The rise of the surgicalist and how this new specialization improves hospital performance
Across the United States, hospitals and surgeons are struggling with the same challenge: providing reliable, consistent 24/7 coverage for emergency surgical services.
This problem is exacerbated by a shortage of surgeons, a reluctance of those surgeons available to provide emergency call coverage, and the desire of many surgeons to improve their quality of life by working regular hours. This is a serious issue that has the potential to affect patient safety, quality of care AND the hospital’s ability to successfully operate in a value-based purchasing, pay-for-performance world.
The rise of the surgicalist
Helping hospitals overcome the challenges of providing dependable surgical services, we are now witnessing the rise of the surgical hospitalist or “surgicalist”—a surgeon who practices his or her profession in the hospital by managing emergency surgical patients presenting in the Emergency Department (ED) or from in-house consultation. Surgical hospitalists can cover all hospital-based surgery practices, including trauma, acute care or general surgery, orthopedic surgery, and neurosurgery.
Surgical hospitalist programs enhance surgeon availability through delivery of fully-staffed and managed practices with dedicated, unencumbered surgeons. These healthcare professionals are available to the ED 24/7 for emergency surgery patients, or to provide surgery consultation for hospitalized patients. What’s more, they provide enhanced care for emergency general surgery patients without impacting the operative volume of surgeons in private practice.
Not all programs are created equal
A good surgical hospitalist program provides 24/7 surgical care to the ED. A great one does more than guarantee round-the-clock surgical coverage—it offers dedicated surgical hospitalist programs that partner with hospitals and lead quality initiatives that are important to the hospital driven by experienced physician leadership and the ability to drive quality forward.
How do you tell the difference? Following are just a few of the attributes of a great surgical hospitalist program.
Great surgical hospitalist programs provide a sustainable solution to resolve the ongoing challenges hospitals deal with in their quest to reduce patient complications and improve outcomes, while lowering costs and increasing efficiency. They offer a collaborative partnership to meet both the hospital’s needs and the surgical care needs of the communities the hospital serves—while raising the level of surgical care available to all patients.
Great surgical hospitalist programs are led by expert surgeons and executives who have the ability to build and manage outstanding surgical teams that deliver care according to evidence-based guidelines. They also are skilled at working collaboratively with hospital staff and departments.
Finally, a great program can substantiate itself with proven (ideally published) results that documents how its programs improve patient care, enhance efficiency, and reduce costs. How? By using metrics, for example, that demonstrate how length of stay is decreased, complications are reduced, and costs are lowered.
For example, the Journal of the American College of Surgeons recently published the groundbreaking study of one of the longest-term (five years) surgical hospitalist programs at Sutter Medical Center, Sacramento which partnered with Surgical Affiliates Management Group. The results showed how the program raised performance and profitability throughout the hospital:
- Length of stay for general surgery cases decreased by as much as 12%—down from 6.5 days, to a low of 5.7 days.
- Reduced complications 43%—falling from a rate of 21% to 12%.
- Readmissions showed a downward trend, though this was not statistically significant. This is an important fact because while length of stay was significantly decreased, the readmission rate did not increase.
- Decreased hospital costs—dropping 31%, from $12,009 to $8,306, indicating potential savings of $2 million (or more) in a single year for a facility of this type and size.
In short, a great surgical hospitalist program can provide a permanent solution to emergency surgical coverage that improves overall hospital metrics for hospitals of all sizes, while providing a “halo effect” of improving performance and outcomes throughout the entire hospital.
Concurrent with the rise of the surgicalist throughout the United States is the transformation of the level of surgical care provided. Most importantly, patients will benefit as they receive timely, high-quality surgical care, experience fewer complications, and go home faster. Hospitals will experience fewer management challenges, better patient throughput, optimized capacity, and cost savings. And surgeons will appreciate the opportunity for an improved quality of life through more manageable schedules and the chance to be part of this transformational movement in surgical care.
Leon J. Owens, M.D., FACS, is President and CEO of Surgical Affiliates Management Group, Inc.
