Hospitalist Daily Census Is Unpredictable.

Hospitalist medicine is unpredictable.  How do I know that?  Because I've been doing this for over eight years and my starting daily census can often vary  from eight to eighteen patients a day.   Over the years, I've come to accept the unpredictable nature of a hospitalist based medical practice.  We are at the mercy of patient. We don't actively recruit our patients. They're here so we care for them.  We can either complain about it or minimize the number and consequences of  unpredictable times.  I believe flexibility is key.  While hospitalist medicine does offer the benefit of fixed schedules, having some flexibility can introduced a satisfying compromise during busy times.

If  hospital succeeds in getting patients into our front doors,  hospitalist medicine services grow too. When the hospital wins, hospitalists win too. We care for hospitalized patients.   It's all about market share in our aging population.  And don't forget the patient wins too with our excellent care.

And let me tell you, I see winning all around me the the incredible changes going.  Slowly, but surely the hospital culture is changing by leaps and bounds.   Despite all the government noise and unfunded mandates we must deal with navigating the uncharted waters  and economic suicide that is ObamaCare, some administrations get it.  They need to win the market share game to survive.  That means busier hospitalists groups for those that win the game.  

With that said, hospitalists always seems to remember the really busy days.  We tend to forget the slow ones.   My hospitalist service occasionally experiences the summer slow down.  This year it came on the first day of Fall!  That's the unpredictable nature of hospitalist medicine.  I can say, without a doubt, I have become busier in my  hospitalist group.  My daily beginning census is growing.  This year, compared with last, I am seeing more patients.  I am seeing sicker patients.  I am seeing more complicated patients.

What is an appropriate starting daily census and appropriate total number of encounters per day for a hospitalist group?  The generally accept point of peak efficiency occurs in the 15-17 total daily encounters per day.  Of course, I believe, that number is widely variable based on the technology platform we are given to work with.  The fewer steps I make in a day, the less often I log into a computer, the more often daily patient data is presented to me in an always on fashion with immediate access to my wide range of data (including lab, x ray and nursing information), the more patients I can see in a day.

Does that mean I could see 25, 30, 35 patients in a day?  I may in the future be able to be that efficient.  I don't think I could do it now.  No way, no how, but, give me the tools to manage my daily census and unpredictable will become irrelevant.  And I'll remember everyday like I only had eight patients.  That's WIN-WIN for everyone.

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