NCH recruiting hospitalists for controversial admissions plan, but they're in short supply

The NCH Baker Hospital Downtown from the outside as photographed on Dec. 17, 2018, in Naples.

A move by NCH Healthcare System toward employed hospitalists handling more patient admissions means hiring more of the hospital-based physicians.

NCH has several advertisements on popular recruitment websites looking for hospitalists — despite a community backlash toward changing the admissions policy, requests from elected officials to present proof it’s good for patient care and a lawsuit threat.

Ads that NCH is running on PracticeMatch.com and PraticeLink.com state that hospitalists with foreign visas would not be welcomed, a search shows. In contrast, an email circulating earlier this week to elected officials and others indicated NCH is open to foreign medical graduates for hospitalist positions.

“I looked at it and it did say ‘no,’ ” Dr. Richard Kravis, an independent concierge physician, said about the ad he saw after getting the email.

More:NCH sticking to hospital admissions change, plans to engage community

Dr. John Nelson, a national hospitalist consultant in Seattle, said hospitals and recruitment companies often accept applicants from outside the United States. He was a co-founder in 1997 of the Society of Hospital Medicine, which has 57,000 members.

“It is reasonably common,” he said, adding there is a shortage of hospitalists nationally.

“It generally depends, but outside of a major medical market, there tends to be a challenge to recruit,” Nelson said. “I don’t know about Naples. It wouldn’t really surprise me to learn that Naples might have a hospitalist recruiting challenge.”

NCH declined to say how many hospitalists it plans to hire or by when.

“Hospitalists are a special skill set and our recruitment for these physicians is competitive,” NCH said in a statement. “As we seek the most qualified expertise our human resources team works through the required process to bring the top talent to NCH.”

More:Attorneys demand NCH Healthcare System rescind admissions change

The hospital system is constantly reviewing its staffing needs for all positions, including hospitalists, according to the statement.

NCH would need to hire about 35 more hospitalists to cover both hospitals for a complete rollout of the admissions change, said Dr. Cesar De Leon, president of the Collier County Medical Society. The medical society is opposing NCH’s pilot study of only NCH-employed hospitalists handling admissions and its plan to expand it. 

Cesar De Leon is president of the Collier County Medical Society.

Origin of hospitalists

The hospitalist field began growing years ago when primary-care physicians told hospital administrators they couldn’t take care of both their practices and seeing hospitalized patients, Nelson said. The solution for hospitals and large practice groups was to hire hospitalists.

“What is happening in Naples is really getting attention, but that is not what happens in most communities,” he said. “What is propelling the hospitalist model is that doctors are choosing to leave the hospital. It is actually rare that hospitals are energetically trying to move to a hospitalist admission policy. Just don’t do anything and it will happen.”

More:Bonita location of NCH emergency room prepares for grand opening

Research is varied on whether the quality of care and outcomes improve with hospitalists, he added.

“There is research that goes both ways,” Nelson said.

Independent primary-care physicians are asking NCH to provide details on how outcomes were evaluated with the NCH hospitalists, who also conduct rounds to see patients with a support team from pharmacy, rehabilitation and other disciplines.

“At this time, NCH has been unable or unwilling to publicize the exact parameters and controls for the study, nor any concise, statistically significant and valid date for review,” De Leon, of the medical society, said in a statement.

On Friday, the Florida Chapter of the American College of Physicians sent a letter to NCH leaders strongly condemning the hospital company’s plan.

“We ask that Naples Community Hospital immediately rescind this outrageous policy in order to allow patients to be cared for by the physicians who know them best,” said Dr. Jason Goldman, president of the Florida chapter.

More:Larger, modern emergency room on tap for NCH Downtown Baker Hospital in Naples

That comes after the Florida Medical Association president, Dr. Corey Howard, of Naples, said this week that the FMA supports medical staff autonomy and the right to full due process when credentials are challenged.

NCH change is result of pilot study

The pilot study started in June at one floor at each NCH hospital and now involves two units at NCH Baker Hospital Downtown and one floor at NCH North Naples Hospital.

The results show a 50 percent decrease in hospital-acquired conditions, about a 50 percent drop in the 30-day readmissions rate and a 20 percent drop in patients’ length of stay, Dr. Allen Weiss, NCH president and CEO, said in his “Straight Talk” column Dec. 13.

Dr. Allen Weiss is president and CEO of NCH Healthcare System

“We want our patients to feel empowered to make informed decisions about their care,” he said. “Therefore, understanding what this program is, and what it is not, is critical.”

He lists a website, https://www.nchmd.org/patient-care-update, for patients to learn more.

In addition, patients can choose not to be placed on a pilot floor and still can be admitted by their primary-care physician, Dr. Bryan Murphey, an internist with NCH, said in a guest commentary he wrote for the Daily News.

“As an internal medicine physician at NCH and a former hospitalist in a previous facility, I have seen first hand the benefits of being treated by a hospitalist,” Murphey said. “Hospitalists are on-site doctors that can be by a patient’s bedside within minutes rather than hours, can discharge a patient as soon as they have recovered, and are available to give patients and their loved ones regular updates about the status of their care.”

More:Residents urge Naples Council to send message to NCH about hospital admissions

Weiss said primary-care physicians are encouraged to partner with the hospitalists for their patients' care.

“While hospitalists are responsible for writing notes and entering orders, primary care personal physicians are empowered to review hospital records and test results; recommend medications, procedures and consultants; and receive regular updates while they see their patients,” Weiss said.