consistent time. During these rounds,
we discuss relevant GI literature
and make timely plans for all patients.
Oftentimes, I am able to supervise the
fellows so they can fit in a scope before
the end of the workday. Ultimately, the
fellows know they can find me and
discuss patients throughout the day.
The fellows consistently have told me
that since the implementation of the
hospitalist system, there has been a
dramatic difference. Collectively, they
feel both their education and patient
care have improved.
In terms of consult efficiency, one
study demonstrated that the transition to a GI hospitalist system resulted in a mean decrease in consult to
urgent esophagogastroduodenosco-py (EGD) time from approximately
24 to 14 hours. 3 However, this occurred in the context of a lower inpatient consult volume and covered
only 2 months. Furthermore, the
time from admission to EGD did not
change. Nonetheless, further studies
are needed to examine the impact of
this model shift.
In terms of a financial benefit,
at our institution the total gross
inpatient charges increased more
than $850,000 for the year. This
was largely attributable to the 79%
increase in the gross charges from
For group practices, the hospitalist
system makes more efficient use of
the physician’s time. Physicians can
either focus on outpatients or inpa-
tients without worrying about going
between the office, the ambulatory
surgical center, and the hospital. In
general, inpatients require a dispro-
portionate amount of time relative to
the revenue collected. Furthermore,
the need for group physicians to go
to the hospital eliminated, they can
carve out 1-2 hours of office time to
When there is one point-person
who handles all inpatient GI, communication is facilitated among
primary teams and other services.
The GI hospitalist develops working
relationships with surgeons, radiologists, anesthesiologists, intensivists,
etc. Teams can often just text or call
me directly, instead of looking for the
covering attending or going through
the office phone service.
What are drawbacks to the
GI hospitalist model?
Since there is only one gastroenterologist in the hospitalist model, if
that person is not doing a good job,
it affects the management of GI conditions for the entire hospital.
There is a loss of continuity of
care. When GI patients get admitted,
the gastroenterologist responsible
for their care will not be the person
with whom they have a long-term
relationship. Furthermore, when the
patient gets discharged, the primary
gastroenterologist will not be fully
aware of the inpatient course.
Also, when outpatient and inpatient gastroenterologists become
segregated based on hospital setting,
they each lose out of learning the
intricacies of managing patients in a
What do you like most about
being a GI hospitalist?
The GI hospitalist position creates a
great opportunity for gastroenterologists to make a remarkable, immediate impact on interesting, high-acuity
patients. The nature of the job also
has the advantage of providing reasonable hours. This may be attractive
to many who want a better work-life
1. Wachter R.M., Goldman L. Zero to 50,000 –
The 20th Anniversary of the Hospitalist. N Engl
J Med. 2016 Sep 15;375[ 11]:1009-11.
2. Estimating the Number and Characteristics of
Hospitalist Physicians in the United States and
Their Possible Workforce Implications. Analysis
in Brief. Available at: https://www.aamc.org/
talist.pdf. Accessed May 1, 2016.
3. Mahadev S., Lebwohl B., Ramirez I., Gar-cia-Carrasquillo R.J., Freedberg, D.E. Transition
to a GI Hospitalist System is Associated with
Expedited Upper Endoscopy. Gastroenterology.
The GI hospitalist position creates a great opportunity for gastroenterologists to
make a remarkable, immediate impact on interesting, high-acuity patients. The
nature of the job also has the advantage of providing reasonable hours.