August 2015 Feature Story: Health Care

Critical coverage

Samaritan Medical Center Hospitalist Program director Dr. David J. Flint cares for a patient at Samaritan Medical Center. The Watertown hospital has 10 such medial professionals on staff who care for the most critically ill while giving primary care physicians a break from being on call. Photo special to NNY Business.

Samaritan Medical Center Hospitalist Program director Dr. David J. Flint cares for a patient at Samaritan Medical Center. The Watertown hospital has 10 such medial professionals on staff who care for the most critically ill while giving primary care physicians a break from being on call. Photo special to NNY Business.

‘Hospitalists’ help deliver primary care to most ill

By Gabrielle Hovendon, NNY Business

If you talk to Dr. Naveel Qureshi, the former chief medical resident at Albany Medical College, about his work at Samaritan Medical Center, you’ll quickly realize it’s not your standard 9 to 5 job.

“For a typical shift, our pager turns on at 7 a.m., and most of us come in at least an hour before that,” said Dr. Qureshi, a native of Niagara Falls, Canada, who joined Samaritan Medical Center last August. “We have a list of patients that we’re responsible for, and usually that first hour is spent looking at their overnight events, their blood work, their test results. We usually start the day in the medical intensive care unit, then move to the progressive care unit and medical-surgical care, seeing patients in order of most sick to most stable.

“It’s a lot of running around: you’re going back and forth between different nursing units and levels of care. But a lot of us find that — although it’s very intense working when you’re on — you have a nice break when you’re off. You know that your colleagues are taking care of your patients, and you can relax.”

What Dr. Qureshi is describing is the job of a hospitalist, a relatively new medical profession. Hospitalists, who are typically full time internal medicine physicians, specialize in caring for acutely ill, hospitalized patients who don’t have a primary care physician available to them — either because the patients lack a family doctor in the north country or because that doctor is currently scheduled with other patients.

Thanks in part to this profession, you’re now guaranteed to find a physician at Samaritan Medical Center 24 hours a day, seven days a week — including Thanksgiving, Christmas, and New Year’s Day. Since its start in late 2003, Samaritan’s hospitalist program has grown from four to 10 members, and it has proven invaluable to the many north country patients in need of critical care.

“These are physicians who only practice right here in the hospital,” explained Krista A. Kittle, hospital spokeswoman. “Their focus is caring for the most critically ill patients who require hospitalization, and they have the experience to treat that acuity.”

In addition to delivering expert care, hospitalists also help patients avoid long wait times in the emergency room. Without a hospitalist, sick people would have to wait for their primary care physicians to come to the hospital to admit them, which often wouldn’t happen until a break in office hours or at the end of the workday.

“Although the hospitalist isn’t the doctor that they’re used to seeing in their office, he or she is in close communication with that primary care doctor,” Ms. Kittle said. “Daily — or even more frequently — the hospitalists are in touch with the patients’ primary care providers to make sure they have full patient histories, that there isn’t any additional information they need to know, and that the provider is aware the patient has been admitted.”

The hospitalists at Samaritan Medical Center are also crucial in serving the significant portion of the north country population that does not have a primary care doctor, and they aim to help patients find a new doctor before they are discharged.

“As a hospitalist, I specialize in helping hospitalized patients get better, but in order to keep them healthy and help them stay out of the hospital in the future, the primary care doctor is super important,” Dr. Qureshi said. “We do everything we possibly can to ensure the patients get established with someone and have an appointment set up before they leave. We want to make sure they’re going to have good follow-up care.”

Among the conditions that Dr. Qureshi sees most frequently at Samaritan Medical Center are congestive heart failure, emphysema, diabetes, and infections ranging from pneumonia to cellulitis. He said there is incredible diversity among the patients he encounters, with anyone from 18-year-old soldiers to 100-year-old nursing home residents showing up in the emergency room on a given day.

“What’s very rewarding about being a hospitalist and what drew me to the profession is that you’re very closely involved with these patients,” Dr. Qureshi said. “They come into the ER and they’re very sick, and you have the chance over 48 or 72 hours to really make an impact and help them get better and see them improve. That’s the best part of the job, doing interventions, helping them get better, and, in most cases, being able to discharge them and send them home. It’s such a sense of accomplishment.

“The most challenging part of the job is that, dealing with such sick patients, you also see some people who are just too sick. You reach those limits, and there’s nothing more that you or modern medicine can do. Having to deal with those situations emotionally with patients and their families is always very challenging.”

Despite the job’s difficulties — including the long hours, fast-paced days, and constant movement between different care units — many hospitalists find the career very rewarding. It’s also a job that rewards local primary care physicians, helping them avoid being constantly on call and allowing them to focus more closely on their private practice patients.

And even though many area physicians continue to have inpatient rounds at the hospital, Ms. Kittle said that more and more have been signing on with Samaritan’s hospitalist program. Knowing that someone will be at the hospital 24-7 to care for their patients gives physicians freedom and flexibility, improving both retention and recruitment rates in the north country.

“It does offer not only that life balance but also the opportunity to spend more time in their offices with their patients,” Ms. Kittle said. “And with the younger physicians who are coming out of training, the work-life balance is very important to them. Years and years ago, the doctors from the quote-unquote ‘old school’ would be here around the clock, they’d come in at night, and they might even do house calls, but that’s changing.”

For the time being, Samaritan Medical Center plans to keep its hospitalist staff at 10, but Ms. Kittle said the hospital will continue to assess patient needs and add more physicians when necessary.

As for Dr. Qureshi, he’s in no hurry to leave his hectic, fulfilling field. Half an hour before he spoke with us, he was busy sending a patient for a cardiac catheterization after a sudden decline in condition — an intervention that no outside physician would have been able to perform as quickly, or as effectively, as someone already stationed in the hospital.

“Hospitalist medicine is a relatively young career path in medicine, but it’s something that I really do enjoy doing and that I intend to do long-term,” Dr. Qureshi said. “Primary care work is absolutely important, but for now I really enjoy the pace of hospital medicine. I wouldn’t want to do anything else.”

Gabrielle Hovendon is a former Watertown Daily Times reporter, north country native and freelance writer who is pursuing a Ph.d. at the University of Georgia in Athens. Email her at ghovendon@gmail.com.