in savings and will live in a mansion next to the golf course are over. Our future will have more nurse practitioners doing primary care in neighborhood clinics. More and more, doctors will become employees working in Accountable Care Organizations (ACO). No longer will solo docs practice alone in tiny offices with a small staff and a serious lack of on-site equipment. In the future, we will get our healthcare in very large medical centers where state-of-the-art medical staff and state-of-the-art medical equipment is all under one roof. It was nice for the Marcus Welby types while it lasted but those days are coming to and end and will be replaced by universal single-payer healthcare.

  7. Wendy says:

    The Affordable Care Act is just the beginning. Those who think we should stop now, they are just plain stupid. The entire world of industrialized nations are decades ahead of us in universal healthcare that covers their entire population. Only in America, the richest nation in the world, we still have over 50 million uninsured and another 25 million underinsured and we are paying twice as much as any other nation in the world for what we get. For those who say, America has the best and most advanced healthcare in the world, they are correct. The problem is, one quarter of the population can’t afford it! If that is how Republicans measure success, Governor Bobby Jindal was correct when he said we must stop being the stupid party.