title: Use of hospitalists and office-based primary care physicians' productivity.
abstract: BACKGROUND
  Growth in the care of hospitalized patients by hospitalists has the potential to increase the productivity of office-based primary care physicians (PCPs) by allowing them to focus on outpatient practice.
  
  
  OBJECTIVE
  Our aim was to examine the association between utilization of hospitalists and the productivity of office-based PCPs.
  
  
  METHODS
  The cross-sectional study was conducted using the 2008 Health Tracking Physician Survey Restricted Use File linked to the Area Resource File. We analyzed a total of 1,158 office-based PCPs representing a weighted total of 97,355 physicians.
  
  
  METHODS
  Utilization of hospitalists was defined as the percentage of a PCP's hospitalized patients treated by a hospitalist. The measures of PCPs' productivity were: (1) number of hospital visits per week, (2) number of office and outpatient clinic visits per week, and (3) direct patient care time per visit.
  
  
  RESULTS
  We found that the use of hospitalists was significantly associated with a decreased number of hospital visits. The use of hospitalists was also associated with an increased number of office visits, but this was only significant for high users. Physicians who used hospitalists for more than three-quarters of their hospitalized patients had an extra 8.8 office visits per week on average (p = 0.05), which was equivalent to a 10 % increase in productivity over the predicted mean of 87 visits for physicians who did not use hospitalists. We did not find any significant differences in direct patient care time per visit.
  
  
  CONCLUSIONS
  Our study demonstrates that the increase in productivity for the one-third of PCPs who use hospitalists extensively may not be sufficient to offset the current loss of PCP workforce. However, our findings provide cautious optimism that if more PCPs effectively and efficiently used hospitalists, this could help mitigate a PCP shortage and improve access to primary care services.
authors.affiliation: Center for Workforce Studies, Association of American Medical Colleges, 655 K Street NW Suite 100, Washington, DC, 20001-2399, USA, jpark14@gwu.edu.
authors.forename: Jeongyoung
authors.initials: J
authors.lastname: Park
authors.forename: Karen
authors.initials: K
authors.lastname: Jones
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D017598:Efficiency, Organizational; D005260:Female; D019538:Health Care Surveys; D020445:Hospitalists / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009819:Office Visits / Q000706:statistics & numerical data; D058007:Physicians, Primary Care / Q000600:supply & distribution*; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care / Q000706:statistics & numerical data*; D011787:Quality of Health Care; D012189:Retrospective Studies; D018570:Risk Assessment; D014481:United States; D016526:Workload