HED: New approach

By Marty Russell

Daily Journal

There is a reason most doctors locate their medical clinics in the shadow of the local hospital but the latest innovation to come to North Mississippi Medical Center could change all that.

Doctors traditionally have to split their time between their clinic patients and patients they have admitted to the hospital. That results in less time available in both places and patients with appointments sometimes left fuming in a clinic waiting room while the doctor is called to the hospital for an emergency there.

The dual - and dueling - work environments not only make for hectic schedules but also force most doctors in rural states like Mississippi to work in both settings when they may excel in one over the other.

But a new approach to treating hospitalized patients is emerging as more and more medical services focus on outpatient treatment.

Last fall, NMMC became the first medical facility in the state to employ a 'hospitalist,' a term coined less than two years ago to describe a physician whose sole practice is treating hospitalized patients.

"We already had a big hospital practice and a big clinic practice and we were trying to work both," said Dr. Renee Wilson, an internal medicine physician with Internal Medicine Associates, which is affiliated with NMMC.

"So when they started talking about trying a hospitalist I wanted it to be me," Wilson said. "I liked hospital work better than office work."

A Jackson native and mother of two young daughters, Wilson has been working since last September admitting and treating patients referred both by her IMA colleagues and by emergency room doctors. On an average day she has about 20 patients to see on her rounds and that's 20 visits other doctors don't have to take time away from their clinics to make.

"It emerged out of managed care, out of having doctors at full speed at their clinics," Wilson said. "It's an idea that came out of managed care, out of cost containment, but I don't think it is detrimental to patients."

In fact, the idea, Wilson said, is to give both the clinic patient and hospital patient more time with their physician.

"Everybody benefits," she said. "The sick patient gets a less frazzled doctor who's not so worn out."

Clinics also benefit from the additional time doctors can devote to clinic practice.

"We've added more than 400 new appointments at the office just by getting (doctors) over there and letting them stay there," Wilson said of IMA.

And clinics will no longer be physically bound to the periphery of the local hospital. NMMC, in fact, is building its new, $2.7 million IMA-affiliated medical clinic not on the hospital's campus but several miles north adjacent to a shopping mall.

Back at the hospital, Wilson admits and treats patients referred by IMA, which accounts for about a third of the hospital's admissions, and patients who come through the emergency room without a doctor and require hospitalization.

She emphasizes that her role does not preclude family doctors from treating patients or checking on their progress.

While she sees a variety of cases, Wilson said more outpatient procedures mean most cases that require hospitalization follow certain patterns.

"You get to be specialized in taking care of very elderly people," Wilson said of the majority of the hospital patient population.

Still, with its 650 hospital beds, one hospitalist can't handle the entire load. Recently, a night-shift hospitalist, Dr. Hans Noffsinger, was added to the NMMC staff.

The only other hospitalist working in the state is employed by Forrest General Hospital in Hattiesburg and came on board after Wilson began her job at NMMC. Nationwide, it is estimated that there are fewer than 2,000 hospitalists.

"This is a busy, busy place and I can't take calls all night long," Wilson said of the addition of Noffsinger, who admits and treats patients after 11 p.m.

The current setup, and possible addition of more hospitalists, should help NMMC and IMA achieve what Wilson said is the real purpose of the specialized position both for hospitalized patients and patients in clinics.

"You get a fresh doctor who can think," she said.

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